 |
 |
Dear Brian, You are describing the non-tremor form of Parkinson's disease, which starts at a later age, usually doesn't show any tremor, progressive course with slowness of movement and gait disturbance, not very effectively respondnding to anti-Parkinson medciation and frequently requiring high doses of meds. In addition, a higher chance of dementia in this patient group. All these different characteristics in different patients is yet another evidence that the cause of Parkisnon's disease must be multi-factorial. Thus, a cure may be found in a subgroup of Parkinson patients, but not in the other. As a neurologist one should be aware of all these differences, one to optimalize treatment and second to fully inform the patient and the family about the course of the disease, treatment options, prognosis etc. Chris van der Linden, M.D. > Hello Chris, I found your comments about under-dosed patients most > interesting. Do you think that the major factor is really that the patient > is not being tested frequently, or is it something more fundamental? My > reason for asking is that among the many and varied symptoms displayed, > I have begun to notice a significant number of PWPs with an interesting > characteristic: When treated with levodopa, starting from zero, they show > progressive benefit up to about the level that one may call 'normal'. As > the level continues to increase however, these PWP s do not develop > Dyskinesias as I would, -they just get sleepy! And as the levodopa level > goes higher, they become almost comatose as long as the levodopa > lasts. The trouble is that it is almost impossible to determine the > optimum dose, and I often find them taking 1600 mg per day (Twice my > level, and one memorable friend who chomped his way through 3000 mg/day. > This is so different to the 'average PWP' I wondered if the symptoms > were known to you? > > (Other symptoms which this group display are: No hand resting tremor: > Main characteristic- stiff legs- patient has to resort to wheelchair > at an early stage. > Regards, > -- > Brian Collins <[log in to unmask]> (59/39/34) >