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A group of  seniors with Parkinson's disease is getting a much needed reprieve from the debilitating symptoms that haunt their daily lives. Erica Hill reports along with fitness expert, Sarah Robichaud. 


A typical P.D. neurological examination

                              

                                                                      Parkinson's Disease



Parkinson's disease is a progressive neurological disease that affects movement. The condition occurs when a group of cells in an area of the brain, called the substantia nigra, become impaired or die. These brain cells are normally responsible for production of the brain chemical, dopamine, which aids in transmission of messages in the parts of the brain that control smooth movement and coordination.
 
In patients with Parkinson's, these brain cells die off at a faster rate, causing a drop in the production of dopamine. According to the Parkinson's Disease Foundation, about one million Americans have Parkinson's disease; 40,000 new cases are diagnosed every year. The condition usually develops after 65, but can occur at younger ages
 
 About 15 percent of Parkinson's patients are under 50. Symptoms of Parkinson's don't appear until a patient has lost about 80 percent of his/her dopamine-producing cells. The earliest sign is usually a tremor on one side of the body, typically in the hand. At first, the tremor is apparent while the limb is at rest and commonly subsides when the limb is in motion. Eventually, the tremor becomes more apparent and spreads to the other side of the body.
 
Other major signs of Parkinson's disease include rigidity (stiffness caused by increased muscle tone), bradykinesia (slowness of movement) and impaired balance and coordination. Some people with Parkinson's disease also experience changes in speech, problems with swallowing, depression, sleep disturbances, memory problems, personality changes, loss of facial expression or sexual dysfunction.
 
Treating Parkinson's Disease
 There is currently no cure for Parkinson's disease. Treatments are aimed at improving symptoms and quality of life. One common therapy is a combination of the drugs levodopa and carbidopa. Nerve cells use levodopa to make dopamine, increasing the supply of the chemical to the brain.
 
The drug, carbidopa, delays the conversion of levodopa by the body until it reaches the brain. Levodopa is most helpful for reducing signs of rigidity and bradykinesia.
 
Some Parkinson's patients may benefit from a treatment called deep brain stimulation. In this procedure, tiny electrodes are implanted into target areas of the brain. The electrodes are connected to a battery-operated pacemaker-like device (called a neurostimulator) that is implanted under the skin near the collarbone or chest. Once in place, the neurostimulator sends electrical impulses to the electrodes, blocking the signals from the areas causing the Parkinson's symptoms.
 
Targeting the Brain The electrodes used in deep brain stimulation must be placed in a precise position to effectively treat the symptoms. Traditionally, the planning and surgery is done using a fixed stereotactic frame placed on the patient's head. The metal frame is attached to the patient's skull using surgical screws and pins. With the head frame attached, the patient undergoes brain imaging.
 
The images from the brain scan are combined with calibration points on the head frame to create a computerized map of the brain. That information helps doctors plan the potential locations for the electrodes. The patient is taken to the surgical suite and the head frame is mounted to the operating table. The patient remains awake during the implantation.
 
After placing a local anesthetic on the head, a small hole is drilled into the skull. Using the brain map for guidance, tiny electrodes are placed on target areas of the brain. As the electrodes are placed in various areas, the patient is asked to respond and report any changes in symptoms or sensations. The process helps to confirm the target location for the implantable electrodes.
 
Once the appropriate area has been located, a permanent electrode is placed in the brain. The fixed frame system is an important tool in helping doctors place the electrodes in the correct area of the brain. However, the frame is very heavy and a patient is unable to move his/her head once it is locked onto the operating table. Anant Patel, M.D. a neurosurgeon at North Austin Medical Center, is using a new, frameless system for placement of electrodes in deep brain stimulation.
 
The day before surgery, five tiny markers are implanted into the scalp. These markers serve as reference points. Then, a CT scan is done. On the day of the surgery, a plastic device (about the diameter of the palm of the hand) is mounted into the skull with three tiny screws. With the frameless system, a patient doesn't have to lie with his/her head completely still. The plastic unit is locked onto the skull, so the reference points don't change, even if the patient moves. Patel says the frameless system is much more comfortable for the patient than using the fixed head frame. The surgery goes a lot faster, and he believes, is more precise.



