When to Start Levodopa Therapy for Parkinson’s Disease

Patients with Parkinson's disease and the neurologists who treat them have had a complicated relationship with levodopa. Despite the undisputed efficacy of levodopa in ameliorating the cardinal motor signs of bradykinesia and rigidity, how and when to initiate treatment have been controversial issues. The practice of delaying and restricting, or "sparing," treatment with levodopa by treating with other medications, such as monoamine oxidase type B inhibitors and dopamine agonists, evolved in the 1980s and 1990s. This approach was derived from concerns about the common complications associated with levodopa — involuntary movements (dyskinesia) and fluctuations of motor control, including a wearing-off . . .