| about daily management |
| Question : The patient is the sole bread earner in the family and his work involves a high level of physical activity. Will the physical exertion worsen his condition and symptoms? |
| Answer : On the contrary, keeping active and busy is the key to keeping PD under control. Physical activity will not harm or worsen PD in any way. The only care to be taken is to avoid falls which can happen in PD. |
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| Question : Do I need to take any precautions before starting Yoga? |
Answer : One may take into consideration the following precautions before starting any form of Yoga.
-One should not perform yoga for at least 2 hours after eating.
-Avoid yoga alone until you’ve practiced it with a qualified teacher.
-Before beginning, always tell your teacher about any medical problems you have, including back and joint problems. Alternatively, you could consult your doctor as to the conduciveness of Yoga yourself.
One shouldn’t push oneself beyond their limits. If experiencing any pain during Yoga, you should tell your instructor, and don’t attempt to do an asana you have difficulty with. |
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| about symptoms |
| Question : In the night when I feel pressure for urine, open my eyes I see black shedow as someone is standing. First I thgought that may be my wife there but she was sleeping. When I got up completely I found nothing. What does it indicate ? |
| Answer : This could indicate hallucinations or a dream, which ended just as you woke up. Though more details would be required to cpmpletely understand this experience, it is important to discuss this with your doctor. REM sleep behavior disorder occurs very commonly in Parkinson’s disease. It may manifest as dream enactment behavior, talking in sleep, shouting, and moving in bed while asleep. It is very easily treated in most cases by a small dose of Clonazepam. Hallucinations is seeing, hearing or feeling things that others do not perceive. This is commonly a side effect of the drugs used for Parkinson’s disease. |
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| Question : I have Parkinson’s since 1994, under good control but I am get severely constipated. Is the constipation drug induced or disease induced? |
| Answer : Constipation is a troublesome complaint experienced by many Pd patients. It is due to the Pd itself and also to a great extent, aggravated by the use of anti PD drugs. Almost all PD drugs can worsen constipation, but the worst offender is anticholinergic medication (pacitane). As far as possible, it wouyld be better to reduce or stop this medication, especially in elderly patients. Taking plenty of water, fruits (papaya and figs) and vegetables would also help in constipation. Stool softeners (softovac), laxatives (dulcolax) and in some cases enema may also be needed. |
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| Question : Is swelling in the feet a result of Parkinson’s disease or a side effect of medicines taken for PD? |
| Answer : Parkinson’s disease itself does not cause swelling of feet. Some anti PD like amantidine can cause swelling and redness around the ankles. A medication called amlodipine used in cases of high blood pressure can cause swelling of feet if a Pd patient is taking it for high BP. Swelling of feet per se is not something to be worried about but you must consult your physician to rule out any medical disorder. Often swelling of the feet subsides if the legs are elevated on the stool or in bed. |
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| Question : Has high blood pressure got anything to do with Parkinson’s disease? |
| Answer : There is no correlation between high BP and typical Parkinson’s disease although both are seen more frequently in the elderly age group. Patients with long standing uncontrolled hypertension may develop a multi-infarct (many small areas of poor circulation in the brain) in which some features of Parkinsonism may occur. |
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| about treatment |
| Question : Once PD has been diagonised as being moderate and treatment (Syndopa and Amantrel) is given, will there be chances of the disease becoming worse? |
Answer : Parkinson’s disease is a gradually progressive disease with loss of dopaminergic neurons (brain cells) in the substantia nigra. It can been controlled with drugs. However it is not curable.
It is not possible to prevent the progression of Parkinson’s disease till date. There has been a recent study with Rasagiline where 1mg showed some benefit in preventing progression of the disease. However 2mg per day did not. This makes the study very hard to believe and at present the results of the study are inconclusive. Till date there is no drug which has been shown to reduce the progression of the disease. |
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| Question : My wife is sufferring from PD for last two years Inspite of taking madicines she is not improving . Is it cureable at all? |
Answer : In addition to being on the right medications (either L Dopa or a dopamine agonist), the dose should also be adequate. Many patients are on very small doses of drugs which are not enough to cover the shortfall of dopamine due to the Parkinson’s disease and hence experience no benefit at all.
Parkinson’s disease is a gradually progressive disease with loss of dopaminergic neurons (brain cells) in the substantia nigra. It can been controlled with drugs. However it is not curable. |
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| Question : What are the side effects of drug Rasalect 1 mg and prolonged administration of pramipex-1 , and syndopa plus along with entacom? |
Answer : Pramipexole (Pramipex, Pramirol) specifically and dopamine agonists in general commonly cause nausea, leg edema (swelling) and excessive daytime sleepiness. More concerning are the behavioral changes seen with these drugs. Many cause a group of side effects called impulse control disorders including compulsive gambling, compulsive shopping, compulsive eating, hypersexuality and punding. In some there can be an elevation of mood and mania. Punding is an interesting side effect where people can spend hours on end doing the same tasks repetitively. Some can be sorting files again and again without any purpose while others can spend hours cleaning and re-cleaning the house etc.
