Susana Romero

Combination of selegiline and controlled release levodopa in the treatment of fluctuations of clinical disability in parkinsonian patients

Abstract– Thirteen parkinsonians with a long duration of the disease and long‐term dopa therapy, seven of them showing severe on‐off oscillations and 6 an “end—of—dose impairment”, were treated with a controlled release (HBS) preparation of L‐DOPA/benserazide for more than 3 years.

A combined regimen of subcutaneous lisuride and oral Madopar HBS in Parkinson’s disease

At the first stage of a pilot study involving 14 parkinsonians with motor fluctuations, treatment with standard Madopar was substituted by a sustained-release form, Madopar HBS, which attenuated fluctuations in patients with end-of-dose impairment, but achieved only moderate improvement in patients with on-off phenomena. In a second phase of the trial, 4 parkinsonians exhibiting the most severe fluctuations of mobility and the poorest response to Madopar HBS (Hydrodynamically Balanced System) were selected for treatment with a combined regimen utilizing subcutaneous lisuride infusions as the additional component. The sequence of the trial was as follows: 1. standard Madopar, 2. Madopar HBS, 3. standard Madopar combined with lisuride infusions and 4. Madopar HBS combined with lisuride infusions. Steady improvement was observed along the lines of this schedule, but the best results were obtained when Madopar HBS was combined with lisuride infusions. Subsequently motor fluctuations were less marked or disappeared, early-morning Parkinson symptoms decreased and dystonia was not recorded any longer. Even better results could be accomplished in an extended trial attempting to establish the best dosage ratio of the combination, possibly admitting increased dosage. The tolerance of the combined regimen was excellent, except in one patient who transiently exhibited delusions and postural hypotension. The combination of sustained-release Madopar and continuous infusions of the dopaminergic agonist lisuride seems to prove a more physiological and effective regimen for the treatment of severe motor fluctuations.

Thirty five years of experience in the treatment of Parkinson’s disease with levodopa and associations

Levodopa has been a milestone in the history of PD treatment and it is the axis of therapeutic strategies. It continues to be the “gold standard”, being the most physiological and potent antiparkinsonian agent, with good balance of action on D1–D2 receptors. The association of dopaminergic agonists, the “silver standard” is the best combination in the therapeutic of this disease.