Brian....
Per your comment, "It is an interesting story to me, because it shows how in
some cases the drugs that we are prescribed can in some cases be infuenced by
fashion as well as by sound clinical logic," it seems to me that a great many
physicians get into the habit.. or rut.. depending upon how ya want to look at
it.... of prescribing a particular drug or drug regimine, without reviewing
that drugs continuing usefulness to the patient over a prolonged period of
time.
The drug and/or drug regimine then becomes a 'fixture" in the individual
patient's treatment, and in sometimes in the UNIVERSAL medical treatment and
lore of many or even ALL patients having the same disease.
So... call it 'fashion," or habit, or laziness....but unfortunately, your
selegeline comment seems to be all too true, in my opinion.
Barb Mallut,
[log in to unmask]
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From: PARKINSN: Parkinson's Disease - Information Exchange Network on behalf
of Default user Brian Collins
Sent: Wednesday, September 25, 1996 2:53 AM
To: Multiple recipients of list PARKINSN
Subject: Selegeline
Subject: Selegeline
I have noticed recently some correspondence on Selegeline; how it relates
to Sinemet (levodopa), and what is the point of taking it on its own.
Those who were around when the MPTP story hit the headlines will recall
that an illegal (and incompetent) drug manufacturer, trying to make a
Heroin substitute, accidentaly made a drug called MPTP. This had the
amazing power to home in on the dopamine- producing cells in the
Substantia Nigra and kill them all - the very cells which die off (slowly)
in PD.
When the chemistry was understood, someone had the bright idea that if
you took selegiline, and then were exposed to MPTP, the Selegeline had the
power to break down the MPTP before it got to the brain.
Now we still don't know what causes PD, so if somone comes along with a
clear route showing how you COULD get PD, it made sense to a lot of people
to take steps to protect against the possibility. So, for several years,
the very first thing that a doctor did when presented with a newly-
diagnosed PWP, was to reach for the Selegeline "just in case", in the hope
of preventing further progress of the symptoms.
Somewhere along the way, it was realised that Selegeline was also helping
to slow down the breakdown of dopamine in the brain, thus prolonging the
effectiveness of the levodopa, and this made another good reason to take
Selegeline. I suspect that there was another reason why a lot of people
thought Selegeline beneficial: This was that one of the by-products of the
breakdown of Selegeline is (I am told) Amphetamine ("speed"). No wonder
Selegeline makes you feel good!
If you have followed this tangled story so far, we're nearly home: Lets
go back to the initial step: The primary reason for taking Selegeline was
to protect against an MPTP attack, and most doctors now believe that MPTP
is not the route by which 99.9% of us get PD. Take away that initial point
and there is not much reason to take Selegeline. When the report (which
may or may not be true) came through linking levodopa, selegeline, and
possible increased risk of death, for most doctors this was the last
straw, and they promptly dropped Selegeline.
It is an interesting story to me, because it shows how in some cases the
drugs that we are prescribed can in some cases be infuenced by fashion
as well as by sound clinical logic.
Sorry if I have rambled on too long.
Regards, Brian Collins
