Evidence-based initiation of dopaminergic therapy in Parkinson's disease

The mainstay of Parkinson's disease (PD) therapy is levodopa. The crucial question is when should levodopa be initiated? Levodopa provides the most potent motor benefit for PD, but longer term use is marked by the development of motor complications such as fluctuations in response and involuntary motor movements. Dopamine agonists reduce the risk of development of motor complications in the 5-year term. However, side effects may change the risk-benefit of dopamine agonist first strategies. In the following, the evidence for levodopa and dopamine agonists as initial monotherapy for PD is examined.