Dopaminergic substitution in Parkinson's disease

Motor complications associated with long-term levodopa application, which follow the so-called honeymoon period of well-tolerated levodopa administration and are looked upon as one clinical marker for progression of Parkinson's disease (PD), initiated a long and controversial debate on the putative neurotoxicity of levodopa. Since dopamine agonists (DA) delay onset of motor complications, they support the neuroprotective treatment strategy in PD. Efficacy and tolerability of DA differs in particular due to their affinity to various dopamine receptor subtypes. The accumulating evidence for levodopa-associated homocysteinaemia, which represents a risk factor for increased incidence of vascular disease in PD, supports the strategy of initial DA application and the use of levodopa as an add-on compound in as low a dose as possible in young PD patients.