Matt,

First, there is absolutely no evidence that levodopa causes disease acceleration. This was the thought at some and neurologists once withheld levodopa therapy as long as possible, thought we all eventually end up taking it. A fairly good overview of the levodopa question is found here; it has in fact instead shown to have neuroprotective properties. There is a fairly recent study you may want to look up for more info; it is ELLDOPA- this has some contradictory results on the protective front, but I think both should serve to support that at the very least it does not seem to accelerate the disease process. Many people take it for decades, so I don't think that would be the case otherwise.

That's not to say Levoodopa does not prevent us with other issues especially when we have to take a lot of it.

CR has a lower rate of bioavailability (70% vs. 99%) than the IR, so it come with its own distinct set of issues (I know these to be true from experience):

- It can result in too much accumulation in the bloodstream later in the day resulting in more dyskinesia.

-It is more reliant on food being present to aid absorption, and the IR is more reliant on a more empty stomach- you can see the issue here.

-Older patients may experience mental confusion and hallucination more readily on the CR formulation.

Is your mom still taking 1 full 25/100 Sinemet IR plus 1 25/100 Sinemet CR for all her doses? Usually, the goal of the CR is to give more time and less IR pills. That means ideally with CR one has 4-6 hours between doses and we use Sinemet IR only when the CR won't kick in.

I am wondering if your mom isn't experiencing times when she is undermedicated due to the difficulty it takes in achieving a balance between the two meds. It also sounds to me from the description of your mom being both stronger physically yet with a weak voice or slowness in speaking that she may be "in between" where her meds are working at like 75% and she's not entirely her normal self - this happens sometimes with the CR; there is also a "skipped dose effect" that can occur where it would appear we did not take our meds at all, and is frustrating. Or she may also be experiencing a little confusion from the CR which may be the "weakness" you hear.

I would ask the neuro her goal in prescribing both? Does she want your mom to take them both together or eventually take less of the IR? Also, she might be able to conduct a little exam to check for confusion if that at all may be an issue. This like I mentioned would be CR related.

Many of us do experience depression and end up going on a med for that as well. Also keep in mind that she has been fairly recently diagnosed and we go a wide range of emotions - it has been likened to going through the stages of grief that Kubler-Ross had identified.

Ask lots of questions; your mom and your family deserve to know exactly what the neuro's goals are with the meds. There are other meds out there if things continue in this vein.

Laura