Factor S A, Weiner W J
Department of Neurology, Albany Medical College, NY 12208.
Mov Disord. 1993 Jul;8(3):257-62. doi: 10.1002/mds.870080302.
The use of early combination therapy with bromocriptine (Br) and levodopa (LD) in Parkinson's disease is controversial. It has been suggested that treatment with this regimen would prevent or delay the onset of motor fluctuations and dyskinesia. Thus, some have recommended it as a standard of care. This recommendation is based on the theory that LD may accelerate the progression of PD and clinical experience using Br monotherapy in early Parkinson's disease, which suggested that Br causes fewer late complications. This article reviews these arguments and shows that the theories are unproven. A single, uncontrolled trial is often referred to as evidence for efficacy of early combination therapy. We critically review this and five other studies which have evaluated the treatment strategy. We show that the literature is often misleading and that these trials do not support the efficacy of early combination therapy. We conclude that there is no justifiable reason to use a combination of Br and LD in early parkinsonian patients.
在帕金森病中早期联合使用溴隐亭（Br）和左旋多巴（LD）存在争议。有人认为采用这种治疗方案可预防或延缓运动波动和异动症的发生。因此，一些人推荐将其作为一种治疗标准。这一推荐基于这样的理论，即左旋多巴可能会加速帕金森病的进展，以及早期帕金森病使用溴隐亭单一疗法的临床经验，该经验表明溴隐亭引起的晚期并发症较少。本文回顾了这些观点，并表明这些理论尚未得到证实。一项无对照的单一试验常被视为早期联合治疗有效性的证据。我们对该试验以及其他五项评估该治疗策略的研究进行了批判性回顾。我们表明，相关文献常常具有误导性，且这些试验并不支持早期联合治疗的有效性。我们得出结论，在早期帕金森病患者中没有合理的理由联合使用溴隐亭和左旋多巴。
