Thursday, August 12, 2010
Parkinson's Disease and Dropped Head Syndrome
My 85-year old father has PD, diagnosed approximately 2004. Early this year he lost his ability to hold his head up. The onset of this condition was rapid, 2-3 weeks. We have since learned that this is known as Dropped Head Syndrome and is most common in ALS patients, but is known to occur in PD patients. Dad had been taking Mirapex, but his neurologist decided to wean him off it, as he thinks there may be a connection. Dad continues to take Stalevo (200mg 4x/day). We don't expect any improvement to the neck from not taking Mirapex - perhaps it will lessen the severity of the DHS?Dad was considering having surgery to fuse C3-C7 vertebrae, however, his neurologist advised against it, as the condition of DHS would not be cured; rather, the "drop" would occur below the fused area.Dad has both hard and soft neck braces but they really don't provide much help. His chin slips inside the brace so his head continues to drop. Tightening the brace makes it very uncomfortable for him.What is your experience with patients with PD and DHS? What treatment(s) can you recommend? Any advice would be greatly appreciated!
Tuesday, June 22, 2010
MEDICATION
I am 4 years post diagnosis. I only take requip( ropinirole). Should I be on any additional medication as my dexterity is worsening and tremors are more prevalent in my right leg.
Saturday, March 20, 2010
what can i do to help my mom?
My mom is very ill. My father is trying his best to take care of her. She seems to have gone from having parkinson's at a level of 4 (on a scale of 1-10 with 10 being the worst) to a 10 in just under a year. We cannot find anyone to help us in the boca area. We have been trying and trying to get in with a neurologist that specializes in movement, filled out the requested prior paperwork, and have not gotten a call yet. It's been over a month. Any advice? Desperate to help her.
Very rapid worsening suggests an atypical form of Parkinsonism or perhaps an intercurrent illness that has caused her to decompensate.I suggest you seek the advice of an expert on Parkinson Disease in Boca:Dr. Stuart Isaacson practices as a Neurologist at Barton & Cochran Neurology in Boca Raton, FL. Call (561) 392-1818
J. Sanchez-Ramos, PhD, MD
Very rapid worsening suggests an atypical form of Parkinsonism or perhaps an intercurrent illness that has caused her to decompensate.I suggest you seek the advice of an expert on Parkinson Disease in Boca:Dr. Stuart Isaacson practices as a Neurologist at Barton & Cochran Neurology in Boca Raton, FL. Call (561) 392-1818
J. Sanchez-Ramos, PhD, MD
Tuesday, February 3, 2009
Common problem in PD: Constipation
"My biggest problem right now is constipation. Sometimes I don’t have a bowel movement for a whole week, and it is never easy. What do you recommend?”
This is one of the most frequent questions I am asked in my PD clinic and as editor of PD UPDATE, the PRF newsletter. Constipation is a very common problem among patients with PD. Most people as they age notice decreased frequency of bowel movements and greater difficulty with defecation. but in PD, the decreased motility of the gastrointestinal system can be very pronounced. Some medications with anti-cholinergic actions (such as trihexyphenydyl or Artane, benztropine or Cogentin) may produce or worsen constipation. Most other medications used in PD improve movement of the body but apparently have no beneficial effects on movement of the gut. In some forms of parkinsonism in which autonomic nervous system function is deficient (as in Shy Drager syndrome), patients require a lot of help in order to empty their bowels. In addition, difficulties with swallowing, urination and control of blood pressure often complicate the lives of patients with this form of parkinsonism. For most PD patients with mild to moderate constipation, a change in diet (grains, fresh vegetables and fruits) and plenty of water is recommended. Regular exercise, including walking is also useful for promoting bowel motility. For more troublesome cases of constipation the occasional use of laxatives may be indicated. Before patients begin self-medicating with many laxatives and enemas, it is worth consulting a gastroenterologist (specialist on the gastrointestinal system).
