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First, Chris: Your collection of case reports about mental changes after DBS certainly deserves formal presentation to your professional colleagues, and in anticipation may I be the first to request a reprint of the article. Second, Andy: Evidently you have reached the "fluctuating" stage of PD, which in my view is when the shortfall of dopamine by the substantia nigra (notwithstanding possible abundance elsewhere in the body) is so severe that the effects of each intermittent dose of medication are felt individually. Since those effects decline or "wear off" steadily during the interval between scheduled doses, at some point we get emphatic, often painful, signs that medication is needed, scheduled or not. You needn't be a rocket scientist to see this relation between cause and effect, but it seems also some other factors are involved. For me, the end-of-dose signs vary with the time of day: Powerful muscle cramps (dystonia) occur only in early morning, after sleeping soundly right past the time I should have taken a dose of pills, and never in waking hours. Possibly muscles become more prone to cramps after prolonged inaction, or perhaps from chills due to accidental exposure. Years before I was diagnosed with PD, I occasionaly had similar cramps that were quickly relieved by heat, as by an electric pad. Now I wonder if that was preclinical PD. During daylight hours, my end-of dose signs are equally clear, but entirely different in nature. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013