What It Feels Like: Deep Brain Stimulation For Parkinson’s Disease
The biggest challenge with Parkinson disease is we dont have a diagnostic test, says Dr. Lorraine Kalia, a neurologist at Toronto Western Hospital. I often describe diagnosis as a test of time. Were looking for symptoms, and also looking to see if the disease responds to medication and progresses as one would expect. It isnt uncommon that years pass before a neurologist may say theyre certain its Parkinsons.
Kalia says there is a wide spectrum when it comes to symptoms and each persons experience with the disease can be remarkably varied. In general, people diagnosed before the age of 40 and those with a tremor will have slower symptom progression. And while physical symptoms are certainly challenging, Kalia says roughly 80 per cent of people will develop dementia 10 to 20 years after being diagnosed with Parkinsons.
How Is The Diagnosis Made
Currently, diagnosis of Parkinson disease is based on clinical features from history and examination, and over time based on the response to dopamine agents and the development of motor fluctuations.30 Motor manifestations of the disorder begin asymmetrically, and commonly include a resting tremor, a soft voice , masked facies , small handwriting , stiffness , slowness of movements , shuffling steps and difficulties with balance. A classic symptom is resting tremor, usually affecting one upper limb, although 20% of patients do not have it 31 30% may first present with tremor in a lower extremity, and there may also be a lip, jaw or even tongue tremor at rest.31,46 Head and voice tremors are uncommon, and one should consider essential tremor in the differential diagnosis in such cases.31 Of all the major features, bradykinesia has the strongest correlation with the extent of dopamine deficiency.47 Diagnosis has been formalized by the criteria of the UK Parkinsons Disease Society Brain Bank,31 with diagnostic accuracy of up to 90% .48
– Levodopa response for five years or more
– Clinical course of 10 years or more
Choosing The Best Treatment Plan For You
As you may know, medications are the backbone of the Parkinsons treatment plan. But because the disease affects everyone differently, and each persons response to therapy will vary, there is no hard-and-fast rule about when you should begin taking medication and what to take first. Some doctors prescribe medication upon diagnosis. Others believe that drugs, especially levodopa, should be delayed as long as possible to avoid earlier onset of medication-related side effects.
Your involvement from the very start is important because you want to be sure your doctor is addressing your individual needs. When your doctor writes a new prescription, or makes a change to an existing one, take the opportunity to ask for an explanation. If her response goes something like, I always start my Parkinsons patients on X dosage of Y, a dopamine agonist, you might want to consider switching to a movement disorders specialist, a neurologist who has had special training in Parkinsons disease and other movement disorders.
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And Speaking Of Timely Parkinsons Disease Diagnosis
Turns out its not just selfies and videos that can help with diagnosing Parkinsons disease.
More and more, people are using speech-activated smart devices, such as Alexa, Apple Watch, and Google Voice Assistant, to accomplish everyday tasks. Could these devices analyze our speech and voices to alert us if we show early warning signs of Parkinsons disease?
Recent work by Rochester researchers suggests its entirely possible. Wasifur Rahman, Sangwu Lee, Md. Saiful Islam, and other students in Hoques lab published findings in the Journal of Medical Internet Research that show how an online tool can be used to help screen almost anyone anywhere for Parkinsons disease remotely using video- or audio-enabled speech tasks.
Taken together, the Rochester researchers efforts are contributing to a future in which equity and access to neurological care is as ubiquitous as owning a smart phone or other internet-enabled device.
Apda Develops Gold Standard Pd Training For Fitness Professionals
We all know exercise is important and has health benefits for people of all ages and abilities. But in the past several years, the importance of exercise and physical activity for people diagnosed with Parkinsons disease has exploded. Exercise produces many multi-system benefits including increased physical functioning , improved gait and balance, cardiovascular fitness, and overall better quality of life. As such, great strides are being made to make exercise a part of the standard treatment of PD.
To further this effort, in 2017, APDA convened a panel of PD and exercise experts that included neurologists, movement disorder specialists, and physical therapists, under the leadership of Terry Ellis, PT, PhD, NCS, Boston University and Lee Dibble, PT, PhD, ATC, University of Utah, to develop a gold standard of exercise recommendations for people with PD, and is proud to announce the launch of the online APDA Parkinsons Disease Training for Fitness Professionals. This one-of-a-kind program will train fitness professionals of all types so they may safely and effectively work with people with PD to develop exercise regimens that will support treatment of their symptoms and substantially improve their quality of life.
We are proud to have assembled such a prestigious panel of experts to develop this important program and were thankful for their contributions:
Terry Ellis, PT, PhD, NCS: Co-ChairBoston University
Lee Dibble, PT, PhD, ATC: Co-ChairThe University of Utah
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What Has Happened To Me
My quality of life was deteriorating due to my neurological issues. Along with poor fine motor skills on my left side and slowness of movement, I was constantly fatigued. This was a fatigue that no amount of quality sleep could ever satisfy. Additionally, I had internal tremors . I thought for sure there must be some kind of natural solution to help cure what ailed me one that did not involve prescription drugs.
