I was diagnosed in the dopamine agonist era, treatment to start with agonists, supplemented with MAOb inhibitor. The aim was to delay taking levodopa as long as possible which in turn would delay onset of motor fluctuations and dyskinesia.
Inevitably, the loss of dopamine was not matched by agonist and MAOb, and then levodopa was introduced. In many cases, agonists side effects became significant and levodopa was introduced at an earlier stage so agonist could be reduced to level low enough to prevent adverse side effects, but still have therapeutic value.
We were encouraged to delay starting levodopa, and stick to our daily schedule as there was strong evidence that future motor complications would be brought on earlier and / or be more troublesome. Same applied to dyskinesia. We were faced with a simple decision; do I delay starting levodopa which will result in a lower quality of life now but will give me a higher quality in the future, or do I go for it now and the future will take care of itself.
It has been observed that in recent times many newly diagnosed are started on levodopa monotherapy. This goes against the advice many of us received. Why the change? And if agonists are not to be used, why not start with MAOb inhibitors?
Could this be the answer?
Summary report in Science Daily:
More detailed report in The Lancet:
Revision - added link to The Lancet article