Thread: Dyskinesia
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Old 07-19-2017, 05:34 AM
johnt johnt is offline
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Join Date: Apr 2009
Location: Stafford, UK
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johnt johnt is offline
Senior Member
 
Join Date: Apr 2009
Location: Stafford, UK
Posts: 1,059
10 yr Member
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bubblyshar,

As I understand it, your dad is on 4 doses per day, each of 200mg of immediate release L/C. That's 800mg in total. He is taking no other PD meds. Is this correct? The dose timings would have been useful.

The timing of the onset of the bobbing later in the day suggests that this is likely to be levodopa induced dyskinesia. This is caused by having too much levodopa in the system. You could confirm this diagnosis if your dad went without a half dose at the dose before the onset of bobbing. You would expect the bobbing not to occur.

The underlying problem is that levodopa has a short half-life, about 90 minutes. So, levels peak and trough during the day. Some dopamine agonists have a longer half-life, but they have problems of their own, so I wouldn't introduce them at this stage. You could try extended release versions of L/C, but some people find them less reliable than immediate release.

So, if you stick with immediate release L/C, you could try lowering the L/C dose, but your dad is getting benefit from the levodopa which you don't want to lose. It may be better to keep the total daily dose as it is, but to extend the time between the first and last doses of the day and to take more, but smaller, doses. For example, four 200mg doses 3 hours apart could be replaced with an initial 200mg dose followed at 2 hourly intervals with six 100mg doses, e.g.
2..2..2..2
2.1.1.1.1.1.1

You will need to take into account mealtimes, to avoid protein competition.

I would advise not making the change all at once, but rather to move one step at a time.

I've written an app that allows you to visualize what's going on. You enter the time and size of each dose, and the program draws a graph of plasma levels of levodopa throughout the day.

Parkinson's Disease Measurement: PwP, surveys, trials, analysis

John
__________________
Born 1955. Diagnosed PD 2005.
Meds 2010-Nov 2016: Stalevo(75 mg) x 4, ropinirole xl 16 mg, rasagiline 1 mg
Current meds: Stalevo(75 mg) x 5, ropinirole xl 8 mg, rasagiline 1 mg
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