                  More about P.D


Parkinson's disease belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50. Early symptoms of PD are subtle and occur gradually. In some people the disease progresses more quickly than in others. As the disease progresses, the shaking, or tremor, which affects the majority of PD patients may begin to interfere with daily activities. Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions. There are no blood or laboratory tests available to diagnose PD.


At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms. Usually, patients are given levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can use levodopa to make dopamine and replenish the brain's dwindling supply. Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all. Anticholinergics may help control tremor and rigidity. Other drugs, such as bromocriptine, pergolide, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine. An antiviral drug, amantadine, also appears to reduce symptoms.

In some cases, surgery may be appropriate if the disease doesn't respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.




MAKING THE BEST OF PARKINSON'S 


There are few among us who don't know at least one person afflicted with Parkinson's disease. More than 500,000 Americans suffer the tremors, slowness, and stiffness of this insidious disorder. Although Parkinson's is not a natural consequence of growing older, there's no question that the odds of getting it do rise with age. It usually begins after age 40, though it sometimes affects younger people. The disease is not contagious and—most important—not fatal.

Physicians have yet to find a one-shot cure for the problem. In fact, doctors don't really know what triggers the disease. However, they do have a wide array of medications that quell its symptoms and delay its progress. With all these remedies at hand, many people with Parkinson's can look forward to years of relatively normal life.


Is It Parkinson's?


Because early symptoms of Parkinson's are subtle and come on very gradually, it's often difficult to decide whether there's a problem or not. Typical early warning signs such as fatigue, weakness, a stiff neck or back, tight muscles, and quivering hands might mean Parkinson's—and might mean nothing at all.

To confuse matters further, as many as 25 percent of Parkinson's patients never develop the one symptom we most associate with the disease, a significant tremor. Likewise, those who do have a tremor don't necessarily have Parkinson's. A relatively harmless condition called essential tremor may be at fault.

This affliction, which is more common than Parkinson's itself, can cause rhythmic shaking of the hands, head, and—occasionally—the vocal cords. Unlike Parkinson's, however, it doesn't always progress; and the other symptoms of Parkinson's, such as slowness and stiffness, never appear. Those with the problem rarely develop Parkinson's as well. Tremors truly caused by Parkinson's have several distinctive features. Like other Parkinson's symptoms, they often start on only one side of the body, then spread to the other. In addition to the hands, the feet, jaw, neck, and tongue can also develop a tremor.

The tremors of Parkinson's, especially in the hands, usually appear at rest, and often stop when the hands are in use. An essential tremor, conversely, is seen more often during activity and less frequently at rest. (This is not an ironclad rule, however. Some Parkinson's tremors grow worse during activity.)

The tremors of Parkinson's usually grow worse under emotional stress. For example, embarrassment over quivering hands can make the shaking worse.

Tremors—if they develop at all—rarely interfere with everyday activities. Far more disabling is the slowdown in movement that accompanies Parkinson's. As this problem develops, people find that motions become hard to start and complete, and difficult to control. They may move like a film in slow motion, needing much longer to perform such daily functions as getting dressed or cooking meals. They may freeze in mid-movement, becoming unable, for example, to continue combing their hair. Performing two movements at once—such as brushing one's teeth with one hand and wiping the sink with the other—becomes difficult or impossible.

At the same time, the muscles begin to become much stiffer than usual. They may freeze in one position or move jerkily in a cogwheel-like motion. Because the back and neck muscles are often affected, a Parkinson's patient may take on a stooped posture, unable to stand up straight. As it becomes difficult to release tension in the body, muscle aches and cramps become common. Handwriting may get smaller and harder to read.

As the muscles grow tighter, people with Parkinson's tend to gesture less during conversation, taking on a stiff appearance. If their facial muscles are affected, they may develop a mask-like expression. When the muscles controlling blinking are involved, they may appear to stare. Alternatively, they may have trouble opening their eyes or keeping them open, making it impossible to read, watch TV, or perform many daily activities.

Parkinson's also gradually affects the way people walk and their ability to balance. People with advanced Parkinson's disease often do not swing their arms while walking, or swing them much less. They may drag one foot, shuffle, have trouble turning, or freeze in mid-stride.

