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For Bill & Bobbie Cotter You were asking about Bill's level of medication as being high. If I understand it, Bill is taking 1 1/2 Sinemet 25/100 every hour. It was not stated how many hours this was happening. I assume some hours were skipped during the night. For calulation I will asume this is the Sinemet consumption for 18 hours per day. Thus Bill is taking 18 x 1.5 Sinememt 25/100 = 27 Sinemet 25/100 pills daily. Add to this about 3 mg of Permax and Bill is in trouble. Looking at carbidopa and levodopa, Bill is taking 27 x 25 = 675 mg of carbidopa and 27 x 100 = 2700 mg of levodopa. What you say Bill is experiencing is that the medication is no long effective. I must assume statements made by Bill are: "I just don't seem to get much value out of additional Sinemet." Or maybe he is saying, "If I take less I am miserable and if I take more, I am miserable. Taking this level gives me the best of all miserable feelings." Bill is in my estimation experiencing "carbidopa toxicity". It is not known if carbidopa crosses the blood brain barrier or if it nullifies levodopa. What is known is that something terribly wrong is happening. If you read the PDR, it states that carbidopa saturates tissue at 70 - 100 mg daily. I believe it states that the manufacture has limit experience at levels of carbidopa above 200 mg daily. Bill is taking 675 mg. or about 3.5 times the maximum recommended by the manufacture. This is what I suggest Bill do after discussing this with his physician. (I really question the experience of your physician (1) to allow a drug holiday that did nothing and (2) letting Bill continue to take this level of meds. You should be looking for another physician before a pallidotomist!) The only way to reduce the carbidopa toxicity is to switch from the 1:4 ratio Sinemet pills to the 1:10 ratio Sinemet pills. That is to use the Sinemet 10/100 and the Sinemet 25/250 pills. This will significintly reduce carbidopa. I would suggest the following: Start the day with 2 x Sinemet 25/100 pills. Then on 2 - 3 hour intervals take 1 Sinemet 10/100. Continue with the same level of Permax. A total of 3 mg of Permax is acceptable. Also, don't change more than one drug at a time. It is the only way to understand the effects of that drug only. Anyway, this schedule on a 2 hour interval gives you 2 x 25/100 + 8 x 10/100 = 130/1000. This is a far cry from 675/2700 but trust me, it may be too much. I know of one man who was taking 30 x 25/100 and is now taking 6 x 25/100 + 1.5 mg of Permax. Please do this for about 5 days to determine the new value of Sinemet. I hope you will be pleasantly surprised. Reducing carbidopa will clear some of the cobwebs from Bill's head and with a little luck, he should be feeling better physically as well as mentally.By the way, you can try this now, or you can wait until you see a neurosurgeon who will tell you to do it then before further evaluation for surgery. (You asked about a neurosurgeon in Salt Lake City. His name is Dr Peter Heilbrun. He is assisted by a fine neurologist by the name of Dr John Roberts. The program is at the U of Utah. Dr Roberts phone is (801) 585-6848.) Let me know how this works out. I am in the San Francisco Bay area and can be reached at (510) 828-9599. Regards, Alan Bonander