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Teresa, Thank you for the compliment. I try to provide the dual perspective of being a physician and a PWP. Regarding Michael, how old is he and what was his age of onset? Do you know the doses of meds- Parlodel, Sinemet and Eldepryl he was taking at the time of the onset of the paranoia and now? I get my PD care from Rush and saw Dr. Klawans for a number of years before entering into some studies when I changed to Dr. Shannon and now Dr. Goetz. The Rush Movement disorders Program are as knowledgeable a group as you will find anywhere in the world and I would suggest that if you can find a way to get Michael to Chicago at least for ongoing consultation i.e. every 6 months to a year arranging with your neurologist (I believe you must be in South Bend) to work with the Rush experts as consultants- but with he remaining your primary Doctor- that is if you feel he is concerned, and willing to work with the Rush people but does not have the expertise in PD necessary with such a complex PD case as is evident in Michael. Regarding the medications he is or was taking- Mellaril can and usually does cause worsening of PD symptoms. Since also med doses of PD meds are usually being reduced at the time that is usually an unsatisfactory solution- although until a few years ago that is all we had. Clozaril was introduced about 8-10 years ago for Schizophrenia. It does not have the movement side effects (pseudoparkinsonism) that most of the other anti psychotic medications demonstrate. In recent years it has been used for psychosis in PWP with some real success (as well as failures) which a number of the list have attested to. There is some small risk involved and weekly blood tests are mandatory to head off a potentially fatal aplastic anemia which occurs in about 1-2% of individuals who take the drug. (but caught early is almost always preventable). There are also sometimes other side effects. Having stated the risks the benefits can truly be remarkable both in schizophrenia its primary indication- and in psychosis associated with PD. Respiridol and now recently Zyprexa are attempts to capture the positive effects of Clozaril without the risk of serious side effects. I have not been impressed with respiridol in my experience - and it seems to have the pseudoparkinson side effects although at a reduced frequency and severity. Zyprexa came out several months ago and with my severely reduced practice at this point I haven't had the chance to try it on patients. That is why I am collecting information about PWP's experience with it on the LIST. I would think that Clozaril would be Michael's best hope- sometimes it can even be helpful to the Parkinson's symptoms themselves- However Psychosis associated with PD &/or PD meds is an "off label" indication for using Clozaril- meaning PD is not an officially FDA approved use for this drug (probably on the basis of failure of the drug company to apply for that approval or red tape). Rush has a series of at least 45 patients that they have tried on Clozaril according to Dr. Shannon the last time I talked to her about it with some good results and some failures. I think it would be worth a try considering that Michael is so dysfunctional at this time. Good luck and keep me informed. Charlie -- ********************************************************** CHARLES T. MEYER, M.D. MADISON, WISCONSIN [log in to unmask] **********************************************************