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First-line Treatment in Parkinson’s Disease
  1. C. A. Davie, Consultant Neurologist*,
  2. A. H. V. Schapira, Professor of Neurology
  1. *University Department of Clinical Neurosciences, Royal Free and University College Medical School and
  2. University Department of Clinical Neurosciences, Royal Free and University College Medical School, and Institute of Neurology, Queen Square, University College London, London; E-mail: lynne{at}


Parkinson’s disease is a common neurodegenerative condition with a prevalence of about 160/100 000 in Western Europe rising to as high as 2% of the population over 80 years old (Mutch et al. 1986). The disease has a major socio-economic impact. The annual direct cost of care per patient is about £6000, while the indirect costs and the burden of the disease on patients and their carers are incalculable (Findley et al. 2003). Furthermore, a move from home to residential care is associated with an approximately 500% cost increase. Therefore, the management of Parkinson’s disease is likely to prove an increasingly important and challenging aspect of medical practice as the population ages.

Therapeutic strategies have for the large part focused on pharmacological agents, and there has also been an increasing trend towards specialist Parkinson’s disease clinics run by physicians with a specific interest in the disease. Such clinics often provide

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