title: [Advantages and limitations in the assessment of neuroprotective treatment of Parkinson's disease by functional imaging].
abstract: BACKGROUND
  The development of neuroprotective strategies is a crucial issue for Parkinson's disease, since up to now only symptomatic therapies are available. The clinical evaluation of neuroprotective drugs is difficult considering the long-term effect of anti-Parkinsonian medication that nearly make impossible accurate measurement of the "true" clinical stage of the disease in the early years of progression.
  
  
  BACKGROUND
  Two recent functional imaging studies (CALM-PD and REAL-PET) using positron emission tomography (PET) or single photon emission computed tomography (SPECT), suggest that dopamine agonist may have a neuroprotective effect compared to L-Dopa.
  
  
  CONCLUSIONS
  These results are still controversial, notably because of the lack of clinical-imaging correlations, the absence of a placebo group and some important methodological considerations. Nevertheless, these studies are encouraging and give some arguments for the potential neuroprotective role of dopamine agonists. The aim of this work is first to present the pros and cons of these studies and second to propose guidelines in order to improve the design and methodology for future studies designed to assess the neuroprotective properties of new drugs in Parkinson's disease.
authors.affiliation: Service de Neurologie D, CERMEP et INSERM U534, Hôpital Neurologique et Neurochirurgical Pierre-Wertheimer, Lyon. stephane.thobois@chu-lyon.fr
authors.forename: S
authors.initials: S
authors.lastname: Thobois
authors.forename: E
authors.initials: E
authors.lastname: Broussolle
authors.forename: P
authors.initials: P
authors.lastname: Remy
mesh_terms: D000978:Antiparkinson Agents / Q000627:therapeutic use*; D003042:Cocaine / Q000031:analogs & derivatives; D004295:Dihydroxyphenylalanine / Q000031:analogs & derivatives; D005462:Fluorine Radioisotopes; D006801:Humans; D010300:Parkinson Disease / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D000978:Antiparkinson Agents; D005462:Fluorine Radioisotopes; D019275:Radiopharmaceuticals; C043437:fluorodopa F 18; C069723:2beta-carbomethoxy-3beta-(4-iodophenyl)tropane; D004295:Dihydroxyphenylalanine; D003042:Cocaine