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Last week,Aliza and I attended a 5 day "vacation PD seminar" in Zichron Yaakov,Israel.We would like to share some of our experiences with the PD list. The Seminar was organized by The Israel PD Support Group,POB 635,Kiryat Bialik 27100,Chairman,Mr Yitzchak Mechraz,Vice Chairman,Dr.Dan Nir based in the Haifa area with branches in Jerusalem,Emek Yizrael,and Tiberias.Tel Aviv has about 800 members in its support group but they are not active and as far as we could learn did not participate in this seminar.Dr. Nir Giladi is the medical advisor to the group,and was instrumental in initiating the group.There were 80 attendees consisting of PWPs and their CGs. The program included: A workshop for PWPs and their CGs,Arts and Crafts, Exercises with music and games,lectures by the top Israeli Neurologists, physical Therapy,Diet,Adapting of the home to physical disabilities, Reflexology,Shiatsu,hydrotherapy,a fashion show,a lecture on the Bedouin culture and their health folklore,sports,Cosmetics,and Chiropractic therapy. We met interesting people.There was entertainment every evening.On thursday, we had a guided tour of Zichron Yaakov,a small coastal town south of Haifa famous for its Rothschild Winery.We also visited a Diamond Jewelry factory and showrooms at nearby Tirat Hacarmel which sponsored our tour. Dr Nir Giladi,head of the Neurology Dept. at Ichilov Hospital in Tel Aviv gave the lead-off lecture which was attended by Member of the Knesset,Gideon Ezra,who later queried the PWPs and their CGs regarding ways the Knesset could help.Dr. Giladi stressed the maintenance of quality of life for the PWP and CG working together to enhance the health of the PWP.He touched on new developments in PD research which included:PD effects on the autonomic system(e.g.digestion,smell,heart,respiration,urination) and diagnostic techniques. He emphasized that PD encompasses a family of syndromes. As a consequence,treatment choices depend upon PD type.e.g.Transplants are only good for certain types of PD.Thus MSA(Multi-System Atrophy) which occurs in about 25% of PD cases can't be treated with fetal transplants.PD may have genetic correlation,but not MSA.He described PSP(Progressive Supernuclear Palsy).One of the severely-disabled attendees in a wheelchair has PSP which was caused by an automobile accident. He emphasized the importance of walking at least 45min per day,and exercise in order to keep the body reflexes active,speech degradation and speech therapy,memory strengthening techniques(if you don't use it,you lose it). Some of the issues mentioned with Gideon Ezra were:Financial support for care giving to severely disabled PWPs,a PD hotline,PD research , PWPs in the workplace,medical insurance and coverage,the establishment of a PD lobby in the Knesset. Naomi Klarfeld,the support group physical therapist gave several dynamic exercise classes.Naomi recently published a PD exercise book in Hebrew and a companion videotape for the PD support group.We attended twice and took pictures. There was a session on adapting the home for the movement disabled. The first part was given by a social worker who described the help that the government and the various health plans can give in the determining specific needs,consulting services,and financial aid. The second part was given by lady from a government office which deals with supplementary help.She got into specifics such as steps,ramps,bannisters,toilet aids,bathtubs,faucets,doorways,sinks,telephone in bathroom,kitchens. She illustrated specific modifications. An action item for us is to obtain a consultation through our local social worker and come up with a plan to modify our home in stages as anticipated including info on costs,materials,and implementation details.We obtained reference sources on design solutions and learned where to see actual equpiment and accesories. There were a number of classes doing arts and crafts which included drawing, sculpture,and the making of puppets.Some of this work will be exhibited at the Annual Support group meeting on July 10th at the Carmel Hospital in Haifa. In the Reflexology lecture we learned about the correlations of different parts of the bottom of each foot with different body parts and how the therapy is performed. For an introduction,see Inge Dougans,Suzanne Ellis,Reflexology,Foot Massage for Total Health,ppbk,Element,Inc.1991. Dr. Honigman ,Head of the Neurology Dept. at Carmel Hospital in Haifa gave the second lecture.It was a tutorial lecture which reviewed PD treatment techniques. 