My initial approach was to go to physical and occupational therapy and to continue my exercise regimen . This plan did not seem to slow disease progression or alleviate my symptoms. My depression and lack of motivation were also hindering me.
How The Levodopa Test Is Conducted
The levodopa test is given at least eight hours after the patients last dose of any medication to boost dopamine levels in the brain and usually takes place in the morning. Motor functions are analyzed before the test and again 60 to 90 minutes after taking levodopa using part 3 of the unified Parkinsons disease rating scale .
- Degree of difficulty while rising from a chair
- General posture
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Doctors Articles On Parkinsons Retracted
For more than 20 years, Dr. Martin C. Hinz has been an advocate and researcher in the use of nutritional products and urinalysis for people suffering from Parkinsons disease, depression and other maladies.
The 67-year-old Duluth native claimed in his most recent paper that the costly amino-acid treatments he says he invented work better than gold-standard therapy prescribed by neurology specialists.
But questions about that work have surfaced in recent months after the owner of Dove Medical Press, an academic publisher of peer-reviewed scientific and medical journals, retracted all six of Hinzs articles on Parkinsons. The six were among 20 papers on various diseases and lab techniques retracted because Hinz and his co-authors failed to produce raw data and medical ethics paperwork after not fully disclosing his and his familys business interests in sales of the costly pills.
It isnt the first time Hinzs theories and methods have drawn scrutiny and criticism.
In 2005 and 2011 he received warnings from the Food and Drug Administration for marketing untested nutrients as drugs. Last year, the Minnesota Board of Medical Practice reprimanded him for false advertising, unethical conduct and fee splitting. The board restored Hinzs Minnesota medical license to full standing in November after he paid a $7,188 civil penalty.
We treat nothing, Hinz wrote in an e-mail. We claim to treat nothing with nutrients.
Progress Toward Fda Approval
It will be a while yet, however, before Hoque and his researchers can start seeking permission to analyze peoples selfies, or even before neurologists can deploy the five-pronged test that the researchers have developed.
An algorithm will never be 100 percent accurate, Hoque says. What if it makes a mistake? We want to be very careful and follow guidance from the FDA if we want anybody from any part of the world to try this and get an assessment.
Moreover, there is a whole family of movement disorders that are closely related to Parkinsons disease, including ataxia, Huntingtons disease, progressive supranuclear palsy, and multiple dystrophy.
They all share similar symptoms of tremor, but the tremors are very different in nature, Hoque says. However, even expert neurologists find it very, very difficult to distinguish among them.
The researchers have made great progress in detecting Parkinsons disease by automatically analyzing expressions, voice and motor movements. Yet further work is needed to develop algorithms to differentiate how these involuntary tremors differ across other movement disorders, including Ataxia and Huntingtons.
We cant tell that just yet, Hoque says. But we are in a pursuit of differentiating those tremors using AI to prevent the potential harm of misdiagnosis while maximizing benefit.
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Rationale And Construct Of The Mds
In this view, in 2015 thead hoc MDS task force proposed new clinical diagnostic criteria for PD . These criteria were specifically designed for use in research, but they also might be adopted as a general guide to the clinical diagnosis of PD in a routine setting . Examination of all cardinal manifestations should be carried out as described in the MDS-Unified Parkinson Disease Rating Scale . In the MDS-PD criteria, the classical signs of the motor syndrome remain the core features of the disease. The essential criterion is the presence of parkinsonism, which is defined as bradykinesia, in combination with at least one between rest tremor and rigidity . However, many non-motor manifestations, often dominating the clinical presentation of the disease, have now been incorporated into the diagnostic criteria . Based on the assumption that the pathological process of PD may begin in non-dopaminergic structures of the brain or peripheral nervous system, a new diagnostic category has been configured, prodromal PD : prodromal PD is considered to represent a true initial stage of PD .
Gait & Balance Abnormalities
Parkinsons Disease Exam
Patients with Parkinsons disease can develop an alteration of the postural reflexes that causes instability in gait and balance control. Such alterations usually develop later in the course of the illness and are a major cause of disability, especially because of the high risk for falls that derives.
Using the exam to pick up postural instability is of the utmost importance for the management of patients with PD, since it will trigger either a medication adjustment or a physical therapy intervention both aimed at falls prevention.
We have three tests for this part of the PD exam:
1) Standing up from a chair
2) Free walking
3) Provoked pull test maneuver for balance
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Passive Manipulation Of Limbs
To test for the presence of rigidity, we need to passively manipulate the limbs of the patient. However, If the disease is in its early stage or the symptoms are well controlled with medications, we may not be able to see rigidity. We will need to use some activation maneuvers, that basically consist in performing repetitive movements with the limb contralateral to the one that is being tested.
Also, there are two types of rigidity:
– Lead-pipe rigidity: where the tone is uniformly and smoothly increased throughout the entire range of movement
– Cogwheel rigidity: where a tremor is superimposed on the hypertonia, making the movement irregular due to intermittent increase and reduction of tone
Upper Extremity Testing
For the upper extremity the most sensitive joint where to check for rigidity is the wrist. To uncover rigidity, passively rotate the wrist and feel for a resistance to the movement. It is very important that the arm of the patient is fully relaxed when rotating the wrist. To do this, place your proximal hand under the patients forearm, while your distal hand grabs and rotates the wrist of the patient. When rigidity is present, the range of motion will be preserved but you will feel a resistance in performing the movement.
