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Joyce: I just found out about the Parkinson List on America Online and threw out that question about the "on-off" phenomenon because that is the problem my mother is trying to deal with. She is 82 years old, was diagnosed with PD a little over four years ago. She is also in a great deal of arthritic pain and is currently undergoing 2-3 hours a week of physical therapy to maintain mobility. Up until 6 months she was responding very well to PD medication - only a total of one and one half tablets of Sinemet CR 50/200 per day (taken at 7 am, l pm and around 6 pm) In the first year she also had about eight months of treatment with Eldyprl - to slow down the disease we were told - but because her stomach is very sensitive to medications, she discontinued the Eldyprl when the doctor thought it had done its job. She is seeing a neurologist who has worked pretty much with PD patients. About 6 months ago she began experiencing the "on-off" periods and upped the Sinemet to a total of 2 a day, taking l whole pill in the morning and half and half with her other meals. That seemed to help for a while - so she continued going back and forth with the dosage. However, 2 a day after a while did result in dyskenesia which she finds very annoying (the head movements especially). The PD continues to progress - more muscle rigidity, some drooling, a little difficulty in swallowing, soft voice, etc. About l month ago, she was having the "on-off" periods almost every day - some lasting for quite a few hours - so her doctor added l/2 tablet of regular Sinemet (25/100) - which she takes with her first dosage of Sinemet CR. It has helped - but the increase in Sinemet is producing the dyskenesia. I should add that she takes l0 mg of Prozac before retiring - to help her sleep - in this low dosage, we are told the perception of pain is altered and she is a little more comfortable. Also, I'm sure the doctor is also addressing the mild depression that seems to exist. The worst part of the "on-off" which I'm sure you are familiar with is the feeling of total exhaustion and shortness of breath. She also complains of a lot of anxiety especially at this time. The doctor does not seem to have many answers for us when we ask about diet, best time to take the Sinemet, the scariness of the "on-off" periods, etc. He tells us and I'm sure he is correct that PD is treated differently in each patient depending on their response. But I would like to have more information. I do subscribe to the American Parkinson Association's newsletter and the National Parksinon Foundation's Report. But I sincerely feel we can get more helpful information from people like yourself who are living with PD every day. I would appreciate any insight from your experience and trust that this lengthy letter does not take up too much of your time. Thank you! Cathy