Motivational Vigor in Parkinson's Disease Requires the Short and Long Duration Response to Levodopa

[Farooqji]

movementdisorders.onlinelib...

[park_bear]

Very interesting:

"The clinical response to the mainstay of PD treatment, L -dopa, is multifaceted, comprising a short duration response (SDR) paralleling plasma levels, and a long duration response (LDR) that slowly increments over the course of days to weeks and likely recedes after therapy cessation over similar timescales"

[Gallowglass]

I confess that I read this but don’t know what it means for me. I take the maximum dosage of CL allowed and get only about an hours relief from each dose. Does this explain why!?

[bullet65 in reply to Gallowglass]

You mentioned that you take the maximum dosage of CL allowed? What dosage are you taking as neurologist has told me there is not a set maximum.

[Gallowglass in reply to bullet65]

2 pills of cl 25/100 at 7am, 11 am, 3 pm, 7 pm, 2 am. I could be wrong but my doctor said it’s not safe to take more.

[park_bear in reply to Gallowglass]

No, this is not applicable to your situation.

What is applicable: Levodopa medication tends to deplete vitamin B6, especially at high doses. B6 deficiency in turn results in diminished response to levodopa medication. This can lead to a vicious circle of increasing Levodopa medication and B6 deficiency. That way out of this is appropriate supplementation. See these posts of mine for details:

healthunlocked.com/cure-par...

healthunlocked.com/cure-par...

[Gallowglass in reply to park_bear]

So I do take b2 and p5p at 5 am. Do I need it more often?

[park_bear in reply to Gallowglass]

No, once a day is sufficient.

If your B2 and B6 levels are good, other things to look at would be adding an MAO-B inhibitor such as rasagiline or COMT inhibitor such as entacapone.

Also consider non-prescription interventions such as high dose thiamine

[Gallowglass in reply to park_bear]

ps: also I do have a diagnosis of peripheral neuropathy in hands and feet and vagal neuropathy affecting swallowing, saliva over production, vision, digestion etc

[park_bear in reply to Gallowglass]

Did this start up before or after you started supplementing B2 and B6 ?

[Gallowglass in reply to park_bear]

Before