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Treatment of severe persistent nausea
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Treatment of severe persistent nausea

How to relieve severe persistent nausea (4 months duration)? GI cause has been eliminated. Psycological and neurological tests show signs of early parkinson's dimentia (dementia). Alprazolam and Ondansetron have been  tried with little help for nausea. Autonomic adjustment is being proposed as possible means of relief from nausea. Any suggestions?
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Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

Without the ability to examine you and obtain a history, I can not tell you what your symptoms are from exactly nor can I recommend treatment. It sounds like you have received a diagnosis of possible parkinson’ disease, and that your nausea may be due to autonomic dysfunction. I am not sure what you mean by autonomic adjustment, but I will try to provide you with some information regarding autonomic dysfunction.

The nervous system has 3 parts: the central nervous system (the brain and spinal cord), the peripheral nerves (nerves to our muscles and for sensation), and the autonomic nervous system. The autonomic nervous system consists of several areas in the brain, spinal cord, and small nerves which regulate blood pressure, heart rate, motion of the stomach and intestines, body temperature and so on. Our stomach and intestines move in a motion called peristalsis because of the autonomic nervous system. A problem with this part of the nervous system leads to autonomic dysfunction. This may manifest as abnormalities of blood pressure and/or heart rate, temperature control problems, and several other symptoms. One symptom of autonomic dysfunction is low motility of the stomach and/or intestines. Medically, the term for poor mobility of the stomach is called gastroparesis. These abnormalities can lead to nausea, food intolerance, abdominal pain, constipation (or less commonly diarrhea) and other symptoms.

The causes of autonomic dysfunction include multiple conditions including most commonly diabetes. Other conditions that can cause autonomic dysfunction include Parkinson’s disease, particularly the group of disorders called parkinson’s plus syndrome, certain protein abnormalities, certain paraneoplastic syndromes (which are related to the presence of cancer) and other conditions. Or autonomic dysfunction can be primary: occurring without any identifiable cause.

There is an extensive battery of testing that needs to be done in order to diagnose autonomic dysfunction and determine its cause. These should be done prior to any intervention such as medications or surgery. To test for abnormalities in stomach and intestinal motility, tests can include barium swallows, gastric emptying studies, manometric studies (that assess pressure in the stomach) etc. For other functions of the autonomic nervous systen, tests include tilt-table testing, which assesses how the body responds to changes in posture with blood pressure and heart rate, in addition to other tests.

The treatment of nausea if it is due to gastric emptying problems or intestinal problems first involves treating any underlying correctable disorder such as diabetes. If the cause is Parkinson’s disease, the symptoms of parkinson’s disease should be addressed, but since there is no cure currently for parkinson’s disease, treatment of the symptoms is usually what is possible. Treatment is related to improving the contractility of the stomach and intestines. Alprazolam and odansteron treat the nausea but not the underlying poor motility of the stomach/intestines. For the latter, there are several medications available, some should be avoided in the setting of parkinson’s disease and others are safe. Gastric pacemaking is an advanced surgery that is only indicated in very specific cases of gastroparesis. Treatment of other autonomic symptoms such as fluctuations in blood pressure is also available.

I recommend continued follow-up with your gastroenterologist and neurologist for further management of your symptoms.

Thank you for using the forum I hope you find this information useful good luck.

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