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Parkinson's Treatment

Time and patience are needed in assessing treatments for chronic diseases. Parkinson's disease is just one example, but here we are fortunate that randomised controlled studies begun over 10 years ago are now providing answers about what, and what not, to use.

Study



A study published in the BMJ [1] examined, inter alia, mortality in 520 patients with Parkinson's disease randomised to one of two treatments, either:
  1. 62.5 mg levodopa three times daily increasing to 125 mg thrice daily followed by individual titration, or
  2. 5 mg selegiline in the morning for a week, increased to 5 mg twice daily for three more weeks, then with levodopa as for the first group


Outcomes



These were principally mortality and differences in disability scores, with evaluations performed every three or four months for up to six years.

Results



After an average follow up of 5.6 years, 44 of 249 patients had died in treatment group 1, and 76 of 271 patients in treatment group 2; mortality was significantly higher in patients taking selegiline and levodopa.

The NNT was 9.6 (95% CI 5.7 - 31). This meant that for every 10 patients treated with selegiline and levodopa, one more would have died in 6 years than if they were treated with levodopa alone. There were no significant differences in disability scores.
  1. AJ Lees. Comparison of therapeutic effects and mortality data of levodopa and levodopa combined with selegiline in patients with early, mild Parkinson's disease. British Medical Journal 1995 311: 1602-7.



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