Why start treatment with levodopa?

[grey]

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:

sciencedaily.com/releases/2...

More detailed report in The Lancet:

thelancet.com/journals/lanc...

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Revision - added link to The Lancet article

[Leilani23]

Thanks for posting this, Grey. I printed it out and will refer to it when the time comes for me to be medicated.

Leilani

[grey in reply to Leilani23]

Leilani, it's would be interesting to hear from you the initial advice you were given on medication.

Useful if you could add country, date of diagnosis and who advised you (neurologist, GP, Parkinson Nurse, etc.)

Indeed, if anyone diagnosed in past couple of years wishes to add their initial medication advice then please do.

[Pete-1]

Preliminary results from a large scale trial (PubMed - I think that is where I heard this from) indicate that using Levodopa early in treatment has no effect on disease progression. Problems seen with Levodopa are resultant from PD progression rather than PD progression being due to treatment by Levodopa.

[grey in reply to Pete-1]

Pete,

I've added reference to The Lancet article about this research. Full report free!

[Pete-1 in reply to grey]

grey,

Thanks for the notice of the Lancet article rergrding the PubMed trial.

[Balderdash]

The SELEDO ( selegieine-levadopa) study was carried out as a multicenter long-term, 5-year trial to evaluate the possible advantages of combining selegiline and levodopa in the early treatment of Parkinson's disease.116 patients were recruited and the study revealed that the early combination of selegiline and levodopa was clearly superior to levodopa monotherapy.

1999 Lippincott Williams & Wilkins.

[TheHealingProject]

My journey is the same as yours, but I was diagnosed at 50 and am 55 now. Experimenting with Levadopa now (NOT Sinamet). Cutting down the agonist (Mirapex .25mg/day) now. I use 200mg Amantadine a day with Selegeline (10mg/day). Never was on Sinemet, but found a product called Dopaboost which has worked - depending on what I ate beforehand.