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I am a 53 year old woman who was disgnosed with PD twenty years ago. I joined the PD Inf. Exch. Ntwk. a few weeks ago and have enjoyed exchanging messages with many kind individuals and am just getting enough confidence to send a message to the List. On-off, better-worse, up-down, forward-backward all describe my condition throughout the day, month, and years that I have been living with PD. It can be so exasperating and it would help me to know if other PWPs experience the same thing and if anyone knows and understands why this occurs. First, there is the unpredictability of the efficacy of a single dose of Sinemet -- Sometimes it works well in reducing or eliminating symptoms, sometimes it appears to have no effect at all, and sometimes it is "too much",, causing disturbing chorea or dyskinesia. Then there is the variance in efficacy over longer periods of time -- One week (or month) my symptoms can be very well controlled, then suddenly the next period of time, my medication just refuses to do its job. Lastly, I find that my location often affects my symptoms and performance; i.e., Whenever I visit my parents in another town, the efficacy of Sinemet is predictably always very good and I function very well, even for long periods of time and with reduced medication. I come back to my own home and the on-off, up-down thing starts again. An exception to the above does occur for me from time to time which I have been told is quite unusual. For no apparant reason, I will suddenly have a period of time (days to weeks) where I am able to cut-down on my medications from five tablets a day (which I have had to take for years to remain functional) to just one or two tablets with no "off" times like I normally get throughout the day or week. My question is -- What accounts for these significant changes or discrepancies in the effectiveness of the medication? We all know that stress (nervousness, worry, upset, excitability) causes PD symptoms to become worse and often I can attribute my off times to that. However, whenever I have had an extremely well-functioning "up" period of time, whether I am at my parent's home or in my own, I cannot pinpoint any stress-related (the lack of stress) reasons for it. I have discussed my puzzlement over the above instances with several neurologists and they have not been able to provide me with an explanation, so I am searching... I look forward to making more Internet friends - "Parkinson Pals" - in the future. JANICE LONG