Marling's recent postings remind me that the list membership
(at least the active communicators) constantly changes, with
continual influx of newly diagnosed and naive members. So
some of our earlier discussion bears repeating:
Virtually all prescription drugs, including those for PD,
have various unpleasant or dangerous side effects, which
also vary widely from patient to patient. Some people may
have no side effect at all from a given drug, but are
absolutely intolerant of another, while other
patients have exactly the opposite esperience. That's why
the drugs are reserved for prescription by presumably
qualified doctors, and why the smart ones will start
with small cautious dosage at first. Some drugs, such as
Sinemet, are thought to have long-delayed side effects
(e.g., dyskinesia) which only appear after years of use.
Opinion is divided about this, but for those PWP who
suffer dyskinesia, there is no doubt. That's why some
(not all) doctors are frugal with Sinemet, sometimes
withholding it altogether until nothing else works. On
the other side are doctors who feel, if Sinemet is so
effective, why not enjoy its benefits immediately?
Regarding distinction of PD (the standard variety caused
by loss of dopamine-producing nerve cells in the substantia
nigra) from other neurodegenerative diseases, there are
a number of those which are hard at first to tell apart.
A lot of research has been and is being done, and as
knowledge improves, new clues to diagnosis continually
appear in the scientific journals. The trouble with
Parkinson's is that sometimes onset is so insidious that
it may be years before symptoms are noticed, even though
in retrospect they were clear enough. IMOHO, I believe
that the predisposition is present from infancy, and if
doctors knew what to look for, they could see it. For a
good, if somewhat dated, introduction to differential
diagnosis, write to Dr. Joseph Jankovic
Baylor University
Houston, TX
for a reprint of his and Dr. Stacy's article in
Neurologic Clinics 1992;10:341-359,
or for a much shorter digest, ask John Cottingham of
this list for my posting a couple of years ago,
Is It Really PD?
from the list archives. Cheers,
Joe
J. R. Bruman (818) 789-3694
3527 Cody Road
Sherman Oaks, CA 91403-5013
