B Common Pitfalls And Side
For the tremor of true idiopathic Parkinsons disease, here are some rules for using the drugs above. In general, if a patient is over 65, you can start immediately with Sinemet . If under 65, you should start with a dopamine agonist. Though the dopamine agonists are overall less effective than Sinemet for the overall treatment of the disease, for the symptom of parkinsonian tremor, they are perhaps slightly more effective than Sinemet. Trihexiphenidyl, amantadine, and MAO-B inhibitors have some efficacy for parkinsonian tremor as well but to a lesser degree.
Vascular parkinsonism does not respond to anti-parkinsonian medications. Medication-induced parkinsonism responds very poorly to antiparkinsonian medications, and you quickly drive side effects.
By far the most effective drugs are propranolol and primidone. Choose the agent based on side effect profile and the patients other comorbidities. If the patient has lung disease , then avoid propranolol and choose primidone first. Likewise, if the patient has insulin-dependent diabetes, your first choice should be primidone. If the patient is elderly/demented or young/working/subject to drug screens, you may choose propranolol first. Primidone is a pro-drug for and metabolized to phenobarbital. Titration of propranolol can be limited by bradycardia or hypotension. Other agents can be added to these if this is insufficient.
What About Cigarettes Parkinsons Smoking And Risk Of Cancer
As I mentioned in a previous blog, there is also an inverse relationship between cigarette smoking and PD. It is unclear whether that is because an ingredient of cigarette smoke protects smokers from PD, or because the lack of dopamine in people with PD make them more risk-averse as a group, and therefore less likely to smoke.
Regardless, because it is clear that smoking increases the risk of multiple types of cancer, any study that investigates the cancer rates of people with PD must always account for the fact that people with PD tend to smoke less than people without PD. The most recent study which analyzes the relationship between cancer risk and PD, as referenced above, takes great pains to remove this confounding factor in its statistical analysis. Even with taking differences in smoking rates into account, the conclusion of the study is that people who have had cancer are less likely to develop PD. It is also the case that rates of certain types of cancers that have not been linked to smoking are lower in people with PD. This fact supports the conclusion that the lower rates of smoking among PD patients is not the cause of the lower rates of cancer. Regardless of any study results, cigarette smoking is linked to numerous deadly diseases and must be avoided.
Other Neurodegenerative Diseases And Cancers
Although the epidemiologic evidence of Alzheimers disease -cancer link is not as intensive as PD-cancer, an inverse association is indicated by several studies. In a prospective cohort study of individuals aged 65 and older, there was 69;% reduced risk of all cancers in AD patients . Romero et al. reported cancer mortality hazard ratio of 0.5 in people with AD versus no dementia . In specific cancers, there is significant 40;% decrease in risk of epithelial and lung cancers and 57;% decrease in risk of colorectal cancer in people with AD . In a gender and age matched case control study, cancer had significant inverse association with AD only in women and endocrine-related tumors with odds ratios of 0.5 for both, although their study suggested overall inverse association with all types of cancers .
Although the biological evidence is scarce, the infamous PTEN gene and protein of PD has a role in AD progression. A significant loss and alteration of PTEN was found in AD neurons and its downstream targets may explain its pathological significance. Glycogen synthase kinase regulates tau phosphorylation while AKT mediates neuronal survival against -amyloid neurotoxicity in experimental models of AD .
Table 3 List of representative neurodegeneration-associated genes and cancer
Treatments And Outcomes Of Dip
DIP is generally treated by cessation of the offending drugs. Patients who cannot stop taking antipsychotic drugs because of their psychiatric diseases, such as those with schizophrenia or major depressive disorders, may be switched to atypical antipsychotics that have a lower risk of EPS. People who are prescribed dopamine antagonists due to simple GI disturbance, headache, dizziness, or insomnia should stop taking the offending drugs as soon as possible. Anticholinergics including trihexyphenidyl, benztropine, amantadine, and levodopa have been empirically tested for their ability to relieve symptoms of DIP, but this has produced no clear evidence of their effects in DIP patients.,,,,
How Can I Manage Chemo
Its important to remember that the symptoms are likely to start improving after your treatment has finished, and there are lots of things you can do in the meantime to help manage constipation or better still to try and prevent it!
