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Parkinson's Disease Community

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Mark A Stacy, MD

DUKE MEDICINE

Joined: 02/03/2010

Expert Profile:

Mark Stacy, MD, is the Director of the Duke Movement Disorders Clinic, Professor of Medicine (Neurology) and Vice Dean for Clinical Research at Duke University School of Medicine.

Mark Stacy's clinical and research interests include Parkinson's disease, motor and non-motor symptoms of wearing off, and pathological gambling and other impulse-control disorders.

His previous experience includes serving as director of the Muhammad Ali Parkinson Research Center at the Barrow Neurological Institute in Phoenix and director of the Parkinson's Disease Clinic and Movement Disorders Center at the University of Missouri. In addition to his current clinical and leadership roles at Duke, he serves as advisor and consultant on numerous national and community committees, including WE MOVE, the Parkinson Study Group, the Dystonia Study Group, the National Parkinson Foundation, and the American Academy of Neurology.

Stacy has published numerous peer-reviewed manuscripts, book chapters, and review articles on the topics of Parkinson's disease, progressive supranuclear palsy, Tourette's syndrome and other tic and movement disorders. He is also the editor of The Handbook of Dystonia.

For more information on Mark A. Stacy, MD, visit
http://www.dukehealth.org/physicians/mark_a_stacy

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Sensory symptoms in Parkinson's Disease

Sensory complaints in PD are not uncommon, and include visual changes, loss of...

Posted by Mark A Stacy, MD

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

Posted byMark A Stacy, MD

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8 Replies | ReplyReport This| Share this:Sensory symptoms in Parkinson's Disease Sensory complaints in PD are not uncommon, and include visual changes, loss of...

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What would you like to know?

Over the last month the PD Exchange has addressed topics concerning diagnosis,...

Posted by Mark A Stacy, MD

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19 Replies | ReplyReport This| Share this:What would you like to know? Over the last month the PD Exchange has addressed topics concerning diagnosis,...

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Reply: When should I take my PD medications?

Tony32vu, I am sorry to read that your medications are not effective; most people...

Posted by Mark A Stacy, MD

2 Replies | ReplyReport This| Share this:When should I take my PD medications? Tony32vu, I am sorry to read that your medications are not effective; most people...

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When should I take my PD medications?

PD medication regimens may be as varied as the number of people with parkinson's....

Posted by Mark A Stacy, MD

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2 Replies | ReplyReport This| Share this:When should I take my PD medications? PD medication regimens may be as varied as the number of people with parkinson's....

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Confirmation of the diagnosis of Parkinson's Disea...

At this time, there is no confirmatory test for PD. The best testing we have is...

Posted by Mark A Stacy, MD

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

Posted byMark A Stacy, MD

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3 Replies | ReplyReport This| Share this:Confirmation of the diagnosis of Parkinson's Disease (PD) At this time, there is no confirmatory test for PD. The best testing we have is...

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Reply: How to prepare for a visit with your PD doctor

Thanks, Caprice!

Posted by Mark A Stacy, MD

2 Replies | ReplyReport This| Share this:How to prepare for a visit with your PD doctor Thanks, Caprice!

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How to prepare for a visit with your PD doctor

Communication is the key to any successful visit with the doctor. As a patient,...

Posted by Mark A Stacy, MD

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2 Replies | ReplyReport This| Share this:How to prepare for a visit with your PD doctor Communication is the key to any successful visit with the doctor. As a patient,...

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Do you have foot cramping in the morning?

If you have PD and notice foot cramping in the morning, you may be having wearing...

Posted by Mark Stacy, MD

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Do you have vivid dreams?

Vivid dreams in Parkinson's Disease are quite common. They may be accompanied by...

Posted by Mark Stacy, MD

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1 Reply | ReplyReport This| Share this:Do you have vivid dreams? Vivid dreams in Parkinson's Disease are quite common. They may be accompanied by...

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Are you tired or dizzy at the end of the day?

If the answer is yes, check your blood pressure sitting and standing. If the top...

Posted by Mark Stacy, MD

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