Ask Dr. Gott » Parkinson’s

Anti-anxiety med for tremor?

Dr. Gott — Sat, 13 Mar 2010 05:01:59 +0000

DEAR DR. GOTT: My doctor has prescribed a light dose of Xanax for an essential tremor, which seems to help. Is this medicine doing me any harm, or is there something better?

DEAR READER: Essential tremor can be caused by several conditions, including anxiety and stress. It is often confused with Parkinson’s disease, and affects almost 15 percent of people over the age of 65.

The Xanax you have been prescribed is in a group of drugs called benzodiazepines. I can only assume your physician prescribed it because he or she believes the tremor is caused by anxiety. Other prescription drugs that have shown promise include beta blockers commonly used for hypertension, some epilepsy drugs and Botox. Without knowing you personally, I cannot say whether the medication is doing you any harm; but should you choose a trial of alternatives, you might consider avoiding caffeine, excessive amounts of alcohol and stress. Hypnosis, massage, acupuncture, physical therapy or biofeedback might be of assistance.

Parkinson’s and excess saliva

Dr. Gott — Thu, 11 Mar 2010 05:01:13 +0000

DEAR DR. GOTT: I have Parkinson’s disease and have a great deal of saliva. I take two kinds of drugs — ropinirole and carbidopa/levodopa — and wonder if they are necessary.

DEAR READER: Parkinson’s is a neurological disorder with a myriad of symptoms, including fatigue, malaise, depression, memory loss, cramped handwriting, tremor, rigidity, gait abnormalities, lack of facial expression and sense of smell, and more. Postural instability develops as the disease progresses. Excess saliva is uncommon, but each person experiences different symptoms, so I won’t unequivocally dismiss any involvement with your diagnosis.

Current research indicates that symptoms of Parkinson’s disease are related to depletion or low levels of dopamine in the brain. Ropinirole is a central-nervous-system agent with some of the same effects as dopamine. Carbidopa and levodopa work in combination. Carbidopa helps to prevent the breakdown of levodopa before it reaches the brain. Then the levodopa kicks in and converts to dopamine once it gets there.

You may have been placed on the ropinirole in addition to your carbidopa/levodopa because the combination drug alone did not control your Parkinson’s symptoms satisfactorily. I urge you to discuss any concerns or questions you may have regarding your treatment with the prescribing physician. You should also be under the care of a neurologist familiar with treating Parkinson’s disease.

Family addresses Parkinson’s

Dr. Gott — Fri, 22 Jan 2010 15:20:07 +0000

DEAR DR. GOTT: My father has recently been diagnosed with Parkinson’s disease. Because we know so little about the condition, we would like to know what we might expect.
DEAR READER: Parkinson’s disease (PD) is a progressive neurological disorder that occurs when neurons located in a portion of the brain become impaired or die. In healthy individuals, these cells produce a chemical known as dopamine that allows smooth, coordinated functioning of muscles and movement. When approximately 80 percent of the dopamine-producing cells are damaged, symptoms of Parkinson’s appear.
This is the second most common neurodegenerative condition, following Alzheimer’s. About 4 million people worldwide are affected, with the disorder being more common in men.
Early symptoms are subtle, may occur slowly, and often include a decreased or total lack of the ability to smell. As the disease progresses, complications may escalate. Handwriting may appear cramped and difficult to read. Rigidity, lack of facial expression, postural instability, slowed thinking, memory loss, sleep disorders, constipation, urinary incontinence, visual hallucinations, dyskinesia (involuntary movements) and emotional changes may occur. Depression affects quality of life and may be present in up to 70 percent of all sufferers. Difficulty swallowing affects about 75 percent of all individuals with moderate to advanced PD. Oddly enough, we’ve been led to believe that the condition is always associated with a tremor when, in actuality, almost one-third of all PD patients fail to have that symptom. When it occurs, it most frequently begins in a hand, although it can appear in a foot or the jaw.
Treatment includes new drugs that may assist in avoiding the complications associated with the long-term use of levodopa, which was introduced in the 1960s and considered the first effective medication for control. Debate remains regarding when to begin initial treatment. Delaying treatment until symptoms become severe is common practice since levodopa is effective only for a period of a few years, but there is a growing consensus that supports early treatment.
As a patient ages, he or she will likely experience difficulty with remembering to take medication. This contributes to a decrease in adherence to drug schedules. In this instance, a pill container listing the days of the week and times of day may come in handy. And it goes without saying that a caregiver will be required to set out and monitor the specific amount of medication prescribed.
Caregivers are an extremely important part of the picture, yet a great deal of auxiliary assistance may be needed at the appropriate time. A patient may benefit from medication; physical, occupational and speech therapy; exercise; massage; acupuncture; and herbs. In fact, almost 50 percent of patients admit to using alternatives such as grape-seed extract and vitamin B50 for control of tremors. Caregivers should realize that a coordinated, successful individual who may have been the primary breadwinner in the family will have difficulty adapting to something over which he or she has no control. Frustration, anger and a feeling of hopelessness may result. The patient must remain as independent and active as possible for as long as possible. The services of an outside counselor might be appropriate.
If he isn’t already, your father should be under the care of a neurologist with appropriate knowledge of Parkinson’s. Ask his primary-care physician for a referral.