1) Eat plenty of fibre
When youre having chemo, its even more important to make sure you have plenty of fibre in your diet. Fibre helps your digestive system to stay healthy and regular, by keeping food moving through the gut and assisting with the removal of waste and toxins.
You can increase your fibre intake by eating whole wheat cereals, wholemeal bread and pasta, brown rice, nuts and seeds, beans and pulses, and plenty of fruit and vegetables . If you have difficulty eating during treatment, you could try making a smooth vegetable soup or fruit juice instead.
Many people recommend trying a natural remedy for constipation, such as prune juice, fig syrup, or dried apricots:
Prune juice helps with constipation, its quite pleasant to drink. You can also try eating prunes or figs, fresh or dried.;Gillie, Live Better With community member.
Some people also recommend using a supplement, such as soluble fibre, or adding chia seeds or flax seeds to their diet, which can help to improve digestive function and cleanse the bowel:
Note: its important to always check with your doctor before taking any kind of supplements.
2) Keep your fluids up
3) Get some exercise
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Parkinsons Disease And Cancer: Whats The Connection
Researchers have long tried to understand the relationship between Parkinsons disease and cancer, with multiple studies conducted over the years. Intuitively, PD and cancer are not at all similar, and can even be thought of as biochemically opposite in one disease , cells die unexpectedly and in the other , cells divide too often and are perpetuated for too long. In fact, there have been many epidemiological studies over past decades that have shown that patients who have had cancer have a lower risk of developing PD than the general population. Other studies have shown that people with PD have lower overall cancer risks than people without PD.
Despite many papers demonstrating this inverse relationship between PD and overall cancer risk, an occasional study has been conducted which concluded that people with PD have an increased risk of cancer. It can be confusing to understand the different studies and determine how the resulting information may or may not apply to you.
Here we highlight some of the more common cancer-related topics when it comes to PD:
A Management Of Clinical Problem Tremor
Treat the underlying etiology. If it is a medication-induced tremor, remove the offending agent. This includes drug-induced parkinsonism as adding anti-parkinsonian agents when a patient is on risperidone is not effective, and the antiparkinsonian drugs could worsen the psychosis anyway .
Essential tremor is treated with primidone or propranolol. Other drugs such as topiramate and gabapentin are significantly less effective.
Parkinsons disease is treated with levodopa with or without COMT inhibitors, dopamine agonists, MAO-B inhibitors, amantadine, trihexyphenidyl. The previous are listed in relative efficacy from most to least potent.
Dystonic tremor is treated by treating the dystonia. Oral agents include trihexiphenidyl or other dopaminergic agents such as carbidopa/levodopa. Most effective is the use of injectable botulinum toxin to the muscles affected by the dystonia. Botulinum toxin injections are most easily done for neck muscles and more difficult in limb muscles .
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Q: Can Being Overweight Cause Incontinence
A: Yes being overweight or obese can cause incontinence. Having extra weight in your body, particularly in your abdomen and pelvis, can put added pressure on the bladder thus causing a weakening of the muscles and connective tissues in the pelvis. Studies have shown that even a small increase in weight can significantly increase the likelihood that one will experience urinary incontinence . Even as little as a 5-10% weight loss can significantly improve incontinence symptoms in many.
Tremors Caused By Medications
In addition to drug-induced parkinsonism, which includes rest tremor and is caused by medications that block the dopamine receptor, there are also a wide variety of medications that do not block the dopamine receptor, but can cause other types of tremors, such as postural and action tremors. So if you have these types of tremors, but without the slowness, stiffness and other PD-like symptoms, you could have drug-induced tremor .
A;postural tremor;occurs when a body part is held against gravity. Postural tremors occur for example, when the arms are extended, such as when holding a tray. An action tremor;occurs when a body part is moving. Action tremors occur for example, when the arm is moving toward the mouth to eat.
Drug-induced tremors typically are symmetric or equal on both sides of the body. The medications that can cause tremor include, but are not limited to, lithium, valproic acid, amiodarone, beta-adrenergic agonists, and selective serotonin reuptake inhibitors . Be attentive to whether a tremor starts after any new medication is started. If it does, discuss this with your doctor.
