Of course. Nita

Brian Collins wrote:

> On Sat 04 Sep, Marg Meikle wrote:
> > Because of the  recent study about Requip being a better bet for Young
> > Onsets (holds off the dyskenesia longer), my neurologist took me off
> > Sinemet.  He put me on Mirapex though, as he said that chemically it is the
> > same aas Requip and he knows the  dosing better. Any thoughts on this?
> > Sounds  like they both are dicey for driving, but I think the Health Canada
> > warning bulletin was about Mirapex.
> >
> > Thanks.  Marg Meikle  43  / 2.5 mos. diagnosed, mother of a 20 month old
> > boy.
> >
> >
> >
> Hello Marge,  I feel a long note coming on because I feel very strongly about
> this subject, but first, let me amswer your direct question  : I think your
> neuro is probably right when he says that Mirapex and Requip are both about as
> effective for the job - That is, to substitute for levodopa in the early
> years with PD.  Having said that, I would urge you to have nothing to do
> with either of them. The idea of using agonists rather than levodopa in the
> early treatment of PD is plain stupid!!  You have put your finger on the
> real problem yourself: Side-Effects.  The family of drugs generally called
> 'Dopamine Agonists' are riddled with potentially dangerous side-effects,
> beside which, levodopa is a model of good behavoir. In fact, the only
> problem with levodopa is that you can take too much, which causes dyskinesia.
>
> Side-effects caused by agonists are many and varied. It appears that every
> one has his own set of side-effects which are unique to that person. You
> only find out by using them, and it may take months or more for the side-
> effect to show. I am talking serious stuff here: the recent problem of
> falling asleep while driving (Still unresolved) is typical of the sort of
> thing which can occur.
>
> Now let's talk about Levodopa.  To show what can be done with levodopa, I
> have had PD for 21 years (from diagnosis) ; I started taking Sinemet/
> Madopar in my second year; I continue to take about 800 mg per day of
> levodopa and am very comfortable with it.  Of course, for the last 6 years
> I have had to supplement the diet with a gradually increasing amount of
> Permax (Pergolide). I am now exceeding the original limits for Permax, and
> may just be beginning to see what may be a side-effect, but at least my
> exposure is only 15 Pergolide-years.  (6 years, ramping fron zero to 5 mg)
> The exposure if you start with an agonist on diagnosis, would be in
> the region of 60 to 100 Pergolide-years.
>
> Next, what is the reasoning which enables neuros to say with authority
> that it is advantageous to delay the introduction of levodopa? Let's
> start with a simple question: "What is Dyskinesia ? Answer: We don't know.
> We DON'T KNOW ?? How do you know then that it will be to your advantage to
> delay the introduction of levodopa? Well, dyskinesias get worse as time
> goes on, yes, and er, the amount of levodopa taken increases as time goes
> by. NO IT DOESN'T -Oh yes, thats right Well erm 'Motor Fluctuations' (They
> always say that when under pressure - The relevance to the subject is
> anybodies guess.
> And that is literally the extent of the reasoning that I have been able to
> glean.  The hope is that if you delay the introduction of Sinemet by say,
> 2 years then at the other end of your life, when we know that it gets more
> and more difficult to control the Parkinsons symptoms, you will buy more
> time before that unhappy event. And that is all it is - a hope.
>    I have a simple amd logical explanation which is naturally linked to
> the number of Substantia Nigra cells remaining. Since nobody has yet
> managed to alter the rate of deterioration of the Substantia Nigra in any
> way, just how do they think they are going to exercise this wonderful feat,
> and at a range of XX years (Fill in however many years you are planning
> to live.)
>
>    I do know of one, inevitable result which will come from the adoption
> of this philosophy - Smith-Kline-Beecham will sell a LOT more Requip..
>
> Now we are talking Big Business!
> Does anyone out there see things my way??
>
> Regards,
>
> --
> Brian Collins  <[log in to unmask]>