PARKINSON'S DISEASE

[BODACIOUS]

I think a lot of us PExers would like to know about this topic. Thank you and more power

[batang uliran]

A disease first described by James Parkinson, in 1817, it is a movement disorder that is more commonly found in older folks. There is a human gene defect in a small percentage of cases (and this gene was in fact discovered by researchers at the institution I work in).

It has 4 cardinal features:

1. Bradykinesia - slowness and difficulty in initiating movement and most often perceived by the patient as weakness.

2. Rigidity - "Cogwheeling" and seen with attempts to passively move one's arms.

3. Resting tremor - subsides with limb movement.

4. Problems with posture and gait - patient is usually slightly bent with a shuffling gait and sometimes, a tendency to accelerate is seen.

Other associated features include a mask facies (facial expression is diminished) and micrographia (handwriting shows smaller letters/words).

It is a clinical diagnosis and lab tests are not routinely employed.

The physiological basis for the disease is loss of the substance dopamine in certain pathways in the brain.

Treatment centers on replacing the dopamine that is deficient with various medications most prominent of which are Sinemet (Levodopa/carbidopa), or drugs that act on the dopamine receptor in the brain such as bromocriptine and pergolide.

In advanced forms brain surgery can be performed (think Michael J. Fox) but this form of treatment is currently in its infancy stage and besides, is not available extensively. Perhaps Ira can comment more on this aspect.

I did a month's rotation with some of the world's authorities on Parkinson's disease and this is the stuff that remains 7 years later!

BTW, here's a link which gives a pretty good overview on this illness:
http://www.rad.bgsm.edu/~tim/papers/park_paper/writeup.html

[Ira]

Neurosurgical approaches for Parkinson's:

1. Ablative surgeries
A. Thalamotomy- It's a procedure where you purposely put a lesion in one side of the thalamus. Bilateral thalamotomies are rarely done due to high postop risk of dysarthria (a speech disorder that is due to a weakness or incoordination of the speech muscles. Speech is slow, weak, imprecise or uncoordinated). It is done primarily for parkinsonian tremor at rest that isn't adequately controlled by medications; for patients with one-sided rigidity and for levodopa-induced dyskinesias. Effects of thalamotomy on bradykinesia is unsure, and limited in patients with gait problems and akinetic symptoms (freezing). Improvement of tremors and rigidity is reported in 80-90% of cases, although few stdies have examined its longterm outcome. Complications include contralateral weakness and numbness, and dysarthria.
B. Pallidotomy- You put a lesion on the posteroventral globus pallidus in this procedure. You can either do open pallidotomy (surgery) or gamma knife pallidotomy (stereotactic radiosurgery, or laser in layman's term) It is primarily for contralateral bradykinesia and rigidity, and levodopa-induced contralateral dyskinesias. It is also useful for tremors, freezing, gait disorders, and other symptoms of Parkinsons. Marked improvement is seen in 80-90% of patients, and a more limited improvement seen in patients with advanced Parkinson's disease who had almost no response to levodopa.

2. Neurotransplantation- Cells that make dopamine are extracted from fetal tissue and treated with specific chemicals, making them suitable for transplant. Then, you put a stereotactic frame on the patient to guide you where the parts of the brain are. The cells are then injected directly into the substantia nigra--the part of the brain destroyed by the disease--in hopes they will produce the needed dopamine. They used to use human fetus since it's not rejected by the recipient, but I think they kind of stopped doing this due to ethical issues involved in harvesting. Right now, a company named Diacrin is conducting a comprehensive study on using fetal pig cell therapy with patients in medical centers across the US. Results so far have been very promising, but it's still too early to tell.

Unfortunately, these procedures are not yet done in the Philippines. Most people are scared of getting their craniums opened, much less undergo a functional procedure--kung brain tumors nga ayaw na nilang pagalaw, what more movement disorders na the risk of dying is much smaller? The technology and the skill is available in the private, first class hospitals for both thalamotomy and pallidotomy. The only problem is willingness to undergo the procedure.

[magz]

Hi Doc Ira!

My mom is suffering from this disease for more than 6 years now. It's so heart-breaking for us, her family to see her agonizing everyday. It seems like without these Sinemet (aside from God's mercy and grace )she couldn't really make it.

Sometimes we find it so hard to buy Sinemet, since not all drugstore in the province has these medicine so most often than not we buy the medicine from Manila. Can you give me some advice on other medicine she can take in lieu of Sinemet?

Thanks so much! :)

[kinkylilith]

well there are recommended rehabilitation management for parkinson's disease:

1. medical management {levadopa,carbidopa,MAO inhibitors, dopamine agonist,amantadine and anticholinergics}
2. high protein diet
3. range of motion exercisesfocusing on trunk extension,hip flexor, and hamstring stretch.
4. coordination exercises focuses primarily on task specific exercises
5. endurance execises
6. blance and gait training with exaggeration of arm swing and with cues; train in falling.
7. breathing exercises and relaxation exercises
8. speech therapy- voice & respiratory control, loudness, pitch variation, control of rate of speech.

there is also specific treatment for PD...like for example they can seek Occupational Therapy intervention

[Ira]

Originally posted by magz
Hi Doc Ira!

My mom is suffering from this disease for more than 6 years now. It's so heart-breaking for us, her family to see her agonizing everyday. It seems like without these Sinemet (aside from God's mercy and grace )she couldn't really make it.

Sometimes we find it so hard to buy Sinemet, since not all drugstore in the province has these medicine so most often than not we buy the medicine from Manila. Can you give me some advice on other medicine she can take in lieu of Sinemet?

Thanks so much! :)

My sympathies to your mom and your family. I deal with PD sufferers on a regular basis and I could only imagine the difficulties and heartbreaks which your family has to undergo daily.

There are other ancillary medications available in the local market like Madopar, Artane, Jumex and Symmetrel, but Sinemet is the mainstay for PD treatment, and I believe that as it is, Sinemet is the easiest to find among these medications. Also, it would depend on your what your mom's symptoms are, as well as how severe they are and whether she is "hiyang" with the medications. Ask her neurologist for substitute medications on her next follow-up. But chances are, it would still be most convenient to keep her on Sinemet.

[magz]

Hi Doc Ira!

Thanks so much. My mother is taking Symmetrel also, if I'm not mistaken. Maybe I'll talk to her neurologist pag balik ko sa Manila. :) Thanks po ulit..

[Ira]

You're welcome.

[ina]

Originally posted by kinkylilith
there is also specific treatment for PD...like for example they can seek Occupational Therapy intervention
hey that's me! :D

kaso i don't really work with adults, more on pedia talaga ako. yun lang, hirit lang me. :beam:



:angel: