Parkinson's syndrome

Also called "shaking palsy", Pakinson's syndrome is an idiopathic, slowly progressive, degenerative CNS disorder. It is characterized by slow and decreased movement, muscular rigidity, resting tremor and postural instability. It is the fourth most common neurodegenerative disease of the elderly.

QUESTIONS AND ANSWERS:
Q: What is Parkinson's Disease?
A: Parkinson's Disease is a degenerative neurological disease which primarily impacts a specific part of the brain (substantia nigra) which produces the neurotransmitter, dopamine.
Q: What are the symptoms of Parkinson's Disease?
A: Trembling (tremor), stooped posture, muscular stiffness (rigidity), short shuffling steps, speaking softly in a rapid tone, poor balance, poor handwriting and slowness of body movements (bradykinesia).
Q: What causes Parkinson's Disease?
A: The cause of Parkinson's Disease is not known. Some researchers believe it may result from toxins, head trauma or stroke. Parkinson's Disease may also have a genetic link.
Q: How many people have Parkinson's Disease?
A: Parkinson's Disease is believed to affect approximately one million people in the United States.
Q: What conventional medications are used to treat Parkinson's Disease?
A: There are several medications available for managing Parkinson's Disease. These are used alone and in combination. These long-term medications include:
1. ANTICHOLINERGICS:
- Antihistamines: Diphenhydramine 25-200mg/day, Orphennadrine 50-200 mg/day.
- Antidepressants: Amitriptyline 10-150mg/day, Doxepin 10-150mg/day, Imipramine 10-150mg/day, Nortriptyline 10-150mg/day.
Miscellaneous:
- Benztrpine 0.5-6mg/day, Biperiden 2-6mg/day, Ethopropazine 40-400mg/day, - Procyclidine 5-40mg/day, Trihexyphenidyl 2-15mg/day.
SIDE EFFECTS (A/R):
GI disturbances, glaucoma, mydriasis, urinary retention, mental disturbances.
2. DOPAMINERGICS:
- Dopamine precursor ---Sinemet2 (levodopa/carbidopa / Madoppar): initially 125 tid. Increase weekly until optimal therapeutic dose is reached. Up to 750 mg or 1 g or more can be given. Contraindication (C/I): Severely decompensated endocrine, renal, hepatic & cardiac disorder, age exceeding 25 years. Cannot use this drug during pregnancy.
SIDE EFFECTS (A/R) : anorexia, GI upset, cardiac arrhythmias, hypotension, abdominal involuntary movement. Mild, transient leucopenia & thrombocytopenia. Mental change; depression, development of suicidal tendencies.
- Dopamine agonists--- including Parlodel3 (bromocriptine mesylate): 0.1-7 mg/day.
(A/R): GI disturbance, dizziness, hypotension, drowsiness, headache, fatigue, allergic skin reactions, constipation, dry mouth, leg cramps, peripheral digital vasospasm.
3. MAO-B INHIBITORS:
- Eldepryl1 Capsules (selegiline hydrochloride, Jumex ): 5-10mg/day, as a monotherapy in the incipient stage of Parkison syndrome, adjuvant to levodopa.
SIDE EFFECTS (A/R): Hypotension, GI upset, nausea, agitation and cerebral effects (hallucination, confusion and hyperkinesias).

Q: Can Parkinson's Disease be cured?
A: In western treatment, there is presently no cure for Parkinson's Disease. However, medications are available to control the slow decline in muscle functions and manage Parkinson's Disease symptoms quite effectively. Since the patient must take the medication continuously to control the symptoms, the patient cannot avoid the complications of the medications. The body's overall system becomes increasingly damaged. Therefore, the longer the patient suffers this disease, the more complications the patient suffers and the more difficult to treat.
Q: What happens in Parkinson's Disease?
A: In Parkinson's disease, for reasons that are not fully understood, nerve cells in the part of the brain that produces dopamine (the substantia nigra) begin to decrease in number. This causes a decrease in the amount of the available dopamine. Also, the chemical in the synapse that breaks down the dopamine (MAO-B) continues to deplete what little dopamine is left. The overall effect is a large loss of dopamine in the brain. This throws off the normal dopamine/acetylcholine balance, since the level of acetylcholine remains normal .
IMBALANCE OF DOPAMINE AND ACETYLCHOLINE IN PARKINSON'S DISEASE:
In Parkinson's Disease, there is not enough dopamine to keep balance with the acetylcholine. This imbalance causes a lack of coordination in movement, which often manifests itself as a tremor, stiff muscles and joints, and/or difficulty in moving. Currently, there is no way to stop the loss of nerve cells that produce dopamine or to restore those that have already been lost. However, there are several methods, including drug therapy, which can help you manage the slow decline in functions that occurs with Parkinson's disease.

