Parkinson’s Disease in the Philippines Support Group (PDPSG)
It has been my ardent dream to put up a support group and eventually a foundation for those afflicted with Parkinson's disease(PD) here in the Philippines. Hence, I have envisioned setting up a blog to propagate my thoughts and plans. A few months back, I just did that but have been remiss in updating my posts. To motivate me and to start the ball rolling so to speak, I am launching this PDPSG as a shout out to all PD patients who want to be part of the drive to increase awareness among Filipinos regarding Parkinson's disease. Coach Freddie Roach, Michael J. Fox and Muhammad Ali are some of the popular international figures that we know who are afflicted with PD. Do we have Filipinos who are equally popular and affected with the same illness? Help me find out so we can also help those who are unable to cope with their PD's.
PDPSG MOTTO: BE PROUD! BE BRAVE! BE AN INDEPENDENT PD IN THE PHILIPPINES!
VISION STATEMENT: TO UPLIFT THE SPIRIT OF EVERY FILIPINO WITH PARKINSON’S DISEASE SO HE CAN STILL FUNCTION IN SOCIETY
MISSION STATEMENTS:
TO UPHOLD THE RIGHT OF EVERY PD PATIENT FOR A SAFE ENVIRONMENT
TO PROVIDE EMOTIONAL AND MORAL SUPPORT TO EACH PD PATIENT AND THEIR FAMILIES/CARE GIVERS
TO PROMOTE INDEPENDENCE IN EVERY PD PATIENT
TO DEVELOP SKILLS IN EACH PD PATIENT SO HE CAN BE A PRODUCTIVE MEMBER OF SOCIETY
TO SLOW DOWN THE PROGRESSION OF PD MANIFESTATIONS THROUGH EARLY DIAGNOSIS AND INTERVENTION
TO HELP LOWER THE COSTS OF TREATMENT AND MANAGEMENT OF PD CASES THROUGH LOWERING THE COSTS OF MEDICINES AND REHABILITATION
TO OPEN AVENUES FOR RESEARCH/STUDIES TO IMPROVE AND FIND BETTER TREATMENT OPTIONS FOR PD PATIENTS IN THE PHILIPPINES
Tuesday, February 16, 2010
Thursday, January 21, 2010
Whole body vibration therapy, a revolutionary technique that efficiently treats Parkinson's disease
There is hope for advanced Parkinson's disease (PD) patients that do not respond well to medications such as L-dopamine. The whole body vibration therapy is a new non-traditional machine for physical therapy and is available for use in Ontario, Canada. However, there is still a question if the said machine can be made available in the Philippines based on its cost, effectivity and applicability.
A previous study was conducted about a year ago which showed that whole vibration therapy is more effective in reversing many of the clinical symptoms of PD patients compared to conventional physical therapy. Specifically, this particular study showed that whole body vibration therapy improved equilibrium and gait four weeks after undergoing an intensive three week regimen consisting of 15 minutes a day for five days a week.
Scientists from the Sun Life Financial Movement Disorders Research and Rehabilitation Center from Ontario, Canada have shown that short term whole body vibration therapy significantly improves the clinical symptoms (loss of gait, tremors and akinesia) of PD patients. In this clinical study, a sample population of 40 PD patients were subject to intensive therapy for a few weeks using a Physioacoustic Chair, a sophisticated device containing speakers that are strategically placed throughout the chair in order to deliver programmed low frequency sound waves throughout the body of the patient.The acoustic therapy has been found to have a significant impact on the well being and quality of life of PD patients.
In summary, the Unified Parkinson's Disease Rating Scale (UPDRS), gait assessments and upper limb control tests showed significant improvements on gait stability and posture, increased stepping time and speed on the peg-board task, a significant decrease in tremors and less rigidity in PD patients receiving whole body vibration therapy compared to a control group that received no therapy. This study also showed that whole body vibration therapy may also be applied to PD patients that do not respond well to L-dopamine medication or deep brain stimulation, a complicated risky surgery that involves delivering mild electrical shocks to the brain via implanted electrodes. The latter technique is used as a last resort to stabilize tremors and rigidity in PD patients.
This study quantitatively also suggests that whole body vibration therapy is more efficient (25% more efficient) than conventional physical therapy for partially reversing clinical symptoms in PD patients that do not respond well to L-dopamine. It has been recommended whether further study can be done to know if a combined therapy that uses both whole body and conventional intervention techniques has an additive/synergistic positive effect in reversing clinical PD symptoms compared to single treatment intervention.
The technology used for conventional physical therapeutic interventions of PD patients have included the use of treadmills, different optical and acoustic devices, balance/ gait training devices and low impact exercise machines. On the other hand, the concept and practice of whole body vibration therapy is not new since this technique has been used by athletes as part of a routine exercise to loose weight, improve muscle tone and increase muscle strength. But it has not been applied in clinical conditions like Parkinsons disease before.
Whole body vibration therapy was initially postulated and developed by Jean Martin Charcot, who also developed a vibration chair many decades ago. There are currently a few devices currently in the market that have been tweaked and redesigned with from other existing prototypes. Some of the most well known whole body vibrational devices are sold by Galileo Fitness and is used for many applications including relaxation therapy, strength training and muscle toning, and for physical therapy. The machine looks like a typical workout machine with arm rests, a bottom platform, and a console that allows a user to program a variety of amplitude and frequency settings (18-28 Hz). Once a patient stands on top of the platform and grabs the arm rests, he/she may receive a short session of either low frequency sound waves that allow for muscle relaxation while higher amplitude and frequency settings is used for increasing muscle tone and contraction.
Whole body vibration therapy has also been used in the past to treat patients affected by neuromuscular debilitating and neurodegenerative disorders such as multiple sclerosis, stroke, cerebral palsy, Huntington's chorea, and other movement disorders. It is not known how whole body acoustic therapy works in Parkinson's disease patients but it is believed that high vibrational frequencies help to partially restore some of the sensory perception (proprioception) that is lost during the progression of the disease and is also used to enhance muscle coordination, a physical trait that is lost during the progression of PD. Finally, high frequency sound waves delivered via physicoacoustic devices has been shown to improve blood flow, electrical conductivity and metabolism of muscle tissue.
A previous study was conducted about a year ago which showed that whole vibration therapy is more effective in reversing many of the clinical symptoms of PD patients compared to conventional physical therapy. Specifically, this particular study showed that whole body vibration therapy improved equilibrium and gait four weeks after undergoing an intensive three week regimen consisting of 15 minutes a day for five days a week.
Scientists from the Sun Life Financial Movement Disorders Research and Rehabilitation Center from Ontario, Canada have shown that short term whole body vibration therapy significantly improves the clinical symptoms (loss of gait, tremors and akinesia) of PD patients. In this clinical study, a sample population of 40 PD patients were subject to intensive therapy for a few weeks using a Physioacoustic Chair, a sophisticated device containing speakers that are strategically placed throughout the chair in order to deliver programmed low frequency sound waves throughout the body of the patient.The acoustic therapy has been found to have a significant impact on the well being and quality of life of PD patients.
In summary, the Unified Parkinson's Disease Rating Scale (UPDRS), gait assessments and upper limb control tests showed significant improvements on gait stability and posture, increased stepping time and speed on the peg-board task, a significant decrease in tremors and less rigidity in PD patients receiving whole body vibration therapy compared to a control group that received no therapy. This study also showed that whole body vibration therapy may also be applied to PD patients that do not respond well to L-dopamine medication or deep brain stimulation, a complicated risky surgery that involves delivering mild electrical shocks to the brain via implanted electrodes. The latter technique is used as a last resort to stabilize tremors and rigidity in PD patients.
This study quantitatively also suggests that whole body vibration therapy is more efficient (25% more efficient) than conventional physical therapy for partially reversing clinical symptoms in PD patients that do not respond well to L-dopamine. It has been recommended whether further study can be done to know if a combined therapy that uses both whole body and conventional intervention techniques has an additive/synergistic positive effect in reversing clinical PD symptoms compared to single treatment intervention.
