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Moet levodopa-behandeling zo lang mogelijk uitgesteld worden in de ziekte van Parkinson?

Moet levodopa-behandeling zo lang mogelijk uitgesteld worden in de ziekte van Parkinson?. Zijn agonisten beter in het vroege stadium? Is levodopa neurotoxisch?. Agonisten vs. Levodopa.

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Moet levodopa-behandeling zo lang mogelijk uitgesteld worden in de ziekte van Parkinson?

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  1. Moet levodopa-behandeling zo lang mogelijk uitgesteld worden in de ziekte van Parkinson? • Zijn agonisten beter in het vroege stadium? • Is levodopa neurotoxisch?

  2. Agonisten vs. Levodopa A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group.N Engl J Med. 2000;342(20):1484-91 Pramipexole vs Levodopa as Initial Treatment for Parkinson Disease A Randomized Controlled Trial. JAMA. 2000;284:1931-1938 Early treatment of Parkinson’s disease with cabergoline delays the onset of motor complications. Drugs 1998; 55 (S1): 23-30

  3. Ropinirole vs Levodopa • 179 pat. Ropinirole • 89 pat. Levodopa • follow-up 5 jaar • Uitkomstmaten: dyskinesieen, UPDRS

  4. Levodopa and the Progression of Parkinson's DiseaseN Engl J Med 2004; 351(24):2498-508 • 361 patienten gerandomiseerd: • 90 placebo • 92 levodopa 150 mg • 88 levodopa 300 mg • 91 levodopa 600 mg 40 weken behandeling, 2 weken ‘wash-out’

  5. Conclusie • Levodopa is wellicht neuroprotectief (vervolg-trial is gepland) • Misschien moeten we minder terughoudend zijn met levodopa

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