Prolonged symptoms of brain dysfunction--adverse effect of levodopa

Symptoms of brain dysfunction occurred in a 67-year-old woman with idiopathic parkinsonism on treatment with levodopa. The adverse effect reappeared in a more severe and prolonged form when she was treated one year later with levodopa in combination with the peripheral decarboxylase inhibitor Ro-4-4602. The symptoms were associated with a markedly altered level of HMPG (a noradrenaline metabolite) in the cerebrospinal fluid.