Please note that no treatment should be altered without prior consultation with your specialist or GP.

I take Sinemet 50/200 three times daily and Requip 1mg four times daily. I have bad lower back pain. Will more medicine take care of this or should I go to physical therapy?

Sorry for the delay in replying. It depends. Pain can occur as part of PD but there are many causes of back pain. Your doctor should be able to tell you whether your low back pain is musculoskeletal or related to your PD. Exercise, stretching and physiotherapy may help both.

Dr. T. Lynch

Dear Dr.Lynch

Regard to my question (Question 81) about my mother's Holmes disease, I have attached her brain scan that I prepared by digital camera. Please inform me whether quality of pictures is good or not? If they are not useable I will scan them by scanner and send you again. I will send a brief movie too about her as soon.

My apologies for the delay in replying. I reviewed the CT brain images. It is difficult to comment further. The scans exclude major stroke and tumours. There is mild atrophy (shrinkage) seen but to characterise this further a brain MRI would be needed to look at the cerebellum and neighbouring brainstem. Dr. T. Lynch

My father, diagnosed with Parkinson's seven years ago, has recently (in the past year), experienced four 'episodes'. These involve, intense sweating, pain/tightness in upper stomach region, complete loss of colour in face, clouding of vision and feeling as though he is going to faint. He is currently taken Sinemet-275.

I would be grateful for any comments/suggestions you might have in this matter.

Apologies for the delay in replying. These "episodes" warrant investigation by his doctor. They may not be related to his Parkinson's disease. For example, angina/cardiac pain could present in such a fashion and therefore your father should be assessed by his doctor and probably have a cardiograph.

T Lynch

My friend has been having some tremors in her left forefinger and thumb for some time, and because I have seen an interview with Michael J. Fox and this was one of his symtoms, I think she should have it checked out. She feels stupid because it is such a minor complaint. I have been trying to tell her that the sooner she sees a doctor either to get early treatment if necessary or to have her mind eased the better for her. If it was a thing that it was the start of Parkinson's disease would it make a difference if it was diagnosed early?

Apologies for the delay in replying.

There are many causes of tremor including PD. If your friend is anxious about the tremor it would be worthwhile seeing her doctor to make a diagnosis at least.

It is unclear whether an early diagnosis of PD helps. Selegeline (Eldepryl) MAY slow the disease progression but this remains unclear. Personally when I see someone with early signs of PD I spend quite a while explaining the problem and advising them about the best approach to dealing with the problem. I do not start people on medication (unless needed) but encourage healthy living - diet (green veg. antioxidants, etc) exercise and sleep. Therefore I believe an early diagnosis is probably best.

T. Lynch

Can you please advise as to whether the tablets my father in law is taking are compatible with each other. He has been diagnosed at different times with different things and won't ask the doctor if they are all ok together.

1. doxasin mesilate 2mg 1 at night (prostrate)
2. bendrofluazide 2.5 mg 1 taken daily (angina)
3. co-careldopa 10/100 four to be taken daily (parkinsons) felodipine 10 mg 1 daily(high blood pressure)
4. atenolol 50 mg 1 daily (high blood pressure)

I think this is a follow on question from an April 18th question.

Bendrofluazide is a diuretic pill that is used for high blood pressure. It results in a need to pass more urine and so may aggravate your father-in-laws prostate symptoms. However it is a good pill. Doxazosin mesylate is a blood pressure pill but may also help prostate symptoms. Felodipine is also a BP pill as is Atenolol. These do not interact with levodopa but four blood pressure pills is a lot. It may be possible to simplify the regimen to two BP pills with his doctor's permission.

Dr. T. Lynch

I was diagnosed with Parkinson's at age 50 which was 8 years ago. I presently take Sinemet 25/100 SR 2 times daily, plus mirapex 0.5 mg 1 1/2 tablets 3 times a day. I also take Propanolol 20 mg once a day, Amitriptyline 25 mg once a day, Senokot tablets (2) at bedtime and Prempro. I have been experiencing a lot of back pain around my waist and lower back which seems to get worse when I lay down to sleep, but also continues throughout the day. I have had many tests including MRI of the Lumbar Spine, CT of the abdomen and pelvis enhanced, and a pelvic ultrasound. I have a degenerative bulge of the L4-5 intervertebral disc, but they do not think this is enough to warrant the pain I am experiencing. My doctor has tried vioxx and celebrex, neither of which helped. My question is, do other Parkinson's patients generally experience this kind of back pain and is there anything that would help. My worst symptom is rigidity.

My exercise consists of walking on treadmill 1 1/2 to 2 miles 5 days a week. Any information would be greatly appreciated as this pain is really interfering with my daily life and activities. Thank you.