Wrist rotation with activation maneuver.
It is also possible to test for rigidity in the elbow by passively flexing and extending the forearm.
Elbow flexion-extension with activation maneuver.
Lower Extremity Testing
Parkinsons Sufferers Offer Tips For Those Struggling With Symptoms
Despite Parkinsons Disease affecting around 1 million people in the US alone, the degenerative disease can be difficult to live with. We Have Parkinsons, one of the growing support and research groups in the US dedicated to helping those live with the disease, has offered those who may feel isolated and struggling with daily tasks tips for living with their illness.
The first port of call for sufferers is to ask for help. Many feel that seeking help is a sign of weakness, but as Parkinsons becomes more well-known, many individuals are much more informed and educated on the topic, meaning theyre often more sympathetic to those suffering.
Speaking about the illness, Jon Sherman, CEO, from We Have Parkinsons, said, Not long ago, not an awful lot was known about Parkinsons, but as treatments have developed, and more people with Parkinsons have spoken about their experiences, there is a growing awareness of the disease. As a result, friends, family and colleagues increasingly will know how to help those struggling. Therefore, anyone who may be struggling with new symptoms, or those whose quality of life is gradually deteriorating, will often find that asking loved ones and even strangers for help can be a huge support.
To find out more about We Have Parkinsons, and read the reviews of Restore Gold, the groups innovative product that has been easing Parkinsons symptoms, visit the website: wehaveparkinsons.com
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What Is Revive Tcm Gold
Revive TCM Gold is a natural libido enhancement formula and, like other enhancement supplements, also contain extracts of natural herbal medicine. It is said to be derived from Ancient Traditional Chinese Medicine and used as a treatment for decreased libido in both men and women. It also brings back the balance between body hormones that usually deteriorate as people grow older.
How Many People Are Affected By Parkinsons Disease
The Parkinsons Foundation reports that 60,000 Americans are diagnosed with PD annually, and the total number of diagnosed people is approaching one million nationally and ten million globally.
Also of note is the diseases affinity for men, who are affected at one and a half times the rate that women are.
Though researchers havent been able to find a cure, they use large-scale prevalence studies to determine who has the disease, where it is most concentrated, and how resources can be best distributed.
Depending on the precise area of the brain affected and the progression of the disease, PD sufferers can experience an entire spectrum of symptoms beyond movement issues.
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What Is The Prognosis
Life expectancy is decreased in Parkinson disease , and medical treatments do not appear to alter mortality or delay the onset of nonmotor symptoms.114 Although progression is slower in patients with early-onset disease and there is longer absolute survival, this comes at the expense of increased years of life lost .24,115 Late-onset Parkinson disease is associated with more rapid disease progression and cognitive decline,116 which may be related to a lack of compensatory strategies against cell death.24 Data on the long-term outcomes and in the older population are lacking.117
Prognostic factors are summarized in Table 4. Patients with early-onset disease were slower to reach stage IIIV on the Hoehn and Yahr scale119 . The distribution of Hoehn and Yahr staging according to disease duration is listed in Appendix 8b. In the Rotterdam Study, Parkinson disease was associated with an increased risk of dementia and increased risk of death . When dementia prevalence was controlled for, risk of mortality was only slightly higher than among the general population.120
I Cant Fight This Alone So Drugs Are An Option
In March 2016, I finally agreed to try Azilect , a prescription medication. Two weeks later, my symptoms had not improved and I felt worse . So, off that medication and on to the next one, ropinirole. This time, it only took a few hours on the medication for me to become extremely sick with vomiting and a pounding headache. I immediately discontinued that medication.
Both my neurologist and primary care physician thought I should focus on treating my depression symptoms with a prescription medication. In August 2016, I tried Viibyrd , an antidepressant. Within a few weeks, I was suffering from intense, gory nightmares every night with no improvement in my symptoms. At this point, I decided my PD symptoms may not be such a bad thing, and I refused to try any more medications.
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Brief Survey Among Movement Disorder Experts
Figure 1. Schematic representation of the three questions posed to the movement disorder experts during the brief survey.
Figure 2. Schematic representation of the senior movement disorder experts answers to the three questions of the brief survey. Legend: Y, yes N, no NA, not available.
This informal brief survey provides current simple information about real-life differences in the approach to the clinical diagnosis of PD among clinicians. Possible limitations of the here reported international audit consist the restricted number of participants and that only experts not directly involved in the production of the criteria have been interviewed, configuring a possible negative bias. In summary, we suggest that the diffusion of the new criteria should be better implemented not only among general neurologists, but also among movement disorders specialists. Although the revised MDS-PD criteria have been published since 2015, many colleagues do not apply these criteria in routine clinical practice because of scarce knowledge and probably also for some prejudices.