Parkinson's Disease CME

Parkinson's Disease CME

Reevaluating Treatment Strategies for Maximizing Patient Benefit

parkinson's disease cme

Neuroprotection in Parkinson's Disease: Are We Getting Close?

CONCLUSIONS

Parkinson's disease is a progressive neurologic disorder of unknown etiology. Because of the progressive nature of the disease, early diagnosis and treatment intervention with neuroprotective therapies to slow or prevent further neurodegeneration and promote neuronal repair are current goals in the management of PD. The development and validation of diagnostic markers of PD are emerging in the areas of symptom recognition and neuroimaging and will aid in the diagnosis of patients with very early PD. Advances in neuroimaging and the development of quantitative biomarkers of PD will improve evaluation of the neuroprotective efficacy of therapies in clinical trials.

REFERENCES

1. Nussbaum RL, Ellis CE. Alzheimer's disease and Parkinson's disease. N Engl J Med. 2003;348(14):1356-1364. 2. What is Parkinson's disease? Parkinson's Disease Foundation. http://www.pdf.org/en/about_pd. Accessed December 8, 2008. 3. About Parkinson's disease. National Parkinson Foundation. http://www.parkinson.org/NETCOMMUNITY/Page.aspx?pid=225&scrid=201. Accessed December 12, 2008. 4. Parkinson's 101. The Michael J. Fox Foundation for Parkinson's Research. http://www.michaeljfox.org/living_aboutParkinsons_parkinsons101.cfm. Accessed December 8, 2008. 5. Weintraub D, Comella CL, Horn S. Parkinson's disease—part 1: pathophysiology, symptoms, burden, diagnosis, and assessment. Am J Manag Care. 2008;14(2 suppl):S40-S48. 6. den Hartog Jager WA, Bethlem J. The distribution of Lewy bodies in the central and autonomic nervous systems in idiopathic paralysis agitans. J Neurol Neurosurg Psychiatry. 1960;23:283-290. 7. Kupsky WJ, Grimes MM, Sweeting J, Bertsch R, Cote LJ. Parkinson's disease and megacolon: concentric hyaline inclusions (Lewy bodies) in enteric ganglion cells. Neurology. 1987;37(7):1253-1255. 8. Qualman SJ, Haupt HM, Yang P, Hamilton SR. Esophageal Lewy bodies associated with ganglion cell loss in achalasia. Similarity to Parkinson's disease. Gastroenterology. 1984;87(4):848-856. 9. Wakabayashi K, Takahashi H, Ohama E, Takeda S, Ikuta F. Lewy bodies in the visceral autonomic nervous system in Parkinson's disease. Adv Neurol. 1993;60:609-612. 10. Wakabayashi K, Takahashi H, Takeda S, Ohama E, Ikuta F. Parkinson's disease: the presence of Lewy bodies in Auerbach's and Meissner's plexuses. Acta Neuropathol. 1988;76(3):217-221. 11. Hughes AJ, Daniel SE, Kilford L, Lees AJ. Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinical pathological study of 100 cases. J Neurol Neurosurg Psychiatry. 1992;55(3):181-184. 12. Braak H, Del Tredici K, Rüb U, De Vos RA, Jansen Steur EN, Braak E. Staging of brain pathology related to sporadic Parkinson's disease. Neurobiol Aging. 2003;24(2):197-211. 13. Braak H, de Vos RAI, Bohl J, Del Tredici K. Gastric α-synuclein immunoreactive inclusions in Meissner's and Auerbach's plexuses in cases staged for Parkinson's disease-related brain pathology. Neurosci Lett. 2006;396(1):67-72. 14. Braak H, Ghebremedhin E, Rüb U, Bratzke H, Del Tredici K. Stages in the development of Parkinson's disease-related pathology. Cell Tissue Res. 2004;318(1):121-134. 15. Braak H, Rüb U, Jansen Steur ENH, Del Tredici K, de Vos RAI. Cognitive status correlates with neuropathologic stage in Parkinson disease. Neurology. 2005;64(8):1404-1410. 16. Halliday G, Hely M, Reid W, Morris J. The progression of pathology in longitudinally followed patients with Parkinson's disease. Acta Neuropathol. 2008;115(4):409-415. 17. Bloch A, Probst A, Bissig H, Adams H, Tolnay M. Alpha-synuclein pathology of the spinal and peripheral autonomic nervous system in neurologically unimpaired elderly subjects. Neuropathol Appl Neurobiol. 2006;32(3):284-295. 18. Jellinger KA. Lewy body-related alpha-synucleinopathy in the aged human brain. J Neural Transm. 2004;111(10-11):1219-1235. 19. Parkkinen L, Pirttilä T, Alafuzoff I. Applicability of current staging/categorization of α-synuclein pathology and their clinical relevance. Acta Neuropathol. 2008;115(4):399-407. 20. Saito Y, Ruberu NN, Sawabe M, et al. Lewy body-related α-synucleinopathy in aging. J Neuropathol Exp Neurol. 2004;63(7):742-749. 21. Kalaitzakis ME, Graeber MB, Gentleman SM, Pearce RK. The dorsal motor nucleus of the vagus is not an obligatory trigger site of Parkinson's disease: a critical analysis of alpha-synuclein staging. Neuropathol Appl Neurobiol. 2008;34(3):284-295. 22. Parkkinen L, Kauppinen T, Pirttilä T, Autere JM, Alafuzoff I. Alpha-synuclein pathology does not predict extrapyramidal symptoms or dementia. Ann Neurol. 2005;57(1):82-91. 23. Attems J, Jellinger KA. The dorsal motor nucleus of the vagus is not an obligatory trigger site of Parkinson's disease. Neuropathol Appl Neurobiol. 2008;34(4):466-467. 