Fasciculations In Healthy Subjects
Fasciculations can also be found in individuals with no neurological disease. In 1963, Reed and Kurland warned that the presence of fasciculations was not necessarily a prelude to the onset of a progressive and lethal disease, due to the involvement of the lower motor neuron. Since then, several authors have explored this topic, defining a benign fasciculation syndrome , that most frequently affects young healthcare professionals,, who, in some cases, have already developed dyspnea. An interesting Australian prospective study published recently examined the cases of 20 physicians complaining of fasciculations. Fourteen of them were very concerned about being diagnosed with ALS. The fasciculations were mainly in the lower limbs, which had normal muscle strength. In the electrophysiological study, fasciculations potentials were of the simple type, motor conduction was normal and no signs of denervation or neurogenic changes of motor units were apparent.
These authors, in agreement with others, concluded that physical exercise, stress, fatigue and caffeine abuse can precipitate or aggravate this picture. Among the other six individuals in the sample, five patients manifested a cramp-fasciculation syndrome and only one suffered from ALS.
Some authors have stated that, in order to establish the clinical diagnosis of BFS, a minimum of five years is necessary, due to the evolution, in some cases, of the motor neuron disease.
Complications Of Multiple System Atrophy
MSA i.e. multiple system atrophy is a problem related to the nervous system, which is very rare and characterized by varied symptoms.1 Usually this problem is observed in adults who are mainly in their 50s or 60s. People suffering from this problem may experience symptoms quite similar to that of Parkinsons disease. In this individuals ability to establish coordination between different voluntary movements of the body is hampered and also some portion of the brain start getting affected causing problem in involuntary movement as well. Involuntary body movements include heart beats, sweating, and regular functioning of bladder and bowel, controlled level of blood pressure and so on.
What Are The Causes
The cause of Parkinson’s is largely unknown. Scientists are currently investigating the role that genetics, environmental factors, and the natural process of aging have on cell death and PD.
There are also secondary forms of PD that are caused by medications such as haloperidol , reserpine , and metoclopramide .
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What Are Atypical Parkinsonian Disorders
Atypical Parkinsonian disorders are progressive diseases that present with some of the signs and symptoms of Parkinsons disease, but that generally do not respond well to drug treatment with levodopa. They are associated with abnormal protein buildup within brain cells.
The term refers to several conditions, each affecting particular parts of the brain and showing a characteristic course:
- Dementia with Lewy bodies, characterized by an abnormal accumulation of alpha-synuclein protein in brain cells
- Progressive supranuclear palsy,; involving tau protein buildup affecting the frontal lobes, brainstem, cerebellum and substantia nigra
- Multiple system atrophy, another synucleinopathy that affects the autonomic nervous system , substantia nigra and at times the cerebellum
- Corticobasal syndrome, a rare tauopathy that typically affects one side of the body more than the other and makes it difficult for patients to see and navigate through space
Low Blood Pressure When Standing
Orthostatic hypotension refers to a persistent drop in blood pressure that occurs when you move from sitting to standing, or from lying down to sitting up or standing. It can cause:
- feeling faint
OH is defined as a blood pressure drop of 20 millimeters of mercury in systolic blood pressure, or a drop of 10 millimeters in diastolic blood pressure.
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Can Parkinsons Disease Be Prevented
Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.
Lifestyle Changes For Muscle Atrophy
Along with medication making some positive changes in the lifestyle can be of great help in coping up with the physical limitations in movement. Instead of blaming god and others for the problem, it is better to adapt with the condition and look for ways to improve. One very common problem, which almost all the people suffering from Parkinsons disease face is getting up and sit in the chair. However, having a lifted chair or customizable chair can be of great help to cope with this physical limitation; similarly, making a use of physical support tool while walking can help in maintaining balance and avoiding any fall or injury.
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What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms; others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
How Is A Diagnosis Made
Because other conditions and medications mimic the symptoms of PD, getting an accurate diagnosis from a physician is important. No single test can confirm a diagnosis of PD, because the symptoms vary from person to person. A thorough history and physical exam should be enough for a diagnosis to be made. Other conditions that have Parkinsons-like symptoms include Parkinsons plus, essential tremor, progressive supranuclear palsy, multi-system atrophy, dystonia, and normal pressure hydrocephalus.
