On Sat 19 Apr, [log in to unmask] wrote:

> Well, Fred, that is his name is 65/15 with sever dementia and hallucinations.
> He has no dyskenisia's or tremors to speak of. He does have rigidity, and
> balance problems like we all have.  His medication schedule is approx. 6
> 25/100, 2 - 3 CR, 1 dprenyl, max out on permax, and clozaril for his
> hallucinations.  His neuro. is a doctor very well respected in the PD field,
> as a matter of fact is head of a movement disorder clinic.
> I just had a call from his wife saying that Fred had a very bad day. He was
> hallucinating that there was a group of people out his backyard today and
> that he even lowered the window to talk to them. Well there was nobody crazy
> enough to be oustide his window during a Rain/Snow storm that we had today.
> He is not taking any anti-depresents like Paxil, Zoloft ect. because it would
> have adverse reaction to clozril. To compound matters, Fred is a retired
> OB/GYN MD.
>

Hello Marv,  I am 57, was diagnosed 18 yrs ago, and can trace early symptoms
back 24 yrs, so I suppose that makes me a sort of geriatric young onset PWP !
I have also used levodopa continuously for the past 17 years.

Regarding your friend Fred, I can of course only comment in general terms, but
some thoughts do occur to me: He appears to be one of a quite sizeable group of
PWPs who have very little or no tremor, just stiffness. The trouble is that
if you start someone from this group on a gradually increasing dose of Sinemet,
they experience a reduction in stiffness, up to the point of either no or very
little stiffness , but if you continue to increase the dose, instead of
developing dyskinesias as most PWPs would, they just begin to get stiff again.
- They have the same symptoms when under-dosed and over-dosed. It is thus very
difficult to tell whether they are under- or over-dosed.

Could you explain what 'max out on permax' means? I take Permax with my
levodopa, but have been careful to keep my intake to 2mg/day (8 x 250 micro-gm)
I have a healthy respect for these Dopamine agonists: I would suggest that,
even though Permax is getting a fairly good reputation for freedom from side-
effects, it should be the first  to go. I believe that the current max
recommended dose is about 4 milligm/day: Fred should not be using more than
about 6 x 250 micro gm/day, in view of his hallucinations.

I would need to see a detailed record of Fred's Sinemet intake to comment on it.
but perhaps I can demonstrate the sensitivity of the correct dosage by quoting
my own case.  I take Madopar dispersible tablets because there is only 50 mg of
levodopa in each tablet, so I can break them down to get small increments  with
some accuracy. My dosage is 1 and a half Madopar Dispersible every 2 hours.
2 hours is the effective life of the tablet, so that 1.5 tablets gives 37.5
mg/hour. 2 tablets every 2 hours would give me strong dyskinesia, and 1 tablet
per 2 hours would not even get me out of the Off condition. But at 1.5 tabs
every 2 hours, I am almost as normal: I can drive, ride my bike, even (When I
really get the optimum dose) write legibly!
   I believe that most people have these characteristics, ( i.e. an optimum
dosage of  X milligrams every Y hours) even though X and Y may vary from person to person. I assume that Fred is in no condition to judge the effectiveness
of one dose versus another, but I do think that you would be nearer if you
took the first step by going to 1/2 a Sinemet 25/100 every 2 hours (or if the
Sinemet CR lasts 4 hours then one CR every 4 hours would be the same. That
is just a start though, so don't expect miracles.
  Well, I've rambled on a lot. I hope I have given you some pointers, and of
course If you have more questions feel free to ask.
Regards,
--
Brian Collins  <[log in to unmask]>