A Case for Early Levodopa Treatment of Parkinsonʼs Disease

Summary: It has been proposed by many authorities that initiation of levodopa treatment in Parkinson's disease should be delayed as long as possible, mainly to delay the appearance of drug-related side effects, in particular, motor fluctuations. This article reviews the evidence of three studies that show that the timing of levodopa initiation has no influence on mortality or on the appearance of motor fluctuations. Our controlled, randomized clinical trial with either levodopa, L-deprenyl, or a dopamine agonist showed, after 5 years, no significant difference in the time of appearance of motor fluctuations in the three groups, although dyskinesias were less in dopamine agonist patients. It is concluded that there is no reason to delay the introduction of levodopa to treat parkinsonian patients.