左旋多巴对健康老年大鼠脑内多巴胺转运体的影响

目的　探讨长期应用左旋多巴 (L dopa)对健康老年大鼠脑内多巴胺转运体 (DAT)的影响。方法　将健康老年大鼠随机分为A、B、C 3组 ,分别每日给予口服大剂量L dopa(15 0mg/kg)、小剂量L dopa(5 0mg/kg)和生理盐水共 4个月。停药 2 4h后 ,经尾静脉注射 99mTc TRODAT 10 2ml(80 0 μGi) ,3h后处死。剥离纹状体、大脑皮质、小脑、脑干 ,称湿重 ,测定放射性计数 ,计算脑组织ID值。结果　纹状体放射活性ID值A组、B组分别为 0 .76 4± 0 .12 9和 0 .92 8± 0 .14 5 ,明显低于C组 (1.5 6 2± 0 .2 89) (P <0 0 0 1,P <0 0 5 ) ,其他部位差异无显著性。结论　长期应用L dopa可以导致纹状体部位DAT减少     

恩他卡朋治疗帕金森病的多中心、随机、双盲、安慰剂对照临床研究

目的　研究恩他卡朋作为左旋多巴的辅助药物治疗帕金森病患者剂末现象的疗效和安全性。方法　帕金森病伴剂末现象患者 2 0 9例的 12周、多中心、随机、双盲、安慰剂、平行分组对照临床试验。根据患者日记记录的“开”和“关”期时间、统一帕金森病评定量表 (UPDRS)各部分评分、研究者总体评估变化量表和左旋多巴每日剂量评定疗效。结果　恩他卡朋治疗 12周时意向性治疗(ITT)人群“开”的时间自基线的 (7 4± 1 8)h/d延长至 (9 1± 2 5 )h/d ;“关”的时间自基线的 (6 8±2 2 )h/d缩短至 (5 2± 2 8)h/d ;UPDRS Ⅲ平均得分自基线的 36 7± 11 3减少至 30 0± 14 4 ;左旋多巴每日剂量 (mg/d)自基线的 5 89 2± 2 6 4 3减少至 4周的 5 6 1 5± 2 4 8 1;总体评估变化量表检查显示 6 9 9%的医生主观感觉到病情好转。与安慰剂组相比差异均有显著意义。常见的不良事件是多巴胺能反应 ,但是与安慰剂组相比差异均无显著意义。结论　恩他卡朋是有效而安全的治疗帕金森病伴剂末现象的辅助药物。     

不同剂量左旋多巴对帕金森病大鼠行为学影响实验研究

目的　观察不同剂量左旋多巴 (L - dopa)治疗帕金森病 (PD)的效果 ,探讨 L - dopa治疗帕金森病的合理方法。方法　通过 6- OHDA脑立体定向注射术建立大鼠 PD模型 ,采用行为学、TUNEL、原位杂交的方法观察左旋多巴小、中、大 3种不同剂量 [10 mg/(kg· d)、5 0 mg/(kg· d)、10 0 mg/(kg· d) ]、不同的作用时间 (1d、3 d、5 d、7d)对 PD大鼠黑质细胞的毒性作用 ,并观察治疗后 7天各项指标的变化。结果　与对照组比较 ,小剂量组大鼠旋转圈数随 L- dopa使用计量和时间增加而减少 ,中、大剂量组相反 ,旋转启动时间随 L- dopa使用剂量和时间增加而加速 ,最高转速及持续时间则相反。结论　我们应尽可能小剂量、间隔使用 L - dopa治疗 PD。     

左旋多巴对帕金森病大鼠毒性作用的实验研究

目的　研究左旋多巴 (L dopa)对帕金森病 (PD)模型大鼠异常行为、黑质抗氧化系统、线粒体呼吸链功能和神经递质代谢的影响及其机制。方法　应用 6 羟基多巴胺 (6 OHDA)立体定向注射制作PD大鼠模型 ,给PD大鼠L dopa 2 5mg/ (kg·d)灌胃 ,共 4 5d。给药前后分别进行行为学测试 ,给药后测定黑质区谷胱甘肽过氧化物酶 (GSH Px)、丙二醛 (MDA)、活性氧 (ROS)及线粒体呼吸链酶复合体Ⅰ水平 ,测定尾状核头部多巴胺 (DA)、高香草酸 (HVA)、单胺氧化酶 B(MAO B)的水平。结果　 (1)L dopa组大鼠旋转速度给药前为(13.1± 1.5 )r/min ,给药后为 (7.2± 1.6 )r/min,给药前后比较差异有显著性 (P <0 .0 1) ;(2 )L dopa组GSH Px活性、呼吸链酶复合体Ⅰ水平降低 ,MDA含量、ROS活性升高 ,与对照组比较差异均有显著性 (均P <0 .0 1) ;(3)L dopa组MAO B活性、DA、HVA含量及DA/HVA比值与对照组比较均显著升高 (P <0 .0 5～ 0 .0 1)。结论L dopa能有效改善PD大鼠的旋转行为 ,但可加重黑质区氧化应激损伤 ,抑制线粒体呼吸链酶活性。     

