Parkinson’s Disease And Vertigo

How Is Parkinsons Disease Diagnosed

Diagnosing Parkinsons disease is sometimes difficult, since early symptoms can mimic other disorders and there are no specific blood or other laboratory tests to diagnose the disease. Imaging tests, such as CT or MRI scans, may be used to rule out other disorders that cause similar symptoms.

To diagnose Parkinsons disease, you will be asked about your medical history and family history of neurologic disorders as well as your current symptoms, medications and possible exposure to toxins. Your doctor will look for signs of tremor and muscle rigidity, watch you walk, check your posture and coordination and look for slowness of movement.

If you think you may have Parkinsons disease, you should probably see a neurologist, preferably a movement disorders-trained neurologist. The treatment decisions made early in the illness can affect the long-term success of the treatment.

What Are The Primary Motor Symptoms Of Parkinsons Disease

There are four primary motor symptoms of Parkinsons disease: tremor, rigidity, bradykinesia and postural instability . Observing two or more of these symptoms is the main way that physicians diagnose Parkinsons.

It is important to know that not all of these symptoms must be present for a diagnosis of Parkinsons disease to be considered. In fact, younger people may only notice one or two of these motor symptoms, especially in the early stages of the disease. Not everyone with Parkinsons disease has a tremor, nor is a tremor proof of Parkinsons. If you suspect Parkinsons, see a neurologist or movement disorders specialist.

Tremors

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An Overlooked Condition That Reduces Blood Flow To The Brain

An often-overlooked condition that can lead to a reduced amount of blood flow to the brain is a misalignment of the C1 vertebra . When the cervical spine is misaligned, the vertebral arteries that facilitate blood flow to the brain may be hindered from doing their job properly. As a result, various conditions can occur including things like dizziness and even migraines. Even blood pressure problems have been linked to upper cervical misalignments.

How can this misalignment be corrected, and what effect may this have on dizziness?

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Invest In Adaptive Kitchen Tools

Its hard to lift food from the plate to your mouth if your hand is shaking. In the beginning, tremors only happen when a person is at rest, says Dr. Savica. As the disease progresses, though, the tremors can be all the time. To help with mealtime tremors, check out weighted utensils or utensils with a stabilizing handle. Plate guards like this one can be attached to any plate to make scooping food onto a utensil easier. Keep plates and bowls securely on the table by putting pieces of Dycem, a non-slip material that can be cut to size, underneath them.

Parkinson’s Disease Pathology In The Central Vestibular System

Seidel et al. conducted a pathological study of -synuclein, which forms Lewy bodies, in the hindbrains of 5 PD patients, 1 patient with Parkinson’s Disease with dementia and 5 with dementia with Lewy bodies. In all cases they found Lewy bodies and Lewy neurites in the substantia nigra, ventral tegmental area, pedunculopontine tegmental nucleus, raphe nuclei, periaqueductal gray, locus coeruleus, parabrachial nuclei, reticular formation, dorsal motor vagal and solitary nuclei, in addition to the vestibular nucleus complex, prepositus hypoglossi, and even the root of the vestibular nerve. The subnuclei of the vestibular nucleus complex included the medial vestibular nucleus, superior vestibular nucleus and the lateral vestibular nucleus. These results suggest very strongly that the neuropathology of PD extends into the central vestibular system and is therefore likely to undermine at least some of the vestibular reflexes, as well as autonomic, limbic system and cortical projections carrying vestibular information.

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Constipation And Parkinsons Disease

Constipation is one of the most commonly reported GI symptoms of Parkinsons disease, affecting 60-80% of patients.17,18 Constipation occurs when movement of material through the GI system slows down. This slowing can result from the direct effects of Parkinsons disease upon the action of intestinal muscles that would normally act to massage material through the intestines in a wave-like action , or indirectly through side-effects of some medications.19 In severe cases, accounting for approximately 7% of those with a parkinsonism, compromised peristalsis can lead to complete gut blockage resulting in further symptoms such as cramping, abdominal pain, vomiting, and bloating.16

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Common Causes Of Dizziness And Vertigo In Parkinsons And How To Treat Them:

In people with early Parkinsons disease , the dizziness has in many cases linked to a lower Montreal Cognitive Assessment score raising the possibility that dizziness may be a non-movement symptom associated with cognitive decline .

Dizziness or vertigo can be tied to many causes and is not unique to Parkinsons. Symptoms can be caused by medications, low blood pressure, anxiety, cold, flu, dehydration, heart conditions and more. Tell your doctor immediately if you regularly experience dizziness or vertigo.

Page reviewed by Dr. Michael S. Okun, Parkinsons Foundation Medical Director, Professor and Chair, Department of Neurology, Executive Director of the Fixel Institute for Neurological Diseases a Parkinsons Foundation Center of Excellence.

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Pd Community Blogread Blog

How can I prevent dizziness?

