PARKINSON PLUS and Meds

    
      Re: PARKINSON PLUS and Meds
    


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Posted by ccf neuro M.D.* on August 18, 1997 at 17:38:10:

In Reply to: PARKINSON PLUS and Meds posted by Debra Murphy on August 18, 1997 at 09:05:50:
  My 72 year old father has Parkinson Plus  he  also has
  atrophy of the cerbellum.  He is on the following meds; 200/50 CR sinement
  3 times a day, Hydroxamilor 50/5 1 tab daily, ativan 2 mgs 2 times a day,
  Vasotex 2 times a day.  He is fine some days, then can hardly move others.
  He gets angry very easily, also seemes very restless, his legs move on their own.
  My question is, could this be a result of the meds or just part of
  Parkinson Plus?  Are there any other meds that might help him?  I understand
  That Parkinsos Plus does not respond well to meds.  Thanks for any help>
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Dear Debrah,
"Parkinsons Plus", known in more formal medical terms as multi-system atrophy (MSA), or, alternatively depending on which syptoms (symptoms) predominate, as Shy-Drager Syndrome or Olivopontocerebellar atrophy (OPCA), is a progressive neurodegenerative disorder of unknown cause. It may affect almost any portion of the brain that sends fibers down to the arms and legs, and may produce Parkinsons-disease type symptoms like stiffness, slowness or inability to move, decreased facial expression, trouble walking, trouble catching one's balance after tripping etc. ;  Cerebellar symptoms like feeling drunk or unsteady when one stands, incoordination, slowness and clumsiness of speech and movement; autonomic symptoms like lightheadedness and even fainting upon standing, retention of urine in the bladder, constipation; and pyramidal tract symptoms, mostly a loss of ability to perform fine motor functions like writing and shirt buttoning, but also spasticity and muscle spasming.  In every person with the disease, which symptoms predominate is different. As you are aware, the Parkinson's symptoms do not generally respond well to therapy. Drugs used to treat these symptoms include L-dopa (Sinemet) and dopamine agonist drugs which are its cousins like Permax/pergolide and bromocriptine. On occasion one of these drugs may be more effective than Sinemet, but the response rate for finding ANY drug that works in this condition is only about  30%, unfortunately. Drugs that can treat the autonomic symptoms, especially the fainting, include Fludrocortisone (Florinef) and mididrine, a newer drug, if your father has such symptoms. Sometimes drugs that control bladder spastcity like Hycosidine or Ditropan are helpful for bladder urgency and incontinence. A neurologist's care and support services are essential for anyone who has, and for family members of anyone who has this condition. Information that we provide on the neurology forum is intended for general medical informational purposes only. Actual treatment of your father's condition should be strictly in conjunction with his treating physicians. If you would be interested in having your father evaluated at the Cleveland Clinic's department of neurology, the number is 216-444-5559, or 1-800-223-2273 extension 45559. I would suggest Dr. Richard Lederman or Dr. Stan Burns in particular for this difficult disorder.