Management of early Parkinson's disease

The two major questions in the treatment of early PD are (1) Does selegilin e slow neuronal loss and delay the progression of clinical disability? and (2) Should dopamine agonists be used as initial symptomatic therapy in earl y disease rather than levodopa/PDI to reduce long-term disability and delay the onset of motor fluctuations and dyskinesia? Selegiline affords neuropr otection for dopamine neurons in cell culture systems and the results of se veral clinical trials are consistent with the hypothesis that it is neuropr otective in Parkinson's disease. Several clinical trials have found that in itial symptomatic therapy with dopamine agonist to which levodopa/carbidopa is later added when needed leads to a lower incidence of long-term motor c omplications. These strategies are now being tested in prospective, randomi zed, blinded trials, many of which include PET or SPECT scans to assess the rate of dopamine neuron loss. These trials will provide more definitive an swers to guide the early medial management of Parkinson's disease in the fu ture.