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Doctors' Answers to "Frequently Asked Questions" - Parkinson's Disease
Parkinson's Disease Treatment
Answer: No, you can stop it. As to the discomfort versus the sinemet, that is her value judgement.
Pramipexole / Mirapex for
Parkinson's Disease [posted 12/02/98]
Answer: Pramipexole is a drug used in Parkinson's Disease because of its partial agonist characteristics at the D2 receptor site. This class is used due to less extra-pyramidal effects.
Parkinson's Disease Treatment
Answer: I didn't hear the speech, so I'm not sure what he is referring to. I'd write the White House and ask for information, I'm sure they would be happy to supply it.
Parkinson's Disease - Fetal brain
Answer: This is a political problem. Probably when the right wing gets Parkinsons.
Depression and Parkinsons
Answer: Each class of antidepressants has certain typical side effects. Within each class there is usually variability in the side effects. Zoloft and Paxil are essentially in the same class of serotonin reuptake inhibitors. I would try a completely different class like Wellbutrin. Also, Serzone might be of use.
Parkinsons Disease - hip joint
Answer: Parkinson's Disease commonly affects one side of the body over the other. The question is whether the rigidity would be improved with extra medications vs. the side effects. Amantadine might be helpful with few side effects. Pardodel might also be, but will probably cause nausea. There are two or three new drugs coming out in Parkinsons Disease, which should be available in 4 to 6 months. However, I'm not sure of the side effect profile without using them.
"After 3 years of research, Virginia Commonwealth University physicians are optimistic that a new skin patch which secretes a steady stream of dopamine-line medication into the bloodstream could be used to treat Parkinsons Disease more effectively. Neurologist Vincent Calabrese points out that his study was small and results only preliminary and more testing is needed."
Answer: I would contact the physician at the VCU medical center. This has not been released yet, although it is promising. There will be two new treatments for Parkinsons disease due out this summer, which may make older drugs nearly obsolete.
Answer: The reason that some patients have more symptoms with time is that there are more nerve cells that die off. This is the primary reason that more medication is needed. However, if you think of the nerve cells that die off as being like a factory processing raw material(Sinemet) and turning out a product (Dopamine) then you can see that once the number of factories gets sufficiently reduced, and that simply giving it more Sinemet may not help. Also, there is the problem of receptor hypersensitivity, which means that the nerve cells that work with the dying population change to become more receptive to diminishing amounts of dopamine, and therefore, any slight or abrupt change in dopamine levels tends to produce a major change in these secondary nerve cells. This may, in part, lead to the "on - off" phenomenon. For these and other reasons, some neurologists tend to hold off using Sinemet until there are sufficient symptoms to warrant treatment. Also, there is a tendency to use other drugs, such as Parlodel or Permax, which act directly on these secondary nerve cells and do not rely on the pre-processing that is done by the cell population that is dying off. Therefore, it may be wise to hold off on using Sinemet until symptoms become bothersome. However, if you let the symptoms take over the patient's life, then this is not good either. It is also worth noting that some patients find that the first 6-18 months on Sinemet to be very gratifying and some have had sustained benefit from small doses of Sinemet, so I would not advise becoming overly afraid of Sinemet.
Answer: It is possible that your problems with 'nerves' could be a symptom of Parkinson's, but without knowing more about your case, medications and other medical history I would not feel comfortable excluding other possible problems. You should mention how you feel to your doctor and if you haven't seen your neurologist recently you should use this as a reason to make another appointment to discuss these symptoms.
Parkinson's Disease Information
Answer: I would suggest that you become knowledgeable about your condition and about the things you can do to improve your overall health. A good place to start is with the different Parkinson's Disease foundations that should be able to send you literature and supply you with reading lists:
1) American Parkinson Disease Assoc. 1250 Hylan Blvd. Staten Island, NY 10305 2) National Parkinson Foundation, Inc. 1501 NW 9th Ave., Rm. 4013 Miami, FL 33136 3) Parkinson's Action Network 818 College Ave., Suite C Santa Rosa, CA 95404 4) Parkinson's Disease Foundation 710 W. 168th St. NY, NY 10032 5) Parkinson's Support Groups of America 11376 Cherry Hill Rd., No. 204 Beltsville, MD 20705 6) Unite Parkinson Foundation and Internation Tremor Foundation 833 W. Washington Blvd. Chicago, IL 60607
Parkinson's- Life Expectancy and Quality Question: What is the life expectancy and quality of life for persons afflicted with Parkinson's Disease?
