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Letters |

Brain Imaging to Assess the Effects of Dopamine Agonists on Progression of Parkinson Disease—Reply

Kenneth Marek, MD; John Seibyl, MD; Michael McDermott, PhD; Stanley Fahn, MD; Anthony Lang, MD
JAMA. 2002;288(3):311-313. doi:10.1001/jama.288.3.311.
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In Reply: Dr Ahlskog and colleagues, Dr Albin and colleagues, and Dr Moorish advise caution in interpreting the relative reduction in the loss of striatal β-CIT uptake from baseline in patients with early PD after initial treatment with pramipexole vs levodopa. We agree entirely that our data do not demonstrate either that pramipexole is neuroprotective or that levodopa is neurotoxic in patients with PD. Ahlskog et al and Albin et al focus on the possibility that either pramipexole or levodopa may alter DAT imaging via a pharmacologic effect. Current data argue against these explanations of our results. Indirect evidence comes from a recent study demonstrating a relative reduction in the loss of 18F-dopa uptake after 2 years of treatment with ropinirole (a dopamine agonist like pramipexole) vs levodopa1 of similar magnitude to the relative reduction in loss of β-CIT uptake in the pramipexole group in our study. This strongly suggests that our observed treatment effects are not explained by acute effects on DAT binding.


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