The technology used for conventional physical therapeutic interventions of PD patients have included the use of treadmills, different optical and acoustic devices, balance/ gait training devices and low impact exercise machines. On the other hand, the concept and practice of whole body vibration therapy is not new since this technique has been used by athletes as part of a routine exercise to loose weight, improve muscle tone and increase muscle strength. But it has not been applied in clinical conditions like Parkinsons disease before.
Whole body vibration therapy was initially postulated and developed by Jean Martin Charcot, who also developed a vibration chair many decades ago. There are currently a few devices currently in the market that have been tweaked and redesigned with from other existing prototypes. Some of the most well known whole body vibrational devices are sold by Galileo Fitness and is used for many applications including relaxation therapy, strength training and muscle toning, and for physical therapy. The machine looks like a typical workout machine with arm rests, a bottom platform, and a console that allows a user to program a variety of amplitude and frequency settings (18-28 Hz). Once a patient stands on top of the platform and grabs the arm rests, he/she may receive a short session of either low frequency sound waves that allow for muscle relaxation while higher amplitude and frequency settings is used for increasing muscle tone and contraction.
Whole body vibration therapy has also been used in the past to treat patients affected by neuromuscular debilitating and neurodegenerative disorders such as multiple sclerosis, stroke, cerebral palsy, Huntington's chorea, and other movement disorders. It is not known how whole body acoustic therapy works in Parkinson's disease patients but it is believed that high vibrational frequencies help to partially restore some of the sensory perception (proprioception) that is lost during the progression of the disease and is also used to enhance muscle coordination, a physical trait that is lost during the progression of PD. Finally, high frequency sound waves delivered via physicoacoustic devices has been shown to improve blood flow, electrical conductivity and metabolism of muscle tissue.
Wednesday, January 20, 2010
Treatment for Parkinson's Disease
Although there is as yet no cure for Parkinson’s Disease (PD), scientists are working hard and fast to look for better treatments to manage its symptoms. There is also a search for treatments that can slow the progression of the disease. Drug therapy to both manage the symptoms of PD, and slow the progression of the disease, remains the ‘Gold Standard’ treatment option for PD. Likewise, the same treatment options are also being offered to patients afflicted with Parkinson's disease even in the Philippines.
Drug Therapies
Levodopa increases the level of dopamine in the brain and thus relieves the movement problems of PD. Levodopa however has side effects. One of Levodopa’s common side effects is nausea so it is usually given with a second drug, carbidopa, that prevents nausea. The combination of Levodopa/Carbidopa effectively treats the symptoms of PD, allowing many people with PD to live relatively normal, active, and productive lives for many years.
Dopamine Agonists are a class of drugs that, like levodopa, increase dopamine activity in the brain. Commonly prescribed dopamine agonists include: bromocriptine (Parlodel), pergolide (Permax), pramiprexole (Mirapex), and ropinirole (Requip). They do not work as well as levodopa for the movement problems of PD but they may be able to slow progression of the disease.
Surgical Treatments
A small percentage of patients with PD do not benefit from drug therapies or suffer from severely disabling dyskinisia as a consequence of drug therapies. When the symptoms become severe surgical procedures may be an option. There are four types of surgical procedures for PD, Pallidotomy, Thalamotomy, Electrical Stimulation (Deep Brain Stimulation) and Neural Implants.
In pallidotomy the globus pallidus, is destroyed. The globus pallidus is targeted because it is a regulatory center for movement circuits of the brain. When the pallidotomy works, it can reduce rigidity and abnormal movements.
In thalamotomy, a small portion of the thalamus, is destroyed. The thalamus relays excitatory information to motor circuits. When the surgery works it can relieve severe tremors.
With Electrical Stimulation (Deep Brain Stimulation) various brain regions involved in motor regulation can be given an electrical stimulus which temporarily blocks activity in that part of the brain. Blocking that activity in turn has beneficial effects on other parts of the brain. Because the blocking is temporary, this procedure is reversible (in contrast to pallidotomoty or thalamotomy). Stimulation to the thalamus controls tremor. Stimulation to the globus pallidus treats balance and rigidity problems, but is generally not used specifically for tremor. The two most common sites for stimulation are the subthalamic nucleus and the globus pallidus.
Neural Implants involve placing tissue that can manufacture dopamine into selected regions of the brain. This treatment option is still very much in the experimental stage.
Physical Therapy
Because PD involves a variety of movement problems a physical therapist can devise a program of exercises that can relieve the patient's pain and maintain the muscle integrity.
Treatment of Non-Motor Behavioral Symptoms
Up to 80% of patients with PD experience depression. Depression in PD can be treated with most of the standard drugs used to treat depression in people without PD such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and venlafaine (Effexor). Triavil and Asendin however should NOT be used by people with PD.
Rarely persons with PD will experience hallucinations. These are usually due to too high a dose of levodopa. These episodes can usually be handled by carefully reducing the levodopa dosage. If that does not help then anti-psychotic drug treatment will usually do the trick.
Sleep problems such as REM Behavior Disorder can be treated with clonazepam. Execessive daytime sleepiness can be treated with modafinil (Provigil).
The management options for PD patients encompass not just the alleviation of the physical signs and symptoms of the disease, but also the improvement of the quality of life and reduction of the potential side effects of whatever treatment modality to be adopted.
Drug Therapies
Levodopa increases the level of dopamine in the brain and thus relieves the movement problems of PD. Levodopa however has side effects. One of Levodopa’s common side effects is nausea so it is usually given with a second drug, carbidopa, that prevents nausea. The combination of Levodopa/Carbidopa effectively treats the symptoms of PD, allowing many people with PD to live relatively normal, active, and productive lives for many years.
Dopamine Agonists are a class of drugs that, like levodopa, increase dopamine activity in the brain. Commonly prescribed dopamine agonists include: bromocriptine (Parlodel), pergolide (Permax), pramiprexole (Mirapex), and ropinirole (Requip). They do not work as well as levodopa for the movement problems of PD but they may be able to slow progression of the disease.
Surgical Treatments
A small percentage of patients with PD do not benefit from drug therapies or suffer from severely disabling dyskinisia as a consequence of drug therapies. When the symptoms become severe surgical procedures may be an option. There are four types of surgical procedures for PD, Pallidotomy, Thalamotomy, Electrical Stimulation (Deep Brain Stimulation) and Neural Implants.
In pallidotomy the globus pallidus, is destroyed. The globus pallidus is targeted because it is a regulatory center for movement circuits of the brain. When the pallidotomy works, it can reduce rigidity and abnormal movements.
In thalamotomy, a small portion of the thalamus, is destroyed. The thalamus relays excitatory information to motor circuits. When the surgery works it can relieve severe tremors.
With Electrical Stimulation (Deep Brain Stimulation) various brain regions involved in motor regulation can be given an electrical stimulus which temporarily blocks activity in that part of the brain. Blocking that activity in turn has beneficial effects on other parts of the brain. Because the blocking is temporary, this procedure is reversible (in contrast to pallidotomoty or thalamotomy). Stimulation to the thalamus controls tremor. Stimulation to the globus pallidus treats balance and rigidity problems, but is generally not used specifically for tremor. The two most common sites for stimulation are the subthalamic nucleus and the globus pallidus.
Neural Implants involve placing tissue that can manufacture dopamine into selected regions of the brain. This treatment option is still very much in the experimental stage.
Physical Therapy
Because PD involves a variety of movement problems a physical therapist can devise a program of exercises that can relieve the patient's pain and maintain the muscle integrity.
Treatment of Non-Motor Behavioral Symptoms
Up to 80% of patients with PD experience depression. Depression in PD can be treated with most of the standard drugs used to treat depression in people without PD such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and venlafaine (Effexor). Triavil and Asendin however should NOT be used by people with PD.
Rarely persons with PD will experience hallucinations. These are usually due to too high a dose of levodopa. These episodes can usually be handled by carefully reducing the levodopa dosage. If that does not help then anti-psychotic drug treatment will usually do the trick.
