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Promise and Problems

Caroline M. Tanner, MD, PhD

JAMA. 2000;284:1971-1973.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The successful use of levodopa, the immediate precursor of dopamine, to reverse motor deficits in Parkinson disease (PD) revolutionized treatment.¹ But for most patients with PD, the benefits of levodopa therapy have been tempered by adverse effects such as involuntary movements or hallucinations. These adverse effects occur in as many as 90% of patients receiving long-term treatment, although whether they are actually caused by levodopa treatment, or simply reflect progression of the underlying disease, is unknown.²

Some evidence suggests that levodopa may injure substantia nigra neurons.^3-4 Thus, the patient with PD is thrust into an almost untenable therapeutic double bind—does effective short-term symptom relief cause permanent nerve cell loss and ultimately a more malignant disease course? As a result, patients with PD commonly are not treated with levodopa until motor disability interferes significantly with independent functioning. The emotional and economic costs of this treatment approach . . . [Full Text of this Article]

Author Affiliation: Parkinson's Institute, Sunnyvale, Calif.

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