Quote:Nervous system side effects Nervous system effects occur in as many as 50% of treated patients on long-term therapy and include involuntary movements and mental status changes most frequently. The types of involuntary movements due to levodopa have been characterized as choreiform, dystonic and dyskinetic. Fluctuations in motor function occur frequently and often increase as the duration of therapy increases.

Choreiform movements due to levodopa therapy may occur in as many as 80% of patients treated for one year and frequently involve facial grimacing, exaggerated chewing and twisting and protrusion of the tongue.

Several types of motor fluctuations may occur and result in "bradykinetic episodes". Some motor fluctuations are related to the timing of dosage administration. For example, patients may experience "peak of the dose dyskinesia" and a wearing-off effect called "end of the dose akinesia". The "wearing-off" may result in early morning dystonia. Such motor fluctuations may be managed by increasing the frequency of dose administration and decreasing the dose administered (or possibly by use of extended release formulations) to achieve a smoother therapeutic effect.

Other motor fluctuations are not related to the timing of dose administration. Such fluctuations are characterized by sudden loss of levodopa effect which may last for minutes to hours and result in akinesia followed by a sudden return of levodopa effect. These "on-off" fluctuations may occur many times per day. "On-off" fluctuations may respond to more frequent dose administration.

Finally, akinesia paridoxica is a sudden episode of akinesia which occurs as patients begin to walk. Akinesia paridoxica frequently results in falls and often responds to levodopa dose reductions.

Other adverse nervous system effects due to levodopa include myoclonus, sleep disturbances (including insomnia, daytime somnolence, altered dreams and episodic nocturnal myoclonus), Meige's syndrome (blepharospasm-oromandibular dystonia) and ocular dyskinesia. In addition, the orofacial movements induced by levodopa have occasionally been reported to cause severe dental erosion.

Some investigators have suggested that levodopa may cause brain dysfunction and may have negative effects on cognitive performance.

Levodopa "drug holidays" have been proposed by some investigators as potentially beneficial (perhaps by causing dopamine receptor resensitization). However, the therapeutic value of these drug holidays is controversial.

Quote:It has been proved that Adolf Hitler suffered from idiopathic Parkinson's disease. ... Two different character traits can be analysed in Hitler's personality: on the one hand the typical premorbid personality of parkinsonian patients with uncorrectable mental rigidity, extreme inflexibility and insupportable pedantry. On the other an antisocial personality disorder with lack of ethical and social values, a deeply rooted tendency to betray others and to deceive himself and uncontrollable emotional reactions. This special combination in Hitler's personality resulted in the uncritical conviction of his mission and an enormous driving for recognition. The neuropsychiatric analysis of Hitler's personality could lead to a better explanation of the pathological traits of one of the most conspicuous historical personalities.

Herbert Spencer Wrote:I like your Gollin/Hitler comparison.  All this time I thought Gollum scratched his ass and picked his nose in public because he was unhygienic and uncouth.  I thought he had weird, fruity mannerisms because he was a weird, fruity person.  Nice to know that his antisocial personality traits are caused by an incurable, fatal disease.  The Lord performs his wonders again.

Geoff Vankirk Wrote:This gives me something to look foward to. I'm rooting for DesElms to start showing signs of the eventually fatal illness that he surely must have contracted living his degenerate lifestyle.