Initiation of Levodopa Therapy in Parkinsonian Patients Should Be Delayed Until the Advanced Stages of the Disease

Abstract

To date, orally administered levodopa, usually in combination with a peripheral dopadecarboxylase inhibitor, remains the most potent agent in the treatment of Parkinson's disease. It is now well established that levodopa improves many of the disabling motor symptoms and signs and the quality of life, as well as life expectancy, in parkinsonian subjects.^1-5Nevertheless, despite its widespread use for more than 15 years, a major unsettled and often heatedly debated question concerning dopa therapy still persists: ie, when should levodopa therapy be started in such patients?^6,7More specifically, it is uncertain whether levodopa should be given to all parkinsonian patients immediately on diagnosis and regardless of the stage and severity of the disorder or whether its long-term administration should be withheld and delayed in milder cases (stages I and II according to Hoehn and Yahr⁸) and restricted to those patients who are in the more advanced stages