This 62-year-old former accountant presented to a neurologist with complaints of a right hand tremor, slowness, and gait difficulties. He was diagnosed with Parkinson’s disease (PD) and received pramipexole up to 1.5 mg tid. On this medication, he reported being well for 2 years. After 3 years of evolution, levodopa/carbidopa was introduced because of a worsening of his parkinsonism. His tremor was initially significantly improved by levodopa, but the effect was lost after less than a year. Higher doses caused episodes of hypotension and also spasms of his neck and toes which were treated with clonazepam. At the fifth year, he developed significant freezing of gait and needed a walker to ambulate safely.