title: Improvement of motor fluctuations in patients with Parkinson's disease following treatment with high doses of pergolide and cessation of levodopa.
abstract: The combination of levodopa and a dopamine agonist in the treatment of patients with Parkinson's disease often reduces the severity of motor fluctuations. In patients with very severe motor fluctuations, monotherapy with continuous subcutaneous infusions of the dopamine agonist apomorphine may result in a marked reduction of hyperkinesia and on-off phenomena. We report 3 patients with Parkinson's disease and motor fluctuations who received high doses of pergolide without levodopa resulting in a reduction of motor fluctuations. All patients received doses of pergolide exceeding the maximum recommended dose. One patient also required additional therapy with amantadine. These data show that in some patients oral treatment with high doses of a dopamine agonist may improve the severity of motor fluctuations and achieve a good control of parkinsonian signs without concomitant levodopa treatment.
authors.affiliation: Department of Neurology, Klinikum Grosshadern, Ludwig Maximilians University, Munich, Germany. johannes.schwarz@medizin.uni-ulm.de
authors.forename: J
authors.initials: J
authors.lastname: Schwarz
authors.forename: K
authors.initials: K
authors.lastname: Scheidtmann
authors.forename: C
authors.initials: C
authors.lastname: Trenkwalder
mesh_terms: D000368:Aged; D000547:Amantadine / Q000008:administration & dosage / Q000009:adverse effects; D000978:Antiparkinson Agents / Q000008:administration & dosage* / Q000009:adverse effects; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000187:drug effects*; D009460:Neurologic Examination / Q000187:drug effects; D010300:Parkinson Disease / Q000188:drug therapy*; D010479:Pergolide / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D000978:Antiparkinson Agents; D010479:Pergolide; D007980:Levodopa; D000547:Amantadine