title: The treatment of early Parkinson's disease: levodopa rehabilitated.
abstract: Many clinicians regard levodopa as a last resort in the symptomatic treatment of Parkinson's disease. Here we critically review the arguments that are typically used to postpone the start of levodopa for as long as possible. We will point out that most concerns are invalid. Levodopa remains the most effective and best tolerated Parkinson's drug to date, and should have an important role in all therapeutic strategies, both as monotherapy in early Parkinson's disease and as part of combination therapy in advanced disease. Regardless of disease stage, the choice of a particular drug should not be driven by fear of long term complications but by the clinical condition of the patient at the time, with an emphasis on functioning in everyday life and any comorbidity. A 'phobia' for levodopa—or, indeed, for any other antiparkinsonian medication—is unacceptable according to current evidence.
authors.affiliation: Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
authors.forename: Annemarie
authors.initials: A
authors.lastname: Vlaar
authors.forename: Ad
authors.initials: A
authors.lastname: Hovestadt
authors.forename: Teus
authors.initials: T
authors.lastname: van Laar
authors.forename: Bastiaan R
authors.initials: BR
authors.lastname: Bloem
mesh_terms: D015259:Dopamine Agents / Q000008:administration & dosage* / Q000009:adverse effects* / Q000378:metabolism; D004351:Drug Resistance / Q000502:physiology; D004409:Dyskinesia, Drug-Induced / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage* / Q000009:adverse effects* / Q000378:metabolism; D010300:Parkinson Disease / Q000188:drug therapy*
chemical_list: D015259:Dopamine Agents; D007980:Levodopa