Involuntary movement is one of the most disturbing and problematic side effects of L-dopa in the treatment of Parkinsonism. Several attempts have been made to reduce this complication, such as an addition of adjuvant, (4) and use of slow release L-dopa. However, the problem remains unsolved probably because hyperkinesis occurs when the akinesis of Parkinonism is overcorrected by L-dopa and produces hyperkinesis (15).
For more than 15 years we have been treating Parkinsonian patients with stereo tactic thalamotomy or pallidotomy or both and began to use L-dopa since 1968. We found that the previous operation reduces the incidence and severity of L-dopa in duced involuntary movements in the treated limbs suggested by several authors (1) (15) (17) Methods 121Parkinsonian patients have been treated with L-dopa since 1968 usually as in-patients. Among these, 94 cases had undergone stereotactic operation, unilaterally or bilaterally with 126 lesions before the trial of L-dopa. 13 of these cases (10.7%) had some history suggesting encephalitis. After the initial admission for the drug therapy, patients have been followed up in the out-patient clinic in one to six month intervals or by proforma completed by the patient or his relatives.The dosage of L-dopa ranged from 0.5 Gm. to 8.0 Gm. daily with the average of 4.2 Gm. for 60 males and 3.2 Gm. for 59 females. The average interval between the onset of Parkinsonism and the L-dopa therapy was 9.9 years for males and 10.0 years for female group, with the average onset of the disease of 49.0 years old and 51.1 years old respectively. The average dose was 3.9 Gm. daily in the involuntary move ment group and 3.6 Gm. in the non-involuntary movement group. Results 1) General comments:Among 121 patients with L-dopa, 29 cases (24%) developed involuntary move ments. 2 patients developed dyskinesia with relatively small doses of 1.5 Gm. daily.