Sleep problems such as REM Behavior Disorder can be treated with clonazepam. Execessive daytime sleepiness can be treated with modafinil (Provigil).
The management options for PD patients encompass not just the alleviation of the physical signs and symptoms of the disease, but also the improvement of the quality of life and reduction of the potential side effects of whatever treatment modality to be adopted.
Tuesday, January 19, 2010
Dopamine agonist withdrawal syndrome (DAWS) in Parkinson's disease patients
Some neurologists advise reducing the doses of certain drugs for Parkinson's disease to alleviate the dangerous side effects. On the other hand, new research has shown that reducing the dosage of dopamine agonist (DA) drugs, a mainstay treatment for Parkinson's disease (PD), sometimes causes acute withdrawal symptoms similar to those reported by cocaine addicts -- including anxiety, panic attacks, depression, sweating, nausea, generalized pain, fatigue, dizziness and drug cravings. These symptoms can be severe, and are not alleviated by other PD medications. Just how applicable this finding would be in the Philippines is yet to be explored.
For the first time, researchers have defined this phenomenon, which they call dopamine agonist withdrawal syndrome, or DAWS. Led by a physician-scientist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the study is reported in the Jan. 11 Archives of Neurology.
"Like cocaine and methamphetamines, dopamine agonists work by stimulating the reward pathways in the brain. For this reason, it makes sense that they would engender similar withdrawal symptoms, particularly in those with high cumulative drug exposure," says senior author Dr. Melissa J. Nirenberg, associate director of the Parkinson's Disease and Movement Disorders Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant professor of neurology and neuroscience at Weill Cornell Medical College.
Dopamine agonists are highly effective drugs that are prescribed to many Parkinson's patients to avoid side effects of the "gold standard" drug L-DOPA, particularly abnormal involuntary movements referred to as dyskinesias. (L-DOPA was perfected by Dr. George C. Cotzias of Cornell University Medical College in the late 1960s; dopamine agonists have been available since the 1990s.) DAs are also FDA-approved for treatment of restless legs syndrome, and used off-label for other conditions such as depression and fibromyalgia. In the United States, there are currently two DAs on the market -- pramipexole (Mirapex®) and ropinirole (Requip®, Requip XL®).
In recent years, there have been increasing concerns about DA side effects, and particularly the fact that they can cause uncontrolled, compulsive behaviors known as impulse control disorders (ICDs). ICDs are reported to occur in about 14 percent to 17 percent of PD patients who use these drugs, and also occur in people who use DAs to treat other medical conditions. In 2006, Dr. Nirenberg published research linking the use of DAs to compulsive eating; others have linked the drugs to behaviors such as compulsive gambling, buying, hypersexuality and Internet addiction. Patients are often unaware of these addictive behaviors, or may not discuss them with physicians because they are in denial, embarrassed by their symptoms, or unaware that they are a medication side effect.
"Impulse control disorders stemming from use of dopamine agonists can be detrimental to a patient's financial, social and physical well-being. Our research identifies another concern -- namely that some patients experience severe, even intolerable, withdrawal syndromes when their dosage is reduced. In this context, it's very important that physicians and their patients use DAs judiciously, and exercise caution when they are tapered," says Dr. Nirenberg.
Study Design and Findings
In the current study, Dr. Nirenberg and first author Christina A. Rabinak, a third-year medical student at Weill Cornell Medical College, performed a retrospective analysis of a cohort of 93 people with Parkinson's disease, of whom 40 received DAs, and 26 tapered a DA for any of a variety of reasons -- most commonly because of ICDs. Among those who tapered a DA, five patients (19 percent) experienced DAWS. Two of the subjects with DAWS recovered fully, but three of the five were unable to successfully discontinue the drug because of severe withdrawal symptoms. These three study participants are currently living with their ICDs.
The NewYork-Presbyterian/Weill Cornell researchers made several observations about DAWS:
• DAWS only occurred in patients with ICDs, and not in those who tapered DAs for other reasons. However, only one-third of patients with ICDs experienced DAWS.
• Withdrawal symptoms were only alleviated by increasing the DA dosage. Other treatments, including high doses of L-DOPA, antidepressants, tranquilizers and psychotherapy, were ineffective.
• DAWS correlated with cumulative exposure to DAs, with the most severe symptoms occurring in patients with the greatest DA exposure.
• Subjects with DAWS had milder physical disability than those without.
The Message for Patients & Physicians
"DAWS has been difficult to identify because its symptoms are 'invisible' -- mainly psychological in nature," says Dr. Nirenberg. In fact, both patients and physicians have mistaken DAWS for a mental health condition such as anxiety or depression. DAWS has also been misinterpreted as a manifestation of PD itself, or of wearing off between doses of medication -- something disproven by the fact that the symptoms are not alleviated by even very high doses of L-DOPA.
Dr. Nirenberg recommends that patients "educate themselves about DA side effects, involve family members and friends in monitoring their behavior for possible ICDs, and promptly inform their physicians if they experience ICDs or DAWS." The authors also provide specific advice for clinicians who use DAs: (1) avoid prescribing high doses of DAs, (2) closely monitor DA-treated patients for signs of ICDs, (3) warn patients of the risks of DAWS, (4) taper DAs at the first sign of ICDs, and (5) closely monitor patients when tapering DAs, particularly those with ICDs. As for future directions, Dr. Nirenberg stated "the most important unanswered questions are how to reduce the risk of DAWS, and how to treat DAWS once it occurs."
Source:Weill Cornell Medical College (2010, January 12). Reducing dosage of Parkinson's drugs can cause symptoms similar to those of cocaine withdrawal. ScienceDaily. Retrieved January 13, 2010, from http://www.sciencedaily.com¬ /releases/2010/01/100111162028.htm
For the first time, researchers have defined this phenomenon, which they call dopamine agonist withdrawal syndrome, or DAWS. Led by a physician-scientist at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, the study is reported in the Jan. 11 Archives of Neurology.
"Like cocaine and methamphetamines, dopamine agonists work by stimulating the reward pathways in the brain. For this reason, it makes sense that they would engender similar withdrawal symptoms, particularly in those with high cumulative drug exposure," says senior author Dr. Melissa J. Nirenberg, associate director of the Parkinson's Disease and Movement Disorders Institute at NewYork-Presbyterian Hospital/Weill Cornell Medical Center and assistant professor of neurology and neuroscience at Weill Cornell Medical College.
Dopamine agonists are highly effective drugs that are prescribed to many Parkinson's patients to avoid side effects of the "gold standard" drug L-DOPA, particularly abnormal involuntary movements referred to as dyskinesias. (L-DOPA was perfected by Dr. George C. Cotzias of Cornell University Medical College in the late 1960s; dopamine agonists have been available since the 1990s.) DAs are also FDA-approved for treatment of restless legs syndrome, and used off-label for other conditions such as depression and fibromyalgia. In the United States, there are currently two DAs on the market -- pramipexole (Mirapex®) and ropinirole (Requip®, Requip XL®).
In recent years, there have been increasing concerns about DA side effects, and particularly the fact that they can cause uncontrolled, compulsive behaviors known as impulse control disorders (ICDs). ICDs are reported to occur in about 14 percent to 17 percent of PD patients who use these drugs, and also occur in people who use DAs to treat other medical conditions. In 2006, Dr. Nirenberg published research linking the use of DAs to compulsive eating; others have linked the drugs to behaviors such as compulsive gambling, buying, hypersexuality and Internet addiction. Patients are often unaware of these addictive behaviors, or may not discuss them with physicians because they are in denial, embarrassed by their symptoms, or unaware that they are a medication side effect.
"Impulse control disorders stemming from use of dopamine agonists can be detrimental to a patient's financial, social and physical well-being. Our research identifies another concern -- namely that some patients experience severe, even intolerable, withdrawal syndromes when their dosage is reduced. In this context, it's very important that physicians and their patients use DAs judiciously, and exercise caution when they are tapered," says Dr. Nirenberg.
