[Algonkian]

I wonder if there are any other PWP who experience "on state" fog (freezing of gait) ? Apparently its rare but does occur.

As well as on state fog, I experience several other symptoms of PD only when "on". These are retropulsion, difficulty rising from seated position, constipation and apathy.

The movement disorder specialist I saw recently could not explain why this should occur.

Anybody else with similar experience ?

[Jomar]

It is pretty up & down for my dad in the on state.. sometimes he can get up & move fairly well and other times he hesitates or gets stuck temporarily....
Dx'd 15 yrs ago or so.

[Algonkian]

Originally Posted by Jo*mar

It is pretty up & down for my dad in the on state.. sometimes he can get up & move fairly well and other times he hesitates or gets stuck temporarily....
Dx'd 15 yrs ago or so.

Thanks Jomar

[Niggs]

Originally Posted by Algonkian

I wonder if there are any other PWP who experience "on state" fog (freezing of gait) ? Apparently its rare but does occur.

As well as on state fog, I experience several other symptoms of PD only when "on". These are retropulsion, difficulty rising from seated position, constipation and apathy.

The movement disorder specialist I saw recently could not explain why this should occur.

Anybody else with similar experience ?

Yes, brain fog is a good description . For me it occurs inline with fluctuating drug levels and confirmation it is a side effect was given by my Neuro.
It is an inability to engage one's thoughts.

Nigel

[johnt]

Algonkian,

I'm no doctor, but it seems to me that your "ons" may not be very "on". Has your neuro suggested increasing your medication? (There may be good reasons for not increasing the dose, such as dyskinesias.)

If you wish to map your level of on-ness and you're on a levodopa based drug, you can do a tap test every 10 or 15 minutes over the period of your medication, and graph the result. See:

http://neurotalk.psychcentral.com/thread183360.html

John

[Algonkian]

John,
Thanks for the reply and apologies for my tardy response.
I can see why you suggest increasing the levodopa dose. But I never experience "off state" freezing, nor do I experience retropulsion, difficulty rising from seated position, constipation and apathy when in the "off" state.

That's the weird thing - I only experience these symptoms of PD when "on" and never when "off".

When I am "on" slowness and stiffness (the PD symptoms that trouble me most when "off") both improve dramatically.

Increasing the ldopa dose increases the incidence of freezing the last time I tried it. If you google "on state freezing" that is one of tests for on state freezing.
I will definitely try the tap test - thanks.
Algonkian.

[Algonkian]

I have since discovered that it is called a paradoxical reaction to medication - ie it produces a reaction opposite to the intended reaction.

SSRI anti depressants result in an increased chance of suicide. One possible explanation for this paradoxical reaction can be found on the web;

**

Sometimes after a good nights rest I wake up more on than off. When I go off at the end of the day after the last dose of levodopa I initially feel terrible with bad akinesia and bradykinesia.

I think my brain is still able to produce some levodopa and something similar to the animal study above is occurring, ie my brains production of levodopa stops when I take levodopa medication.

[Algonkian]

The animal study referred to is from Dr. Ann Blake Tracy's book "Prozac: Panacea or Pandora?"

“animal studies demonstrate that in the initial administration Prozac actually causes the brain to shut down its own production of serotonin, thereby causing a paradoxical effect or opposite effect on the level of serotonin."

In the previous post I said that I initially experience bad akinesia and bradykinesia after "going off" after taking my last dose of levodopa. I meant to add that after an hour or so my symptoms improve dramatically. Presumably my brain starts to make dopamine again, and the paradoxical reaction symptoms I experience when in the "on state" disappear when this happens

[johnt]

The body continues to produce its own (endogenous) dopamine until late into the disease. I'm certainly not suggesting that you do this, but you can estimate how much dopamine is produced locally by going drug free for a day, which is long enough to clear almost all of the levodopa from your body. I find that I can still function, albeit at a lower level than with drugs. My side-to-side tap test results approximately halve.

You mention waking up feeling good. I put this down to the endogenous dopamine being produced and stored during the night. It is stored in reservoirs (vesicles) which die off as the disease progresses, making the effect of drugs more spiky. This eventually leads to dyskinesia.

You mention feeling worse immediately after taking the drugs. I experience this too. I'm not sure what causes this. It could be just a continuation of the decline in plasma levels of levodopa due to the half-life effect. Alternatively, I suspect that the brain reacts to the surge of exogenous levodopa by switching off endogenous dopamine production. Unfortunately, the unfocussed extent of the levodopa across the brain is not as effective as the locally produced dopamine in the dopaminergic neurons: there is enough levodopa, but it is not all in the right place.

John

[Algonkian]

Your post makes sense and fits with my experience of levodopa therapy. My post has had a quote edited out because I did not attribute it . The quote presents a possible explanation for the increases risk of suicide from the SSRI anti depressant Prozac (a paradoxical drug reaction). Crudely put, an increase in brain levels of serotonin because of taking Prozac leads to a reduction in endogenous serotonin production - similar to your alternative explanation. However, I feel at my worst not immediately after taking a dose of levodopa as you state, but after the last dose has stopped working and I am in the "off" state. After about an hour, I feel much better - presumably because my endogenous production of dopamine has kicked in again.