PubMed · 1630949
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J MacSweeney. A helpful assessment.. https://pubmed.ncbi.nlm.nih.gov/1630949/
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In the course of long-term treatment of Parkinson's disease many problems, which cannot yet be satisfactorily solved, arise with time in a large number of patients. This overview describes some strategies which are used nowadays to tackle these problems. Special attention is drawn to the treatment of painful dystonias and off-periods with apomorphine.
The author reviews the various strategies for treatment of Parkinson's disease by modern drugs. Either levodopa or a levodopa agonist is recommended for treatment of early Parkinson's disease. For long-term treatment, a combination of levodopa and levodopa agonist is preferable, since combined treatment appears to cause fewer side effects and motor fluctuations than does high dose monotherapy. Selegeline may be added, both in initial and long-term treatment. However, it is still uncertain whether selegeline acts only as a dopamine agonist, or also has a neuroprotective effect.
A 60-year-old woman, under treatment for parkinsonism with dopicar, was hospitalized in a stuporous catatonic state. After several days, while dopicar was being tapered off, she developed a clinical picture similar to malignant neuroleptic-like syndrome, including continuous high fever, elevated blood pressure and increased perspiration, and the parkinsonian symptoms became more severe. Neuroleptic medication was not used, but renewal of dopicar treatment relieved this typical syndrome. It is suggested that a relative deficiency of dopamine is involved in the pathogenesis of malignant neuroleptic-like syndromes.