Apologies for the delay. Yes PD patients do get different types of pain. After 8 years of PD l-dopa (Sinemet) is less effective and can wear off. As it wears off people can get cramps ("off" dystonia) of their toes, feet, fingers and arms usually on their PD side. Sometimes people get abdominal and back cramps/pain. You may be able to identify a pattern related to your medication, i.e. 2-3 hours after the last Sinemet/Mirapexin or just before the next pill - does Sinemet relieve the pain? If your pain is related to wearing "off" (l-dopa level dropping in blood sream) sometimes adjusting the frequency/dosage of Sinemet can solve the problem. Also, Sinemet CR is unreliably absorbed when people are constipated.

Therefore a possible approach to solve the problem would be to consider (discuss with your doctor) changing Sinemet CR to Sinemet Plus (25/100) three times/day and use Madopar 62.5 dispersible to see if it eases the pain quickly (it is absorbed rapidly).

T. Lynch

From the media we learned of the surgical procedure performed by Mr. Steven Gill to reverse the symtoms of Parkinson's disease by pumping a growth factor into the brain. Is it practical to consider this treatment seeing we live in Australia ?

Dr Gill's study is in its early days. I think if his preliminary results are confirmed over time with more patients other international groups will follow suit. It is an intriguing idea and obviously is feasible. Ideally we would like a growth factor that could be taken by mouth but that is not available yet.

Dr Lynch

I find Requip to be useless but do not want to continue taking Sinemet because of the long term use side effects. I have "upped" my Requip to 4mg 3/day and decreased Sinemet 25-100 to once a day. My symptoms are not really helped by these meds. Can you suggest another med? Is it wise to switch to Mirapex? Thank you.

Sorry for the delay.

If you have been on Sinemet for a number of years it will be difficult to decrease it to a daily dose. In general keeping the dose of Sinemet low (eg 3-4/day) is desirable to avoid later dyskinesias, wearing off, etc. etc.

Furthermore I think you should only change the medication in consultation with your doctor as the pharmacology of PD is increasingly complex. Other agents that can boost/help Sinemet include Entacapone and Selegeline. Other dopamine agonists include Mirapexin, Celance, Parlodel, Cabergaline, etc. etc.

Overall I aim to have a patient on low dose Sinemet boosted by Selegeline and/or Entacapone so that the overall l-dopa dose is low and supplemented sometimes with Requip or Mirapexin or Celance or Amantadine.

T Lynch

Hello Sir

My father developed a shake in his hand in January of 2001 and has been diagonised with Parkinson's disease. He just finished a six month course of the drug Artane. As this had no noticeably positive effect he has been switched to the drug Sinemet.

The problem is he also consumes in excess of forty pints of alcohol a week as well as maybe 10-15 Solpadeine painkillers.

My question is: will this level of alcohol consumption have a negative effect on the ability of the Sinemet drug to be effective?

Thanks a million in advance.

My apologies for the delay in replying.

Over 40 pints/week is excessive for anyone and should be decreased. Alcohol does not interact with Sinemet directly but may interfere with Sinemet absorption from the belly because of irregular meals. (Protein competes with Sinemet for absorption)

Secondly alcohol has an effect on brain function and balance over time and should be curtailed in patients with PD.

T. Lynch

Dear Dr Lynch,

My mother was diagnosed with Parkinson's disease two years ago. She suffers from extreme rigidity in her right side (hand/arm/face) and has very bad pins & needles which wax and wane. She now has problems walking and experiences very bad pins and needles in the right side of her face, in addition to those in her right arm and foot.

She is currently taking 4 (125mg Madopar/day) and Dostinex (cabergoline). The Dostinex has relieved the pain in her leg but she has no other benefit from the medication, in terms of rigidity, restored movement etc. When she increases the dose of the Madopar her condition deteriorates, even when taking only 5 (madpar/day). She loses coordination, her speech deteriorates, she has difficulty walking and feel very shaky inside. Is this normal with such subtle changes in medication? After taking her medication she feels noticably worse for several hours. She doesn't so much require the medication in a "wear off" manner but actually deteriorates by taking it!

Does this all sound right for Parkinson's disease, or is there another disease which is being overlooked here? I appreciate your time.

Apologies for the delay. A difficult problem. Sensory complains and pain can occur not uncommonly in PD. They can be relieved by L-dopa (Madopar) but sometimes painful spasms/cramps (dystonia) of the hand or foot can occur as the medication "kicks in or wears off".

I would have expected your mother to have a good response to L-dopa after only two years of PD. It is a little perturbing she is not responding well. Possible causes of this include - constipation (poor L-dopa absorption), other medical illnesses/problems (e.g. urine infection) or poor absorption of L-dopa from her intestine because of dietary factors (e.g. meat, high protein). The other possibility is an atypical form of parkinsonism that frequently does not respond well to L-dopa. For example corticobasal degeneration can cause parkinsonism with sensory complaints down one side of the body.

Dr Lynch