雌激素对MPP+诱导的PC12细胞损伤的防护作用

目的　探讨在离体的细胞培养物中 ,雌激素 (estrogen ,E)对 1 甲基 4 苯基吡啶离子(MPP+ )诱导的帕金森模型是否具有保护作用。方法　以PC12细胞为多巴胺能神经元的细胞模型 ,将MPP+ 或E加入培养的PC12细胞 ,四甲基偶氮唑盐 (MTT)法检测细胞活性及代谢状态 ,SABC法检测酪氨酸羟化酶 (TH)的含量 ,流式细胞术检测细胞凋亡率 ,比较各组的差异。结果　随MPP+ 浓度增加 ,细胞活性下降 ,MPP+ 浓度为 2 5 0 μmol/L时 ,吸光度A570 值为 0 30± 0 0 7,符合帕金森病细胞模型 ;随E浓度增加 ,细胞活性升高 ,呈量效依赖关系 ;当雌激素浓度 >10nmol/L ,细胞活性无明显增加。单纯用E组A570 值为 0 6 1± 0 17,比空白对照组 (0 4 9± 0 11)、MPP+ 组 (0 30± 0 0 7)、E +MPP+ 组 (0 5 6± 0 16 )细胞活性高 (P <0 0 5 ) ;TH阳性细胞平均吸光度E组 (0 4 6± 0 0 6 )比空白对照组 (0 2 2± 0 0 7)、MPP+ 组 (0 10± 0 0 3)、E +MPP+ 组 (0 2 4± 0 0 4 )高 (P <0 0 5 ) ;凋亡率E组(11 5 % )比对照组 (31 3% )、MPP+ 组 (6 3 5 % )、E +MPP+ 组 (33 6 % )低 (P <0 0 5 ) ,每组细胞数为 2× 10 5个 /ml。E +MPP+ 组比MPP+ 组细胞活性高 ,TH含量高 ,凋亡率低 (P <0 0 5 )。结论　雌激素对PC12细胞可     

左旋多巴诱发异动症大鼠纹状体区P38及GAP-43表达的变化

目的　观察帕金森病(Parkinson disease, PD)大鼠经慢性间断性左旋多巴(levodopa,L- dopa)治疗后纹状体区域突触功能的变化。方法　 6 羟多巴胺 (6 OHDA)脑立体定位注射制备偏侧PD大鼠模型,复方L dopa甲酯治疗4周[按体重20 mg/(kg·d),分2次进行腹腔注射]建立异动症(levodopa induced dyskinesias,LID)大鼠模型,采用免疫组化方法检测 PD组和 LID组纹状体内突触素(synaptophysin, P38)及生长相关蛋白(growth associated protein, GAP 43)的表达。结果　 PD 大鼠损毁侧 P38 免疫反应阳性颗粒的数密度[(0. 002 1±0 000. 5)个/μm2]和面密度(0. 045±0.01)均明显高于健侧[分别为(0 .015 0±0. 000 6)个/μm2, (0 027±0 .009)](P<0 .01),GAP- 43阳性颗粒面密度(0. 015±0. 000 3)高于健侧(0. 01±0 .000 27)(P<0. 05);LID大鼠经L dopa治疗后两者表达进一步增多,与PD组大鼠损毁侧相比差异有显著性(均 P<0 .05)。结论　慢性L dopa治疗进一步促进了PD大鼠纹状体区域P38及GAP -43的高表达,可能涉及皮质纹状体病理性长时程增强的突触前机制,提示皮质 纹状体环路的突触可塑性与LID发生密切相关。     