Study Design and Findings
In the current study, Dr. Nirenberg and first author Christina A. Rabinak, a third-year medical student at Weill Cornell Medical College, performed a retrospective analysis of a cohort of 93 people with Parkinson's disease, of whom 40 received DAs, and 26 tapered a DA for any of a variety of reasons -- most commonly because of ICDs. Among those who tapered a DA, five patients (19 percent) experienced DAWS. Two of the subjects with DAWS recovered fully, but three of the five were unable to successfully discontinue the drug because of severe withdrawal symptoms. These three study participants are currently living with their ICDs.
The NewYork-Presbyterian/Weill Cornell researchers made several observations about DAWS:
• DAWS only occurred in patients with ICDs, and not in those who tapered DAs for other reasons. However, only one-third of patients with ICDs experienced DAWS.
• Withdrawal symptoms were only alleviated by increasing the DA dosage. Other treatments, including high doses of L-DOPA, antidepressants, tranquilizers and psychotherapy, were ineffective.
• DAWS correlated with cumulative exposure to DAs, with the most severe symptoms occurring in patients with the greatest DA exposure.
• Subjects with DAWS had milder physical disability than those without.
The Message for Patients & Physicians
"DAWS has been difficult to identify because its symptoms are 'invisible' -- mainly psychological in nature," says Dr. Nirenberg. In fact, both patients and physicians have mistaken DAWS for a mental health condition such as anxiety or depression. DAWS has also been misinterpreted as a manifestation of PD itself, or of wearing off between doses of medication -- something disproven by the fact that the symptoms are not alleviated by even very high doses of L-DOPA.
Dr. Nirenberg recommends that patients "educate themselves about DA side effects, involve family members and friends in monitoring their behavior for possible ICDs, and promptly inform their physicians if they experience ICDs or DAWS." The authors also provide specific advice for clinicians who use DAs: (1) avoid prescribing high doses of DAs, (2) closely monitor DA-treated patients for signs of ICDs, (3) warn patients of the risks of DAWS, (4) taper DAs at the first sign of ICDs, and (5) closely monitor patients when tapering DAs, particularly those with ICDs. As for future directions, Dr. Nirenberg stated "the most important unanswered questions are how to reduce the risk of DAWS, and how to treat DAWS once it occurs."
Source:Weill Cornell Medical College (2010, January 12). Reducing dosage of Parkinson's drugs can cause symptoms similar to those of cocaine withdrawal. ScienceDaily. Retrieved January 13, 2010, from http://www.sciencedaily.com¬ /releases/2010/01/100111162028.htm
Monday, January 18, 2010
Parkinson's Disease Medication Can Trigger Destructive Behaviors, Study Finds
The study below has not been conducted in the Philippines but in Mayo Clinic. Nevertheless, its applicability regarding observing the same behavior among patients receiving the same medical treatment for Parkinson's in the Philippine setting has yet to be verified.
The report is that one in six patients receiving therapeutic doses of certain drugs for Parkinson's disease develops new-onset, potentially destructive behaviors, notably compulsive gambling or hypersexuality.
The study extends findings from two Mayo case series published in 2005 that reported a connection between dopamine agonist medications and compulsive gambling or hypersexuality.
Dopamine agonists are a class of drugs that include pramipexole and ropinirole. They are commonly used to treat Parkinson's disease, but low doses also are used for restless legs syndrome. They uniquely stimulate brain limbic circuits, which are thought to be fundamental substrates for emotional, reward and hedonistic behaviors.
"The 2005 case series alerted us that something bad was happening to some unfortunate people. This study was done to assess the likelihood that this effect would happen to the average Parkinson's patient treated with these agents," says J. Michael Bostwick, M.D., Mayo Clinic psychiatrist who spearheaded the new study. It is published in the April issue of Mayo Clinic Proceedings.
The researchers analyzed the medical records of patients with Parkinson's disease residing in counties surrounding Rochester, Minn., who received their primary neurological care at Mayo Clinic in Rochester between 2004 and 2006. This group included 267 patients. Of those, 66 were taking dopamine agonists for their Parkinson's disease. Of those 66, 38 were taking the drugs in therapeutic doses (doses expected to be at least minimally beneficial).
The findings were definitive. Seven patients experiencing new-onset compulsive gambling or hypersexuality were taking dopamine agonists in therapeutic doses. None of the other Parkinson's disease patients developed compulsive gambling habits or hypersexuality, including the 28 patients on subtherapeutic dopamine agonist doses or the other 201 patients not taking dopamine agonists. None of the 178 patients treated only with the standard drug for Parkinson's disease, carbidopa/levodopa, developed these behaviors.
"It is crucial for clinicians prescribing dopamine agonists to apprise patients as well as their spouses or partners about this potential side effect. The onset can be insidious and overlooked until life-altering problems develop," says J. Eric Ahlskog, M.D., Ph.D., Mayo Clinic neurologist who co-authored and treated many of the patients in the 2005 study. "It also is worth noting that the affected patients were all taking therapeutic doses. Very low doses, such as those used to treat restless legs syndrome, carry much less risk."
"For some patients, a reduction in the dose of the dopamine agonist may prove to be sufficient treatment," says Dr. Ahlskog, "although total elimination of the offending drug is often necessary."
Source: Mayo Clinic (2009, April 10). Parkinson's Disease Medication Can Trigger Destructive Behaviors, Study Finds. ScienceDaily. Retrieved January 13, 2010, from http://www.sciencedaily.com¬ /releases/2009/04/090408145346.htm
The report is that one in six patients receiving therapeutic doses of certain drugs for Parkinson's disease develops new-onset, potentially destructive behaviors, notably compulsive gambling or hypersexuality.
The study extends findings from two Mayo case series published in 2005 that reported a connection between dopamine agonist medications and compulsive gambling or hypersexuality.
Dopamine agonists are a class of drugs that include pramipexole and ropinirole. They are commonly used to treat Parkinson's disease, but low doses also are used for restless legs syndrome. They uniquely stimulate brain limbic circuits, which are thought to be fundamental substrates for emotional, reward and hedonistic behaviors.
"The 2005 case series alerted us that something bad was happening to some unfortunate people. This study was done to assess the likelihood that this effect would happen to the average Parkinson's patient treated with these agents," says J. Michael Bostwick, M.D., Mayo Clinic psychiatrist who spearheaded the new study. It is published in the April issue of Mayo Clinic Proceedings.
The researchers analyzed the medical records of patients with Parkinson's disease residing in counties surrounding Rochester, Minn., who received their primary neurological care at Mayo Clinic in Rochester between 2004 and 2006. This group included 267 patients. Of those, 66 were taking dopamine agonists for their Parkinson's disease. Of those 66, 38 were taking the drugs in therapeutic doses (doses expected to be at least minimally beneficial).
The findings were definitive. Seven patients experiencing new-onset compulsive gambling or hypersexuality were taking dopamine agonists in therapeutic doses. None of the other Parkinson's disease patients developed compulsive gambling habits or hypersexuality, including the 28 patients on subtherapeutic dopamine agonist doses or the other 201 patients not taking dopamine agonists. None of the 178 patients treated only with the standard drug for Parkinson's disease, carbidopa/levodopa, developed these behaviors.
"It is crucial for clinicians prescribing dopamine agonists to apprise patients as well as their spouses or partners about this potential side effect. The onset can be insidious and overlooked until life-altering problems develop," says J. Eric Ahlskog, M.D., Ph.D., Mayo Clinic neurologist who co-authored and treated many of the patients in the 2005 study. "It also is worth noting that the affected patients were all taking therapeutic doses. Very low doses, such as those used to treat restless legs syndrome, carry much less risk."
"For some patients, a reduction in the dose of the dopamine agonist may prove to be sufficient treatment," says Dr. Ahlskog, "although total elimination of the offending drug is often necessary."