1.Pharmacological Treatment L-dopa Dopamine agonists Amantadine Anticholinergics MAO B Inhibitors COMT Inhibitors 2.Surgical Treatment Thaladotomy Pallidotomy Deep Brain Stimulation Transplants 3.The Multi-disciplinary Treatment Team GP,N,PTs,SG,CG,Nurses There was a panel discussion on Treatment Algorithms.The panel consisted of two neurologists,a social worker and a PD nurse from the Carmel Hospital. They discussed the use of apomorphine shots,relations between L-dopa treatment and blood pressure,a publication by Yehudit Mechraz on PWP Rights in Israel,Controlled Release Sinemet,Selegeline vs Pergolide,Is L-dopa toxic?,Bromocriptine vs Pergolide. The third lecture was given by Dr Yehudit Aaron,Neurologist from Rambam hospital,Haifa. She talked about the effects of PD on Cognition including: Ability to learn new material Short-term and long-term memory Ability to concentrate Associative memory Memory of independent events and information Recall and recognition Ability to access stored information Ability to jump quickly from one topic to another Response slowness Difficulties in planning ahead Difficulties in planning complex tasks Effects of tranquilizers,e.g.causing confusion She referred to two books: The Rain Man The Man who Thought His wife was a Hat There was a presentation by a two young Chiropractors from the U.S. They discussed the role of the vertebra in health and "Dis-ease". They used the term "Subluxation"in connection with misalignments of the bones.They referred to displacement of the "Medulla Obligata"as causing reduction of Dopamine in the brain.I missed the part where they dealt with PD therapy. The fourth lecture was by Prof Rabai,Director of the Neurology Dept. At Asaph Harofe Hospital since 1995.He has been involved in neurochemistry research at NPF,NYU and in Tennesee. He talked about drug side-effects;e.g.cold and clasping fingers as a side effect of Dopamine Agonists such as Pergolide.He referred to 50% PWPs having ON-OFF effects within 5 years. Meds reduce OFF but don't improve ON.e.g. use of Carborgaline,which will be available within a year in Israel.He also spoke of Ropinerol,Pramipexole,and Raselegiline.The latter is being developed in Israel and will be available in about two years.It is an MAO inhibitor which delays the operation of the Dopamine so that it lasts longer.An advantage of Raselegiline is that it does not cause the generation of Amphetamines which are addictive as does selegiline.He referred to the development of Liquid Levadopa by an Israel team at Beilenson,Rambam and Ichilov Hospitals. He referred to Motillium for reducing nausea side-effects. He mentioned Nomiphensine,a new drug whose trials are scheduled to begin in a year,which acts like cocaine as a Dopamine blocker. He defined a YPD(young PWP) as a PWP younger than 70. He talked about pallidotomies.He doesn't favor two sided pallidotomies.He talked of successes with fetal transplants showing Dopamine concentration increase after three years,based on PET scan measuremnts. He pointed out that 8 embryos are needed for each transplant. There is research on artificially generated embryos.He pointed out that transplants are not done after a pallidotomy. Interacting With other PWPs and CGs Dr. Dan Nir is a Physicist with PWP and follows recent PD research.He had a number of interesting papers and books with him.I copied chapters on PD from the following references: 1. R.L.Adams,O.A.Parsons,J.L.Culbertson,S.J.Nixon,Neuropsychology for Clinical Practice,Etiology,Assessment,and Treatment of Common Neurological Disorders,American Psychological Association,Wash.,D.C.1996.ISBN 1-55798- 298-8,Chap.9,pp 243-267. Chap.9 deals with PD.It reviews diagnosis criteria,classification of Parkinsonism,epidemiology,and Etiological Concerns,Genetics,PathophysiologyImaging Techniques,Symptom Presentation, Prognosis,Neuropsychological Studies,dementia,Neuropsychological Assesment,Rating scales for assessing level of disability,Treatment. 2.Neurological Rehabilitation,D.A.Umphred,Editor,3rd Edition,Mosby-Year Book, 1995.ISBN 0-8016-7925-7,Chapter 21,Basal Ganglia Disorders,pp 615-640. Chap.21 discusses PD Symptoms:Bradykinesia and Akinesia,Rigidity,Tremor,Postural Instability, Gait,Attentional and Cognitive Deficits,Pharmacologocal Considerations,,Medical Management, PWP Evaluation,Treatment Goals,and Procedures. A lady in her early fifties(I guess) was diagnosed with PD 9.5 years ago and is doing well with only selegiline twice a day and no levadopa.She swims and exercises regularly and from her appearance one would not know she is a PWP.She traveled to Baden,Switzerland a few years ago where the Dopamine loss in her brain was estimated as 70%.She is a patient of Dr. Giladi. A man in his 70s diagnosed 9 years ago takes Dopicar and sinemet every hour and one half and is in a much more advanced stage. A lady in her 40s is in a wheel a wheel chair.She was diagnosed two years ago.A photo of her at last year's seminar showed a very different person dancing with her husband. A tall thin man in his early fifties is on crutches. He has a severe balance problem. A tall grey-haired lady in her middle 40s is always smiling and very active. She has a high freqency tremor in both hands. A man in his late 70s is cared for by his blind wife and helped at the Seminar by their pretty blonde daughter. A man in his mid-60s diagnosed 9 years ago had a pallidotomy 9 months ago in Sweden.He is disappointed with the results.He is on heavy frequent medication which was just marginally reduced after the operation.He has serious rigidity.His ON-OFF has been improved by the operation. We did not find it depressing.Almost everyone had a very positive attitude and an optimistic approach to their PD.We were very impressed. Gil Lieberman,74,CG for Aliza 73,PD 2+ [log in to unmask]