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The long-term results of levodopa therapy in Parkinsonian patients is described. Between January 1969 and December 1972, dopaminergic therapy was started in 186 patients with Parkinson's disease. Their progress after six months, five years and in the autumn of 1980, was assessed. The initial benefit in the majority of patients was followed by a gradual loss of efficacy in most patients with increasing side effects of central-mediated type. We suggest that it may be wise to delay the onset of levodopa therapy until progress of the disease makes treatment imperative.

IMPAIRMENT of speech, leading sometimes to unintelligibility, was recognized by Parkinson1to be part of the disease which now bears his name. Reduced voice volume, dysarthria and prosodic monotony are common manifestations of Parkinsonism2and are generally attributed to hypokinesis, a cardinal feature of the disease, the physiological basis of which is ill understood. The term itself is difficult of definition, but it is generally thought to imply a delay in initiation of movement combined with slowness and restriction in amplitude of movements once initiated.