| Abstract: | It was the aim of our study based on a group of 460 patients suffering from Parkinson's disease to find out possible pathogenetic linkups for the so-called "on-off" phenomenon. The method was based on two questionnaires of different structure, and in 90 cases we also called personally on the patient in his home. The patients were either known from neurological treatment they received at the Department of Neurology of the University of Essen, or were approached on-target via their membership in the German Parkinson Association. After evaluation, 43 patients with an on-off phenomenon and 81 with end-of-dose akinesia, as well as 336 patients without fluctuations of motility, could be classified and evaluated further. All patients with an on-off phenomenon or end-of-dose akinesia had received L-dopa treatment for several years; the average treatment period was 8.4 years in a patient with on-off phenomenon and 7.3 years in case of end-of-dose akinesia. Compared therewith, patients without fluctuations had only an average L-Dopa intake period of 5 years. It is a striking fact that in the patient group without fluctuations (n = 336) 51 patients (15.7%) had never taken an L-dopa preparation. 72.1% of the on-off group suffered from hyperkinesia before abrupt onset of the phase, while at the same time a recession of L-dopa efficacy was seen after several years of treatment. In about 40% of the questioned on-off patients we found that end-of-dose akinesia had preceded the on-off condition, and that the time correlation of the akinesia with the intake of the preparation was gradually abandoned. The age of the patients with on-off or end-of-dose patterns was, at the time of diagnosis, 55.6 or 54.2 years respectively. These patients were therefore much younger on the average than those of the comparative group without any disturbance of motility (60.1 years). On-off patients suffered comparatively more often from concomitant cardiovascular disease and their more active smoking habits were very noticeable. Taking the pathological specialities into consideration, it is recommended to critically reconsider the early use of L-dopa in relatively young patients with concomitant cardiovascular diseases, and to give preference in case of an indication for L-dopa to a combination treatment especially with MAO-B inhibitors and dopamin antagnonists in order to keep the daily L-dopa dose low. Arguments against L-dopa to be taken three times daily are discussed, as are the pros and cons of concomitant therapy. |
