Parkinson’s Surgery: Pallidotomy And Thalamotomy
Another type of surgery used when symptoms are poorly responsive to medications is brain surgery that either removes or destroys brain tissue. The techniques are termed pallidotomy and subthalamotomy. The techniques usually involve radiofrequency to destroy small areas of brain tissue. Some patient’s symptoms can be reduced by these techniques but they do not reduce all symptoms and some patients suffer complications when brain tissue is irreversibly destroyed. Deep brain stimulation is replacing these treatments.
Therapy For Masked Facies
Facial expression matters. Research has shown that quality of life is better in persons with Parkinson’s who have undergone therapy to improve facial control than those who have not. It typically demands an intensive, therapist-guided program which would initially focus on broader facial movements, such as lifting the eyebrows, stretching the mouth, or puckering the face.
One technique called the Lee Silverman voice treatment is used by some to help people with Parkinson’s speak louder and clearer. It employs articulation exercises that are similar to stage acting techniques in which a person is taught to projects and enact “speaking behavior” by:
- Looking a person directly in the face
- Keeping the chin up
Challenges Of The Mask
Interaction with others is a mixture of verbal and nonverbal communication, and facial expressions play a large role in the nonverbal communication, displaying our emotions and interest. When PD affects the facial muscles, causing a mask-like expression, many of the nonverbal cues are not present, which may lead to challenges communicating with others and negatively impact relationships. The relationships most often affected are those with family and friends, as well as relationships with healthcare providers. The emotion behind the words may be further compromised by a monotone voice, another symptom that makes it difficult for a person with PD to vary the tone of their voice.3,4
Research into the facial masking that occurs with PD has found that people with PD have less facial masking when responding to positive questions and more facial masking is seen when patients respond to negative questions. Unfortunately, most healthcare appointments focus on problems, which may lead to more missed cues in relationships between people with PD and their healthcare providers.4
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A Note For Caregivers
Caregivers can be challenged by the increasing needs of a declining Parkinson’s patient. It is important that caregivers have a good concept of this progressive disease. Support groups are available to help caregivers understand the disease process and how to cope with the various problems they face in caring for a Parkinson’s disease patient.
Additional Information on Parkinson’s Disease
For more information about Parkinson’s Disease, please consider the following:
Adjusting My Medication Regime Really Helped
I was having problems physically expressing my emotions, but my mental health issues continued to affect me too. So not only could I not move my facial muscles easily, but the feelings of motivation, enjoyment and enthusiasm all seemed to have waned and diminished within me.
After I was prescribed the right medication, friends and family said I looked much happier, and that I was smiling and laughing more. Adjusting my medication regime really helped.
He says: I went to the Parkinsons UK Members Day. It was truly inspiring. It made me feel more positive, and I realised just how much help is available. Im learning to cope with my condition and Im grateful to have excellent support from my wife, family and friends. I now realise that most things in life are never as bad as they first appear.
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Living With Parkinson’s Disease
Parkinson’s disease, especially in the more advanced patients, often requires an adjustment in lifestyle. As symptoms progress, anxiety and depression are often experienced by the patient . Items in the home such as throw rugs, electrical cords, and slippery tile may need to be removed to reduce the risk of falls. Bathroom modifications such as handles or grab bars may be needed. The diet might need modification if swallowing or constipation becomes a problem. An occupational and speech therapist may help with other problems.
The Parkinson’s Patient Can Reportedly Be Identified If He Has Unconsiderable Facial Expressions Like Frowning Or Smiling And May Even Appear Depressed Or Angry
Parkinsons disease has checked the list of diseases that are being taken seriously by the medical fraternity. It is an illness that affects the brain parts, making them impaired eventually and also attacks the nervous system resulting in tremors. Among many symptoms that are considered signs of the illness, a new symptom called masked face is also being considered as a tracker of Parkinsons in people.
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Less Animated By Things
Its these feelings of apathy and a lack of motivation which characterise Marks Parkinsons. In fact, his wife Chrissie noticed these symptoms before he was diagnosed, commenting that Mark seemed less animated by things.
At the same time that Mark was experiencing issues, he was also having trouble with his facial muscles.
I remember going with Chrissie to her appointment when she was diagnosed with breast cancer. Afterwards, she said I appeared unmoved by it all. I couldnt understand it.
Friends and family also commented that Mark looked flat and sad. Eventually, he realised his reduced facial muscles were causing him to experience a Parkinsons mask, which meant he was less able to express himself.
Does Parkinsons Affect Voice
The voice is affected too, because the voice box is ultimately controlled by the basal ganglia as well. Thus the voice becomes soft, slurred and hushed. Others may comment that the patient is mumbling. The mumbling goes away temporarily once the patient becomes aware of it but soon returns to the soft, slurred state.
