Early Parkinson's Disease: What Drugs Should You Take?
Oct. 6, 2000 -- So you've just been diagnosed with Parkinson's disease and are wondering what medication is best. Well, you're not alone. Some of the biggest names in the field can't agree on that very issue, as highlighted in a debate sparked by a recent study featured in TheNew England Journal of Medicine (NEJM).
The problems with stiffness, shaking, and movement that come along with Parkinson's disease are all related to loss of dopamine, a brain chemical that lets the nerve cells that control movement talk with each other. For over 30 years, these typical Parkinson's problems have been successfully treated with levodopa, a drug which turns into dopamine once it enters the brain.
A more recent approach is to bypass dopamine altogether, using drugs called dopamine agonists that act directly on nerve cells. The NEJM study suggested that a dopamine agonist called Requip (ropinirole), and others like it, might have some advantages over levodopa.
But not all neurologists agree.
"To be blunt, the lay public and doctors are being sold a bill of goods concerning the treatment of [Parkinson's disease]," Bradley C. Hiner, MD, tells WebMD. "There seems to be a huge push by the pharmaceutical industry to promote [Requip] and other new dopamine agonists over traditional therapy with [levodopa], and ... high-profile opinion-makers in [Parkinson's disease] seem to be on the bandwagon."
"But the new [drugs are] not as effective in relieving symptoms, and [they] are three to four times more expensive," says Hiner, director of movement disorders at the Marshfield Clinic in Marshfield, Wis.
At Hiner's local pharmacy, a month's worth of Requip costs $215, whereas levodopa goes for $45 to $50 a month, Hiner says. "That's a big difference, especially when you're talking about older patients on fixed incomes," he says.
So why would doctors prescribe Requip or other dopamine agonists instead of levodopa? Mainly because of the dyskinesias some patients develop after taking levodopa for many years. Dyskinesias are an unpleasant sensation of restlessness -- or, as Hiner describes them, they are "when patients wiggle and waggle and can't sit still."
"Dyskinesias are what forced actor Michael J. Fox to leave his TV show," says the senior author of the NEJM study, Anthony E. Lang, MD, professor of neurology at the University of Toronto.
"Dyskinesias have a very negative effect on the quality of life of these patients, and their prevention is very important," NEJM study co-author Amos D. Korczyn, MD, MSc, tells WebMD. "Our study shows that [Requip] is superior to levodopa in early treatment of [Parkinson's disease], since it is as effective in milder cases, yet protects patients from the development of dyskinesias later on," says Korczyn, professor of neurology at Tel Aviv University in Israel.