FLUCTUATING PARKINSONS-DISEASE - TREATMENT WITH THE LONG-ACTING DOPAMINE AGONIST CABERGOLINE

Objective: Assessment of the very long-acting dopamine agonist medicat ion cabergoline in the control of motor fluctuations in Parkinson's di sease. Design: Open-label trial (13 weeks). Setting: Referral centers (Mayo Clinic, Rochester, Minn, and Scottsdale, Ariz). Patients: Volunt eer sample of 41 patients with idiopathic Parkinson's disease who were experiencing motor fluctuations while receiving stable doses of carbi dopa and levodopa. Intervention: Adjunctive oral cabergoline was incre mentally administered once daily with the maintenance dose determined by the clinical response (maximum dose, 5 mg/d). Main Outcome Measures : Standardized serial motor examinations were performed, beginning any where from 30 minutes before and continuing to 6 hours after test dose s of medications were administered. Scores during adjunctive cabergoli ne therapy were compared with the prestudy baseline scores during ther apy with carbidopa and levodopa without cabergoline. Results: Adjuncti ve cabergoline therapy significantly improved mean motor scores at the time of each standardized serial examination, from 30 minutes to 6 ho urs after the administration of test doses of medications. Significant motor score improvement was also measured 24 hours after the last cab ergoline dose was administered, suggesting a very long-acting antipark insonian effect. Mean dyskinesia scores were slightly but nonsignifica ntly elevated. Diary card ''off-time'' was im proved by 42%, whereas t he levodopa dosage was reduced by 18%. Only three patients dropped out (7% of the total), which contrasts with much higher dropout rates owi ng to adverse events in previous clinical trials of other antiparkinso nian dopamine agonists. Conclusions: Cabergoline improved motor contro l in patients with Parkinson's disease who were experiencing clinical fluctuations. Possible advantages of this medication include an extend ed clinical response (persisting to 24 hours), tolerability, and ease of use (once per day administration).