Jump to ContentJump to Main Navigation
Dementia with Lewy Body and Parkinson's Disease PatientsPatient, Family, and Clinician Working Together for Better Outcomes$
Users without a subscription are not able to see the full content.

J. Eric Ahlskog

Print publication date: 2013

Print ISBN-13: 9780199977567

Published to Oxford Scholarship Online: November 2020

DOI: 10.1093/oso/9780199977567.001.0001

Show Summary Details
Page of

PRINTED FROM OXFORD SCHOLARSHIP ONLINE (oxford.universitypressscholarship.com). (c) Copyright Oxford University Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in OSO for personal use. date: 20 June 2021

Unstable Responses and Dyskinesias: Later Motor Problems

Unstable Responses and Dyskinesias: Later Motor Problems

(p.89) 8 Unstable Responses and Dyskinesias: Later Motor Problems
Dementia with Lewy Body and Parkinson's Disease Patients

J. Eric Ahlskog

Oxford University Press

Chapter 6 outlined the symptoms that should benefit from carbidopa/levodopa treatment and how to initiate it. Once the optimum dosing scheme has been established there usually is not much medication adjustment required for the initial few years. However, this situation changes with longer durations of DLB or Parkinson’s disease. During the first several years of DLB or Parkinson’s disease, treatment with carbidopa/levodopa is straightforward—the responses are stable and unchanging over the course of the day. Thus, the exact time a person takes the doses is not important as long as they are administered on an empty stomach (at least 1 hour before and 2 hours after meals). If the dosage is changed, it takes about a week for the response to fully develop. This pattern of a stable levodopa response that slowly accumulates over a week is termed the long-duration response. For this response to fully develop and capture the maximum benefit, about six to eight tablets of the regular (immediate-release) carbidopa/levodopa 25/100 tablets per day are necessary. While this has not been well studied in clinical trials, experience in the clinic suggests that this is approximately correct. After a few years of having DLB or Parkinson’s disease, the person’s response to levodopa tends to change. The long-duration effect persists, but part of the benefit becomes time-locked to each dose. This response does not reflect how long the person has been taking carbidopa/levodopa but how long he or she has had DLB or Parkinson’s disease. As these conditions progress, the capacity to maintain a stable, around-the-clock effect from levodopa diminishes, as if the effect could no longer be stored-up. This is not simply a brain levodopa storage problem, but it behaves that way. People with this time-locked benefit from levodopa will note that their gait, stiffness, tremor, and slowness will improve an hour or so after taking a carbidopa/levodopa dose. In other words, it takes about an hour (sometimes less) for the regular carbidopa/levodopa to “kick in.” Initially, this benefit may last 4 to 5 hours, but after many years it may diminish to 2 hours or less.

Keywords:   Namenda (memantine), akathisia (inner restlessness), glutamate (neurotransmitter), levodopa-induced dyskinesias, memantine (Namenda)

Oxford Scholarship Online requires a subscription or purchase to access the full text of books within the service. Public users can however freely search the site and view the abstracts and keywords for each book and chapter.

Please, subscribe or login to access full text content.

If you think you should have access to this title, please contact your librarian.

To troubleshoot, please check our FAQs , and if you can't find the answer there, please contact us .