hi all,

i have another question about levodopa, if anyone is interested in responding.

in my limited interaction with folks on sinemet, i have started to get the impression one symptom in particular might be especially alleviated by it, and that is rigidity.

or does it do a number on bradykinesia, too?

if you experienced both bradykinesia and rigidity before you started sinemet, which interfered with your ability to carry on with your life more?

hope you all don't mind all my questions.

thanks,
boann

boann...ask ALL the questions you are looking for answer to

I looked for a reference that contained all three words. So, far this is all I could find. It does answer the question. I don't agree with the tremor part though...my personal feeling since mine gets worse all the time.

Neurosurgical Medical Clinic, San Diego, CA

http://www.sd-neurosurgeon.com/diseases/pd.html

Excerpt:

The introduction of L-dopa in the 1960's brought a marked reduction in stereotactic surgery for PD. L-dopa alleviates bradykinesia, rigidity and tremor, allowing patients to improve in activities of daily living. Its combination with carbidopa (as Sinemet) reduces severe side effects and revolutionized the medical treatment of PD. Unfortunately, after many years use, higher doses of Sinemet are required. Many patients develop jerking and writhing movements (dyskinesias) and rapid, unpredictable fluctuations in symptoms (on-off phenomenon) as well as other side effects. The short amount of time Sinemet lasts after oral dosage, and interference with its absorption from the stomach by food protein further complicated its use.

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Thank you for the reassurance - because i have lots of questions!

thank you for the blurb on levodopa and for your experience, too - actually, somewhere along the line i read or heard that levodopa does nothing for tremor, and your experience supports that. i was hoping to hear from others, as well, but i'm not sure that is going to happen.

thanks,
boann

Hi,

For me it's difficult to separate Bradykinesia from rigidity. (I've always had some trouble determining just what is being referred to with "rigidity" anyway)

Bradykinesia IS Parkinson's for me - it's not just a symptom ... and yes, Sinemet is VERY effective in alleviating it.

As bad as the Dyskinesia / Dystonia from the Sinemet can be (and with me it's horrible) Bradykinesia is worse. I'm very near worthless and non-functional without my Sinemet.

Hope this helped ...

MikeTTF

I have been quite distracted and have thought of answering many threads as I read but haven't, which seems to be a permanent characteristic now.

Anyway, Sinemet helps both bradykinesia and rigidity. I do not have a regular tremor, but do recall my neurologist saying way back at diagnosis that tremor is harder to control. Bradykinesia and rigidity are very linked together for me and dystonia is the worst of both. Sinemet is the only relief. The agonists used to work alone, so they are useful for some for awhile without sinemet. I took eldepryl and mirapex before taking sinemet.

Paula

one of the other postings relates to this--though definitive answers are not available, someone is looking at this question....

relationship between clinical improvement and in vivo synaptic dopamine (DA) release

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Neurology. 2006 Nov 14;67(9):1612-7. Related Articles, Links


Clinical correlates of levodopa-induced dopamine release in Parkinson disease: a PET study.

Pavese N, Evans AH, Tai YF, Hotton G, Brooks DJ, Lees AJ, Piccini P.

MRC Clinical Sciences Centre and Division of Neurosciences, Faculty of Medicine, Imperial College, Hammersmith Hospital, Du Cane Road, London W12 ONN, UK.
CONCLUSION: In advanced Parkinson disease, the improvement of rigidity and bradykinesia and the presence of dyskinesias after a single dose of oral levodopa are governed by the level of dopamine generated at striatal D2 receptors. In contrast, relief of parkinsonian tremor and axial symptoms is not related to striatal synaptic dopamine levels and presumably occurs via extrastriatal mechanisms.

I didn't see MikeTTF response before I posted mine.....but we said the same thing I think. Hard to separate the two[bradykinesia and rigidity} in terms of how you feel.

Paula

on the nature of bradykinesia without rigidity. i have very little rigidity, which i have concluded must refer to the involuntary tensing of muscles - and i once read somewhere that it is the simultaneous tensing of both the muscles that bend a certain joint and the muscles that straighten that joint that occurs in PD - no idea whether that is accurate.

i consider myself to be extremely fortunate to have escaped rigidity for this long, because it seems to me that that – and this gets to the heart of why I asked the question – is the most physically uncomfortable motor symptom of PD. All three cardinal symptoms can be disabling, but I can tell you from experience that while bradykinesia slowly robs you of abilities you once had, at least it does not cause pain or extreme discomfort.

This is the best way I have found of describing it to healthy people – you know how it feels when you have been out in the cold without gloves or pockets for some time, and then you try to do something like get change out of your change purse or even dollars out of your wallet while your fingers are still half frozen? Your fine motor coordination is impaired, right? Well, that is what bradykinesia is like, for me, minus the cold. No, there is no pain, just the failure of your fingers to adequately carry out the actions your brain is telling them to perform. (everyone can identify with pain – if you take that out of the equation, people look at you blankly when they try to understand the problem)

I can see how rigidity would impair movement, as well, but it would also be anywhere from physically uncomfortable to physically painful and/or unbearable.

I am trying to get a sense of why people start taking sinemet – and there are a million possible reasons ranging from “I don’t know anything about it and my symptoms are not so bad - I started taking it because my doctor said I should” to “I am fully aware of the dangers but for X reason I have decided to take the risk,” and I had the sense that “X reason” might more often be ultimately related to rigidity than to straight bradykinesia.

See, I am not a neuroscientist so I may be way off track, but the more I read the more convinced I become that not only is levodopa toxic (dyskinesias are clear evidence of that) but that it actually is toxic specifically to dopaminergic neurons, and I am concerned that it may be being prescribed for people who a) are not fully informed and therefore are not able to make an informed decision, and b) that some of those people might be able to get by without it – and that ultimately they would be better off for having done so.

My method, is, of course, impeccable, from a scientific perspective.

thank you - this reminds me of another question i have. i have recently read that dopamine is toxic to dopaminergic neurons (go figure) and that in the normal course of events, the neurons are protected somehow from the dopamine once it is secreted. (i could very well be butchering the reality of the situation, here, but this is what i understand from what i have read so far).

if the above is accurate, what happens when l-dopa is converted to dopamine in the brain? since it makes its entry to brain tissue via a different path than indiginous (sp?) dopamine, do the same mechanisms kick in to protect dopaminergic neurons that would had it made its entry in the usual way?

any thoughts?