Geogg
Sorry not to reply to you in an earlier reply.  I have just returned from 10
days and PAN (Parkinson's Action Network) and have a lot of catching up to
do.

In attempting to share my limited knowledge with you, here are my responses
to your questions:

Quest. 1. (part 1)  Has anyone diagnosed with PD, NEVER taken any prescribed
medication . .  .

Ans: Yes - but my guess is their quality of life after a while is nothing to
be desired!   Many "newly diagnosed" are only prescribed an agonist
(Mirapex, Requip, etc) based on studies that are still ambiguous, and must
have to do with the second part of your question.

Below are some of the studies' findings:

Dopamine receptor agonists in the therapy of Parkinson's disease.

Foley P, Gerlach M, Double KL, Riederer P.
Clinical Neurochemistry, Clinic for Psychiatry and Psychotherapy, University
of Wurzburg, Germany.

Forty years after its introduction by Birkmayer and Hornykiewicz (1961),
L-DOPA-based therapy of Parkinson's disease remains the central pillar in
the management of the disorder. Nevertheless, it is not unproblematic, and
dopamine receptor agonists play increasingly important roles in
antiparkinsonian therapy. Pharmacological and pharmacokinetic properties of
these agents are briefly reviewed and followed by a detailed summary of
available literature concerning controlled trials in Parkinson's disease. It
is concluded that there is little unequivocal evidence to suggest that any
of the major dopamine receptor agonists should be invariably preferred in
the therapy of Parkinson's disease; their application must be based on the
needs and responses of individual patients.
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15480844
* * *
Nippon Rinsho. 2004 Sep;62(9):1716-9.

[The therapy of wearing-off]

Murata M.
Department of Neurology, Musashi Hospital, National Center of Neurology and
Psychiatry.

Wearing-off, predictable end of dose deterioration, is one of the major
problems of long-term levodopa treatment for Parkinson's disease. The
mechanisms of wearing-off are (1) loss of striatal dopamine storage, (2)
change in the peripheral pharmacokinetics of levodopa and (3) modification
of dopamine receptors. The main therapeutic strategy for wearing-off is
continuous stimulation of dopamine system. For this purpose, we increase
frequency of levodopa doses and use long half-life dopamine
agonist(continuous stimulation of dopamine receptors), COMT inhibitor and
MAOB inhibitor (prolongation of the half-life of levodopa and dopamine), and
zonisamide (long-term increase of dopamine synthesis).
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15462390

Quest. 1 (part 2) . . . and if so, how rapid was their deterioration. Also,
were the symptoms as bad, or worse, than the increasingly severe
side-effects produced by the
medication  (whatever this may have been, as used by others?);

Symptom progression (deterioriation) is highly individualized, differing
greatly from person to person.  Medication results can vary due to weight,
rate of progression, metabolism, dosage, other medications administered
simultaneously, and a thousand other variables.  However, it makes sense
that to start initial therapy on L-dopa would not be best, as findings
definitely show that if one begins on dopamine therapy, the earlier the side
effects.  Also, the jury is still out on the neuroprotective qualities of
agonists alone, but some studies point in that direction.
* * *
Nippon Rinsho. 2004 Sep;62(9):1701-8. Related Articles, Links

[Treatment for patients with early Parkinson's disease]

Kikuchi S.
Department of Neurology, Hokkaido University Graduate School of Medicine.

Ad hoc committee of Japanese Neurological Society made a guideline for the
treatment of Parkinson's disease in 2002. Based on the chapter of treatment
for early Parkinson's disease, starting drugs were discussed in this
article. Three points should be considered in initiating the drug treatment,
that is, neuroprotection, motor complications, and side effects. In order to
demonstrate neuroprotection of dopamine agonists by using neuroimaging
techniques, CALM-PD CIT study (pramipexole) and REAL-PET study (ropinirole)
were done. There are, however, many controversies concerning neuroprotection
and no definite conclusion was drawn. On the contrary, the inhibitory
effects of dopamine agonists on the appearance of motor complications were
clearly elucidated by several large-scale studies. For the present, although
the side effects were reported more frequently in those treated by dopamine
agonists than by levodopa, starting the treatment by dopamine agonists were
recommended except in patients with dementia and in elderly patients, for
whom levodopa should be used first.
Source:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15462388

Quest. 2. Re. Pallidotomy: Many PWPs who have undergone this operation, and
gained relief on the side affected, find soon after that PD symptoms begin
to
manifest  on the opposite side of their bodies (Michael J. Fox is a
well-known
example.)  My question is, if the operation is NOT carried out on PWPs who
are affected  down one side alone, do the symptoms also spread to their
"good"
side?

Ans:  Michael J. Fox did NOT have pallidotomy, but a similar operation known
as Thalamotomy.
"Thalamotomy is a neurosurgical procedure, first introduced in the 1950s for
the treatment of Parkinson's type tremor, that selectively lesions a part of
the ventrolateral thalamus. Patients with benign essential tremor and
dystonia are also candidates for thalamotomy. This lesion relieves tremor of
PD but it does not prevent the progression or alleviate the predominantly
more incapacitating symptoms of akinesia, off phenomenon, postural
instability or bradykinesia."

The pallidotomy and thalamotomy "kill" the cells of the brain that are
causing the involuntary movements.  The progression of the disease will
continue  (or not continue) without other interventions.  Bilateral
involvment with PD symptoms is a reason the disease is considered
"progressive."
(See here for the staging instruments used in diagnosing PD progression)
http://www.neuroland.com/move/stag_park.htm
I hope this helps answer your questions somewhat.
Peggy

----- Original Message -----
From: MyFirstname Mylastname
To: [log in to unmask]
Sent: Sunday, February 13, 2005 2:02 PM
Subject: Same old questions?!


Could anyone enlighten me on the following, please:-

1. Has anyone diagnosed with PD, NEVER taken any prescribed medication . .
.
and if so, how rapid was their deterioration. Also, were the symptoms as
bad,
 or worse, than the increasingly severe side-effects produced by the
medication  (whatever this may have been, as used by others?);

2. Re. Pallidotomy: Many PWPs who have undergone this operation, and gained
relief on the side affected, find soon after that PD symptoms begin to
manifest  on the opposite side of their bodies (Michael J. Fox is a
well-known
example.)  My question is, if the operation is NOT carried out on PWPs who
are
affected  down one side alone, do the symptoms also spread to their "good"
side?

Thanks for your time and any clarification of one or both questions.

Best Wishes,

Geoff Wade

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