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John B

Effect of sudden stopping of Sinemet

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My wife has been taking Sinemet 10/100 for 2 years prescribed by a Psychiatrist and it seems to help with her walking stability and also with anxiety.  Recently the symptoms are recurring at 2.5 hours after taking Sinemet and the dosages are at 3 hour interval, causing her some discomfort.  She is now on 4/day and the Psych was hesitant about increasing it without Neurologist consult.  The Neurologist reaction was that this treatment is all wrong.  He says she should never have had Sinemet as she was never proven to have PD.  He wants to see her without Sinemet and wants her off the med for 3 days.

I fear that this will have serious ramifications.  Previous medication changes have landed her in the hospital.

I would like to know what the effects might be of stopping this med suddenly for 3 days.

Thank You.

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We generally in our practive stop the medications the day prior to the visit only.  See the patient and record an objective scale (like the UPDRS) and then give the meds back in clinic and record another scale.

Abruptly stopping for many days has a risk of neuroleptic malignant syndrome.

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Thank you for your response.  Neuroleptic malignant syndrome sounds serious.

This confirms my fears, but leaves me in question as to my actions in support of my wife.  I think I will call the Neurologist office and at least confirm that they intend to record a UPDRS or other objective scale.  I would hate for her to go through what I know will be a major ordeal and not get good data from it.  I have no doubt that the second part (restore the Sinemet and record another scale) will NOT be done.  This particular office is just too rushed.  Maybe I should be shopping for a Neurologist who has time for her.

Concerning the objective scale...  I have looked at the UPDRS response sheet and it looks like it should take a good bit of time to do the evaluation.  Not a problem for us of course, but I am just wondering how much time should the Doctor have allotted to this activity.  Previous exams have been fairly quick (15 minutes), but I think he has allotted 30 minutes for the upcoming visit.

Again, thank you for your input.  It helps me to not feel quite so alone in this.

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It takes us about 5-10 minutes to do the motor portion of the UPDRS examination.

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For making response to dopamine determinations the UPDRS III motor is the most important.  The other sections will help to assess mood symptoms, activities of daily living and fluctuations.

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