end of dose dyskinesia
 

I ssem to be having lots of end of dose dyskinesia. My carbidopa doseage has been reasonably stable. Anyone found anything that works for this problem. I seem to recall amantadine? Thanks.

"Nip it in the bud!
 

....as Barney Fife would say. Once established it can be a *****. From Wikipedia-
"dyskinesia (DD), which occur when the drug concentration rises or falls. If dyskinesia becomes too severe or impairs the patient's quality of life, a reduction in L-Dopa might be necessary, however this may be accompanied by a worsening of motor performance. Therefore, once established, LID is difficult to treat.[5] Amongst pharmacological treatment, N-methyl-D-aspartate (NMDA) antagonist, (a glutamate receptor), amantadine, has been proven to be clinically effective in a small number of placebo controlled randomized controlled trials, while many others have only shown promise in animal models,.[4][7] Attempts to moderate dyskinesia by the use of other treatments such as bromocriptine (Parlodel), a dopamine agonist, appears to be ineffective.[8] In order to avoid dyskinesia, patients with the young-onset form of the disease or young-onset Parkinson's disease (YOPD) are often hesitant to commence L-DOPA therapy until absolutely necessary for fear of suffering severe dyskinesia later on. Alternatives include the use of DA agonists (i.e. ropinirole or pramipexole) in lieu of early L-DOPA use which delays the use of L-DOPA. Additionally, a review (Stocchi, F., Clin Neuropharmacol, 2010, 33, 198) shows that highly soluble L-DOPA prodrugs may be effective in avoiding the in vivo blood concentration swings that potentially lead to motor fluctuations and dyskinesia.

Patients with prominent dyskinesia resulting from high doses of antiparkinsonian medications may benefit from deep brain stimulation (DBS), which benefits the patient in two ways: 1) DBS allows a reduction in L-DOPA dosage of 50-60% (thus tackling the underlying cause); 2) DBS treatment itself (in the subthalamic nucleus or globus pallidus) can reduce dyskinesia.[9]

The use of MDMA ("Ecstasy") has been shown to enhance the effects of L-DOPA while reducing the associated dyskinesia in primates with advanced PD.[10] Its serotonergic actions may be responsible for this effect."


I thnk that dextrometorphan is an NDMA antagonist. It might be worth tryind a low dose there.

-Rick

From Psychcentral Newsletter
 

Cough Medicine Helps Parkinson’s
By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on November 8, 2007

MedicineResearchers discover a cough suppressant and a drug tested as a schizophrenia therapy appears to mitigate some of the debilitating side effects of the levodopa , the primary medicine used for Parkinson’s disease.

Dextromethorphan, used in such cold and flu medications as Robitussin, Sucrets, Triaminic and Vicks, suppresses dyskinesias in rats, researchers at Oregon Health & Science University found. Dyskinesias are the spastic or repetitive motions that result from taking levodopa, or L-dopa, over long periods.

Dyskinesia Tips
 

Few dyskinesia treatment tips some of them already mentioned by Rick.

"If you have severe dyskinesia(s) here are a few treatment tips we have found valuable over the years:

Go to a Parkinson’s specialist who has a lot of experience dealing with this issue, and remember it may take multiple visits to resolve the issue.
Remember that dyskinesia is usually driven by the dose of levodopa (sinemet) and/or agonist. Reducing the dose, and possibly taking smaller doses more frequently may be an option.
Remember that drugs like Entacapone (Comtan) (which is also a component of Stalevo) can make dyskinesia worse.
In severe cases, holding a dose or two of sinemet can be helpful to gain control of the situation. Remember stopping sinemet for a day or two can be dangerous so always consult your doctor for prolonged drug holidays (which are not recommended).
In severe prolonged and disabling dyskinesia many experts will eliminate dopamine agonists, MAO-B drugs, Comtan (or Stalevo), and may switch to a sinemet only regimen. They will search for a low dose of sinemet that will allow the patient to feel “on” with minimal to no dyskinesia. They will then give this low dose frequently enough to keep them “on” for as many hours in the day as possible.
Occasionally, patients with severe dyskinesia can be switched to liquid sinemet, although for most patients this is not a long-term viable strategy.
Amantadine can be added to a regimen to suppress dyskinesia– for some sufferers.
The most severe and medication resistant cases may be considered to be screened for deep brain stimulation or a duodopa pump.

Parkinson’s Treatment Tips is a blog brought to you by Dr. Michael S. Okun of the University of Florida Center for Movement Disorders and Neurorestoration"