Improved control of brittle Parkinsonism by separate administration of levodopa and benserazide

A 59-year-old woman who had had Parkinsonism for 12 years was treated with orphenadrine and levodopa combined with a dopa carboxylase inhibitor. The initial response was good, but after several years' treatment her condition alternated between severe bradykinesia and incapacitating, violent chorea, interspersed with short periods of mobility. A new regimen was devised, using levodopa in capsules of 40 mg and benserazide in separate capsules of 10 or 25 mg. Levodopa 40 mg was taken at intervals of half to two and a half hours, usually with benserazide 10 mg but alone in the late morning and evening. Additional benserazide was required one hour after lunch. With this regimen her condition was greatly improved, though she still had an abnormal gait and spells of bradykinesia and chorea. Separate, frequent small doses of levodopa and benserazide may give better control of brittle Parkinsonism.