Answer: Parkinson's Disease, like many neurologic diseases, is a disease that is hard to predict. Its usual course is very gradual so that diagnosis is sometimes difficult because of the slow progression. Often it is only after treatment that the family and sometimes ones physician recognizes that the disease has been slowly progressing for several years. Some patients have rapid progression of the disease, other progress more slowly. Generally, the progression is slow. Treatment does not seem to affect the progression although this has been difficult to accurately test. The quality of life is usually affected by the difficulty with motor activity. Falling and difficulty performing usual daily activities usually frustrate the patient and family. About 10-15% of patients will experience dementia with Parkinson's and this will dramatically affect their life. However, most patients do not experience loss of mental ability.
Levodopa w/Carbidopa Eldepryl
Answer: Levodopa w/ carbidopa is Sinemet, and is perhaps the most frequently used medication in the treatment of Parkinson's disease. It does not cure the patient of the condition, but it can be very helpful in reducing the symptoms of stiffness, slowness of movement, and tremor. Eldepryl likewise is a very common medication used in the treatment of Parkinson's disease. It is used in hopes of preventing much progression of the disease though this assertion is still somewhat controversial. It has some minimal Sinemet-like action but is used not so much for what it can do for the patient, but rather for its potential to possibly slow down the process whereby nerve cells are dying. Any medication that one anticipates using must be checked for its appropriateness for the situation and whether it would interfere with any other medications that are already being used.
Parkinson's- Emotional Support
Answer: When I am trying to provide emotional support in my practice, I always focus on how I would prefer to be treated. First, I acknowledge that I cannot ever truly understand the feelings if I have not "walked in those shoes". This does not, however, prevent me from feeling empathy. Second, I try to validate any feelings that an individual has. This means accepting without criticism any feeling as OK and valid. This approach will commonly allow an entry into ones emotional side. The most common problem I see is a difficulty by most people to discuss their feelings. This can sometimes be addressed by starting conversations in the "I" mode. That is, a statement like "When I had my kidney transplant I felt very_______". This is an approach that often works for me in my practice.
Answer: The treatment of Parkinson's Disease has over the years had certain fads; drug holidays, high dose Parlodel. Currently there is much enthusiasm to avoid using Sinemet until it is absolutely necessary. Using Amantadine, Artane and Eldepryl represent ways of treating the Parkinson's patient without using Sinemet. The question that the patient must always answer for the physician is whether these methods work, and are you, the patient, satisfied with the level of treatment? While Sinemet is not good at treating tremor (as compared to the anti-cholinergic) it, nonetheless, has some ability to reduce tremor. Other options for the tremor patient is to explore other anti-cholinergic medications and to be examined to make sure that you have not developed an action tremor which is treated differently.
NADH Treatment and Parkinson's
Answer: Few literature citations are found in regards to this treatment. NADH is a co-enzyme found naturally in the body. There have been a flurry of reports of its benefits to Parkinson's patients when given intravenously. Of note, these reports seem to come from primarily the Birkmayer Institute for Parkinson's Therapy, Vienna, Austria. A report in 1994 from the Dept. of Neurology, University Hospital, Linkoping, Sweden, found no sustained benefit from this therapy. The reviewer had actually never heard of this therapy prior to researching this topic. I would consider this therapy is as of yet an unproven benefit.
Answer: Sinemet does nothing to arrest or slow the progression of Parkinson's Disease. In some patients, side-effects develop which appear to be either dose or time-related. These side-effects are usually difficult to treat. Consequently, most physicians delay the treatment of Parkinsons until the tremor is disabling. Once begun, the medication works within one to two days if at the correct dosage.
Answer: I am unaware of any FDA approved transdermal product for the tremor of Parkinson's. For that matter I have not heard of any transdermal product that has been used off of FDA approval for this condition. Send us more information such as a name (product or generic) or the manufacturer and we'd sure be happy to look into it.
Answer: The most exciting treatment in Parkinson's Disease is the use of
implantable stimulators in the brain. These send electrical signals to affected areas and
can "turn off" the tremor of Parkinson's Disease. It does not seem to affect the
rigidity and facial stiffness seen in the disease. New treatments are coming very rapidly
in this disease entity.
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