(topic open for debate-discussion)
Fact number 1: Patients with young onset disease are prone to developing early and severe dyskinesias and motor fluctuations induced by chronic treatment with levodopa.
Fact number 2: Levodopa remains the most effective and better tolerated drug for Parkinson's treatment. It's the only drug with proved efficacy in prolonging our life expectancy and significantly improving our quality of life (QOL)
Fact number 3: Many neurologists are hesitant to prescribe levodopa-especially early in the disease and to patients with YOPD- or try keeping the dose of levodopa as low as possible for as long as possible in order to avoid the emergence of dyskinesias and motor fluctuations.
Fact number 4: Dopamine agonists represent the most effective alternative to levodopa, either as monotherapy in early disease, or as an adjunct to levodopa allowing for administration of lower overall doses of levodopa
Fact number 5: Monotherapy with dopamine agonists seems to be the preferred initial treatment for patients under 60 years of age. The main reason for this is "levodopa phobia".
Fact number 6: Dopamine agonists, especially when given at high doses, may cause severe side effects, including not only the temporary symptoms of nausea, vomiting and postural hypotension but, most importantly, behavioral disorders (impulse control disorders, hallucinations...)
Fact number 7: Patients started on dopamine agonists (instead of levodopa) have a significantly lower incidence of MILD TO MODERATE NON DISABLING motor complications (as compared to patients started on levodopa). However, the duration of this benefit is only temporary, and does not seem to exceed the first 5 years of treatment. There appears to be no significant long-term advantage to starting treatment with a dopamine agonist as regards the development of SEVERE AND DISABLING dyskinesias
Fact number 8: Parkinson's is a chronic degenerative incurable disease. The initial choice of treatment-levodopa or dopamine agonists-has little-if any-effect on long-term prognosis. As Weiner and Reich commented on this: "Agonist or levodopa for Parkinson's disease? Ultimately it doesn't matter, neither is good enough"
Patients with PD should be active partners in disease management. Fully informed in order to make informed decisions and critical choices, depending on their particular needs.There's no "one-size-fits-all" treatment.
Let's keep updating this topic with evidence-based data on PD treatment, to help us all make the right decisions on our treatment.
Edited by christie, 05 April 2013 - 06:29 AM.