Source: Mayo Clinic (2009, April 10). Parkinson's Disease Medication Can Trigger Destructive Behaviors, Study Finds. ScienceDaily. Retrieved January 13, 2010, from http://www.sciencedaily.com¬ /releases/2009/04/090408145346.htm
Sunday, January 17, 2010
Dopamine Medications for Parkinson's Disease
The ‘Gold-standard’ treatment for Parkinson’s Disease (PD) is medication or drug therapy. Virtually all of the available drug therapies act to increase the level of dopamine in the brain. The way in which a given drug accomplishes this feat has a lot to do with the effectiveness of the drug and with potential side-effects of the drug.
Levodopa
Levodopa is the ‘first-line’ medicine for PD. It is a building block in the process that brain cells use to manufacture dopamine. Cells can use this building block to manufacture more dopamine. Levodopa works. It practically normalizes motor symptoms making you feel less stiff, more mobile and more flexible. Unfortunately it does not cure PD and cannot stop the underlying disease process itself.
Levodopa also has side effects. These side effects, however, can usually be eliminated by combining levodopa with other additional drugs. One major side effect of levodopa when used alone is nausea. When there is too much dopamine circulating in the body’s blood stream instead of in the brain, nausea is the result. To prevent this nausea and to enhance the amount of levodopa reaching the brain, levodopa is often given with another drug type called a dopa decarboxylase inhibitor (DDI). A DDI blocks the conversion of levodopa to dopamine in the body’s bloodstream thus allowing more levodopa to reach the brain and preventing nausea.
The most common form of DDI used in most countries is Carbidopa. The combination of levodopa and carbidopa is known by the trade name Sinemet.
Benserazide (Prolopa of Madopar) is the DDI used in Canada and Europe.
In most countries carbidopa/levodopa dosage levels are designated as a fraction: the numerator is the amount of carbidopa in each tablet, and the denominator the amount of levodopa. For example, a combination of 25/100 is composed of 25 milligrams of carbidopa and 100 milligrams of levodopa. Carbidopa/levodopa is also available in a controlled-release formulation known as Sinemet CR. The controlled-release formulations of Sinemet allow for a slower release-time of levodopa into the bloodstream, which helps to smooth out end-of-dose wearing-off fluctuations as well as nighttime sleep disturbances.
Other Dopamine Drugs
Although levodopa effectively treats the symptoms of the disease, the disease nevertheless still progresses and gets worse over time. The disease damages brain cells, neurons, that manufacture dopamine or that convert levodopa to dopamine. As the disease progresses it gets more and more difficult to stimulate the brain production of dopamine. We therefore need alternative ways of keeping brain dopamine levels high enough to support normal motor functioning.
Since dopamine production cells are damaged by the disease we must target other cells that may not produce dopamine but act to use existing dopamine more effectively. Two classes of drugs can do this: drugs that directly stimulate cells that use dopamine--the ‘dopamine agonists’ and drugs that inhibit the breakdown of dopamine in the body and thus increase the levels available to the brain--the ‘COMT and MAO inhibitors’.
Dopamine Agonists
There are several dopamine agonists- Bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip). Less widely used agonists include lisuride and cabergoline. All of these agonist drugs mimic the effects of dopamine at selected dopamine ‘receptors’. Receptors are cells that enhance the effects of dopamine in the brain.
There are five types of dopamine receptors in the brain, called D1, D2, D3, D4, and D5. The D2 receptor is most important for the motor symptoms of PD so all of the dopamine agonist drugs stimulate D2. Pramipexole and ropinirole, in addition, stimulate D3 receptors. Because the D3 receptor is involved in mood, personality and emotion, pramipexole and ropinirole may affect mood as well as motor symptoms.
All the dopamine agonist drugs can produce side effects like dizziness, low blood pressure, and psychiatric disturbances so they must be started as a very low dosage, and only gradually increased.
COMT Inhibitors and MAO Inhibitors
The COMT (catechol-O-methyltransferase) inhibitors and MAO-B (monoamine oxidase type B) inhibitors work to block the breakdown and inactivation of dopamine in the body and brain. If COMT is blocked or inhibited, for example, more levodopa can reach the brain’s motor control system. The most common COMT inhibitors are tolcapone (Tasmar) and entacapone (Comtan). COMT inhibitors are particularly helpful for people with motor fluctuations.
But they have side effects. Five to ten percent of patients taking a COMT inhibitor develop diarrhea. This usually means the drug must be stopped. Two to three percent of people taking tolcapone develop serious liver problems requiring close monitoring of liver function when on the drug or cessation of use of the drug entirely. Entacapone does not have these liver toxicity problems.
The MAO-B inhibitors, such as selegiline (Eldepryl) and rasagiline (Azilect), prevent the enzyme MAO-B from breaking down dopamine in the brain itself.
Selegiline is used primarily to prevent or smooth out end of dose motor fluctuations. Its effects are very mild. Selegiline was once believed to act as a neuroprotective drug preventing further damage to dopamine neurons in the brain. It turns out that this neuroprotective effect of selegiline is small or non-existent.
Rasagiline (Azilect), on the other hand, looks to be more promising with respect to its potential neuroprotective effects-though the jury is still out on this crucial effect of the drug. Rasagiline is mostly used in early and moderate Parkinson’s to reduce motor fluctuations. More evidence on rasagiline’s effectiveness and safety is needed.
Source:http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601068.html
Levodopa
Levodopa is the ‘first-line’ medicine for PD. It is a building block in the process that brain cells use to manufacture dopamine. Cells can use this building block to manufacture more dopamine. Levodopa works. It practically normalizes motor symptoms making you feel less stiff, more mobile and more flexible. Unfortunately it does not cure PD and cannot stop the underlying disease process itself.
Levodopa also has side effects. These side effects, however, can usually be eliminated by combining levodopa with other additional drugs. One major side effect of levodopa when used alone is nausea. When there is too much dopamine circulating in the body’s blood stream instead of in the brain, nausea is the result. To prevent this nausea and to enhance the amount of levodopa reaching the brain, levodopa is often given with another drug type called a dopa decarboxylase inhibitor (DDI). A DDI blocks the conversion of levodopa to dopamine in the body’s bloodstream thus allowing more levodopa to reach the brain and preventing nausea.
The most common form of DDI used in most countries is Carbidopa. The combination of levodopa and carbidopa is known by the trade name Sinemet.
Benserazide (Prolopa of Madopar) is the DDI used in Canada and Europe.
In most countries carbidopa/levodopa dosage levels are designated as a fraction: the numerator is the amount of carbidopa in each tablet, and the denominator the amount of levodopa. For example, a combination of 25/100 is composed of 25 milligrams of carbidopa and 100 milligrams of levodopa. Carbidopa/levodopa is also available in a controlled-release formulation known as Sinemet CR. The controlled-release formulations of Sinemet allow for a slower release-time of levodopa into the bloodstream, which helps to smooth out end-of-dose wearing-off fluctuations as well as nighttime sleep disturbances.
Other Dopamine Drugs
Although levodopa effectively treats the symptoms of the disease, the disease nevertheless still progresses and gets worse over time. The disease damages brain cells, neurons, that manufacture dopamine or that convert levodopa to dopamine. As the disease progresses it gets more and more difficult to stimulate the brain production of dopamine. We therefore need alternative ways of keeping brain dopamine levels high enough to support normal motor functioning.
Since dopamine production cells are damaged by the disease we must target other cells that may not produce dopamine but act to use existing dopamine more effectively. Two classes of drugs can do this: drugs that directly stimulate cells that use dopamine--the ‘dopamine agonists’ and drugs that inhibit the breakdown of dopamine in the body and thus increase the levels available to the brain--the ‘COMT and MAO inhibitors’.
Dopamine Agonists
There are several dopamine agonists- Bromocriptine (Parlodel), pergolide (Permax), pramipexole (Mirapex) and ropinirole (Requip). Less widely used agonists include lisuride and cabergoline. All of these agonist drugs mimic the effects of dopamine at selected dopamine ‘receptors’. Receptors are cells that enhance the effects of dopamine in the brain.
There are five types of dopamine receptors in the brain, called D1, D2, D3, D4, and D5. The D2 receptor is most important for the motor symptoms of PD so all of the dopamine agonist drugs stimulate D2. Pramipexole and ropinirole, in addition, stimulate D3 receptors. Because the D3 receptor is involved in mood, personality and emotion, pramipexole and ropinirole may affect mood as well as motor symptoms.