The disease also interferes with the muscles and reflexes that prevent us from falling. People with more advanced Parkinson's who are pushed or otherwise knocked off balance are prone to fall. They may become unable to take anything but short steps, freeze in place, or run forward or backward, unable to stop until they meet an obstacle.

In a majority of cases (between 70 and 90 percent), the vocal cords and muscles controlling speech are gradually affected. A Parkinson's sufferer may begin to speak more softly, less distinctly, and in a monotone. Victims may stammer, as if "stuck" on one syllable. Swallowing can become difficult: drooling could become a problem; and food can get stuck in the throat. There's a danger, too, that a Parkinson's patient may lose the ability to cough automatically when food goes down the windpipe.

Along with these physical problems comes a vulnerability to depression. If a Parkinson's patient develops symptoms such as insomnia, apathy, and weight loss, the problems may be signs of an emotional problem that's easily remedied with antidepressant medications.

After many years with the illness, Parkinson's patients also face the prospect of at least some decline in mental ability. The problem, known medically as dementia, ranges from mild to severe. Its initial signs may take the form of short-term memory loss, difficulty with mental tasks such as balancing a checkbook, or confusion in new surroundings—for example, while on vacation.

Do not assume, however, that Parkinson's is automatically at fault if these or more serious problems begin to develop. A medication or depression may be the true culprit. Ask your doctor whether changing medication or starting an antidepressant might be advisable. Many of the drugs prescribed for Parkinson's disease do have mental side effects, and the older you are, the more likely they are to occur.



     What Lies Behind the Problem

Parkinson's develops when, for a still unknown reason, cells deteriorate in the parts of the brain that govern movement, balance, and walking. The affected areas are the striatum, which relies on a substance called dopamine to transmit its messages, and the substantia nigra, where the necessary dopamine is made. As the supply of dopamine shrinks, so does the striatum's ability to control movement. (Deficiencies of other chemical messengers, such as norepinephrine, serotonin, and gamma amino butyric acid (GABA), also may play a role.)
 
Scientists have discovered some abnormal genes associated with forms of Parkinson's that run in families. However, many people with Parkinson's do not have a family history of the disease, so some experts believe that the condition may result from a combination of genetic and environmental influences. There's some reason to believe that heredity is a significant factor only in the form of the disease that begins before the age of 50.

Amazingly, a great deal of damage can occur before any symptoms develop. The first signs of the disease don't start to appear until the body has lost 70 to 80 percent of the cells in the substantia nigra and 80 percent of the dopamine in the striatum. From that point onward, the rate of progression varies widely. For a majority of patients, symptoms remain manageable for more than 10 years. Disability within 5 to 10 years strikes only a small minority.


Holding Symptoms at Bay


Doctors may not have a cure for Parkinson's, but they can often fend off the symptoms for so long that it sometimes seems as though they do. They have a host of medications at their disposal, and during the course of the disease are likely to use a fairly wide selection.

Different drugs work better at different stages of the disease, and many therapies eventually produce side effects that partly offset their benefits. Treating Parkinson's is therefore a constant balancing act—a trial-and-error effort to identify which drug or drugs best control the most symptoms with the fewest side effects at any given moment. The task is complicated by wide variations in response from one person to the next. A medication that provides great relief for one individual may have little effect—or cause unacceptable side effects—in another.

By far the most effective drug for treating Parkinson's is levodopa, also called L-dopa. It revolutionized care of the disease when it was introduced in the late 1960s. Since its release, most people with Parkinson's have been able to look forward to a relatively normal life. For some patients, however, it will not be the first drug prescribed.

Doctors may hold back from using levodopa immediately for one very simple reason: It has a limited lifespan. After working well for several years, it begins to either cause troublesome side effects or lose its ability to control symptoms. Higher doses may restore its effectiveness, but are likely to increase its side effects as well.

Some authorities believe that using levodopa early in the illness speeds development of problems with the drug. They prefer to withhold levodopa as long as possible. Others start levodopa early to improve a person's quality of life as much and as soon as they can. In favor of the latter approach, there's some evidence that delaying levodopa until serious disability occurs can lead to a shorter life span.