DRUG THERAPY IN MANAGING THE EFFECTS OF PARKINSON'S DISEASE:
During the past several years, the development of newer medications and an understanding of how best to use them have significantly improved the outlook for people with Parkinson's disease. The medications outlined below form the mainstay of Western Parkinson's disease therapy. Your doctor may prescribe one or more of these medications to replace or simulate the effect of the dopamine you have lost, slow the ongoing loss of dopamine, or bring the level of acetylcholine back into balance with the dopamine in the brain. It is very important for you to understand how your therapy works and why your doctor prescribed it. Then you will also understand that it is your duty to adhere to your doctor's plan and communicate with your doctor to decide how to adjust that plan, if and when needed, over the next several years.

Q: Why Does Your Doctor Prescribe Specific Medications?
A: While there is still no cure for Parkinson's disease, your doctor can prescribe a variety of medications to meet your long-term goal for managing its symptoms. These medications can increase the level of dopamine in your system and correct the imbalance between dopamine and acetylcholine. This may be achieved by using one medication in the earlier stages of Parkinson's disease, or a combination of two or more medications later on in the process of the disease.
METHODS OF PARKINSON'S DISEASE THERAPY:
1. REPLACING THE MISSING DOPAMINE
Sinemet (levodopa/carbidopa) is the single most effective medication for controlling the symptoms of Parkinson's disease. Sinemet is transported to the brain and is picked up by the nerve cells that produce dopamine. Once there, Sinemet is converted into dopamine for the nerve cells to use as a neurotransmitter. Most patients can use Sinemet to replace their missing dopamine and control their symptoms for several years. But, as the loss of dopamine-producing nerve cells continues, symptoms will continue to worsen and the dose of Sinemet will have to be increased.
Dopamine replacement therapy (Sinemet) is turned into dopamine within the nerve cell.
Your doctor may want to keep the Sinemet dose as low as possible for as long as possible, because there are likely to be more side effects with higher doses of Sinemet. Over time, continual increases in the Sinemet dose may eventually lead to the development of side effects, some of which may make it impossible to increase the dose any more. At this point, treatment options become limited. Reading on, you will see how doctors can employ Eldepryl Capsules, 5mg (selegiline hydrochloride), to help keep the Sinemet dose lower over time and therefore prolong the usefulness of Sinemet.
2. SUBSTITUTING A DIFFERENT SUBSTANCE THAT "MIMICS" DOPAMINE
Dopamine substitution therapy (Parlodel and Permax) act like dopamine.
Parlodel (bromocriptine mesylate) and Permax (pergolide mesylate) are medications that mimic the action of dopamine by fitting into the dopamine pockets on the surface of the nerve cell that is receiving the dopamine message. One advantage of this substitution approach is that dyskinesias* are less likely to occur, because the amount of dopamine is not actually being increased, as with Sinemet. Instead, Parlodel or Permax acts as a substitute for dopamine. This makes it less likely for dyskinesias to occur since they are caused by too much dopamine in the brain.
*Dyskinesias are involuntary muscular movements that appear to result from an overload of Sinemet, or dopamine, in the brain.
3. HELPING NERVE CELLS RELEASE STORED DOPAMINE
Dopamine-releasing therapy (Symmetrel) helps more dopamine enter the synapse.
Symmetrel (amantadine hydrochloride) appears to make it easier for dopamine-producing nerve cells to open a "window" and release their stored dopamine into the synapses. This approach is helpful in more mild cases of Parkinson's disease, in which Symmetrel works to reduce disease symptoms.
4. ADJUSTING THE BRAIN'S CHEMICAL BALANCE
This chemical therapy adjusts the activity of Acetylcholine to restore the Dopamine/Acetylcholine balance. Artane (trihexyphenidyl HCl) and Cogentin (benztropine mesylate) can be used to restore the dopamine/acetylcholine balance by reducing the activity of acetylcholine in the brain. This successfully reduces the tremor and muscle stiffness resulting from having much more acetylcholine than dopamine. But these medications do not correct the basic problem of too little dopamine. Usually, these agents will be used in the early stages of Parkinson's disease, or in combination with some of the other agents discussed here.
5. CONSERVING THE DOPAMINE ALREADY IN THE BRAIN
Eldepryl prevents dopamine from being gobbled up in the synapse. Eldepryl works differently from all the other agents to slow the loss of dopamine and help correct the dopamine/acetylcholine imbalance. Eldepryl actually blocks the chemical in the synapses that breaks down dopamine (MAO-B). So, even if there is only a small amount of naturally produced dopamine -- or a larger amount provided by replacement therapy with Sinemet -- Eldepryl makes the most of it by keeping the dopamine from being destroyed, so it can stay in the synapses longer. The longer the dopamine particles stay in the synapses, the more likely they are to successfully reach a dopamine receiver on the receiving nerve cell to transmit the right message. So, Eldepryl helps conserve the naturally produced dopamine and maximizes the amount of dopamine replacement provided by a dose of Sinemet. Thereby, the dose of Sinemet can be kept lower over time.