24. Kalaitzakis ME, Graeber MB, Gentleman SM, Pearce RKB. Controversies over the staging of α-synuclein pathology in Parkinson's disease. Acta Neuropathol. 2008;116(1):125-128. 25. Hasegawa K, Kowa H. Autosomal dominant familial Parkinson disease: older onset of age, and good response to levodopa therapy. Eur Neurol. 1997;38(suppl 1):39-43. 26. Mori H, Kondo T, Yokochi M, et al. Pathologic and biochemical studies of juvenile parkinsonism linked to chromosome 6q. Neurology. 1998;51(3):890-892. 27. Rajput A, Dickson DW, Robinson CA, et al. Parkinsonism, Lrrk2 G2019S, and tau neuropathology. Neurology. 2006;67(8):1506-1508. 28. Takahashi H, Ohama E, Suzuki S, et al. Familial juvenile parkinsonism: clinical and pathologic study in a family. Neurology. 1994;44(3 pt 1):437-441. 29. van de Warrenburg BPC, Lammens M, Lücking CB, et al. Clinical and pathologic abnormalities in a family with parkinsonism and parkin gene mutations. Neurology. 2001;56(4):555-557. 30. Wszolek ZK, Pfeiffer RF, Tsuboi Y, et al. Autosomal dominant parkinsonism associated with variable synuclein and tau pathology. Neurology. 2004;62(9):1619-1622. 31. Colosimo C, Hughes AJ, Kilford L, Lees AJ. Lewy body cortical involvement may not always predict dementia in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2003;74(7):852-856. 32. Jankovic J. Parkinson's disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry. 2008;79(4):368-376. 33. Hoehn MM, Yahr MD. Parkinsonism: onset, progression and mortality. Neurology. 1967;17(5):427-442. 34. Hely MA, Morris JGL, Reid WGJ, Trafficante R. Sydney multicenter study of Parkinson's disease: non-L-dopa–responsive problems dominate after 15 years. Mov Disord. 2005;20(2):190-199. 35. Hely MA, Morris JGL, Trafficante R, Reid WGJ, O'Sullivan DJ, Williamson PM. The Sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. J Neurol Neurosurg Psychiatry. 1999;67(3):300-307. 36. Ebmeier KP, Calder SA, Crawford JR, Stewart L, Besson JA, Mutch WJ. Mortality and causes of death in idiopathic Parkinson's disease: results from the Aberdeen whole population study. Scott Med J. 1990;35(6):173-175. 37. Wermuth L, Stenager EN, Stenager E, Boldsen J. Mortality in patients with Parkinson's disease. Acta Neurol Scand. 1995;92(1):55-58. 38. Ishihara LS, Cheesbrough A, Brayne C, Schrag A. Estimated life expectancy of Parkinson's patients compared with the UK population. J Neurol Neurosurg Psychiatry. 2007;78(12):1304-1309. 39. Louis ED, Marder K, Cote L, Tang M, Mayeux R. Mortality from Parkinson disease. Arch Neurol. 1997;54(3):260-264. 40. Uitti RJ, Ahlskog JE, Maraganore DM, et al. Levodopa therapy and survival in idiopathic Parkinson's disease: Olmsted County project. Neurology. 1993;43(10):1918-1926. 41. Berg D. Biomarkers for the early detection of Parkinson's and Alzheimer's disease. Neurodegener Dis. 2008;5(3-4):133-136. 42. Zesiewicz TA, Sullivan KL, Hauser RA. Nonmotor symptoms of Parkinson's disease. Expert Rev Neurother. 2006;6(12):1811-1822. 43. Thanvi BR, Munshi SK, Vijaykumar N, Lo TCN. Neuropsychiatric non-motor aspects of Parkinson's disease. Postgrad Med J. 2003;79(936):561-565. 44. Olanow CW. Rationale for considering that propargylamines might be neuroprotective in Parkinson's disease. Neurology. 2006;66(suppl 4):S69-S79. 45. Shoulson I. Where do we stand on neuroprotection? Where do we go from here? Mov Disord. 1998;13(suppl 1):46-48. 46. The Parkinson Study Group. Impact of deprenyl and tocopherol treatment on Parkinson's disease in DATATOP subjects not requiring levodopa. Ann Neurol. 1996;39(1):29-36. 47. The Parkinson Study Group. Levodopa and the progression of Parkinson's disease. N Engl J Med. 2004;351(24):2498-2508. 48. Ahlskog JE, Muenter MD. Frequency of levodopa-related dyskinesias and motor fluctuations as estimated from the cumulative literature. Mov Disord. 2001;16(3):448-458. 49. Schrag A, Quinn N. Dyskinesias and motor fluctuations in Parkinson's disease. A community-based study. Brain. 2000;123(pt 11):2297-2305. 50. Sweet RD, McDowell FH. Five years' treatment of Parkinson's disease with levodopa. Therapeutic results and survival of 100 patients. Ann Intern Med. 1975;83(4):456-463. 51. Hauser RA, Zesiewicz TA. Advances in the pharmacologic management of early Parkinson disease. Neurologist. 2007;13(3):126-132. 52. Weintraub D, Comella CL, Horn S. Parkinson's disease—part 2: treatment of motor symptoms. Am J Manag Care. 2008;14(suppl 2):S49-S58. 53. Heikkila RE, Cohen G. Evaluation of amantadine as a releasing agent or uptake blocker for H3-dopamine in rat brain slices. Eur J Pharmacol. 1972;20(2):156-160. 54. Scatton B, Cheramy A, Besson MJ, Glowinski J. Increased synthesis and release of dopamine in the striatum of the rat after amantadine treatment. Eur J Pharmacol. 1970;13(1):131-133. 55. Von Voigtlander PF, Moore KE. Dopamine: release from the brain in vivo by amantadine. Science. 1971;174(7):408-410. 