A rational approach to the treatment of early Parkinson's disease

Parkinson's disease (PD) is an age-related, inexorably progressive, neurodegenerative disorder. The mean age of onset is approximately 60 years, but many cases begin in their 40's and 50's and cases beginning before the age of 40 are not rare. This implies that many PD patients will suffer from this disorder for the bulk of their adult lives. The introduction of levodopa in the late 1960s revolutionized treatment for this disorder and provided PD patients with reduced morbidity and decreased mortality. However, chronic levodopa treatment is associated with the development of adverse events in the majority of patients, primarily in the form of motor complications (dyskinesia and motor fluctuations). Further, despite levodopa, PD patients continue to progress and eventually develop 'non-dopaminergic features' such as freezing, gait and balance disorders, autonomic dysfunction etc. that do not respond to levodopa treatment. It is now becoming clear that the approach to the treatment of early PD is of great importance and may very well influence the likelihood that motor complications will develop and the rate at which the disease will progress. This article will review these issues and suggest a treatment approach to the early stages of PD. Copyright (C) 1999 Elsevier Science Ltd.