Early Therapy for Parkinson's Disease

The start of therapy for Parkinson's disease (PD) is still a matter of debate. Concerns against early therapy include possible toxic effects leading to a more rapid disease progression. New studies, however, have contested this view. Another main reason against early therapy was the occurrence of fluctuations and dyskinesias. They, however, can be compensated later with various interventions. Dopamine agonists, another intervention for early treatment, has a well-known adverse event profile which raises concerns for treatment monitoring but not for delaying its early use. Other treatments like amantadine, MAO inhibitors and COMT inhibitors are all available for special clinical constellations. Additionally there is the MAO inhibitor rasagiline may which a slow down disease progression. Disease progression is quite high during the first years as can be estimated from the placebo arms of various trials. There seems to be an associated pronounced loss of quality of life. Therefore, many research clinicians in this field have shifted their procedures for an immediate therapy after diagnosis of PD. The drugs to be used are selected according to the recommendations of the German Society for Neurology.