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APDA Symposium "This event looks more like a show and tell about being up-to-date than a real effort to inform patients and caregivers." I think that the APDA has done quite a service to the Parkinson's community by putting together their satellite symposium. The speakers were all leaders in their field and well informed of the latest developments in care and research. It appeared to be an honest effort to inform the greatest possible audience of patients and caregivers. If people are disatisfied with the amount of pre-publicity or technical organization of the event then they should address their constructive criticism directly to those responsible at APDA so that improvements can be made in the future. I'm sure that the APDA would love nothing more than to have a greater number of participants. We can help them do a more comprehensive job in the future with our suggestions. Finally, until someone else does a better job of reaching out to the numerous patients and caregivers around the US with limited access to information on PD the APDA deserves our support for this type of mass media educational event. A few points of interest from the symposium: Ray Watts of Emory University maintained that the use of other medications besides sinemet, can reduce the intake of L-dopa by 50%. This is important if you are concerned that excessive use of L-dopa is related to premature loss of effectiveness over time and could even speed up progression. Some dopamine receptors (D1 & D2) are believed to control motor function while others (D3, D4 & D5) control behavioral functions. Eventually medications will be designed to target specific classes of dopamine receptors allowing better treatment of individual symptoms, ie tremor, depression, dyskinesia, hallucinations. Falling when trying to get up can be caused by orthostatic hypotension in PD. This problem is aggravated in hot weather which reduces body fluids. It is particularly important for those who suffer with this problem to maintain adequate body fluid levels. Hallucinations are the #1 reason why some people with PD end up in nursing homes. The implication here is that if hallucinations were better treated many could avoid unnecessary confinement in a home. Dr. Warren Olanow of Mt. Sinai feels that free radicals are most important aspect in pathogenesis of PD. He believes that selegeline (deprenyl) helps significantly. Tom Freeman of Mt. Sinai has done 6 fetal tissue surgeries and claims good results. Olanow is excited about the prospects of using pig fetal neurons & genetically altered cells for transplants in the future. Pallidotomy surgery works better now than 30 years ago because we understand anatomy better. Deep brain stimulation is the functional equivalent of creating a lesion in the subthlamic nucleus without the risk of side effects. Dr. Koller of the University of Kansas believes strongly in the value of daily exercise as one of the best things you can do if you have PD. He says that exercise is as important as taking medications properly. One third of patients stop taking medications without telling their doctor. (I'm sure that many have good reason and may know as much about their meds as their doctor, however it still must be a source of frustration to neurologists to never be sure that their prescription has been followed.) Koller maintains that because the cluster effect involving folks with PD is insignificant PD is probably due more to genetic predisposition combined with the action of a toxin(s). There is a class of small molecules that seems to do the same thing as neurotrophic factors - prevent cell death from apoptosis. If this is true use of these molecules will be advantageous in that they can cross the blood brain barrier. Fetal transplant may end up being suggested at a younger age because it can alleviate the negatives of long term L-Dopa treatment. The latest methods of diagnosis include PETscan, SPECTscan, movement measurement techniques and a "scratch and sniff" test. 25% of patients who think they have PD actually have PD+. Neurologists have come to accept that other physical sensations - tingling, parasthesia and various pains are part of PD. They have found that the basal ganglia is also closely related to sensory neurons. Koller believes that young-onset PD is not on increase. It is now better recognized wheareas before it was often misdiagnosed. Two studies claim that 40% of people who have PD are not diagnosed. PDers have higher frequency of alzheimer's pathology than the general population & vice versa. Please excuse any misquotes or misinterpretations. -Ken Aidekman