Parkinsonism and levodopa: a five-year experience

Seventy parkinsonian patients were treated continuously with levodopa for five years. During the first year, sixty-three patients (90 per cent) improved. After five years, however, only thirty-seven patients remained improved while thirty-three patients (48 per cent) experienced progressive disease. Complications of treatment, albeit nonfatal, increased in frequency during the five-year interval. The reason for early improvement and subsequent deterioration of parkinsonian symptoms and signs in spite of levodopa therapy remains unexplained. It suggests that Parkinson's disease may not be simply a striatal dopamine deficiency syndrome and that treatment with levodopa is more than replacement therapy.