TREATMENT OF PARKINSONS-DISEASE

The treatment of Parkinson's disease is reviewed. The rationale for us ing selegiline (deprenyl) as the first treatment in recently diagnosed patients is presented. Selegiline delays the need for levodopa; howev er, it is unclear whether this results from a symptomatic or a neuropr otective effect of selegiline. Levodopa combined with a decarboxylase inhibitor is the principal treatment for patients with moderate or mar ked symptoms. There is little evidence that levodopa has a deleterious effect on the court of Parkinson's disease. The relationship of levod opa to dyskinesias and response fluctuations is discussed. Pharmacokin etic and pharmacodynamic studies suggest that continuous dopaminergic stimulation may be superior to intermittent pulse therapy. The best ap proximation to continuous stimulation is the use of long-acting levodo pa-carbidopa preparations supplemented by dopamine agonists.