Parkinson's disease (PD) is one of the most common chronic neurodegenerative diseases. Levodopa provides the best symptomatic benefit with the fewest short-term adverse effects, but its use is associated with the development of motor fluctuations and dyskinesias. The introduction of dopamine agonists early in the treatment of PD leads to a delay of these motor complications, but all available dopamine agonists may cause profound adverse effects in some patients. The objective of this manuscript is to review the initial treatment, the neurotoxicity of levodopa, the swallowing disturbance and QOL of PD. Levodopa still is the gold standard for PD. However, the treatment decisions should be based on considerations of risks versus benefits for individual patients.