Strategies in the treatment of early Parkinson's disease

Over recent years I have been studying whether dopamine agonist treatment alone, or in early combination with levodopa, might institute a better long-term treatment in Parkinson's disease than levodopa alone. Indeed, early combination of levodopa with bromocriptine, pergolide or lisuride has indicated that this kind of treatment results in better management of Parkinson's disease with fewer fluctuations in disability, especially end-of-dose disturbances and dyskinesias, than treatment with levodopa alone. Furthermore, similar results were obtained by using lisuride in combination with selegiline and levodopa. Thus, it appears advisable to initiate the dopaminergic treatment in early Parkinson's disease by using a combination of selegiline, levodopa and a dopamine agonist. There are many ways of building up this kind of treatment. Instead of levodopa, it is possible to use initially a dopamine agonist and to add selegiline and levodopa when the therapeutic response becomes insufficient. Another alternative would be to start with selegiline alone, then to add a dopamine agonist and, finally, levodopa when clinically indicated.