Chapter

Neuroprotection and disease-modification in Parkinson’s disease

Olivier Rascol

in Parkinson's Disease

Published on behalf of Oxford University Press

ISBN: 9780199550630
Published online May 2011 | e-ISBN: 9780199607297 | DOI: http://dx.doi.org/10.1093/med/9780199550630.003.0010

Series: Oxford Neurology Library

Neuroprotection and disease-modification in Parkinson’s disease

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• ‘Neuroprotective’ compounds blocking neuronal death mechanisms are expected to slow the progression of Parkinson’s disease (PD) symptoms and to reduce patients’ cumulative disability. This clinical effect is called ‘disease-modification’. • No drug has yet been approved for a ‘disease-modification’ indication in PD due to controversial trial designs (study duration, placebo comparison, clinical relevancy of endpoints, and confounding effect of symptomatic medications…) and negative or ambiguous results with various compounds including dopamine agonists, MAO-B inhibitors, and others • In a recent ‘delayed-start’ trial (ADAGIO), rasagiline 1 mg daily early therapy provided a benefit on UPDRS scores that could not be equalled when the drug was introduced late. This is compatible with a ‘disease-modification’ effect but can be explained by other mechanisms than neuroprotection (enhanced compensation for example) and supports the concept of early management of PD patients with this drug • Longer follow-up and pragmatic trials must be conducted to assess if the early but modest benefits detected in ‘delayed-start’ trials are clinically relevant on longer follow-up.

Chapter.  3943 words.  Illustrated.

Subjects: Neurology

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