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Does Parkinsons Affect Voice
The voice is affected too, because the voice box is ultimately controlled by the basal ganglia as well. Thus the voice becomes soft, slurred and hushed. Others may comment that the patient is mumbling. The mumbling goes away temporarily once the patient becomes aware of it but soon returns to the soft, slurred state.;
This temporary improvement when attention is paid is true of many of the motor symptoms of PD because the condition primarily affects subconscious movements, and does not directly affect nerve or muscle control at the most basic level. Thus, conscious awareness can override the slowness to a certain extent. This fact is one reason why physical therapy and physical activity are so useful and necessary in treating PD.
- Slowness of walking and other movements
- Trouble with dexterity
- Reduced arm swing or stride length
- Delayed reactions physically
- Reduced facial reactions
- Softer or slurred speech
- Tremor in one or both limbs with the limb at rest
- Sometimes also tremor with holding a posture or with actions
- Usually asymmetric
Imbalance, loss of balance reflexes
- May fall backwards
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What Are The Symptoms
Symptoms of PD vary from person to person, as does the rate of progression. A person who has Parkinson’s may experience some of these more common “hallmark” symptoms:
- Bradykinesia – slowness of movement, impaired dexterity, decreased blinking, drooling, expressionless face.
- Tremor at rest – involuntary shaking that decreases with purposeful movement. Typically starts on one side of the body, usually the hand.
- Rigidity – stiffness caused by involuntary increase in muscle tone.
- Postural instability – sense of imbalance. Patients often compensate by lowering their center of gravity, which results in a stooped posture.
Other symptoms that may or may not occur:
Freezing or being stuck in place Shuffling gait or dragging of one foot Stooped posture Cognitive impairment
Distinguishing Between Parkinsons Disease And Msa
It can be challenging to differentiate between PD and MSA. Early on in the course of the illness, MSA can manifest with mild parkinsonism and autonomic dysfunction. These clinical features are also often present in PD. Furthermore, in the beginning, the parkinsonism of MSA can be minimally responsive to levodopa, complicating the distinction between the diseases even more. Both diseases have a high rate of REM behavior sleep disorder . Therefore, it is very common for someone with MSA to initially receive a diagnosis of PD.
Over time, clinical features may develop that are not as common in PD and may suggest MSA as a diagnosis. However, although these features are not as common in PD, they can still be present in PD, so diagnosis remains difficult. The more features that are uncommon in PD that are present, the more the clinical situation warrants the consideration of MSA as the diagnosis. These red flags include:
- Poor levodopa response
- Facial dystonia from levodopa
- Sleep-disordered breathing such as obstructive sleep apnea
- Inspiratory stridor during daytime or sleep
- Jerky tremor when performing an action
- Axial postural abnormalities
- Cold, darkened/reddened hands and feet
- Severe difficulty with speech
- Severe difficulty with swallowing
- Pseudobulbar affect the Involuntary and uncontrollable reactions of laughing or crying that are out of proportion to the cause of the emotional response
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How Do The Newly Identified Mutations Contribute To Edmd
Like the gene mutations that had previously been identified as compromising the integrity of the nucleus scaffold, SUN1 and SUN2 also produce proteins that form part of the scaffold structure.
The mutated versions of SUN1 and SUN2 interfere with connections between the nucleus and the rest of the cell, resulting in the nuclei being positioned abnormally within muscle cells.
The nuclei are normally anchored at the edges of muscle cells, Shackleton explains, probably so that they do not get in the way of the main structures of the cell that are involved in muscle contraction.
She adds that this incorrect positioning could cause damage to the nuclei and also impair muscle contraction, which leads to muscle wasting and weakness:
We therefore believe that incorrect positioning of muscle nuclei may contribute to causing the symptoms of EDMD.
The findings, she says, offer the possibility for a novel drug target for the treatment of this disease in the future.
However, Shackleton says that further research is needed to investigate the disease mechanism and increase understanding of the positioning of nuclei within healthy muscle cells.