Drugs for Early Parkinson's


While symptoms are mild, your doctor may try alternatives to L-dopa such as: anticholinergics, amantadine, diphenhydramine, selegiline, and dopamine agonists. With the exception of selegiline and the dopamine agonists, these drugs work at least partly by blocking the action of the messenger chemical acetylcholine. Blocking it can be helpful because the brain depends on a balance between this substance and dopamine. When dopamine levels drop, undiminished amounts of acetylcholine become a liability.



Anticholinergics

may help with significant tremor early in the disease. Several are available, including trihexyphenidyl (Artane) and benztropine (Cogentin). Although these drugs used to be among the first ones tried for Parkinson's, they are now generally reserved for patients with severely disabling tremor. They have a number of potential side effects, including dry mouth, constipation, blurred vision, sedation, a fall in blood psymptoms no longer respond to levodopa-carbidopa are candidates for a pallidotomy. 
The operation can greatly improve the impaired movement associated with levodopa and the slowed movement associated with levodopa's "off" periods. A five-year study concluded in 1998 found that 70 percent of Parkinson's patients experienced good to excellent improvement in mobility after pallidotomy. However, the operation can leave the patient with vision problems, speech and swallowing difficulties, confusion, or stroke. The operation usually is performed on one side of the brain and therefore relieves symptoms on only one side of the body. Surgery on both sides of the brain increases the risk of complications.ressure upon standing up, and difficulty urinating. They also may impair thinking. Older patients are often unable to tolerate these effects.

Amantadine (Symmetrel)

relieves tremor, rigidity, and slowness of movement, in many patients. It boasts fewer side effects than the anticholinergics, and proves helpful in early, mild Parkinson's about half the time. Later in the disease, it can be given along with levodopa. It loses its effectiveness after a period of months when used alone.

Diphenhydramine (Benadryl
)
is an antihistamine with some effect on acetylcholine. It often controls the tremors of Parkinson's. Its main side effect, sedation, often wears off with continued use.

Dopamine agonists
.
Two relatively new drugs in this class can improve symptoms when used alone, and can help delay the use of levodopa. The drugs—pramipexole (Mirapex) and ropinirole (Requip)—are also used along with levodopa. For more information on these and other dopamine agonists, see "Stand-Ins for Dopamine" below.

Levodopa: The Mainstay Medication
This drug is so unfailingly effective for Parkinson's disease that people who do not respond to it probably have a different illness. Initial response is often dramatic: For many people, symptoms virtually vanish. Indeed, the first 2 to 5 years on the drug are sometimes called the "levodopa honeymoon." Rigidity and slowness of movement improve the most, but tremor also diminishes noticeably.
 
Levodopa corrects the shortage of dopamine in the brain. Dopamine itself can't be used for this because it will not move out of the bloodstream and into the brain tissue. Levodopa, however, does move into the brain, where it is promptly converted to dopamine. When levodopa is given alone, much of this conversion takes place before it reaches the brain. This can produce excessive levels of dopamine in the rest of the body, causing such side effects as nausea, vomiting, abdominal cramping, weight loss, flushing, and low blood pressure upon standing up. To minimize these problems, levodopa is usually combined with carbidopa, a substance that prevents conversion to dopamine until the drug reaches the brain.
 
This combination is available in a single pill (Atamet, Sinemet). When setting the dosage, doctors have to balance the drug's benefits against its potential side effects. Higher doses may improve control of symptoms but cause involuntary movements, such as facial grimacing, foot cramps, and restless movements of the arms, legs, neck, and head. Doctors also have to adjust the dosing schedule. At first, people tend to respond well to the drug throughout the day. Eventually, however, the medication begins to wear off before it's time for the next dose. Gradually, the drug becomes effective for a shorter and shorter time each day.
 
Involuntary movements may start to occur just after a dose or just before the next dose. These movements may be slight at first, but can become frequent, uncomfortable, painful, and distressing. The problem is thought to be the result of fluctuating levels of levodopa in the blood.
 
To stabilize the levels, the doctor may prescribe a controlled-release form of levodopa-carbidopa such as Sinemet CR. Lowering the dose of levodopa also may help. After a while, some people begin to experience periods of relief followed by a dramatic increase in symptoms unrelated to the time they take the drug. With this "on-off" response someone may go from being normally active to totally bedridden in just minutes. Faced with this yo-yo effect, patients may find themselves attempting to cram their chores and recreation into their "on" times.
 
