When the moment came for me to walk out on the 140-foot high scaffolding and take the torch from Janet Evans, I realized I had the eyes of the world on me. I also realized that as I held the Olympic torch high above my head, my tremors had taken over. Just at that moment, I heard a rumble in the stadium that became a pounding roar and then turned into a deafening applause. I was reminded of my 1960 Olympic experience in Rome, when I won the gold medal. Those 36 years between Rome and Atlanta flashed before me and I realized that I had come full circle.
Some controversy surrounds the appropriate time to initiate levodopa therapy. Early use (ie, in the patient with minimal symptoms and signs) leads to predictable treatment complications after several years of therapy. These include wearing off, on-off motor fluctuations, and the development of dyskinesias. The half-life of levodopa is only about 60 minutes, resulting in multiple peaks and valleys of drug level during a typical day of therapy. It is now believed that this pulsed stimulation of the dopamine receptors is non-physiologic when compared with the more constant and tonic physiologically normal state. After years of treatment, diminished efficacy, dyskinesias, or on-off periods (radical swings between functioning and nonfunctioning states) begin to appear. For this reason, it is current practice to initiate treatment with one of the dopamine agonists, which have longer half-lives than levodopa, when the patient's quality of life demands more aggressive treatment.