Five-year follow-up of early lisuride and levodopa combination therapy versus levodopa monotherapy in de novo Parkinson's disease. The French Lisuride Study Group.
ABSTRACT The value of an early initial coadministration of levodopa (L-dopa) and lisuride in Parkinson's disease was the main goal of the present study. Eighty-two patients with recently diagnosed idiopathic Parkinson's disease were randomized into two groups for treatment with L-dopa alone or L-dopa + lisuride. The trial was double-blinded for the first year and open for the following 4 years. Selegiline (10 mg/day b.i.d.) was added in both groups at the end of the first year. Outcome measures were evolution of L-dopa dosage and Unified Parkinson's Disease Rating Scale scores and subscores, and incidence of motor complications. The dropout rate was higher in the L-dopa group (63.4%) than in the combination group. Motor improvement was better (p < 0.01) in the L-dopa + lisuride group. Expected motor complications were rare, moderate and equivalent in the two groups despite a difference in L-dopa dosage (446.7 vs. 387.5 mg/day). Long-term follow-up demonstrated the L-dopa-sparing effect of lisuride (average 1 mg/day), the beneficial effect of early combination therapy on motor status and the paucity of motor complications in both groups.
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ABSTRACT: Both disease progression and pulsatile stimulation of dopaminergic receptors are responsible for development of fluctuations and dyskinesia in about 50% of patients with Parkinson disease (PD) after 4-6 years of therapy with levodopa. In order to prevent motor complications, the ideal therapy should secure continuous dopaminergic stimulation (CDS). The concept of CDS is supported by the results of both experimental and clinical studies. Several treatment options are available to achieve CDS. Dopamine agonists have a longer half-life than levodopa and the development of dyskinesia is delayed when they are used as monotherapy in early PD. Continuous delivery of agonists can be improved with prolonged-release oral preparations, a transdermal delivery system or continuous subcutaneous infusion. Continuous enteral infusion of levodopa is another way to achieve CDS and it is very effective in reducing motor complications in advanced PD.Neurologia i neurochirurgia polska 44(4):385-95. · 0.54 Impact Factor
Article: 11. CONSENTIMENTO INFORMADO É obrigatória a cientificação do paciente, ou de seu responsável legal, dos potenciais riscos e efeitos colaterais relacionados ao uso dos medicamentos preconizados neste Protocolo, o que deverá ser formalizado por meio da assinatura de Termo de Consentimento Informado
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ABSTRACT: We did a systematic review, with a uniform method of assessment of efficacy and safety, to assess the different interventions available for the management of Parkinson's disease (drugs, surgical interventions, and physical treatments) with respect to the following indications: prevention of disease progression, symptomatic treatment of motor features (parkinsonism), symptomatic control of motor complications, prevention of motor complications, and symptomatic treatment of non-motor features. Our aim was not to define practice guidelines, but rather to improve clinicians' knowledge of the presently available published clinical evidence, based mainly on randomised controlled trials. We hope that our review will help doctors to incorporate this background into their own decision-making strategy to make appropriate choices with respect to the treatment of individual patients with Parkinson's disease.The Lancet 06/2002; 359(9317):1589-98. DOI:10.1016/S0140-6736(02)08520-3 · 45.22 Impact Factor