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Neurological Side Effects Of Chemotherapy
Many of the medications used to kill cancer also fog our minds and numb the nerves that send information to our brain.
Its not always easy to tell friend from foe. Is a particular symptom due to cancer, or the drugs fighting that cancer? Or is it due to something else entirely?
There are a number of different ways that chemotherapeutic agents can damage the nervous system. What follows is far from exhaustive, but gives an overview of some of the ways chemotherapy can damage the nervous system.
Diagnosis Of Dip And The Role Of Dat Imaging
The clinical diagnostic criteria for DIP are defined as 1) the presence of parkinsonism, 2) no history of parkinsonism before the use of the offending drug, and 3) onset of parkinsonian symptoms during use of the offending drug. Since asymmetrical rest tremors are common in many DIP patients and symptoms persist or progress after cessation of the offending drug, patients clinically diagnosed with DIP may include individuals in the preclinical stage of PD whose symptoms were unmasked by the drug.,,,
DATs are presynaptic proteins in the membrane on terminals of dopaminergic neurons. They take up dopamine from the synaptic cleft projections that extend from the substantia nigra to the striatum. These transporters control dopaminergic transmission by spatial and temporal buffering, rendering the molecule an imaging target in diseases affecting the dopaminergic nigrostriatal pathway. Single-photon-emission computed tomography and positron-emission tomography scans are available using several DAT ligands., SPECT radioligands include 123I-N-3-fluoropropyl-2-carbomethoxy-3-nortropane , 123I-ioflupane, DaTSCAN, and 123I-2-carbomethoxy-3-tropane . PET scans may be superior to SPECT for imaging DATs, in that the lower energy of positrons provides higher resolution, resulting in better image quality with widespread clinical applications. However, most DAT imaging studies, including those in patients with DIP, have utilized SPECT.,-
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The Link Between Parkinsons Disease And Toxic Chemicals
A new book calls the increasing prominence of Parkinsons a man-made pandemic.
- Read in app
Michael Richard Clifford, a 66-year-old retired astronaut living in Cary, N.C., learned before his third spaceflight that he had Parkinsons disease. He was only 44 and in excellent health at the time, and had no family history of this disabling neurological disorder.
What he did have was years of exposure to numerous toxic chemicals, several of which have since been shown in animal studies to cause the kind of brain damage and symptoms that afflict people with Parkinsons.
As a youngster, Mr. Clifford said, he worked in a gas station using degreasers to clean car engines. He also worked on a farm where he used pesticides and in fields where DDT was sprayed. Then, as an aviator, he cleaned engines readying them for test flights. But at none of these jobs was he protected from exposure to hazardous chemicals that are readily inhaled or absorbed through the skin.
Now Mr. Clifford, a lifelong nonsmoker, believes that his close contact with these various substances explains why he developed Parkinsons disease at such a young age. Several of the chemicals have strong links to Parkinsons, and a growing body of evidence suggests that exposure to them may very well account for the dramatic rise in the diagnosis of Parkinsons in recent decades.
Sometimes, though, the links are so strong and the evidence so compelling that there can be little doubt that one causes the other.
Chemotherapy’s Damage To The Brain Detailed
- University of Rochester Medical Center
- A commonly used chemotherapy drug causes healthy brain cells to die off long after treatment has ended and may be one of the underlying biological causes of the cognitive side effects — or “chemo brain” — that many cancer patients experience.
A commonly used chemotherapy drug causes healthy brain cells to die off long after treatment has ended and may be one of the underlying biological causes of the cognitive side effects — or “chemo brain” — that many cancer patients experience. That is the conclusion of a study published recently in the Journal of Biology.
A team of researchers at the University of Rochester Medical Center and Harvard Medical School have linked the widely used chemotherapy drug 5-fluorouracil to a progressing collapse of populations of stem cells and their progeny in the central nervous system.
