High dose therapy of a patient with Parkinson's disease with the novel dopamine agonist Pramipexole allows reduction of L-dopa down to nil

We report a 63-years old patient with Parkinson's disease, who experienced slight fluctuations 10 years after first signs of the disease and two years after initiation of levodopa/carbidopa and biperiden therapy. He was enrol led in a double blind,placebo controlled study with the dopamine agonist pr amipexole. This study was extended to an open phase. During this phase we w ere able to reduce levodopa/carbidopa down to zero, while fluctuations and peak dose dyskinesias ceased. The most important adverse event were hyperso mnia and very slight persistent dyskinesias,which were reported tolerable b y the patient. Treatment without levodopa/carbidopa could be maintained for 31 months. We conclude that in selected cases patients in Hoehn and Yahrs stages II to III and with mild fluctuations might be treated with pramipexo le without levodopa.