J. Sanchez-Ramos, PhD, MD
This is one of the most frequent questions I am asked in my PD clinic and as editor of PD UPDATE, the PRF newsletter. Constipation is a very common problem among patients with PD. Most people as they age notice decreased frequency of bowel movements and greater difficulty with defecation. but in PD, the decreased motility of the gastrointestinal system can be very pronounced. Some medications with anti-cholinergic actions (such as trihexyphenydyl or Artane, benztropine or Cogentin) may produce or worsen constipation. Most other medications used in PD improve movement of the body but apparently have no beneficial effects on movement of the gut. In some forms of parkinsonism in which autonomic nervous system function is deficient (as in Shy Drager syndrome), patients require a lot of help in order to empty their bowels. In addition, difficulties with swallowing, urination and control of blood pressure often complicate the lives of patients with this form of parkinsonism. For most PD patients with mild to moderate constipation, a change in diet (grains, fresh vegetables and fruits) and plenty of water is recommended. Regular exercise, including walking is also useful for promoting bowel motility. For more troublesome cases of constipation the occasional use of laxatives may be indicated. Before patients begin self-medicating with many laxatives and enemas, it is worth consulting a gastroenterologist (specialist on the gastrointestinal system).
J. Sanchez-Ramos, PhD, MD
Sunday, February 1, 2009
Visual Complaints by Patients with Parkinson's Disease
I've gotten many questions over the years about changes in vision that bother many PD patients. So I prepared a brief article discussing the visual changes common in this illness. We recently published the article in the newsletter "PD UPDATE".
Many patients with PD at some time or other notice that their vision is declinng. Of course this happens normally with aging, but there are some specific complaints that patients have that are more likely to occur during the course of Parkinson’s disease. Some patients may experience episodic blurring of vision and others may have transient double vision where objects are seen in duplicate, most often side by side. Some patients notice difficulty with reading either because they cannot focus on near objects or because they cannot scan the page easily. They may tire from reading much more easily than in the past. Patients may also develop problems driving, especially during twilight or at night. Each of these symptoms or complaints has an explanation in the context of the process of the illness. First of all, blurring of near vision when objects are brought close to the eyes is a normal process that occurs with aging due primarily to a decline in the ability of the lens to change shape automatically (“accommodate”) in the language of the ophthalmologist). However this can be terribly aggravated by certain medicines used to treat PD such as bentzropine (Cogentin) or trihexyphenidyl (Artane). Episodes of double vision usually are due to the asymmetric fatigue of the extraocular muscles of the eye. In normal vision, the eyes are ‘yoked’ to maintain conjugate gaze, like a pair of horses that are harnessed together and controlled by subtle adjustment of the reins. There are sets of muscles for each eye that are responsible for moving the eyes together as one unit, in perfect coordination. Since PD develops asymmetrically, the muscles on one side of the body may be more stiff and slow than the muscles on the other side. The eye muscles likewise are susceptible to the slowness and stiffness that affects other muscles in PD. So when muscles of one eye are slower or stiffer than the other eye, the result is double vision. When it is slight and long standing, the brain adjusts for it. But when the asymmetry in muscle stiffness is great enough there is definite double vision. This may be corrected by the anti-PD medication (levodopa), but as the medicines wear off, some patients may experience a transient double vision because the eyes are no longer yoked together, much as the chariot might veer to one side when one horse becomes more fatigued than the other or when the reins of one horse are pulled more tightly than the reins of the other horse. Difficulty in scanning a page while reading is similarly related to easy fatiguability of the eye muscles. Many times this is experienced as a transient fatigue and may be related to wearing off of levodopa effects. Problems with driving at night or during twilight hours is related to the difficulty with peripheral vision and discrimination of shades of grey. Although a PD patient may have normal acuity tested in the usual way and corrected with the appropriate lenses, he may still have difficulty discriminating shades of grey. This defect, measured by specific tests that assess “contrast-sensitivity”, is known to occur in PD patients. Loss of contrast sensitivity in PD patients has been related to the loss of dopamine neurons in the retina (the “visual receptor screen” at the back of the eye) which transduces light information into nervous signals to be interpreted by the brain as an image. Hence, contrast sensitivity can transiently improve with levodopa treatment. Finally there is a problem of higher visual processing that is more subtle. When specific neuropsychological tests of cognitive function were administered to many PD patients, it became evident that a significant proportion of patients scored poorly on problems that required perception of objects in three dimensional space and their relatonship to each other. It is not clear what the functional consequences of this deficit is in everyday life, but it would not be surprising to associate it with difficulties in driving a car.
