Dear Pat, Donna, Rosemary, Robert and David
Robert, you used a beautiful metaphor. I have not yet tried to change
the last med's of the day from sinemet-CR into sinemet-gen. The reason is
that it makes sense to change one thing at a time experimenting with
drugs and wait till the effect has stabilised before changing the
next thing. But your suggestion seems worthwile and I'll try it later. I
am so relieved that my days with sometimes up to 8 hours of
dyskinesia are past.
My neuro did never hear about the use of my current med's strategy.
He said it has some resemblance with the Med's holiday. This has been
a strategy in the past for PWP's who were no longer able to endure
sinemet. It was based on the idea that some synapses are getting
hypersensitive and have to be calmed down regularly. The patient
did not take med's in the week end. This caused in the first days
of the next week a better reaction on the med's, but because this
did last only for two or three days the costs were higher than the
gains. So this strategy of drug holiday was dismissed. Also the
appearing of the first agonist, parlodel, had a role in this.
Wat you said Pat that the new meds like tolcapone can be helpfull,
makes much sense, because they are expected to influence these synapses
in the globus pallidus. It may be they can do in a chemical way about
the same as a pallidotomy. So if the strategy from the kicking off
every day, as I do, does not appeal to you, or does not cause an
amelioration, it is still not hopeless.
David L, you are the one who started this thread. I can agree with
your observation that the wearing off dyskinesia is not influenced
by the amount of drugs taken, moreover it may be that the end of dose
dyskinesia is less with a higher dose. The problem
for me however is, that I have a diminished therapeutic window on top of
the mentioned symptoms. So when I take too much sinemet I can expect top
of dose dysk. Your Parkinson, David, is not as much advanced as mine is.
Rosemary, I remember you wrote about it earlier. Is there anything you
could try to get some relief? Do you have a neuro who can help you
with it? I don't have of course some ready solution. But I
would appreciate to be able to think along with you.
Donna, maybe this al is rather confusing for you. It is not even sure
wether your symptoms fit in the two-phasic kind. If they don't you
will find a conventional solution in trying to get a more constant
level of dopamine in your brain, maybe with help of permax. If the symptoms do
fit in I can only give you the same advice, I gave to Rosemary.
Because the site mgh.harvard.edu/lnctnlhp.htm. from which I got the
information, is not available these days I append the part of the article
with the crucial information.
Ida Kamphuis (53/12+)
Holland
QUOTE:
>The usual dosages of carbidopa-levodopa used to treat conventional
>parkinsonian motor problems are adequate for demonstration of the
>diphasic dyskinesia pattern (ie, 100 to 250 mg of levodopa).
>Typically, it is the end-of-dose dyskinetic period rather than
>the initial dyskinetic phase that is the more troublesome and
>sustained. It tends to occur at a fairly well-defined portion of
>the levodopa response cycle, usually 2 to 8 hours after a single
>dose of carbidopa-levodopa. One treatment strategy is to overlap
>four to five doses of carbidopa-levodopa at intervals that are
>just long enough to preclude the development of the dyskinetic
>phase at the end of each dosage cycle[124]After the last dose,
>however, patients will cycle through the dyskinetic phase but at
>relatively predictable time. Thus, they can arrange to be at
>home-and perhaps self administer a mild, short-acting tranquilizer
>such as alprazolam--during the time the dyskinetic period is expected.
>Once they have cycled through this dyskinetic period, patients typically
>experience adequate control of their parkinsonian motor symptoms for the
>remainder of the day, although control is not quite as good as during the
>time of peak levodopa response. This control typically continues overnight
>and into the next morning. If left untreated, patients usually start to
>experience increasing motor manifestations of parkinsonism by mid to late
>morning, at which time they can again restart their levodopa cycle, taking
>four to five overlapping doses. Thus, with this strategy patients can
>attain good control of their parkinsonian symptoms for several midday hours
>and adequate control during other portions of the day, once they have
>cycled through their last dyskinetic period.
