Neurology At The Gw Medical Faculty Associates
As a division of The GW Medical Faculty Associates Department of Neurology, we work closely with our respected colleagues in the Department of Neurosurgery to offer comprehensive functional neurosurgical treatment. Our deep brain stimulation program, run by a specialty-trained neurosurgeon and neurologist team, includes pre-operative planning, intra-operative monitoring, and long-term programming for patients with advanced Parkinsons disease, tremors, and other diagnoses.
Animal Toxicology And/or Pharmacology
Single- and repeated-dose intravenous toxicity studies have been performed using ioflupane in rats, rabbits, and dogs. Additionally, single-dose acute toxicity studies have been performed in cynomolgus monkeys. No mortality or other toxicity was observed at doses up to 5,500 times the maximum clinical dose of DaTscan at doses greater than 1,500 times the maximum clinical dose, pharmacological responses such as mydriasis and hyperactivity were seen in some species.
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Diagnosis Of Parkinsons Via Datscan And Clinical Exam Are Similarly Accurate
Despite the DaTscan being available to help diagnose Parkinsons, in most clinical situations, a DaTscan will not add information to what can be gleaned from the clinical exam. One study actually demonstrated that the accuracy of diagnosis in early PD was the same whether the diagnosis was reached using clinical exam or using DaTscan.
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Genetic Testing For Parkinsons Disease
Similar to other complex diseases, the reason a particular person develops Parkinsons disease is likely a combination of genetic makeup and environment. In most people, the genetic contribution to disease development may be due to a number of different genes and the interactions between them. For only a very small percentage of people with PD, about 10%, the disease can be attributed to a single abnormal gene. Figuring out the identity and contributions of all the different genes that play a role in disease development is a very hot topic in PD research today.
What Is The Prognosis For Parkinsons Disease
The rate at which Parkinsons progresses varies from patient to patient. Some patients experience its changes over 20 years or more. While others find the disease advances quicker.
Parkinsons is not a fatal disease. However, secondary complications from symptoms may increase falls, blood clots or pneumonia, which can be life-threatening. These are more common in later stages of Parkinsons.
In general, the average life expectancy of Parkinson’s patients is similar to people without the disease.
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Push And Release Test Predicts Better Parkinson Fallers And Nonfallers Than The Pull Test: Comparison In Off And On Medication States
2nd Department of Neurology, School of Medicine, Comenius University, Bratislava, Slovak Republic
Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
2nd Department of Neurology, School of Medicine, Comenius University, Bratislava, Slovak Republic
Institute of Normal and Pathological Physiology, Slovak Academy of Sciences, Bratislava, Slovak Republic
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Driveable Cognitive Assessment Tool
Is an in-office assessment of cognitive abilities essential for safe driving. This includes tests of motor speed and control, attention, judgment, memory and decision-making, and making judgments of driving situations.
The DCAT measures only the specific cognitive functions needed for safe driving. It does not measure a persons overall cognitive functioning or intelligence.
No knowledge of computers or their applications are needed an individual only needs to touch the screen and press a button to complete the tasks. A mouse and a keyboard are never used.
A trained healthcare professional, typically an occupational therapist or kinesiologist administers the DCAT and guides the individual.
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Whats Hot In Pd An Update On Dat Scanning For Parkinsons Disease Diagnosis
In 2011, the FDA approved a diagnostic test for Parkinsons disease. The DaTscan is a radiopharmaceutical agent which is injected into a patients veins in a procedure referred to as SPECT imaging. DaTscan, when it was approved, was considered an important addition to the armamentarium of the bedside clinician. In 2011 I wrote a Whats Hot column on DAT scanning, and this month I will update that posting and bring everyone up to date on the impact of this test.
One of the most frequently asked questions about Parkinsons disease on NPFs Ask the Doctor web-based forum is whether or not to pursue DaT or PET scan to confirm a diagnosis of Parkinsons disease. The short answer is that the DaT test is over-used in clinical practice, and is only FDA approved to distinguish potential Parkinsons disease from essential tremor. In fact, the test only tells the clinician if there is an abnormality in the dopamine transporter, and does not actually diagnose Parkinsons disease . PET is also overused, though it can be a more powerful diagnostic tool when in the right expert hands.