 As the disease progresses, however, these fluctuations may become more severe. Taking smaller doses of levodopa more frequently often reduces or delays these problems, but usually doesn't eliminate them. Adding a dopamine agonist (see "Stand-ins for Dopamine" below) to low-dose levodopa-carbidopa therapy early in the disease can reduce the risk of complications later.

Selegiline (Atapryl, Carbex, Eldepryl)
can enhance the effect of levodopa. It is sometimes added after levodopa's on-off effects begin, enabling the patient to reduce the levodopa dosage. However, there is no evidence to support the idea that selegiline delays the natural progression of Parkinson's disease. Despite all these strategies, for many patients there comes a point at which levodopa will no longer work. For about one-third, that juncture is reached in 4 to 5 years.
 
For another third, the drug lasts 5 to 7 years. For the remainder, the drug keeps on working for most of their lives. Stand-Ins for Dopamine As the effects of levodopa become problematic, doctors often add one of the so-called dopamine agonists— pramipexole (Mirapex), ropinirole (Requip), bromocriptine mesylate (Parlodel) or pergolide mesylate (Permax). These medications mimic the effect of dopamine in the brain. Unlike levodopa, which depends on the substantia nigra for its conversion to dopamine, these drugs act directly on the striatum. They can therefore remain effective even as cells in the substantia nigra continue to die. Although these drugs usually are not as effective as levodopa, they can reduce the amount of levodopa needed, and may smooth out fluctuations in levodopa's effectiveness.

For many people, these dopamine agonists work best on muscle control. The two newer members of this category—Mirapex and Requip—are generally believed to cause less side effects than the older drugs. However, they have been associated with sleep attacks. Some people taking these agents have unknowingly fallen asleep while driving, on the phone, or during business meetings. Other side effects (shared with the older dopamine agonists) include hallucinations, memory problems, confusion, low blood pressure upon standing up, nausea, and constipation.
 
 Side effects are more common when the drugs are taken with levodopa, especially if the dosage of levodopa is relatively high (more than 600 milligrams a day). New Dopamine Boosters The newest drugs in the Parkinson's arena are called COMT inhibitors. They interfere with the activity of the enzyme catechol O-methyltransferase (COMT) which ordinarily breaks down both dopamine and levodopa. With COMT rendered ineffective, more levodopa can reach the brain and less needs to be taken. The first drug in this class, tolcapone (Tasmar), has enabled patients to reduce their levodopa dosage by 25 percent.
 
A few patients taking tolcapone have had liver damage, however, and three have died from liver failure. Therefore, tolcapone is now approved for use only by people on levodopa-carbidopa who are experiencing symptom fluctuations and are either not responding well to other drugs or are not candidates for other therapy. Everyone receiving tolcapone must have frequent blood tests to monitor their liver function. A less potent COMT inhibitor, entacapone (Comtan), poses less risk to the liver, but should still be used cautiously by anyone with liver disease. In clinical trials, both tolcapone and entacapone were effective against the "wearing off" that occurs with levodopa. Patients receiving a COMT inhibitor report increased energy levels, better sleep, and improved functioning.
 
Side effects include those related to enhancement of levodopa, along with diarrhea and brownish-orange urine. Additional Possibilities A couple of other medications are sometimes prescribed for Parkinson's. Propranolol, a beta blocker originally used for high blood pressure, may help when tremor worsens with activity. Botulinum toxin, available as an injectable drug, is useful for alleviating spasms in the muscles that control winking and for relieving abnormal muscle tone in the arms and legs.
 
These problems sometimes persist after other symptoms are controlled with medications. "Antioxidant" supplements such as vitamin E and selenium have been advocated by some proponents of nutritional therapy. And new research suggests that estrogen replacement therapy may help prevent the onset of Parkinson's disease, as well as alleviate some of its symptoms, for some women.Other Measures That Help Although medications are the foundation of Parkinson's therapy, there are many other ways to hold off the disease's worst results. Exercise and speech and swallowing therapy can complement the benefits of medications, make people more comfortable, and compensate somewhat for the disease's effects. Support groups can help patients and their families cope with the illness, and keep them informed about new therapies (check the listings in the Resource Guide near the end of the book). And some minor changes in day-to-day living arrangements can make a major difference in the ease of daily activities (see the nearby box).


