Selegiline as initial treatment in de novo parkinsonian patients

Myllylä, Vilho V.; Sotaniemi, K. A.; Vuorinen, Jouni; Heinonen, Esa

doi:10.1212/wnl.42.2.339

Cited by 146 publications

(38 citation statements)

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“…Due to a mild symptomatic benefit from selegiline (improvement of about 3 points on the total Unified Parkinson's Disease Rating Scale [UPDRS] compared with placebo after 3 months), doubt remained whether these results could be used to support a disease-modifying effect. Other trials have had similar results [50,51].…”

Section: Selegilinementioning

confidence: 61%

Defining the Role of the Monoamine Oxidase-B Inhibitors for Parkinson’s Disease

Robakis

Fahn

2015

CNS Drugs

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Inhibitors of monoamine oxidase-B (MAO-B) occupy an important place in the treatment of Parkinson's disease. Selegiline was the first MAO-B to be used therapeutically, while rasagiline is a second-generation drug with higher potency and selectivity. Safinamide is an investigational MAO-B inhibitor with non-dopaminergic properties that may provide advantages over its predecessors. As a class, MAO-B inhibitors are safe and well tolerated and provide symptomatic benefit both as monotherapy and in combination with other antiparkinsonian medications from early to late stages of disease. In combination with levodopa, MAO-B inhibitors may improve motor fluctuations and allow for lower total doses of levodopa. Patient characteristics and preferences can be important factors in deciding between agents. As a class, MAO-B inhibitors have shown promise as disease-modifying agents, but the clinical trial evidence to date has not been strong enough to afford them such a label. Future research may help further elucidate their relative merits and clarify their role in altering disease progression. Key PointsRasagiline and selegiline are two monoamine oxidase-B (MAO-B) inhibitors commonly used in the treatment of Parkinson's disease (PD), while safinamide is an investigational agent of the same class.MAO-B inhibitors are safe, with few serious side effects, and provide mild but worthwhile improvements in the motor symptoms of PD, either as monotherapy or adjunctive to levodopa.The possibility that MAO-B inhibitors could slow down the progression of PD has been suggested by some studies but not by others and remains an open question.

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Section: Selegilinementioning

confidence: 61%

Defining the Role of the Monoamine Oxidase-B Inhibitors for Parkinson’s Disease

Robakis

Fahn

2015

CNS Drugs

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“…Other investigators conducted other studies testing selegiline, showing similar results. 121,122 Because the DATATOP study found that selegiline has a mild symptomatic effect that is long lasting, one could explain its ability to delay progression of disability entirely on this symptomatic effect. Furthermore, selegiline's benefit in delaying the introduction of levodopa gradually diminishes over time 120 with the best results occurring in the first year of treatment.…”

Section: Neuroprotective Strategies and Clinical Trialsmentioning

confidence: 99%

Neurodegeneration and neuroprotection in Parkinson disease

2004

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Summary:Many of the motoric features that define Parkinson disease (PD) result primarily from the loss of the neuromelanin (NM)-containing dopamine (DA) neurons of the substantia nigra (SN), and to a lesser extent, other mostly catecholaminergic neurons, and are associated with cytoplasmic "Lewy body" inclusions in some of the surviving neurons. While there are uncommon instances of familial PD, and rare instances of known genetic causes, the etiology of the vast majority of PD cases remains unknown (i.e., idiopathic). Here we outline genetic and environmental findings related to PD epidemiology, suggestions that aberrant protein degradation may play a role in disease pathogenesis, and pathogenetic mechanisms including oxidative stress due to DA oxidation that could underlie the selectivity of neurodegeneration. We then outline potential approaches to neuroprotection for PD that are derived from current notions on disease pathogenesis.

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“…Ihr Hauptergebnis ist, dass Selegilin den Zeitpunkt, an dem eine L-Dopa-Behandlung bei Patienten mit neu diagnostizierter IPD notwendig scheint, um etwa 9 Monate hinausschiebt [47]. Eine kleinere finnische Studie kam zu einem ähn-lichen Ergebnis [48]. Die Langzeitwirkungen einer frühen Selegilin-Behandlung sind jedoch nicht günstig.…”

Section: Selegilinunclassified

Medikamentöse Behandlung der idiopathischen Parkinson-Krankheit

Klockgether¹

2003

Der Nervenarzt

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Idiopathic Parkinson's disease (IPD) results from a largely selective degeneration of nigrostriatal dopaminergic neurons. Therefore, compounds which strengthen dopaminergic transmission in the striatum are the most important therapeutic approach. These include L-dopa, dopamine receptor agonists, selegeline, and entacapon. Since nigrostriatal degeneration leads to secondary alterations of cholinergic and glutamatergic transmission to the basal ganglia,nondopaminergic compounds such as anticholinergics and N-methyl-D-aspartate (NMDA) receptor antagonists are also used in the management of IPD. L-dopa is the most effective substance but after 3-5 years of L-dopa treatment, approximately half of all IPD patients develop fluctuations. Therefore, initial treatment with a dopamine receptor agonist is recommended.

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Selegiline as initial treatment in de novo parkinsonian patients

Cited by 146 publications

References 0 publications

Defining the Role of the Monoamine Oxidase-B Inhibitors for Parkinson’s Disease

Defining the Role of the Monoamine Oxidase-B Inhibitors for Parkinson’s Disease

Neurodegeneration and neuroprotection in Parkinson disease

Medikamentöse Behandlung der idiopathischen Parkinson-Krankheit

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