A. Peak dose chorea

1. Evaluate the value of adjunctive PD medications

2. Decrease risk by lowering Sinemet dose when adding other PD medications

3. Adjust levodopa formulation, dose, or frequency

4. Add amantadine

5. Add propranolol, fluoxetine, buspirone, or clozapine

6. Deep-brain stimulation

B. Off period dystonia in the early morning (e.g., foot cramping)

1. Add Sinemet CR or dopamine agonist at bedtime if having nighttime offs

2. Morning Sinemet dose should be immediate-release with or without CR

3. Selective denervation with botulinum toxin

4. Add lithium or baclofen C. Diphasic dyskinesia

1. Avoid controlled-release preparations; consider liquid Sinemet

2. Add dopamine agonist, amantadine, or COMT inhibitor

3. Increase Sinemet dose and frequency

4. Deep brain stimulation III. Akathisia

1. Benzodiazepine

2. Propranolol

3. Dopamine agonists

4. Gabapentin

COMT, catechol-O-methyltransferase. From Refs. 2, 15, 16, 44-46.

Do Not Panic

Do Not Panic

This guide Don't Panic has tips and additional information on what you should do when you are experiencing an anxiety or panic attack. With so much going on in the world today with taking care of your family, working full time, dealing with office politics and other things, you could experience a serious meltdown. All of these things could at one point cause you to stress out and snap.

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