The new DaT scans use a substance that tags a part of a neuron in the brain where dopamine attaches to it, thus showing the density of healthy dopamine neurons. Thus, the more of the picture that lights up, the more surviving brain cells. Dark areas could mean either Parkinsons disease or parkinsonism.
Selected References
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Primary Symptoms Of Parkinsons
The symptoms someone has and how quickly the condition develops will differ from one person to the next. Always consult your doctor to determine if the symptoms youre experiencing may be a sign of Parkinsons disease or a sign of other health issues.
Slowness of Movement
Individuals with Parkinsons disease experience a change in spontaneous movement that causes them to move or respond slowly. The face may lack changing facial expressions .
Tremor
Tremors occur in about 70% of those living with Parkinsons. Typically, the tremor appears on one side of the body in the hand or foot while relaxed or at rest.
Rigidity
Muscles may fail to relax like normal muscles causing the individual to appear rigid and have a decreased range of motion. Rigidity can cause posture changes. Tightness of the muscles of the body may be painful.
Postural Instability
Loss of some reflexes needed to maintain an upright posture may cause individuals to be unstable when standing. The presence of postural instability increases the likelihood of falling.
Secondary motor symptoms include:
Non-motor symptoms of PD include:
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What Can I Expect If I Have This Condition
Parkinsons disease is a degenerative condition, meaning the effects on your brain get worse over time. However, this condition usually takes time to get worse. Most people have a normal life span with this condition.
You’ll need little to no help in the earlier stages and can keep living independently. As the effects worsen, youll need medication to limit how the symptoms affect you. Most medications, especially levodopa, are moderately or even very effective once your provider finds the minimum dose you need to treat your symptoms.
Most of the effects and symptoms are manageable with treatment, but the treatments become less effective and more complicated over time. Living independently will also become more and more difficult as the disease worsens.
How long does Parkinsons disease last?
Parkinsons disease isnt curable, which means its a permanent, life-long condition.
Whats the outlook for Parkinsons disease?
Parkinson’s disease isn’t fatal, but the symptoms and effects are often contributing factors to death. The average life expectancy for Parkinson’s disease in 1967 was a little under 10 years. Since then, the average life expectancy has increased by about 55%, rising to more than 14.5 years. That, combined with the fact that Parkinson’s diagnosis is much more likely after age 60, means this condition doesn’t often affect your life expectancy by more than a few years .
How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
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If Its Not Parkinsons Disease What Else Could It Be
There are several other conditions that might produce symptoms that can be mistaken for Parkinsons disease. Here are some possibilities:
- Medication side effects: Certain drugs can produce or exacerbate symptoms.
- Essential, or familial, tremor: This is a relatively common and benign cause of recurrent tremor and is often confused with the tremor of idiopathic Parkinsons. A general neurologist or movement disorder specialist is the best physician to help differentiate between these two conditions.
- A Parkinsonian syndrome: The symptoms of several neurologic conditions are similar to those of idiopathic Parkinsons, but they are often managed differently and often do not respond to the typical medications.
Remember: Only a general neurologist or movement disorder specialist can tell you with reasonable certainty if you have idiopathic Parkinsons. If for some reason you are not comfortable with the results of your first physician visit, getting a second opinion from another general neurologist or movement disorder specialist is always an option. It is important that you feel comfortable with your physician to ensure the best possible outcome for you.
Once you or your loved one has a diagnosis of Parkinsons disease, it is time to discuss treatment options with your physician.
Mayo Clinic Q And A: Diagnosing Parkinsons Disease
DEAR MAYO CLINIC: My mother was recently diagnosed with Parkinsons, but she doesnt have many symptoms. I would like her to get a second opinion. Is there a blood test that can determine if the diagnosis is accurate?