In a linked comment, Dr. Marita Pohlschmidt, director of research at the Muscular Dystrophy Campaign, welcomes the results of the study, which she describes as encouraging.
Difficulty Swallowing Or Eating
Parkinsons affects the muscles in the face, mouth, and throat that control speaking and swallowing. Dysphagia, or difficulty swallowing, is a symptom of Parkinsons that can lead to trouble eating.
It can lead to malnutrition, dehydration, or aspiration which happens when food or saliva goes down the wrong pipe and is inhaled into the lungs. Aspiration can lead to aspiration pneumonia, the leading cause of death in Parkinsons.
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal; and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
What Is Parkinson’s Disease
Parkinsons disease is a degenerative, progressive disorder that affects nerve cells in deep parts of the brain called the basal ganglia and the substantia nigra. Nerve cells in the substantia nigra produce the neurotransmitter dopamine and are responsible for relaying messages that plan and control body movement. For reasons not yet understood, the dopamine-producing nerve cells of the substantia nigra begin to die off in some individuals. When 80 percent of dopamine is lost, PD symptoms such as tremor, slowness of movement, stiffness, and balance problems occur.
Body movement is controlled by a complex chain of decisions involving inter-connected groups of nerve cells called ganglia. Information comes to a central area of the brain called the striatum, which works with the substantia nigra to send impulses back and forth from the spinal cord to the brain. The basal ganglia and cerebellum are responsible for ensuring that movement is carried out in a smooth, fluid manner .
The action of dopamine is opposed by another neurotransmitter called acetylcholine. In PD the nerve cells that produce dopamine are dying. The PD symptoms of tremor and stiffness occur when the nerve cells fire and there isn’t enough dopamine to transmit messages. High levels of glutamate, another neurotransmitter, also appear in PD as the body tries to compensate for the lack of dopamine.
Common Forms Of Dystonia In Msa
Dystonia of the cervical spine is common in MSA patients, though some experts contend that it is not an actual dystonia, but a form of Parkinsonian-type muscle rigidity1. Also referred to as torticollis, it causes a severe forward or backward bending of the head. Because it affects the orientation of the head in space, cervical dystonia can contribute to balance and gait problems6. MSA patients also often experience dystonia of the muscles of the mouth and face that alters speech, resulting in high-pitched sounds1. Dystonia of the vocal cords can occur and contribute to obstructive sleep apnea. Dystonia of the trunk muscles alters posture and gait in some MSA patients.
Inactivity For Extended Periods
Prolonged inactivity, such as bed rest, can lead to a loss of muscle mass. Bed rest may be necessary due to injuries or illnesses that leave a person unable to move.
According to , muscle wasting can develop within 10 days in healthy older adults on bed rest. Due to the muscle wasting, a 40% decrease in muscle strength can occur within the first week.
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Impaired Posture And Balance
Postural instability is the most difficult Parkinsons symptom to treat, and one of the most important criteria for diagnosing Parkinsons.
Postural instability is the inability to balance due to loss of postural reflexes and often leads to falls. Patients with impaired posture and balance might revert to a stooped posture and have a shuffling gait.
Treating And Managing Rigidity
Talk to your doctor as rigidity tends to respond well to medication, for example levodopa. As with all Parkinsons medications though, what works for one person may not work for another. Be prepared for your doctor to try several approaches to see what works best for you.
He or she may refer you to a doctor who specialises in;movement disorders or to a;physiotherapist,;occupational therapist;or;speech and language therapist depending on the country in which you live and your individual needs. Seeing a therapist soon after problems begin is more likely to result in successful treatment.
Treatment varies from country to country but the following broadly outlines the support you might receive:
- A physiotherapist can advise on exercises to maintain or improve both mobility and the range of movement in your muscles and joints. He or she can also suggest strategies to perform daily activities in a more effective way, for example how to roll in bed or get up from a chair.;
- An occupational therapist or physiotherapist will be able to advise on devices and aids to help you in your everyday life. An occupational therapist will also be able to suggest changes to your routine to help you to stay mobile and independent.
- A speech therapist can teach you facial exercises to help with speech and communication.
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