Treatment of Parkinsonism with Levodopa

One hundred patients with Parkinson's disease began taking levodopa in 1968; 72 of them have continued treatment under close supervision for at least 2 years. After treatment for 2 years 82% of the patients were improved 25% or more compared with their pretreatment condition; 49% were improved 50% or more. Tremor improved more than did rigidity or akinesia. The average dose at 2 years was 4.5 g/day. Side effects were frequent but required treatment to be stopped in only three patients. Commonest were involuntary movements, nausea and transient delirium, and confusion and memory loss. The dementia associated with parkinsonism improved in some patients but progressed in others. Although parkinsonism did not appear to progress during levodopa treatment, a 2-year treatment experience does not permit us to draw conclusions as to the effect of levodopa on the natural history of Parkinson's disease. Levodopa continues to be the most effective treatment available.