All the dopamine agonist drugs can produce side effects like dizziness, low blood pressure, and psychiatric disturbances so they must be started as a very low dosage, and only gradually increased.
COMT Inhibitors and MAO Inhibitors
The COMT (catechol-O-methyltransferase) inhibitors and MAO-B (monoamine oxidase type B) inhibitors work to block the breakdown and inactivation of dopamine in the body and brain. If COMT is blocked or inhibited, for example, more levodopa can reach the brain’s motor control system. The most common COMT inhibitors are tolcapone (Tasmar) and entacapone (Comtan). COMT inhibitors are particularly helpful for people with motor fluctuations.
But they have side effects. Five to ten percent of patients taking a COMT inhibitor develop diarrhea. This usually means the drug must be stopped. Two to three percent of people taking tolcapone develop serious liver problems requiring close monitoring of liver function when on the drug or cessation of use of the drug entirely. Entacapone does not have these liver toxicity problems.
The MAO-B inhibitors, such as selegiline (Eldepryl) and rasagiline (Azilect), prevent the enzyme MAO-B from breaking down dopamine in the brain itself.
Selegiline is used primarily to prevent or smooth out end of dose motor fluctuations. Its effects are very mild. Selegiline was once believed to act as a neuroprotective drug preventing further damage to dopamine neurons in the brain. It turns out that this neuroprotective effect of selegiline is small or non-existent.
Rasagiline (Azilect), on the other hand, looks to be more promising with respect to its potential neuroprotective effects-though the jury is still out on this crucial effect of the drug. Rasagiline is mostly used in early and moderate Parkinson’s to reduce motor fluctuations. More evidence on rasagiline’s effectiveness and safety is needed.
Source:http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601068.html
Complementary and Alternative Medicine Therapies for Parkinson’s Disease
CAM Therapies
Complementary and alternative medicine or CAM is a name given to a range of therapies that are more often practiced in eastern than in western countries, such as acupuncture. Acupuncture has been practiced for centuries in China. In the past few decades, several scientific investigations have established that certain forms of needle acupuncture can trigger release of the body's natural opioids and other chemicals that may help with healing. Studies on meditation and relaxation, massage therapy, yoga and Tai Chi have also shown that they can have positive impact if delivered by well-trained practitioners.
In 1998, the National Institute of Health (NIH) established the National Center for Complementary and Alternative Medicines (NCCAM) in order to boost research into these therapies to see if they can work -- because lots of people were spending money on these therapies, even though it was unclear if they worked. The good news is that several CAM therapies appear to have significant (better than placebo) and positive effects on health.
Choosing a CAM Therapy and a Practitioner
• To help you choose a CAM therapy that is right for you, talk with your neurologist and make sure that the therapy in question poses no undue risks to you.
• NEVER listen to any CAM therapist who tells you that levodopa is toxic or that Parkinson’s disease can be cured via their therapy.
• Make sure that the therapist is a licensed, certified practitioner and that the license is obtained from a reputable source.
• Ask the therapist if your health insurance will help cover the costs. Many therapists have to present educational and training credentials to insurance companies before the insurance companies will cover their clients. Always prefer therapies that are covered by insurance, it both keeps your costs down and it helps establish the legitimacy of the therapist.
• Ask the therapist about the risks associated with the treatment and how those risks will be minimized in your case.
• Ask the therapist how many treatment sessions are necessary before you can expect to feel positive results.
If you do not receive satisfactory answers to these questions, or if the therapist can present no credentials then it may be wise to seek an alternative therapist.
Acupuncture
During acupuncture, sterile needles (about the size of a human hair) are inserted into various regions of the body, like the earlobe, the back, the buttocks and the legs in order to re-balance "energy flows" in the body. Usually several treatment sessions are required lasting anywhere from a half hour to an hour. After the needles are put into place the therapist turns on some relaxing music and leaves the room. You then relax and allow the needles to do their work. After a few minutes the needles are removed and that’s it.
To date, only a single study has evaluated effects of acupuncture on Parkinson's disease and that study found no improvement of motor or mood symptoms in the 20 patients who had the treatments. These same patients, however, reported that they felt a bit better and slept a bit better.
Massage Therapies
Common sense suggests that if you feel stiffness, pain and rigidity in your muscles, massage will help. It is no wonder then that many people with PD utilize various forms of massage therapy to relieve some of their symptoms. Most often this use of massage therapy is supported by PD specialists as long as the massage therapist is a trained and certified therapist.
There are many forms of massage therapy including Swedish massage, neuromuscular therapy, Shiatsu, acupressure, craniosacral therapy and many others besides. To date only neuromuscular therapy (NMT) has been assessed with adequately controlled experimental designs. NMT focuses on manipulating "trigger points" in the body -- places in muscle tissue that have become "knots" and painful discomfort. These trigger points are gently massaged until they dissolve away. The good news is that the available evidence suggests that NMT appears to have significant beneficial effects on both motor and non-motor symptoms of PD. All of the other forms of massage therapy have been assessed in less rigorous ways but they too generally show significant positive impact on PD symptoms.
How does massage work? It very likely makes you feel good to start with. This "feel good" effect alone may boost your mood and relieve muscle tension. Massage can also increase blood supply to your muscles and increase your range of motion in those muscles thus decreasing rigidity in those muscle groups.
Don’t be deterred by the expense involved in massage therapy if it helps you. More and more therapeutic massage is being covered by insurance –- especially if your doctor prescribes it as medically necessary.
Relaxation and Meditation Techniques
Living with PD can be stressful and with time, it can become more difficult to find ways to relax. Studies show that one way to relax is to actively attempt to do so by setting aside 20 minutes per day to just sit, watch your breath and then just let your mind wander. When you find your attention wandering just smile and bring it back to your breath…and that’s all you need to do each day.
You can add more intense relaxation exercises to these meditation sittings by simply turning your attention away from your breath and onto one body region at a time. Many persons with PD find it valuable to listen to "guided relaxation" tapes or CDs. Here the guide walks you through relaxation of one muscle group after another until your whole body has received attention and is relaxed.
Here are some other tips that may be helpful to you in your relaxation and meditation exercises:
• Make relaxation and meditation a daily practice. 20 minutes each day without worrying about getting it "right"…just put in the time each day and your body will soon respond
• Select a form of meditation that fits your fundamental beliefs. A Christian might visualize sitting in the presence of Jesus while an atheist might visualize sitting on a quiet sunlit beach…find an image that works for you, that gives you a sense of peace and well-being and then just bask in it.
• Use a "mantra," or a short phrase, that has some spiritual content that you repeat over and over again, while you sit and breathe. Again choose a mantra that fits with your fundamental beliefs and that gives you comfort. A religious person might just repeat “Lord” over and over again, while an atheist might repeat “calm” over and over again.
Chinese Martial Arts
One of the major problems for people with PD is postural instability. If you have difficulty maintaining your balance you might fall and hurt yourself. Strengthening your muscles through exercise can offset some of the postural problems associated with PD. Adding some training in Chinese martial arts techniques, in addition to your regular exercise regimen, may help you to better compensate for these postural problems AND strengthen your muscles more generally.
Always check with your doctor before you attempt any of these martial arts training programs.
T’ai Chi Chuan (TCC)
TCC combines aspects of aerobic exercise and measured breathing with slow, dance-like movements derived from self-defense moves. The best way to learn TCC and related arts (like QiGong) is to learn it from a trained professional. There are now many Chinese martial arts centers in the major cities. Just make sure that your trainer has some certifications in the practice before signing on with him. To date studies have not shown significant motor benefits in Western PD patients as the techniques take so long to learn. But non-westerners and Chinese patients, who have been exposed to these martial arts programs for many years may derive more benefit. The jury is still out on these programs with respect to benefits for people with PD.
