Levodopa in the treatment of Parkinson's disease: Current controversies

C. Warren Olanow, Yves Agid, Yoshi Mizuno, Alberto Albanese, U. Bonucelli, Philip Damier, Justo De Yebenes, Oscar Gershanik, Mark Guttman, F. Grandas, Mark Hallett, Ole Hornykiewicz, Peter Jenner, R. Katzenschlager, William J. Langston, Peter LeWitt, Eldad Melamed, M. A. Mena, P. P. Michel, Catherine MytilineouJose A. Obeso, Werner Poewe, Niall Quinn, R. Raisman-Vozari, Ali H. Rajput, Olivier Rascol, Christina Sampaio, Fabrizio Stocchi

Research output: Contribution to journalArticlepeer-review


Levodopa is the most effective symptomatic agent in the treatment of Parkinson's disease (PD) and the "gold standard" against which new agents must be compared. However, there remain two areas of controversy: (1) whether levodopa is toxic, and (2) whether levodopa directly causes motor complications. Levodopa is toxic to cultured dopamine neurons, and this may be a problem in PD where there is evidence of oxidative stress in the nigra. However, there is little firm evidence to suggest that levodopa is toxic in vivo or in PD. Clinical trials have not clarified this situation. Levodopa is also associated with motor complications. Increasing evidence suggests that they are related, at least in part, to the short half-life of the drug (and its potential to induce pulsatile stimulation of dopamine receptors) rather than to specific properties of the molecule. Treatment strategies that provide more continuous stimulation of dopamine receptors provide reduced motor complications in MPTP monkeys and PD patients. These studies raise the possibility that more continuous and physiological delivery of levodopa might reduce the risk of motor complications. Clinical trials to test this hypothesis are underway. We review current evidence relating to these areas of controversy.

Original languageEnglish
Pages (from-to)997-1005
Number of pages9
JournalMovement Disorders
Issue number9
Publication statusPublished - Sept 2004


  • Dyskinesia
  • Levodopa
  • Moto complications
  • Neurotoxicity
  • Parkinson's disease

ASJC Scopus subject areas

  • Clinical Neurology
  • Neuroscience(all)


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