My aunt, daughter of grandfather with PD was bipolar and took lithium. 
Grandpa "PD" and I both had migraines.  Uncle had epilepsy; Mom had 
trigeminal neuralgia.   Another aunt had dementia/Alzheimers; only oldest 
son escaped these brain maladies.
there is/was something wrong in all our brains.  Ray

Parkinson's case offers glimmer of hope for future research
08:50 AM CDT on Saturday, August 16, 2008
By JEFFREY WEISS / The Dallas Morning News
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DALLAS - Matthew Greenstein is living a story about illness, failure and a 
chance at redemption. He's also an example of how, in an era when medical 
research is mostly about crowds of scientists and millions of dollars, a 
little luck might still make a difference.
 Kye R. Lee/DMN
Matthew Greenstein (cq) and his wife Rachel kiss their two-year-old daughter 
Lea as they spend their afternoon time with her at their Dallas home on 
Monday afternoon, August 4, 2008. At 28, Greenstein was diagnosed with 
Parkinsons. As the disease progressed, he eventually fell into depression 
and other psychological problems. A couple of months go those problems got 
so severe that he was given lithium, a powerful and effective drug that is 
only given to people with pretty significant psychological issues. And 
suddenly, his Parkinson's symptoms got a lot better. He now can button his 
own shirt, lift his daughter, and do other things in the morning that were 
impossible.
Some of the details of his life are like an anti-lottery ticket: Matt has 
Parkinson's disease at an age - 32 -when almost nobody has it. He has 
psychological issues that require medication - but most of the medicines are 
either bad for people with Parkinson's or not strong enough to treat Matt's 
problem.
But here's the kicker: A couple of months ago, right after his Dallas 
psychiatrist prescribed his one remaining choice of medication, Matt's 
Parkinson's got a lot better.
And while nobody knows if one is related to the other, a top Parkinson's 
researcher is interested and wants to find out if there's a connection.
"I've been given a gift that few people have ever been given, a second 
chance," Matt said.
When Matt was growing up on Long Island, he was athletic enough to play 
competitive golf and football.
While at law school at Tulane, he met Rachel, now his wife. It's also where 
he noticed a mild tremor in his right hand, a slight limp in his right leg.
Matt hoped they would go away.
"I've never worked hard at something and not achieved my goals," he said.
But not this time. A doctor's tests came in with a stunning diagnosis: 
Parkinson's. The classic symptoms include shaking, balance issues, rigid 
muscles, some speech difficulties -- pretty much what Matt was starting to 
experience. Only 1 percent of people with Parkinson's are diagnosed as young 
as he was. "Young onset" PD, as it's called, does have one famous face: 
Actor Michael J. Fox.
Mr. Fox was 29 when he was diagnosed. When Matt got the news, he was 28.
Parkinson's is a degenerative disease that seems to be related to the 
unexplained death of brain cells and the loss of an important chemical 
called dopamine. Doctors don't know the cause, but genetics, prior 
infections and other environmental factors may all play some role.
And while there are medications that help relieve symptoms in many people, 
there is no cure.
Matt and Rachel got married in March of 2004. But the illness started to 
crowd out bits of what had been Matt's normal life. The stress of a Type A 
legal career made the symptoms worse - stress does that to a lot of people 
with PD - so he shifted jobs.
But the symptoms continued to get worse.
Then he had a bit of good luck. His father, an internal medicine physician 
in Long Island, has a friend with a distant connection to Michael Fox. The 
friend pulled some strings and Mr. Fox himself called Matt's dad and offered 
some support. And the name of his own neurologist: Dr. Susan Bressman, who 
chairs the neurology department at Beth Israel Medical Center in New York 
City and is a medical advisor for the Michael J. Fox Foundation for 
Parkinson's Research.
As with many PD patients, the drugs she gave to Matt offered only a window 
of relief. Rachel had to button his shirt before work. When their daughter, 
Lea, was born in August of 2006, Matt couldn't lift her from her crib in the 
morning. If they went out to dinner at night, Matt had to think about the 
degree of difficulty of menu items.
"It's so dehumanizing that a 30-year-old man can't cut his own food," Matt 
said. "It just grinds you."
Neither his friends nor family knew how much that grinding was getting to 
him. Matt had been hitting the New Jersey casinos since he was 21. What had 
been a gambler's itch became a serious psychological addiction - and a way 
to escape his PD.
"Chips make you equal," he said.
It was also a side of his life that he kept hidden. These days, Matt uses 
words like "betrayal" to describe how he treated his friends and family.
In February 2007, a new job opportunity moved the family to Dallas.
Last year, Rachel found out about the gambling and Matt stopped for a while. 
Nine months later, he fell off the wagon and had what he calls "a 10-day 
manic episode." His family convinced him to see a Dallas psychiatrist, Dr. 
