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On Thu 25 Sep, Stephan Schwartz wrote: > Good day, Brian Collins: > You asked about severe motor fluctuations associated > with long-term use of levodopa therapy. > Stefan: Thanks for your response to my request for a definition of 'Severe motor fluctuations'. I was not laying traps for anyone, I just felt that in this case the inference was that patients started banging around from tremor to dyskinesia and back again for no change in input, which is of course nonsense. I have formed my own opinions about control of tremor, and have read several papers on the subject, and I have to say that the inconsistencies in the writings of these doctors suggests that when you get right down to it, nobody really knows for sure. Add to that the fact that I have been taking levodopa for the past 18 years, and written a program to optimise the use of that levodopa, and I think maybe I am entitled to question some of the quotes that Stefan has collected. We take levodopa to make up for the lack of 'home-produced' Dopamine. As the cell-count decreases, so the required amount of levodopa increases (not by much, just enough make up for the loss of that last 10% of dopamine- producing cells. I believe that in most cases, when trying to explain a set of observations, the correct explanation is usually the one which requires the fewest number of unrelated 'coincidences. My picture of the system - which I believe can explain all the observations quoted - requires only one event :The continued decrease in dopamine-producing cells. I have heard about these 'super dopamine-producing cells, capable of up to 10 times the normal output, but I would like to know how many of these cells have been recorded and in what concentration? The attitude to the controlled release tablets really makes me wonder: I am always suspicious of doctors who seem to expect to achieve a tablet schedule which gives acceptable control of symptoms, using whole tablets only. There is no magic in the choice of 100 mg in a tablet, (or 200 mg in a CR tablet. I used to take Sinemet CR when I was in the earlier stages, and it was very nice too . However, if I took one of them now, bins, the resulting flow rate of levodopa would be too high. (A sinemet CR tablet gives about 50 mg/hour, whereas my requirement is for 37.5 mg/hr. If only the drug companies could understand, and produce a set of tablets, each with its own controlled release rate; say 10,20,30 and 50 mg/hr then we could really do some good. I'll stop now because it is rather late. If there is enough interest, I could explain my 'simple' model. Regards -- Brian Collins <[log in to unmask]>