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Current Science Reviews by Joe Bruman January 1996 (Part 2) Lees A: BMJ 16 Dec 95; 1602-1607: The debate rages on! Snapping at the heels of Olanow's recent report (see Part 1) comes a UK study showing not only that selegiline (Deprenyl, Eldepryl) is of no benefit in PD, but also that mortality of participants during the 5-6 year followup was an alarming 60% higher among those given selegiline plus levodopa (about 1/3 of the total 520) than the others. Ages and causes of death were not specified. The study conclusions attack a) the free radical hypothesis and b) the oxidative stress hypothesis of PD etiology. The three trial groups got respectively, levodopa alone, levodopa plus selegiline, and bromocriptine (Parlodel) alone. The UK report also faults conclusions of the earlier US DATATOP study as subjective. (All the trials thus far seem to rely on clinical evaluation of psychological performance. Results might be better defined if a trial were based on more "tangible" evidence, such as FD PET scans of each participant.) Calne D: BMJ 16 Dec 95; 1584: Commentary on the article reviewed above, with rather scathing remarks about earlier trials which were claimed to indicate a neuroprotective effect. Some curious discrepancies regarding medication protocol and number of subjects, but otherwise a fair representation of the UK study results. Especially unkind treatment of W. Birkmayer, developer of selegiline. (I note that most of the respondents in the current informal parkinsn survey seem to be taking selegiline along with levodopa and other medications. At this point, patients taking selegiline must be wondering, what to do and whom to believe. We all can offer opinions, but with consequences so serious I hesitate to do so.) Jacobs D. M. et al: Neur 1995;45:1691-1696: Impaired verbal fluency may offer a preclinical sign of PD dementia. Jacobs D. H. et al: Neur 1995;45:1696-1702: PD patients are poor not only at expressing emotion facially, but also at perceiving facial expression of others. Maricle R et al: Neur 1995;45:1757-1760: Mood elevation and anxiety reduction following levodopa dosing are true pharmacologic, not placebo, effects. Carrero-Valenzuela R et al: Neur 1995;45:1760-1763: Gene mutations have been linked to several neural diseases, but the suspect mutation was not found in the case of PD. J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks CA 91403