A 72-year-old woman was seen with her husband at the movement disorder clinic. She was referred by her attending neurologist who has been following her for 9 years for Parkinson’s disease (PD). Her symptoms had begun 10 years ago, with a left arm tremor that progressively worsened to affect the left side of her body and her right arm. The tremor was accompanied by generalized slowness of movement and stiffness. She was put on l-3,4-dihydroxyphenylalanine (L-DOPA) 8 years ago with a good initial response. Doses were progressively increased over the years. When seen at the clinic, she was taking L-DOPA/carbidopa (referred to as L-DOPA) 100/25 mg 1.5 pills every 3 hours from 6:00 a.m. to midnight, a total of 10.5 pills daily. Sometimes, she had to take an extra pill at night because of difficulty turning over in bed. She believed the effect of the antiparkinsonian medication was not lasting more than 2.5 hours and felt uncomfortable, with tremor resurgence, about 30 min before taking the next L-DOPA dose. Approximately 1 hour after L-DOPA intake, she would present fidgetiness and mild abnormal movements that were not bothersome but that were noticed by her husband and children. She had a few accidental falls. She sometimes experienced dizziness upon standing up rapidly. Approximately 1 year ago, she began experiencing visual hallucinations (VHs) that were, at times, frightening and prevented the neurologist from increasing L-DOPA doses. Most of the times, the VHs consisted of bugs, but on a few occasions they encompassed faces of unknown people. She had to be put on quetiapine 25 mg a.m. and 50 mg at bedtime to alleviate these VHs. Her husband was also concerned that she had become more forgetful in the past year. She was more apathetic and was not interested in going out anymore. At times, she was going through episodes of confusion. She was also experiencing episodes of daytime sleepiness and would have to nap for at least 1 hour every afternoon.