Selegiline use to prevent progression of Parkinson's disease. Experience in 22 de novo patients
T. S. Elizan, M. D. Yahr, D. A. Moros, M. R. Mendoza, S. Pang and C. A. Bodian
Department of Neurology, Mount Sinai Medical Center, City University of New York, NY 10029.
To test the hypothesis that selegiline (L-deprenyl), a selective inhibitor
of B-type monoamine oxidase, can halt the natural progression of
Parkinson's disease, its use in 22 naive patients (mean age, 58 years; mean
Parkinson's disease duration, 2.3 years) in the early stages (1 to 2) of
the disease was studied. Patients were started and maintained on a daily
dose of 10 mg of selegiline, and they underwent neurologic examinations at
3-month intervals using our center's disease staging and total rated
disability scores. The criterion set for disease progression was defined as
either the appearance of a new objective sign and/or a definite, persistent
worsening (greater than 25%) of existing signs after the initiation of the
selegiline trial. Patients remained on a regimen of selegiline [corrected]
for periods ranging from 7 to 84 months. At the time of their latest
neurologic examination, 17 (77%) of the 22 patients had conditions that
demonstrably worsened with selegiline alone at an average of 10.8 months
from the start of the drug therapy. Six of these 17 patients with worsening
conditions (or 27% of the original 22) eventually required the addition of
levodopa with carbidopa (Sinemet) on average at 13 months from the start of
selegiline therapy; they have continued, to date, taking this combination
for an additional mean follow-up period of 20.7 months. Four of the
original 22 patients had relatively unchanged, stable neurologic status at
the time of their latest examination (average follow-up period, 11.6
months).(ABSTRACT TRUNCATED AT 250 WORDS)