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Treatment of Early Parkinson's Disease

Published online by Cambridge University Press:  02 December 2014

David A. Grimes  and
Anthony E. Lang
David A. Grimes
Affiliation:
Division of Neurology, Department of Medicine, University of Toronto, and the Morton & Gloria Shulman Movement Disorders Center, The Toronto Hospital
Anthony E. Lang
Affiliation:
Division of Neurology, Department of Medicine, University of Toronto, and the Morton & Gloria Shulman Movement Disorders Center, The Toronto Hospital
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Abstract

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The early treatment of Parkinson's disease continues to be controversial as our understanding of the etiology of the disease remains incomplete. Ideally an intervention that reverses or protects against further damage to dopaminergic neurons would be initiated once the symptoms of the disease are recognized. Unfortunately, there are no currently available therapies that have been shown to have a major impact on the progression of the disease. However, delaying effective symptomatic therapy beyond a point of significant disability does result in increased mortality. Concerns have been raised regarding the potential toxicity of levodopa on remaining nigral neurons. Although there is little support for this concept, levodopa is associated with important complications. The development of new symptomatic treatments has made the management of early Parkinson's disease even more complex and requires that many different factors be considered prior to initiating therapy in an attempt to minimize current and future disability caused by the disease and its treatment.

Résumé

RÉSUMÉ

Le traitement de la maladie de Parkinson (MP) au début demeure controversé à cause de notre compréhension limitée de l'étiologie de la maladie. Idéalement, une intervention qui répare les dommages subis par les neurones dopaminergiques ou qui protège contre la progression de ces dommages devrait être débutée dès que les symptômes de la maladie sont détectés. Malheureusement, il n'existe pas présentement de traitement disponible dont on ait prouvé l'efficacité sur la progression de la maladie. Cependant, le fait de retarder le traitement efficace des symptômes au-delà du moment où le patient éprouve un degré significatif d'invalidité résulte en une mortalité augmentée. La toxicité potentielle de la lévodopa sur les neu-rones nigraux restants demeure un sujet de préoccupation. Bien qu'il existe peu d'évidence en faveur de ce concept, la lévodopa est associée à des complications importantes. Le développement de nouveaux traitements symptomatiques a rendu le traitement de la MP au début encore plus complexe. On doit considérer plusieurs facteurs différents avant de commencer le traitement afin de minimiser l'invalidité présente et future causée par la maladie et son traitement.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 26 , Issue S2 , August 1999 , pp. S39 - S44
Copyright
Copyright © The Canadian Journal of Neurological 1999

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