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Controversies in Neurology
December 2004

Initial Parkinson Disease Therapy: Levodopa, Dopamine Agonists, or Both?

Arch Neurol. 2004;61(12):1972-1973. doi:10.1001/archneur.61.12.1972

She had never forgotten that, if you drink from a bottle marked “poison,” it is almost certain to disagree with you, sooner or later.—Lewis Carroll Alice's Adventures in Wonderland

Almost 2 decades ago in this column, neurologists argued about the timing of levodopa treatment initiation in individuals with Parkinson disease.1-3 The debate in 1986 was whether to begin levodopa treatment as soon as the diagnosis was made or to defer treatment until the disease was more advanced. Advocates of later levodopa treatment worried about the apparent limited duration of efficacy and about the frequent occurrence after a few years of dyskinesias, erratic on-off phenomena, and other complications. In effect, these physicians argued to save the levodopa for when it was really needed because they perceived that it had a finite period of usefulness.1 Proponents of immediate treatment argued instead that Parkinson disease is a progressive disorder and pointed to the similarity of disability scores in patients whose levodopa treatment began soon after diagnosis compared with those whose treatment began years later.2

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