I was talking to a motor disorders neurologist about some lesser-known aspects of Parkinson's disease.
Sinemet is a common brand name for the compound Levodopa which helps replace dopamine (for a few hours).
Can PD patients have excessive or unpredictable autnomic "flight or fight" responses, to what otherwise would be mild stimuli or commonplace (daily life) stressors? This is autonomic nervous system hypersensitivity (ANS hypersensitivity.)
Yes, the ANS hyperresponsivity is definitely a PD thing. In many people, especially those with trauma histories, the ANS spike feels like, or triggers, a sense of panic.
If the patient is spared the anxiety part, a touch of propranolol may be useful before business meetings and other events. Watch out for orthostasis, or wash the propranolol down with Gatorade, but for zoom meetings that won’t be a problem.
If the propranolol slows the patient's HR and prevents the tremor, but they have cortical arousal symptoms like panic, that’s very common in PD. Some people get a sense of panic or doom at the end of every levodopa cycle, or they wake up with it.
There is more to say, plus some graphs, about how anxiety and depression are often mismanaged in PD, if the person is interested in that.
Some PD patients have intermittent or broken sleep, but sleep much better with a bedtime Sinemet. Comments?
Yes, for some patients the need for levodopa at bed or in the middle of the night is totally real. For most people bedtime Sinemet is treating PD off-state stiffness or restless leg symptoms or bladder urgency, but for some people it prevents off-state mood crashes that keep them awake.
