More that 20 years of clinical experience with levodopa therapy in the management of Parkinson's disease has confirmed unequivocally that quality of life is substantially improved in the majority of patients with Lewy body Parkinson's disease. Levodopa probably reduces the number of deaths in patients with Parkinson's disease in the first 6 years of treatment. The decision when to start levodopa therapy is always an individual one, but virtually all patients will be receiving the drug within 3 years after diagnosis. Current treatment strategies endeavor to control symptoms with smaller daily doses, and the use of controlled-release levodopa formulations and the combination with a dopamine agonist and/or selective monoamine oxidase inhibitors has also proved beneficial in many patients. The advent of catechol-O-methyl-transferase inhibitors and their use in combination with levodopa is also likely in the next few years to lead to further therapeutic benefits.