Dyskinesia
 

Hi all,

My Dad was diagnosed with PD 8 years ago and taking medication for the last 3. He takes levodopa /carbidopa 100/25- 2 tablets - 4 x a day. He recently started bobbing his head (moreso later in the day). The Neurologist says this is dyskinesia but he is getting benefit from the drug so it is worth keeping the dosage. I am wondering if there is anything that you all find helpful with dyskinesia?

Any advice would be helpful.

Thanks!

Some information -
Parkinson’s Treatment Tips for Dyskinesia >> Center for Movement Disorders and Neurorestoration >> College of Medicine >> University of Florida

Also a site search will bring up past mentions of Dyskinesia
https://www.neurotalk.org/search.php

bubblyshar,

As I understand it, your dad is on 4 doses per day, each of 200mg of immediate release L/C. That's 800mg in total. He is taking no other PD meds. Is this correct? The dose timings would have been useful.

The timing of the onset of the bobbing later in the day suggests that this is likely to be levodopa induced dyskinesia. This is caused by having too much levodopa in the system. You could confirm this diagnosis if your dad went without a half dose at the dose before the onset of bobbing. You would expect the bobbing not to occur.

The underlying problem is that levodopa has a short half-life, about 90 minutes. So, levels peak and trough during the day. Some dopamine agonists have a longer half-life, but they have problems of their own, so I wouldn't introduce them at this stage. You could try extended release versions of L/C, but some people find them less reliable than immediate release.

So, if you stick with immediate release L/C, you could try lowering the L/C dose, but your dad is getting benefit from the levodopa which you don't want to lose. It may be better to keep the total daily dose as it is, but to extend the time between the first and last doses of the day and to take more, but smaller, doses. For example, four 200mg doses 3 hours apart could be replaced with an initial 200mg dose followed at 2 hourly intervals with six 100mg doses, e.g.
2..2..2..2
2.1.1.1.1.1.1

You will need to take into account mealtimes, to avoid protein competition.

I would advise not making the change all at once, but rather to move one step at a time.

I've written an app that allows you to visualize what's going on. You enter the time and size of each dose, and the program draws a graph of plasma levels of levodopa throughout the day.

Parkinson's Disease Measurement: PwP, surveys, trials, analysis

John

Good post John ...
 

my Neuro has been telling me for the last 13 years merry trip down the PD road that PD drugs are best used little and often rather than infrequently and a lot.

I agree with John that you should talk to your Neuro about dosage. 200 mg in a single sitting would clean me out, I take a mix of 100 mg and 75 mg 6/7 times a day.

Also my experience of Sinemet cr was negative, didn't really work for me. Stalevo (a sort of constant release drug) is very good for me. Try to get some smoothing of the dopamine hit rather than all at once which will reduce the Levadopa hit.

Again also, don't knock Dopamine Agonists. They can be used alongside Levadopa and are less likely to produce Dyskinesia. Less likely but certainly not never. I take full dose of Pramipexole and its good for me although some people (usually older PWP), cannot handle the side effects.

Also Amantadyne works great for me at reducing Dysks.

As you can see you have a lot of options open to you. Get into your Neuro and discuss options and I am sure that it will be a worthwhile discussion.

Take care,
Neil.

I recently got a prescription for amantadine but have hesitated to try it because of the side effects. Simple question, if I try it and get bizarre side effects, will they go away as the drug wears off? Thanks!

Paracetamol ....
 

KNPV, my understanding is that Amantadine is "just" another dopamine agonist, and in theory there is no reason why you should get more and/or fewer side effects than with any other agonist.

I was dx'ed at age 40 and have never had any problem with Amantadine. I can however say that it is the only thing to hit my dysks. However as is always the way in PD we all have specific versions of the disease so you might get side effects, who knows. My advice, try them, see how you are, decide whether to re use. Remember Paula_W a prolific (and brilliant) poster she took Amantadine for approx. 10 years and it was still working for her.

If you allow your fear of side effects to stop your drug usage you will miss some very fine and effective drugs.

Like my Neuro says ... Nowadays they couldn't get paracetamol through trials because of its reported side effects.

Take care,
Neil.

Thanks for your sensible reply. I will try it.
:)