Long-term experience with selegiline and levodopa in Parkinson's disease.

Between 1982 and 1989, 197 patients with Parkinson's disease were treated with selegiline and levodopa for at least 0.3 years. Two groups of patients were included: a group of 65 patients (stage 2 or 3 on the Hoehn and Yahr Scale) who recently had been started on levodopa and were not experiencing response fluctuations, and a group of 132 patients on levodopa who were experiencing fluctuations. More nonfluctuating than fluctuating patients improved, although the differences were not significant; a higher percentage of fluctuating patients worsened, compared with nonfluctuating patients, and these differences were significant. The percentage of patients who were stable was similar between the two groups, and adverse effects were minor and reversible. Our study suggests that among patients on levodopa, fewer patients worsen when selegiline is added earlier than when it is added later.