[Madopar: more than 20 years].

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.