Amine metabolites in the cerebrospinal fluid in Parkinson's disease and the response to levodopa

The amine metabolites HVA and 5HIAA in the lumbar CSF of patients with Parkinson's disease were determined before and during treatment with levodopa. Residual symptoms after 3 months' treatment were significantly more severe in patients with higher pre-treatment HVA concentrations. The results suggested an association between the coexistence of relatively high pre-treatment HVA and low 5HIAA concentrations and a limited beneficial effect of levodopa. These findings are discussed in relation to the possible value of combined levodopa and tryptophan treatment of selected patients. Three patients, all with very severe rigidity and akinesia and mild tremor, showed a markedly fluctuating response to levodopa.