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---------------------------------------------------- >>> Posting number 20402, dated 17 Feb 1997 20:05:08 Date: Mon, 17 Feb 1997 20:05:08 -0500 From: "J.R. Bruman" <[log in to unmask]> Subject: Autonomic System AUTONOMIC SYSTEM AND PD (Feb 1997) Normally, we don't pay much attention to body functions such as breathing, blood pressure, pulse rate, digestion, peristalsis, etc. Unlike conscious activity such as talking, reading, riding a bike, the body takes care of unconscious functions by itself. Except in PD. IMHO too little attention is given, both in literature for PWP and in research on management of the disease. Books for PWP, for example the one by R. Duvoisin, mention some autonomic symptoms, but skip any explanation of their relation to dopamine and how they are caused. So here is a bit of info, limited by the amount of current work as well as my slight knowledge, to help PWP understand the disease better. My reference material is old, dating as far back as 1972, but I think still OK. First, a few definitions: The human nervous system is divided into the central system, consisting of the brain and spinal cord, and the peripheral system, which is everything else. The peripheral system includes nerves to muscles and sense organs, for example, and the autonomic system. The autonomic system is further divided into the sympathetic (outgoing or efferent) system and the parasympathetic (incoming or afferent) system. Those two components form a feedback loop for each of many connected organs, muscles, or functions. For example, the brain senses a need for more blood, and sends a signal raising blood pressure and pulse rate. Then it receives a signal back when the needed increase has occurred. The process is continuous, as are all other autonomic functions, and although some people can learn to influence it consciously, that is not necessary. For another example, we can all hold our breath (briefly) or take a deep breath, when we want to. But if we ignore breathing, as usual, the autonomic system, using the very same muscles, tends to it. I don't know if sleep apnea is associated with PD, but it might be. Dopamine circulates in the blood, to mediate action at the distal terminals of the autonomic system. Symptoms of autonomic failure, presumably due to dopamine deficiency of PD, include: difficulty swallowing; drooling (either excess salivation or failure to swallow enough); insufficient or excess sweating; urinary retention or hesitancy; sexual (in men) dysfunction; seborrhea (not dandruff as some neurologists seem to think}; constipation (which can be life-threatening); conjunctivitis, from reduced tear secretion; solid matter in eyes (from excess tear secretion?); poor muscular endurance (abnormal fatigue); poor sensation of temperature or poor temperature regulation; dizziness on suddenly arising (postural hypotension). Paradoxically, one severe form of autonomic (non-PD) failure is congenital lack of the enzyme that converts dopamine to norepinephrine, resulting in excess, rather than deficiency, of plasma dopamine. Much of the above is my conjecture, since there doesn't seem to be much literature on the relation of the autonomic system to PD, nor have I found any current research on it. More of either would probably help PWP a lot. Joe ---------------------------------------------------- >>> Posting number 54391, dated 29 Dec 1998 19:44:00 Date: Tue, 29 Dec 1998 19:44:00 -0800 From: bobc <[log in to unmask]> Subject: Drooling I have had a problem with drooling / excessive saliva, starting maybe 7 years ago. I was dx with PD four years ago. In the last 7-8 months my drooling has increased considerably in volume and frequency. I haven't seen much, if anything, posted on the list re: drooling. Is it a symptom of PD ? Can it be controlled? Thanks for any info. Bob Chapman, 65 age now /61 age dx /55 age onset ---------------------------------------------------- >>> Posting number 54537, dated 3 Jan 1999 13:45:05 Date: Sun, 3 Jan 1999 13:45:05 -0500 From: Phil Tompkins <[log in to unmask]> Subject: Re: Drooling bobc wrote: > I have had a problem with drooling / excessive saliva... Is it a > symptom of PD ? Can it be controlled? Hello, According to Dr. Abraham Lieberman's book "Parkinson's Disease" drooling by PWP is not due to excess saliva but rather to insufficient swallowing caused by bradykinesia. For people without PD, automatic