Sensory complaints in PD are not uncommon, and include visual changes, loss of sense of smell, restless legs syndrome (RLS), and pain. Changes in vision may result from alteration in visual acuity, contrast sensitivity, color discrimination, motion perception, peripheral visual field sensitivity and visual processing speed. Visual acuity can be improved with corrective glasses. Contrast sensitivity and color discrimination is important - especially if you are having trouble with freezing. To help with this problem, try increasing the light in the room, and consider using brighter patterns - sorry I cannot write a prescription to pay for redecorating… Slower visual processing speed also leads to decline in visual perception, particularly for rapidly changing visual activity - birds flying or rapid action on TV. Unfortunately, there is little treatment for these symptoms, but a thorough vision examination will make sure that other eye diseases are not a problem.
Loss of sense of smell has been considered by some to be the earliest symptom of PD, and is seen in up to 90% of PD patients, and this increases as the disease advances. There is no treatment for this symptom.
Restless legs symptoms are commonly reported in PD, usually at the end of a dosing interval - "wearing off." Distinguishing between true RLS and wearing-off limb discomfort and restlessness can be difficult. Nonetheless, the first treatment would be trying to take your PD medication at regular intervals - and dosing prior to the onset of the uncomfortable symptoms. If this is not helpful, medications like clonazepam may be helpful.
Shoulder pain is known to be an early, sometimes initial symptom of PD. Other pain symptoms can be a common complaint in PD, however it is important to differentiate between dystonic (muscle cramping) versus non-dystonic pain. Pain associated with dystonia is likely related to low blood levodopa levels, and responds to levodopa therapy. Non-dystonic pain (numbness, tingling, burning, aching, coldness, heat and pain) in PD is poorly understood and difficult to treat. Sometimes this also responds to treatment with PD medications, and may simply be treated with over the counter drugs like tylenol or ibuprofen. If these do not work, discuss the symptoms with your doctor.View Thread
Tony32vu, I am sorry to read that your medications are not effective; most people with PSP notice less response to drugs that PD patients. However, sometimes higher dosages may produce some benefit. I usually will try to simplify a medication regimen to only carbidopa/levodopa (25/100), and try gradually increasing to 2 tablets four times daily.
You may wish to discuss this strategy with your doctor.View Thread
PD medication regimens may be as varied as the number of people with parkinson's. There are several things that are useful when organizing a medical regimen.
First of all some PD medications last a short time. Levodopa, the active ingredient in Sinemet, lasts in the blood stream (and brain) from 2.5 to 4 hours. The controlled release form (Sinemet CR) may last up to 6 hours, but usually only 5. Levodopa competes with other protein for absorption to the blood stream, and some recommend that it not be taken with meals. I think this is not a major problem, and have my patients usually take the medication at mealtimes, and as the medication effect becomes shorter, may move to four- hour intervals (eg. 7am -11am -3pm, -7pm). Drugs that make levodopa last a bit longer include entacapone and rasagiline. (Carbidopa/levodopa/entacapone tablets are brand named "Stalevo.")
Dopamine agonists, pramipexole (Mirapex) and ropinirole (Requip), usually last 6-12 hours, and both have recently developed once daily preparations. These new agents may be great for people who are having mobility problems in the night. I recc the once daily forms to be taken with the first dose of the day, unless night-time is difficult, and then will dose later. The original formulations are now available in generic, and may be also dosed at mealtimes - and simultaneously with levodopa.View Thread
At this time, there is no confirmatory test for PD. The best testing we have is functional brain imaging to assess dopamine concentration in the "basal ganglia" or "striatum." This area of the brain demonstrates a decrease in dopamine concentrations with PD, and may be imaged using a Positron Emission Tomography (PET) scan or a SIngle Photon Emission Computed Tomography (SPECT) scan. PET scanners with dopamine-type imaging are not widely available, and dopamine scanning with SPECT is not available in the United States at this time. However, a SPECT imaging molecule may be approved in 2010, and there are others in development for use in the US.
