Tremor first thing in morning?

[zawy]

How is your tremor first thing in the morning? Mine is a lot less if I test it as soon as I wake up and I'm still groggy. I recently posted about 20 days ago that my tremor disappeared and I stopped doing everything and was trying to test things one by one. It was gone for about 2 weeks. It has come back, and I'm still trying to identify what it was. My best guess is that I was being more consistent with over 1 hour per day exercise.

[mekewero]

its not severe ,it doesn't wake me up,eg..asleep 1230 am..woke about7am.my meds of cinemet for the tremors,i'm trying to use sparingly,although 4 hourly if i'm working(commercial cleaning/janitor)

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[johntPM]

I have a minor tremor first thing in the morning.

The size of my tremor seems to be a function of whether I'm "on" or "off" and stress. I wake up feeling OK, as though my dopamine levels had partially replenished during the night. I often go 2 to 3 hours before taking my drugs.

Another thing to consider is the flux of dopamine or equivalent provided by your drugs. This can get complicated if you are on a number of different drugs, taken at different times and with different half-lives.

John

[twotutts42]

My tremor in my right side arm and leg. My leg tremors sometimes more so when I have exercised or ridden my bike. My arm tremors start when I get up from bed not when I lying down. Bizarrely if I yawn and stretch my arm has a really bad tremor. .... does anyone else find this? Some days my tremor will not be visible at all like you makes me think what I did differently but can never fathom it out. Maybe we will never know

[zawy in reply to twotutts42]

I think there is sometimes a slight shiver that goes along with yawning and stretching, so maybe the PD is simply amplifying that natural effect.

[Hidden in reply to twotutts42]

Yes if I stretch hard in themorning while still in bed, it will trigger the tremors on, but if I move slowly and "mindfully" then not so much, twotutts42

[samealbertnotbefore]

In the morning when I wake up I have no tremor,but as the morning goes along the tremor starts. I exercise,go for long walks, do swimming and Tai Chi during the week, but the tremor is still with me. I am 64 had pd for about 18 months. albert

[swva]

My tremor starts as soon I wake up. If I stretch, my legs and arms shake. The tremors are only in my left hand and they seem to get better later in the day.

[racerCP]

When you say your tremor disappeared for two weeks, is that with or without meds? If without it sounds like you were 'cured' for two weeks. What is the purpose of measuring the tremor though?

[zawy in reply to racerCP]

I am and was taking rasagiline, for about 6 months. There seemed to be something that suddenly started working and I was doing a lot of things which I posted in the past. There can be a lot of problems other than "tremor" so it going away would not be a "cure", but of course it should be a good thing. I monitor tremor only as a way of keeping track of how fast the condition is progressing. Sleep, concentration, memory, and mood are the things that bother me more than tremor, but I can't measure those, except for an inaccurate card-flipping memory game I have played for many years.

My mood did improve at the same time the tremors reduced. Mood is still a lot better even now that they have come back.

[racerCP]

My question is, do you take medication? Does the medication reduce or eliminate the tremor? If the medication does not reduce your tremor what other symptoms does it address effectively?

The next question is during the two-week period of no tremor were you continuing with your medication on regular schedule?

I know that's a lot of questions and I appreciate your quick response. Thank you.

[zawy in reply to racerCP]

As I said, I take rasagiline and I had not noticed an effect on the tremors from it. I take rasagiline primarily because it is supposed to slow progression. It seemed to improve mood when I first took it. As I indicated, I did not stop taking the medication, before, during, or after the tremor stopped. Exercise, melatonin, light therapy, alcohol, nicotine, weed, and good food seem to affect me more than the rasagiline.

[johntPM in reply to zawy]

1mg of rasagiline is equivalent to about 100mg of levodopa. However, it remains effective for about 24hr, whereas a dose of levodopa lasts for 3 - 4 hours. The strength of a typical dose of 100mg levodopa is, therefore, 6 - 8 times that of 1mg rasagiline, the standard dose..

Although you may not feel any impact from rasagiline, it has been claimed, though this is disputed, to slowdown the progression of the disease. It also does a job in smoothing out dopamine levels in the brain. I take rasagiline, ropinirole and Stalevo, with the net effect that I never get badly "off".

John

[zawy in reply to johntPM]

Rasagiline attaches to MAO-B enzymes (that break down dopamine) for up to 2 weeks, thereby keeping dopamine higher. So 2 weeks is about the time you should see maximum effect. Although there is also a short term effect as you describe. It seemed to reach a peak effect in me that I could notice after less than a week. I wonder if it loses some of the effect after your body adapts to it by producing more MAO-B, so there might be some withdrawal effect.

FDA allows them to claim it slows down progression. [edit: this last sentence is wrong. John is right, see the following oosts]

[johntPM in reply to zawy]

My understanding of the rasagiline (Azilect) situation is different. In 2011 Teva wanted to extend the drug's indication from being just a treatment for the symptoms of PD. But, as Kevin Grogan of Pharma Times reported, the FDA's Peripheral and Central Nervous System Drugs Advisory Committee had unanimously voted that the drug

"has not been shown to slow progression of the disease."

pharmatimes.com/Article/11-...

John

[zawy in reply to johntPM]

Thanks for correcting me. The people taking 2 mg did not show a "disease modifying effect" but the 1 mg dose did. There appear to be good reasons not to call it "disease modifying" since the vote was 17-0. At first it seems to have a nice strong effect. There's a good slide presentation from the FDA (2nd link) if you do a google search for:

FDA 17 rasagiline

[Hidden in reply to johntPM]

then why are they still giving it to folks if it doesn't slow down symptoms like advertised?

[zawy in reply to Hidden]

Because it alleviates symptoms for at least the first year.

[zawy in reply to johntPM]

The 1 mg dose did show a "disease modifying effect" because the delayed start group did not "catch up" with the "early start" group. The FDA was concerned because the same effect was not seen in the 2 mg dose group. This could be the result of toxicity at higher doses. Another concern that appears to be the reason for the 17 to 0 vote is that they need 2 trials to show "repeatability". There were 2 phase 3 trials, TEMPO and ADAGIO, and both are arguably showing a slowing down of the disease progression, but the 17 to 0 vote is pretty clear. So it is like John initially said: "it has been claimed, though this is disputed, to slowdown the progression of the disease. "

Here's some papers discussing the "disease modifying" aspect:

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pubmed/214...

[churchill435 in reply to zawy]

ZAWY I have the same symptoms you posted 2011. Curious to know how your now doing?

[zawy in reply to churchill435]

Most of my problems seems to have been low iron causing low oxygen which I can see with a $15 pulse oxymeter. Also making sure to drink water prevents exhaustion. Thirdly, I seem to be afflicted with general anxiety that is not connected to thoughts and can't sleep very good. I never have dreams which indicates lack of deep sleep. Lack of sleep causes irritability and inability to concentrate. I take up to 100 mg melatonin (a massive dose) to try to get deeper sleep. Also staying away from simple carbs keeps anxiety from flaring up.

[racerCP]

Thank you, Zawy.