56. Baldessarini RJ, Lipinski JF, Chace KV. Effects of amantadine hydrochloride on catecholamine metabolism in the brain of the rat. Biochem Pharmacol. 1972;21(1):77-87. 57. Gianutsos G, Chute S, Dunn JP. Pharmacological changes in dopaminergic systems induced by long-term administration of amantadine. Eur J Pharmacol. 1985;110(3):357-361. 58. Gelb DJ, Oliver E, Gilman S. Diagnostic criteria for Parkinson disease. Arch Neurol. 1999;56(1):33-39. 59. Gibb WR, Lees AJ. The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease. J Neurol Neurosurg Psychiatry. 1988;51(6):745-752. 60. Parkinson Associated Risk Study (PARS): Evaluating Potential Screening Tools for Parkinson's Disease. http://www.pdtrials.org/en/browse/all/view/135. Accessed September 5, 2008. 61. Ponsen MM, Stoffers D, Booij J, van Eck-Smit BL, Wolters ECh, Berendse HW. Idiopathic hyposmia as a preclinical sign of Parkinson's disease. Ann Neurol. 2004;56(2):173-181. 62. Ross GW, Petrovitch H, Abbott RD, et al. Association of olfactory dysfunction with risk for future Parkinson's disease. Ann Neurol. 2008;63(2):167-173. 63. Abbott RD, Ross GW, White LR, et al. Excessive daytime sleepiness and subsequent development of Parkinson disease. Neurology. 2005;65(9):1442-1446. 64. Hickey MG, Demaerschalk BM, Caselli RJ, Parish JM, Wingerchuk DM. "Idiopathic" rapid-eye-movement (REM) sleep behavior disorder is associated with future development of neurodegenerative diseases. Neurologist. 2007;13(2):98-101. 65. Iranzo A, Molinuevo JL, Santamaría J, et al. Rapid-eye-movement sleep behaviour disorder as an early marker for a neurodegenerative disorder: a descriptive study. Lancet Neurol. 2006;5(7):572-577. 66. Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology. 1996;46(2):388-393. 67. Abbott RD, Ross GW, White LR, et al. Midlife adiposity and the future risk of Parkinson's disease. Neurology. 2002;59(7):1051-1057. 68. Chen H, Zhang SM, Schwarzschild MA, Hernán MA, Willett WC, Ascherio A. Obesity and the risk of Parkinson's disease. Am J Epidemiol. 2004;159(6):547-555. 69. Abbott RD, Petrovitch H, White LR, et al. Frequency of bowel movements and the future risk of Parkinson's disease. Neurology. 2001;57(3):456-462. 70. Braune S. The role of cardiac metaiodobenzylguanidine uptake in the differential diagnosis of parkinsonian syndromes. Clin Auton Res. 2001;11(6):351-355. 71. Yoshita M. Differentiation of idiopathic Parkinson's disease from striatonigral degeneration and progressive supranuclear palsy using iodine-123 meta-iodobenzylguanidine myocardial scintigraphy. J Neurol Sci. 1998;155(1):60-67. 72. Chaudhuri KR, Healy DG, Schapira AHV. Non-motor symptoms of Parkinson's disease: diagnosis and management. Lancet Neurol. 2006;5(3):235-245. 73. Lauterbach EC, Freeman A, Vogel RL. Differential DSM-III psychiatric disorder prevalence profiles in dystonia and Parkinson's disease. J Neuropsychiatry Clin Neurosci. 2004;16(1):29-36. 74. Nilsson FM, Kessing LV, Bolwig TG. Increased risk of developing Parkinson's disease for patients with major affective disorder: a register study. Acta Psychiatr Scand. 2001;104(5):380-386. 75. Schuurman AG, van den Akker M, Ensinck KTJL, et al. Increased risk of Parkinson's disease after depression: a retrospective cohort study. Neurology. 2002;58(10):1501-1504. 76. Shiba M, Bower JH, Maraganore DM, et al. Anxiety disorders and depressive disorders preceding Parkinson's disease: a case-control study. Mov Disord. 2000;15(4):669-677. 77. Schifitto G, Friedman JH, Oakes D, et al. Fatigue in levodopa-naive subjects with Parkinson disease. Neurology. 2008;71(7):481-485. 78. Weisskopf MG, Chen H, Schwarzschild MA, Kawachi I, Ascherio A. Prospective study of phobic anxiety and risk of Parkinson's disease. Mov Disord. 2003;18(6):646-651. 79. Shagam JY. Unlocking the secrets of Parkinson disease. Radiol Technol. 2008;79(3):227-239; quiz 240-222. 80. Marek K, Jennings D, Seibyl J. Do dopamine agonists or levodopa modify Parkinson's disease progression? Eur J Neurol. 2002;9(suppl 3):15-22. 81. Nandhagopal R, McKeown MJ, Stoessl AJ. Invited article: functional imaging in Parkinson disease. Neurology. 2008;70(part 2 of 2):1478-1488. 82. Huang C, Mattis P, Tang C, Perrine K, Carbon M, Eidelberg D. Metabolic brain networks associated with cognitive function in Parkinson's disease. Neuroimage. 2007;34(2):714-723. 83. Huang C, Tang C, Feigin A, et al. Changes in network activity with the progression of Parkinson's disease. Brain. 2007;130(pt 7):1834-1846. 84. Ma Y, Tang C, Spetsieris PG, Dhawan V, Eidelberg D. Abnormal metabolic network activity in Parkinson's disease: test-retest reproducibility. J Cereb Blood Flow Metab. 2007;27(3):597-605. 85. Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson's disease (2001): treatment guidelines. Neurology. 2001;56(11 suppl 5):1-88. 86. The Parkinson Study Group. Dopamine transporter brain imaging to assess the effects of pramipexole vs levodopa on Parkinson disease progression. JAMA. 2002;287(13):1653-1661. 