Q: I am a 45 years old male experiencing a problem while walking, which started six years back. After consulting a neurologist, I was informed that I have the symptoms of early onset of Parkinson's. Initially, I underwent physiotherapy only for two years, and later I started taking medicines – 12 mg of Ropark (4 dosages of 3 mg for a day) and 200 mg of Amantral (100 mg of 2 dosages in a day). In between whenever I felt stiffer, then the doctor suggested me to take (Syndopa 110 mg) but stopped after taking it for 10 days. Recently, I observed that the "on time" duration has reduced from five hours or three hours in between doses. Why am I experiencing a sudden dip in the "on time"? How can Parkinson’s disease be treated?

A:Parkinson's disease (PD), we all know now, is caused by degeneration of dopamine secreting neurons in the brain. This degeneration is usually progressive, and the treatments we have today do not stop it (except some newer drugs which slow down the process). The effects of medicines used to treat PD are not always predictable. The time to onset of action, the maximal effect, and the sustained effect become variable (and unreliable) as the disease progresses. It is present medical wisdom to start Syndopa (levodopa) as late as possible, as it causes certain side effects after long use, and may not remain effective after few years.

The maximum dose of Ropark is 24 mg per day in divided doses. If tolerated well, the dose may be increased further in your case. An extended release (XL) form is also available, which might work in your case, as it gradually builds up the levels in blood. It usually takes 4-5 days after starting the XL form to achieve stable blood levels. Amantadine may also be increased to three times a day. There are some new preparations now available like pramipexole or rasagiline, which might help you.

You should consider changing drugs or increasing doses only after a Neurologist's advice, and under supervision. In case of a social event or during functions etc at home, you may want to use small doses of Syndopa temporarily for the tide-over purpose.