Short of functional brain imaging, Neurologists look for signs and symptoms associated with PD to lead to diagnosis. Early symptoms include: resting tremor, difficulty with handwriting, dressing, cutting food, and other fine motor tasks. It is also helpful to see if one side of the body is more affected than the other.
Early signs are termed "cardinal characteristics," and include resting tremor, bradykinesia (slowness of movement), and rigidity (stiffness of the limbs, when moved through a range of motion by the examiner). If two of three of these signs are present, there is a 70% chance that the condition is PD.
The next step is to treat with medication, and if a significant benefit is seen, the chance that it is PD increases to 90%. Before initiating therapy, it is important to define these expectations, and remember, if you barely show signs of PD, you may not show a dramatic or significant improvement. In addition, the medications suggested in early PD, differ significantly from the medications used in more symptomatic PD. I prefer to start drugs that may slow disease progression in many patients, particularly in very mild cases, and use more potent therapies later.
If there is no symptomatic benefit, you should discuss other possibilities with your doctor. I would consider brain imaging in some instances. Symptoms that lead to other diagnostic concerns include: frequent falling as a first sign or early in the disease, double vision (particularly when reading), frequent crying or laughing at minor things, a hand that seems to have a "mind of its own" or that will not move the way a patient wants it to move, urinary incontinence, or significant memory disturbances. In addition, a highly symmetric presentation (both sides affected equally), or lack of tremor will push me to consider other diagnoses.View Thread
Communication is the key to any successful visit with the doctor. As a patient, even though I am a doctor in other settings, I have experienced leaving a doctor visit, thinking - I did not get my question asked, or even worse, I did not remember what the doctor told me...
As a doctor, here are some tips that may be helpful to all.
First is to be prepared. Make a list of questions or concerns about any symptom. Then prioritize them, and review (or maybe even rehearse) them with a friend or loved one.
Second: give the doctor an out as you begin to ask your questions. For example if you say, "Doctor, I know we do not have much time, and I have 10 questions. If there is nothing to do about one of my concerns, just say pass, and we will move on to the next," it let's me off the hook about things not related to your PD. More importantly, it let's me try to help you on a symptom that I may be able to do something about. Remember, at the core Doctors are service providers, and we do like to think we have made a difference.
Third: Have a list - typed! - of your medicines with the dosage, number of tablets and times of day you take them, and whether you need refills of your prescriptions. A doctor can often be writing these while listening to your concerns, and then will not save time at the end of a visit to write them - that will give you more "real time" in the meeting.
Fourth: Take someone with you to listen. If your companion can be your advocate - and not take over your visit - educate him or her to reasons you are asking a question, in order to ask a follow-up. You may be trapped in the polite listening mode, and not be able to do so.
Fifth: do not take all the time with questions. The doctor does need to examine you, and may have other issues that he or she would like to address.View Thread
If you have PD and notice foot cramping in the morning, you may be having wearing off from your previous day's medications. There are several things you can discuss with your doctors. Potential treatments include: taking a dosage at bedtime or during the night, taking your first dose of anti-parkinson medication before you get out of bed, and sometimes taking a medication like baclofen at bedtime may help.View Thread
Vivid dreams in Parkinson's Disease are quite common. They may be accompanied by yelling or thrashing about during sleep. If this is occurring, it may represent a condition called REM-sleep Behavior Disorder. It is important to talk about this with your doctor, and for you to realize that when these dreams occur, they are not the same as hallucinations. Treatment of REM-sleep Behavior Disorder is different from treatment for hallucinations.View Thread
If the answer is yes, check your blood pressure sitting and standing. If the top number is dropping more than 20 points - or below 100, you may need to discuss further with your doctor. For example, if your sitting blood pressure is 110/70 when you are sitting, that is great - right? Now stand up and wait 30 - 60 seconds. Recheck your blood pressure. If it drops to 90/50, you may be a bit dehydrated. Drinking a glass of water at breakfast and lunch may be all that is needed to help this. Other things to raise blood pressure include talking with your doctor to reduce any medications that lower blood pressure, and after that increasing the salt in your diet or trying medications available to raise blood pressure.View Thread