Brian,

PWP's who suffer from 'end of dose' dyskinesia usually suffer from 'start
of dose' dyskinesia too. You don't report that. Nevertheless it is possible
that
your reaction on overdosing is the same as a regular (as is described in the
typical DID-reaction) 'end of dose' reaction. The past years it hardly happened
to me I overdosed myself to the point of having the top of med's dyskinesia. So
if your reaction is the same it is not triggered by the same stimuli. Maybe
your end of dose dykinesia is not at all the same as the
one that is part of the DID way of reacting.
Maybe you simply can't react the DID way, like someone who has no Parkinson
can't react on dopamine the way PWP's do. If that is true, count your blessings.

For a long time I did assume I had to fight my dysk. by taking less
sinemet and so I have  tried (among others) the liquid form. It has been
confusing for me. Now that I take my sinemet dose more concentrated in a
smaller part of the day and as a consequence kick the habit every day, my
dyskinesia is only a fraction of what it was before.
I do not think at all this is the best thing to do for everyone. I am
convinced the so called DID's are a minority in Parkinsonia.
About your advise, to be carefull with the quick start, you are right. In
my experience the immediate consequences of being overdosed may not be
worse than being underdosed, but, after the overdosing it is more difficult to
go back
to the most feasible equilibrium.
That's why it makes sense to increase PWP's awareness of these matters.

                               Ida Kamphuis, 53/12+
                                        Holland


Brian, You wrote:

> > The idea of crushing the tablet reminds me of something I read this
week in an earlier APDA newsletter (Spring 1996).  There's a column by
Enrico Fazzini, D.O., Ph.D (Asst Prof. Neurology, NY Univ.) that includes
brief answers to readers questions.  One reader says, in part, that it takes
up to an hour for his Sinemet CR dose to start working.  Fazzini replies
for this specific PWP that, in part, perhaps taking a regular 25/100
Sinemet (not CR) simultaneously with the Sinemet CR would help. I want to warn
you of a danger inherent in the process,....>>

> 1. These notes are based on my own observations, using my analysis
> program, but I have analysed a few other people; enough to know that my
experience
> is not so different to other PWPs, BUT ONLY those who are well down the road
> with PD. People with less than 7 or 8 years of PD are unlikely to have
> experienced these particular phenomena.
> 2. When I manage to hit the magic 37 mg per hour, the effect is almost
> as if I do not have PD; it really is that dramatic..
> 3. There is though, another way to get through the day: One which at
> first sight seems quite good, (- but I have my doubts....) To follow this
> route, you have to take a booster shot of levodopa, typically first thing in
> the morning. 'Kick-starting' the system seems to be the idea, and of
> course it does just that. You can imagine that it takes more time to approach
37
> mg/hr by rounding off as it gets to the target value, than it does if you go
> shooting through the 37mg/hr target, on your way to a condition
> corresponding to a much higher dosage.
> >>>>>>>>>>>>>
> The killer blow comes when you try to get out of the 'Twilight Zone'.
> You can do no more than shut off the flow of levodopa and wait :- and as
> the descent begins, so do the dyskinesias. They are very distressing in my
> case, and I assume that they are what is called 'End-of-dose Dyskinesias'
> 6 If this is so, then I have described a way to produce End-of-dose
> Dyskinesias, and a way to avoid them. What I don't have is an
> explanation of the phenomenon. Still, you can't have everything....
> I would appreciate comments on these observations, especially those
> who have experienced the end-of-dose type of dyskinesias.
>
>
> Regards,
> --
> Brian Collins  <[log in to unmask]>
>