WHAT DO YOU NEED TO KNOW WHILE ON THERAPY?
1. ON LONG-TERM THERAPY
With the medications available today, people can continue to lead relatively normal and active lives for many years after being diagnosed as Parkinson's disease. Every improvement you make in your exercise routine, diet, and participation in physical therapy and support groups can help you live your life to the optimum.
2. FOLLOW YOUR DOCTOR'S INSTRUCTIONS
Take the right dose of each medication on the schedule your doctor provides you. Tampering with this plan on your own can set you back -- don't risk it!
3. MONITOR YOUR OWN PROGRESS
Keep track of how you are doing -- how you are feeling, what activities you can do, what makes you feel better and what does not. Discuss your findings with your doctor.
4. BE AWARE OF THE MEDICATION'S SIDE EFFECTS
All chemical medications have side effects. You may experience some side effects with the drugs prescribed by your health care professional for your Parkinson's Disease. You should note these and discuss them with your health care professional as soon as possible. By knowing your responses to the prescribed medications, your health care professional will be able to counsel you and tailor your regime to maximize the safety and efficacy.

OTHER WAYS TO MANAGE THE EFFECTS OF PARKINSON'S DISEASE
Parkinson's disease cannot be cured or its course reversed by western conventional treatment. Here the western approach assumes the long-term goal is to manage the symptoms, remain healthy and active, and live a relatively normal life for as long as possible.
SURGICAL TREATMENT:
You have, no doubt, heard about research in which dopamine-producing tissue is transplanted into brains of people with Parkinson's Disease. There have also been attempts to transplant growth-factor-producing cells into the brain to re-grow damaged dopamine-producing nerve cells. Right now, these approaches are strictly experimental. So far, the results have been encouraging, but with limited success. Nonetheless, these exciting prospects hold strong promise for the future.
DIET:
Weight control is important for everybody, especially for people with Parkinson's disease. Every extra pound means more work and more trouble for your muscles. In the early stages of Parkinson's disease, people may gain weight because they are less active than they used to be. Some people may eat more because they feel depressed about their medical condition. Consequently, you must carefully control your diet. In addition there is an adverse effect from different kinds of food on your medication. For example, the protein in your diet affects how your body absorbs your medication. Therefore, you may need to cut down on high-protein foods, or plan to eat those foods only at times that won't affect your medication. Your doctor can advise you on a diet plan that's right for you.
EXERCISE:
Nearly as important as your medications, regular exercise is essential for keeping you strong and flexible. Whatever form of exercise you choose, make sure it is something that gets your muscles moving, your heart pumping, and that you can keep up with every day. Walking, jogging, stretching, swimming, and other activities are terrific ways to help you cope with the tremor, muscle stiffness, and slow movements that occur with Parkinson's disease. A daily exercise routine will help you feel better about yourself concerning your condition, help in maintaining a good body weight, and help you sleep better at night.
Make sure to ask your doctor first about how to get started.
PHYSICAL THERAPY:
Many people with Parkinson's disease see a professional physical therapist -- someone who is trained to look at your individual needs and design therapy for your maximum benefit. You may arrange for physical therapy sessions at home or at the hospital on a schedule that is convenient for you. To find out what physical therapy can do for you, ask your doctor to recommend a physical therapist.
SUPPORT GROUPS:
Never forget, you are not alone. There are 1 million people with Parkinson's disease in the United States today. They have already confronted their diagnosis, felt the frustrations, and found ways to cope. You may be able to learn a lot from them. And, they can help you share your feelings and come to terms with Parkinson's Disease. If you haven't already joined a support group, you might consider doing so. Most groups are affiliated with the American Parkinson's Disease Association or the National Parkinson's Foundation, which are organized through local hospitals. Ask your doctor or nurse how to contact a group near you, or see the Resource Directory.
VISIT YOUR DOCTOR REGULARLY:
This is important to help ensure that you get the best medical attention possible. During each office visit, your doctor can evaluate how you are doing and suggest changes that might further help you. You can also use these visits to tell your doctor how you feel about your condition and get answers to questions you may have. Remember, you and your doctor share the same long-term goal: to help you get the most out of your treatment so you can live a relatively normal and active life.

