Practical importance of neuroprotection in Parkinson's disease.
Consensus could be reached that there is overwhelming evidence of preclinical neuroprotection. However, the evidence of neuroprotection/neurorescue under clinical conditions is limited. Lessons from clinical trials designed to show neuroprotection (selegiline, amantadine, dopamine agonists) demonstrate that with the drugs available neuroprotection/neurorescue has to start as early as possible. A PET-controlled clinical trial with ropinirole shows that there seems to be a good chance for neuroprotection in the early phase of Parkinson's disease in patients treated from the very beginning of the disease while there is no such benefit in patients with a late start of a neuroprotective therapeutic strategy. Also long-term clinical neuroprotection cannot be reached. Complicating factors to demonstrate clinical neuroprotection are discussed.
Riederer
P
P
Clinical Neurochemistry, Clinic and Policlinic of Psychiatry and Psychotherapy, University of Würzburg, 97080 Würzburg, Germany. peter.riederer@mail.uni-wuerzburg.de
Gille
G
G
Müller
T
T
Przuntek
H
H
Reichmann
H
H
Riess
O
O
Schwartz
A
A
Schwarz
J
J
Vogt
T
T
D000547:Amantadine / Q000627:therapeutic use; D000978:Antiparkinson Agents / Q000627:therapeutic use*; D018491:Dopamine Agonists / Q000627:therapeutic use; D006801:Humans; D007211:Indoles / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use*; D010300:Parkinson Disease / Q000628:therapy*; D012642:Selegiline / Q000627:therapeutic use
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D007211:Indoles; D018696:Neuroprotective Agents; C046649:ropinirole; D012642:Selegiline; D000547:Amantadine