ANSWER: Theres no one test that can be used to diagnose Parkinsons disease. Instead, the diagnosis is based on a persons medical history and symptoms, along with a neurological and physical exam. If your mother has doubts about her Parkinsons diagnosis, getting a second opinion from a neurologist who specializes in the disease would be reasonable.
Parkinsons disease is a progressive disorder of the nervous system that affects movement. In people who have this disease, certain nerve cells in the brain, called neurons, gradually die.
Many Parkinsons symptoms are related to the loss of brain neurons that produce a chemical messenger called dopamine. Loss of dopamine can lead to a variety of symptoms. Those symptoms can vary widely from person to person. Parkinsons develops slowly over time. In the diseases early stages, symptoms may be very mild and barely noticeable.
Parkinsons typically impairs a persons normal spontaneous body movements, such as blinking, smiling or swinging the arms while walking. The loss of dopamine that happens in Parkinsons may sometimes trigger sleep disorders, panic attacks, anxiety or insomnia.
If your GP suspects Parkinsons disease, youll be referred to a specialist.
This will usually be:
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What Are The Early Warning Signs Of Parkinson’s Disease
Parkinsons warning signs can be motor symptoms like slow movements, tremors or stiffness. However, they can also be non-motor symptoms. Many of the possible non-motor symptoms can appear years or even decades ahead of motor symptoms. However, non-motor symptoms can also be vague, making it difficult to connect them to Parkinson’s disease.
Non-motor symptoms that might be early warning signs include:
- Sleep problems such as periodic limb movement disorder , rapid eye movement behavior disorder and restless legs syndrome.
What Are The Symptoms Of Parkinson’s Disease
The main symptoms of Parkinson’s disease are:
- tremor or shaking, often when resting or tired. It usually begins in one arm or hand
- muscle rigidity or stiffness, which can limit movement and may be painful
- slowing of movement, which may lead to periods of freezing and small shuffling steps
- stooped posture and balance problems
The symptoms of Parkinson’s disease vary from person to person as well as over time. Some people also experience:
- loss of unconscious movements, such as blinking and smiling
- difficulties with handwriting
- drop in blood pressure leading to dizziness
- difficulty swallowing
Many of the symptoms of Parkinson’s disease could be caused by other conditions. For example, stooped posture could be caused by osteoporosis. But if you are worried by your symptoms, it is a good idea to see your doctor.
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How Do I Take Care Of Myself
If you have Parkinsons disease, the best thing you can do is follow the guidance of your healthcare provider on how to take care of yourself.
- Take your medication as prescribed. Taking your medications can make a huge difference in the symptoms of Parkinson’s disease. You should take your medications as prescribed and talk to your provider if you notice side effects or start to feel like your medications aren’t as effective.
- See your provider as recommended. Your healthcare provider will set up a schedule for you to see them. These visits are especially important to help with managing your conditions and finding the right medications and dosages.
- Dont ignore or avoid symptoms. Parkinsons disease can cause a wide range of symptoms, many of which are treatable by treating the condition or the symptoms themselves. Treatment can make a major difference in keeping symptoms from having worse effects.
How Does This Condition Affect My Body
Parkinsons disease causes a specific area of your brain, the basal ganglia, to deteriorate. As this area deteriorates, you lose the abilities those areas once controlled. Researchers have uncovered that Parkinsons disease causes a major shift in your brain chemistry.
Under normal circumstances, your brain uses chemicals known as neurotransmitters to control how your brain cells communicate with each other. When you have Parkinsons disease, you dont have enough dopamine, one of the most important neurotransmitters.
When your brain sends activation signals that tell your muscles to move, it fine-tunes your movements using cells that require dopamine. Thats why lack of dopamine causes the slowed movements and tremors symptoms of Parkinson’s disease.
As Parkinson’s disease progresses, the symptoms expand and intensify. Later stages of the disease often affect how your brain functions, causing dementia-like symptoms and depression.
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Assessing Level Of Rigidity
Healthcare providers also look for rigidity by moving the joints in your elbows, wrists, knees, and ankles to see if thereâs resistance. The resistance may be smooth or may appear as slight hesitations in movements, known as cogwheeling. This is sometimes made more obvious by the patient actively moving the opposite limb.
