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.
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.
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...
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.
Actor Michael J. Fox, who has been the most famous promoter of Parkinson's disease research since his diagnosis 12 years ago, recently published an autobiography that makes jokes of the past and has a hopeful look at the future.
In a recent interview on Good Morning America, Fox discussed the book, which is what he says is a letter to those graduating from high school from a high school drop out.
You can read an excerpt from the book, 'A Funny Thing Happened on the Way to the Future,' and watch his interview with George Stephanopolous on ABC.com.
A recent study published in the Neurology Journal found longtime smoking reduces the risk of developing Parkinson's disease.
The study looked at the lifetime smoking history of more than 300,000 people, and confirmed the inverse relationship between smoking and Parkinson's disease, established in earlier scientific studies.
But don't be so quick to light up those cig's.
Researchers say they've found a critical new piece to the puzzle: It appears to be the length of time one has been a smoker - not the number of cigarettes smoked - that has the most effect on disease risk reduction.
"Nobody should advocate smoking to prevent Parkinson's disease," Dr. Honglei Chen, the lead study author and a tenure-track investigator at the National Institute of Environmental Health Science, told CNN. "It's important to make that very, very clear."
Smoking continues to be the leading cause of preventable death in the United States and has been linked to an increase in heart-disease risk, stroke risk, and several types of cancers.
There's a new treatment option available for patients with early Parkinson's disease. Mirapex ER is the "extended release" version of Mirapex, a drug that's already on the market. The difference between the two is that Mirapex ER only needs to be taken once a day, while Mirapez has to be taken three times daily.
Studies comparing the two drugs found that one daily dose of Mirapex ER improved Parkinson's symptoms to about the same degree as the three-times-daily Mirapex. The potential side effects of both drugs are similar: nausea, sweating, sleepiness, hallucination, dizziness, constipation, vomiting, fatigue, muscle spasms, and dry mouth.
Talk to your doctor about whether Mirapex ER may be an option for you.
A study by the Parkinson's Institute found that the risk of developing Parkinson's disease was nearly six times greater in people exposed to the common industrial solvent trichloroethylene (TCE).
Trichloroethylene, or TCE, is a solvent that was once widely used in dry cleaning and to clean grease off metal parts, and it was once used as an anesthetic, especially during childbirth. But concerns about its toxicity led to it being mostly abandoned and replaced by other anesthetics and solvents.
For the study researchers took job histories of 99 pairs of twins in which only one twin had Parkinson's Disease. Scientists used twins in the study because they are genetically identical or very similar and provide an ideal population for evaluating environmental risk factors.
"This is the first time a population-based study has confirmed case reports that exposure to TCE may increase a person's risk of developing Parkinson's disease," said Samuel Goldman, MD, MPH of the Parkinson's Institute. "TCE has been widely used for more than 50 years in a range of industrial settings and products. It is now primarily used to clean grease off metal parts, and as a component in glues, paints, lubricants and stain removers. PERC is the predominant solvent used in dry-cleaning."
Parkinson's disease, caused by the death of cells in the brain that secrete the neurotransmitter dopamine, is characterized by severe tremors, rigidity in the limbs and other symptoms. It strikes an estimated 100,000 Americans each year and is ultimately fatal. Genetics may play a role in susceptibility to Parkinson's, but the disease has also been linked to environmental factors such as pesticides and head trauma.
People with young onset forms of Parkinson’s disease (PD) face unique challenges – among them raising children and maintaining partnerships and relationships while coping with a progressive and chronic illness. Of course, these sorts of challenges also occur for older people with PD, but they may be more pressing for those with young onset PD. An older person with PD may not have a young child calling him ‘Dad’ or ‘Mom’ and may not be in the initial and building stages of a sexual and romantic relationship with a partner. People with young onset PD, however, often are just starting families or are still building families and so their challenges are different than those of older people with PD. Recent studies of sexual and relationship satisfaction in couples with young onset PD show that levels of dissatisfaction were prevalent among young onset PD patients. PD patients were similar to their partners in their level of sexual and relationship dissatisfaction. The degree of dissatisfaction did not correlate with disease characteristics. Instead, depression seemed to be fueling the dissatisfaction in sexual and romantic relationships. These findings underlie the importance of treating depression aggressively in people with young onset forms of PD.
Source: Wielinski, C. L., Varpness, S. C., Erickson-Davis, C., Paraschos, A. J., & Parashos, S. A. (2009). Sexual and relationship satisfaction among persons with young onset Parkinson’s disease. Journal of Sexual Medicine. [Epub ahead of print]
The English philosopher, Thomas Hobbes (1588-1679), is best known for his political philosophy, although during his day he was more widely known as a scientist, a mathematician, a translator of the Greek classics (such as Thucydides’ History), and a fierce and passionate writer on religious questions. He developed the ‘shaking palsy’ sometime in his 50s or early 60s…sometime in the mid-1640s. By the 1650s or 1660s, we know he was using secretaries to do his writing as he had lost that ability. He would dictate his works to his secretaries. It is fascinating that Hobbes wrote his most influential works right before the estimated onset of his Parkinson’s disease (PD) and right after onset of the disease. For example, he wrote the De Cive [On the Citizen] (1642) right before the onset of his PD and he wrote his most famous work, Leviathan, in 1650-1651 right after onset of the disease. His disease onset and progression also coincided with some of the most momentous events in English history: The terrible Civil Wars of 1642-1646 and 1648-1651 occurred coincidently with the onset and early progression of his disease. Those civil wars involved the most fearsome forms of religious fanaticism and ended in the execution of the King. Through all of this and with his disease progressing, Hobbes was forced to leave the country for his personal safety and lived in France from 1640 to 1651. It is difficult to travel with PD now in the modern era. Imagine what it was like for Hobbes to travel with the disease in the 1650s – all while seeing his home country engulfed in religious fanaticism of the most extreme and deadliest kind. Did his PD influence his political philosophy? It is impossible to say. The disease, however, clearly did not slow him down intellectually. On the contrary, he produced his best most creative work just when the disease was trying to claim his body.