This temporary improvement when attention is paid is true of many of the motor symptoms of PD because the condition primarily affects subconscious movements, and does not directly affect nerve or muscle control at the most basic level. Thus, conscious awareness can override the slowness to a certain extent. This fact is one reason why physical therapy and physical activity are so useful and necessary in treating PD.
- Slowness of walking and other movements
- Trouble with dexterity
- Reduced arm swing or stride length
- Delayed reactions physically
- Reduced facial reactions
- Softer or slurred speech
- Tremor in one or both limbs with the limb at rest
- Sometimes also tremor with holding a posture or with actions
- Usually asymmetric
Imbalance, loss of balance reflexes
- May fall backwards
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Financial Disclosures Of The Previous 12months
Dr. Carolina Soares, Dr. Diogo Reis Carneiro, Dr. Rafael Dias, Dr. Daniel Ferreira, Dr. Mário Sousa, and Dr. Ana Oliveira have no disclosures. Dr. João Massano has received speaking fees from Bial, Boston Scientific, GE Healthcare, and Novartis and consulting fees from AbbVie, Bial, Merck Sharp & Dohme, and Zambon. Dr. Ana Morgadinho and Dr. Maria José Rosas have no disclosures. Dr. Rui Araújo has received speaking fees from BIAL and consulting fees from Roche.
What Is A Parkinsons Mask
We caught up with Parkinsons nurse Linda, from the Parkinsons UK helpline, to find out more about a Parkinsons mask.
In people with Parkinsons, a lack of dopamine in the brain can stop your facial muscles working as well as they used to.
- When this happens, people with the condition can look like they have a blank expression, even if they are actually experiencing a strong emotion. The medical term is hypomimia.
- Having a Parkinsons mask is a common symptom. But this doesnt mean someone with the condition is feeling low or depressed they just cant use their facial muscles to express themselves as easily anymore.
- However, many people with Parkinsons also report issues like apathy and problems with motivation, meaning they may not respond to emotions like they used to.
- It may seem like there is a link in some cases, but it may be two common aspects of Parkinsons, happening at the same time.
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How Does Parkinsons Affect The Face
Everyday tasks such as getting dressed, writing, picking something up off the floor take twice as long as they used to. Some people describe the feeling of slowness and stiffness as walking through molasses or moving in slow-motion. Because subconscious muscle movements of the face are responsible for ones facial expressions and others interpretation of our mood, patients can be thought to be upset or depressed when they are not. This is known as having a masked face.
I Wont Lie There Are Many Down Times But I Have A Choice Do Nothing And Achieve Nothing Or Battle On I Chose The Battle
Does it hinder your creativity?
It makes all the other things that I did, apart from photography, a chore and no longer a means of relaxation. I love drawing but it is so slow and I need to concentrate so hard that the sheer joy of flowing strokes becomes a battle.
How has it affected you outlook on life?
I wont lie, there are many down times but I have a choice do nothing and achieve nothing, or battle on I chose the battle.
Explain the concept behind your Concrete project. Why did you decide to do it?
Since I picked up the camera again, I would occasionally ask my subject if they wouldnt mind placing their face in water and looking at the camera. I just liked the effect. Then early last year it dawned on me, I was making people cry because I wouldnt, couldnt, real men dont cry! So then I thought why not do something with the images to raise awareness of Parkinsons disease. I call it Concrete after a little poem that I wrote.
The photos are incredibly stark representations how did you get the reactions out of your subjects for each emotion?
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What Is Parkinsons Disease
Parkinsons disease is a progressive disorder affecting the central nervous system. The symptoms of Parkinsons disease are caused by a loss of dopamine producing nerve cells in the substantia nigra part of the brain.
Once these cells start dying, dopamine levels begin to fall and the nerve cells in the brain lose their ability to send messages instructing the muscles to work properly.
The loss of muscle function is a slow and gradual process. Different parts of the body can be affected by the progressive deterioration caused by Parkinsons disease and some people find that one side of the body is affected more than the other.
Facial masking in Parkinsons occurs when the disease affects the nerves connected to our facial muscles, and over time, nerve signals are unable to reach the muscles and they cease functioning.
Nowadays I Always Wear 2 Masks
I received an email yesterday from my mother-in-law. It had been forwarded to her from a friend of hers. It was missing the attachment, so I dont know what the email said apart from the five words found in the subject line. They read: Why I wear two masks.
It intrigued me and made me think about those of us with Parkinsons disease who already wear two masks every day.
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What Does Masked Face Mean
Hypomimia is a common symptom of Parkinsons disease. Its included in the Unified Parkinsons Disease Rating Scale as a characteristic that can range from slight to severe.
