Levodopa for the Treatment of Parkinson's Disease

• Published in: The New England journal of medicine Vol. 359; no. 23; pp. 2468 - 2476
• Main Author: LeWitt, Peter A
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 04-12-2008
• Subjects: Antiparkinson Agents - adverse effects; Antiparkinson Agents - therapeutic use; Biological and medical sciences; Blood-brain barrier; Brain - metabolism; Brain Stem - pathology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dopamine; Dopamine - biosynthesis; General aspects; Handwriting; Humans; Levodopa - adverse effects; Levodopa - metabolism; Levodopa - therapeutic use; Male; Medical sciences; Middle Aged; Neurology; Neurons - metabolism; Parkinson Disease - drug therapy; Parkinson Disease - metabolism; Parkinson Disease - pathology; Parkinson's disease; Patients; Practice Guidelines as Topic; Medicine; Agonist; Nervous system diseases; D2 Dopamine receptor; Treatment; Central nervous system disease; Parkinson disease; Degenerative disease; Levodopa; Antiparkinson agent; Cerebral disorder; Extrapyramidal syndrome
• ISSN: 0028-4793; 1533-4406
• DOI: 10.1056/NEJMct0800326

A 62-year-old man presents with Parkinson's disease, and treatment with levodopa is recommended. Levodopa, a naturally occurring amino acid that is metabolized to dopamine in the brain, is considered the most effective drug available for Parkinson's disease. However, after several years of therapy, serious side effects, including motor fluctuations and dyskinesias, may occur.
A 62-year-old man presents with Parkinson's disease, and treatment with levodopa is recommended. Levodopa is considered the most effective drug available for Parkinson's disease. However, after several years of therapy, serious side effects, including motor fluctuations and dyskinesias, may occur.
Foreword
This
Journal
feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are reviewed. Relevant formal guidelines, if they exist, are presented. The article ends with the author's clinical recommendations.
Stage
A 62-year-old man presents with weakness and impaired coordination. The physical examination discloses a resting tremor of the right hand, with mild rigidity at the right wrist, and a slow, shuffling gait. The patient is referred to a neurologist, who makes the diagnosis of Parkinson's disease and initiates therapy with amantadine. Initially, there is improvement in the patient's condition. However, during the next 2 years, the patient's tremor worsens, and his handwriting becomes notable for small letters. His movements also become slowed in the left arm. At this point, the neurologist considers therapy with levodopa.
The Clinical Problem
Parkinson's . . .