On 9-30 there was an interesting symposium in Middletown,Ohio, which
several from our group attended. I would like to share a few of the points
made by speakers which relate to questions often asked on this list.
Three Ohio neurologists spoke and answered questions from an audience of
about 150. They were Dr. Arthur Hughes,on staff of 4 Cincinnati hospitals,
who addressed PD Dementia, Dr. Subodh Wadhwa of Middletown (Peter's neuro)
who spoke on Advanced PD, and Dr, George Paulson, Dir. of the {D Center of Exce
llence, Ohio State U.,Columbus, and Chief of Staff of the OSU Hospitals. (BTW
the is listed in the book, "100 Best Doctors in America" ) Points noted:
Paulson:**New research has established that there is no problem with starting
l-dopa early in treatment. **It is now believed that Eldepryl does NNOT slow
the progression of PD **Newer agonists, such as entacapone may prove better
than Permax or Parlodel. ** Some doctors say to start agonists before Sinemet.
** Patients must be carefully evaluated for pallidotomy, which both U.Cincinnat
and Ohio State are starting to do, and suggests "not running off to get it--wai
t a year or two"
Dr. Wadhwa expressed empathy with the problems of asvanced PD pts.,as docs
have little to offer them as people stop responding to l-dopa. **Wearing off
between doses is to be expected, and is corrected by the next dose, but the
ON-OFF phases are harder, as they have no relation to meds. ** Clozapine
for hallucinations should be a much smaller dose than is given for schizo-
phrenia--1/2 of a 25mg pill. ** Low blood pressure is a very big problem
(wear support hose, increase salt, try Florinet.
Dr.Hughes said about 25% of Alzheimers pts. eventually get PD symptoms. In AD
the dementia comes from loss of the neurotransmitter acetylcholine, while in PD
it is from loss of dopamine. ** 10%-40% with PD will develop AD and pts. with
slowness and rigidity but little tremor are at greater risk for this.
** Marginal dementia may be triggered by stress, and dr. must find cause of
stress, which may be correctable. **Artane, Cogentin, & sometimes Sinemet
in excess can cause stress and confusion. **Meds which relieve dementia (
(Haldol, Clozaril ) may worsen PD symptoms **Artane is good for night sweats.
Hope some of this is useful :-)
Camilla Flintermann (C) Oxford,OH
