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Neurology (Expert Forum)
Re: Parkinson's
This forum is for questions and support regarding neurology issues such as: Alzheimer's Disease, ALS, Autism, Brain Cancer, Cerebral Palsy, Chronic Pain, Epilepsy, Fibromyalgia, Headaches, MS, Neuralgia, Neuropathy, Parkinson's Disease, RSD, Sleep Disorders, Stroke, Traumatic Brain Injury.
Re: Parkinson's
by CF-Neuro-MD, Jan 01, 1995 12:00AM
Posted By CCF Neuro MD on April 07, 1997 at 21:54:44:
In Reply to: Parkinson's posted by Debbie White on April 07, 1997 at 21:53:09:
: My mother, 67, was diagnosed with Parkinson's about 2 months ago. Her symptoms are: cannot do much with left hand (she can squeeze you with it,
but not use it to lift a bottle, type of a keyboard, etc.), the "weakness" in her left hand is moving up her left arm, her left toes drag after
having broke her ankle from a fall about 4 months ago, her speech is ever so lightly slurred, her movements are slow, and (the most annoying one, she
says) she feels off balance (not a spinning sensation, she said). Her MRI showed nothing unusual.
She was diagnosed by a neuro who put her on Sinemet 25/100 3x/day, later increasing it an additional 1/2 tablet every time. She then saw a movement disorder specialist. The Sinemet was not helping much with the symptoms
(although she has missed some doses since and definitely feels the difference when not taking it). She was then put on the following drug program: 1 and 1/2 25/100 Sinemet first thing in the morning, followed by 1
25/100 Sinemet 3 times in the day. She is also now slowly introducing Permax into the equation (currently she's at 1/2 tablet .25 mg., 2x/day). The goal is to increase the Permax to 1 100 mg. tablet 4x/day. Although he
doctor assures her that she doesn't need to pay particular attention to diet at this time (she's in the early stages), she nevertheless has cut down on protein and consumes most of it at night.
My question is this: The drugs sometimes help with the off balance (some days are better than others). However, when they don't work she feels the off balance problem is worse than it was 2 months ago. Also, nothing has helped with increasing mobility in her left hand (which, under stress, tremors slightly).
Is one drug more effective than another in treating balance problems? Does this sound like a typical Parkinson's scenario? Does this drug program sound right? Is it worth it, under a doctor's guidance, to quit all drugs to see if the Sinemet is really helping? Can Permax on it's own every be effective in treating these types of symptoms?
Thanks for any insight into this. Debbie White
=
Hello Debbie,
Parkinson's Disease is one of the more common "degenerative disorders" of the nervous system that is seen in a general
neurologist's practice. The cardinal symptom/sign of Parkinson's disease is "bradykinesia" (which is a medical term for
slowness of movement.) This is experienced by the patient as low volume speech, shuffling gait, lack of the normal facial
expressions, small handwriting etc. However, there are several disorders that have some features of Parkinson's disease but in
addition have features that are not typically seen in the early stages of Parkinson's disease. Loss of balance is not typically seen
an early symptom in Parkinson's disease. There are several other "degenerative disorders" that can present with problems with
balance. Some examples are Multisystem atrophy, and Progressive supranuclear palsy. The problems with balance are among
the most challanging symptoms to treat in this group of disorders. Sinemet and permax tend to improve the symptoms of
bradykinesia but do not
consistently improve balance. The most significant morbidity in patients who have difficulty with balance is falling and
developing a fracture of the femur. A devise such as a three wheeled walker with hand brakes could help prevent this from
occurring. The drug regiment that your doctor has chosen seems well thought out. You may want to consider obtaining a three
wheeled walker in addition to continuing with the current medication regiment. If you were to consider taking your mother off
medications you may find that she becomes a lot more slower in her movements. The stragegy of treatment of symptoms of
Parkinson's disease and the other disease that share some features of Parkinson's disease are highly invidualized and require
the careful monitoring by a neurologist. I would suggest that you convey some of your concerns to your neurologist so that she
or he may explain their treatment strategy to you. I hope you will find this helpful.
In Reply to: Parkinson's posted by Debbie White on April 07, 1997 at 21:53:09:
: My mother, 67, was diagnosed with Parkinson's about 2 months ago. Her symptoms are: cannot do much with left hand (she can squeeze you with it,
but not use it to lift a bottle, type of a keyboard, etc.), the "weakness" in her left hand is moving up her left arm, her left toes drag after
having broke her ankle from a fall about 4 months ago, her speech is ever so lightly slurred, her movements are slow, and (the most annoying one, she
says) she feels off balance (not a spinning sensation, she said). Her MRI showed nothing unusual.
She was diagnosed by a neuro who put her on Sinemet 25/100 3x/day, later increasing it an additional 1/2 tablet every time. She then saw a movement disorder specialist. The Sinemet was not helping much with the symptoms
(although she has missed some doses since and definitely feels the difference when not taking it). She was then put on the following drug program: 1 and 1/2 25/100 Sinemet first thing in the morning, followed by 1
25/100 Sinemet 3 times in the day. She is also now slowly introducing Permax into the equation (currently she's at 1/2 tablet .25 mg., 2x/day). The goal is to increase the Permax to 1 100 mg. tablet 4x/day. Although he
doctor assures her that she doesn't need to pay particular attention to diet at this time (she's in the early stages), she nevertheless has cut down on protein and consumes most of it at night.
My question is this: The drugs sometimes help with the off balance (some days are better than others). However, when they don't work she feels the off balance problem is worse than it was 2 months ago. Also, nothing has helped with increasing mobility in her left hand (which, under stress, tremors slightly).
Is one drug more effective than another in treating balance problems? Does this sound like a typical Parkinson's scenario? Does this drug program sound right? Is it worth it, under a doctor's guidance, to quit all drugs to see if the Sinemet is really helping? Can Permax on it's own every be effective in treating these types of symptoms?
Thanks for any insight into this. Debbie White
=
Hello Debbie,
Parkinson's Disease is one of the more common "degenerative disorders" of the nervous system that is seen in a general
neurologist's practice. The cardinal symptom/sign of Parkinson's disease is "bradykinesia" (which is a medical term for
slowness of movement.) This is experienced by the patient as low volume speech, shuffling gait, lack of the normal facial
expressions, small handwriting etc. However, there are several disorders that have some features of Parkinson's disease but in
addition have features that are not typically seen in the early stages of Parkinson's disease. Loss of balance is not typically seen
an early symptom in Parkinson's disease. There are several other "degenerative disorders" that can present with problems with
balance. Some examples are Multisystem atrophy, and Progressive supranuclear palsy. The problems with balance are among
the most challanging symptoms to treat in this group of disorders. Sinemet and permax tend to improve the symptoms of
bradykinesia but do not
consistently improve balance. The most significant morbidity in patients who have difficulty with balance is falling and
developing a fracture of the femur. A devise such as a three wheeled walker with hand brakes could help prevent this from
occurring. The drug regiment that your doctor has chosen seems well thought out. You may want to consider obtaining a three
wheeled walker in addition to continuing with the current medication regiment. If you were to consider taking your mother off
medications you may find that she becomes a lot more slower in her movements. The stragegy of treatment of symptoms of
Parkinson's disease and the other disease that share some features of Parkinson's disease are highly invidualized and require
the careful monitoring by a neurologist. I would suggest that you convey some of your concerns to your neurologist so that she
or he may explain their treatment strategy to you. I hope you will find this helpful.
