This Article  • References  • Full text PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Freezing of gait in PD: Prospective assessment in the DATATOP cohort
Giladi et al.
Neurology 2001;56:1712-1721.
ABSTRACT | FULL TEXT  

An algorithm (decision tree) for the management of Parkinson's disease (2001):: Treatment
Olanow et al.
Neurology 2001;56:S1-S88.
FULL TEXT  

Fluctuating Parkinson's Disease: Treatment With the Eong-Acting Dopamine Agonist Cabergoline
Ahlskog et al.
Arch Neurol 1994;51:1236-1241.
ABSTRACT  

Poor Tolerability of MK-458
Cutler et al.
Arch Neurol 1993;50:896-896.
ABSTRACT