87. Vingerhoets FJ, Schulzer M, Calne DB, Snow BJ. Which clinical sign of Parkinson's disease best reflects the nigrostriatal lesion? Ann Neurol. 1997;41(1):58-64. 88. Lee CS, Samii A, Sossi V, et al. In vivo positron emission tomographic evidence for compensatory changes in presynaptic dopaminergic nerve terminals in Parkinson's disease. Ann Neurol. 2000;47(4):493-503. 89. Piccini P, Brooks DJ. New developments of brain imaging for Parkinson's disease and related disorders. Mov Disord. 2006;21(12):2035-2041. 90. Whone AL, Watts RL, Stoessl AJ, et al. Slower progression of Parkinson's disease with ropinirole versus levodopa: The REAL-PET study. Ann Neurol. 2003;54(1):93-101. 91. The Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: a 4-year randomized controlled trial. Arch Neurol. 2004;61(7):1044-1053. 92. The Parkinson Study Group. Pramipexole vs levodopa as initial treatment for Parkinson disease: A randomized controlled trial. JAMA. 2000;284(15):1931-1938. 93. Movement Disorder Society Task Force on Ratings Scales for Parkinson's Disease. The Unified Parkinson's Disease Rating Scale (UPDRS): status and recommendations. Mov Disord. 2003;18(7):738-750. 94. Goetz CG, Fahn S, Martinez-Martin P, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): process, format, and clinimetric testing plan. Mov Disord. 2007;22(1):41-47. 95. Mandel S, Grunblatt E, Riederer P, Gerlach M, Levites Y, Youdim MBH. Neuroprotective strategies in Parkinson's disease: an update on progress. CNS Drugs. 2003;17(10):729-762. 96. Schapira AHV. Progress in neuroprotection in Parkinson's disease. Eur J Neurol. 2008;15(suppl 1):5-13. 97. Chen JJ, Swope DM, Dashtipour K. Comprehensive review of rasagiline, a second-generation monoamine oxidase inhibitor, for the treatement of Parkinson's disease. Clin Ther. 2007;29(9):1825-1849. 98. Finnegan KT, Skratt JJ, Irwin I, DeLanney LE, Langston JW. Protection against DSP-4-induced neurotoxicity by deprenyl is not related to its inhibition of MAO B. Eur J Pharmacol. 1990;184(1):119-126. 99. Wu RM, Chen RC, Chiueh CC. Effect of MAO-B inhibitors on MPP+ toxicity in Vivo. Ann N Y Acad Sci. 2000;899:255-261. 100. Youdim MBH, Wadia A, Tatton W, Weinstock M. The anti-Parkinson drug rasagiline and its cholinesterase inhibitor derivatives exert neuroprotection unrelated to MAO inhibition in cell culture and in vivo. Ann N Y Acad Sci. 2001;939:450-458. 101. Eldepryl [package insert]. Tampa, FL: Somerset Pharmaceuticals, Inc; 1998. 102. Mizuta I, Ohta M, Ohta K, et al. Selegiline and desmethylselegiline stimulate NGF, BDNF, and GDNF synthesis in cultured mouse astrocytes. Biochem Biophys Res Commun. 2000;279(3):751-755. 103. Mytilineou C, Radcliffe PM, Olanow CW. L-(-)-desmethylselegiline, a metabolite of selegiline [L-(-)-deprenyl], protects mesencephalic dopamine neurons from excitotoxicity in vitro. J Neurochem. 1997;68(1):434-436. 104. Takahata K, Katsuki H, Kobayashi Y, et al. Protective effects of selegiline and desmethylselegiline against N-methyl-D-aspartate-induced rat retinal damage. Eur J Pharmacol. 2003;458(1-2):81-89. 105. Tatton WG, Chalmers-Redman RM. Modulation of gene expression rather than monoamine oxidase inhibition: (-)-deprenyl-related compounds in controlling neurodegeneration. Neurology. 1996;47(6 suppl 3):S171-S183. 106. Abu-Raya S, Tabakman R, Blaugrund E, Trembovler V, Lazarovici P. Neuroprotective and neurotoxic effects of monoamine oxidase-B inhibitors and derived metabolites under ischemia in PC12 cells. Eur J Pharmacol. 2002;434(3):109-116. 107. Bar Am O, Amit T, Youdim MB. Contrasting neuroprotective and neurotoxic actions of respective metabolites of anti-Parkinson drugs rasagiline and selegiline. Neurosci Lett. 2004;355(3):169-172. 108. Oh C, Murray B, Bhattacharya N, Holland D, Tatton WG. (-)-Deprenyl alters the survival of adult murine facial motoneurons after axotomy: increases in vulnerable C57BL strain but decreases in motor neuron degeneration mutants. J Neurosci Res. 1994;38(1):64-74. 109. Azilect [package insert]. Kansas City, MO: Teva Neuroscience, Inc; 2006. 110. Bar-Am O, Amit T, Youdim MB. Aminoindan and hydroxyaminoindan, metabolites of rasagiline and ladostigil, respectively, exert neuroprotective properties in vitro. J Neurochem. 2007;103(2):500-508. 111. Maruyama W, Akao Y, Youdim MB, Naoi M. Neurotoxins induce apoptosis in dopamine neurons: protection by N-propargylamine-1(R)- and (S)-aminoindan, rasagiline and TV1022. J Neural Transm Suppl. 2000;(60):171-186. 112. Maruyama W, Naoi M. Neuroprotection by (-)-deprenyl and related compounds. Mech Ageing Dev. 1999;111(2-3):189-200. 113. Maruyama W, Yamamoto T, Kitani K, Carrillo MC, Youdim M, Naoi M. Mechanism underlying anti-apoptotic activity of a (-)deprenyl-related propargylamine, rasagiline. Mech Ageing Dev. 2000;116(2-3):181-191. 