Greetings Phil:
You wrote -
>>> Phil Gesotti <[log in to unmask]> 08/15/97
10:20pm >>>
>>>what is meant by peak dose dystonia. What are the
symptoms?<<< >>>My new neuro added Permax to my
current 4 daily Sinemet 25/100 CR. As I titrated (love that
word) from 0.05 to 0.75 mg per day over a two week period, I
noticed a decrease in the dystonia; however, after about a
three week period the dystonia would return at times during
the day.<<<
>>>I was having problems with dystonia last week so I
decided to go cold turkey on Monday and try no meds. I felt
great all day. I took two 0.25 mg doses of Permax on
Tuesday. I felt O.K., but was somewhat agitated in the
evening. For the rest of the week I took a morning and early
evening dose of 25/100 Sinemet and a morning and noon
time 0.25 mg dose of Permax. I seem to feel better, but am
not sure that I may also be experiencing the benefits of a
mini-drug holiday. Is dystonia also a symptom of over
medication?<<<
Patients who have been on Levodopa therapy for several
years sometimes experience fluctuations in their response to
the meds. The medication doesn't seem to last as long.
Some of these PWP develop dyskinesias (abnormal
involuntary movements: twisting or dancing movements) or
dystonia (sustained, sometimes painful tightening of the
muscles resulting in distorted postures). Dyskinesias (peak
dose) is usually treated by reducing the amount of each dose
of Levodopa and adding an agonist (such as Permax).
Basically doctors feel that the best way to treat
dyskinesias is to try to obtain constant stimulation of the
dopamine receptors (D1, D2, etc.) throughout the day.
Dystonia is usually attributed to the timing of the meds.
It can occur as a function of excess medication, usually one
to two hours after meds are taken - "Peak dose." Or it can
be a feature of the wearing-off of the meds.
Dystonia feels like the muscles have been overexercised
and can be a function of a prior injury, arthritis or poor
circulation. However, if your symptoms are involved with the
cramping of the toes or foot, it is usually a result of lack of
dopamine. Scientists believe that the toes are involved
because the cells in the brain are arranged so that the
neurons for the foot are at the rear (dorsal) part of the
putamen and are the first ones to die.
Some PWP experience only minor discomfort, others
much pain. Doctors will attempt to sustain the action of
Levodopa by switching to Sinemet CR, or adding Eldepryl.
Some neurologists prefer a nighttime dose of long acting
meds such as Permax.
Permax is usually started at 0.05mg a day and increased
by 0.01mg to 0.15mg every 2 to 3 days. Permax has a
longer half-life than other agonists (except the new Mirapex)
and is usually divided over three doses per day. Permax can
be taken up to 6mg (yes 6mg) per day.
Anticholinergic meds (Artane) may help, as could muscle
relaxants (Flexeril or Lioresal).
Doctors consider this problem to be individual to each
PWP and sometimes much experimentation is required
before the method of sustaining the Levodopa response is
obtained for that patient.
Good luck, Phil. Keep experimenting.
Stephan Schwartz 53/7 <[log in to unmask]>
