Servicio de Neurologia,
Hospital General Universitario de Alicante, España.
OBJECTIVE: To review the main landmarks
which led to the introduction of levadopa in the the
treatment of Parkinson's disease and the impact of
levadopatherapy. DEVELOPMENT: The introduction of
levadopa was based on the results of basic scientific
investigations in neurochemistry and neuropharmacology.
In 1959 the possibility of dopamine being a neurotransmissor,
and the role it plays in motor control, had been discovered.
In 1960, Hornykiewiez and Ehringer published a paper
on the existence of a marked deficit of dopamine in
the caudate nucleus and putamen of patients with Parkinson's
disease. Almost simultaneously, Birkmayer and Barbeau
treated their patients with levadopa for the first
time. However, levadopa was not introduced into clinical
practice until 1967 and 1969 when Cotzias published
papers establishing the principles of levadopatherapy
as we now know it. Introduction of levadopa produced
a markedly beneficial effect on the course and mortality
of Parkinson's disease. However, it was soon seen
that progression of the disease was not halted and
that undesirable side effects appeared in patients
on long-term treatment. This has led to the development
of strategies to prolong the beneficial effects of
levadopa and minimize its side effects. CONCLUSION:
More than 25 years after the introduction of levadopatherapy,
it is still the mainstay of the treatment of Parkinson's
disease, in combination with other medical and surgical
treatment. Definitive treatment, however, will have
to wait until the cause of this illness is fully understood.
