Initial management of Parkinson’s disease

<div class="line" id="line-26"> Objective: To determine initial pharmacological treatment patterns in the management of Parkinson <span style="font-family: ff3;"> &rsquo; </span> s disease.</div><div class="line" id="line-30"> Background: There is controversy as to whether <span style="font-size: 24px;"> L </span> -dopa or dopamine agonists should be used as initial therapy for Parkinson <span style="font-family: ff3;"> &rsquo; </span> s disease(PD). Limited information is currently available concerning the therapeutic preferences of medical specialists who treat PD.</div><div class="line" id="line-36"> <br/></div><div class="line" id="line-38"> Methods: We conducted telephone and in-person interviews with 229idiopathic PD patients who presented to a university movement disorders center in Tampa, Florida, USA for treatment from 2000 through 2001.Patients &filig;lled out questionnaires regarding their initial and current pharmacotherapy, and information on the type of specialist who initiated treatment. Data was corroborated by retrospective chart reviews.</div><div class="line" id="line-40"> <br/></div><div class="line" id="line-42"> Results: Prior to 1998, 67% of all PD patients under 70 years of age were initially started on L-dopa/carbidopa, 16% were started on selegiline, 5%on trihexyphenidyl, 4% on amantadine, and 3% on a dopamine agonist. Seventy-eight percent of these patients were started on an initial medication by a general neurologist, while 9% were given initial medication by a movement disorders expert. From 1998 through 2001, the percent of PD patients under 70 years of age who were initially started on L-dopa/carbidopa decreased to 40%, while the percent of patients initially started on a dopamine agonist increased to 12%. Eighteen percent of patients were initially started on selegiline, 14% entered a clinical trial, 6% were given amantadine, and 6% started trihexyphenidyl. Eighty percent of these patients were started on an initial medication by a general neurologist, while 9% were given initial medication by a movement disorders expert. Seventy-three percent of all patients took a dopamine agonist at some time during their illness. Of these, 34% were prescribed a dopamine agonist before 1998, while 66% were given dopamine agonists after 1998.</div><div class="line" id="line-44"> <br/></div><div class="line" id="line-46"> Conclusions: Our study indicates that L-dopa use as initial antiparkinsonian therapy has decreased since 1998 in patients under 70 years of age. Use of dopamine agonists as both initial and adjunct therapy has increased since 1998 in patients under 70 years of age. In our study, general neurologists played a pivotal role in initiating antiparkinsonian medications.</div>