From: Rafal Smigrodzki (rms2g@virginia.edu)
Date: Thu Feb 13 2003 - 12:55:26 MST
gts wrote:
> Here is published evidence that selegiline (deprenyl) increases
> life-expectancy in Parkinson's Disease, (something that Rafal
> considers impossible.)
### So, finally I had the time to look at the article.
It turns out to be an open, uncontrolled study, which according to the AAN
Practice Guidelines is class IV evidence (meaning - hardly any evidence at
all). In the presence of class II studies, such as DATATOP, this can be
discarded as worthless.
See http://www.aan.com/professionals/practice/pdfs/int_par.pdf
---------
>
> In this 9 year study, 564 of 941 PD patients were given selegiline
> as part of their treatment. The patients treated with selegiline
> lived significantly longer than those not treated with selegiline.
> This is strong evidence that selegiline actually slows the
> progression of the disease in addition to relieving its symptoms.
### It is not evidence of anything at all. The results of open, uncontrolled
studies are subject to so many sources of bias that all they are good for is
suggesting additional research, which in this case flatly refuted the
conclusion of this study.
Rafal
>
> ABSTRACT
> Increased life expectancy resulting from addition of L-deprenyl to
> Madopar treatment in Parkinson's disease: a longterm study.
>
> J Neural Transm 1985;64(2):113-27 (ISSN: 0300-9564)
> Birkmayer W; Knoll J; Riederer P; Youdim MB; Hars V; Marton J
> In an open, uncontrolled study the longterm (9 years) effect of
> treatment with Madopar alone (n = 377) or in combination with
> l-deprenyl (selegiline, selective monoamine oxidase type B inhibitor)
> (n = 564) have been compared in Parkinsonian patients. In patients
> who lost their response to conventional Madopar therapy the addition
> of l-deprenyl resulted in a significant recouping of levodopa effect.
> The survival analysis revealed a significant increase of life
> expectancy in Madopar--l-deprenyl group regardless of the fact
> whether or not the significant demographic differences between the
> two groups were taken into account. Although the mechanism underlying
> this action of l-deprenyl is not known, the results are interpreted
> as indicating l-deprenyl's ability to prevent or retard the
> degeneration of striatal dopaminergic neurons. l-Deprenyl is the
> first anti-Parkinson drug having such a property. This hypothesis is
> not far fetched since l-deprenyl selectively prevents the
> degeneration of striatal dopaminergic neurons induced in animals by
> the illicit drug 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP).
> Since latter compound is known to cause Parkinsonism in man and
> primates or Parkinson-like neurochemical and pathological changes in
> other animals the implications of the present study involving
> monoamine oxidase activity and l-deprenyl are apparent.
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