Among the number of books I've devoured in order to learn more
about my Parkinson's Disease, one that stands out is John G.
Nutt, et.al., PARKINSON'S DISEASE:100 MAXIMS (1992). It is the
second volume in the series 100 Maxims in Neurology written for
primary care physicians. One of the maxims states a theme that
has been constant here on our information network, namely, we as
patients should exercise some control over our medication
schedule. Let me quote at length maxim # 60 (pp.85-86).
"THERE ARE ADVANTAGES AND DISADVANTAGES TO PATIENT
SELF-TITRATION OF SINEMET.
The need for levodopa is not constant from day to day. Many
patients find that if they are active they require more levodopa.
Likewise, if they are going out for the evening they may need an
extra dose of levodopa. On some days, because of dietary or
unknown causes patients seem to require more drug; on other days,
however, the dyskinesias may be prominent such that increasing
the dose intervals or reducing the size of the doses is
appropriate.
The patient who is a good observer may be able to rationally make
dose adjustments independently, enabling better control of
parkinsonism with fewer side-effects than would be possible
adhering to a rigid levodopa dose schedule. Many times, an
optimal levodopa schedule is achieved by trial and error, and it
is advantageous for patients to try adjusting their levodopa
based on drug response.
On the other hand their are potential disadvantages to having
patients adjust their leodopa. First, it is difficult or
impossible for some patients to reliably distinguish between
parkinsonism and dyskinesias; the dose adjustments made by these
patients may be inappropriate. Second, some drug responses are
very confusing and complex, and do not follow simple patterns.
For example, a patient with 'off' dystonia and 'on' dyskinesia
and dystonia may be unable to determine which specific symptoms
are due to recurrent parkinsonism and which are due to acute
side-effects of levodopa. Diphasic dyskinesias, in particular,
may be very confusing. Third, there is a danger of
over-medication with levodopa; some patients may even develop
what could reasonably be termed levodopa abuse. Patients with
levodopa-induced euphoria or severe 'off' depression or pain are
particularly susceptible to escalating levodopa usage and
ultimately, levodopa toxicity.
Thus, the physician must first judge the patient's understanding
of fluctuations before allowing the patient to self-titrate
levodopa. Second, the physician should establish upper limits to
size and number of levodopa doses the patient can take.
Self-titration of anti-parkinsonian medications other than
levodopa is generally inffective and not necessary. Having the
patient keep an 'on-off' chart can establish patterns of response
and help the patient increase his or her skill in titrating
levodopa."
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| Sid Roberts [log in to unmask] |
| Youngstown State History Department |
| University Youngstown, OH 44555 |
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