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To: Bruce McCallum: Re: Sinemet, early or late Dear Bruce (and Listmembers): I am responding, as promised, to your query of February 16, regarding the advisability of starting Sinemet early or late, this based on concerns that Sinemet *may* "hasten the destruction of dopamine-producing cells". I queried a neurologist friend of mine, and below is his response: ------------------------------------------------------------------------ ------------------------ >>There is disagreement among the experts on whether to begin Sinemet early or late and it is my impression from reading both sides that the disease is sufficiently variable that, unfortunately, no one knows. Just as the tremor or bradykinesia or imbalance may predominate, so the rate of progression varies as well. Based on what I know, Eldepryl acts differently from Sinemet. As a mono-amine oxidase inhibitor (mild), it is an anti-oxidant and a study out of Scandinavia a few years back, an autopsy study, suggested that early Rx with Eldepryl appeared to spare the pigmentation in the substantia nigra. My practice is - based on the patient's inclination - to start ELDEPRYL early and SINEMET later. But that's just my worm's eye view.<< ------------------------------------------------------------------------ ---------------------------- Hope that this is helpful. Best, Bob -- ******************************************************** Robert A. Fink, M. D., F.A.C.S. Phone: 510-849-2555 Neurological Surgery FAX: 510-849-2557 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 USA E-Mail: [log in to unmask] CompuServe: 72303,3442 America Online: BobFink "Ex Tristitia Virtus" ********************************************************