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Advanced Neurology George Cotzias and L-DOPA therapy

His paper “Modification of Parkinsonism: chronic
treatment with L-DOPA” published in the New England
Journal of Medicine, in 1969, presented the findings of
the study. 3,7,16,34 As Oliver Sacks mentioned in his book
“Awakenings,” it was in 1969 that Sacks, at the Mount
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Carmel Hospital, administered L-DOPA to his patients.
Sacks vividly described the unexpected and valuable
impact of L-DOPA on the patients’ health and lives. 73,74
He dedicated the book to the effects of L-DOPA, even
choosing the title “Awakenings” in reference to Cotzias’
use of the term to describe the transformative results of
the drug. The significance of L-DOPA eventually reached
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the cinema. In 1990, the movie Awakenings, based on
Sacks’ book, which was directed by Penny Marshall, with a
screenplay written by Oliver Sacks and Steven Zaillian, was
released to the public. 75 Figure 2. Internal L-DOPA and PD image. Copyright ©[2015] [Dr Dr
Mylonas Anastasios] . Reprinted with permission of Dr Dr Mylonas
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The article and the study’s video recordings by Cotzias Anastasios.
fascinated Melvin Yahr to such a degree that in 1969,
he and his research team started a study on L-DOPA 5.2. Further benefits of L-DOPA
therapy. 1,2,7,19,33 Yahr’s study was the most important research
of that time because it comprised the first prospective, Responsiveness to L-DOPA is considered a hallmark of
double-blind, controlled clinical trial, which included PD diagnosis. 28,54 It was the only treatment that filled the
46
a placebo to emphasize the effect of L-DOPA. 1,2,7,19,32,33 dopamine gaps in the brains of PD patients. It is worth
The study enrolled 60 patients, 1,2,7,19,33 of whom 56 were noting that Cotzias himself in his scientific study had shown
diagnosed with idiopathic PD, three with postencephalitic that L-DOPA has the capacity to stop the progression
35
parkinsonism, and one with probable progressive of PD. L-DOPA helped millions of Parkinsonian
7,46
supranuclear palsy. 2,7,19 The study clearly indicated that patients worldwide. Levodopa had impressive results,
the beneficial dose of L-DOPA could vary between 3 and especially in the early stages of PD in improving tremor,
8 g/day, dyskinesia was an inevitable side effect, while bradykinesia, and rigidity. 4,34,66 Commencing L-DOPA
cardiac arrhythmia, vomiting, nausea, and hypotension since the early stages of PD means living a better and
were defined as self-limited adverse effects of L-DOPA. 2,7,19 longer life because it offers a greater improvement in the
st
Furthermore, according to the study, L-DOPA had unique 1 year of the disease, without side effects on later years,
positive results that a placebo could not provide. At least and keeps the subject active, physically and mentally,
7
68
80% of the participants significantly benefited, and more which means middle-age prepared for older. L-DOPA
1,7
than 90% of the patients had at least 20% improvement was proven to be non-toxic, easy to administer, and a
not later than 4 months of treatment. The conclusions of better-tolerated therapy, which could also ameliorate
7,33
Yahr’s study confirmed the positive therapeutic effects of the health condition of manganese-poisoned people
Cotzias’ earlier study. 1,7,19,21,29,32,33,61 After confirmation from with no impulsive movements. 3,8,32,46,69 Another precious
Yahr and other scientific studies, L-DOPA was recognized characteristic of the therapy was the ability to alleviate
as the most effective treatment for PD at all stages. 7,25,33,60 the consequences of PD, which, in certain cases, have
35
While it does not impede the progression of the disease, been proved fatal. 7,15,18,41,50 In other words, L-DOPA saved
in at least 50% of cases, it can significantly improve the the lives of many people with PD. Even though previous
patients’ QoL. 20,35,37,66 L-DOPA remains the standard studies, with doubtful results, claimed that there were cases
therapy for PD. 52,54,59,60,62-67 in which the use of L-DOPA therapy caused deterioration
of neuronal degeneration and toxicity, there was no strong
In 1970, the Food and Drug Administration approved evidence to support their hypothesis. 17,22,37,41,69 Moreover,
L-DOPA therapy. 3,7,19,28,32,34 none of these studies failed to emphasize the positive
Cotzias et al. classified the invention of L-DOPA as “the influence of L-DOPA on Parkinsonian people’s health and
most significant contribution to the medical treatment lives. 25,28,37,41,69 It has been proved that the revolutionary
of neurological examinations in the past 50 years.” and the most effective therapy for PD, L-DOPA, possesses
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Nowadays, it is the cheapest and most prescribed neuroprotective abilities and can halt the progression of the
antiparkinsonian drug (Figure 2). 42 disease. 2,4,7,8,21,34,35,70 Yet, the unsatisfying L-DOPA response

Volume 4 Issue 2 (2025) 45 doi: 10.36922/an.5177