改良Webster症状评分对脑内核团毁损术治疗帕金森病的疗效评估

目的 :通过改良Webster记分评价脑内核团毁损术治疗帕金森病的疗效 ,从而判定手术价值。方法 :应用改良Webster症状评分表 ,对帕金森病人分别在手术前后进行 10组症状记分 ,1～ 10分为轻度障碍 ;11～ 2 0分为中度障碍 ;2 1～ 30分为重度障碍 ;术后改善 2 5 %以下为无效 ,2 6 %～ 5 0 %为有效 ,5 1%～ 75 %为显效 ,76 %以上为特别显效。结果 :术前评分为 19 90± 5 2 7,术后评分为 10 5 7± 6 10 ,差别非常显著 ;但无 1例症状完全消除 ,平均改善 8 95± 3 37分 ,其中特别显效 4例 ,占 9 5 % ;显效 17例 ,占 40 5 % ;有效 16例 ,占 38 1% ,总有效率为88 1% ,单靶点毁损 34例 ,改善 8 5 9± 3 5 3分 ,双靶点 8例 ,改善 10 0 0± 4 14分 ,两组差别无统计学意义。分组统计结果表明 ,症状轻者术后改善的百分比较高。结论 :脑内核团毁损术不能完全消除帕金森病的症状 ,可使其明显改善 ;单侧双靶点毁损与单靶点毁损的疗效差别无显著意义 ,可能与病例数较少有关 ;症状越轻 ,术后改善越明显。对于药物疗效降低以及出现毒副作用的帕金森病患者 ,采用电生理引导立体定向脑内核团毁损术是一种值得提倡的有效方法。     

β-淀粉样多肽神经毒性的氧化应激机制和褪黑素神经保护机制研究

目的　观察氧化应激在 β 淀粉样多肽 (Aβ)神经毒性的介导作用和褪黑素 (Mel)神经保护作用的抗氧化机制 ,为老年性痴呆的抗氧化治疗提供依据。方法　新生大鼠原代神经元培养 ,分为实验组 (A1 ,B1 ,C1 ,D1 组 )、治疗组 (A2 ,B2 ,C2 ,D2 组 )和空白对照组。实验组四组分别暴露浓度为 0 5 ,1 0 ,1 0 0 ,2 0 0 μmol/L的Aβ2 5 35,治疗组四组同时暴露 1 0 μmol/LMel。比色法测定丙二醛 (MDA)、还原型谷胱甘肽 (GSH)水平以及过氧化氢酶 (CAT)和谷胱甘肽过氧化物酶 (GSH Px)活力 ,并用MTT法测定培养神经元细胞存活率。统计学方法采用方差分析、t检验和相关分析。结果　细胞存活率与Aβ浓度呈显著性负相关 (r=- 0 834 ,P <0 0 0 1 )。MDA :实验组 (A1 ,B1 ,C1 ,D1 组 ,以下同 )分别为 (2 1±0 5)nmol/L ,(3 1± 0 5)nmol/L ,(4 8± 0 9)nmol/L ,(6 0± 0 6)nmol/L ;治疗组 (A2 ,B2 ,C2 ,D2 组 ,以下同 )分别为 (1 9± 0 3)nmol/L ,(2 3± 0 3)nmol/L ,(2 8± 0 5)nmol/L ,(2 9± 0 4)nmol/L ;对照组为(1 6± 0 2 )nmol/L。GSH :实验组分别为 (8 3± 1 5)g/L ,(5 8± 1 7)g/L ,(4 4± 1 3)g/L ,(3 7± 0 5)g/L ,治疗组分别为 (9 9± 1 6)g/L ,(7 7± 1 7)g/L ,(6 3± 1 2 )g/L ,     

结核性脑膜炎的脑神经损害与脑脊液免疫球蛋白、白蛋白的关系

目的　分析结核性脑膜炎 (TM)的脑神经损害的特征 ,及其与脑脊液 (CSF)免疫球蛋白 (Ig)和白蛋白 (Alb)的关系。方法　将确诊的 4 8例TM患者分为两组 :无脑神经麻痹TM组 (A组 ,30例 )和有脑神经麻痹TM组 (B组 ,18例 ) ,用速率散射比浊法测定其CSFIg和Alb的含量。结果　B组中展神经受损最多 ,为 10例 (5 5 6 % ) ,其次为动眼神经受损 (6例 )。视神经、听神经损害分别为 4例、2例 ;B组CSF蛋白含量明显高于A组 (P <0 0 0 1) ,CSFIgG、IgM、Alb含量 :A组分别为 (135 7± 4 1 4 )mg/L、(12 4± 3 3)mg/L及 (5 6 6 5± 2 71 8)mg/L ,B组分别为 (197 2± 4 5 1)mg/L、(36 7± 5 8)mg/L及 (813 3± 2 84 5 )mg/L ,两组比较差异均有显著性 (均P <0 0 0 1)。结论　TM常有脑神经损害 ,且与血 脑屏障破坏、CSFIg和Alb升高有关     

