Treatment of Parkinson's Disease with Bromocriptine

Bromocriptine in high doses (up to 100 mg per day) was administered to 14 patients with advanced Parkinson's disease whose disorder was progressing despite optimum treatment with levodopa combined with a peripheral dopa decarboxylase inhibitor (carbidopa). In 10, bromocriptine (mean dose, 57 mg) induced a statistically significant (P<0.01) improvement in rigidity, tremor, bradykinesia, gait disturbance and total score. In seven patients levodopa with carbidopa was completely replaced by bromocriptine (mean dose, 70 mg), with improvement in four. Adverse effects were similar to those observed with levodopa and carbidopa, except that in individual patients abnormal involuntary movements and diurnal oscillations in performance (on-off effect) were decreased whereas orthostatic hypotension and mental changes were increased. Bromocriptine appears to be a major new agent in Parkinson's disease that is especially promising in patients no longer responding to levodopa. (N Engl J Med 295:1400–1404, 1976) The most important problem in the treatment of Parkinson's disease is the increasingly large number of patients who, after showing a good response to levodopa with or without a peripheral decarboxylase inhibitor, fail to maintain this response and have signs of progression of the disease.¹²³⁴⁵This problem may be explained in several ways. In Parkinson's disease there is a degeneration of pigmented neurons in the substantia nigra, their number averaging one-third those of normal controls.⁶⁷⁸These cells convert dopa to dopamine, transport the newly formed dopamine to the intact striatum and synapse with the post-synaptic neurons on specialized receptors, with.