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To Ron and other members of the two-phase dysk. gang: <bigger>Ron Vetter wrote and quoted: >From: Alastair Wyse <<[log in to unmask]> snip... > The first thing I read on PD after I was diagnosed was Dr.Harvey >Sagar's book " Parkinson's Disease " in which he explains dyskinesia >as occuring at max dopamine or peak dose i.e. too much dopamine but very interestingly he says this occurs 1/2 hour after taking L-dopa. I don't believe in peak dose dyskinesia except where the first and >second phase have run together . I sometimes get this effect when I >do not take enough L-dopa . Too much L-dopa does not produce >dyskinesia but slight dizzyness . snip... Ron, You add a new theory to the existing ones about two-phase dyskinesia. Alastair seems to say it is the only kind of dyskinesia that realy exists and that the top of med's dyskinesia is in fact a two-phase dyskinesia in disguise. The other two theories that have been discussed are the one of Bob Martone, who said that in two phase dyskinesia the dysk. is provoked by a certain level of dopamine, which one can't avoid passing through on the way to the therapeutical level and again coming down from this, because staying in the high therapeutic level is impossible. And my first theory, which was that the end of dose dyskinesia was an abstinence symptom and the same thing as a cold turkey of a heroine addict. This is founded only on my own observation that my wearing of symptoms resembled so much the abstinence symptoms of alcoholics and heroine addicts. This was especially so in the first years of using sinemet, after that very heavy dyskinesia replaced those earlier symptoms. I don't have enough expertise to assess, how much the fact that all addictiveness has close relation with dopamine, supports my view. A very weak point of my theorie is it has nothing to say about the "start of med's" dyskinesia. =20 Te theories of Alastair and Martone are closely linked, but a difference is that Alastair says there is only one kind of dyskinesia and it is always triggered by a higher than zero, but yet a too low dopa level. He says in fact that too high doses don't exist and the theorie predicts that every dyskinesia can be avoided by taking some extra sinemet. Bob Martone and also my theory say that it is important to distinguish top of med's dysk from start of dosis or end of dosis dysk. Top of med's dysk can never subside by taking some more sinemet, while the short term effect of taking some more while in the start or end phase can be expected to be getting rid of the dysk. I have found (in the litterature about two-phasic dysk.) that sinemet CR is contra-indicated for PWP's suffering from it. That supports the Alastair or Martone theory.=20 The supposed differences among patients in their reactions to dopamine is greater in the theory of Martone and me than in that of Allastair. That makes the last theory attractive, because more simple. I have experienced after my pallidotomy how much I can ameliorate the effect of a dosis, when I first don't use no sinemet at all. I now start using Sinemet 4 hours after getting up and that makes the effect better and more predictable. After a short "drug holiday" of one day I can profit from sinemet without any dyskinesia. I don't think this fact supports especially one of the theories. But it supports in general the notion that the whole matter is complex and the effect of one dosis is determined also by other variables. I will end with a remark about the astonishment which I felt reading that some PWP's take a sinemet to sleep. It sounds for me as absurd as taking amphetamine to sleep. To be able to sleep I need absolutely first kick off from sinemet. Ida Kamphuis, Holland </bigger> -------------------------------------------------------------- Vriendelijke Groeten / Kind regards, Ida Kamphuis mailto: [log in to unmask]