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On Sat 19 Apr, [log in to unmask] wrote: > Well, Fred, that is his name is 65/15 with sever dementia and hallucinations. > He has no dyskenisia's or tremors to speak of. He does have rigidity, and > balance problems like we all have. His medication schedule is approx. 6 > 25/100, 2 - 3 CR, 1 dprenyl, max out on permax, and clozaril for his > hallucinations. His neuro. is a doctor very well respected in the PD field, > as a matter of fact is head of a movement disorder clinic. > I just had a call from his wife saying that Fred had a very bad day. He was > hallucinating that there was a group of people out his backyard today and > that he even lowered the window to talk to them. Well there was nobody crazy > enough to be oustide his window during a Rain/Snow storm that we had today. > He is not taking any anti-depresents like Paxil, Zoloft ect. because it would > have adverse reaction to clozril. To compound matters, Fred is a retired > OB/GYN MD. > Hello Marv, I am 57, was diagnosed 18 yrs ago, and can trace early symptoms back 24 yrs, so I suppose that makes me a sort of geriatric young onset PWP ! I have also used levodopa continuously for the past 17 years. Regarding your friend Fred, I can of course only comment in general terms, but some thoughts do occur to me: He appears to be one of a quite sizeable group of PWPs who have very little or no tremor, just stiffness. The trouble is that if you start someone from this group on a gradually increasing dose of Sinemet, they experience a reduction in stiffness, up to the point of either no or very little stiffness , but if you continue to increase the dose, instead of developing dyskinesias as most PWPs would, they just begin to get stiff again. - They have the same symptoms when under-dosed and over-dosed. It is thus very difficult to tell whether they are under- or over-dosed. Could you explain what 'max out on permax' means? I take Permax with my levodopa, but have been careful to keep my intake to 2mg/day (8 x 250 micro-gm) I have a healthy respect for these Dopamine agonists: I would suggest that, even though Permax is getting a fairly good reputation for freedom from side- effects, it should be the first to go. I believe that the current max recommended dose is about 4 milligm/day: Fred should not be using more than about 6 x 250 micro gm/day, in view of his hallucinations. I would need to see a detailed record of Fred's Sinemet intake to comment on it. but perhaps I can demonstrate the sensitivity of the correct dosage by quoting my own case. I take Madopar dispersible tablets because there is only 50 mg of levodopa in each tablet, so I can break them down to get small increments with some accuracy. My dosage is 1 and a half Madopar Dispersible every 2 hours. 2 hours is the effective life of the tablet, so that 1.5 tablets gives 37.5 mg/hour. 2 tablets every 2 hours would give me strong dyskinesia, and 1 tablet per 2 hours would not even get me out of the Off condition. But at 1.5 tabs every 2 hours, I am almost as normal: I can drive, ride my bike, even (When I really get the optimum dose) write legibly! I believe that most people have these characteristics, ( i.e. an optimum dosage of X milligrams every Y hours) even though X and Y may vary from person to person. I assume that Fred is in no condition to judge the effectiveness of one dose versus another, but I do think that you would be nearer if you took the first step by going to 1/2 a Sinemet 25/100 every 2 hours (or if the Sinemet CR lasts 4 hours then one CR every 4 hours would be the same. That is just a start though, so don't expect miracles. Well, I've rambled on a lot. I hope I have given you some pointers, and of course If you have more questions feel free to ask. Regards, -- Brian Collins <[log in to unmask]>