The face contains 42 individual muscles. These muscles are used, often unconsciously, to display happiness, sadness, confusion, contentment, and many other emotional states.
If you have Parkinsons masked face, your facial motor control isnt working as they usually would. This causes a disconnect between what youre thinking, saying, or feeling with how your face appears to others.
A person with Parkinsons masked face may seem uninterested or uncaring, even when the opposite is true. They may also look angry, sad, or completely free of emotion.
Parkinsons disease can also affect the movements that control your voice, giving you a flat, low monotone. This together with masked face can make it hard to communicate what youre feeling and thinking.
Parkinsons disease affects the brain cells that make dopamine. Dopamine helps control muscle movements, and without enough dopamine, the regulation of movement is impaired. This affects the face as well as other movements throughout the body.
Parkinsons disease can affect the facial movements in several important ways by causing:
Join The Parkinsons Forums: An Online Community For People With Parkinsons Disease And Their Caregivers
Does your loved one seem to be dragging one of their feet when they walk? Are they shuffling slightly? Has one of their arms lost its swing when they walk? Do they seem stiff in their movements? You have an objective perspective and may notice these things sooner.
No one who is happy or joyful likes to be asked, Whats wrong with you? That can happen with an early sign of PD known as the masked face. Why masked face? Because the facial muscles have tightened and people with PD have a harder time smiling or showing emotion.
Another symptom that I struggle with is my voice getting softer, making it hard for others to hear me. I had a soft voice to begin with, and when it got softer it made it more difficult to converse. Speech and vocal exercises can be done to strengthen the vocal cords if the problem is due to PD.
If you think someone you know might have early signs of PD, you might want to approach them as if they hadnt noticed their symptoms. For example, dont stare at them when they are shaking and ask, Do I make you nervous? Ask them if theyve noticed that their hand shakes slightly. If they bring it to your attention, encourage them to have it checked out. If they are concerned and you act like its nothing, especially when you notice it, coupled with other signs related to early PD, they will feel silly and may think they are imagining things.
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Treatment: Drugs That Make Dopamine
Parkinson’s affects nerve cells in your brain that make a chemical called dopamine. As a result, levels of the chemical fall. Doctors usually start treatment with levodopa . Your brain turns it into dopamine. But it can make you sick to your stomach, so youâll probably take it with another medicine called carbidopa to control these side effects. The combination drug is called carbidopa-levodopa .
When Might You Have Masked Face With Parkinsons
Parkinsons disease is a chronic, progressive condition. There are five different stages of Parkinsons when certain symptoms may appear or worsen. Masked face can manifest as an early symptom in stage 1.
Masked face severity can progress and worsen as Parkinsons takes hold. According to the Unified Parkinsons Disease Rating Scale, masked face symptoms are categorized from slight to severe. Each masked face stage includes the symptoms of the previous stages, plus new ones. Here is a breakdown of each stage:
- Slight. In this stage, you may blink less often than usual.
- Mild. This stage includes minimal masked facies and less movement in the lower face, including mouth movements and spontaneous smiling. People with mild hypomimia still have the ability to keep their lips closed.
- Moderate. The moderate stage has an increase in masked facies. The lips are held in a parted position for some of the time when the mouth is at rest.
- Severe. Theres an increase in masked facies, and the lips are parted most of the time when the mouth is at rest.
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Can Symptoms Be Prevented
Currently, there is nothing that can prevent symptoms of Parkinson’s disease although treatment can reduce symptoms. Statistically, people who drink coffee and smokers have a lower incidence of Parkinson’s disease, but they may develop other problems due to these habits . Since researchers speculate that about 90% of Parkinson’s disease is due to a combination of genetic and environmental causes, avoiding certain environmental triggers may prevent some individuals from developing the disease. In addition, researchers are trying to find medications or supplements that can protect the brain cells that produce dopamine.
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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Sometimes He Cannot Even Eat But Other Times He Can Do Anything Hes Almost Like Superman And Clark Kent Tommy 47
Why did you decide to embark on the photography project?
The idea is to give the image of Parkinsons disease a total makeover. There is huge potential for better and more powerful storytelling within the Parkinsons community. In medical textbooks, as well as in the media, people with Parkinsons are traditionally depicted as tiptoeing, shaking and stooping seniors with whispering voices and a staring glare, imparting the impression of an apathetic or asocial person who lacks empathy and is uninterested in taking part in normal social interplay. This image is of no help to the patient as it fosters prejudice.
How does your exhibition challenge the stereotype?
This exhibition showcases proud people with their emotions and abilities, including self-respect and humour, intact. They are different from each other just like everyone else. Some have little children. They are young. They are vulnerable. They have dreams. They want action and they are willing to contribute.