Tuesday September 04, 2012

Dizziness can have multiple causes in Parkinsons. Most common, is low blood pressure, specifically a drop in blood pressure with standing a condition caused orthostatic hypotension. People of use the term dizziness to describe many different problems. The term dizziness is also used to describe a sense of imbalance when standing or walking, vertigo or sense of motion caused by inner ear or vestibular problems and a lack of mental clarity.

Low blood pressure can cause dizziness, passing out, fatigue, walking problems, and thinking problems.

Dizziness due to orthostatic hypotension can be treated. Most of these treatments work by increasing the volume of blood in your circulatory system, increasing blood pressure and optimizing heart function.

Monique L. Giroux, MD

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Walking And Staying Balanced

• People with Parkinsons can be more likely to experience issues with balance. You may also experience freezing, where your feet feel glued to the floor.

• If you notice issues with balance and freezing, see a physiotherapist for an assessment so they can advise you on improving your mobility.

• Be careful when reaching above your head or below your knees as this is when you can become unsteady.

• When you are walking, try not to turn too quickly or pivot on the spot. Marching your feet around in the direction you need to turn can help.

• Getting into a rhythm when you walk can help you take bigger, more focused strides. You could count each step or walk to a particular tune in your head, for example.

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When Is Orthostatic Hypotension Treated

Not all forms of orthostatic hypotension require treatment. If you experience a drop in blood pressure when you stand up, but have no other symptoms you probably wont need treatment. Sometimes all it takes is sitting on the edge of the bed for a minute or steadying yourself for a moment after you stand up. But, if you feel dizzy or lightheaded to the point where you might lose your balance or lose consciousness, you will need treatment.

Because some drugs can cause severe orthostatic hypotension, your doctor may first try reducing some of your medicine or may switch you to another type of medicine. If you have significant symptoms of orthostatic hypotension, and it is not possible to change your medications, then your doctor will likely treat the orthostatic hypotension itself.

What Are The Different Stages Of Parkinsons Disease

Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.

In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:

Early stage

Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.

Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.

Mid stage

Mid-late stage

Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.

Advanced stage

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How Parkinsons Disease Affects The Autonomic Nervous System And The Heart

In PD, there are two major reasons why the automatic control of the cardiac system is impaired. First, areas of the brain that control this system often contain Lewy bodies and have undergone neurodegeneration. In addition, the autonomic nervous system itself is directly affected by Lewy body-like accumulations and neurodegeneration. This means, when the baroreceptors in the heart and carotid artery sense a drop in blood pressure and try to generate a signal to the heart and blood vessels to increase the blood pressure, the message may not get through. This results in neurogenic orthostatic hypotension , or drops in blood pressure upon standing due to autonomic nervous system dysfunction. There are no medications that can cure nOH by restoring the autonomic nervous system in PD. nOH however, can be treated. Read more about nOH and its treatments here.

Structural problems of the heart such as coronary artery disease or cardiomyopathy are not thought to be part of the pathology of PD, although of course, could co-exist with PD.

Late Complications Of Parkinsons Disease

Patients with PD respond to levodopa almost immediately. However, 20 to 50% of patients will develop motor fluctuations or dyskinesias within 5 years of starting levodopa therapy. Response fluctuations consist of a mixture of wearing-off phenomenon, on dyskinesias , Diphasic dyskinesias , and off dystonia .

Wearing off can be managed by decreasing the dosing interval, switching to a longer acting product, or by adding or increasing the dose of dopamine agonist. On-off effects are harder to manage. The addition of a direct dopamine agonist or switching to a slow acting dopamine preparation may reduce the frequency of dyskinesias and on/off events. Pramipexole, as initial therapy compared to levodopa, reduces the risk of developing complications by about 55%, but it is not as effective as Levodopa and has some adverse affects . COMT inhibitors may smooth smooth out the peaks/troughs of dopamine and reduce fluctuation.

Psychiatric adverse effects include psychosis, confusion, agitation, hallucinations and delusions. These can be treated by decreasing dopamine medication, reducing or discontinuing anticholinergics, amantadine or selegiline, or by using clozipine at doses of 6.25 to 50 mg/d .

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Dizziness And Nausea Vomitting Induced By Ropinirole Therapy In An Elderly Patient With Parkinsons Disease : A Case Report

Emilia Sidharta, Hanny Cahyadi

Abstract

Background: Ropinirole is a non-ergoline dopamine agonist drug that is widely used in a therapy for patients diagnosed with Parkinsons disease. In long-term use, several published studies have mentioned the occurrence of side effects of ropinirole in the therapy of Parkinsons disease, but there has been no case report on the occurrence of side effects in the form of dizziness and nausea-vomiting, especially in Indonesia.

Analysis using Naranjo Scale shows a score of 6 which indicates a probable association between dizziness, nausea-vomiting and ropinirole in an elderly patient with Parkinsons Disease.