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What Are The Limitations Of The Test
Currently, DaTscan that is in clinical use is not quantitative, which means that the test is not designed to determine how impaired the dopamine system is just whether it is or not. This means that the test is not used to tell you whether the disease has progressed over time and is not used to follow a patients disease. It also is not used currently as a clinical test to screen for the disease before motor symptoms are evident. Because of these limitations, the search continues for additional measurable indicators, known as biomarkers, to help diagnosis and manage PD.
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I Mentation Behavior And Mood
1. Intellectual Impairment
0 = None. 1 = Mild. Consistent forgetfulness with partial recollection of events and no other difficulties. 2 = Moderate memory loss, with disorientation and moderate difficulty handling complex problems. Mild but definite impairment of function at home with need of occasional prompting. 3 = Severe memory loss with disorientation for time and often to place. Severe impairment in handling problems. 4 = Severe memory loss with orientation preserved to person only. Unable to make judgements or solve problems. Requires much help with personal care. Cannot be left alone at all.
2. Thought Disorder
0 = None. 2 = Benign hallucinations with insight retained. 3 = Occasional to frequent hallucinations or delusions without insight could interfere with daily activities. 4 = Persistent hallucinations, delusions, or florrid psychosis. Not able to care for self.
3. Depression
1 = Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 = Sustained depression . 3 = Sustained depression with vegetative symptoms . 4 = Sustained depression with vegetative symptoms and suicidal thoughts or intent.
4. Motivation/Initiative
1 = Less assertive than usual more passive. 2 = Loss of initiative or disinterest in elective activities. 3 = Loss of initiative or disinterest in day to day activities. 4 = Withdrawn, complete loss of motivation.
Medicines For Parkinsons Disease
Medicines can help treat the symptoms of Parkinsons by:
- Increasing the level of dopamine in the brain
- Having an effect on other brain chemicals, such as neurotransmitters, which transfer information between brain cells
- Helping control non-movement symptoms
The main therapy for Parkinsons is levodopa. Nerve cells use levodopa to make dopamine to replenish the brains dwindling supply. Usually, people take levodopa along with another medication called carbidopa. Carbidopa prevents or reduces some of the side effects of levodopa therapy such as nausea, vomiting, low blood pressure, and restlessness and reduces the amount of levodopa needed to improve symptoms.
People living with Parkinsons disease should never stop taking levodopa without telling their doctor. Suddenly stopping the drug may have serious side effects, like being unable to move or having difficulty breathing.
The doctor may prescribe other medicines to treat Parkinsons symptoms, including:
- Dopamine agonists to stimulate the production of dopamine in the brain
- Enzyme inhibitors to increase the amount of dopamine by slowing down the enzymes that break down dopamine in the brain
- Amantadine to help reduce involuntary movements
- Anticholinergic drugs to reduce tremors and muscle rigidity
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Validating A New Biomarker
Hansson and his colleagues developed a blood test that is, essentially, a variation on an existing test capable of detecting neurofilament light chain protein in spinal fluid. This protein is a component of nerve cells, and when these cells die, it can be detected in both spinal fluid and blood.
Because spinal fluid is not easily obtained by a primary care doctor, this diagnostic test is not very useful, so Hansson developed a blood test and investigated its accuracy in the new study.
When validating a new biomarker for disease, one should always analyze at least two different to make sure that the results are reproducible, said Hansson, who added that participants should also include both early- and late-stage patients established at different clinics.
All told, a total of 244 people with Parkinsons and 79 healthy volunteers serving as a comparison group participated in Hanssons study, along with 181 patients with atypical parkinsonism disorders.
Of these, 88 patients had multiple system atrophy, which impairs the bodys involuntary functions such as heart rate, blood pressure and digestion.
Seventy patients had progressive supranuclear palsy, which affects movement, walking, balance, speech, swallowing, vision, mood and thinking.
And 23 patients had corticobasal degeneration, which causes decreased movement on one side of the body, muscle rigidity, tremor and a disconnection between thought and action.