Effect of pergolide and madopar as initial treatment on the prognosis of patients with Parkinson disease

Wuwei ZHAO; Xiaojun HE; Jingjing SU; Huijun XIE; Zhifeng ZHANG; Lingshan KONG

ABSTRACT

BACKGROUND:

Pergolide and madopar are the effective medicines to treat Parkinson disease, but the effects on the prognosis of patients with Parkinson disease are still under discussion. The progress of neuroimaging makes it possible to evaluate quantitatively the effect of the drug treatment on the prognosis of Parkinson disease.OBJBCTIVE To observe the influence of pergolide or madopar as initial treatment on the prognosis and the striatal dopaminergic neuron in patients with early Parkinson disease by means of 99Tcm-TRODAT-1 dopamine transporter imaging single-photon emission computed tomtheography (SPECT) in combination with Parkinson disease scale.

DESIGN:

A randomized grouping, parallel control and placebo control trial.

SETTING:

Department of Neurology, the 81 Hospital of Chinese PLA;Department of Neurology and Department of Nuclear Medicine, Changhai Hospital of the Second Military Medical University of Chinese PLA.

PARTICIPANTS:

Thirty-six patients with early Parkinson disease who were recruited at the Specific Clinic of Parkinson Disease in the Shanghai Changhai Hospital affiliated to the Second Military Medical University of Chinese PLA and did not receive any drug treatment before, were enrolled between February and July 2002. They were randomly divided into artane control group (n=12), pergolide-treated group (n=12) and madopar-treated group. The diagnosis accorded with the clinical diagnostic standard set by United Kingdom Society of Parkinson Disease. This protocol was approved by the Medical Ethics Committee of Changhai Hospital, and all the subjects were enrolled in this study with informed consent.

INTERVENTIONS:

After test with unified Parkinson disease rating scale (UPDRS) and 99Tcm-TRODAT-1 SPECT, patients in the artane control group, pergolide-treated group and madopar-treated group were treated with corresponding drugs respectively, and each capsule of artane, pergolide and madopar contained drug of 0.05, 0.05 and 125 mg respectively. In the 1st week, the dosage was 1 capsule for each time, once a day, and then the daily dosage was increased by 1 capsule per week later, and the daily dosage reached 0.2, 0.2 and 500 mg respectively after 1 month, and then the dosages were kept constant. The curative effects were evaluated with UPDRS at 6 and 10 months after treatment. At 10 months after treatment,the 99Tcm-TRODAT-1 specific intakes of ipsilateral or contralateral striatum of the affected limb were tested with striatum dopamine transporter SPECT and semi-quantitative analysis.MAIN OUTCOME

MEASURES:

① Changes of percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb at 10 months after treatment were compared among the three groups;② Changes of UPDRS scores before and after treatment were compared among the three groups.

RESULTS:

Totally 36 patients were involved in the study, and 1 case lost in each of the 3 groups respectively at 10 months after treatment, finally 33 cases entered the analysis of results. ① Changes of percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb at 10 months after treatment At 10 months after treatment, the percentage of 99Tcm-TRODAT-1 decrease of ipsilateral or contralateral striatum of the affected limb were obviously higher in the madopar-treated group than in the artane control group and pergolide-treated group [(46.3±19.4)%, (28.9±13.0)%, (34.4±18,1)%; (47.5±20.8)%, (31.8±15.6)%, (33.8±17.2)%; P all ＜ 0.05]. ② Changes of UPDRS scores before and after treatment As compared with the UPDRS scores before treatment, there was no obvious change in the artane control group at 10 months after treatment,but those in the madopar-treated group and pergolide-treated group were obviously decreased [(15.5±8.68), (6.4±9.05); (15.8±6.75), (10.36±8.30); Pall ＜ 0.05].

CONCLUSION:

Both madopar and pergolide can ameliorate the symptoms of early Parkinson disease, but they had different influences on the prognosis of patients with Parkinson disease. Madopar may accelerate the apoptosis of dopaminergic neuron and then aggravate the severity, but pergolide does not affect the prognosis of Parkinson disease, so it is a more suitable selective drug for the treatment of early Parkinson disease.