Rasagiline, as a MAO-B inhibitor, can significantly improve motor symptoms and delay disease progression in Parkinson's disease. Discontinuation of the drug should be gradually reduced to avoid withdrawal reactions. The following will explain from two aspects: treatment effect evaluation and medication discontinuation management.

1. Evaluation of treatment efficacy

(1) Improvement of motor symptoms

Single drug treatment can improve UPDRS motor scores by 2-3 points in early patients, with better efficacy than selegiline. When combined with levodopa, the "off period" time is reduced by 1.8 hours/day, and the therapeutic effect is maintained for at least 5 years.

(2) Disease modifying effect

ADAGIO research shows that a daily dose of 1mg can delay functional decline, and the annual deterioration rate of UPDRS score in early medication patients is reduced by 0.04 points per month, indicating neuroprotective potential.

(3) Benefit from non motor symptoms

It can improve depressive symptoms (MADRS score reduced by 2.1 points) and cognitive function, but has limited improvement on sleep disorders. The combination with dopamine receptor agonists has a more significant effect.

2. Precautions for discontinuation of medication

(1) Prevention of withdrawal syndrome

Gradually reduce dosage within 2-4 weeks, sudden discontinuation of medication may lead to worsening of motor symptoms, anxiety, or inability to sit still. Combination therapy patients should first adjust the dosage of other drugs.

(2) Alternative therapy transition

If it is necessary to switch to other MAO inhibitors, there should be at least a 14 day interval. When converting to COMT inhibitors, overlapping medication for one week and monitoring blood pressure fluctuations are required.

(3) Management of special populations

Patients with liver dysfunction still need to be monitored for 2 weeks after discontinuing medication; The reduction rate for elderly patients should be slower (4-6 weeks); During pregnancy, medication should be stopped immediately under the guidance of a doctor.

(4) Follow up after discontinuation of medication

It is recommended to follow up monthly within 3 months after discontinuing medication to evaluate changes in motor function and non motor symptoms. If symptoms rebound, consider restarting treatment or adjusting the plan.