114. Tatton WG, Ju WY, Holland DP, Tai C, Kwan M. (-)-Deprenyl reduces PC12 cell apoptosis by inducing new protein synthesis. J Neurochem. 1994;63(4):1572-1575. 115. Carrillo MC, Minami C, Kitani K, et al. Enhancing effect of rasagiline on superoxide dismutase and catalase activities in the dopaminergic system in the rat. Life Sci. 2000;67(5):577-585. 116. Chiueh CC, Huang SJ, Murphy DL. Enhanced hydroxyl radical generation by 2'-methyl analog of MPTP: suppression by clorgyline and deprenyl. Synapse. 1992;11(4):346-348. 117. Cohen G, Spina MB. Deprenyl suppresses the oxidant stress associated with increased dopamine turnover. Ann Neurol. 1989;26(5):689-690. 118. Sprague JE, Nichols DE. The monoamine oxidase-B inhibitor L-deprenyl protects against 3,4-methylenedioxymethamphetamine-induced lipid peroxidation and long-term serotonergic deficits. J Pharmacol Exp Ther. 1995;273(2):667-673. 119. Wu RM, Chiueh CC, Pert A, Murphy DL. Apparent antioxidant effect of l-deprenyl on hydroxyl radical formation and nigral injury elicited by MPP+ in vivo. Eur J Pharmacol. 1993;243(3):241-247. 120. Gibson CJ. Inhibition of MAO B, but not MAO A, blocks DSP-4 toxicity on central NE neurons. Eur J Pharmacol. 1987;141(1):135-138. 121. Mytilineou C, Cohen G. Deprenyl protects dopamine neurons from the neurotoxic effect of 1-methyl-4-phenylpyridinium ion. J Neurochem. 1985;45(6):1951-1953. 122. Salonen T, Haapalinna A, Heinonen E, Suhonen J, Hervonen A. Monoamine oxidase B inhibitor selegiline protects young and aged rat peripheral sympathetic neurons against 6-hydroxydopamine-induced neurotoxicity. Acta Neuropathol. 1996;91(5):466-474. 123. Tatton WG, Greenwood CE. Rescue of dying neurons: a new action for deprenyl in MPTP parkinsonism. J Neurosci Res. 1991;30(4):666-672. 124. Wu RM, Murphy DL, Chiueh CC. Neuronal protective and rescue effects of deprenyl against MPP+ dopaminergic toxicity. J Neural Transm Gen Sect. 1995;100(1):53-61. 125. Bar-Am O, Weinreb O, Amit T, Youdim MBH. Regulation of Bcl-2 family proteins, neurotrophic factors, and APP processing in the neurorescue activity of propargylamine. FASEB J. 2005;19(13):1899-1901. 126. Biagini G, Frasoldati A, Fuxe K, Agnati LF. The concept of astrocyte-kinetic drug in the treatment of neurodegenerative diseases: evidence for L-deprenyl-induced activation of reactive astrocytes. Neurochem Int. 1994;25(1):17-22. 127. Maruyama W, Nitta A, Shamoto-Nagai M, et al. N-Propargyl-1 (R)-aminoindan, rasagiline, increases glial cell line-derived neurotrophic factor (GDNF) in neuroblastoma SH-SY5Y cells through activation of NF-kappaB transcription factor. Neurochem Int. 2004;44(6):393-400. 128. Semkova I, Wolz P, Schilling M, Krieglstein J. Selegiline enhances NGF synthesis and protects central nervous system neurons from excitotoxic and ischemic damage. Eur J Pharmacol. 1996;315(1):19-30. 129. Seniuk NA, Henderson JT, Tatton WG, Roder JC. Increased CNTF gene expression in process-bearing astrocytes following injury is augmented by R(-)-deprenyl. J Neurosci Res. 1994;37(2):278-286. 130. Weinreb O, Bar-Am O, Amit T, Chillag-Talmor O, Youdim MBH. Neuroprotection via pro-survival protein kinase C isoforms associated with Bcl-2 family members. FASEB J. 2004;18(12):1471-1473. 131. Abramova NA, Cassarino DS, Khan SM, Painter TW, Bennett JP Jr. Inhibition by R(+) or S(-) pramipexole of caspase activation and cell death induced by methylpyridinium ion or beta amyloid peptide in SH-SY5Y neuroblastoma. J Neurosci Res. 2002;67(4):494-500. 132. Cassarino DS, Fall CP, Smith TS, Bennett JP Jr. Pramipexole reduces reactive oxygen species production in vivo and in vitro and inhibits the mitochondrial permeability transition produced by the parkinsonian neurotoxin methylpyridinium ion. J Neurochem. 1998;71(1):295-301. 133. Gu M, Iravani MM, Cooper JM, King D, Jenner P, Schapira AH. Pramipexole protects against apoptotic cell death by non-dopaminergic mechanisms. J Neurochem. 2004;91(5):1075-1081. 134. Kitamura Y, Kosaka T, Kakimura J-I, et al. Protective effects of the antiparkinsonian drugs talipexole and pramipexole against 1-methyl-4-phenylpyridinium-induced apoptotic death in human neuroblastoma SH-SY5Y cells. Mol Pharmacol. 1998;54(6):1046-1054. 135. Weinreb O, Mandel S, Youdim MBH. cDNA gene expression profile homology of antioxidants and their antiapoptotic and proapoptotic activities in human neuroblastoma cells. FASEB J. 2003;17(8):935-937. 136. Zou L, Jankovic J, Rowe DB, Xie W, Appel SH, Le W. Neuroprotection by pramipexole against dopamine- and levodopa-induced cytotoxicity. Life Sci. 1999;64(15):1275-1285. 137. Finotti N, Castagna L, Moretti A, Marzatico F. Reduction of lipid peroxidation in different rat brain areas after cabergoline treatment. Pharmacol Res. 2000;42(4):287-291. 138. Gassen M, Glinka Y, Pinchasi B, Youdim MB. Apomorphine is a highly potent free radical scavenger in rat brain mitochondrial fraction. Eur J Pharmacol. 1996;308(2):219-225. 