颈动脉粥样硬化斑块及相关生化指标与脑梗死的关系

目的　探讨颈动脉粥样硬化斑块及其相关生化指标与脑梗死的关系。方法　对 6 5例脑梗死患者 (脑梗死组 )及 35例非脑梗死患者 (对照组 )分别进行彩色多普勒超声检测 ,并记录两组颈动脉粥样硬化斑块的部位、数目、性质和颈动脉内径 ;同时检测两组的血脂、血糖和纤维蛋白原等生化指标。结果　脑梗死组颈动脉粥样硬化斑块检出率、左右颈总动脉内径 [81 5 4 %、(7 4 3± 0 0 7)mm、(7 5 2± 0 6 0 )mm]与对照组[2 8 5 7%、(7 75± 0 10 )mm、(7 97± 0 75 )mm]比较差异均有显著性 (均P <0 0 5 )。粥样硬化斑块位于颈总动脉最多 (78 2 3% ) ,其次是颈总动脉分叉处 (14 5 2 % ) ,颈内动脉颅外段最少 (7 2 5 % )。斑块部位与脑梗死部位有显著同侧相关性 (P <0 0 5 ) ;脑梗死组三酰甘油 (TG) [(1 81± 0 12 )mmol/L]、餐后 2h血糖 [(9 2 2± 0 4 3)mmol/L]及纤维蛋白原 [(3 18± 0 0 7)mmol/L]也均显著高于对照组 [(1 39± 0 0 9)mmol/L、(8 2 0± 0 35 )mmol/L、(2 6 4± 0 14 )mmol/L](均P <0 0 5 ) ;脑梗死组中颈总动脉内径与TG有显著正相关性 (r=0 34,P <0 0 1) ,与高密度脂蛋白 (HDL)存在显著负相关 (r=- 0 2 5 ,P <0 0 5 )。结论　颈动脉粥样硬化斑块与脑梗死发生有密切关系 ,部分脂质     

Effectiveness of Madopar HBS plus Madopar standard in patients with fluctuating Parkinson's disease: two years of follow-up

Clinical response to a new galenic formulation of levodopa plus benserazide, Madopar HBS, was studied in 25 fluctuating parkinsonians. This open study was planned in two phases. In the first phase, the administering of HBS alone resulted in a surprisingly high number of dropouts. In the second phase, Madopar standard in association with Madopar HBS, the follow-up period was 24 months. A stable long-lasting improvement in predictable fluctuations and their severity was maintained for the whole period without any change in drug dose. Nocturnal and early morning akinesia improved too. The study shows that Madopar HBS plus Madopar standard is effective in producing a prolonged and stable response in parkinsonian fluctuating patients.     

