Aim. To summarize current knowledge about one of the drugs most frequently used in neurology and gerontology – the still highly controversial selegiline.
Review. Selegiline is a selective, irreversible inhibitor of monoaminooxygenase type B (MAO-B). Many papers have been recently published concerning the efficacy, tolerability and safety of selegiline in Parkinson s disease. The publications systematize our knowledge about the drug and should influence its rational use in clinical practice. Selegiline is a useful drug producing a modest benefit, mostly in an early stage of the disease. According to many authors it may either delay the time when levodopa is necessary, or when administered concomitantly, allows to decrease the levodopa dose. Great hopes have been raised by the alleged neuroprotective action of selegiline – unfortunately, no such effect of the drug has been univocally proved so far. This mode of action is supposed to result from inhibition of free radicals formation in the process of dopamine metabolism due to inhibition of MAO-B. According to recent research, this neuroprotection may be obtained in a way unrelated to MAO-B inhibition, but due to antiapoptotic activity of desmethyloselegiline, one of selegiline metabolites. Selegiline was also used in clinical trials in Alzheimer's disease, narcolepsy and attention-deficit hyperactivity disorder in children.
Conclusions. Selegiline is a useful, but rather weak drug in the symptomatic treatment of Parkinson s disease, with no proven neuroprotective action (although many authors believe in such a mechanism). Its use in Alzheimer's disease, narcolepsy and Tourettism requires further study. Despite its wide use, possible side effects of selegiline should be kept in mind, as well as its relatively numerous potential interactions with other drugs, especially in the elderly.