139. Gómez-Vargas M, Nishibayashi-Asanuma S, Asanuma M, Kondo Y, Iwata E, Ogawa N. Pergolide scavenges both hydroxyl and nitric oxide free radicals in vitro and inhibits lipid peroxidation in different regions of the rat brain. Brain Res. 1998;790(1-2):202-208. 140. Iida M, Miyazaki I, Tanaka K, Kabuto H, Iwata-Ichikawa E, Ogawa N. Dopamine D2 receptor-mediated antioxidant and neuroprotective effects of ropinirole, a dopamine agonist. Brain Res. 1999;838(1-2):51-59. 141. Kondo T, Ito T, Sugita Y. Bromocriptine scavenges methamphetamine-induced hydroxyl radicals and attenuates dopamine depletion in mouse striatum. Ann N Y Acad Sci. 1994;738:222-229. 142. Le WD, Jankovic J, Xie W, Appel SH. Antioxidant property of pramipexole independent of dopamine receptor activation in neuroprotection. J Neural Transm. 2000;107(10):1165-1173. 143. Muralikrishnan D, Mohanakumar KP. Neuroprotection by bromocriptine against 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced neurotoxicity in mice. FASEB J. 1998;12(10):905-912. 144. Nishibayashi S, Asanuma M, Kohno M, Gómez-Vargas M, Ogawa N. Scavenging effects of dopamine agonists on nitric oxide radicals. J Neurochem. 1996;67(5):2208-2211. 145. Ogawa N, Tanaka K, Asanuma M, et al. Bromocriptine protects mice against 6-hydroxydopamine and scavenges hydroxyl free radicals in vitro. Brain Res. 1994;657(1-2):207-213. 146. Sam EE, Verbeke N. Free radical scavenging properties of apomorphine enantiomers and dopamine: possible implication in their mechanism of action in parkinsonism. J Neural Transm Park Dis Dement Sect. 1995;10(2-3):115-127. 147. Yoshioka M, Tanaka K, Miyazaki I, et al. The dopamine agonist cabergoline provides neuroprotection by activation of the glutathione system and scavenging free radicals. Neurosci Res. 2002;43(3):259-267. 148. VonVoigtlander PF, Fici GJ, Althaus JS. Pharmacological approaches to counter the toxicity of Dopa. Amino Acids. 1998;14(1-3):189-196. 149. Gassen M, Gross A, Youdim MB. Apomorphine enantiomers protect cultured pheochromocytoma (PC12) cells from oxidative stress induced by H2O2 and 6-hydroxydopamine. Mov Disord. 1998;13(4):661-667. 150. Sawada H, Ibi M, Kihara T, et al. Dopamine D2-type agonists protect mesencephalic neurons from glutamate neurotoxicity: mechanisms of neuroprotective treatment against oxidative stress. Ann Neurol. 1998;44(1):110-119. 151. Zou L, Xu J, Jankovic J, He Y, Appel SH, Le W. Pramipexole inhibits lipid peroxidation and reduces injury in the substantia nigra induced by the dopaminergic neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in C57BL/6 mice. Neurosci Lett. 2000;281(2-3):167-170. 152. Fornai F, Battaglia G, Gesi M, Orzi F, Nicoletti F, Ruggieri S. Dose-dependent protective effects of apomorphine against methamphetamine-induced nigrostriatal damage. Brain Res. 2001;898(1):27-35. 153. Hall ED, Andrus PK, Oostveen JA, Althaus JS, VonVoigtlander PF. Neuroprotective effects of the dopamine D2/D3 agonist pramipexole against postischemic or methamphetamine-induced degeneration of nigrostriatal neurons. Brain Res. 1996;742(1-2):80-88. 154. Iravani MM, Haddon CO, Cooper JM, Jenner P, Schapira AH. Pramipexole protects against MPTP toxicity in non-human primates. J Neurochem. 2006;96(5):1315-1321. 155. Takashima H, Tsujihata M, Kishikawa M, Freed WJ. Bromocriptine protects dopaminergic neurons from levodopa-induced toxicity by stimulating D(2)receptors. Exp Neurol. 1999;159(1):98-104. 156. Du F, Li R, Huang Y, Li X, Le W. Dopamine D3 receptor-preferring agonists induce neurotrophic effects on mesencephalic dopamine neurons. Eur J Neurosci. 2005;22(10):2422-2430. 157. Imamura K, Takeshima T, Nakaso K, Ito S, Nakashima K. Pramipexole has astrocyte-mediated neuroprotective effects against lactacystin toxicity. Neurosci Lett. 2008;440(2):97-102. 158. Ohta K, Fujinami A, Kuno S, et al. Cabergoline stimulates synthesis and secretion of nerve growth factor, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor by mouse astrocytes in primary culture. Pharmacology. 2004;71(3):162-168. 159. Ohta K, Kuno S, Mizuta I, Fujinami A, Matsui H, Ohta M. Effects of dopamine agonists bromocriptine, pergolide, cabergoline, and SKF-38393 on GDNF, NGF, and BDNF synthesis in cultured mouse astrocytes. Life Sci. 2003;73(5):617-626. 160. Ohta M, Mizuta I, Ohta K, et al. Apomorphine up-regulates NGF and GDNF synthesis in cultured mouse astrocytes. Biochem Biophys Res Commun. 2000;272(1):18-22. 161. Presgraves SP, Borwege S, Millan MJ, Joyce JN. Involvement of dopamine D(2)/D(3) receptors and BDNF in the neuroprotective effects of S32504 and pramipexole against 1-methyl-4-phenylpyridinium in terminally differentiated SH-SY5Y cells. Exp Neurol. 2004;190(1):157-170. 162. Tetrud JW, Langston JW. The effect of deprenyl (selegiline) on the natural history of Parkinson's disease. Science. 1989;245(4917):519-522. 163. The Parkinson Study Group. Effect of deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med. 1989;321(20):1364-1371. 