普拉克索添加治疗帕金森病临床随机对照研究

目的 评价新型多巴胺受体激动剂普拉克索联合美多巴与单用美多巴治疗帕金森病(PD)患者的疗效及安全性. 方法 采用随机对照开放式研究,将70例PD患者按照随机数字表法分为普拉克索+美多巴组和美多巴组,每组各35例.治疗12周后判断其疗效及安全性.疗效判定的主要指标为统一PD评定量表第Ⅲ部分(UPDRSⅢ)的运动检查总评分相对患者基线的变化和第Ⅱ部分(UPDRS Ⅱ)的日常生活活动能力总评分相对患者基线的变化;次要指标为第Ⅰ部分(UPDRS Ⅰ)的精神、行为和情感总评分相对患者基线的变化和第Ⅳ部分(UPDRS Ⅳ)的治疗并发症总评分相对患者基线的变化和美多巴药物每日剂量相对基线的变化.安全性指标依据药物的不良反应来判定. 结果 普拉克索+美多巴组患者UPDRS Ⅲ总评分均值与基线相比下降了11.40分,高于美多巴组(9.26分),比较差异有统计学意义(P<0.05);UPDRS Ⅱ总评分均值与基线相比下降了4.57分,高于美多巴组(4.50分),比较差异无统计学意义(P<0.05);UPDRS Ⅰ总评分均值与基线相比下降了0.66分,低于美多巴组(1.14分),差异无统计学意义(P0.05);UPDRS Ⅳ总评分均值与基线相比下降了0.22分,美多巴组则升高了0.06分,差异有统计学意义(P<0.05).与基线相比,治疗后12周普拉克索+美多巴组美多巴的日用量下降了163.57 mg/d,美多巴组升高了8.57 mg/d,差异有统计学意义(P<0.05).普拉克索+美多巴组在治疗后12周发生疗效减退、症状波动、异动症的例数均低于美多巴组,差异有统计学意义(P<0.05).美多巴组出现了明显的疗效减退、症状波动、异动症,而普拉克索+美多巴组无明显的上述症状,但有2例出现突然入睡发作、1例嗜睡、1例直立性低血压. 结论 普拉克索+美多巴组在改善PD运动功能方面优于美多巴组,在日常活动,精神、行为和情绪方面疗效相似.同时服用普拉克索可以明显减少美多巴的用量及其治疗后所引起的并发症(疗效减退、症状波动及异动症)的发生率.普拉克索可引起突然入睡发作、嗜睡、直立性低血压等副作用.     

Madopar HBS in Parkinson patients with nocturnal akinesia

Madopar Hydrodynamically Balanced System (HBS), a new sustained-release levodopa preparation, was used to control severe nightly disabilities in 15 outpatients suffering from Parkinson's disease in an advanced state and with long-term levodopa therapy. This medication was given ante noctem in addition to an otherwise unchanged daily regimen of levodopa administration. In 13 patients a considerable diminution in nocturnal akinesia and in the frequency of waking up was reached with a mean dosage of 308 mg of Madopar HBS. Early morning akinesia was only slightly alleviated in four patients. The nocturnal off-period pain disappeared in one patient. Adverse effects consisted of nocturnal dyskinesia in two patients and early morning dystonia in another two patients. The regular use of sleeping pills was clearly reduced after Madopar HBS therapy.     

Madopar HBS and the decompensated phase of Parkinson disease

The most important current problem in the treatment of Parkinson disease in the so-called L-dopa long-term-treatment syndrome. We present here the results of our experience with Madopar HBS in the treatment of two groups of patients suffering from L-dopa long-term treatment syndrome. In the first study we replaced the standard Madopar with Madopar HBS. In the second study, after identifying the most disabling “off” periods, we added Madopar HBS to the previous treatment in such a way as to control these “off” phases. Our study suggests that Madopar HBS is useful in reducing typical fluctuation phenomena in the majority of patients.

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Sommario Attualmente il problema più importante nel trattamento del morbo di Parkinson è costituito dalla cosiddetta “sindrome da trattamento cronico con L-dopa”. Presentiamo qui di seguito i risultati della nostra esperienza con Madopar HBS nel trattamento di 2 gruppi di pazienti affetti da tale sindrome. Nella prima parte dello studio abbiamo sostituito del tutto il Madopar standard con Madopar HBS, nella seconda parte, dopo aver identificato il periodo “off” maggiormente invalidante, abbiamo aggiunto Madopar HBS al trattamento precedente in modo che fosse efficace sulla fase off così identificata. Il nostro lavoro suggerisce che il Madopar HBS è utile nel ridurre le fluttuazioni motorie nella maggioranza dei pazienti parkinsoniani.

     

