A quantitative functional evaluation, the motility index, was used as the principal measure of a patient's status in the study of levodopa therapy in the long-term treatment of parkinsonism. This study had three objectives: (1) to determine whether, after initial rapid improvement, patients continued to improve more slowly, level off, or decline over the long term; (2) to determine the effect of temporary withdrawal of the drug; and (3) to infer from the preceding whether levodopa alters the progression of parkinsonism. Sixtyeight patients who had been on a regimen of levodopa for at least one year maintained their initial improvement for over 30 months. Forty of these patients were temporarily placed on a placebo. Most of them experienced a rapid return of parkinsonian symptoms and signs. The results of the study suggest that a period of levodopa withdrawal can be beneficial and that the usual tendency for progression in parkinsonism may have been altered.
Stern PH, McDowell F, Miller JM, Robinson MB. Levodopa Therapy Effects on Natural History of Parkinsonism. Arch Neurol. 1972;27(6):481–485. doi:10.1001/archneur.1972.00490180017005
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