Review: selegiline improves symptoms and levodopa is better than pramipexole for motor function in untreated Parkinson disease.

D a t a e x t r a c t i o n Studies were rated for quality (class I [highquality randomized controlled trials with blinded outcome assessment] to class IV [uncontrolled studies, case series, case reports, or expert opinion]). M a i n r e s u l t s Selegiline: 2 class-II studies on the neuroprotective effects of selegiline were included. Selegiline improved symptoms, but the evidence was insufficient for showing a neuroprotective effect. 1 meta-analysis and 1 study showed that selegiline, alone or combined with levodopa, did not increase mortality. Initiating dopaminergic treatment: 1 class-I study and 2 class-II studies compared dopamine agonists with levodopa. The classI study showed that after 23.5 months of treatment levodopa was better than pramipexole on the motor (mean score 7.3 vs 3.4, P < 0.001) and activities-of-daily-living (ADLs) (mean score 2.2 vs 1.1, P = 0.001) components of the Unified Parkinson Disease Rating Scale. Pramipexole led to fewer motor complications {hazard ratio 0.45, 95% CI 0.30 to 0.66}* but more somnolence ({32% vs 17%}*, P = 0.003), hallucinations (P = 0.03), and generalized (P = 0.01) and peripheral (P = 0.002) edema than did levodopa. In the class-II studies, follow-up was < 80% in 1 study, and the groups were not statistically compared in the other study. Sustained-release levodopa compared with immediate-release levodopa: One 5-year class-II study showed that the only difference was a greater improvement in ADLs for sustained-release levodopa than for immediate-release levodopa (mean score change −0.8 vs 0.2, P = 0.031).