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Two informative articles on Medscape web site today- see www.medscape.com Access to the site requires registration - but it's free. "Choosing the Right Dopamine Agonist for Patients With Parkinson's Disease " from Current Medical Research and Opinion by C. Lebrun-Frenay, M. Borg Summary Dopamine receptor agonists (DA) are assuming an increasing importance in the treatment of both early and advanced symptoms of Parkinson's disease (PD). However, choosing the right DA for patients with PD unfortunately remains more a pragmatic medical art than a science. The aim of this review is to provide a realistic point of view on the strengths and weaknesses of five DAs: bromocriptine, ropinirole, pergolide, pramipexole and piribedil. This has been done by analysing their respective: (1) flexibility in PD, i.e. in monotherapy, in early and in late combination with levodopa; (2) safety profile and (3) titration schedule. These five DAs are not evenly matched regarding these three criteria. The differences observed highlight the therapeutic value of piribedil, which has a flexible indication, adapted to all stages of PD, a safer profile and the most simple initiation schedule. CME: "Levodopa: Why the Controversy?" Introduction On January 17-18, 2002, a consensus meeting was held in Zürs, Austria, to discuss the current issues relating to levodopa therapy in the management of Parkinson's disease (PD). This meeting involved a panel of 28 neurologists and neuroscientists, including world-renowned experts in the pathophysiology and clinical treatment of PD. Evidence from tissue culture studies, rodent and primate models of PD, and clinical studies were discussed to reach a consensus on how these findings should influence the use of levodopa in the clinical management of PD. The goal of the panel was to arrive at a statement describing a consensus among experts in the field of PD that could both guide and reassure practicing physicians. In addition, it was hoped that such a consensus statement would assist physicians in their decision as to how to appropriately treat PD on an individual basis. By keeping the medical community well informed of the most recent therapeutic advances, the consensus statement would enable physicians to bring their standards of care completely up-to-date. This program is designed to present the discussions of the panelists and to reveal how they reached their consensus. Two main questions were addressed during the consensus meeting: (1) Is levodopa toxic? (2) What is the basis of levodopa-associated motor complications and how can they best be managed? Consequently, this program has been split into 4 main sections: the background of PD and levodopa therapy; the question of whether levodopa is toxic; new insights into the effective management of levodopa-associated motor complications; and the final consensus statement. ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn