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The severity peaks during dose escalation for a physiological reason: receptor density in the area postrema exceeds that in peripheral tissues, so central effects hit harder and faster than metabolic benefits

The pattern is clear: Lcarnitine tends to help most when baseline muscle carnitine is low or when metabolic stress and exercise create conditions where improved fattyacid transport matters

Ann Clin Lab Sci 39:219232 Merola A et al (2016) Peripheral neuropathy associated with levodopacarbidopa intestinal infusion: a long-term prospective assessment

In addition, in vivo experiments show that acetaminophen injection induces neuronal death in the rat cortex