Abstract

Parkinson’s disease (PD) is a chronic, degenerative disease associated with motor complication that progressively affects quality of life and causes significant disability, either related to disease progression or treatment consequences. A number of guidelines provide treatment algorithms for selection of anti-Parkinsonian medications which suggest delaying the introduction of L-dopa due to the development of motor complications following prolonged exposure. This study examines the efficacy of the treatment model, adopted within a single Australian outpatient clinic, for polypharmacy (based on initiating L-dopa and complemented with later introduction of selegiline and subsequently a dopamine agonist and thence entacapone) for the treatment of Parkinson’s disease and to evaluate this approach to patient management. Of 152 patients with PD identified, 40 had been treated between 5 and 20 years and were analysed further to provide sufficient period to determine disease progression and treatment evaluation. Among the 40 long-term patients, 2.5% of patients required a wheelchair and 15% demonstrated motor complications. The majority of patients were coping well with their Parkinson’s disease and reported good quality of life. This study demonstrates that despite accepted guidelines, adopting a treatment algorithm based on early commencement of treatment with L-dopa and maintenance of low dose therapy with polypharmacy, appears beneficial both in the short term and the long-term management of patients with Parkinson’s disease.