The Concept of Continuous Dopaminergic Stimulation: What We Should Consider when Starting Parkinson’s Disease Treatment

Treatment of early Parkinson's disease (PD) should pursue objectives like possible disease-modifying effect, more physiological dopaminergic stimulation, and avoidance of motor fluctuations. The recent published ADAGIO trial showed that rasagiline (1 mg/day), used in early PD, has a disease-modifying effect. Dopaminergic drugs administered to provide more continuous dopaminergic stimulation prevent or minimize motor fluctuations in experimental animals. Dopamine (DA) agonists delay motor fluctuations in humans providing a more continuous dopaminergic stimulation. New formulations of DA agonists, such as once a day preparations and patch technology, have been developed to provide a more continuous delivery of drug and consequently a more physiological stimulation. According to patient characteristics, treatment of PD should be started with rasagiline and/or with long-acting DA agonists.