The quantitative 2-deoxy['4C]glucose autoradiographic method was used to map the distribution of alterations in local cerebral glucose utilization that accompanies clinically effective chronic L-dopa therapy of rhesus monkeys made parkinsonian by the administration of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). This pattern of changes was compared to the effects of a similar treatment regimen in normal monkeys. L-Dopa (100 mg with 10 mg carbidopa) was administered orally to normal and parkinsonian monkeys 3 times daily for 60-120 days prior to measurement of local cerebral glucose utilization. In parkinsonian monkeys treated with L-dopa, signs and symptoms of parkinsonism were controlled or suppressed, and widespread increases in glucose utilization were seen throughout the brain. Cerebral metabolic activity was increased both in areas rich in dopaminergic receptors, such as the caudate and putamen, and in nondopaminergic areas involved in motor functions. In many structures the rates of glucose utilization in L-dopatreated parkinsonian monkeys were increased to levels that far exceeded rates measured in normal monkeys. In sharp contrast, similar treatment with L-dopa in normal monkeys had little if any effect on local cerebral glucose utilization. L-Dopa, then, appears to have an action in animals with selective lesions of the substantia nigra pars compacta produced by MPTP that is distinctly different from its effects in the normal monkey.L-Dopa (3,4-dihydroxy-L-phenylalanine) is the most effective and commonly prescribed drug for the treatment ofParkinson disease. Treatment with this dopamine precursor diminishes the severity of many signs and symptoms of Parkinson disease, including bradykinesia, tremor, and rigidity, and often restores relatively normal motor function (1). Although its mechanisms of action are not fully understood, it is generally assumed that L-dopa enters the brain and is converted to dopamine, which then interacts with dopamine receptors to produce the therapeutic effects (2). A further implicit assumption is that the site of this action is in the striatum, which in Parkinson disease is depleted of dopamine as a result of the degeneration of the dopaminergic nigrostriatal pathway.In humans (3, 4) and nonhuman primates (5-8), 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) produces a typical parkinsonian syndrome, characterized by akinesia, rigidity, tremor, and flexed posture, that can be ameliorated by L-dopa treatment. MPTP administration causes almost complete and relatively selective destruction of the dopaminecontaining cells of the substantia nigra pars compacta and consequent depletion of dopamine and dopamine metabolites within the striatum (5-8). Because both the behavioral and the neuropathological characteristics of MPTP-induced parkinsonism in primates resemble human idiopathic Parkinson disease so closely, it appears that this syndrome provides an almost ideal animal model with which to study the effects of L-dopa treatment.The autoradiographic 2-deoxy['...