swallowing handles the saliva. With PD the muscles involved are affected by bradykinesia, so we swallow with less force and frequency. The muscles will weaken and undergo atrophy unless we make conscious efforts, not only to remember to swallow, but also to keep in practice by incorporating swallowing into our exercise routines. If this doesn't work, there are medicines that decrease saliva production. Dr. Lieberman's book, a paperback published by Simon and Schuster (I don't receive any benefits from this plug) contains the most thorough discussion of PD symptoms I have seen. Phil Tompkins Hoboken NJ age 61/dx 1990 ---------------------------------------------------- >>> Posting number 57143, dated 5 Mar 1999 12:07:39 Date: Fri, 5 Mar 1999 12:07:39 EST From: Marty Polonsky <[log in to unmask]> Subject: Re: Excessive saliva??? Camilla, II didn't see the original posting on this so I'm replying to you. I'm sure you're just dying to get more mail,, so here you are. I've had lots of experience with excessive saliva--no, drooling--following my second (bilateral) pallidotomy. I don't know whether it's really a matter of excessive saliva or inability to hold it--I think it's both--but I found a few things which helped. I accidentally tripped on one solution--i.e meds which have a side effect of drying you out internally. The most effective for me, in this regard. is imipramine, brand name tofranil, which is used as a mild antidepressant and to dry you out, for other reasons. II also tried robinall. a mild tranquilizer but it wasn't as effective for me. Anyone with this problem should, of course, talk to their neuro's about meds but these are suggested meds that they can ask their neuro about. The other, more consistently effective measure was to chew gum--yeah, that simple. Apparently the act of chewing makes you more diligent about the task of removing (excessive amounts of) saliva from your mouth. I think that it was more effective when I chewed big pieces of gum (chaws) This can be a considertiaion if you chew sugarless gum--eg trident which comes in small pieces, so you might want to chew 2 at a time. Good luck. Marty Polonsky ---------------------------------------------------- >>> Posting number 57479, dated 19 Mar 1999 13:10:43 Date: Fri, 19 Mar 1999 13:10:43 -0500 From: "Bonnie Cunningham, R.N." <[log in to unmask]> Subject: Re: Drooling Dear Will: According to everything that I've read and have heard in conferences, (I've read and heard Dr. Abraham Lieberman, specifically, address this topic), Kathrynne is correct when she stated that Parkinson's does not cause excessive salivation. As a matter of fact, she is right on target that the saliva does indeed pool under the tongue. Normally, throughout the day, we all subconsciously swallow at regular intervals. In those with PD, due to the increased incidence of swallowing difficulties, the tendency is not to swallow as frequently, therefore leading to a build up of saliva. When you mentioned post pallidotomy speech and swallowing problems in relation to "excessive saliva" (drooling), it reinforces this concept. With post-operative swallowing difficulties, there may appear to be an increase in saliva, however, once again, it is the decrease in the automatic swallowing. The good news is that there are certain 'exercises' that can be done to help this problem and a Speech Pathologist can show you those exercises. An excessive secretion of saliva is called 'ptyalism' and according to Taber's medical dictionary there are several conditions in which this can occur. It also can be caused by some medications (Taber's mentions mercury, iodides and pilocarpine). I know that for so many people, drooling is quite a problem. In Dr. Lieberman's book (Parkinson's Disease - The Complete Gude for Patients and Caregivers), he suggests that during the day sucking on a hard piece of candy will help as it will force the person to "remember" to swallow. He also suggests that for those who are in advanced stages of PD with this problem, that their caregivers periodically remove the saliva with a bulb syringe. Also the suggestion is made to have the person sleep on their side so that they will not have a choking episode. Warm Regards, Bonnie Cunningham NPF ---------------------------------------------------- janet paterson 52 now / 41 dx / 37 onset a new voice: http://www.geocities.com/janet313/ 613 256 8340 PO Box 171 Almonte Ontario Canada K0A 1A0