April 2006 the American Academy
of Neurology issued new guidelines about diagnosis and treatment of
individuals with Parkinson’s Disease (PD). Since the disease is
often misdiagnosed, the guidelines were aimed at giving more options
to physicians concerning diagnosis, as well as providing patients
and caregivers with insights into treatment options. Estimates are
that 5 – 10 percent of individuals are diagnosed incorrectly, while
20 percent who are diagnosed with Parkinson’s are diagnosed with
another disease post mortem.
Not only do the new guidelines
address diagnosis and prognosis, there are guidelines for treatment
strategies; evaluation and screening for co-morbid (coexisting)
disorders, like depression; as well as hints to patients and
caregivers for sustaining quality of life as long as possible. The
full set of guidelines can be downloaded at www.aan.com/pd.
Diagnosis:
After careful review of existing
literature, the researchers issued the guidelines in hopes of making
the diagnosis and treatment process easier for physicians and
patients to manage. Since there is no one definitive test that
pinpoints PD, doctors have to interpret a battery tests that can
identify a series of symptoms that either points to PD or points
another cause for the symptoms. The guidelines offer several testing
mechanisms for physicians that make diagnosis an easier process.
If patients present with
symptoms such as lack of tremor, the doctor should be concerned that
PD is not the ultimate cause of the symptoms. In addition, patients
falling early in the disease progression can generally indicate that
something else is to blame for the symptoms. Since the disease is
progressive, it generally takes a number of years to progress from
the beginning stages to the more severe ones. If a patient begins to
move too rapidly through the stages, this could be another clue that
PD is not the disease in question.
In developing the guidelines,
researchers combed through all existing research to decide the tests
that most accurately predicted PD. When they reviewed the research,
some noticeable trends developed. One of these included evidence
that the drug levodopa, a medication that increases dopamine levels,
is an effective treatment and does not speed up the appearance of PD
symptoms as some people had once suspected. The new guidelines
indicate that levodopa should be considered as a “challenge” to
whether or not the symptoms respond to the medication. If symptoms
respond, PD should be considered a correct diagnosis.
Evaluation of Coexisting
Disorders:
Patients with PD are more likely
to have bouts of depression. Dopamine, the neurotransmitter involved
in the onset of PD symptoms like rigidity and trembling, is also
involved in regulating mood. Many of today’s antidepressant
medications also increase the amount of dopamine produced in the
brain in order to elevate mood and alleviate depression.
In addition, patients should not
feel that symptoms like depression, hallucinations, and psychosis
are a natural part of the disease progression. William J. Weiner,
MD, FAAN, of the University of Maryland School of Medicine in
Baltimore noted when the guidelines were issued, “Effective
treatments are available, and treatment can greatly improve the
patient’s quality of life.”
Additional Treatment
Methodologies:
Researchers were pleased to
discover that there is a wide range of treatment options for PD.
Included in the guidelines are treatment recommendations for various
stages of the disease, including medications that may help symptoms
subside, at least in part. It is particularly noteworthy to include
that some of the symptoms that may respond to medications include
individuals who experience motor movement fluctuations and
dyskinesia. The Michael J. Fox Foundation for Parkinson’s Research
defines dyskinesia as “Involuntary, uncontrollable, and often
excessive movement.”
For patients with debilitating
movement issues, there are also guidelines for deep brain
stimulation, a surgical procedure that may be able to assist these
patients. According to the National Institute of Neurological
Disorders and Stroke (NIDS), deep brain stimulation implants a small
battery-operated neurostimulator “to deliver electrical stimulation
to targeted areas in the brain that control movement, blocking the
abnormal nerve signals that cause tremor and PD symptoms.” The
surgery can be reversed if other treatments are discovered that may
help the patient, and the stimulation to the brain can be adjusted
as time passes and the disease progresses.
Nutritional Supplements:
Many people have tried to use
nutritional supplements such as Vitamin E as a way to improve or
slow down the progression of PD symptoms. When researchers reviewed
studies, they found no evidence that these nutritional supplements
provide any health benefit. In other words, save money that would be
otherwise spent on these vitamins and use it for other treatment
possibilities.
Exercise and Patient Way of
Life:
Exercise, however, can be
beneficial to the PD patient. There is a great deal of research to
support exercise as a healthy alternative to strengthening muscles
and keeping them as flexible as possible. Since muscle rigidity is a
serious issue for PD patients, it makes sense to keep muscles as
toned as possible. There are many ways to do exercise, including
walking; swimming; Tai Chi, a Chinese form of martial arts that
focuses on toning muscles and balance; and even housework or
gardening. It is important that the PD patient have a companion when
exercising, since freezing of the muscles can happen when least
expected and could lead to a dangerous situation, especially in a
swimming pool. While exercise won’t cure PD, it will give the
patient better control over their muscles and slow the progression
of the disease.
Speech therapy and facial
exercises can also help with keeping facial muscles toned and
working as well as possible. Practicing different facial expressions
such as surprise or pleasure or even general disgust can keep
muscles resilient. Speech therapy will help with some of the
problems produced by PD such as slow speech, coarse or raspy voice,
a low speaking volume, and other speech-related issues.
Eating a sensible diet is
another mechanism that will help keep the Parkinson’s patient as
healthy as possible. While discussed previously, there are no
specific vitamins proven to have an effect on PD. Yet, eating a
healthy diet can improve cardiovascular health and keep the person
in good physical health. Since Parkinson’s is a progressive movement
disorder, it makes sense to keep a person’s weight at a manageable
level in order to keep movement issues at bay as long as possible.
The new guidelines for PD act as
a set of protocols to better assist physicians in diagnosing,
treating, and managing the disease. In addition, it provides
patients and caregivers with information about standardized
treatments that have been scientifically proven to provide some
relief from the disease’s devastating effects. Since the guidelines
are based on rigorous research and leave room for new scientific
developments, doctors have the ability to deliver the best possible
care to patients and their families. Patients can assume a more
active role in the management of their disease.
Caregivers also benefit from the
guidelines’ issuance because they have a better understanding of the
basics of PD and what to expect during the diagnosis phase and with
different treatment options. For example, caregivers will learn that
depression is treatable and does not have to be endured as part of
the disease. As a result, caregivers are better equipped to help
their loved ones make informed choices about their medical care.
Overall, the guidelines provide a better quality of life for
patients and caregivers, while equipping physicians to make informed
diagnosis, treatment, and disease management decisions.
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