Exercise and Physical Therapy

Exercise can relieve pain caused by rigid muscles, cramps, and stooped posture, and may prevent deterioration due to contractures (muscles and joints that become frozen in certain positions). Exercise also prevents the problems that always result from inactivity. Parkinson's itself does not significantly reduce muscle strength, for example, but the lack of activity it fosters certainly will. Staying sedentary can cause swelling in legs and ankles, and increase the risk of suffering a blood clot in the lung. Parkinson's itself causes loss of range of motion; inactivity can also speed the loss of range of motion that Parkinson's induces, while exercise alleviates it.

If you have trouble sticking with an exercise program at home, try a group exercise program with other Parkinson's patients. Water exercise, strengthening programs, and aerobic exercise programs are all available. Consider swimming regularly. It builds range of motion and involves most muscle groups.
Daily range-of-motion and stretching exercises are also highly recommended. Even a little bit of exercise each day can help make a difference. It is best to start exercising early in the illness, when it may still be possible to prevent or reverse musculoskeletal changes.
It's also easier to develop the habit of exercise before late-stage disease, when freezing, inability to move, and contractures become more likely. But do check with your doctor or physical therapist for advice before starting your program.

Speech and Swallowing Therapy
Speech therapy aims to correct the poor enunciation, soft voice, mumbling, slurring, and inappropriate rate of speech that Parkinson's patients often develop. It involves training to speak more loudly, exercises to build the strength of muscles that control inhaling, and practice to build the habit of breathing deeply. Experts disagree about the lasting value of speech therapy, but if you're having difficulty with speaking, it may be worth a try. To maintain the benefits, you need to continue the exercises after formal training is over. Muscle exercises can also help relieve swallowing problems.
Other suggestions include eating slowly, chewing each mouthful thoroughly before swallowing, drinking liquids with every meal, and preparing foods that don't require a great deal of chewing.

Surgical Remedies
Surgery used to be reserved for patients who developed Parkinson's at a relatively young age and faced disability in their prime working years. Now it is considered an option even for older patients as long as they fail to respond to available medications and can tolerate the operation. Doctors today have also had more experience with the various surgical options. Some have become safer, and others (specifically, adrenal transplantation) have been discredited.

Pallidotomy.
This risky form of brain surgery gained favor in the 1940s, then faded from use with the advent of levodopa. It was resurrected in 1992 with the aid of magnetic resonance imaging (MRI), which enables the surgeon to see the part of the brain on which he is operating, called the globus pallidus. During the operation, cells in this area are destroyed with an electrode. People whose Thalamotomy. This surgery destroys a group of cells in the region of the brain called the thalamus that lies near the globus pallidus. Candidates for it are the 5 to 10 percent of patients with disabling tremor in the arm or hand. Surgery reduces or eliminates tremor in as many as 90 percent of patients.

Deep brain stimulation.

Researchers have found that electrical stimulation of the thalamus can produce the benefits of thalamotomy without the risk of irreversible tissue loss. Surgeons insert one end of an electrode wire into the thalamus and link the other end to a generator the size and shape of a heart pacemaker. This generator is implanted under the skin in the chest area. When the patient activates the unit by passing a small (2-inch) hand-held magnet over the chest, tremor resolves on one side of the body. Similar electrical stimulation techniques involving the globus pallidus and the subthalamic nucleus are becoming accepted as an alternative to pallidotomy.

Tissue transplantation.
Scientists continue to experiment with transplantation of dopamine-producing cells into the brain. Experiments in this area have included the failed effort with human adrenal tissue, as well as more promising attempts with human fetal tissue and pig neural tissue. However, moral objections have been raised against the use of human fetal cells, and the use of pig cells poses the possibility of unforeseen complications. To circumvent these difficulties, scientists are exploring other potential sources of useful cells. One group has reported successfully growing rat neural stem cells (immature nerve cells) outside the body. 

