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Dopamine Agonist Treatment of Fluctuating Parkinsonisn
Arch Neurol 49:560-568, Ahlskog,J.E.,et al, 1992
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Article Abstract
Adjunctive treatment with the very potent and selective dopamine D-2 agonist MK-458(controlled-release formulation)improved the control of parkinsonism in patients with fluctuating responses to levodopa therapy (with carbidopa).We subsequently switched patients to adjunctive treatment with pergolide,a less potent D-2 agonist.Pergolide therapy controlled parkinsonism more effectively than controlled-release MK-458.Unlike MS- 458,pergolide mesylate also had D-1 agonist properties,apparently accounting for its greater antiparkinsonism efficacy.Adjunctive treatment with controlled-release MD-458 elicited less choreiform dyskinesias than either pergolide adjunctive therapy or therapy with carbidopa-levodopa alone;this finding suggests that D-1 receptor stimulation contributes to the elicitation of medication-induced chorea.The highest doses of controlled-release MD-458 resulted in paradoxical freezing of gait in almost one third of patients.This finding suggests that gait freezing, common in untreated parkinsonism,can also be elicited by excessive D-2 stimulation.
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dopamine agonist
dopamine receptor,D2
Parkinson disease
Parkinson disease,on-off phenomena in
Parkinson disease,treatment of
pergolide
treatment of neurologic disorder
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