Motor fluctuations and levodopa-induced dyskinesias are critical manifestations of advanced Parkin- son’s disease. Dopamine agonist drugs have been suggested as treatment for these complications. We report our first experience with pergolide (Permax ® ). The treatment was introduced in 75 patients with Parkinson’s disease, in Hoehn & Yahr stages 1 to 4, mean age 57, and mean disease duration 9 years. 71 from 75 patients were treated with levodopa for 6 years on average, most of them suffering from motor fluctuations and dyskinesias. In four patients with early disease, pergolide was used as their first dopaminergic treatment. Pergolide was introduced in a progressive dosage up to a fully effective dose (mean, 2.3 mg daily). In retrospective evaluation, motor status and functional abilities improved in 66 of 75 patients (88 %). The mean levodopa dose decreased from 877 to 805 mg daily (by 8 %). Adverse side effects of pergolide were recorded in 36 (48 %) patients, typically transitory dizziness, nausea, or deterioration of dyskinesias. In 7 cases (8 %), pergolide had to be discontinnued, mostly because of nausea, dizziness, or anxiety. The treatment was successful in all four patients to whom pergolide was given in monotherapy. A prospective evaluation was performed in a sub-group of 23 patients. After 3 months, mean UPDRS (Unified Parkinson’s Disease Rating Scale) scores decreased significantly: motor score in the „on“ state, from 18.7 to 7.7 points (p < 0.0001), activities of daily living score, from 8.8 to 4.9 (p < 0.0001) and motor complications score, from 4.0 to 2.2 (p < 0.001). According to the patients’ diaries, the daily duration of deteriorated locomotion decreased by 53 %, from 6.6 to 3.1 hours. In conclusion, our experience demonstrates pergolide as highly efficient treatment in combination with levodopa in advanced Parkinson’s disease. Pergolide significantly improves the patients’ motor status and their ability for daily living activities, and decreases motor fluctuations. In some patients, adverse side-effects appeares which are mostly transient and do not require discontinuation of treatment.

        Key words: dopamine agonists, dyskinesias, motor fluctuations, levodopa, Parkinson’s disease, pergo-