This suggests the possibility of growing human nerve cells in a similar manner. Researchers also are experimenting with genetically engineered skin cells and a variety of other human and animal cells that can be altered to produce dopamine. Neurotrophic proteins. These proteins appear to protect dopamine-producing cells from dying. One naturally occurring compound under study is called glial derived neurotrophic factor (GDNF).

about treatments and what to expect physiologicaly
.
 
Thanks to increased awareness brought about in part by actor Michael J. Fox's disclosure that he lives with Parkinson's and the subsequent creation of his foundation, and also due to new advances in stem cell research and other therapies, a lot of information about Parkinson's disease is now available to the public. Many countries have national associations with regional headquarters helping people with Parkinson's. Here is a list of six tips that will make living with Parkinson's disease easier.
 
1. Exercise: Parkinson's disease impacts your mobility, so it is important that people with Parkinson's make certain their bodies are as strong and flexible as possible. Simple activities like stretching, walking, running, and swimming are ideal to build strength. If exercising by yourself doesn't sound much fun, look into group classes, community walking clubs, or water-aerobics sessions. Many communities have low-cost facilities, equipment, space and instruction where necessary. Special classes which take particular conditions into consideration are also commonly available.
 
2. Diet: nutritional health is essential for strength and vitality no matter what your health situation. Through eating right, Parkinson's patients can steady their energy and better control their weight, which can have a big effect on struggling muscles. Check with a physician to establish whether diet could have an adverse effect on medication. Case in point- high-protein foods may interfere with absorption of medications. Keeping a food journal can be an invaluable tool in pinpointing problems with medication.
 
.
Six Tips for Dealing with Parkinson's Disease
by Carlo Morelli
 

That diagnosis of Parkinson's disease can be frightening is certain. It's a serious malady that, if left unchecked, can end in debilitating changes to one's body. Nonetheless, advances in medical treatment in combination with some basic lifestyle changes can significantly lessen the impact of Parkinson's disease.

Your diagnosing physician is always a valuable first resource. He or she can advise someone diagnosed with Parkinson's about treatments and what to expect physiologicaly.

Thanks to increased awareness brought about in part by actor Michael J. Fox's disclosure that he lives with Parkinson's and the subsequent creation of his foundation, and also due to new advances in stem cell research and other therapies, a lot of information about Parkinson's disease is now available to the public.

Many countries have national associations with regional headquarters helping people with Parkinson's.

Here is a list of six tips that will make living with Parkinson's disease easier:

1. Exercise: Parkinson's disease impacts your mobility, so it is important that people with Parkinson's make certain their bodies are as strong and flexible as possible. Simple activities like stretching, walking, running, and swimming are ideal to build strength.
If exercising by yourself doesn't sound much fun, look into group classes, community walking clubs, or water-aerobics sessions. Many communities have low-cost facilities, equipment, space and instruction where necessary.
Special classes which take particular conditions into consideration are also commonly available.

2. Diet: nutritional health is essential for strength and vitality no matter what your health situation. Through eating right, Parkinson's patients can steady their energy and better control their weight, which can have a big effect on struggling muscles. Check with a physician to establish whether diet could have an adverse effect on medication. Case in point- high-protein foods may interfere with absorption of medications. Keeping a food journal can be an invaluable tool in pinpointing problems with medication.

3. Wardrobe: Parkinson's reduces motor skills, which can make buttoning of shirts and pants, or doing up a bra difficult. Go for loose (but not flapping) clothing with elastic waists, pull-on shirts and dresses and a minimum of buttons, zippers, hooks and ties, as well as slip-on or Velcro-fastened shoes.
This may not be required in the early stages of the disease, but will become important later on.

4. Compensating tactics: strategize about ways to overcome problems associated with Parkinson's disease, like dropping things. For instance, Parkinson's patients find they may often drop their wallets when fumbling for change. To counteract this problem, buy a large wallet that is easy to grip and doesn't send you digging into deep corners.
Using a debit or credit card may be an easier alternative to searching for coins and bills. Another example of a helpful compensating strategy would be to switch from delicate porcelain tableware to more durable shatter-proof or plastic pieces.

5. Take naps: Parkinson's can interfere with restorative sleep, even though many people who have the disease suffer from fatigue. Take a short nap a couple times a day to keep your energy up.