ALTERNATIVE MEDICATION FOR PARKINSON'S DISEASE
by Dr. Li
The unique thing about Traditional Chinese Medicine (TCM) is that we are not limited to tremor pathologies that are actually the Parkinson's disease and those that aren't. we 've treated a number of people with Parkinson's for which limited Western treatments really helped. If we differentiate the cause of the tremors using TCM system, then we have a treatment principle and protocol.
According to TCM, tremors and/or muscle ticks are usually considered "internal wind". So, if we simply answer the question about its cause, we are done.
For example, we treated a man with tremors in both of his hands. Signs and symptoms supported the diagnosis of "Internal Wind due to Liver Yin Deficiency."
What does that mean?
In TCM, things generally boil down to Yin and Yang. Yin is the structure of the entire body -- the bodily fluids, the cellular proteins, etc. Yang is the functioning of the entire body -- the metabolic heat, the activity of the cells, etc. Yin is passive, while Yang is active.
When a specific organ is deficient in Yin or Yang, then pathologies of that organ follow that have certain predictable pathological manifestations. The (Chinese concept is that the) Liver is in charge of keeping the flow of Qi energy in the body moving smoothly.
Perhaps this concept would be best translated as the nervous system in Western terms. So, Liver Yin would be the parasympathetic nervous system (things that calm you down), while Liver Yang would be the Sympathetic nervous system (things that excite you). If there is a deficiency of Liver Yin we might see a deficiency of the parasympathetic nervous system's ability to control the spasms of the muscles. Thus, a" Liver Yin deficiency" leads to "internal wind".
So, we inject certain Chinese herbs and Vitamins directly into certain acupuncture points for the "internal wind" and for the "Liver Yin deficiency". The herbs we use follow the diagnosis; to strengthen the Liver Yin and extinguish the wind. The Vitamin B group strengthens the nervous system and balances the body's functions. After one to two weeks, the patient's condition is much improved.
This combination therapy called "Acupoint Injection Therapy" (AIT) is more powerful than Acupuncture alone or taking herbs and vitamins orally .

INTRODUCTION TO AIT TREATMENT
When the patient arrives, we:
1. Record the details of the patient's history and medications
2. Differentiate diagnose each patient by reading the pulse and tongue in order to select Chinese herbs and vitamins for injection into specific meridian acupuncture points - for treatment once daily.
3. When the patient feels better, we start to reduce the patient's conventional drugs little by little, to minimize the chemical drugs involved. This reduces further damage from the drugs' side effects.
4. At the same time we teach the patient to practice Tai Ji Qi Gong exercises every day.

HOW DOES AIT WORK ON PARKINSON'S SYMPTOMS?
1.AIT stimulates the brain and the nervous system. Certain herbs and Vitamin B combine with specific acupuncture points to keep the Qi flowing and improve blood circulation. Thus, more nutrition and oxygen go to the brain which improves brain's function.
2. AIT balances the body 's Yin and Yang by using herbs, such as Shen Mai,to raise the Yin to treat Yin deficiency by injecting them directly into specific acupoints, e.g. Liv-3, K-3
3. AIT is a powerful agent for detoxification. A Parkinson's Disease patient takes medication for years, so a lot of toxins are accumulated in the body. This causes more complications, making treatment more difficult. Certain Chinese herbs (Da Huang Ten, Yu Xing Cao, etc.) combined with specific acupoints can effectively release toxins from the body.
4.AIT improves the general health condition and strengthens the immune system, so patients have more confidence to fight the disease and more energy to exercise and these improve their mobility.

HOW DOES TAI JI QI GONG HELP PARKINSON'S DISEASE?
We prescribe an exercise combining Tai Ji with Qi Gong together. By practicing Tai Ji Qi Gong, the patient can learn to perform movement with a slow variety of dynamics, tempos, and directions. Thus, Parkinson's patients memorize how to decrease their muscle tension to achieve normal movement coordination. With deep breathing ( Qi Gong ), the person begins to know what relaxed or "released" muscle tone is. The patient thereby begins to be able to tell when the muscle is reducing. We then create movement tasks that encourage the relaxation of muscles and the awareness of specific Parkinsonian "events", and provide tools to release them.
This movement of Tai Ji Qi Gong involves a combination of imagery, movement, meditation and dance-like improvisations. A significant goal of the treatment is to help the person experience pleasure in movement -- both passive and active -- because the concrete experience of this effortlessly organized movement is what Parkinson's sufferers do not to experience in their daily lives. These exercises can operate both as an inspirational goal and as a functional clue, helping them to visualize and direct their movement process with vivid reminders of what it feels like to "get it right."
The goals of the exercises in addressing Parkinson's patients are promoting relaxation, decreasing dyskinesia, increasing fluidity of movement and increasing sensory input. The movements are involved with helping the body to compensate for lack of exercise in restricted areas. They also relieve depression for these patients.