Most of us have seen someone with Parkinson's disease. Typically people with the disorder have a tremor in one hand or arm; the appendage often seems to be moving with a mind of its own. Sometimes facial muscles may seem rigid or those with Parkinson's may have a lot of trouble initiating walking. And the disorder is very common, affecting about 1 million people in the US alone, with perhaps 4 million worldwide. More men than women develop Parkinson's.
Turns out that while the muscle effects, or so called 'motor symptoms' of Parkinson's disease are very troublesome, most people with the disorder are more bothered by the other constellation of accompanying problems, or so called 'nonmotor' symptoms. Treatment of nonmotor symptoms of Parkinson's disease in this issue of Neurology chronicles these and discusses their management.
High on the list for men with the disorder is erectile dysfunction, and this can be managed effectively for many with sildenafil or its cousins. For people who have trouble sleeping use of levodopa/carbodopa seems to help. This may make sense since Parkinson's disease arises because of the destruction of nerve cells or neurons that produce a chemical to help nerve cells communicate called dopamine. These drugs may also help with restless legs syndrome or RLS, where an irresistible urge to move one's legs while trying to sleep is also problematic and may affect those with Parkinson's disease. Some report that use of the supplement melatonin aids in the sleep issue.
The review concludes that for many of the other problems people with Parkinson's report, including depression, excessive daytime sleepiness, and low blood pressure when rising from a reclining position, known in medicalese as 'orthostatic hypotension' there is insufficient evidence to recommend a specific treatment but clinicians might try a number of possibilities and see if they help. Rick and I agree that the review underscores the need for people with Parkinson's disease to express problems other than the muscle issues to their physician. Greater awareness of the range of troublesome conditions affecting folks with Parkinson's disease will lead to develop of more effective, evidence-based management strategies.
Other topics in this week's podcast include personal identification possible using bacteria on hands from the Proceedings of the National Academy of Sciences (PNAS), and neither tighter blood pressure or lipid control seem to help people with diabetes avoid complications of cardiovascular disease such as heart attacks or strokes (meeting brief to be published). Until next week, y'all live well.
Thanks for this great blog! I just wanted to chime in with one thing:
ReplyDeleteIf they have orthostatic hypotension and Parkinsonian symptoms, then the diagnosis of Multisystem Atrophy (previously known as Shy-Drager syndrome)ought to be entertained, especially if there is a significant history of falls and ataxia.
http://emedicine.medscape.com/article/1154583-overview
An excellent point!
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