At 08:02 17-2-99 EST, Joan wrote:
>Have just become a member and am overwhelmed with mail.
> none have seen the severe shaking that occurs at the end of the day when
the > pills are what I call "worn off". The tremor is severe for about an
hour, >preceeded by "correa". Then the tremor stops, but he is rigid--off
time. >Anyone have an experience with this?
>
>Thanks for your input.
>Joan
Joan
I answer this with some hesitation, because I fear the only effect is merely
increasing your confusion and I agree with Judith Patterson's questions.
Answering them might make things more clear, though it would be better yet
to be able to observe the symptoms you are talking about. Without such
observation, a high level of guessing can't be avoided in answering. So
please read this with that in mind.
One effect of levo-dopa is not getting the attention it deserves. Reading
about the "on-off" phenomenon one has the impression that a PWP, who is on
levo-dopa quite some time, can discrminate two stages(on and off), when he
has exactly the right dose and three stages (one on with dyskinesia, one on
without dyskinesia and off), when he takes too much or too much at once of
levo-dopa.
Some patients however, do have not only two kinds of on, but also two kinds
of off. The First one, the "real" off (in which the primary Parkinson
symptoms reappear) and the second, the "wearing off"( with very severe
dyskinesia in combination with dystonia).
This last type of dyskinesia is also mentioned in the literature under the
names of interdose dyskinesia or evening dyskinesia or dyphasic (two-phase)
dyskinesia, because people with this kind of reaction in the "wearing off"
phase tend to have the same reaction, though less severe, in the starting
up phase.
I myself have suffered from heavy "end of dose" dyskinesia, which has
disappeared completely on the most affected half of my body, following a
pallidotomy.
The painfullness of this "end of dose" reaction is caused by the
combination of dyskinesia and a high muscle tonus.
It is possible that a neuro who works in an outpatient centre, never sees
those symptoms, because patients who suffer from them are incapable to come
to the office when this symptoms are manifest they and will take this into
account when making an appointment.
A quote from chapter 7 http://www.ionet.net/~jcott/homepage/archive/patp.html,
of Algorithm For The Management Of Parkinson's Disease, (a supplement of
the American Academy of Neurology. Reprinted in Neurology 1994;44:S1-S52.
Editors: William Koller, M.D. Ph.D Dee Silver, M.D. Abraham Lieberman, M.D.):
Choreodystonic dyskinesias are also seen in a second distinct pattern, in
which these adventitious movements occur just at the beginning and again at
the end of the levodopa response cycle. This has been termed "diphasic
dyskinesia" or D-I-D response, a shorthand for
"dyskinesia-improvement-dyskinesia").[124] This pattern is much less common
than peak-dose dyskinesia and is often difficult to diagnose because the
pattern may not he obvious, either to the patient or the clinician. The
end-of-dose period of dyskinesias is typically more prolonged and
troublesome than the initial dyskinetic period of the levodopa cycle.
Ida Kamphuis (54/14)
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Vriendelijke Groeten / Kind regards,
Ida Kamphuis mailto: [log in to unmask]
