From: Rafal Smigrodzki (rms2g@virginia.edu)
Date: Fri Feb 07 2003 - 10:56:04 MST
gts wrote:
>
> Many, many dozens of published studies state, suggest, or offer
> evidence of the neuroprotective value of selegiline in PD.
### Show me any class A studies to this effect.
Listing dozens of animal studies is perfectly irrelevant - in clinical
medicine animal studies are not even class C evidence, they are not evidence
at all.
"Neuroprotection in PD" means that the rate of neuron loss is reduced
compared to a control group. There must be a clinical effect, or else the
neuroprotection (if detected post mortem) is useless.
There must be either, maintenance of UPDRS improvement after washout of the
drug, or delay to untreatable disability, or delay of death. Neither
occurred in DATATOP.
The class A study, DATATOP, shows no evidence of clinically significant
neuroprotection. Period. End of discussion.
------------------
>>> As background: there was once a hypothesis that levodopa
>>> accelerates the attrition of dopaminergic neurons, and that
>>> levodopa-sparing therapy would delay the onset of dyskinesias which
>>> usually develop after about 5-7 years on levodopa, and perhaps
>>> prolong survival. A nice hypothesis, but not true -substituting
>>> dopa-agonists or selegiline for levodopa in initial treatment does
>>> not delay the onset of dyskinesia. ...
>
> I think are mistaken here to include selegiline in the same class of
> drugs as levodopa. Levodopa is merely a simple dopamine agonist --
> actually it's not even that -- it's merely an ordinary amino acid and
> a precursor to dopamine. Selegiline's actions are far more complex
> and less well understood.
### I think you are mistaken to say I included selegiline in the same class
of drugs as levodopa.
------------------------
>
> If you were really on top of this subject, Rafal, then I believe you
> and I would not be arguing whether selegiline is neuroprotective.
### OK, I am just too incompetent to discuss PD with you.
All my years of training as a neurologist, my movement disorders fellowship,
and you simply crush me with the abstracts of a few little rat studies.
On the other hand, if you were a neurologist and a scientist you would not
waste anybody's time with fuzzy tissue-culture experiments and try to treat
them as adequate arguments against double-blind placebo controlled studies.
-----------------------
Other studies show
> that selegiline increases lifespan in <snip> human PD
> patients.
>
### Quote them and show they are more reliable and trustworthy than DATATOP.
Rafal
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