In patients with early, mild Parkinson disease (PD), does the long-term effectiveness of levodopa alone differ from that of levodopa plus selegiline or initial bromocriptine mono-therapy? Randomized {allocation concealed*} †, blinded {data safety and monitoring commit-tee} †,* controlled trial with a mean 9.2-year follow-up. P a t i e n t s 782 patients with a clinical diagnosis of PD. Exclusio...

Levodopa-induced dyskinesias are disabling motor complications of long-term dopamine replacement in patients with Parkinson’s disease. In recent years, several alternative models have been proposed to explain the pathophysiological mechanisms underlying this hyperkinetic motor disorder. In particular, our group has shed new light on the role of the prefrontal cortex as a key site of interest, d...

BACKGROUND Motor fluctuations and dyskinesias can cause disability and reduce quality of life for patients with Parkinson disease (PD). OBJECTIVES To evaluate factors associated with the development of motor fluctuations and dyskinesias and to assess the sequence in which they occur in individual patients. DESIGN We performed a retrospective analysis of data from a randomized clinical trial...

Six Parkinsonian patients on long term levodopa therapy complained of short-lived deterioration of Parkinsonian symptoms immediately after levodopa intake. After withdrawal of the drug overnight, and following an oral challenge with levodopa/carbidopa (250/25) in all six cases, and with subcutaneous apomorphine (3 mg) in two, deterioration below base line levels of disability were observed whic...

BACKGROUND Long-term levodopa usage in Parkinson's disease (PD) patients is known to cause several motor complications. It may be related to several factors such as levodopa dosage, duration of treatment and severity of disease. OBJECTIVE To study the prevalence of levodopa motor complications and associated factors in Thai Parkinson's disease patients. MATERIAL AND METHOD The authors prosp...

OBJECTIVE The purpose of this study was to assess the effect of levodopa-carbidopa intestinal gel (carbidopa-levodopa enteral suspension) in advanced Parkinson's disease patients with troublesome dyskinesia. METHODS Post hoc analyses of patient data from a 12-week, randomized, double-blind study and a 54-week open-label study were performed. Efficacy was assessed in the subgroup of patients d...

Parkinson disease (PD) is a neurodegenerative disorder characterized by 3 cardinal motor symptoms: resting tremor, rigidity, and bradykinesia. Since its introduction 40 years ago, levodopa has represented the gold standard for dopaminergic stimulation therapy in patients with PD. Levodopa is routinely combined with a dopa-decarboxylase inhibitor (DDCI) to prevent the conversion of levodopa into...

Objective: The pathophysiological mechanisms leading to dyskinesias in Parkinson’s disease (PD) after long-term treatment with levodopa remain unclear. This study investigates the neuronal firing characteristics of the entopeduncular nucleus (EPN), the rat equivalent of the human globus pallidus internus and output nucleus of the basal ganglia, and its coherence with the motor cortex (MCx) fiel...

Because an optimal time for beginning treatment with levodopa is not clarified so far, an aim of the study was to specify key risk factors for the development of motor fluctuations and dyskinesias and to study correlations between their manifestation and time for beginning treatment with levodopa. Forty patients (mean age 57,86+/-8,02 years; mean illness duration 6,38+/-3,2 years) with Parkinso...

Thirty patients with Parkinson's disease were treated for four weeks with levodopa combined with an inhibitor of extracerebral dopa decarboxylase, L-alpha-methyldopahydrazine (MK 486). The therapeutic results were compared with the effects of treatment of a group of 40 patients with levodopa alone. Patients treated with the combined therapy improved more rapidly, had less nausea and vomiting, a...