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Analysis of the clinical problems in parkinsonism and the complications of long-term levodopa therapy

Department of Neurology, Columbia University, College of physiciansand Surgeons; and the Neurological Institute, New York, New York.

We evaluated the current status of 131 patients with idiopathic parkinsonism who were receiving levodopa therapy. The residual parkinsonian symptoms and signs were tabulated, as were the adverse effects from medication. Response to therapy was correlated with duration of the disease and with duration of treatment. Patients with on-off or wearing-off effects were likely to have been treated for 4 years or longer. Patients treated with levodopa for 4 to 8 years were significantly more impaired with parkinsonism than patients treated for 0 to 3 years, even when patients were matched for total duration of disease. These data suggest that the deterioration of responsiveness after several years of levodopa therapy may be due to the therapy itself. Our findings support the concept that utilization of levodopa therapy should be delayed until a patient becomes significantly impaired in occupational or social situations.

Address correspondence to Dr. Fahn, Neurological Institute, 710 West 168th Street, New York, NY 10032.

Presented in part at the thirtieth annual meeting of the American Academy of Neurology, Los Angeles, April 1978.

Accepted for publication February 28, 1979.

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