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The treatment of early Parkinson's disease: levodopa rehabilitated
  1. Annemarie Vlaar1,
  2. Ad Hovestadt2,
  3. Teus van Laar3,
  4. Bastiaan R Bloem4
  1. 1Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands
  2. 2Department of Neurology, Meander Medisch Centrum, Amersfoort, The Netherlands
  3. 3Department of Neurology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
  4. 4Neurologist, Department of Neurology, Donders Institute for Brain Cognition and Behaviour, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands
  1. Correspondence to Professor B R Bloem, Department of Neurology (935), Donders Institute for Brain, Cognition and Behaviour, Nijmegen Medical Centre, Radboud University, PO Box 9 101, 6500HB Nijmegen, The Netherlands; b.bloem{at}neuro.umcn.nl

Abstract

Many clinicians regard levodopa as a last resort in the symptomatic treatment of Parkinson's disease. Here we critically review the arguments that are typically used to postpone the start of levodopa for as long as possible. We will point out that most concerns are invalid. Levodopa remains the most effective and best tolerated Parkinson's drug to date, and should have an important role in all therapeutic strategies, both as monotherapy in early Parkinson's disease and as part of combination therapy in advanced disease. Regardless of disease stage, the choice of a particular drug should not be driven by fear of long term complications but by the clinical condition of the patient at the time, with an emphasis on functioning in everyday life and any comorbidity. A ‘phobia’ for levodopa—or, indeed, for any other antiparkinsonian medication—is unacceptable according to current evidence.

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Footnotes

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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