Levodopa in the treatment of Parkinson’s disease: an old drug still going strong

Abstract

Werner Poewe1, Angelo Antonini2, Jan CM Zijlmans3, Pierre R Burkhard4, François Vingerhoets51Department of Neurology, Medical University of Innsbruck, Austria; 2Parkinson Department, IRCCS San Camillo, Venice, and University of Padua, Italy; 3Department of Neurology, Amphia Hospital, Breda, The Netherlands; 4Department of Neurology, Faculty of Medicine and University Hospitals of Geneva, Switzerland; 5Neurodegenerative Disorders Unit, Neurology Department, CHUV, Lausanne, SwitzerlandAbstract: After more than 40 years of clinical use, levodopa (LD) remains the gold standard of symptomatic efficacy in the drug treatment of Parkinson’s disease (PD). Compared with other available dopaminergic therapies, dopamine replacement with LD is associated with the greatest improvement in motor function. Long-term treatment with LD is, however, often complicated by the development of various types of motor response oscillations over the day, as well as drug-induced dyskinesias. Motor fluctuations can be improved by the addition of drugs such as entacapone or monoamine oxidase inhibitors, which extend the half-life of levodopa or dopamine, respectively. However, dyskinesia control still represents a major challenge. As a result, many neurologists have become cautious when prescribing therapy with LD. This review summarizes the available evidence regarding the use of LD to treat PD and will also address the issue of LD delivery as a critical factor for the drug’s propensity to induce motor complications.Keywords: levodopa, motor fluctuations, dyskinesia, Parkinson’s disease

Keywords

• levodopa
• motor fluctuations
• dyskinesia
• Parkinson's disease