Treatment of Early Parkinson’s Disease

From the time of the original description of Parkinson’s disease (PD)1 until the 1960s, the pharmacotherapy of PD was not too complex a matter: anticholinergics were the cornerstone of treatment. The introduction of levodopa in the 1960s, and the proof of its effectiveness in the treatment of PD,2 have resulted in vastly improved quality of life and reduction of disability in PD patients. Today, carbidopa/levodopa (or benserazide/levodopa) and dopamine agonists (DA) have become the major drugs used in the treatment of PD. The optimum initial pharmacological treatment of early PD is debatable,3-8 and the goal of this chapter is to provide a sound rationale for initial pharmacotherapy in early PD based on current scientific evidence and personal experience.