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hi gerry - brig is extremely fortunate, and not just if her onset was on the young side. a 1987 study (Quinn N, Movement Disorders, Vol 2, No 2, pp. 73-91, 1987) showed the following regarding young onset (under 40) and l-dopa: 20% chance of dyskinesias within one month on l-dopa 55% chance within one year 74% chance within four years (at 2 year mark, 50% of dyskinesias classified as “often causing functional disability”) 100% chance within six years and 10% chance of on/off fluctuations within one month on l-dopa 38% chance within one year 50% chance within 2-3 years 96% chance within 6 years In the 2004 article entitlled “Levodopa in the Treatment of PD: Current Controversies,” a team of researchers led by Warren Olanow states that DOOFs occur in approximately 50 - 80% of PD patients who have received l-dopa for more than 5 to 10 years,”* which is telling even in spite of its ambiguity. In May 2005, Olanow made a presentation as part of a Continuing Medical Education event called “Spotlight on Parkinson’s” in which he was considerably less ambiguous, saying “motor complications affect approximately 80% of patients treated with levodopa for > 5 years” and “develop in approximately 100% of young-onset PD patients.”’ Dr. Kapil Sethi cites a 1997 study by John Nutt published in the Annals of Neurology (for which one cannot even pay for access) in his presentation at the same Continuing Medical Education event saying that “a majority of patients develop motor fluctuations even during the first year of therapy,” and, from the DATATOP trial, “wearing-off has been reported in 50% of patient within two years of L-dopa therapy.” I know I saw Stanley Fahn also quoted as citing the 80% number - can’t remember if it was within 5 or 10 years - but can’t lay my hand on it right now. A 2005 study (Kumar N, Movement Disorders, Vol 20, No 3, pp 342-366, 2005) found that within 5 years, onset at age 40-49* had a 40% chance of developing dyskinesias, 50-59 had a 53% chance, 60-69 a 26% chance, 70-79 a 16% chance, and 80-89 a 14% chance. *this particular age group only had a population of 5 people in this study - the next three age groups ranged from 19-35 people in size, and 80-89 consisted of 7 people Perhaps the most telling thing I have read so far was published in The Lancet a mere 10 years after l-dopa came to market in 1967. Unfortunately,The Lancet’s online archives do not go back to 1977, but there is an “abstract” on PubMed, and it says that patients undergoing long-term treatment with levodopa may run into problems, two of which: “...have emerged as frequent and serious, an insidious and progressive loss of benefit and the appearance of progessively more severe fluctuations in disability....Discovery of the exact causes for loss of benefit may provide a rational basis for new therapy.” So as long as 30 yearsago, l-dopa was acknowledged to be *inadequate,* both in terms of benefit (or loss thereof) and side effects, and yet it is still touted as the “gold standard.” Yes, everyone is different, and Brig is extremely fortunate- but if I had started l-dopa five years ago, I would be a mess today, and I wonder how many others there are or were out there like me - i also wonder what the definition of “toxic” is. I mean please - they called the Freed/Fahn fetal tissue transplantation study a failure because 15% of the subjects experienced non-levodopa induced dyskinesias even though according to at least one measure, there was "significant" improvement when off medication both in the transplant group as a whole and in the younger patients in the group - and at the same time, levodopa, which has an 80 - 100% chance of causing dyskinesias which, after 2 years, have a 50% chance (at least in young-onset,) of being functionally disabling, is hailed as the gold standard? It is hard to be sure that that comparison is valid without a PhD in neurology... but if it is, who, exactly, is doing the math, here? mackenzie --- Gerry Haines <[log in to unmask]> wrote: > For info., Brig has been on Sinemet for 20 years and > is now experiencing > some movement./ > Everyone is different. > Gerry > > ---------------------------------------------------------------------- > To sign-off Parkinsn send a message to: > mailto:[log in to unmask] > In the body of the message put: signoff parkinsn > __________________________________________________ Do You Yahoo!? Tired of spam? Yahoo! Mail has the best spam protection around http://mail.yahoo.com ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn