Conclusions

Conclusions Until recently, the major research effort over the past 30 years has centred on dopamine and how it acts in the brain. The result has been the development of a range of medicines that can protect levodopa and dopamine from breaking down too rapidly, thus greatly increasing the efficacy of levodopa therapy.

The newest of these medicines are the COMT inhibitors, tolcapone and entacapone, which have either been licensed for use or are under active review. The search for more selective medicines that mimic dopamine has also been successful and three, ropinirole, cabergoline and pramipexole, have been identified. If all goes to plan, five new medicines for Parkinson’s will have been made available between 1996 and 1998.

In parallel, our understanding of how the brain works has improved enormously and new targets such as adenosine and the NMDA receptors have been identified. Within the next few years we shall know whether medicines that act on these new targets are going to live up to their early promise. Increased understanding of the brain has also led to the reinstatement of specialised surgical methods to deal with more intractable problems and now appears to have a small but specific place in the treatment of Parkinson’s.

The ultimate goal is the prevention and cure of Parkinson’s. Finding a preventable cause has been elusive, but the search for a cure goes on. The greatest hopes here lie in the new biotechnologies – especially the use of factors that stimulate nerve growth and the new science of gene therapy. Great progress has been made in both these areas. The next decade will be one of expectation and hope that at least future generations will be spared from this common and distressing condition.