Deprenyl, a selective inhibitor of
monoamine oxidase, type B, which is free of the "
tyramine effect," may ameliorate symptom fluctuations in advanced
Parkinson's disease (PD). We randomized 96 patients with marked symptom fluctuations at three centers to receive either
deprenyl 5 mg b.i.d. or placebo in parallel fashion in addition to a previously optimized
levodopa/
carbidopa (
Sinemet) regimen. Disability was recorded hourly at home by patients 3 days weekly during the 2-week baseline and the 6-week treatment period. Disability during the "on" state was assessed each week by examination. Mean hourly self-assessment of gait improved in 28 of 50 patients (56%) receiving
deprenyl (mean degree of improvement 0.25 points on a 0-2 scale) and in 14 of 46 (30.4%) taking placebo (mean 0.15). Mean hourly overall symptom control improved in 29 (58%) taking
deprenyl (mean 0.34) and in 12 (26.1%) taking placebo (mean 0.15) (p less than 0.01 for each parameter). No significant improvement occurred in the objective quality of the "on" state with
deprenyl. Mean daily
Sinemet dosage decreases were 17% in the
deprenyl group and 7% in the placebo group. Adverse effects included
nausea,
light-headedness,
dyskinesias, and
hallucinations, all of which abated after the
Sinemet dose was reduced. We conclude that
deprenyl is of moderate benefit in a majority of patients with symptom fluctuations complicating PD and is generally well tolerated.