Hi there,

I didn't see any patterns but there was a constant buzzing in my head that I didn't realize was there until I stopped taking it.

You seem to be on too high a dose. Look for behavioural changes with the agonists.

Hi, thanks Wendy S,

(I've been wondering that very question if I'm more stubborn, or stupid!)

I'm glad you do well on Mirapex. I'm fairly young in terms of Parkinson's, 51.

My side effects do go up and down on any given day, so my hope was good days would increase. If needed I'll lower the dose, it sounds like it may be needed. I do prefer to avoid Requip for myself. I actually found a few references to possible lights being seen by a few people taking that. The description seemed different though. Thanks for all your good information. Hope you are tolerating Sinemet well.

Polliwog

(I've heard that from several sources, regarding heart valves and Permax).

Hi there bluedahlia,

It sounds like the Mirapex can be quite an irritant at too high a dose. After I had brain surgery for my aneurysm for a few months I couldn't stand to have television on, or the radio too loud...too much sound bothered me. It went away after awhile but since I have been on the Mirapex I am noticing that same irritation with sound, or too much going on at once. Thanks for the input. Your experience with the buzzing, made me think to mention that. It's certainly unlike anything I've ever taken.

Polliwog

http://brain.oxfordjournals.org/cgi/...ct/129/12/3356

Startling facts about emotion in Parkinson's disease: blunted reactivity to aversive stimuli

The amygdala is closely linked to basal ganglia circuitry and plays a key role in danger detection and fear-potentiated startle. Based on recent findings of amygdalar abnormalities in Parkinson's disease, we hypothesized that non-demented patients with this illness would show blunted reactivity during aversive/unpleasant events, as indexed by diminished emotional modulation of the startle eyeblink response. To test this hypothesis, 23 idiopathic patients with Parkinson's disease and 17 controls viewed standardized sets of aversive, pleasant and neutral pictures for 6 s each. During this time, white noise bursts (50 ms, 95 db) were binaurally presented to elicit startle eyeblink responses, measured from electrodes over the orbicularis oculi. After viewing each picture, subjects provided ratings of valence and arousal. The Parkinson's disease patients were in the early to middle stages of their disease, not demented or depressed, and were tested ‘on’ dopaminergic medication. The two groups were similar in age, education, gender and cognitive screening status. The control group had larger startle responses when viewing negative, aversive pictures than neutral or pleasant pictures. As predicted, startle enhancement during aversive pictures was significantly muted in the Parkinson's disease patients. This blunting was not due to abnormalities in the mechanics of the startle eyeblink per se. Nor was it related to depression symptoms, medications (psychotropics), or failure to perceive/appreciate the negative meaning of aversive pictures (i.e. normal valence ratings). Reduced startle reactivity in the disease group was related to disease severity (Hoehn–Yahr) and occurred in the context of reduced arousal ratings of aversive pictures. These findings of blunted startle reactivity add to the literature on emotional changes associated with Parkinson's disease. The basis for this muted reactivity is unknown but may involve an amygdala-based translational defect whereby the results of cognitive appraisal are not appropriately transcoded into somato-motor-arousal responses normally associated with an aversive motivational state. This may arise from faulty dopaminergic gating of the amygdala, resulting in ‘inhibition’ of the amygdala in the manner described by Marowsky et al. (Marowsky A, Yanagawa Y, Obata K, Vogt E. Neuron 2005; 48: 1025–37). More broadly, the findings of muted reactivity to aversive stimuli may reflect a ‘bradylimbic’ affective disturbance in patients with Parkinson's disease. Future studies are needed to address whether the physiologic blunting observed here might be a useful correlate of apathy.


Key Words: amygdala; depression; dopamine; emotion; psychophysiology; startle


Abbreviations: BDI, Beck Depression Inventory; UPDRS, Unified Parkinson's Disease Rating Scale

Received July 11, 2006. Revised September 11, 2006. Accepted September 26, 2006.

I was diagnosed at 30 I am now 44-

my hallucinations where "little brown fuzzies" in my peripheral vision.

As I recall I titrated up .25 mg per month

I quit mirapex , and sinemet, tasmar and amantadine when I got my DBS. Just recently started back on sinemet.


it seems to take about a year to get over the hallucinations and sleep apneas.

No, I do not recall seeing lights.

Perhaps it is time to try sinemet??

Charlie

Thanks again Charlie—

(I'll put some information here, others might be able to make use of, regarding hallucinations and Mirapex).

I haven't spoken of hallucinations, but I'm grateful for your description of them. After hearing that, and reading an article last week,(see quote and source below) I have a better understanding of what they can entail and do realize I have been having them occasionally, as I suspected. I thought they would be more obvious, since descriptions mention seeing people and animals, and such 'well-formed' things. I had wondered then, if what I do see was provoked by fatigue. It sounds like a common type of hallucination on Mirapex. I do feel I see them more when I am tired. Compared to the other side effects of the drug, I don't find them troublesome. In part because I have this information now, about just what they are. I'll share what I've experienced here in case it may benefit someone else. Perhaps I could hear from others having this type of event occur as a result of Mirapex?

