Yesterday (Sat 7/31) was another good day. No "off"time until evening when I cut short the medication day to see what would happen. Even that was improved. Most interestingly, I experienced a moment of, for lack of a better term, "fluidity" when my muscles worked smoothly as I turned my body. This is hard to explain, but it was as though my body realized that the turn was going to leave me open for a fall, belatedly began to brace for it, and was surprised when it did not materialize.

Another change- My medication cycle has an unfortunate feature. As sinemet comes on I must urinate. But this occurs before motor function returns. The result is that I make regular use of a chairside urinal. Or at least I did until yesterday when I realized that the whole day had passed with the urinal unused.

Found this review of the small study that started this thread:

"esults

Six subjects completed the study - one withdrew with nausea, malaise, and increasing 'off' periods while taking perindopril. After 4 weeks on the ACE inhibitor, 5 of the 6 had a significant increase in the area over the curve for their Webster scores, indicating an increased motor response to their standardized dose of L-dopa. There was a faster onset, and a reduction in 'on' phase peak dyskinesia.

The UPDRS II scores showed that perindopril was associated with improved functional ability in 'off' phases. The patient diaries revealed a modest but significant increase in 'on' periods during ACE inhibitor treatment, which was maximal in the 3rd and 4th weeks on the drug.

While peak dyskinesia scores were reduced, four of six patients had an increase in dyskinesia during the waking day with perindopril. This was probably a reflection of their increased total 'on' times.

There were no perindopril-related adverse effects on blood pressure, postural hypotension, or renal function.

Comment

This study confirmed the concept that an ACE inhibitor can improve the motor response to L-dopa in patients with Parkinson's disease. The drug also increased the proportion of the day spent in the 'on' state, as well as showing an improvement in the functional disability scale used.

Most effective agents in Parkinson's disease induce dyskinesia; perindopril, on the other hand, produced a greater amplitude of motor response to L-dopa with a reduction in peak dyskinesia, i.e. it seems to have an effect beyond simply increasing dopamine release.

The authors of the study point out that the benefits of perindopril were "modest, and not of the magnitude of L-dopa itself". However, the dose was relatively small, and treatment duration was short. As tolerance as good, there is every reason to conduct further studies with higher doses, for longer treatment periods.

Trandolopril, spiropril and perindopril are ACE inhibitors that can penetrate the blood-brain barrier, while enalapril cannot."