To solve the problem of blurry vision it is important to make sure it is not related to the use of drugs like Artane or Cogentin. If double vision is a persistent problem, then a good exam by a neuro-ophthalmologist (a specialist of the visual nervous system) should be performed. The specialist may recommend special lenses with prisms to correct the double vision. The most important step a patient can take after seeing a good ophthalmologist and/or neurophthalmologist is to make sure the anti-PD medicines are properly adjusted since many of the visual complaints might improve with a better schedule of medication. And if a patient is prone to automobile accidents, the most prudent advice is to avoid driving.
Many patients with PD at some time or other notice that their vision is declinng. Of course this happens normally with aging, but there are some specific complaints that patients have that are more likely to occur during the course of Parkinson’s disease. Some patients may experience episodic blurring of vision and others may have transient double vision where objects are seen in duplicate, most often side by side. Some patients notice difficulty with reading either because they cannot focus on near objects or because they cannot scan the page easily. They may tire from reading much more easily than in the past. Patients may also develop problems driving, especially during twilight or at night. Each of these symptoms or complaints has an explanation in the context of the process of the illness. First of all, blurring of near vision when objects are brought close to the eyes is a normal process that occurs with aging due primarily to a decline in the ability of the lens to change shape automatically (“accommodate”) in the language of the ophthalmologist). However this can be terribly aggravated by certain medicines used to treat PD such as bentzropine (Cogentin) or trihexyphenidyl (Artane). Episodes of double vision usually are due to the asymmetric fatigue of the extraocular muscles of the eye. In normal vision, the eyes are ‘yoked’ to maintain conjugate gaze, like a pair of horses that are harnessed together and controlled by subtle adjustment of the reins. There are sets of muscles for each eye that are responsible for moving the eyes together as one unit, in perfect coordination. Since PD develops asymmetrically, the muscles on one side of the body may be more stiff and slow than the muscles on the other side. The eye muscles likewise are susceptible to the slowness and stiffness that affects other muscles in PD. So when muscles of one eye are slower or stiffer than the other eye, the result is double vision. When it is slight and long standing, the brain adjusts for it. But when the asymmetry in muscle stiffness is great enough there is definite double vision. This may be corrected by the anti-PD medication (levodopa), but as the medicines wear off, some patients may experience a transient double vision because the eyes are no longer yoked together, much as the chariot might veer to one side when one horse becomes more fatigued than the other or when the reins of one horse are pulled more tightly than the reins of the other horse. Difficulty in scanning a page while reading is similarly related to easy fatiguability of the eye muscles. Many times this is experienced as a transient fatigue and may be related to wearing off of levodopa effects. Problems with driving at night or during twilight hours is related to the difficulty with peripheral vision and discrimination of shades of grey. Although a PD patient may have normal acuity tested in the usual way and corrected with the appropriate lenses, he may still have difficulty discriminating shades of grey. This defect, measured by specific tests that assess “contrast-sensitivity”, is known to occur in PD patients. Loss of contrast sensitivity in PD patients has been related to the loss of dopamine neurons in the retina (the “visual receptor screen” at the back of the eye) which transduces light information into nervous signals to be interpreted by the brain as an image. Hence, contrast sensitivity can transiently improve with levodopa treatment. Finally there is a problem of higher visual processing that is more subtle. When specific neuropsychological tests of cognitive function were administered to many PD patients, it became evident that a significant proportion of patients scored poorly on problems that required perception of objects in three dimensional space and their relatonship to each other. It is not clear what the functional consequences of this deficit is in everyday life, but it would not be surprising to associate it with difficulties in driving a car.
To solve the problem of blurry vision it is important to make sure it is not related to the use of drugs like Artane or Cogentin. If double vision is a persistent problem, then a good exam by a neuro-ophthalmologist (a specialist of the visual nervous system) should be performed. The specialist may recommend special lenses with prisms to correct the double vision. The most important step a patient can take after seeing a good ophthalmologist and/or neurophthalmologist is to make sure the anti-PD medicines are properly adjusted since many of the visual complaints might improve with a better schedule of medication. And if a patient is prone to automobile accidents, the most prudent advice is to avoid driving.
Thursday, October 30, 2008
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