Subject: Who's Afraid of Levodopa

Hello folks,
           I keep seeing comments in mail to the list along the following
lines:

* Has anyone (not on sinemet) had success in reducing tremor....etc

* I do not wish to use Sinemet as yet but would like to try an agonist....

* Once a person starts Sinemet there is no turning back...

* He feels that a person builds a resistance to it ....

I Would like to set the record straight.  The following comments have the
agreement of many neurologists, and I discussed the subject today with a
highly respected neurologist,in the course of a long conversation. None
of what I say here is new - in fact the same subject was debated  in this
forum only a few months ago. At that time, several people felt that what I
was saying was so far out that they went straight to their neurologists
to get their comments, and several of you were good enough to report back
to me that their neuros had endorsed what I said. Nobody came back with a
dissenting comment from am authoritative source.

Nonsense no.1 Put off the introduction of levodopa for as long as you can
     because it will be of more use later when things are getting worse.
     WRONG : Early introduction of levodopa has nothing whatever to do
     with difficulties in getting the dosages right in later years.  The
     simple fact is that PD is a Degenerative disease: It always gets
     worse: It never gets better, and as the number of functioning dopamine
     -producing cells gets ever smaller, so the difficulty of bridging the
     gap with tablet-derived levodopa become more difficult. ( I have
     produced a chart which illustrates this process - many of you already
     have copies.)

Nonsense no. 2. Once started,there is no turning back. Let's accept that
     there are a few people who have the misfortune to have a bad reaction
     to levodopa. Fortunately they are vey few, and thhey have my sympathy.
     I don't know of anyone else voluntarily giving up levodopa once
     started , for the simple reason that it works! And don't forget that
     it is replacing a missing substance (Dopamine) with ....more Dopamine.
     Why oh why are people happy to tank up on alien chemicals with lists
     of potential adverse reactions as long as your arm, and yet shy away
     from a chemical which occurs naturally in the brain?
        If you are one of those people who think that it is not "natural"
     unless you take the chemical as part of your diet, then go ahead and
     eat Fava beans. They contain the genuine article, just like in the
     tablets.  The only snag is that you must eat about two buckets full
     a day, and you won't have many friends left......
     Levodopa is not addictive, unlike Selegeline for example (- produces
     amphetamine in the brain)


Nonsesense no.3. The brain builds up an immunity to levodopa, requiring
     more and more levodopa. WRONG.  All the available evidence shows
     that the minimum quantity of dopamine required by the brain to
     function correctly remains essentially constant ( it may rise very
     slightly). Of course, as more brain cells die, so more 'external'
     levodopa will br required to compensate.

Nonsense no. 4 I can get by without levodopa, just using Artane,  Permax,
     Bromocriptine, Amantadine, etc....
     WRONG.  OK, inthe first year or two or maybe more if you are 'lucky'
     enough to have the slowly deteriorating type of PD, you can manage
     (just) to combat the symptoms. However what have you achieved by this
     great effort? For the first ten years after I started on levodopa, I
     played a fairly good game of Badminton to keep fit. ( Finally had to
     stop with an inflamed rotator cuff tendon). The simple fact is that
     a lot of compounds will allieviate the symptoms, simply becuse it
     only needs a little push to top up the missing quantity. AND don't
     forget those side effects !!

     Of course, dopamine agonists have their place in the game: used as an
     adjunct to levodopa, they seem to take the place of Dopamine in a
     relatively small small number of cells, allowing a slight reduction
     in levodopa, thus widening the target 'window' that we are aiming at.
     However, the effect is small compared to levodopa.

 I know that I must sound like a commercial for Sinamet, but I am just
 putting the facts in their proper perspective. I know that I can expect
 some lively debate so come on all you doubters - my cards are on the
 table.

Regards,  Brian Collins