The treatment of patients with Parkinson disease is an art. If the clinical science were so clear, there would not be the continued “controversy” articles published. Is this debate concerning initial choice of symptomatic therapeutic agents relevant to the care of patients with Parkinson disease? Under most circumstances, if the neurologist had to choose between drug A and B for a given condition and drug A was known to be safe, efficacious, associated with fewer adverse events, few drug interactions, was easier for the patient to use, easier for the clinician to prescribe, and was cheaper, why would the neurologist start with drug B? This is an interesting question, which relates to concern about “neuroprotection,” concern about better long-term management of Parkinson disease, and nonmedical influences that relate to prescribing practices.
Weiner WJ. Initial Treatment of Parkinson DiseaseLevodopa or Dopamine Agonists. Arch Neurol. 2004;61(12):1966-1969. doi:10.1001/archneur.61.12.1966