The "Taking Control of Parkinson's Disease Second
National Satellite Symposium" was broadcast out of Colorado last
March 7th to some 113 sites where a hoped for audience of 8000
viewed the proceedings. The following is a partial summary of
what took place. It is accurate to the extent that my
micrographia and cryptic notes permit.
There were four major presenters, followed by a physical
therapist who led the group in stretching exercises that lasted
for about ten minutes, and then the Question and Answer period
for call-in viewers.
The moderator, Dr. Dee Silver, opened the symposium with a
presentation entitled "Living with Parkinson's Disease:A
Pharmacological Approach." This was a general overview of PD
where Dr. Silver's theme was the observation that every patient
was different, and because of different reactions to medication
and different rates of 'progress' of the disease it was vitally
important that patients consult with trained, experienced experts
in the field. The key, he said at one point, is the
individualization of treatment, especially as the disease
progresses.
Dr. William Tatton, MD from Nova Scotia, spoke about "New
Frontiers in Science" accompanied by many slides. His talk was
too technical for me to understand and beyond my ability to
summarize. I suspect he was not talking to patients and care
givers but rather to medical professionals. The third presenter
was Dr. C. Warren Olanow from Mt.Sinai, New York who spoke on
"Concepts of Neuro Protection." Jeffrey Kordower, PHD, Chicago,
delivered a paper entitled "Surgical Options: Pallidotomy and
Transplant Options." Of particular interest to me was Dr.
Kodower's observation that not only did the transplanted cells
produce dopamine but that they were unaffected by the patient's
Parkinson's Disease. His was a most optimistic presentation.
Dr. Silver began the symposium with a short - perhaps 2 minutes
long - film that explained what happens in Parkinson's Disease,
that while the cause of PD is unknown the result is a shortage of
dopamine in the basal ganglia. People with normal dopamine
production perform physical acts on automatic pilot without much
thinking but PD'rs have problems converting their thoughts into
physical actions. (It is thought that at the time of diagnosis
most patients have already lost some 60 to 80% of their
dopamine.)
Silver observed that the optimal approach to PD was a drug and a
non-drug treatment that was aimed specificaly for the individual,
for every patient is different and the disease progresses
differently. Nonetheless, he said there were four ( but he
offered five) standard items in PD diagnosis:
Resting tremor
Akinesia (slowness of movement)
Rigidity (stiffness)
Postural Instability
Positive response to Levodopa (Sinemet) treatment.
He listed the common symptoms of PD as:
Shakiness of the hand
Dragging of one leg
Arm stiffness
Handwriting difficulties
Speech disturbances
Staring
Weakness
Dr. Silver next presented a list (much of his resentation
consisted of lists) of common symptoms of PD seen by physicians
and by caregivers:
Tremor
Absence of arm swing
Rigidity
Bradykinesia
Expressionless face
Impared postural reflex
Flexed posture
Propulsion - Retropulsion
Short festinating steps
Low speech volume, monotonous tone
Stuttering (dysfluency)
Hesitation of initiation of movement
He spoke briefly about these symptoms and those of Atypical PD
patients as well. Then went on to deal with the
non-pharmacological treatment of PD which he saw in four parts,
namely: Education, Exercise, Nutrition, and Group Support.
Dr. Silver next emphasized that the established treatment
algorithm for PD was based on which of two groups the patient was
in. The two clinical PD groups are:
Younger with normal cognition (below 70 or 65)
Older with some cognitive impairment
PD'rs are divided into these two groups for three important
considerations:
Duration of possible treatment expected
Group response to medication
Groups potential for side-effects
So, for example, older PD'rs don't do as well with Sinemet CR as
do younger, older patients don't do as well with
anticholinergics. The standard PD drugs (Eldepryl, Sinemet,
Dopamine Agonists, Anticholinergics, Amantadine Hydrochloride,
Benadryl, and beta blockers) are prescribed based on which of the
above two clinical groups one belongs in.
I see that I have gone on at too great a length summarizing (!)
what went on in the symposium and I have not even finished with
the first presenter. I best stop unless some one wants more. Do
you suppose long-windedness is another symptom?
--------------------
Sid Roberts 66/dx2
[log in to unmask] Youngstown, Ohio