6. Be understanding: medical treatment and lifestyle changes can do a lot to minimize Parkinson's symptoms, but it's likely that people will notice things like tremors or tics at some point. Children, in particular, may ask blunt questions. Try not to be offended, and when possible, use it as a chance to educate about Parkinson's and its effects.



New guidelines for diagnosis and treatment of Parkinson's disease

Medical Condition News Published: Monday, 3-Apr-2006

New guidelines developed by the American Academy of Neurology aim to educate physicians on the diagnosis and treatment of Parkinson disease and provide people with Parkinson disease an improved quality of life.

The guidelines, released at the American Academy of Neurology 58th Annual Meeting in San Diego, Calif., April 1 - 8, 2006, and published in the journal Neurology, were developed through a rigorous, comprehensive review of all of the scientific evidence available on Parkinson disease.

"It is possible to improve the quality of life for people with Parkinson disease," said guideline author and Parkinson expert William J. Weiner, MD, FAAN, of the University of Maryland School of Medicine in Baltimore. "The guidelines provide recommendations for: making the correct diagnosis as early as possible, making the best use of time-tested and effective therapies to improve motor function, and screening for and treating depression, psychosis and dementia--common symptoms of Parkinson disease that often are left untreated."

Parkinson disease is often misdiagnosed. It is estimated that five to 10 percent of people with Parkinson disease are misdiagnosed. Also, up to 20 percent of people diagnosed with Parkinson disease are found to have a different diagnosis during an autopsy. The new guidelines help doctors correctly diagnose Parkinson disease earlier and more accurately. Then neurologists can suggest treatments and lifestyle changes to better manage and treat the disease.

There are a variety of therapies available to treat the motor symptoms of Parkinson disease. The guidelines present how strong the evidence is for each of these drugs and surgery so that physicians can make the best decisions in treating their individual patients. Surprising news includes the wide variety of treatments that are available to help patients with Parkinson disease.

No evidence was available to support that nutritional supplements, including vitamin E, are useful in slowing the progress or improving symptoms of Parkinson disease. Some people have feared that levodopa, one of the most effective treatments for Parkinson disease, may speed up disease symptoms.

The guidelines demonstrate that levodopa is a safe and effective treatment to improve movement and does not speed up disease progression. According to a guideline published by the AAN in 2002, either levodopa or a dopamine agonist drug may be used as a first treatment for Parkinson disease.
Movement difficulties can be improved with regular exercise and physical and speech therapy, according to the guidelines. "It's important to keep talking with your neurologist about new problems or symptoms or any changes," Weiner said. "People often aren't aware that exercise and therapy can help with many of these problems." The guidelines recommend that people with Parkinson disease be screened for and treated for depression, psychosis, and dementia, which can affect quality of life and how well they function.
"Many people just assume that depression, hallucinations, and memory loss are inevitable side effects of Parkinson disease and don't even discuss them with their neurologist," Weiner said. "Effective treatments are available, and treatment can greatly improve the patient's quality of life."


The guidelines were divided into four broad areas, with 20 specific recommendations sprinkled through.

The broad areas included:

Diagnosis and prognosis of new-onset disease;
Neuroprotective treatments and alternative therapies;
Management of Parkinson's disease with motor fluctuations and dyskinesia; Depression, psychosis, and dementia that are associated with Parkinson's disease.


Tests such as the Mini Mental State Examination and the Cambridge Cognitive Examination should be used to screen for dementia in such patients, Dr. Miyasaki added.

The guidelines included the use of new drugs, Comtan (entacapone) and Azilect (rasagiline), and indicated that there is a role in treatment for deep brain stimulation. Rajesh Pahwa, M.D., of the University of Kansas Medical Center in Kansas City, said evidence supports use of Comtan and Azilect to reduce "off" time in patients whose disease has progressed and whose medication provides less reliable amelioration of symptoms.

Parkinson disease is a progressive movement disorder that affects about one million people in the United States and Canada. In people with Parkinson disease a vital chemical in the brain, dopamine, slowly decreases. Dopamine makes smooth and coordinated muscle movement possible. A loss of dopamine leads to symptoms of Parkinson, such as shaking (tremor), stiffness, shuffling walk, slowness of movements, balance problems, small or cramped handwriting, loss of facial expression, and soft, muffled speech.




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