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Suggest Treatment For Dystonia

Posted on Mon, 1 Dec 2014

Question: Hi, I have idiopathic parkinsons , I take sinemet 100/25 x 2 tbs @ 0530 , 1200 , 1600 . After each dose two and a half hours later I seize up where it difficult to move, arms in particular , voice will slur and right leg will drag or big toe will curl up. This can last from half to an hr then abate to so called normal until after next dose .I have tried entacapone (200mg) with sinemet but this prolonged seizure. Have tried ropinerol ,amantadine with same result. How can this seizure effect (dystonia ? ) on off ) be treated
Regards XXXXXXX

Answered by Dr. Dr. Erion Spaho (4 hours later)

Brief Answer:
Try new regimen of Sinemet.

Detailed Answer:
Hi, I had gone through your question and understand your concerns. It seems like a wearing-off effect of dystonia related to dosage and timing administration. I suggest you to try a new regimen of Sinemet. You should increase frequency and decrease dosage of Sinemet, example: Sinemet 100/25 tab 5 x 1 tab daily ( 05.30-09.30-14.00-18.00-22.00). I think this leads to better distribution of medicament and lowering the possibility of the peak of the dose dyskinesia. Another possibility is to try to use extended release formulations of Levo-Dopa/Carbidopa.
Hope this answers your question. If you have additional questions or follow up questions then please do not hesitate in writing to us. I will be happy to answer your questions.

Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju

Follow up: Dr. Dr. Erion Spaho (19 hours later)

Hi Dr Spaho , thanks for input, I have tried increase frequency/less dosage, this caused dystonia on off effect to be more frequent. The more sinemet ie 2x100/25 the longer the time before dystonia set in ,normally 2 to 2.5 hrs whereas 1x100/25 dystonia set in 1 to 2hrs with less control of tremors and body movement becomes very slow. Have tried sinemet 200/50CR but this seemed to be too slow to control slow movement and dystonia effect. Madopar 62.5 did not cause dystonia but again did not help slow movement and tremors Other meds I take are aspirin 100mg od, quinapril, doxazosin. It seems I am out on a limb on my own with my neurologist unable to pin point remedy. Thanks again for your help Kind Regards XXXXXXX Wattie New Zealand .PS there is no cure for PD but I am hoping to get on top of this dystonia effect

Answered by Dr. Dr. Erion Spaho (15 hours later)

Brief Answer:
Physical therapy and other medicaments may help.

Detailed Answer:
Hi and thanks for asking again. You tried dosing adjustment and it didn't work, Another ting to try is increasing your physical activities, if you didn't you can try physical therapy. Drugs that relax muscles may be also beneficial ( Baclofen, Diasepam), for your limb symptoms. Relaxing, meditation also may help reduce symptoms. Hope this helps. If you have further questions, feel free to ask.

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Dr. Erion Spaho (32 minutes later)

Hi , I forgot to mention that for the past week I have been taking Diazepam 2mg three times per day but this has no effect. My work is demanding with a 12 hr day. Regards XXXXXXX

Answered by Dr. Dr. Erion Spaho (19 hours later)

Brief Answer:
Another possibility Deep Brain Stimulation.

Detailed Answer:
Hi again! Seems to me you tried a lot of medications and combinations of drugs without any satisfactory results. Another medical procedure for treatment of Parkinson is Deep Brain Stimulation surgery. For its indications, procedure, results and complications, there's need to consult a specialized neurosurgical center. Hope this helps. Wishing you good health.

Above answer was peer-reviewed by : Dr. Shanthi.E