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My comments spring from a very interesting (in the same sense as the Chinese >curse) time I had back in '84. They do describe what happens with Sinemet >-especially following a period of abstinence. I do not consider these >comments too be any sort of therapeutic recommendation. I hope you find this >helpful. > >Regards, >WHH 54/18 Debbie, I don't know which symptoms of your mother make her think she is over- or undermedicated, but I hope this is of some help. William, Do you think I talk about the same thing as you did with your chronic and acute effects? The way to determine whether a symptom is caused by under- or by overmedication is to making a list of all the symptoms that show up during the day and subsequently look for the time relation each symptom has to the time table which rules the meds intake. Each dopa intake might cause a cycle from low level, with parkinson symptoms of undermedication to a higher level with no symptoms at all or symptoms of overmedication, back to a lower level with parkinson symptoms of undermedication again. This may seem simple enough and not raising questions, but it is not that simple. There are two sources of confusion. The first is that in discriminating one has to look to the time table; when does a symptom show up, and to the content of the symptom; dyskinesia being indicative for overmedication and Park. symptoms for undermedication. What should one decide when these two indicaters don't say the same thing : for example when 4 or 5 hours after an intake of sinemet CR dyskinesia shows up in stead of the expected PD symptoms. To determine whether this dyskinesia is an indicator of being under- or overmedicated one could do an experiment: take a next sinemet. When this causes the symptoms to disapear or decrease, it seems sensible to conclude this dykinesia was an indication of being undermedicated. When the dyskinesia starts to increase as soon as the next sinemet is starting to do its work, one might conclude it was an indication of being overmedicated. If one suffers from dyskinesia, which shows up after the last sinemet is supposed to have finished to do his job, it is important to understand that dyskinesia can be triggered during two different phases in the meds cycle. It makes sense to try to find some differences between the one dykinesie( caused by overmed. that increases if another sinemet is added) and the other on (caused by undermedication, which decreases when the next sinemet is added). Yet another source of confusion is that that the effect of a sinemet pill depends partly on the the amount of sinemet that was used during a longer preceding period. That is why in the past a drug-holiday was prescribed for patients who could not benefit any more from sinemet, because the dyskinetic effect outstripped the therapeutic effect. Years ago I discovered by chance that I could benefit much more from sinemet the day after a day I did undermedicate myself. This was not because sinemet counteracted the Parkinson symptoms more vigorously, but because it caused no more dyskinesia. So the two kinds of dyskinesia, which are triggered by two different phases of the meds.cycle are both, but in a different way, leva-dopa induced, but it can be as William Heitman calls it an acute or a chronic effect. For most PWP's dyskinetic symptoms are due to an chronic and acute overmedication. For some PWP's they also can be an effect of both cronic overmedication and acute undermedication. Regards Ida -------------------------------------------------------------- Vriendelijke Groeten / Kind regards, Ida Kamphuis mailto: [log in to unmask]