> From: David Langridge <[log in to unmask]> > >Dear David and others, > > > >David, you wrote in a mail long ago that you wished to know the > >physiological causes of diph.dysk. I have often tried to find them. And > >now, I for the first time found something that does not clarify the whole > >problem, but makes a start. I found the text in: Ray L. Watts and William > >C.Koller: Movement Disorders, Neurologic Principles and Practice: chapter > >14: Pharmacological treatment of Parkinson's disease page 204; > >Quote: > >The emergence of response oscilations is usually associated with the > >appearance of L-dopa induced abnormal involuntary movements. According to > >their relation to L-dopa response cycles, they are commonly divided into > >three main types: > >a. "Peakdose" or "interdose" dyskinesias occur when there is a full L-dopa > >motor response and are characterized by phasic ( choreic or ballistic) > >asymmetric limb movements, but may also involve facial grimacing as well as > >trunk and neck rotations > >b."Biphasic dyskinesias are clincally linked to transition periods (onset > >or wearing-off of benefit from an individual dose)and frequenly contain > >phasic and dystonic elements > >causing bizarr twisting movement of the trunk and extremeties. Again, limb > >involvement > >may be asymmetric. > >c."Off-period dystonia occurs after the motor response has worn off and may > >initially linked to the early morning hours ("early morning dystonia"). It > >characteristically of unilateral distal painfull dystonic limb cramps, most > >often involving one foot. > >The exact pathophysiology of dyskinesias is not fully understood, but they > >are probably related to striatal dopamine receptor changes after > >dopaminergic denervation and chronic exposure to l-dopa, These receptor > >alterations include changes of sensitivity, relative balance between > >different receptor subtypes and different translational and neuromodulatory > >system responses, The denervation induced imbalance between D1 and D2 > >receptor controlled direct and indirect outflow pathways appears to be > >sustained by L-dopa, perhaps through its predominant action on the D1 > >receptor. > > > >This is a start. If I find more I'll inform you. > > > >Ida Kamphuis, Holland > > > >-------------------------------------------------------------- > >Vriendelijke Groeten / Kind regards, > > > >Ida Kamphuis mailto: [log in to unmask] > > > > > IDA > > Thankyou for your research.I found the bit about receptors hard to > understand but it at least gives more credence to this diphasic thing > which SOME still doubt.I bet there are no end of unreported cases about > simply because this problems with dyskinesia mainly occur some time after > sinemet has been taken and a lot of people even those who should know better > think that the symptoms are caused by pd rather than the drug.Keep up the > good work. > > David Langridge Hi 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 ie too much dopamine . but very interestingly he says this occurs 1/2 hour after taking L-dopa . He also says that there is an end of dose dyskinesia for which he has no explanation . What he is describing in his peak dose dyskinesia is the first phase of biphasic dyskinesia because the maximum concentration of dopamine in the brain occurs 1 to 1 1/2 hours after taking the L-dopa . I dont believe in peak dose dyskinesia except where the first and second phase have run together . I sometimes get this effect when I do not tke enough L-dopa . Too much L-dopa does not produce dyskinesia but slight dizzyness . Dr . Sagar along with much of the medical profession are twisting the data to fit their theories . I believe that concentrating too much on the different receptors etc. is not seeing the wood for the trees . peace Alastair ( [log in to unmask] )