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October 1991

Early Therapy for Parkinson's Disease

Author Affiliations

Department of Neurology University of South Florida Harbour Side Medical Tower 4 Columbia Dr, Suite 410 Tampa, FL 33606

Arch Neurol. 1991;48(10):1009. doi:10.1001/archneur.1991.00530220025009

To the Editor.  —We read with interest the article by Elizan et al in the January issue of the Archives.1 The authors suggest that the early combination of selegiline and levodopa initiated at the "earliest clinical expression of the disease process" seems a most reasonable approach. They base this suggestion on their observation that patients receiving selegiline alone experience a dramatic improvement in parkinsonian score following the addition of levodopa (Sinemet). As selegiline alone provides little or no symptomatic benefit as monotherapy in early Parkinson's disease,2 it is not surprising that a significant symptomatic response was observed with the addition of levodopa. As the authors point out, it is not known how the response to levodopa and selegiline compares with that which could be achieved with levodopa alone, a dopamine agonist alone, or the combination of selegiline and a dopamine agonist.The rationale for the use of selegiline in

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