Keywords: ropinirole, Parkinson, case report, elderly, side-effects

Full Text:

Dizziness Vs Vertigo Vs Lightheadness Vs Imbalance

Dizziness is symptom that can be very specific or very hard to describe. For medical professionals, dizziness is the general term that refers to everything from a spinning sensation to a foggy head to losing your balance when you walk.

We can define dizziness more specifically in these following ways:

VertigoThis is the sensation of motion that should not be there. Its usually described as a feeling that youre spinning or that the room is spinning, or can be felt like youre being pulled in a specific direction.

Central instability at restThis is the sensation of rocking or swaying when youre still

LightheadednessThis is a vague sensation commonly described as having a floating head or feeling ungrounded. Its usually persistent, and can often comes with anxiety, being overheated or feeling as if youre about to faint.

ImbalanceThis is the loss of stability that occurs when you change position quickly or while you are walking.

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What Causes A Greater Risk Of Falling

While thinking about falling and balance problems, we usually have in mind an older person. While seniors are indeed most commonly treated for fall and balance problems, conditions such as dizziness, vertigo, and other vestibular issues often affect a younger audience. More and more young people are referred to physical therapy clinics for vestibular treatment and balance improvement programs because of complaints of inner ear disorders.

Still, elderly people are more prone to experience ailments such as dizziness and lack of balance than a younger generation. They also may develop long-term conditions that impact their gait and balance as well as, as time progresses, make it more difficult to exercise or even move. Therefore, they tend to stay more indoors which results in muscle weakening and joints issues. With lower exposure to sunshine, the vitamin D level slowly diminishes, increasing the risk of bones frail. Also, environmental factors such as poor lighting, clutter, loose carpets, and slick floors can jeopardize a seniors safety in their home. Activities with a high risk associated with them, for example climbing on a chair to get an object from a high shelf, are also mentioned as one of the most common reasons for falling.

RISK FACTORS FOR FALLS

Many medical conditions can affect balance and increase the risk of falling.

PARKINSONS DISEASE AND FALLING

FALL PREVENTION AND BALANCE PROGRAM

What Are The Symptoms Of Parkinsons Disease

Symptoms of Parkinsons disease and the rate of decline vary widely from person to person. The most common symptoms include:

Other symptoms include:

• Speech/vocal changes: Speech may be quick, become slurred or be soft in tone. You may hesitate before speaking. The pitch of your voice may become unchanged .
• Handwriting changes: You handwriting may become smaller and more difficult to read.
• Depression and anxiety.

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Late Complications Of Parkinson’s Disease

Patients with PD respond to levodopa almost immediately. However, 20 to 50% of patients will develop motor fluctuations or dyskinesias within 5 years of starting levodopa therapy. Response fluctuations consist of a mixture of “wearing-off” phenomenon, “on” dyskinesias , “Diphasic dyskinesias” , and “off” dystonia .

Wearing off can be managed by decreasing the dosing interval, switching to a longer acting product, or by adding or increasing the dose of dopamine agonist. On-off effects are harder to manage. The addition of a direct dopamine agonist or switching to a slow acting dopamine preparation may reduce the frequency of dyskinesias and on/off events. Pramipexole, as initial therapy compared to levodopa, reduces the risk of developing complications by about 55%, but it is not as effective as Levodopa and has some adverse affects . COMT inhibitors may smooth smooth out the peaks/troughs of dopamine and reduce fluctuation.

Psychiatric adverse effects include psychosis, confusion, agitation, hallucinations and delusions. These can be treated by decreasing dopamine medication, reducing or discontinuing anticholinergics, amantadine or selegiline, or by using clozipine at doses of 6.25 to 50 mg/d .

What Is Mnires Disease

Ménières disease is a disorder of the inner ear that causes severe dizziness , ringing in the ears , hearing loss, and a feeling of fullness or congestion in the ear. Ménières disease usually affects only one ear.

Attacks of dizziness may come on suddenly or after a short period of tinnitus or muffled hearing. Some people will have single attacks of dizziness separated by long periods of time. Others may experience many attacks closer together over a number of days. Some people with Ménières disease have vertigo so extreme that they lose their balance and fall. These episodes are called drop attacks.Ménières disease can develop at any age, but it is more likely to happen to adults between 40 and 60 years of age. The National Institute on Deafness and Other Communication Disorders estimates that approximately 615,000 individuals in the United States are currently diagnosed with Ménières disease and that 45,500 cases are newly diagnosed each year.

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Adjust Your Drug Dose

Side effects like dyskinesia might be due to the amount of levodopa youre taking. Ask your doctor whether you can lower your dose enough to prevent side effects while still managing your Parkinsons symptoms. It might take some trial and error to get the dose just right.

Another option is to switch to an extended-release form of dopamine. Because the drug releases more slowly into your blood, it prevents the dopamine spikes and valleys that can trigger dyskinesia.

You might also need to add more of a drug. For example, adding extra carbidopa to levodopa can cut down on nausea.

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