http://www.parkinsonresearchfoundati...d=780&Itemid=1
Ten Years Follow-up: Levodopa or Ropinirole?
Written by Catherine O'Neill
Tuesday, 11 March 2008
Researchers and clinicians argue about the optimal treatment for patients with early Parkinson’s disease. They worry that premature treatment with levodopa alone will set patients back, provoking early motor complications and dyskinesias when other medications, not containing dopamine may avoid such difficulties. Several studies comparing dopamine agonists with initial levodopa therapy reported a lower incidence of motor complications and less dyskinesia when the two medications were used in tandem. The overall benefit, as evidenced by quality of life standards, UPDRS (Unified Parkinson Disease Rating Scale) scores and activities of daily living scores were generally comparable. Reduced motor disability however, was greater in patients treated with levodopa alone. However, the incidence and severity of motor complications evident in four to five years may be too short a time span to accurately assess potential long- term benefits of early treatment with a dopamine agonist, compared to levodopa.

It's all relative - i.e. whether it is more advantageous to use L-dopa or agonist therapy for newly diagnosed.

It's relative to age:
Can you see the rationalae behind writing an Rx carbidopa/levadopa (Siinemet) for a newdiagnosed who is 80, as opposed to a newly diagnosed age 40?

Is the 80 year old even going to live long enough to see motor coomplications of L-dopa? Not usually.

It's relative to individual patient:
Everyone is unique. Some people hallucinate on agonists - others have lower leg edema. Some get dyskinesia with 10/100 L-dopa therapy 3X a day. Others don't get dyskinesia until 50/200 6X a day.

It depends on how the individual metabolizes their medications, what they are taking along with the PD meds, and what diet and activity the individual uses.

It's relative to preferennce:
Does ann 80 year old newly diagnosed shoot for better quality of life now or later? Does the individual have a delecate system highly sensitive to medication and prefers to suffer symptoms of the disease over side-effeccts of the meds?

You understand my point by now, I hope. It is a very personal, individual choice. My charge is that you know and understand all of your options . . .

Nice to see you post Peg, so I'll put in my two cents too.
I am somewhere in my 11th year now Dxed at 39 years of age. Worked for 6 years after Dx, untill my wake/sleep cycles were beyond help by hypnotics and stimulants, and my dystonias and dyskinesia were too much to handle publicly.
I tried every D agonist in the book, including Apomorphine. I tried them each several times, I tried them going up slowly, I tried them going up quickly. I just couldn't handle any one of them, they made me sick, they made me faint, they made me swell up, they made me half-crazy, like a zombie.
I am an "akinetic" PWP. Rarely shaking, but commonly twisting with dyskinesia, and hurting from dystonias.
I was put on Amantadine as sole treatment for the first 3 months, then added sinemet 25'100, 3/day. With Klonopin to stop dyskinesia I was good with this for 3 years, almost like PD wasn't a problem. Then the ON/OFF syndrome hit. That's when I tried Comtan and all the agonists to no avail. The next 3 years of work were hell, so I retired in 2003.
JUst forgot about trying agonists again for the most part, although i can handle a small amount of Mirapex with decent results every now and again. Can NOT go without Amantadine. Went up to 1500mg of L-dopa /day, but was able to drop back to 600-800 mg/day with 200mg Amantadine and have stabilized. I had a period of frequent falls, but that seemed to diminish as I learned the "ART" of festination. I can walk for short distances unaided, a little longer with a cane, but if I don't time things right, I can suddenly have a severe off. This is very disconcerting if it happens when I'm out by myself, but chewing 200mg of sinemet usually brings me around enough in about 15-25 minutes, to finish what i've got to do for the day then hit the chair or the sack. I take pain medication and medication for GERD and Gout. If I MUST keep myself on my two hind legs for any amout of time (wedding or funeral), then I take ritalin, but for as much as it keeps you up, you pay for it later. Would consider my life OK, except for family problems all related to PD. It's personal, but i will say it's frustrating and heartbreaking.
Looking forward to something which will at least ensure that I don't get much worse, soon. cs

Good 2 C U 2 Translation "to see you, too," cs!

I don't visit the forums often enough.
I have been busy overextending myself (as usual), and only giving each commitment half as much as I should. Overcommitment has been a problem for me my entire life.

If you asked my husband, he would say my every living momen is PD related - whether it be fighting the off time or advocacy. But in reality, I spend a lot of time doing things with and for my 3 grand kids. I will be 58 in November.

cs, you write so well and have a fascinating science background (pharmaceuticals). Why don't you do some writing? It could be for publication or for addressing issues via the media. We could work on something toget her (there I go commiting myself, again!)

You have my email address - or send a private message and I'll get back to you.
Peg

i have finaly started the pharmaceutical, car/levoo. i bipast all the agonist and the newer ones like azilect because i have depession and fatigue issues and i cant deal with anny more side effects. in the future i may try them if dyskinesias force me. there are consequences no matter what we do and i feel such incredible relief from the stiffness and the crushing anxiety in nov, dec, and jan.i am a new man realy. i am grateful to be alive