Quote:
Originally Posted by johnt
Boxtel et al. write [1]:
"Classically, the worsening of clinical signs in patients given very low dose antiparkinsonian drugs is explained by a preferential stimulation of presynaptic dopaminergic receptors ... limiting release of endogenous dopamine."
This observation complicates the prescribing process: a baseline result, followed by a negative result is not, in itself, adequate to conclude that an antiparkinson medication is not efficacious.
It may also explain why I perform fairly well in the morning before taking the first dose of the day, but get worse briefly while the drug's absorbed up to working levels. I often go 12 hours, 8 half-lives of levodopa, overnight between doses, so the drug has almost been washed out.
It also suggests that too much exogenous levodopa may lead to a decrease in endogenous dopamine production. This would favour the "runway" hypothesis of dosing, rather than the, I think, currently favoured "use or lose" hypothesis.
Reference:
[1] "Drug Benefits and Risks: International Textbook of Clinical Pharmacology"
edited by C.J. van Boxtel, B. Santoso, I.R. Edwards
John
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Hi John
Yes I also experience a worsening of pd symptoms after the fist dose, but then I do after every dose at times, though mainly my 1st and 2nd. I was told it was because of wearing off between doses. I pointed out the fact that the main one was the first and that the stalevo had been nil for some hours. I was ignored. I said I'm often better first thing than during the night. I was told of course sleep recharges any remaing cells, I said it's the same if I've not slept or had only 2 hr. I was ignored.
OCD and panic attacks so bad I was taken to hospital have resulted in me suddenly having to reduce ropinirole. It was increasing this and switch to stalevo that brought me to the forum. Early 2016 I posted finally mastered 12mg. I was then ramped up to 16 mg and now back to 10 mg !
Another 1.5 yrs wasted !
Tuning a Ferrari they say ? This post illustrates what I've always believed Parkinson's is all smoke and mirrors. There are more theories created, challenged, archived and re-done than I'd ever believe. I don't know but I certainly believe there are some fundamental faults in the current bible of all things parkinsonian.
Hope everyone's as well as possible
Keep batting folks !
Nigel