Yoga
Yoga exercise classes are now available in every major city in the West and probably in the East as well. To date no controlled studies of yoga for PD have been published. But it is possible that low-impact forms of Yoga may be helpful for PD. Yoga as taught in the West typically involves learning a series of body postures that allow for stretching and relaxing muscle groups. Yoga also involves spiritual and meditative exercises as well as attention to breath.
As will all the other CAM therapies, find a practitioner who is certified in the yoga therapy he or she is offering. Ask him or her to modify the traditional yoga postures to accommodate your limitations.
Complementary and alternative medicine or CAM is a name given to a range of therapies that are more often practiced in eastern than in western countries, such as acupuncture. Acupuncture has been practiced for centuries in China. In the past few decades, several scientific investigations have established that certain forms of needle acupuncture can trigger release of the body's natural opioids and other chemicals that may help with healing. Studies on meditation and relaxation, massage therapy, yoga and Tai Chi have also shown that they can have positive impact if delivered by well-trained practitioners.
In 1998, the National Institute of Health (NIH) established the National Center for Complementary and Alternative Medicines (NCCAM) in order to boost research into these therapies to see if they can work -- because lots of people were spending money on these therapies, even though it was unclear if they worked. The good news is that several CAM therapies appear to have significant (better than placebo) and positive effects on health.
Choosing a CAM Therapy and a Practitioner
• To help you choose a CAM therapy that is right for you, talk with your neurologist and make sure that the therapy in question poses no undue risks to you.
• NEVER listen to any CAM therapist who tells you that levodopa is toxic or that Parkinson’s disease can be cured via their therapy.
• Make sure that the therapist is a licensed, certified practitioner and that the license is obtained from a reputable source.
• Ask the therapist if your health insurance will help cover the costs. Many therapists have to present educational and training credentials to insurance companies before the insurance companies will cover their clients. Always prefer therapies that are covered by insurance, it both keeps your costs down and it helps establish the legitimacy of the therapist.
• Ask the therapist about the risks associated with the treatment and how those risks will be minimized in your case.
• Ask the therapist how many treatment sessions are necessary before you can expect to feel positive results.
If you do not receive satisfactory answers to these questions, or if the therapist can present no credentials then it may be wise to seek an alternative therapist.
Acupuncture
During acupuncture, sterile needles (about the size of a human hair) are inserted into various regions of the body, like the earlobe, the back, the buttocks and the legs in order to re-balance "energy flows" in the body. Usually several treatment sessions are required lasting anywhere from a half hour to an hour. After the needles are put into place the therapist turns on some relaxing music and leaves the room. You then relax and allow the needles to do their work. After a few minutes the needles are removed and that’s it.
To date, only a single study has evaluated effects of acupuncture on Parkinson's disease and that study found no improvement of motor or mood symptoms in the 20 patients who had the treatments. These same patients, however, reported that they felt a bit better and slept a bit better.
Massage Therapies
Common sense suggests that if you feel stiffness, pain and rigidity in your muscles, massage will help. It is no wonder then that many people with PD utilize various forms of massage therapy to relieve some of their symptoms. Most often this use of massage therapy is supported by PD specialists as long as the massage therapist is a trained and certified therapist.
There are many forms of massage therapy including Swedish massage, neuromuscular therapy, Shiatsu, acupressure, craniosacral therapy and many others besides. To date only neuromuscular therapy (NMT) has been assessed with adequately controlled experimental designs. NMT focuses on manipulating "trigger points" in the body -- places in muscle tissue that have become "knots" and painful discomfort. These trigger points are gently massaged until they dissolve away. The good news is that the available evidence suggests that NMT appears to have significant beneficial effects on both motor and non-motor symptoms of PD. All of the other forms of massage therapy have been assessed in less rigorous ways but they too generally show significant positive impact on PD symptoms.
How does massage work? It very likely makes you feel good to start with. This "feel good" effect alone may boost your mood and relieve muscle tension. Massage can also increase blood supply to your muscles and increase your range of motion in those muscles thus decreasing rigidity in those muscle groups.
Don’t be deterred by the expense involved in massage therapy if it helps you. More and more therapeutic massage is being covered by insurance –- especially if your doctor prescribes it as medically necessary.
Relaxation and Meditation Techniques
Living with PD can be stressful and with time, it can become more difficult to find ways to relax. Studies show that one way to relax is to actively attempt to do so by setting aside 20 minutes per day to just sit, watch your breath and then just let your mind wander. When you find your attention wandering just smile and bring it back to your breath…and that’s all you need to do each day.
You can add more intense relaxation exercises to these meditation sittings by simply turning your attention away from your breath and onto one body region at a time. Many persons with PD find it valuable to listen to "guided relaxation" tapes or CDs. Here the guide walks you through relaxation of one muscle group after another until your whole body has received attention and is relaxed.
Here are some other tips that may be helpful to you in your relaxation and meditation exercises:
• Make relaxation and meditation a daily practice. 20 minutes each day without worrying about getting it "right"…just put in the time each day and your body will soon respond
• Select a form of meditation that fits your fundamental beliefs. A Christian might visualize sitting in the presence of Jesus while an atheist might visualize sitting on a quiet sunlit beach…find an image that works for you, that gives you a sense of peace and well-being and then just bask in it.
• Use a "mantra," or a short phrase, that has some spiritual content that you repeat over and over again, while you sit and breathe. Again choose a mantra that fits with your fundamental beliefs and that gives you comfort. A religious person might just repeat “Lord” over and over again, while an atheist might repeat “calm” over and over again.
Chinese Martial Arts
One of the major problems for people with PD is postural instability. If you have difficulty maintaining your balance you might fall and hurt yourself. Strengthening your muscles through exercise can offset some of the postural problems associated with PD. Adding some training in Chinese martial arts techniques, in addition to your regular exercise regimen, may help you to better compensate for these postural problems AND strengthen your muscles more generally.
Always check with your doctor before you attempt any of these martial arts training programs.
T’ai Chi Chuan (TCC)
TCC combines aspects of aerobic exercise and measured breathing with slow, dance-like movements derived from self-defense moves. The best way to learn TCC and related arts (like QiGong) is to learn it from a trained professional. There are now many Chinese martial arts centers in the major cities. Just make sure that your trainer has some certifications in the practice before signing on with him. To date studies have not shown significant motor benefits in Western PD patients as the techniques take so long to learn. But non-westerners and Chinese patients, who have been exposed to these martial arts programs for many years may derive more benefit. The jury is still out on these programs with respect to benefits for people with PD.
Yoga
Yoga exercise classes are now available in every major city in the West and probably in the East as well. To date no controlled studies of yoga for PD have been published. But it is possible that low-impact forms of Yoga may be helpful for PD. Yoga as taught in the West typically involves learning a series of body postures that allow for stretching and relaxing muscle groups. Yoga also involves spiritual and meditative exercises as well as attention to breath.
As will all the other CAM therapies, find a practitioner who is certified in the yoga therapy he or she is offering. Ask him or her to modify the traditional yoga postures to accommodate your limitations.
A Balanced Diet in Parkinson's Disease
While no diets have been proven to alleviate the symptoms of Parkinson's disease (PD), there are also no special dietary restrictions. Remember to always check with your healthcare provider before changing your diet.
A healthy diet is important.
It's particularly important to stay active and energetic if you have Parkinson's disease. Eat a variety of foods from every major food group, including fruits and vegetables, grains, dairy products, meat, fish, poultry, and beans.
A balanced diet can keep you healthy and help manage digestion. This is important because PD can affect the muscles and nerves that control the digestive process. People with Parkinson's disease sometimes experience problems including constipation and gastroparesis (slowing of the muscles that help move food through the stomach and intestines).
Additionally, certain foods can slow digestion and delay, or reduce the amount of levodopa that your body can use. This can cause your treatment to work less effectively.
