On Mon 09 Dec, elizabeth leslie wrote:
> Brian, will you say a little more about neuros who still believe in
> delaying levodopa?  Maybe help me understand the pros/cons of
> conservative/progressive approaches.  I'd sure be a lot happier at this
> stage if I could get some more mobility in my left hand, and if this
> clearly associated backache (which responds minimally to physiotherapy)
> could be lessened.  But I too feel cautious about commencing other
> medication (taking Eldepryl 10 mgs per day now).
>
> Beth Leslie
>
>
 You may be in the early days of your PD, and are
> > being trwated by one of the rapidly disappearing group who seem to think
> > that it is a good idea to delay the introduction of levodopa for as long
> > as possible (it isn't): Or you may be being treated by an MD whose last
> >update on PD was in 1955.

Hello Beth.  I will try to givc you a concise version of my views on this
subject. I have written at some length in previous emails, and you could
retreive these writings if you want to dig deeper. ( I suspect I've thrown
my copies  away).

This is in 2 parts: 1/ How the myth arose, and 2/ What I think really
happens.

1/ There are still quite a lot of doctors (and neuros) who seem to
still believe that it is better to delay the initiation into the mysteries
of levodopa until their hand is forced by the inability of whatever they
are taking to do the job.

The simple fact is that in the early days of PD, you don't need much extra
support from external sources, so there is a wide choice of 'solutions' to
the problem. The anti-cholinergic group( Artane etc.) the Dopamine agonists
(Bromocryptine, Permax(Celance), Requip). All of these can be used to make
up for a small Dopamine defiency which is the case in the early days, BUT
a small dose of levodopa can also achieve the same objective and (Once
again) with a far lower risk of unpleasant side effects

Levodopa seems to have a bad name because it is widely known that after
taking levodopa for a number of years, it becomes difficult if not
impossible to define a dose of levodopa which can control the symptoms
without provoking unpleasant dyskinesias etc. That is unfortunately true,
but what these simple souls seem to overlook is the fact (which we all know)
that PD is a progressive disease: It always gets worse; it never gets better
; there is no remission. hard facts to take on board, but that's the way it
is. This is why levodopa starts to struggle, and NONE of the so-called
alternatives can get near to providing relief from the symptoms by them-
selves at this time. What this means is that what you do in the early days
has nothing to do with what happens 10,15, or 20 years later. It is
programmed into us apparently, and we currently have no control over it.

I don't know if it will mean anything to you, but I believe that one good
chart can communicate more than hundreds of words. I am attaching a chart
that I use to explain why it gets more difficult to control PD in later
years.

There is one important point to keep in mind: in the early years of PD,
your brain can cope with large doses of levodopa (The chart explains why)
Doctors often prescribe the Madopar 250, or the Sinemet 275 tablets,  but
in my view, just because the brain can cope, there is no need to take such
large doses. Always go for the mimimum dose.

By using this theory I have managed to keep going fairly well on levodopa
for the past 16 years. Of course I use the dopamine agonists as well now (
currently Permax).

I hope this helps your understanding of the subject,

Regards,
--
Brian Collins <[log in to unmask]>