In a message dated 96-01-24 00:20:16 EST, <[log in to unmask]> wrote:
>The problem started after she had leakage in her right eye and it
>blocked her vision. This started in November. She has since had laser
>surgery in this eye and the doctor has told her that her other eye is
>starting to leak but very small. She has started seeing sparkles, white
>dust, spider webs, flies, things that move across the floor, worms coming
out...
>
>...she is aware and knows that they are not real. We have decreased
>the sinemet to 1 1/2 pills per day and she is tolerating that well but she
is
>still seeing things. Her doctor is out of town until the end of the month.
> My question is has anyone else experienced this or know of someone and did
>the halucinations go away or are they something that will continue?
These hallucinations sound like they are due to medications & not the eye
surgery. They are complex visual hallucinations with a clear sensorium &
preserved insight (awareness that they are not real). This type of
hallucinations are seen in 3.9% of patients on Sinemet and an even higher
percentage of those on amantidine or anticholinergics (which are the
anti-parkinsonisn meds most likely to cause these problems). Although your
doctor may want to get rid of some meds (e.g. amantidine), UNDERTREATING the
parkinsonism is a bad way to deal with this problem. One of the better ways
is to use low doses (6.25mg or 12.5mg qhs) of the drug Clozaril (clozapine)
to block the hallucinogenic side effects of the Sinemet. Clozaril is an
'atypical' antipsychotic that will not increase PD symptoms like Haldol and
Mellaril do. (Haldol is contraindicated in Parkinson's and should never be
used in PD patients) One drawback to clozapine - weekly blood tests are
required for clozapine therapy due to a rare side effect (agranulocytosis).
Sometimes, we use a low doses (0.25mg or 0.5mg qhs) of another drug,
Risperdol (risperidone), which does not require the blood monitoring.
However, this may also increase PD symptoms somewhat (though much less than
Haldol and Mellaril do). Clozaril seems to be the first choice for treating
hallucinations related to anti-PD meds.
Ask your doctor about it. Feel free to have him/her contact me.
mike
IMPORTANT DISCLAIMER!
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All information contained here is for information purposes
only and is provided by Dr. Usman as a public service. It
is not intended to represent the direct provision of any
medical services, including the diagnosis of a medical
condition, prescription of treatments or medications, or
recommendations of specific types of care or treatment.
All opinions expressed here are solely those of Dr. Usman
are not intended to represent those of the Alzheimer's
Disease Alliance or any other organization he may be
affiliated with.
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Mahmood (Mike) A. Usman, M.D.
Director of Research and Behavioral Sciences
Atrium I Alzheimer Care and Research Center
5180 Campbells Run Road
Pittsburgh, PA 15205 U.S.A.
Phone (412) 494-5801
Fax (412) 494-5805
e-mail: [log in to unmask] (preferred)
or [log in to unmask]
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