Brief Answer:
What is the dose and frequency of Sinemet as you are taking?Other drugs?

Detailed Answer:
Hi,
Thanks for being on healthcaremagic.com.
I am Dr.Ajay Panwar,a neurologist,here to answer your query.

I have gone through your discussions with the fellow neurologist.I fully understand your concerns and I shall try to address them in the best possible manner.

Firstly,I want to make it clear that it is not weakness, rather it is extrapyramidal symptoms(rigidity,bradykinesia and tremors) which make the life troublesome in parkinson's disease.You are not able to walk probably, because of rigidity.

So,if you have to improve on functional grounds,the basic pathology of the disease has to be targeted. Improvement in rigidity, will improve the walking ability. Sinemet(Levodopa-carbidopa) is the drug of choice in this condition. If you don't take it due to the risk of its side effects, then how will your symptoms improve? First concern here is the effects, and then the side effects. I agree that this drug may have some side effects, but the dramatic improvement it causes in patients of parkinson's disease, makes some real difference.

Further,I would like to know that what is your prescribed dose and frequency of Sinemet?Also,I need to know about the other medicines you are taking with their dose and frequency in order to plan an effective management strategy for you.

Hope this helps.I shall be glad to have you in follow-up with further queries.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Continue Sinemet as per schedule.

Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.

As of now, you are taking 2 half tablets of Sinemet 100/25, which is underdose and is not likely to result in significant benefit.However,please continue Sinemet as per the schedule and it will probably show clinical effects when you make it a full tablet.

Further,I have slight doubt here,that whether there is some component of vascular parkinsonism or not? Though,you did not mention about any history of stroke or vascular event till now, but your medication schedule with aspirin and lipitor may be indicative for that.So,at this point it becomes important for me to know that for what indication you are taking these medicines-cardiac issues or ischemic brain events?Please tell the same in the follow-up.

I shall be glad to have you in follow-up.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
As you are taking it for that cardiac event,it may not be vascular park.

Detailed Answer:
Hi,
Thanks for being in follow-up and providing further details.

Sometimes after ischemic stroke,patient may develop parkinson disease like features.In that case,though it is parkinsonism but secodary to ischemic stroke(ischemic stroke is usually caused by the blocking of blood vessels supplying brain by a clot,and so is called a vascular etiology),so it is called as vascular perkinsonism.In ischemic stroke patients,medicines to be given are aspirin and statins(as lipitor here).Same two medicines are given for cardiac patients as well.That's why I asked if you are taking it for stroke or cardiac etiology.If you would have told me stroke,then the possibility of vascular parkinsonism would have been high.But now,as you have told that it was your cardiac bypass surgery,for which you are taking the medicines-it my just be Parkinson disease.

Sinemet though,does not have definite role in vascular parkinsonism but a trial is given to see for effects.


For now,I suggest you to continue on Sinemet schedule.You will probably start showing results.

Hope that I have answered your query.If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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Brief Answer:
Medicines will play the major role in improving the rigidity.

Detailed Answer:
Hi,
Thanks for being in follow-up.

I must make it clear for a point over here, that in Parkinson's disease,it is the medicines that play the major role in improving the rigidity.Exercises are of course, supportive but the basic pathophysiology of the disease which is based on depleted dopamine levels,can improve only with a medicine which can replace the deficient dopamine levels.

I suggest you to do the exercises under the guidance of a physiotherapist, who can help design an effective exercise programme,depending on the muscle groups involved.

Hope this helps. If you have some further questions,I shall be glad to answer else please close the thread,rate it and write a review.

Regards
Dr.Ajay Panwar,
MD,DM(Neurology)

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