Hello doctordoris,
At least 50,000 people in the US are diagnosed with PD each year.
You probably know that Parkinson?s Disease (PD) affects brain cell
degeneration of the mid-brain, causes brain lesions, causes metabolic
abnormalities, and presents with physical symptoms - tremor or jerky
movements, usually affecting the hand, jaw and foot of one side of the
body, and occurs while the affected muscles are in a resting state.
Symptoms may present differently in timing and severity for each
patient. As the disease progresses, the patient may experience
bradykinesia, a slowing of voluntary movement, such as walking,
writing, reaching, etc. Secondary symptoms may include difficulty
writing (micrographia), memory problems, difficulty with thinking and
remembering, and dementis and confusion. These secondary symptoms
would be what might keep a patient from completing deskwork, staying
focused on tasks or planning future events. The inability to handle
everyday activities, such as paperwork, etc., usually does not appear
until Stage IV or V, or Advanced, depending by which scale you use.
PD involves other symptoms too; depression, sexual dysfunction and
even constipation, effectively reducing the quality of life for the
sufferer, and caretaker alike.
http://www.medscape.com/pages/editorial/resourcecenters/public/parkinsons/rc-parkinsons.ov?src=hp17.rctop
http://www.npf.healthology.com/webcast_transcript.asp?b=npf&f=parkinsons_disease&c=pd_currenttrt&spg=TRNI
http://my.webmd.com/hw/health_guide_atoz/hw78534.asp
According to Parkinsons.org, PD patients who have been on medication
for several years develop an ?On/Off? fluctuation of symptoms. When
the ?On? switch is toggled, the patient seems to be able to function
relatively well, handling their own daily living activities, and
experiencing fewer tremors. When the ?Off? switch is toggled, daily
activities, particularly bathing, walking and eating may be impaired.
This seems to occur when the medication is wearing off.
This site has excellent resources, including this page:
http://www.parkinson.org/med8.htm
The table of contents for this site is found here:
http://www.parkinson.org/med3.htm
In the absence of drug-induced psychosis and/or hallucinations, a PD
patient may not have a great loss of cognitive function for years.
However, stroke can occur, and Alzheimers can strike PD patients.
Another degenerative process that is receiving some attention is
?Diffuse Lewy body disease, or Dementia with lewey Bodies? that shares
some symptoms with PS and Alzheimer?s disease.
?These mild alterations in thought processes are relatively well
tolerated by most patients as they do not hinder day-to-day activities
and responsibilities. Incidentally, some patients actually report
improvements in motivation and concentration when they take the
dopaminergic medications discussed previously.?
http://www.parkinson.org/med31.htm
More about Diffuse Lewey Body Disease
http://www.neuro.nwu.edu/meded/behavioral/lewy.html
http://www.emedicine.com/neuro/topic91.htm
Recently a new combo drug, Stalevo, has been released that combines
levodopa, carbidopa, and COMT inhibitors, usually entacapone, in one
pill. Levodopa is still considered the most effective drug for PD.
This drug is now available in the US and most parts of the world. The
presence of COMT inhibitors allows levodopa to maintain higher levels,
longer.
From Health and Age, ?The pharmacokinetic characteristics of
entacapone and levodopa are similar, so that entacapone can be
co-administered with each levodopa dose. Given this way, entacapone
increases the area under the concentration-time curve of levodopa,
prolonging its half-life of elimination without influencing the peak
concentration or time to reach peak concentration. The study
summarized here was conducted to evaluate the clinical benefit of
entacapone when added to levodopa treatment in patients with
Parkinson's disease who were demonstrating the well-known wearing-off
phenomenon?
http://www.npf.healthology.com/webcast_transcript.asp?b=npf&f=parkinsons_disease&c=pd_currenttrt&spg=TRNI
http://www.medscape.com/viewarticle/478117
From the makers of Stalevo
http://www.stalevo.com/index.jsp?checked=y
Page 4
http://pharmacy.nova.edu/NewWebsite/Documents/DI_News_061903.pdf
http://www.healthandage.com/PHome/gid2=452
http://www.iqb.es/cbasicas/farma/farma04/e010.htm
?Rasagiline is now in the last stage of the approval process with a
decision expected later this year. Teva Pharmaceuticals will then
market the new drug. The treatment?s effectiveness was measured by
Unified Parkinson?s Disease Rating Scale (UPDR) and compared with the
control group that received a placebo. The group that received 1
milligram showed an improvement of 4.2 UPDR units on average. Those
who received 2 milligrams showed an improvement of 3.56 UPDR units.?
http://www.ats.org/news.php?id=58
Pallidotomy, if performed by experienced and skilled surgeons can be
an effective treatment for PD, as it seems pallidotomy and levodopa
medication are complimenatary. ?Pallidotomy is a neurosurgical
procedure that can reduce many of the symptoms of Parkinson's Disease.
Although it is not a cure, this treatment can permanently eliminate
dyskinesias, rigidity, and reduce tremor, bradykinesia, masked faces,
stooped posture, shuffling gait, dystonia and greatly improve "on-off"
motor fluctuations.
?In this procedure a pearl-sized heat lesion to correct the abnormally
discharging nerve cells located in the globus pallidus internus is
made using refined stereotactic techniques. The results occur during
the treatment while in the operating room. If the operation is
performed by an experienced neurosurgeon, the benefits are dramatic,
safe, long-lasting and without negative side effects.?
http://www.pallidotomy.com/pallidotomy.html
From the National Parkinson?s Foundation on pallidotomy, the surgical
procedure to alleviate PD:
The procedure that really attracted the most attention was called
pallidotomy, and what pallidotomy did really was improve Parkinsonism,
but more importantly, make these dyskinesia or involuntary movements
go away, so that we could get better control of patients with
levodopa.