Growth hormone and prolactin stimulation by Madopar in Parkinson's disease

Madopar, a combination of levodopa with benserazide, induced an inconsistent rise in plasma growth hormone in unmedicated patients with Parkinson's disease and in controls, and a greater growth hormone rise in Parkinsonian subjects on chronic Madopar therapy. In subjects on chronic therapy with levodopa and carbidopa (Sinemet), the growth hormone releasing effect of Madopar was blunted. Madopar increased plasma prolactin (PRL) in controls, unmedicated patients and patients on Madopar therapy while in patients on Sinemet therapy the PRL-releasing effect of Madopar was strikingly reduced. Since these data were interpreted as due to a defective dopamine tone in the hypothalamus of Parkinsonian subjects on Madopar but not Sinemet therapy, a direct dopamine receptor agonist, lisuride was administered. Lisuride, however, elicited a blunted growth hormone response both in patients on Madopar and Sinemet therapy, without revealing a state of supersensitivity of dopamine receptors for growth hormone control in Parkinsonian subjects on Madopar therapy. No difference was present in the PRL-lowering effect of lisuride in the different experimental groups. These findings suggest that: (1) hypothalamic dopamine function is impaired in Parkinsonian subjects on Madopar therapy, preserved in unmedicated patients and enhanced in patients on Sinemet therapy; (2) the endocrine effects observed in Parkinsonian subjects on chronic Madopar therapy may be due to some penetration of benserazide across the blood brain barrier in the region of the hypothalamus; (3) since Madopar and Sinemet are in essence equally effective antiparkinsonian remedies, penetration of benserazide does not occur across the blood brain barrier surrounding the nigrostriatal system.     

Madopar HBS in fluctuating parkinsonian patients: two-year treatment

In an open-label study, we substituted conventional levodopa plus benserazide: 100/25 (Madopar) with a controlled-release form (HBS) in 18 fluctuating parkinsonian patients for 24 months. Significantly positive results were obtained in both peak-dose and diphasic dyskinesias up to 12 months of treatment; morning akinesias were also improved up to 6 months. A general trend of deterioration, compared to the first 3-6 months of HBS treatment, was observed in "off" fluctuations after 1 year: akinesias due to a delayed response worsened after 1 year of treatment also when compared with the conventional treatment. Positive results were obtained with new HBS on standard Madopar-related psychiatric disorders.     

Enantiomeric composition of urinary salsolinol in Parkinsonian patients after Madopar

Summary Urinary salsolinol output had been shown to be lower in Parkinsonian patients than in controls and to increase largely after L-dopa therapy. It had also been established that the R enantiomer of salsolinol is either the predominant or the sole enantiomer present in the urine of healthy subjects.When Madopar was administered to Parkinsonians, the enantiomeric composition of urinary salsolinol showed an S/R ratio around 1. Considering brain and plasma concentrations in dopamine, acetaldehyde and pyruvate, it is suggested that, under physiological conditions, urinary salsolinol should have a central origin in humans. Conversely, urinary salsolinol in Madopar-treated Parkinsonian patients might be predominantly formed at the periphery.     

A controlled release form of Madopar in Parkinsonian patients with advanced disease and marked fluctuations in motor performance

Flucuations in motor performance is a major problem in long-term levodopa treatment of Parkinsonian patients. A slow release preparation of levodopa with benserazide, Madopar HBS, has been developed in an attempt to decrease this problem. Eleven of 22 Parkinsonian patients with advanced disease and marked fluctuations experienced long-lasting benefit with reduction of their fluctuations in motor performance on treatment with Madopar HBS; 11 dropped out within the first 5 months of the trial. This was probably due to lack of experience with the effect of this new slow-release formulation. Nine patients (82%) required an additional dose of standard Madopar, especially in the morning. Significant improvements were found for akinetic phenomenon and dystonic cramps, and with the global evaluation of motor fluctuations. The occurrence of peak dose dyskinesia remained unchanged. No abnormalities in laboratory values were found.     

Sustained-release Madopar HBS® compared with standard Madopar® in the long-term treatment of de novo parkinsonian patients

In this Danish-Norwegian randomized double-blind parallel-group multicentre study, we compared the therapeutic response of slow-release Madopar HBS® to standard Madopar® in 134 de novo patients with idiopathic Parkinson's disease during a 5-year period. The drugs were dosed according to the individual need of the patients. The Webster, NUDS, UPDRS and Hoehn & Yahr scales were used for evaluation of symptoms. Addition of a morning dose of standard Madopar 62.5 mg was allowed after 6 months. Bromocriptine could be administered but not Selegiline. Sixty-five patients got Madopar HBS and 69 standard Madopar. Surprisingly, no differences were found as to the mean daily levodopa dose, the mean number of daily doses or the use of and doses of bromocriptine. Unexpectedly, we found a trend towards a more frequent use of a morning dose of standard Madopar in the group treated with the standard formulation. No differences were observed in the occurrence of motor fluctuations or dyskinesia, the incidence of which was relatively low. Sustained-release Madopar (HBS) thus proved to be as effective as standard Madopar in the long-term treatment of de novo parkinsonian patients, but the drug showed no advantage in postponing or reducing the long-term levodopa treatment problems.