Why delay levodopa therapy for PD patients?


#1

The latest Pathfinder Newsletter (June 2015) contains the following snippet :

Levodopa is the main treatment for Parkinson’s but it can have side effects such as involuntary movements of the body.  If we can delay the need to take levodopa we could potentially give people years without the worry of such side effects.”

This seems at odds with the findings of a 4-year (2008-12) multicentre study whose primary objectives were to:

  • test the suggestion from some large drug trials that the initiation of levodopa therapy should be delayed to reduce the risks of motor complications in Parkinson’s patients
  • investigate whether the occurrence of motor complications is primarily related to the duration of levodopa therapy or to disease-related factors.

The study concluded that motor fluctuations and dyskinesias are not associated with the duration of levodopa therapy, but rather with longer disease duration and higher levodopa daily dose.

[see http://www.ncbi.nlm.nih.gov/pubmed/25034897 ]

Hence, the practice to withhold levodopa therapy with the objective of delaying the occurrence of motor complications is not justified.

This concurs with my personal experience whereby following diagnosis I was prescribed a significant levodopa overdose resulting in dyskinesias, vivid dreams, muscle cramps – all eliminated through being evaluated by a Movement Disorder Specialist who prescribed an effective levodopa regime,  With symptoms now well under control I consider this far preferable to postponing treatment with the worry of an inevitable uncomfortable future.

It would be interesting to hear of others’ experiences.


#2

I'd sum it up as the more you take the sharper the ON/OFF changeover occurs, but starting on low doses asap helps manage symptoms so well it can help minimise the cocktail of other meds required early on.