Dr Sacks' remarks remind us that indeed, the more things change, the more they remain the same; it is interesting to observe how medical controversies such as the levodopa toxicity debate persist in the face of significant progress in the management of Parkinson disease.
It is true that levodopa's adverse effects "may be attenuated but not prevented by concurrent therapy" with adjunctive medications; however, we should not permit the perfect to be the enemy of the good. A reduction in the frequency and severity of motor fluctuations and dyskinesia can have a dramatic impact on the quality of life.
Shulman LM. Weighing the Neurological Complexities of Long-term Levodopa Use—Reply. Arch Neurol. 2000;57(10):1531. doi: