DIAGNOSING AND TREATMENT OF PARKINSON’S DISEASE

Friday, March 27, 2009 5:33

How Is Parkinson’s Disease Diagnosed? Your physician should be aware that some medications precipitate or aggravate Parkinson’s disease. A careful history and physical examination is usually required to confirm the diagnosis. Your physician should watch you walk, turn, and get out of a chair. He should also feel the way your arms move as he pushes them back and forth. If you have Parkinson’s disease, he can feel that the muscles are intermittently stiff when they are moved. This is usually sufficient to make a diagnosis. There is no laboratory test to diagnose this illness.

How Is Parkinson’s Disease Treated? Some major advances in the treatment of Parkinson’s disease have been made. With medications such as levodopa or levodopa-carbidopa, most people can expect notable improvement in their function. Other effective medications, such as bromocriptine and amantadine, taken alone or in combination, can also be prescribed. If your illness is not recognized and treated, you might become markedly disabled. This is a great shame when a few tablets a day might allow you to remain active.

For example, recently I saw an elderly immigrant from the Soviet Union. She had experienced difficulty in walking for many years and was told that it was because of her age. After she fell and fractured her hip, surgery was not done because she was considered “too old” and unable to walk anyway.

I found that she suffered from severe Parkinson’s disease. She showed excellent improvement after being treated with medications. Even with the poorly healed hip, she was able to walk with the assistance of a walker by the time she was discharged from the hospital.

Some people may not be able to tolerate some antiparkinson drugs, which can cause mental agitation and nightmares. There may also be a lowering of blood pressure or abnormal heart rhythms. A few patients are so sensitive that very small doses can cause involuntary shaking movements. These tremors usually do not interfere with walking and are often preferable to the stiffness that occurs when the medication is discontinued.

If you cannot tolerate the medication, it should be stopped, then started again in a smaller dose, and increased very gradually. Sometimes a different drug can be substituted. Fortunately, there are very few people with Parkinson’s disease who cannot take any of the medications at all in the early stages of the disease. Later on, some people cannot tolerate antiparkinson medication because of the side effects of mental agitation and confusion.

After many years of drug therapy, the disease may become uncontrollable. However, new drugs are being tested that may improve the symptoms that no longer respond to the existing medications. Whenever a new drug becomes available, those people with the most severe symptoms are the first to be treated with it. Some physicians believe that stopping the drugs temporarily and then resuming them may lead to improvement, but this approach has not been as beneficial as originally hoped.

Some people benefit from a decrease in dietary protein intake during the day. Such dietary manipulation may smooth out the beneficial effect of medications. It should be discussed with your doctor for proper supervision.

During the past few years some remarkable experimental achievements have occurred in the pursuit of a cure for parkinsonism. In addition to many new drugs that may hold promise, surgical grafting of tissues from the adrenal gland (which can act chemically like brain tissue) into the brain of victims of Parkinson’s disease has resulted in an improvement in neurological symptoms. The technique is still experimental and very controversial but reports suggest that this and similar techniques are promising. At present, however, such experimental surgical procedures cannot be considered for sufferers of Parkinson’s disease.

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