Why is carbidopa always given with levodopa

When levodopa was first introduced, its major side effects were nausea and vomiting. In spite of its remarkable benefits, many patients could not or would not take it. The problem was in the conversion of L-dopa or levodopa to dopamine. The L-dopa or levodopa was changed in the stomach by an enzyme called dopa-decarboxylase (DDC) into dopamine. Dopamine in the stomach and circulating in the blood cannot cross the blood brain barrier to reach the sub-stantia nigra. However, dopamine in the...

Have oily skin Is this PD

In some people, patches of oily, greasy, scaly, inflamed, reddened, and itchy skin develop in response to excess sebum production. Your scalp, the sides of your nose, your eyebrows, your eyelids, the skin behind your ears and the middle of your chest are the most common sites. These areas have the highest concentration of sebaceous glands. Associated with the dermatitis, dandruff may appear as scaling on your scalp without redness. Seborrheic dermatitis is common in infants, where it is called...

As a caregiver how can I cope with my partners PD

As a partner of someone with PD, you never expected to be in this situation, and you may feel unprepared for your new responsibilities. Frustration, anger, resentment, fear, sadness, and hopelessness may all rush over you, and then you may feel guilty for having these emotions Life seems to be spinning out of control. Like your PD partner, you need to accept this situation because PD is something over which you have no control. When you accept this, you can focus on parts of your life over...

Should I take glutathione

Glutathione is known to be an important antioxidant in the body and the brain. Glutathione is a tri-peptide, that is, it is made up of three amino acids strung together. Glutathione and the enzymes related to its metabolism have been reported to be depleted in the substantia nigra of people with PD. Whether this precedes the loss of the dopamine cells, or is a consequence of their loss (fewer cells means less 4Adapted with permission from Parkinson's Disease Guidelines for Medical Nutrition...

Is coffee good for PD

There have been studies that suggest that caffeine protects against PD. Thus, if your drink several cups of coffee a day, and have been doing so for many years, you may be 30 less likely to have PD. However, care must be taken in how these data are interpreted. Although it was found that people who drank coffee or other caffeine containing beverages such as tea, cocoa, and cola had lower incidences of PD, other explanations are possible. It could be that as PD develops, with its tremors and...

Is there surgery for PD

Surgery for PD and other movement disorders was pioneered in the 1940s by Meyers (United States). Large regions of the brain were exposed and using surface landmarks (there were no CT scans or MRIs) the basal ganglia a series of interconnected regions of the brain including the striatum, globus pallidus, and thalamus were located and ablated (destroyed). In 1947, Spiegel and Wycis developed a crown-like stereotaxic frame that held the head in place and allowed regions inside the brain to be...

Will I lose my mind

Approximately 30 of all people with PD develop a dementia, which is defined as a loss of previously acquired thinking skills. A mild loss of some of these skills is not dementia, but a marked loss of many of them is. Sometimes family members overlook changes in thinking and assume that the patient is exhibiting willful behavior or that the changes are part of a depression. Some patients are good at concealing their problems by deferring questions to other members of the family or by denying...

My husband seespeople in our bedroom Whats happening

Hallucinations may occur in people who are treated with PD drugs. They are usually visual and are often accompanied by delusions. The combination is called a psychosis. It may be difficult or even impossible for you to convince your spouse that there isn't anyone there or that you aren't going to harm him or her. Such symptoms cause distress to families and are the most frequently given reason for placing a patient in a nursing home. Psychosis may occur without dementia as in LSD, amphetamine,...

What are the side effects of Sinemet

Some of the side effects are not entirely side effects of Sinemet. Some (wearing off or on-off) result from progression of PD and the short duration of action of Sinemet some (dystonia, freezing) can be symptoms of PD (unrelated to drugs) or a side effect of Sinemet some (dyskinesia) are side effects of Sinemet and some (psychosis) are the effects of Sinemet and dopamine agonists temporarily unmasking an underlying dementia. Wearing off. After an optimal peak effect from Sinemet is attained the...

Ive been told that because I had a melanoma I cant take Sinemet Is this true

Shortly after levodopa's release, the author of this book, Dr. Abraham Lieberman, saw a person with PD who developed a recurrence of his melanoma after 4 months of treatment with levodopa. Melanoma is a pigmented cancer of the skin. If not recognized and treated, it can metastasize (spread) almost everywhere in the body, which can be fatal. However, even if a melanoma is recognized and removed, years later it can reappear. Melanoma contains an enzyme, tyrosine oxidase, that can use levodopa as...

Why are there two kinds of Sinemet

Carbidopa levodopa, Sinemet, comes in two forms immediate or regular release and controlled release. People with more advanced PD who had shorter responses to regular-release Sinemet were expected to benefit from the slower controlled-release form called Sinemet-CR. The coating surrounding Sinemet-CR slowed the absorption of levodopa into the bloodstream. It was thought this would overcome the wearing off effect that eventually appeared during treatment with regular-release Sinemet. Although...

