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Re: Frequent smaller doses for advanced PWPs Is it just me, or did anyone else boggle at the statement given to Bob by the two neurologists (see below) ?? > >I've discussed liquid Sinemet and the issue of frequent smaller doses of > >Sinemet vs. less frequent larger doses with two neuro's at the Kansas > >University Neurological Foundation. Both are widely known PD and movement > >disorder specialists who see a number of other List members. My > >understanding from both conversations is that the body responds more > >predictably to less frequent larger doses, regardless of the method of > >administration and that increased dosing frequency often results in more > >on/off swings. This betrays a shocking lack of understanding of the problems faced by older PWPs. Yes, the body does respond more predictably to a larger dose -it goes into wild dyskinesias. They also seem to be ignorant of the significance of the on/off phenomenon when they say that 'increased dosing frequency resulrs in more on/off swings'. This just seems to be a statement of the blindingly obvious : If you take one big dose, you will experience one cycle of symptoms: If you take five (smaller) more frequent doses (of a size carefully chosen to take you to the switch point), you may experience five on/off swings, but they will be minor and acceptable compared to the person given the single big dose. You will note that I started to choose my words more carefully towards the end of that last paragraph: That is because when dealing with PWPs who are long-term sufferers, there are no guaranteed rules to work with. Maybe each person has his own small variation and the trick is to decipher those variables, but it can be very rewarding if you hit the right spot. I firmly believe that it is by a philosophy along these lines, together with a readiness to test and analyse the parameters, that I have managed to maintain a reasonable quality of life. It makes me fume to hear the stories of some patients (and as Secretary of the local branch of the PDS I hear plenty) and to realise how much suffering can be caused by a ill-judged prescrtiption. What do you tell a 75 year old 8-year PWP, who has been prescribed 8 Artane tabs per day (Nothing else)? Oops, I nearly got started on one of my hobby-horses then. Time to sign off. Regards, -- Brian Collins <[log in to unmask]>