“Levodopa phobia”: A new iatrogenic cause of disability in Parkinson disease

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Abstract
Two recent research directions have raised question about the role of levodopa in treating Parkinson disease (PD). First is evidence that levodopa is toxic in nigral neuronal cell cultures.1 Second are clinical trials showing that compared to beginning therapy with a dopamine agonist, initial treatment with levodopa is associated with earlier appearance of dyskinesias and wearing-off fluctuations.2,3 There has been much publicity about these potential negative aspects of levodopa. I report two patients with PD who became disabled because their treating neurologists were fearful of prescribing levodopa because of the widespread publicity. #### Case 1. A 72-year-old man had been diagnosed with PD 3 years earlier. He was initially treated with ropinirole and required steadily increasing dosages up to 24 mg/day. Due to ongoing bradykinesia and gait …