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Bob - Two thoughts on your sudden increase in off-time: 1) Have you been under stress and/or exerting more physical lately lately? If so, you could simply be under-medicated for your current requirements. (I think excessive heat would qualify as a stressor, in case that's a factor). 2) If nothing in your life has changed but you're still having these off-times, you may be under-medicated for the current stage of your PD. In either situation, ask your neurologist about taking your meds more frequently, for a higher total dose. As to the pallidotomy, it's a great boon to many PWP, and well worth considering. Your insurance will probably cover at least part of it. Good luck, and let us know what you figure out. Margie Swindler [log in to unmask]