Try these tips for eating a balanced diet, managing digestive problems, and maintaining an effective treatment plan:
• Eat meals at the same time every day
• Include high-fiber foods like whole grain breads and cereals, fruits and vegetables, and beans
• Drink plenty of fluids throughout the day
• Avoid caffeine and alcohol; they act as diuretics and can aggravate constipation
• Manage your protein intake. High protein foods may lessen your body's ability to absorb levodopa
• Avoid iron salts (usually found in multi-vitamin tablets), they may reduce the amount of levodopa in your body
A healthy diet is important.
It's particularly important to stay active and energetic if you have Parkinson's disease. Eat a variety of foods from every major food group, including fruits and vegetables, grains, dairy products, meat, fish, poultry, and beans.
A balanced diet can keep you healthy and help manage digestion. This is important because PD can affect the muscles and nerves that control the digestive process. People with Parkinson's disease sometimes experience problems including constipation and gastroparesis (slowing of the muscles that help move food through the stomach and intestines).
Additionally, certain foods can slow digestion and delay, or reduce the amount of levodopa that your body can use. This can cause your treatment to work less effectively.
Try these tips for eating a balanced diet, managing digestive problems, and maintaining an effective treatment plan:
• Eat meals at the same time every day
• Include high-fiber foods like whole grain breads and cereals, fruits and vegetables, and beans
• Drink plenty of fluids throughout the day
• Avoid caffeine and alcohol; they act as diuretics and can aggravate constipation
• Manage your protein intake. High protein foods may lessen your body's ability to absorb levodopa
• Avoid iron salts (usually found in multi-vitamin tablets), they may reduce the amount of levodopa in your body
Sunday, January 3, 2010
Diet in Early Stages of Parkinson's Disease
Patrick Namara, Ph.D., has given the following dietary tips for patients with Parkinson's Disease.
Foods like spinach, nuts, and vegetables contain nutrients that may help reduce the loss of dopamine producing neurons.
In the early stages of Parkinson's disease (PD), no special dietary changes are typically required. However, one may want to increase the intake of foods rich in antioxidants. Antioxidants are those chemicals that scavenge and eat-up so-called ‘free radicals’ –- tiny molecules that circulate in your tissues and damage those tissues. Free radicals have a special affinity for cells that produce dopamine. So the greater the number of antioxidants in the system, the fewer the number of circulating free radicals. Theoretically that should reduce the rate of loss of dopamine cells over time.
So what foods contain a lot of antioxidants? Fruits and vegetables -- especially the darkly colored fruits and vegetables. Some examples include leafy green vegetables (such as spinach), broccoli, tomatoes, carrots, garlic, red kidney beans, pinto beans, blueberries, cranberries, strawberries, plums and apples. Tea -- especially green tea and black tea -- contains a lot of antioxidants. Red wine contains antioxidants. Dark juices like pomegranate and blueberry juices are rich in antioxidants.
Omega-3 fatty acids are an essential nutrient for most tissues in the body so one may want to make sure to consume adequate amounts of these nutrients. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is probably a good idea to add fish to the diet if one is not already eating fish on a regular basis.
There is also a need to get adequate sources of calcium, magnesium, and vitamins D and K to strengthen skin and bone. One can usually obtain these nutrients from dairy products like yogurt and milk. A person need some amount of sunlight to get enough vitamin D
Here are some ways to include these healthy foods in one's diet:
• Blueberries, raspberries and blackberries can be stirred into vanilla yogurt for a delicious dessert. Or they can be blended with fat-free yogurt and ice in a blender to make a smoothie. Fruit smoothies can also help prevent the constipation associated with some PD medications.
• Spinach may be combined with foods such as salad or rice or scrambled eggs. These combinations are better than any of the stand alone alternatives. One may stir chopped, fresh spinach, tossed in olive oil into salads or into steamed brown rice. One may also sometimes add raisins to that rice and spinach dish.
• Carrots are loaded with a potent antioxidant called beta-carotene. Cooked, steamed or pureed carrots liberate the antioxidants or somehow make them easier to absorb. Cooked carrots are often more tasty as well. The carrots may be steamed and then slowly cooked in the juices of whatever meat dish one is having.
• Vitamin E is a potent antioxidant and is found in some nuts in whole grains. Although studies on the anti-PD effects of vitamin E have yielded only discouraging or mixed results vitamin E should nevertheless be a part of ones diet. Most of the vitamin E are from whole grains. One may cook and steam some whole grain like brown rice, cous cous or bulgur wheat. Then one may add items like raisins or cranberries, chopped parsley or spinach, and olive oil.
Sources:
Weiner, W. J., Shulman, L.M. and Lang, A. E. (2007). Parkinsons Disease, Second Edition, A Complete guide for patients and families. Johns Hopkins Press Book, Baltimore.
Marczewska A, De Notaris R, Sieri S, Barichella M, Fusconi E, Pezzoli G. Protein intake in Parkinsonian patients using the EPIC food frequency questionnaire. Movement Disorder. 2006 Aug;21(8):1229-31.
Foods like spinach, nuts, and vegetables contain nutrients that may help reduce the loss of dopamine producing neurons.
In the early stages of Parkinson's disease (PD), no special dietary changes are typically required. However, one may want to increase the intake of foods rich in antioxidants. Antioxidants are those chemicals that scavenge and eat-up so-called ‘free radicals’ –- tiny molecules that circulate in your tissues and damage those tissues. Free radicals have a special affinity for cells that produce dopamine. So the greater the number of antioxidants in the system, the fewer the number of circulating free radicals. Theoretically that should reduce the rate of loss of dopamine cells over time.
So what foods contain a lot of antioxidants? Fruits and vegetables -- especially the darkly colored fruits and vegetables. Some examples include leafy green vegetables (such as spinach), broccoli, tomatoes, carrots, garlic, red kidney beans, pinto beans, blueberries, cranberries, strawberries, plums and apples. Tea -- especially green tea and black tea -- contains a lot of antioxidants. Red wine contains antioxidants. Dark juices like pomegranate and blueberry juices are rich in antioxidants.
Omega-3 fatty acids are an essential nutrient for most tissues in the body so one may want to make sure to consume adequate amounts of these nutrients. Fatty fish like mackerel, lake trout, herring, sardines, albacore tuna and salmon are high in two kinds of omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It is probably a good idea to add fish to the diet if one is not already eating fish on a regular basis.
There is also a need to get adequate sources of calcium, magnesium, and vitamins D and K to strengthen skin and bone. One can usually obtain these nutrients from dairy products like yogurt and milk. A person need some amount of sunlight to get enough vitamin D
Here are some ways to include these healthy foods in one's diet:
• Blueberries, raspberries and blackberries can be stirred into vanilla yogurt for a delicious dessert. Or they can be blended with fat-free yogurt and ice in a blender to make a smoothie. Fruit smoothies can also help prevent the constipation associated with some PD medications.
• Spinach may be combined with foods such as salad or rice or scrambled eggs. These combinations are better than any of the stand alone alternatives. One may stir chopped, fresh spinach, tossed in olive oil into salads or into steamed brown rice. One may also sometimes add raisins to that rice and spinach dish.
• Carrots are loaded with a potent antioxidant called beta-carotene. Cooked, steamed or pureed carrots liberate the antioxidants or somehow make them easier to absorb. Cooked carrots are often more tasty as well. The carrots may be steamed and then slowly cooked in the juices of whatever meat dish one is having.
• Vitamin E is a potent antioxidant and is found in some nuts in whole grains. Although studies on the anti-PD effects of vitamin E have yielded only discouraging or mixed results vitamin E should nevertheless be a part of ones diet. Most of the vitamin E are from whole grains. One may cook and steam some whole grain like brown rice, cous cous or bulgur wheat. Then one may add items like raisins or cranberries, chopped parsley or spinach, and olive oil.
Sources:
Weiner, W. J., Shulman, L.M. and Lang, A. E. (2007). Parkinsons Disease, Second Edition, A Complete guide for patients and families. Johns Hopkins Press Book, Baltimore.
Marczewska A, De Notaris R, Sieri S, Barichella M, Fusconi E, Pezzoli G. Protein intake in Parkinsonian patients using the EPIC food frequency questionnaire. Movement Disorder. 2006 Aug;21(8):1229-31.
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