Initiation of symptomatic therapy in Parkinson's disease: dopamine agonists versus levodopa

Abstract

Parkinson's disease (PD) is a chronic progressive neurodegenerative disease and its early treatment is of prime importance. Early treatment of PD has several goals: to increase the patient's quality of life and to have symptomatic benefits, to slow disease progression, and to prevent treatment-related morbidity in the long-term. The treatment strategy in patients with de novo, early-stage PD has numerous facets and should be individually tailored. Levodopa is the gold standard for the symptomatic treatment of PD. However, despite clinical experience with levodopa for more than three decades, there are still unanswered questions about its effect on disease progression and delayed motor complications. There is now an increasing use of dopamine agonists as effective early monotherapy in the treatment of PD. Evidence from randomized-controlled trials has shown that initiating symptomatic therapy with dopamine agonists reduces the risk of development of motor complications and there are also some data suggesting that such treatment may slow disease progression. This article reviews the laboratory and clinical evidence on the therapeutic options in early de novo PD so as to help physicians establish the best-fitting treatment strategy adapted for the individual patient.