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At 09:39 27-9-98 -0400, you wrote: >How does one know when you are ready for 50/200, or 10/100, or CR, or >liquid vs the standard 25/100 version? Thanks. >B. Bruce Anderson (52, 4) >Schooley's Mtn., NJ >[log in to unmask] Bruce, This is a crucial question for every PWP on this list and it deserves more attention than it gets. To know when the meds have to be changed, every, PWP has to observe his own reactions to the meds and by relating those reactions to the time schedule of the med,s intake one is able to make a guess, what this reaction at this time of the meds cycle, tells us about the adequacy of that schedule Janet Patterson wrote in this object: Quote >>the benefits were a smoothing out of the on/off fluctuation >>due to over/under medication and an overall daily reduction in sinemet intake >>once in a while i tried sinemet cr as an alternative but it always made me dyskinetic >>as well as dyspeptic >>to make a long story shorter >>pd symptoms = under medication >>dyskinesia = over medication end of quote From another mail from Judith Rischards one of these days one can't but deduce that it is not that easy Quote >>Neurology 1998 Aug;51(2 Suppl 2):S25-s29. >>Classification of fluctuations in patients with Parkinson's disease. >>Quinn NP >>University Department of Clinical Neurology, Institute of Neurology; >>London; England. >>It is important to distinguish between “off” period freezing, which may be >>helped by measures to increase time “on,” and freezing that is present >>in both “on” and “off” periods, which is difficult if not impossible to >>treat. Medium-duration fluctuations associated with chronic L-dopa >>treatment include wearing-off and “on-off” responses, which can involve >>(a) return of parkinsonism, (b) dyskinesias, and (c) non-motor >>fluctuations. A poorly understood long-duration pharmacodynamic response >>to L-dopa lasting up to 2 weeks may also be seen. This may manifest as >>late deterioration after L-dopa is withdrawn. More importantly, and more >>commonly, it is important to recognize that the ultimate effect of an >>alteration in L-dopa treatment may take 2 weeks to equilibrate in the >>brain. “Optimization” of L-dopa therapy is therefore not a realistic >>expectation during an inpatient admission and is instead primarily a >>long-term outpatient procedure. The “off” state is not the same as >>untreated PD, and may represent rebound worsening after the beneficial >>effect of L-dopa has worn off. Sometimes there is also transient >>worsening at the onset of effect of a dose. “Off” period dyskinesias >>tend to be relatively fixed, and painful, and dystonic. Biphasic >>(beginning and/or end of dose) dyskinesias are often severe; ballistic; >>and stereotypic. Peak dose or “square wave” dyskinesias comprise a mix >>of mobile dystonia or chorea that is usually painless. End of Quote This text says it is not evident a certain symptom is caused by over--- or undermedication. That is why I agree with David Moorfeld, when he says one has to learn what causes a symptom by trial and error Quote >>It mainly comes from experience or trial and error.. A neuro may ask you to >>try a perticular medication. You may try it and find it has negative side >>effects.So you try something else. Its whatever works for you. End of Quote So if we observing our symptoms are not sure ,what is causing it we may deduce a hypothesis about that and we can test this hypothesis by a little experiment. When the hypothesis is a certain kind of dyskinesia is caused by to much sinemet, that can be tested by taking during the next cycle less sinemet and a next time some more and looking to the differen results That is the way the short term effects can be determined. The long term effects or modulation effects are more difficult to determine. In my case the long term effects of levodopa were, when I started using sinemet, increasing the benefit of it, and after years of using it increasing wearing off dykinesia, without necessarely decreasing the level of the benefit, but shortening it. To learn about this long term effects a meds holiday might be necessary. Judith says, her dyskinesia increased by using sinemet cr in sead of sin.gen., that tells her that the dyskinesia is not an immediate effect of having a to high levodopa level but more so to having not a level which is high enough. This is of course not true if the difference was not only replacing ginemet gen to sinemet cr, but also heightening of the total amount of sinemet. Regards Ida -------------------------------------------------------------- Vriendelijke Groeten / Kind regards, Ida Kamphuis mailto: [log in to unmask]