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Chris, I agree, but wouldn't you say also that it is wise to withhold l-dopa as long as the patient is reasonably comfortable and reserve it for those people whose quality of life is being materially affected? I for instance started l-dopa about 4-5 months after diagnosis and a trial of bromocriptine which only helped slightly (that was about all there was at the time). If for instance ropinerole or or Mirapex had been available and worked for me wouldn't the dyskinesia which I have been suffering with almost as much as PD itself have been delayed? It is certainly ridiculous to suffer when there is l-dopa around which clearly is the "gold standard". But if you don't have to use it doesn't it make sense to keep it in reserve? Charlie Chris van der Linden wrote: > Any combination of meds without levodopa will eventually not be sufficient > to do the job. Levodopa is really necessary to get the optimal response, > even at an early and later stage. (no I don't have stocks Merck Sharp and > Dohm, but just a note from my professional experience!) > > Chris van der Linden, M.D. -- ****************************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************