title: Initiation of Parkinson's disease treatment.
abstract: Parkinson therapy should be commenced as soon as patients feel impaired by motor or other symptoms. Recently it has been stated, however, to start treatment immediately after the diagnosis of PD has been made, in order to offer some neuroprotection to active dopaminergic neurons and to prevent deleterious compensatory mechanisms in dopaminergic cells. The selection of the medication depends on the state of the disease, the clinical symptoms, concomitant diseases and age. In de novo patients, most guidelines, including those of the German Neurological Society, advocate to start with a dopamine agonist. In my opinion, initial treatment with a MAO-B-inhibitor and subsequent combination with a long-acting dopamine agonist may be even more promising with regard to neuroprotection, modification of the disease, avoidance of dyskinesia and good motor improvement.
authors.affiliation: Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany. Heinz.Reichmann@uniklinikum-dresden.de
authors.forename: Heinz
authors.initials: H
authors.lastname: Reichmann
mesh_terms: D006801:Humans; D010300:Parkinson Disease / Q000628:therapy*; D013997:Time Factors
references.citation: N Engl J Med. 2004 Dec 9;351(24):2498-508
references.pmid: 15590952
references.citation: Neurology. 1991 Feb;41(2 ( Pt 1)):202-5
references.pmid: 1992362
references.citation: N Engl J Med. 2000 May 18;342(20):1484-91
references.pmid: 10816186
references.citation: Mov Disord. 2005 Nov;20(11):1502-7
references.pmid: 16037924
references.citation: Neurology. 2007 Jan 23;68(4):272-6
references.pmid: 17202432
references.citation: Nat Rev Neurosci. 2006 Apr;7(4):295-309
references.pmid: 16552415
references.citation: Acta Neurol Scand. 1998 Mar;97(3):175-83
references.pmid: 9531434
references.citation: Ann Neurol. 2006 Mar;59(3):559-62
references.pmid: 16489611
references.citation: Arch Neurol. 2002 Dec;59(12):1937-43
references.pmid: 12470183
references.citation: Clin Ther. 2007 Dec;29(12):2654-66
references.pmid: 18201581
references.citation: Lancet Neurol. 2006 Aug;5(8):677-87
references.pmid: 16857573
references.citation: Exp Neurol. 2008 May;211(1):172-9
references.pmid: 18321484