Robert Schwartz.
Dr. Schwartz quickly diagnosed him with moderate to severe manic symptoms, 
which seemed at the time like another piece of particularly bad luck:
Some newer medications used to treat manic symptoms can make PD symptoms 
worse, others aren't strong enough to help Matt. That left one older drug, 
lithium, that also has some potentially severe side effects - including 
Parkinson's-like symptoms in some people who don't have PD.
Psychological relief from the drug started after a day or two. But the 
medical mystery began after a week: Matt's PD symptoms suddenly got better.
"I got out of bed in the morning and started to walk, normally, to the 
bathroom," Matt said.
Mornings, before his PD pills kicked in, had been very bad. And yet, that 
morning, he was more fluid, more normal. Ditto for that night, long after 
the day's PD pills should have worn off. And so on. For the past two months.
Someone who meets Matt in the morning these days sees a soft-spoken man who 
walks with only the slightest hint of a limp and who lifts his daughter over 
his head with only a slight tremor.
Could it have been the standard cocktail of medications suddenly working 
better? Could it have been a spontaneous remission - doctorspeak for "We don't 
know why you got better"? Or maybe, just maybe, the lithium had something to 
do with it?
"It isn't crazy," Dr. Bressman said. "We don't know everything about 
Parkinson's disease, and we don't know everything about how lithium works."
And Matt's particular run of medical bad luck - PD plus severe manic 
symptoms requiring lithium - is very unusual, she said. Unusual enough that 
a beneficial effect on Parkinson's from lithium may have been missed until 
now.
But there may not be anything useful to others in Matt's case, she warned.
There are at least two tantalizing hints about lithium and PD in the medical 
literature:
Dr. De-Maw Chuang is a researcher with the National Institutes of Health who 
has published reports that lithium protects and even contributes to 
regeneration of mouse brain cells afflicted with conditions that look 
something like Parkinson's.
And earlier this year, Italian researchers reported remarkable results in a 
small study of lithium of patients with ALS, better known as Lou Gehrig's 
disease. The researchers said they'd like to try the drug on PD, if they 
could get the money.
Dr. Bressman is in the middle of a research study about PD and mood 
disorders - such as Matt's manic symptoms. His case is prompting her to go 
back into the data looking for any cases similar to Matt's. And to 
informally ask her colleagues if they've heard of similar cases. But whether 
Matt's case turns out to be a trigger for productive treatment or just 
another blind alley will take years to answer.
What's next? Neither Matt nor his doctors know. Matt and Rachel have both 
seen the movie Awakenings. It's based on the real story of people left in a 
near coma for decades who were helped dramatically by a new drug - but only 
for a short time.
"I'm not ready to have a big parade," Rachel said. "Who knows how long this 
will last?"
She figures Matt has lost any excuse for not picking up his towels or 
loading the dishwasher. And then there are the serious moments.
"The pleasure I have is to see him hold his daughter in a normal way," she 
said.
But Matt's grip on normalcy is still fragile. His PD is not cured, by any 
means. He still sometimes talks a bit too quickly and fidgets, a sign that 
the manic problems are only held at bay, not erased. And the temptation to 
gamble is as close as a computer screen.
Last week, Matt went to Atlanta for a national conference about Young Onset 
PD organized by the National Parkinson's Foundation. Weeks earlier, he had 
contacted one of the keynote speakers, Tom Curran, a TV anchorman from Tampa 
who was diagnosed in his early 50s. He and Matt got together the day he got 
to Atlanta. And the next day Mr. Curran called Matt to the stage at the 
conclusion of his speech about "Hope for Tomorrow."
Matt talked about four years of deepening depression - and about his new 
attitude. He and Mr. Curran had agreed beforehand not to mention the 
lithium. Even so, Matt said, he had no trouble talking about hope to a 
roomful of people with PD.
"It's about not looking at Parkinson's as a ball and chain, but as a 
motivator," Matt said.
MORE ABOUT PARKINSON'S DISEASE
.Parkinson's disease is a progressive, degenerative brain disease named 
after a London doctor named James Parkinson who wrote about the condition in 
1817. Symptoms include bradykinesia, which is a slowness in voluntary 
movement; tremors in arms, legs and head; stiffness in the muscles; 
difficulty speaking; an expressionless, mask-like face; and difficulty 
walking.
.There's no blood test, brain scan or other medical analysis that 
unambiguously identifies Parkinson's. If a patient has at least two of the 
primary symptoms, a doctor will test for other conditions - stroke, brain 
tumor, etc. - that can produce similar effects. If other causes are ruled 
out, the doctor will diagnose Parkinson's.
.Doctors don't know the cause, but genetics, prior infections and other 
environmental factors may all play some role.
.While there are medications that help relieve symptoms in many people, 
there is no cure.
SOURCE: Dallas Morning News research

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
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