L Dopa (Syndopa, Tidomet, LCD) in the short term is associated with nausea, lightheadedness and hallucination. In the long term a cause of concern is involuntary movements called dyskinesias. These movements is usually associated with a progression of the disease as well (usually a combination of the two). Entacapone (Entacom, Adcapone) per say only increases the duration of action of L Dopa. Hence the side effect profile is similar. Only one difference is that entacapone causes the urine to be discolored yellow. This has no long term consequence.
Rasalect (Rasagiline) is a new drug in the Indian Market. It is relatively well tolerated. It may add to the side effect of L Dopa, as like Entacapone, it too increases the duration of action of L Dopa. |
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| Question : Though there are a number of Anti-Parkinson’s drug groups available in the market, for e.g. Levodopa, dopamine agonists and anticholinergics, I am confused as to which is most appropriate for patients at different stages of progression of Parkinson’s disease. |
| Answer : Unlike treatment of many diseases, treatment for Parkinson’s disease is tailor-made for each patient. From a therapeutic standpoint, Parkinson’s disease can be divided in to three stages-Early, Non- Fluctuating and Fluctuating. All though the same drugs , namely carbidopa-levodopa preparations, dopamine agonists and anticholinergic preparations, are usually prescribed, their pattern of use, including frequency and dosage varies depending on the nature of the dominant symptoms and stage of the disease. Management of Parkinson’s disease requires familiarity with both; the disease-rlated and drug-related components. Optimal functional efficiency for the patient is gained through striking a delicate balance between the drug regime and the disease related components. |
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| Question : Please give me some practical guidelines about the use of the new drug Pramipex. |
| Answer : Pramipexole is a dopamine receptor agonist. Being a Non ergot drug it does not have many of the side effects of the older dopamine agonists like bromocryptine. It is useful in improving the motor symptoms of PD, both in the initial stages and in the more advanced cases. It is especially useful in young PD patients where we want to delay the use of levodopa as long as possible. As an added benefit, Pramipexole also has anti depressant properties and can improve the mood of patients. In some patients, it can cause excessive sleepiness |
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| Question : I have read an article that Nicotine patches reduce tremors. Please let us have your views. |
| Answer : To the best of our knowledge, Nicotine patches do not reduce the tremors of PD. The tremors which occur as part of a withdrawal state when smoking is stopped maybe helped by Nicotine patches, not PD tremors. |
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| Question : For dyskinesias which drug is used- Amantrel or Pacitane? |
| Answer : Dyskinesias are involuntary movements which occur with progression of Parkinson’s disease and are due to PD medications, mainly levodopa. Pacitane does not help dyskinesias, but Amantadine (Amantrel) has been found to be useful in reducing dyskinesias in long standing PD cases. |
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| Question : My age is 60 and I have PD for the last 10 years. What is your opinion on surgery? |
| Answer : surgery, particularly Subthalamic Nucleus Deep Brain Stimulation, does significantly improve the motor symptoms of Pd in advanced cases. It, however, should be considered only in those cases in whom PD medications no longer give relief either due to lack of efficacy or due to disabling dyskinesias (on-off). |
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| Related concerns |
| Question : I am 60 years old parkinsons patient using medicine regularly. recently i have started experiencing difficulty having intercourse with my wife. is it the side effect of parkinsons disease or old age problem? |
Answer : Erectile dysfunction is a common problem in Parkinson’s disease. This usually occurs a few years after the start of the disease. Patients who have this problem can take VIAGRA if they have no heart problems or other contraindications.
Just a note of caution, very early erectile dysfunction sometimes occurring even before the symptoms of Parkinson’s disease should raise the suspicion of atypical parkinsonisms like Multiple System Atrophy. Hence we urge all patients to discuss this matter with their doctor during their visit.
Lastly erectile dysfunction occurs in the absence of Parkinson’s disease or similar disorders in the population quite commonly esp. in this age group. Hence do not always assume the worst scenario if this occurs. DISCUSS this with your doctors…… |
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| Question : Is Parkinson's disease common? |
| Answer : Yes, Unfortunately Parkinson’s disease is very common. It is said to affect 1% of the population over 60 years. |
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| Question : What is understood by the terms "advanced stage Parkinson's disease" AND "early stage PD" in India? |
Answer : Usually early stage of Parkinson’s disease refers to the early part of the disease course before motor fluctuations set in. This is a ‘honey moon’ stage where the patient can have a good quality of life on the medications.
Advanced stages of Parkinson’s disease usually refers to patients of Parkinson’s disease with motor fluctuations while on medications, some may show non-motor features |
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| Question : My father has Parkinson's. I am 21 years old male. What are the chances of me getting Parkinson's? |
Answer : Parkinson's disease most commonly occurs sporadically from causes which we don't know.
Less than 5% of Parkinson's disease actually has a genetic origin. Among those who are more likely to have a genetic pattern are those whose onset of disease is very young (i.e. <40years of age); or those who have a strong family history of a disease (i.e more than 2-3 closely related family members). Even for those with an onset of 40 years or less the risk of genetic transmission is very low.Unless there is another affected member testing for genetic forms is not undertaken.
Lastly among the familial group too one may have the gene for parkinson's disease and never get it. There is no way to predict who will and who won't. |
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