Tuesday March 4, 2014
Diagnosing Parkinson's disease is not an easy process particularly since there really is no definitive test for this illness. As physicians we rely on our patients' descriptions of their symptoms, what we see on physical exam and we sometimes require neuroimaging like a DaTscan to help decide if the diagnosis is indeed Parkinson's. As patients we often go through a time of uncertainty particularly early in the disease or if we have any atypical features. All in all, it can be a frustrating and frightening time as we are put through reams of clinical testing as our bodies seem to disengage from our brains.
Fear of the unknown and trepidation about the possibilities are very real issues we face during this process of diagnosis. In an effort to provide some insight and hopefully allay some of that anxiety, I've started a patient's guide to Parkinson's disease which discusses the diagnostic process in general, symptoms of PD, the signs seen on physical examination, the neuroimaging that is sometimes necessary, the differential diagnosis that physicians consider and how this whole process will be revolutionized with the discovery of a disease biomarker.
I hope this proves to be a valuable resource and I will continue to expand on its contents. Suggestions and feedback always appreciated.
Tuesday February 18, 2014
Parkinson's Disease is a challenge to manage both for the person affected as well as their physicians. The line between symptom control and medication side effects is a fine one. Add into the mix fluctuations in symptoms due to external factors like sleep, exercise, diet and stress and it becomes even further complicated. Optimizing your management involves recognizing certain aspects of your disease - both symptoms and side effects - and any relation they may have to your medication schedule. The importance of distinguishing between two abnormal movements is explored in "Dystonia vs Dyskinesia - An Important Distinction".
Educating yourself about what's important in facing the challenges this disease presents will ultimately improve your quality of life. In the weeks ahead, I want to start at the beginning - the time of diagnosis. What are the symptoms and signs that your physician looks for? What are the standard tests and imaging studies? What do the Parkinson's evaluation scales mean? What else could it be if not Parkinson's Disease? Looking forward to the conversation.
Sunday February 9, 2014
As the new contributor to the About.com Parkinson's site, I would like to say that it is an absolute honour to be able to connect with all of you in this way. As both a physician and a person with Young Onset Parkinson's Disease diagnosed at age 27, over 16 years ago, I have learned a lot about how to cope with this challenge. This is not a simple disease, as I discussed in my first article, "The Complex Etiology of Parkinson's Disease" and presents with not only the motor symptoms we are familiar with but also with many nondopaminergic symptoms such as pain, mood disorders and sleep problems to name a very few. I hope to address these issues and have begun with "Dealing With Sleep Disorders in Parkinson's Disease". I also hope to provide you with a framework to manage your illness and provide information that helps to enrich your life experience and improve your quality of life. To this end I've posted information on how to "Build Your Support Team". I also hope to provide more topical information such as the blog on "Pesticides and Parkinson's Disease". Much more to come...
Wednesday February 5, 2014
A recent study conducted by researchers at UCLA looked at a group of patients with Parkinson's Disease compared to a control group and investigated their levels of pesticide exposure at home and in the community. They found that 11 of the pesticides they tested, increased the risk for Parkinson's Disease. The most alarming result was that the level of exposure to these chemicals that caused an increased risk was actually much lower than the concentrations normally used. These pesticides currently are being used in parks and recreational areas, to control pests inside homes and other structures and have penetrated our food chain. This broad use unfortunately means that there is an increased number of people at risk.
All these pesticides seem to do their damage by inhibiting ALDH (aldehyde dehydrogenase) an enzyme that converts aldehyde to a less toxic agent. This is an important process because aldehydes are highly toxic to those cells responsible for producing dopamine. Dopamine loss is of course a central cause of the symptoms of this disease.
Researchers found fairly commonly that there are individuals who carry an abnormal ALDH gene and in those people exposure to these pesticides put them at a 2 to 6 fold increased risk of developing Parkinson's Disease compared to those without the mutation.
This study adds to our understanding of what role environmental exposure can play in the development of Parkinson's Disease particularly in genetically susceptible individuals.
The abstract can be found on the Neurology journal website.