Parkinson's disease (PD) affects 145,000 people in Japan. Most of these patients are treated with levodopa in combination with other anti-PD therapies. In order to maximize efficacy and patient satisfaction, this survey was conducted to investigate patients' perspective of current PD management in Japan. This survey was conducted in 2008 by questionnaire (3,935) and interview (407). The majority of responders were members of the Japan PD Association. Severity of PD, medication, impact of wearing-off, and patients' attitudes to therapy were assessed. Most patients (95%) were on levodopa, with an average dose of 370 mg/day. Although dose increased with duration of treatment, the majority of patients remained within 300-400 mg/day. Patients with wearing-off were less satisfied with their therapy than those without wearing-off (36 vs 49%). Most patients are less concerned by mild dyskinesias. Hallucination is the most distressing side effect. For patients preferring mobility over dyskinesia, levodopa should be dosed sufficiently, and possibly titrated, to maximize clinical benefit and patient satisfaction.