The development of dopamine agonists, particularly, pramipexole and ropinirole, has gradually shifted treatment paradigms in PD. In the last 20 years, many PD specialists have moved from using dopamine agonists only as adjunctive therapy to lev-odopa to initiating antiparkinson therapy with one of these agents (58). Imaging data with SPECT and PET scanning has produced debate regarding the possible "neuroprotective" advantages of dopamine agonists when compared to levodopa (2-4). In this regard, some have questioned whether these agents should be initiated sooner in the disease course, perhaps before obvious disability develops. Regardless of when dopamine agonist therapy is initiated, patients benefit from the choice of several agents for treating PD symptoms.
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