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    DBS GPI AND GENERIC SINEMET (DR. MARK STACY)
    avatar
    migvel posted:
    DEAR DR. I'M MIGUIEL FROM MEXICO CITY, Dx, PD SINCE 2002, IN 2010 I WAS IMPLANTED DBS IN GPI, MY NEURO ABOUT 2 MONTHS AGO INCREASED MY PARAMETERS IN MY NEUROSTIMULATOR (BRIO, ST. JUDE) AS FOLLOWING :
    IMPEDANCE 779, AMPLITUDE (mA)= 4.1, FRECUENCY (Hz)= 150, PULSE WIDTH (mS)= 100, MODE=CONT, ELECTRODES= 9- 10+.
    I DONT UNDERSTAND VERY WELL THESE NUMBERS AND I´M TAKING NOW ONLY GENERIC SINEMET (250/25 ONLY PRESENTATION AVAILABLE HERE) 1/2 PILL EVERY 2 HOURS AND ALSO I'VE TRIED 1/4 EVERY HOUR BUT I FELT OFF MOST OF THE TIME, PROBLEMS TO WALK AND SPEECH, I MOVE SLOW AND IF I TAKE A LITTLE MORE TO TRY TO IMPROVE THESE RESULT ONLY A FEW MINUTES FEEL GOOD AND THEN I GET OVERDOSE AND GET HORRIBLE DISKINESIA IN MY RIGHT ARM AND LEG BUT NOT AS INVOLUNTARY MOVEMENTS BUT I FEEL A LOT MUSCLE TENSION IN MY ARM AND LEG , SO I CANNOT GET A GOOD FEELING. BUT ALSO, I TRIED TWO CONSECUTIVE DAYS REDUCING MY DOSE TO 1 STALEVO(100 MG) PER DAY, THE FIRST DAY I FEEL VERY MUCH BETTER WITHOUT FLUCTUATIONS BUT MY NEURO TOLD ME NOT TO DO IT BECAUSE I WILL FEEL WORSE AFTER A WHILE AND SECOND DAY I REALLY FELT MORE INCAPABLE TO MOVE, WHAT DO YOU RECOMMEND ME TO DO? ARE THE PARAMETERS CORRECT? I CANNOT FIND A CORRECT DOSE, IT'S FRUSTRATING. PLEASE HELP.
    Reply
     
    avatar
    DUKE MEDICINE
    Mark A Stacy, MD responded:
    Dear Miguel,
    Thank you for your note. The GPi site is appropriate for a patient with dyskinesia, so I agree with this. The settings you describe for impedence, amplitude, frequency and pulse width seem quite reasonable. I am confused by the electrode setting of 9- 10 . When I review the St Judes website, the international product appears to have only 8 leads, but I do not know how they are numbered. It also suggests that you have had DBS on only one side of the brain. If this is the case, the right side dyskinesia suggests you had the surgery on the right side of the brain (because it is treating the dyskinesia on the left side of the body)

    Here are questions I suggest for your doctor:
    Can you explain to me the electrode settings for my DBS?
    Should this be changed to help with my dyskinesia?

    Now your medications:
    Stalevo 100 contains: carbidopa 25 mg, levodopa 100 mg and entacapone 200 mg

    With one Stalevo and 8-10 half tablets of carbidopa/levodopa 25/250, you are taking 2100 - 2600 mg levodopa per day.

    I would suggest talking with your doctor about taking a combination of Stalevo 100 and carbidopa/levodopa 25/250 on a less frequent basis, but this should be decided by the two of you in the doctor's office. You may also need to have DBS on the left side. This should help with the dyskinesias.
     
    avatar
    migvel replied to Mark A Stacy, MD's response:
    I WAS IMPLANTED WITH TWO ELECTRODES (BILATERALLY) AND MY PRESENT DOSE OF LEVODOPA IS 3 TO 4 PILLS A DAY (1000 mg.) OF GENERIC SINEMET THAT I TAKE 1/2 ABOUT 2 TO 3 HRS. A DAY, AS I NEED, BUT THE POINT IS THAT IS A BIG TROUBLE TO ME TO FIND THE OPTIMUM DOSE TO FEEL WITHOUT FLUCTUATIONS , BECAUSE THE INTERFERENCE OF MEALS WITH MEDICATION.


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