Feel a bit better today. Still shaking a bit and still feel tired, although I did manage to do some housework this morning. My lovely, lovely wife left me in bed this morning as I'd had a bit of a bad night, and I slept until 8 30 am!! For me this is astounding.
I have still decided I will speak to the PD nurse but she is only available tomorrow. Do you guys have any thoughts as to what I should do?
I notice that it's taken a month or so for things to change. I wonder if it takes a month when you start drugs as well?
I feel I'm at a cross roads with this experiment. We shall see.
Well the drugs are palliative but also addictive. Working in part on the pleasure/reward sections of the brain is I'm sure why they give a temporary 'better quality of life'.
ReplyDeleteEventually the positive effects of each med diminishes and new stronger drugs have to be introduced.
The real question is how much better did you feel when on the drugs ?
Dopamine Agonist Withdrawal Syndrome in Parkinson Disease
ReplyDeleteChristina A. Rabinak, BSE; Melissa J. Nirenberg, MD, PhD
Arch Neurol. 2010;67(1):58-63.
Objectives To report and characterize a dopamine agonist (DA) withdrawal syndrome (DAWS) in Parkinson disease.
Design Retrospective cohort study.
Setting Outpatient tertiary movement disorders clinic.
Patients A cohort of 93 nondemented patients with Parkinson disease enrolled in a prospective study of nonmotor and motor disease manifestations.
Main Outcome Measure The presence of DAWS, defined as a severe, stereotyped cluster of physical and psychological symptoms that correlate with DA withdrawal in a dose-dependent manner, cause clinically significant distress or social/occupational dysfunction, are refractory to levodopa and other Parkinson disease medications, and cannot be accounted for by other clinical factors.
Results Of 40 subjects treated with a DA, 26 underwent subsequent DA taper. Of these 26 subjects, 5 (19%) developed DAWS and 21 (81%) did not. All subjects with DAWS had baseline DA-related impulse control disorders. Symptoms of DAWS resembled those of other drug withdrawal syndromes and included anxiety, panic attacks, agoraphobia, depression, dysphoria, diaphoresis, fatigue, pain, orthostatic hypotension, and drug cravings. Subjects with DAWS as compared with those without DAWS had higher baseline DA use (mean [SD], 420 [170] vs 230 [180] DA levodopa equivalent daily doses [DA-LEDD], respectively; P = .04) and higher cumulative DA exposure (mean [SD], 1800 [1200] vs 700 [900] DA-LEDD-years, respectively; P = .03). Subjects with DAWS also had considerably lower Unified Parkinson's Disease Rating Scale motor scores than those without DAWS (mean [SD], 21 [5] vs 31 [10], respectively; P = .007), despite comparable disease duration (mean [SD], 7.3 [7] vs 6.3 [4] years, respectively; P = .77) and similar total dopaminergic medication use (mean [SD], 830 [450] vs 640 [610] total LEDD, respectively; P = .52) in the 2 groups.
Conclusions Dopamine agonists have a stereotyped withdrawal syndrome that can lead to profound disability in a subset of patients. Physicians should monitor patients closely when tapering these medications.
Author Affiliations: Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, New York.