Hi, it is good to have you here, and always nice to hear fresh voices and thinking.

AS I see it the problem with even trying to balance neurotransmitters is how do you know what 'normal' levels are in any given individual - they could vary considerably throughout the day, and are at work throughout the body not just the brain. Even taking sinemet is like taking a sledgehammer to a nut, as only a tiny amount gets to where it needs to go, it certainly does not target the SN directly. That is why taking it is a trail and error process, and you may have seen some of us use the analogy of 'walking a tightrope', when trying to manage our medications.

Having said that, and read Paula's post, in particular, there is something to be said for 'trying' to do something. Many of the neurotransmitters when out of balance give rise to other conditions, they are not the same as vitamins, and Paula has done a lot looking into this, and into which ones we may be lacking. An immediate one that some to mind is acetylcholine, as in terms of movement mechanics it provides the opposite message to dopamine. I take a medication in this class, for another PD related symptom, and it smooths my movement, and helps me not wear off. There are loads of them, and various non-neuro specialists who see PD patients for other things are aware from the anecdotal evidence of their patients that they can help with certain aspects of PD. As can some of the antidepressive medications.

Another problem with this is that neuros are and have been very l-dopa centric, but that is actually changing, and the wide range of studies being undertaken looking at this may eventually lead to treatments. But the passage of novel and good ideas through the pipeline to make it to patients is ver, very slow.

The better news is that some of these medications are actually licensed for other conditions.

Going back to my earlier point, trying to balance neurotransmitters still remains a trial and error thing, and other than l-dopa the best treatment that we know of is exercise, which can be very easy for some of us, and an immense hurdle for others. My guess is that when sufficiently exercised in a way that restores normal movement the body will generate some of the neurotransmitters and get them to the right places, and this will compensate for loss of dopamine, or trigger it's production in the non-SN areas of the brain and elsewhere in the body.

There is a great piece of video that was posted in recent weeks of a woman who is using chi kung, and nancyclist and many others are using exercise. How well this works in the very long term is something only time will tell.

I have strayed a little from the balance of neurotransmitters, but my personal belief is that the more naturally you can boost them or re-balance them the better, and it is likely that exercise will be found eventually to play a huge role in staving off the worst effects of PD.

Though how you get this to the people who are already far enough down the line to suffer from inertia and slowness is going to be an issue. Campaigning for care modalities that include exercise as a vital part of PD treatment is one possible way to go.

Lindy