What do I tell my grandchildren

Sooner or later your children or grandchildren will need to be told. How you tell them will affect how they deal with both you and PD. Keep the conversation light. Don't let your anxiety show. Let them know that it is a natural event, and reassure them that it isn't fatal or something contagious that they can catch. Use language that is appropriate for their age and level ofunder-standing. Encourage them to ask questions and share their concerns. The more accepting that you are of your...

What does a neurologist do

The neurologist will want to know why you came, your medical history, your family history (especially a history of PD or tremor), and what, if anything, in your social and work history may have contributed to your symptoms. Bring a summary of your medical history, including serious and chronic illness, hospitalizations, surgeries, allergies, medications taken, family and personal background, occupational risks, and lifestyle risks. If what you have to talk about is difficult to discuss,...

Does shortness of breath mean Im worse

Breathing is a basic function that occurs automatically, usually without conscious awareness. Breathing is controlled by the respiratory center in the brainstem. When a signal arrives from the respiratory center, the chest wall muscles and the diaphragm contract. This increases the space between the chest wall and the lungs, which in turn decreases the pressure inside the lungs. The lungs inhale to equalize the pressure inside with the pressure outside. As the lungs expand to fill the space in...

Do agonists slow the rate of progression of PD

Two studies strongly suggest that this may be true. One study using pramipexole (Mirapex) recruited 82 newly diagnosed PD patients from 17 movement disorder clinics to participate in a 46-month study. The patients were randomly divided into two groups, one receiving Mirapex and the other Sinemet. They underwent SPECT using special markers to measure striatal uptake of dopamine at four different times during the study. The first was at baseline. The second was after 22 months. The third was...

Why am I obsessed

Prior to the introduction of L-dopa, doctors described a PD personality a person who was controlling, who had a need to do things just so, who was obsessed with orderliness and cleanliness. Today this person might be diagnosed as having an obsessive-compulsive disorder (OCD). After the introduction of L-dopa there were reports of obsessive-compulsive behavior in many people with PD who were on L-dopa. The behavior included an obsessive fixation on sex. Indeed, at one time, L-dopa was thought to...

Organ Donation

National Neurological Research Specimen Bank VMAC (W127-A)-West Los Angeles 11301 Wilshire Boulevard Los Angeles, CA 90073 (310) 268-3536 Francine M. Benes, M.D., Ph.D., Director Harvard Brain Tissue Resource Center www.brainbank.mclean.org.8080 Privately sponsored National Disease Research Interchange (NDR) 1880 JFK Boulevard, 6th Floor Philadelphia, PA 191103 (800) 222-NDRI (800 222-6374) (215) 557-7361 University of Miami Brain Endowment Bank Department of Neurology (D4-5) 1501 N. W. Ninth...

Why cant I read anymore

You may have excellent vision, but reading is difficult. In PD, the muscles of your eyes slow down and may be less able to accommodate for the rapid movements that are necessary for scanning a line of print. Occasionally, you may have double vision. This condition, related to PD, may be helped by using specially designed prisms. A second condition related to PD may involve interpretation of the images cast on the retina by the lens of your eye. The retina contains dopamine cells, and when the...

Am seeing a neurologist What should I expect

Although your primary care doctor may have recognized the symptoms of PD, he or she is trained in family medicine or internal medicine and may see few people with PD perhaps 5 a year. Although he or she may recognize the symptoms, a family doctor may not have had the training in neurology to deal efficiently and effectively with PD. General practitioners may not be up to date on developments in PD, just as neurologists may not be up to date on developments in diabetes, heart disease, or cancer....

Should I take a drug holiday

If you're thinking vacation, don't think drug holiday it's not a vacation. Before dopamine agonists were available as alternatives to L-dopa, and before Clozaril, Geodon, and Seroquel, were used to treat the psychiatric complications of L-dopa, drug holidays temporary withdrawal of L-dopa to counteract side effects such as dyskinesia and psychosis were the rage. The holiday purged or cleaned the brain of excess L-dopa, but unfortunately it nearly did in the patient, as well. The holiday was...

What are some of the secondary

Secondary symptoms are often combinations of one or more primary symptoms, or they occur less frequently and consistently than primary symptoms, or they are minor annoyances. However, some secondary symptoms can result in major discomfort and disability. Not everyone with PD even has the same symptoms they vary from person to person. Understanding these symptoms can reduce their impact. There are several such symptoms, and although it's not possible to address them all, the most common ones are...

Is smoking good for PD

Several studies suggest cigarette smoking may protect against developing PD. Thus, if you smoke one or two packs a day and have been doing so for many years, you may be about 50 less likely to have PD. These studies indicate that the degree of protection is related to the number of packs smoked per day, and the number of years of smoking. There is no evidence, however, that once PD begins, smoking is protective. At different times it has been proposed that certain chemicals in cigarette smoke,...

