Low-dosage treatment in de novo patients with Parkinson's disease: a prospective study.

In 68 younger de novo patients with the hypokinetic-rigid type of PD the action of bromocriptine, Sinemet, a combination of these drugs, and orphenadrine with additional bromocriptine or Sinemet medication was investigated over at least a 6-year period. The favorable reaction on Sinemet medication was complicated by the occurrence of dyskinesias in the majority of cases as contrasted with the bromocriptine group. Dyskinesias were mild and not prominent in the combined group. In the sixth year, it appeared necessary to increase the dosage in the first three groups. Temporary complete replacement after 5 years of Sinemet by bromocriptine caused a clinical deterioration, whereas the dyskinesias did not (completely) disappear. Both drugs markedly improved the hypokinesia in the orphenadrine group. The results in the old-age category (60 patients) without high vascular risk were comparable with those of the young patients. The same applied for those PD patients with high vascular risk, in whom the cerebral circulation could be restored. The final conclusion of this study can be formulated as follows: Primary multitherapy with low dosage bromocriptine and a levodopa preparation may be the therapy of choice. In case of high vascular risk, improvement of the cerebral circulation may be as important as treatment with anti-parkinsonian drugs.