“This study is the first model of a delayed degeneration syndrome that involves a global disruption of the myelin-forming cells that are essential for normal neuronal function,” said Mark Noble, Ph.D., director of the University of Rochester Stem Cell and Regenerative Medicine Institute and senior author of the study. “Because of our growing knowledge of stem cells and their biology, we can now begin to understand and define the molecular mechanisms behind the cognitive difficulties that linger and worsen in a significant number of cancer patients.”
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C History Part : Competing Diagnoses That Can Mimic Parkinson’s Disease/parkinsonism
Essential tremor is a type of action tremor, usually symmetrically involving hands and/or head. It is of unclear etiology, and is oftentimes linked with autosomal dominant inheritance. Patients do not have other parkinsonian symptoms. Most common pharmacologic agent for treatment is beta-blockers.
Lewy Body Dementia is typically characterized by parkinsonism, visual hallucinations and mental decline. It is the second most common neurodegenerative disorder in the United States following Alzheimers Disease.
Drug-induced parkinsonism is commonly caused by antipsychotics, antiemetics, antiepileptics and calcium channel blockers. It is usually reversible and typically resolves within weeks to months with cessation of the offending agent.
Parkinson Syndromes: These include corticobasal degeneration , multi system atrophy and progressive supranuclear palsy .
Phosphatase And Tensin Homolog And Putative Kinase 1
PTEN was first identified as a tumor suppressor gene located on chromosome 10q23. PTEN removes the 3phosphate from phosphatidylinositol 3,4,5-triphosphate and eventually shuts down PI3K-Akt-mTOR pathway leading to growth inhibition and apoptosis . Frequent inactive mutations of PTEN were detected in a variety of human cancers including glioblastoma, advanced prostate, and endometrial cancers, and reduced expression is found in many other tumor types such as lung and breast cancer .
While its role as tumor suppressor is established unambiguously, emerging evidence shows that the biological function of PTEN extends to the CNS where it is widely expressed and localized to the cytoplasm and nucleus . Several studies indicate that PTEN is a crucial regulator of neuronal development, neuronal survival, axonal regeneration, and synaptic plasticity and has been linked to the pathogenesis of neurodegenerative disorders at the molecular level . The main target of PTEN, mTOR, plays an essential role in maintaining the integrity of postmitotic neurons by regulating key cellular processes such as protein synthesis, autophagy, mitochondrial metabolism, and biogenesis . The selective inhibitor of mTORC1, rapamycin was shown to be neuroprotective in experimental models of Alzheimers disease and PD .
Symptoms And Diagnosis Of Parkinsons:
Lets take a further look at Parkinsons disease.
Did you know that certain medical procedures, such as bone marrow transplants, can cause Parkinsons symptoms? Head trauma, liver disease, tumors, lesions, and vascular disease are all direct causes of Parkinsons disease. Physicians tend to be careful when testing for Parkinsons. Several different tests need to be done:
- The first test will be a blood test. The purpose is to test for toxins that may be causing the symptoms of Parkinsons.
- Next, an MRI and CT scan will examine the entire body and look for any unusual obstructions or abnormal functions in the vascular region.
C Criteria For Diagnosing Each Diagnosis In The Method Above
All of the above are diagnosed by clinical criteria and do not require any confirmatory ancillary testing.
Parkinsons disease: requires at least two of the four cardinal symptoms to be diagnosed with Parkinsons disease. Parkinsons is so commonly asymmetric that symmetric presentation brings into question whether the diagnosis is correct.
Vascular parkinsonism: Parkinsonian features as above but sudden onset and exclusively affects one hemibody , corroborated by imaging documenting infarct in the basal ganglia.
Drug-induced parkinsonism: Again, features of parkinsonism but loss of asymmetry. Must have history of dopaminergic blockade .
Essential tremor: Postural/action in the bilateral hands and/or head tremor and/or voice tremor, often with positive family history and +/- recognition that alcohol intake improves the tremor.
Dystonic tremor: Almost always from a cervical dystonia, so given the name, a dystonia must also be present. For a dystonic head tremor, the null point should be seen. For dystonic limb tremor, there should be striking asymmetry and task-specificity .
Medication-induced tremor: High frequency low amplitude exaggerated physiologic tremoranddocumented history of use of drugs on this list:
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