My partner kicks and screams in his sleep Is he crazy

No But he may have a disorder of rapid eye movement (REM) sleep. Vivid and frightening dreams dominate thus, your partner may kick and scream as if running away from something, but after waking, he remembers nothing. REM sleep disorders are more disturbing to you than to your partner. Typically, dreaming occurs during a phase of sleep called REM (when the eyes are moving). Muscle tone during REM sleep is minimal, which stops your partner from acting out his dreams. During disordered REM sleep,...

Why start with a dopamine agonist

Dopamine agonists stimulate the dopamine receptors in the striatum directly, without having to be changed into dopamine. There are at least five types of in PD, the condition of alternating on (asymptomatic) periods with off periods in which symptoms such as freezing or dyskinesia are evident. a measure of the duration of the drug's action. dopamine receptors, labeled D-1, D-2, D-3, D-4, and D-5. The D-1 and D-2 receptors are important in PD. The D-3 receptors may be important in anxiety and...

How do I apply for disability

Many employers offer varying types of disability insurance as part of their benefits package to employees. If you are fortunate enough to be covered by such a policy, the human resources department of your employer will be able to guide you. There are also numerous other insurance policies for long-term disability, and if you have one, the insurance company should direct you as to how to apply. The one benefit that all Americans have paid into is Social Security, which, in addition to...

Why do I drool

Drooling (sialorrhea) results from difficulty in swallowing. Most of the time drooling is an annoyance. However, sometimes it's an embarrassment, and sometimes it's even a hazard Aspiration of saliva (swallowing saliva into your lungs) may result in pneumonia. Swallowing requires coordination of the muscles of your lips, tongue, mouth, and throat. Gravity aids in swallowing. During the day, when your head is erect (while you're seated or standing), saliva, propelled by your tongue, palate, and...

What are the primary symptoms ofPD

There are four primary symptoms of PD. To diagnose PD, at least two primary symptoms must be present. Tremor is the most characteristic symptom of PD and is the first symptom in 75 of people with PD. It appears as a beating or oscillating movement, usually of the hands but occasionally of the feet or chin. The movement is regular (4-6 beats per second) and is rhythmic, with each movement resembling the other. The tremor usually appears when the muscles of the hands or feet are relaxed, when...

Is Agent Orange or the Gulf War Syndrome a cause ofPD

Some studies show that people who work or live in rural, agricultural areas are more likely to develop PD than people who live in urban areas. Rural people are more likely to work with herbicides or pesticides. A few pesticides, such as one called rotenone, can cause PD in mice. At present it is not known if this is so in humans. Agent Orange is the name of a herbicide developed for the military, primarily for use in Vietnam. The purpose of Agent Orange was to deny the enemy cover and...

Is hormone replacement therapy HRT good for PD

Estrogen replacement can relieve hot flashes, which in some people can be debilitating. This is of concern to women with PD, whose risk for osteoporosis is increased. Also, although studies are not conclusive, there is evidence that estrogen may protect against PD. Evidence for this is small but tantalizing. More men than women have PD 55 men for every 45 women. Estrogen may modulate dopamine receptors. Some premenopausal women report that their PD drugs are ineffective during ovulation (the...

Abraham Lieberman MD

100 Questions & Answers About Parkinson Disease Sudbury, Massachusetts BOSTON TORONTO LONDON SINGAPORE Jones and Bartlett Publishers Jones and Bartlett Jones and Bartlett Publishers International Barb House, Barb Mews London W6 7PA UK 40 Tall Pine Drive Sudbury, MA 01776 978-443-5000 6339 Ormindale Way Mississauga, ON L5V 1J2 CANADA Copyright 2003 by Jones and Bartlett Publishers, Inc. All rights reserved. No part of the material protected by this copyright notice may be reproduced or...

Cant get an erection

Few men bring up this issue with their doctors, and few doctors ask about it. This doesn't mean it's unimportant. The ability to achieve and maintain an erection is frustrating, embarrassing, and distressing to you and your partner. Achieving and maintaining an erection results from the successful interplay of several different physical and psychological processes. One or more of these may be impaired in PD. Thus, anxiety and or depression may result in a loss of a desire to have or think about...

Who is Abraham Lieberman

If you have Parkinson Disease, you may ask who I am, and why have the authority to write about the disease. I've studied PD for 30 years, and I'm currently the national medical director of The Parkinson Foundation, the largest charitable organization devoted to finding a cure for PD. The Parkinson Foundation TPF was formed in 2003 from the National Parkinson Foundation NPF headquartered in Miami and the Parkinson Disease Foundation PDF headquartered in New York. I am the Harold S. Diamond...