And in the past number of years, we're actually able to do even
better, using a strategy called deep brain stimulation, and here an
electrode is implanted into a critical region of the brain and
connected to a pacemaker, which can cause that region to be stimulated
at a very high frequency. When that happens, you simulate the effect
of a destructive lesion, but without having to actually destroy
tissue, and in fact, if you get side effects, you can turn off the
stimulator. Alternatively, you can adjust aspects of the stimulator in
order to try and get the optimal effect.
What I think is important to appreciate is while these procedures are
extremely valuable, what they really do is treat the motor
complications of levodopa. What they don't do is provide a benefit
that's superior to what you get with levodopa alone. So if you were
able to administer levodopa is such a way that you did not experience
motor complications, than most of the surgery we do today wouldn't be
required. January 14 2004
http://www.npf.healthology.com/webcast_transcript.asp?b=npf&f=fast_facts&c=ff_pd_currenttrt01&spg=FII#
Activa Therapy -- Deep Brain Stimulation therapy According to the New
Hope for Parkinson?s site, this therapy is called a ? pacemaker for
the brain? and has been featured on CNN and Good Morning America. You
can request a free information kit here:
http://www.newhopeforparkinsons.com/web/pid/5/
Activa utilizes an electrical stimulation device, that is implanted in
the chest, with electrodes that run into the brain. It is similar to a
heart pacemaker in size and function.
?The Activa Tremor Control System stimulates targeted cells in the
thalamus - the brain's message relay center-via electrodes that are
surgically implanted in the brain and connected to a neurostimulator
implanted near the collarbone. The electrical stimulation can be
non-invasively adjusted to maximize the benefits of the therapy for
each patient.?
http://www.medtronic.com/servlet/ContentServer?pagename=Medtronic/Website/ConditionArticle&ConditionName=Essential+Tremor&Article=et_art_activa
?In clinical studies patients receiving Activa® Tremor Control Therapy
have resumed daily life activities that were previously difficult or
impossible, such as writing, pouring liquids, feeding, and dressing
themselves?
http://www.medtronic.com/hic/tremor.html
One patient?s experience with Activa
http://www.medtronic.com/servlet/ContentServer?pagename=Medtronic/Website/Patient&ConditionName=Essential+Tremor&Article=et_ps_1us.html
Clozapine seems to be helpful in alleviating drug-induced delusions
and hallucinations due to the effects of domapmins.
?Clozapine is effective in treating drug-induced psychosis in
Parkinson's disease (PD), according to the results of a randomized
trial published in the May issue of the Journal of Neurology,
Neurosurgery and Psychiatry.?
http://www.medscape.com/viewarticle/477661
Psychosis and Parkinson?s
http://www.medscape.com/viewarticle/472319
?Drug-induced hallucininosis may begin with vivid or disturbing
dreams. Often hallucinations occur in low light situations, and when
the individual is going from one state of consciousness to another,
such as waking from sleep. Someone might "see" a relative in the
bedroom upon awakening, but then realize the person is not really
present. Something may be seen darting out of the corner of the eye,
or crawling bugs will be seen in patterned wall coverings or floor
tiles?
?Some physicians prescribe medications such as tacrine HCl, (Cognex®)
or donepezil (Aricept®), approved for use in the Alzheimer population,
to treat dementia associated with Parkinson's disease. While they have
not yet been widely tested in the Parkinson population, it can be
argued that such drugs might be tried since they are relatively safe
and we have no other proven treatments to offer. There is clearly a
desperate need for effective remedies for the problems of
Parkinson-related dementia.?
http://www.parkinson.org/med32.htm#hal
?It is well documented that individuals with Parkinson's disease (PD)
experience significant impairment on tests of simple RT, but it is
unclear whether such deficits can be interpreted as 'pure' slowness of
information processing, or a delay in the selection and output of a
motor response.?
(Second article on this page)
http://www.medscape.com/viewarticle/468014
There is currently a Phase II study about the effects of Valerian, a
medicinal herb, on sleep in PD patients, who generally have trouble
with their sleep patterns.
http://www.clinicaltrials.gov/ct/show/NCT00070928?order=26
Advances in Neurology has published an interview with a Parkinson?s
patient, his wife and neurologist. You can get a glimpse of how the
patient feels by reading this article. Several online videos is also
available on this page.
http://www.advancesinneurology.com/webcast_transcript.asp?f=parkinsons_disease&c=parkinsons_carepersp&b=ain&spg=SHO
If you have a family member with PD, you may be interested in these
two newsletters:
Sign up for a free newsletter on Parkinson?s
http://www.advancesinneurology.com/neurology/parkinsons.asp
Another newsletter:
http://www.newhopeforparkinsons.com/regpsv/
There is an interesting slide show, that explains symptoms and stages
of PD on this site:
http://www.dna2z.com/projects/PD/park4_1.html
?If you are having problems with activities of daily living, an
occupational therapist (OT) can help minimize difficulties you may
have in performing these tasks. (Week of May. 15, 2004)?
http://www.stalevo.com/info/tools/tip_of_the_week.jsp
Resources for PD:
This page has multiple links to helpful and informative websites for
PD patients and their caregivers.
http://www.newhopeforparkinsons.com/web/pid/9/
This is a handy Patient Journal, to track medications and symptoms.
http://www.parkinson.org/medB3.htm
Parkinson?s Management Tree
http://www.parkinson.org/medC2.htm
I hope this answer has answered your question adequately. If any part
is unclear, or if I have unknowingly duplicated information you
already had, please request an Answer Clarification, before rating.
This will allow me to assist you further, if possible.
Sincerely,
crabcakes
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