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BRIAN,IDA,AND OTHERS

I have been so tied up in other matters in recent weeks that I have been
unable to join in the latest spate of postings. I need to apologize to Brian
as I had promised to send you information on my medication schedule. I had
in fact completed a number of record sheets but found real difficulty in
doing so because of the problems  of clearly determining my position on the
-2 to +2 scale which is mainly because I only experience symptoms when I am
standing up  and have been moving around for some little while.Something
like driving a car I can do all day without even taking any medication and
the only clear way I can know if I am in the 0 'on' state is to be sure that
my left arm  is swinging properly and that I am not limping and dragging my
left leg which can only be determined after about five minutes of walking if
I have been sitting down or standing up but not actually walking about to
any extent.Also my position on the dyskinesia scale is difficult sometimes
to determine unless I am actually active.

However after a lot of experimenting with all sorts of schedules and doses I
am sure that in my case the dyskinesia only comes to a small extent at the
beginning of a dose of sinemet and almost always at the end WHATEVER THE
SIZE OF THE DOSE.I have tried SinemetCR 25.100 one tablet at intervals from
2 to 4 hours - ok if there is sufficient overlapping but quite difficult to
achieve in practice.CR 25.100 taking two tablets every 4 to 5 hours again
the overlapping problem.Sinemet Plus 25.100 - quarter of a tablet every hour
but this takes up to three hours to build up to give any effective relief
and  tends to produce a strange sort of intermittent dyskinesia.  One third
of the same tablet every hour produces a slightly better result.But here is
the interesting thing on one occasion treating myself as a guinea pig I took
one whole sinemetplus 25.100 tablet every hour for ten hours and the
dyskinesia only started an hour or so after the end of the regime and more
recently two 25.100 tablets every hour for 12 hours and again the dyskinesia
not significantly unpleasant again came at end of dose. In both cases the
higher doses produced a lot of energy and acted as an aphrodisiac.
In addition to Seleginin 10mg I also take Permax 1mg a day and have tried
more with no obvious benefit.

These experiments with high and low sinemet inputs lead me to believe that
end of dose dyskinesia is not just a simple matter of over dosing.Brian
suggest that overdosing may have shot one into the 'twighlight zone'. It
seems to me that that for people who suffer from end of dose there is a sort
of very sensitive 'subliminal' zone on the way up to the fully dosed zone
where problems occur with too low concentations of dopamine.If on starting
your routine you are taking not enough sinemet you will climb too slowly
through this subliminal zone and suffer start of dose dyskinesia but taking
enough you will sail through it quickly and  provided you keep above it you
will be ok until some time after your last dose which is not too bad
depending on the rate you descend  back through the subliminal level.Best if
this is when you are not  going to be very active.In practice this  is not
very easy to achieve and it comes back to my original gripe several months
ago that one ends up taking increased doses of sinemet not to deal with more
severe pd symptoms but to deal with the dyskinesic effects of sinemet at the
subliminal level. I would still prefer to use as little sinemet as possible
and because of these effects I only really take it when I need it. For
instance I usually go without medication until mid morning or when I am
sedentary for long periods like driving a car  or sitting at this screen.

I'm very pleased Ida to hear that your own experience seems  to tie in with
this and that the  new more flexible regime you adopted seems to have
produced a lot of relief.I know many people think that you should not play
about with times and doses. I have a rather self opiniated cousin who is a
pharmacist and who is always preaching to me that the most important thing
about medicine is to take the prescribed dose at the same time every
day--good advice for a lot of medicines no doubt but one wonders how many PD
sufferers are caught in this trap- not too many hopefully on this list but
they should ask there doctors first.I wonder also whether some people suffer
from diphasic and don't recognize it thinking it a normal part of PD and not
drug caused!

All the best David 68/4