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Hello Nancy, Thu, 4 Jun 1998 19:35:30 -0500 Nancy Shlaes <[log in to unmask]> wrote: >I have asked 3 neuros this question but never got an understandable answer.< You'd better find yourself a fourth neuro, that CAN answer your questions! >Is there a defined amount of Sinemet available to each of us PWPs in a >lifetime---unknown in amount but definitely limited. What I mean by >that is: if we take more now, will the dyskinesia begin earlier and >therefore there will be less available for later? Are we using up our >"allotment" by taking Sinemet soon after the diagnosis or is there another >reason to delay starting Sinemet?< "Yes, yes, yes, yes, yes, yes! All yes!", the neuro's should have said, and they should have explained it as follows: After having diagnosed PD (not an easy disease to diagnose) by a neuro, most start the treatment with a "test"-period of a few months with Sinemet. They do this to see if the patient responds to the treatment. If (s)he does respond, that is an extra confirmation of the diagnose PD. After that (especially when you are relatively young as you are!!!) they take you of the Sinemet and start with an other med or sometimes no med, depending on the severeness of your symptoms. As you gathered right, the neuro wants to delay the use of Sinemet (=L-dopa) as long as possible. Why is that? As the PD-symptoms worsen, you will need more L-dopa. At a certain (patient-specific) moment you will have reached the maximum dose. Your symptoms will still worsen, but you can't take more L-dopa, so after that point the treatment will have a less positive result as you had before. Furthermore: the higher the dose of L-dopa, the bigger becomes the chance of unwanted side-effects as hallucinations and dyskinesia. Therefor the time L-dopa can be used in a succesfull way is limited. (An average period of 10-15 years). Since the L-dopa at the moment still is the best med available with the best results, this is obviously best taken in the later stages of PD. In the early stages with the less severe symptoms, other meds will have enough effect to fight the symptoms (e.g. agonists: as single therapy or sometimes with a very small dose of L-dopa added). BTW: most of the other meds can also cause the side-effects mentioned, but not in such a strong way and the average period these meds (agonists) work is longer (10-20 years) than is the case of L-dopa. >I have asked this same question in a lot of different ways because I seem >to have trouble making myself clear on this subject.< You were clear enough, the neuro's are the troubled ones!! Hope this helps! If *I* wasn't clear enough, ask again, and again, and again, until it IS clear to YOU!! Greetings, Hans.