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Brian Collins wrote eloquently about this
Subject: When to start PD Medicines

  <To: Cindy Birk Conley

  <Hello Cindy, I think you will find that the opinion among the majority of
  <neurologists these days is that the timing of the introduction of Levadopa
  <(which is by far the most important drug in overcoming the symptoms of PD),
  <does not influence the duration of effectiveness, or the build-up of
  <tolerance.  The view expressed by your doctor is ,I think, governed by the
  <observation that later on it becomes more and more difficult to find a
  <dosage regime for Levadopa( Usually the drug Sinemet) which is effective
  <and without side effects. The probability however is that this increased
  <sensitivity is caused by the continuing progress of Parkinson's Disease,
  <which always gets worse, never gets better, and would have got there with
  <or without the use of Levodopa.
  <There is a warning however: Some doctors go a bit overboard with this
  <strategy, and prescribe large doses such as the 250mg version of Sinemet.
  <Your mother will probably be able to take even that high quantity in her
  <present state, but later on there could be trouble. The message is: Only
  <take enough to do the job, and creep up to that minimum level slowly and
  <carefully. In fact that is good advice to apply to all Parkinson's Drugs;
  <they are powerfull drugs and should be treated with care. But for the
  <improvement that they provide, it is worth the effort.

  <Regards,  Brian Collins.

Hi Brian,

I have often wondered about this. There does not seem to be a constancy in the
way
doctors prescribe PD medicines. Each seems to do his own thing.
When I was diagnosed 5 years ago