164. The Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med. 1993;328(3):176-183. 165. The Parkinson Study Group. Mortality in DATATOP: a multicenter trial in early Parkinson's disease. Ann Neurol. 1998;43(3):318-325. 166. Olanow CW, Hauser RA, Gauger L, et al. The effect of deprenyl and levodopa on the progression of Parkinson's disease. Ann Neurol. 1995;38(5):771-777. 167. Pålhagen S, Heinonen E, Hägglund J, Kaugesaar T, Maki-Ikola O, Palm R, and the Swedish Parkinson Study Group. Selegiline slows the progression of the symptoms of Parkinson disease. Neurology. 2006;66(8):1200-1206. 168. Pålhagen S, Heinonen EH, Hägglund J, et al, and the Swedish Parkinson Study Group. Selegiline delays the onset of disability in de novo parkinsonian patients. Neurology. 1998;51(2):520-525. 169. The Parkinson Study Group. A controlled, randomized, delayed-start study of rasagiline in early Parkinson disease. Arch Neurol. 2004;61(4):561-566. 170. Hauser RA, Lew MF, Hurtig HI, Ondo WG, Wojcieszek J, Fitzer-Attas CJ, on behalf of the TEMPO Open-label Study Group. Long-term outcome of early versus delayed rasagiline treatment in early parkinson's disease. Mov Disord. In press. 171. Olanow CW, Hauser RA, Jankovic J, et al. A randomized, double-blind, placebo-controlled, delayed start study to assess rasagiline as a disease modifying therapy in Parkinson's disease (the ADAGIO study): Rationale, design, and baseline characteristics. Mov Disord. 2008;23(15):2194-2201. 172. Olanow CW, Rascol O. Early rasagiline treatment slows UPDRS decline in the ADAGIO delayed start study. Oral presentation presented at: 12th Congress of European Federation of Neurological Societies; September 23, 2008; Madrid, Spain. 173. Hauser RA, Rascol O, Korczyn AD, et al. Ten-year follow-up of Parkinson's disease patients randomized to initial therapy with ropinirole or levodopa. Mov Disord. 2007;22(16):2409-2417. 174. Rascol O, Brooks DJ, Korczyn AD, De Deyn PP, Clarke CE, Lang AE. A five-year study of the incidence of dyskinesia in patients with early Parkinson's disease who were treated with ropinirole or levodopa. 056 Study Group. N Engl J Med. 2000;342(20):1484-1491. 175. Goggi J, Theofilopoulos S, Riaz SS, Jauniaux E, Stern GM, Bradford HF. The neuronal survival effects of rasagiline and deprenyl on fetal human and rat ventral mesencephalic neurones in culture. Neuroreport. 2000;11(18):3937-3941. 176. Maruyama W, Takahashi T, Youdim M, Naoi M. The anti-Parkinson drug, rasagiline, prevents apoptotic DNA damage induced by peroxynitrite in human dopaminergic neuroblastoma SH-SY5Y cells. J Neural Transm. 2002;109(4):467-481. 177. Naoi M, Maruyama W, Youdim MB, Yu P, Boulton AA. Anti-apoptotic function of propargylamine inhibitors of type-B monoamine oxidase. Inflammopharmacology. 2003;11(2):175-181. 178. Youdim MBH, Gross A, Finberg JPM. Rasagiline [N-propargyl-1R(+)-aminoindan], a selective and potent inhibitor of mitochondrial monoamine oxidase B. Br J Pharmacol. 2001;132(2):500-506. 179. The Parkinson Study Group. A controlled trial of rasagiline in early Parkinson disease: the TEMPO Study. Arch Neurol. 2002;59(12):1937-1943. 180. The Parkinson Study Group. A randomized placebo-controlled trial of rasagiline in levodopa-treated patients with Parkinson disease and motor fluctuations: the PRESTO study. Arch Neurol. 2005;62(2):241-248. 181. Rabey JM, Sagi I, Huberman M, et al. Rasagiline mesylate, a new MAO-B inhibitor for the treatment of Parkinson's disease: a double-blind study as adjunctive therapy to levodopa. Clin Neuropharmacol. 2000;23(6):324-330. 182. Rascol O, Brooks DJ, Melamed E, et al. Rasagiline as an adjunct to levodopa in patients with Parkinson's disease and motor fluctuations (LARGO, Lasting effect in Adjunct therapy with Rasagiline Given Once daily, study): a randomised, double-blind, parallel-group trial. Lancet. 2005;365(9463):947-954. 183. Blunt SB, Jenner P, Marsden CD. Suppressive effect of L-dopa on dopamine cells remaining in the ventral tegmental area of rats previously exposed to the neurotoxin 6-hydroxydopamine. Mov Disord. 1993;8(2):129-133. 184. Lai CT, Yu PH. Dopamine- and L-beta-3,4-dihydroxyphenylalanine hydrochloride (L-Dopa)-induced cytotoxicity towards catecholaminergic neuroblastoma SH-SY5Y cells. Effects of oxidative stress and antioxidative factors. Biochem Pharmacol. 1997;53(3):363-372. 185. Mena MA, Pardo B, Casarejos MJ, Fahn S, Garcia de Yebenes J. Neurotoxicity of levodopa on catecholamine-rich neurons. Mov Disord. 1992;7(1):23-31. 186. Mytilineou C, Han SK, Cohen G. Toxic and protective effects of L-dopa on mesencephalic cell cultures. J Neurochem. 1993;61(4):1470-1478. 187. Mytilineou C, Walker RH, JnoBaptiste R, Olanow CW. Levodopa is toxic to dopamine neurons in an in vitro but not an in vivo model of oxidative stress. J Pharmacol Exp Ther. 2003;304(2):792-800. 