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Hallucinations may be encountered in the later stages of Parkinson's Disease. They are made worse by almost any of the antiparkinsonian medications - those containing levodopa, the agonists, the anticholinergic drugs, and amantadine. In so far as I know, the drugs do not CAUSE the tendency for hallucinations, but sure do make the hallucinations worse. The hallucinations are part of the advancing disease and dementia. They were well described even in the 1880's (yes, more than a century ago), even before any of the current antiparkinsonian drugs were ever used. If the dose of antiparkinsonian drugs cannot be adjusted downward, there are two antipsychotic drugs that seem to be particularly useful: quetiapine (Seroquel), and clozapine (Clozaril). Most of the others seem to make the motor symptoms of PD worse, including olanzapine (Zyprexa) and risperidone (Risperdol), and the more classic tranquilizers and antipsychotic drugs. (The dose of quetiapine may be as high as 400 to 800 mg per day, although it is best to begin with lower doses to see if they are effective. In my experience, doses as low as 25 to 50 mg have been dramatically helpful in some patients. It is best to start low and go slow.) In the most severe cases, one has to make a judgement concerning the lesser of two evils. If the hallucinations are so distressing, perhaps one has to sacrifice the therapeutic effect of the antiparkinsonian drugs in order to reduce the hallucinations and improve the overall quality of life. It may be a hard choice sometimes, but I have usually favored the improvement in mental symptoms as a higher priority than the improvement in motor symptoms. Most PWP that I have treated with this problem seem to agree - a clear mind without distress is more important than relief of rigidity and bradykinesia - if the choice must be made. These issues can and should be discussed with your neurologist. Jorge Romero, MD ----- Original Message ----- From: "Sharon Headley" <[log in to unmask]> To: <[log in to unmask]> Sent: Sunday, September 16, 2001 5:38 PM Subject: New Member and a Nightmare > I am a new subscriber the this network. I would like to briefly share my > story----- > My dear sister was diagnosed with young onset Parkinson's about 12 years ago. > She has had excellent care-including a pallidotomy AND Deep Brain Stimulation > over the years- but each operation was minimally successful, at best. She > currently receives Botox injections for severe dystonia about once evry 3 > months. > While degenerative, things appeared "handlable" till about 3 years ago--at > this time my sister began experinecing classic symptoms of > psychoses-including paranoid delusions. Believe me when I say that these > HORRIFIC psychological manifestations are worse than her physical symptoms. I > want to share this: We have been told in no uncertain temrs that the > psychoses is a side effect of the YEARsof Sinamet and related agonists over > the years. This side effect does not afflict ALL Parkinson's sufferers, but > it DOES happen. The problem is that the patient certainly cannot stop the > Sinamet. While an antipsychotic drug helps somewhat. the psychoticsymtoms are > OVERWHLEMING AND HORRIFIC-you would not believe what her mind thinks os real > and of course the actions she makes based on these ddelusions. In addition, > since the Parkinson's continues to progress,my sister is also showing signs > of "Parkinson's dementia"-again, this does not happen to ALL PD patients, but > it sdoes to some. This includes poor judgement and reasoning capabilities, > dofficulty with ligical thinkging, etc. So, as you can see, the Parkinson's > has not only attacked my sister physically, but psychologically as well. Our > lives have been FOREVER changed, adn there appears to be no solution. > My plea--Have ANY OF YOU had experience with not only the physical aspect > but also the impact-as the disease has progressed- of the HORRIFIC Psychoses > wrought by medication and the advancement of the disease???? MY sister, while > not an immenent danger to self or others, cannot be helped in a supportive > envoronment (such as assisted living, etc) without her concent and of course > she refuses this help (this is part of the mental side of the illness). > Guardianship CANNOT happen until she is deemed incompetent by the state-but > because she is not a "danger" to self or others, she cannot be committed for > help. > Our family's faith, binds. and emotional stamina is almost completely > broken--DOES ANYONE HAVE PERSONAL EXPERIENCE WITH THIS??????? Thank you all > for listening, .........and I am eagerly awaiting your responses ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn