A close friend summed all this up for me after I relayed all that we go through with meds and everything always centered around achieving the proper balance:

"In other words, don't take homeostasis for granted."

And it hit me, yes this pretty much nails it.

I am primarily on old school meds now too; I want to stop Requip XL but need to wait until the Holiday break from school. That'll leave me with Sinemet and Amantadine. Amantadine has been wonderful; it's smoothed everything out so much that I actually have to pay attention to a clock again the wear off is so subtle.

Recently, due to anxiety I am having over the appearance of another symptom, I started to take Klonopin. This is great because I actually want to sleep at night. However, I noticed that my symptom seems more prevalent when on it; that is it surfaces almost all the time if meds wear off before I remember to dose. Well, I looked into it and Klonopin is in a class of drugs that exacerbates that particular thing by enhancing GABA which we end up having too much of in the first place! Now I am left wondering do I treat the anxiety which is the result of the motor symptom knowing that it may make that motor symptom more of an issue than it has to be or not!!

I tell my friends and family this and they are so surprised that the doctor doesn't know how all the drugs might affect this way. I used to make excuses for our doctors; it's unrealistic to expect the doctor to know every little thing about PD, but I think they should at least be able to guide us around these pitfalls. I just don't understand why they don't take into consideration how other neurotransmitters factor into PD. It's just plain oldie but goodie common sense. When I read or hear of how evidence based medicine must guide practice, I want to scream. Somehow, the practice of prescribing AD anti-dementia drugs didn't have to go through the evidence based practice trial even though PET scans reveal that only some patients will respond.

Results showed that patients with lower baseline AChE activity in the prefrontal and frontal-limbic regions of the brain were associated with greater cognitive responses to treatment.

What about the evidence that the very same drug that inhibits reuptake of acetylcholine is something that all people with PD do not need? It can, in fact, make our symptoms worse or better yet, put a patient on Aricept at the same time they are taking an anticholinergic to make both drugs absolutely pointless. Ugh. When we are diagnosed, we should all receive a baseline reading of our neurotransmitter levels whether through PET scan or cerebrospinal fluid samples. This should serve as a guide post for our treatment and a way to measure disease progression. I know this is oversimplifying, but come on, how difficult can that be. It's light years beyond what we have now.

Okay, sorry, end of rant.

Laura