According to modern treatment principles, there is no justification for delaying treatment. The disease has been progressing for an estimated period of around 3–5 years before symptoms appear, and during this time the remaining nerve cells have increased dopamine production, but at the cost of increased dopamine turnover, which in turn increases the turnover and production of waste products, considered to be potentially harmful to nerve cells.
When you start taking anti-Parkinson’s medication, it takes at least three months for these adverse compensatory mechanisms to normalise – which is why it is very common for patients to feel that the medication is not helping at all. It does help, but it does not always relieve symptoms immediately.
It is incorrect to suggest that one should delay starting medication in order to ‘save’ medication. There is compelling evidence that attempting to delay starting medication in order to avoid complications such as hyperkinesia does not help. It is the duration of the illness and the severity of the dopamine deficiency that lead to hyperkinesia, regardless of whether one has delayed starting medication early or late.
According to current guidelines, the recommendation is to start medication as soon as there are sufficient symptoms to make a diagnosis. /Håkan Widner