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D-2 (Controlled-Release MK-458) vs Combined D-1 and D-2 (Pergolide)

J. Eric Ahlskog, PhD, MD; Manfred D. Muenter, MD; Patricia A. Bailey, RN; Patricia M. Stevens, RN

Arch Neurol. 1992;49(5):560-568.

Abstract
• Adjunctive treatment with the very potent and selective dopamine D-2 agonist MK-458 (controlled-release formulation) improved the control of parkinsonism in patients with fluctuating responses to levodopa therapy (with carbidopa). We subsequently switched patients to adjunctive treatment with pergolide, a less potent D-2 agonist. Pergolide therapy controlled parkinsonism more effectively than controlled-release MK-458. Unlike MK-458, pergolide mesylate also has D-1 agonist properties, apparently accounting for its greater antiparkinsonism efficacy. Adjunctive treatment with controlled-release MK-458 elicited less choreiform dyskinesias than either pergolide adjunctive therapy or therapy with carbidopa-levodopa alone; this finding suggests that D-1 receptor stimulation contributes to the elicitation of medication-induced chorea. The highest doses of controlled-release MK-458 resulted in paradoxical freezing of gait in almost one third of patients. This finding suggests that gait freezing, common in untreated parkinsonism, can also be elicited by excessive D-2 stimulation.

Author Affiliations
From the Department of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minn (Dr Ahlskog and Ms Bailey), and the Section of Neurology, Lee Silverman Center for Parkinson's Disease and Movement Disorders, Mayo Clinic Scottsdale (Ariz) (Dr Muenter and Mrs Stevens).

Footnotes
Accepted for publication January 15, 1992.

Presented in part at the First International Congress of Movement Disorders, Washington, DC, April 27,1990, and at the 10th International Symposium on Parkinson's Disease, Tokyo, Japan, October 29, 1991.

Reprint requests to the Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN 55905 (Dr Ahlskog).

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