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On Mon 02 Aug, janet paterson wrote: > Should treatment of Parkinson's disease be started with a dopamine agonist? > > > Neurology 1998 Aug;51(2 Suppl 2):S21-4 > Poewe W > Department of Neurology, University of Innsbruck, Austria. > PMID: 9711976, UI: 98375794 > > <http://www.ncbi.nlm.nih.gov/PubMed/> > > janet paterson > I was quite pleased to read the paper unearthed by Janet Patterson, on the subject of levodopa vs Dopamine Agonist as the first treatment for PD -Until I got to the bottom line: Dopamine agonists remain first-line treatment only for those at particular risk for developing levodopa-induced dyskinesias, i.e., young-onset PD patients. And there it is again, that morbid fear of the unknown which has been the cause of so many newly-diagnosed PWPs suffering the early stages of PD without the benefit of any relief. Do these neuros really believe that what happens in say 1999 is going to result in more margin in 2020, or perhaps 2025? Just when does this benefit appear, and how much suffering time should we have to spend now, to gain access to this exclusive club. Perhaps the concept of suffering now to gain reward later appeals to some deeply buried Puritan ethic? I ask every Neurologist the same question: What is Dyskinesia? I don't mean the outward physical manifestations of dyskinesia - we all know those, but what is really going on? The answer so far has been "We don't know" It is in the presence of this vaccuum of understanding that I feel justified in offering my 'Model' of what is going on (See Sinon Coles Web pages for the full write-up: <http://james.parkinsons.org.uk/> Nobody would be happier than I, if someone would make an authoritative definition to displace mine. All it needs to do is to present a reasonable explanation of the observed behavior of levodopa. Regards, -- Brian Collins <[log in to unmask]>