Levodopa has remained the mainstay of clinicians’ armamentarium in the treatment of Parkinson’s disease for more than 50 years. However, levodopa is limited in its ability to control motor symptoms as the disease progresses, and its effectiveness is particularly reduced in patients with advanced PD. Two common problems associated with prolonged levodopa use are the so-called “wearing-off” and “on-off” effects leading to motor fluctuations and dyskinesias. Alternative therapies may therefore be required to control motor disturbances, including other disease modifying drugs and surgical intervention, but these too may cause complications. In advanced PD, the therapeutic strategy must be carefully considered to control motor disturbances without introducing unwanted side effects.