> > >
> > Hello Charlie, I am disappointed: after all that has been written in these
> > columns, do you still subscribe to that nonsense about 'delaying the start
> > of levodopa therapy'
> > Regards,
> > --
> > Brian Collins <[log in to unmask]>
>
> ************
>
> CHARLES T. MEYER, M.D.
> Middleton, WI
> [log in to unmask]
>
n Sun 02 Nov, Charles T. Meyer wrote:
> Brian,
>
> I think the jury is still out. It makes sense to me that given an
> unknown one should try agonists first but not delay l-dopa if there is
> significant disability. Do you have data that there is no difference in
> the onset of dyskinesia regardless of when someone starts l-dopa?
>
> Charlie ***************
Hello Charlie I am not aware of any papers addressing the question of the
effective duration of levodopa therapy. In fact, I find it very strange that
such a contentious issue should be so ignored. One would have thought that
it was of critical importance to hundreds of thousands of people.
Considering the importance of continuity of employment to a large proportion
of newly-diagnosed Parkies, it is very sad that the medical raternity should
spread the story in such a cavalier fashion when, as far as I can tell, they
have no objective evidence. The only quote facts unquote that I have seem
are found in the press releases accompanying some new agonist drug.- oh
yes, and selegiline.
I think you will agree that there is no reason whatever to expect a
balanced, objective view-point in defence of levodopa to come from a drug
manufacturer promoting a competitive product. Nevertheless, let's see what
they say:
Two phrases spring to mind :'... the PWP becomes insensitive to levodopa...'
and '....the PWP develops random motor fluctuations...'
There is no doubt that achieving a stable condition with levodopa gets more
difficult as the disease progresses - in fact the clue is in that sentence:
the disease progresses. It can be shown quite simply that the difficulty
in maintaining effective control is directly related to the loss of dopamine-
producing cells. If ever anyone comes up with an EFFECTIVE neuro-protective
compound I will buy it, because it should prolong the life of the dopamine-
producing cells, thus making it easier to take the levodopa.
Another point which always bothers me is the eagerness to take large doses of
Dopamine agonists in place of levodopa. At least levodopa is a naturally
-occurring substance in the brain, but is there a risk attached to these man-
made agonists? I must own up to taking Permax myself - all I can say is that
I only take the smallest dose that is forced upon me, but I have, step been
forced up to 2.5 mg der day
Another
Have you noticed that a common prescription for a newly-diagnosed PWP is one
or more tablets of 50/200 sinemet. There is no doubt that the brain can cope
with large doses of levodopa in the early stages (when in fact we do not NEED
large doses. I have no way of knowing, but can't help wondering if those
large unnecessary doses in the early days contribute to the later problems.
I seem to have wandered a bit, but actually I think all of these points have
some relevance to the subject. Have I convinced anyone ? I doubt it, but
maybe you look at the subject with a bit more scepticism.
Regards,
--
Brian Collins <[log in to unmask]>
