Drug may slow Parkinson's disease
NEW YORK, Aug 20, 1998 (Reuters) -- Use of the drug selegiline in the
early stages of Parkinson's disease
postpones the need for treatment with the drug levodopa -- the mainstay
of Parkinson's therapy -- by
several months, say Swedish researchers.
According to their report, published this month in the journal
Neurology, selegiline may also slow the
progression of Parkinson's disease in its early stages.
Since the beneficial effects of levodopa tend to wear off with time,
many doctors try to postpone
initiating it at Parkinson's early stages, and may prescribe selegiline
instead, although it is more
expensive.
Both selegiline and levodopa affect the brain's supply of dopamine, the
chemical that is progressively
diminished in parts of the brain as part of the disease process.
Levodopa increases brain dopamine
levels by being converted in the body into dopamine. Selegiline acts
through a different mechanism, by
delaying the breakdown of dopamine.
Parkinson's disease affects 1% of people over age 60. It causes tremors,
muscle rigidity, a shuffling gait,
coordination problems, and a loss of facial expressions, all of which
get worse over time.
After giving 141 patients in the early stages of the disease either a
placebo or selegiline, the Swedish
researchers found that the selegiline patients were able to wait an
average of 12.7 months before starting
levodopa, whereas the placebo patients had to start levodopa an average
of 8.6 months later.
But the researchers believe their findings demonstrate that selegiline
may have done more for the study
participants than just treat their symptoms of Parkinson's. They believe
that the drug may have slowed
the disease process, possibly through a ''neuroprotective' effect..
Regarding the use of selegiline to postpone the initiation of levodopa
therapy, ``This is a confirmatory
study of others that have been done,'' Dr. David Bennett, from the Rush
Institute for Healthy Aging in
Chicago, Illinois, told Reuters Health, referring to a 1993 New England
Journal of Medicine that
reported similar findings.
But Bennett is not convinced that selegiline can slow the disease
process. ``When you give selegiline in
the early stages of Parkinson's they get a little bit better, it has
that symptomatic effect,'' he said, but
added that the researchers ''don't resolve the issue of whether or not
selegiline is slowing down the
underlying neurobiology.''
``Is (selegiline) going to have any affect on the lifespan of the
illness?'' he asked. ``We don't know.''
The researchers write that they plan to continue to follow the study
participants ``to determine the
long-term effects of early selegiline treatment in Parkinson's disease
patients.''
SOURCE: Neurology 1998;51:520-525.
--
Judith Richards, London, Ontario, Canada
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