188. Ziv I, Melamed E, Nardi N, et al. Dopamine induces apoptosis-like cell death in cultured chick sympathetic neurons—a possible novel pathogenetic mechanism in Parkinson's disease. Neurosci Lett. 1994;170(1):136-140. 189. Basma AN, Morris EJ, Nicklas WJ, Geller HM. L-dopa cytotoxicity to PC12 cells in culture is via its autoxidation. J Neurochem. 1995;64(2):825-832. 190. Cotzias GC, Miller ST, Tang LC, Papavasiliou PS. Levodopa, fertility, and longevity. Science. 1977;196(4289):549-551. 191. Datla KP, Blunt SB, Dexter DT. Chronic L-DOPA administration is not toxic to the remaining dopaminergic nigrostriatal neurons, but instead may promote their functional recovery, in rats with partial 6-OHDA or FeCl(3) nigrostriatal lesions. Mov Disord. 2001;16(3):424-434. 192. Diamond SG, Markham CH, Hoehn MM, McDowell FH, Muenter MD. Multi-center study of Parkinson mortality with early versus later dopa treatment. Ann Neurol. 1987;22(1):8-12. 193. Dziewczapolski G, Murer G, Agid Y, Gershanik O, Raisman-Vozari R. Absence of neurotoxicity of chronic L-DOPA in 6-hydroxydopamine-lesioned rats. Neuroreport. 1997;8(4):975-979. 194. Hefti F, Melamed E, Bhawan J, Wurtman RJ. Long-term administration of L-DOPA does not damage dopaminergic neurons in the mouse. Neurology. 1981;31(9):1194-1195. 195. Mena MA, Davila V, Sulzer D. Neurotrophic effects of L-DOPA in postnatal midbrain dopamine neuron/cortical astrocyte cocultures. J Neurochem. 1997;69(4):1398-1408. 196. Murer MG, Dziewczapolski G, Menalled LB, et al. Chronic levodopa is not toxic for remaining dopamine neurons, but instead promotes their recovery, in rats with moderate nigrostriatal lesions. Ann Neurol. 1998;43(5):561-575. 197. Perry TL, Yong VW, Ito M, et al. Nigrostriatal dopaminergic neurons remain undamaged in rats given high doses of L-DOPA and carbidopa chronically. J Neurochem. 1984;43(4):990-993. 198. Scigliano G, Musicco M, Soliveri P, et al. Mortality associated with early and late levodopa therapy initiation in Parkinson's disease. Neurology. 1990;40(2):265-269. 199. Chen H-SV, Pellegrini JW, Aggarwal SK, et al. Open-channel block of N-methyl-D-aspartate (NMDA) responses by memantine: therapeutic advantage against NMDA receptor-mediated neurotoxicity. J Neurosci. 1992;12(11):4427-4436. 200. Erdö SL, Schäfer M. Memantine is highly potent in protecting cortical cultures against excitotoxic cell death evoked by glutamate and N-methyl-D-aspartate. Eur J Pharmacol. 1991;198(2-3):215-217. 201. Lustig HS, Ahern KV, Greenberg DA. Antiparkinsonian drugs and in vitro excitotoxicity. Brain Res. 1992;597(1):148-150. 202. Osborne NN, Quack G. Memantine stimulates inositol phosphates production in neurones and nullifies N-methyl-D-aspartate-induced destruction of retinal neurones. Neurochem Int. 1992;21(3):329-336. 203. Seif el Nasr M, Peruche B, Rossberg C, Mennel HD, Krieglstein J. Neuroprotective effect of memantine demonstrated in vivo and in vitro. Eur J Pharmacol. 1990;185(1):19-24. 204. Rojas P, Altagracia M, Kravsov J, Rios C. Partially protective effect of amantadine in the MPTP model of Parkinson's disease. Proc West Pharmacol Soc. 1992;35:33-35. 205. Uitti RJ, Rajput AH, Ahlskog JE, et al. Amantadine treatment is an independent predictor of improved survival in Parkinson's disease. Neurology. 1996;46(6):1551-1556. 206. The NINDS NET-PD Investigators. A randomized, double-blind, futility clinical trial of creatine and minocycline in early Parkinson disease. Neurology. 2006;66(5):664-671. 207. Bender A, Koch W, Elstner M, et al. Creatine supplementation in Parkinson disease: a placebo-controlled randomized pilot trial. Neurology. 2006;67(7):1262-1264. 208. NET-PD LS-1 creatine in Parkinson's disease—recruiting 1720 participants! PD trials http://www.pdtrials.org/en/browse/all/view/131.  Accessed August 22, 2008. 209. Grondin R, Zhang Z, Yi A, et al. Chronic, controlled GDNF infusion promotes structural and functional recovery in advanced parkinsonian monkeys. Brain. 2002;125(pt 10):2191-2201. 210. Kordower JH, Emborg ME, Bloch J, et al. Neurodegeneration prevented by lentiviral vector delivery of GDNF in primate models of Parkinson's disease. Science. 2000;290(5492):767-773. 211. Gill SS, Patel NK, Hotton GR, et al. Direct brain infusion of glial cell line-derived neurotrophic factor in Parkinson disease. Nat Med. 2003;9(5):589-595. 212. Slevin JT, Gash DM, Smith CD, et al. Unilateral intraputamenal glial cell line–derived neurotrophic factor in patients with Parkinson disease: response to 1 year of treatment and 1 year of withdrawal. J Neurosurg. 2007;106(4):614-620. 213. Lang AE, Gill S, Patel NK, et al. Randomized controlled trial of intraputamenal glial cell line–derived neurotrophic factor infusion in Parkinson disease. Ann Neurol. 2006;59(3):459-466. 214. Peck P. Amgen decision to halt GDNF clinical trials and withdraw the drug triggers protest from researcher and patients. Neurology Today. 2005;5(4):4, 7, 24.