My hallucinations are fleeting shadows, or movement of shapes, also brown in color—usually in my peripheral vision but sometimes directly seen, momentarily. Often they kind of slip or slide quickly across a table, in the air, over my leg—that kind of thing. They fade quickly. Shape and size varies. They are often small and kind of flat, and for me the color has always been brown. At first I often was startled, and thought a bug or spider was moving on the desk, or something flying, perhaps my cat in edge of my vision, etc. In response to the movement it may prompt me to move desk papers looking for a bug, or jump back thinking something is near my face, etc. I once saw a much larger shadow shape, directly, which 'jumped' over my leg and chair as I watched, then disappeared. It's funny because even that you try and make sense of—at first looking a moment for my cat, but of course it wasn't him.

*************************************
I don't know if I'm allowed to post the entire article here without permission, so won't. I'll point you to it, and place a quote.

From:
November-December 2002 Northwest Parkinson's Foundation newsletter: 'Parkinson's Post'
(They mail the newsletter every other month, and offer a weekly e-mail: Parkinson's News Update. You can sign up for both).

http://nwpf.@nwpf.org/ Northwest Parkinson's Foundation
Within their Site Map they include a 'Parkinson's Post Archive'

From the Article: Hallucinations in the Person with Parkinson's

"It surprises some to learn that hallucinations come in many forms:

•*visual (seeing imaginary animals or “angels”)
•*auditory (hearing voices)
•*tactile (feeling sensations that are not real)
•*gustatory (tasting things that aren´t real)
•*olfactory (smelling smells that aren´t actually there)

People with PD most often experience visual hallucinations, which in some instances are due to the effects of anti-Parkinson´s medications such as Symmetrel (Amantadine) or dopamine agonists such as Mirapex (Pramipexole) or Requip (Ropinirole).

Drug-induced hallucinations often begin with vivid or disturbing dreams that usually occur when the person is going in and out of consciousness. Examples of these visual disturbances include “seeing” someone who is not really present, something darting out of the corner of their eye, or imaginary bugs/spiders crawling or “flying” around the room. When these hallucinations first begin, the person can often distinguish the difference between what is real and what is imaginary. However, as these hallucinations become more vivid and “real,” people with PD may have a difficult time determining the difference between the two.

Often, if the hallucinations are not overly bothersome, little may need to be done. Sometimes, however, hallucinations greatly upset the person with PD or cause the person to become agitated and confused. If this happens then the patient or caregiver should contact the neurologist or primary care physician."

***********************
I've had a couple events that made me wonder if I've seen a few other kinds of things, visual and auditory, but since they weren't repeated I'll assume they were not.

I'd prefer to save Sinemet for the more advanced stages, it will depend on how rapidly my symptoms progress. I'm in the early stages, but have had a lot of significant changes in the past year. The mild strokes I had also put another variable in the mix.

Hello CTena Louise,

I'll check out that documentary, I appreciate the link.

(Funny, the study in part indicating less reaction to some things. Not sure what to think of all that, in my situation. Between the shadowy hallucinations, the optical night lights, my aversion to excess sound and and noise stimulation, and pure fatigue—I think I've become more responsive to many things—emotionally and physically. Just the ring of the bell on my computer mail can startle me, and make me jump).

I see you were diagnosed 14 years ago. Your outlook is a good one, hope you're doing well with the physical aspects also.

All the best to you,
Polliwog

hi polliwog. and a late welcome to neurotalk.

have you been to an opthamologist? my dad has the same brown things. they are "floaters". has nothing to do with his meds. he was on requip and had all the bad bad side effects when we found out about the floaters. he also had cataract surgery while coming off the hallucinations. was not a fun time.

Hello Curious

Thanks for the welcome. Good point, I didn’t think to mention. Yes, my eyes check out fine, but anyone having these kinds of problems should go to their ophthalmologist to rule out any other problems. Retinal tears can also cause dark curtain like shadows. Optical migraines have gridlike and other odd visual effects also. (My daughter has had those during problems with hydrocephalus).

So at this point my doctors are agreeing I am reacting to the Mirapex. I see no one else is telling me they’ve seen that ‘light show’ I have, so it must be an uncommon response. That seems to be my norm. Perhaps the dose will need adjusting. I was just hoping to get as much response from it as I could. Especially because of my hand and arm. Harder to do parts of my job (art) if it is acting up.

I wonder if most people with tremor, on Mirapex therapy alone, still have intermittent symptoms of their tremors in the course of each day, in spite of the drug therapy?

Best of luck to your dad. Thanks
Polliwog

Mirapex never stopped tremor for me. Sinemet didn't either. Then I started to take Amantadine (an anti-viral drug which for some reason makes Sinemet work better) along with Sinemet and bingo! Tremor is all but non-existent. I have taken Sinemet from the second year after diagnosis. It has been ten years and I still take almost the same amount (two 25/100) but recently I cut that in half because it caused me to grind my teeth. I take .5 Mirapex three times a day. It causes blotching on my legs, sleepiness if I drive and take it, and a desire to snack (gained 15 pounds). It also makes me have an attention deficit. However, it stops my restless leg syndrome in its tracks.

Ann