New Guidelines for Parkinson's Disease
By Sandra Ray, Staff Writer

April 2006 the American Academy of Neurology issued new guidelines about diagnosis and treatment of individuals with Parkinson’s Disease (PD). Since the disease is often misdiagnosed, the guidelines were aimed at giving more options to physicians concerning diagnosis, as well as providing patients and caregivers with insights into treatment options. Estimates are that 5 – 10 percent of individuals are diagnosed incorrectly, while 20 percent who are diagnosed with Parkinson’s are diagnosed with another disease post mortem.

Not only do the new guidelines address diagnosis and prognosis, there are guidelines for treatment strategies; evaluation and screening for co-morbid (coexisting) disorders, like depression; as well as hints to patients and caregivers for sustaining quality of life as long as possible. The full set of guidelines can be downloaded at www.aan.com/pd.

 Diagnosis:

After careful review of existing literature, the researchers issued the guidelines in hopes of making the diagnosis and treatment process easier for physicians and patients to manage. Since there is no one definitive test that pinpoints PD, doctors have to interpret a battery tests that can identify a series of symptoms that either points to PD or points another cause for the symptoms. The guidelines offer several testing mechanisms for physicians that make diagnosis an easier process.

If patients present with symptoms such as lack of tremor, the doctor should be concerned that PD is not the ultimate cause of the symptoms. In addition, patients falling early in the disease progression can generally indicate that something else is to blame for the symptoms. Since the disease is progressive, it generally takes a number of years to progress from the beginning stages to the more severe ones. If a patient begins to move too rapidly through the stages, this could be another clue that PD is not the disease in question.

In developing the guidelines, researchers combed through all existing research to decide the tests that most accurately predicted PD. When they reviewed the research, some noticeable trends developed. One of these included evidence that the drug levodopa, a medication that increases dopamine levels, is an effective treatment and does not speed up the appearance of PD symptoms as some people had once suspected. The new guidelines indicate that levodopa should be considered as a “challenge” to whether or not the symptoms respond to the medication. If symptoms respond, PD should be considered a correct diagnosis.

Evaluation of Coexisting Disorders:

Patients with PD are more likely to have bouts of depression. Dopamine, the neurotransmitter involved in the onset of PD symptoms like rigidity and trembling, is also involved in regulating mood. Many of today’s antidepressant medications also increase the amount of dopamine produced in the brain in order to elevate mood and alleviate depression.

In addition, patients should not feel that symptoms like depression, hallucinations, and psychosis are a natural part of the disease progression. William J. Weiner, MD, FAAN, of the University of Maryland School of Medicine in Baltimore noted when the guidelines were issued, “Effective treatments are available, and treatment can greatly improve the patient’s quality of life.”

Additional Treatment Methodologies:

Researchers were pleased to discover that there is a wide range of treatment options for PD. Included in the guidelines are treatment recommendations for various stages of the disease, including medications that may help symptoms subside, at least in part. It is particularly noteworthy to include that some of the symptoms that may respond to medications include individuals who experience motor movement fluctuations and dyskinesia. The Michael J. Fox Foundation for Parkinson’s Research defines dyskinesia as “Involuntary, uncontrollable, and often excessive movement.”

For patients with debilitating movement issues, there are also guidelines for deep brain stimulation, a surgical procedure that may be able to assist these patients. According to the National Institute of Neurological Disorders and Stroke (NIDS), deep brain stimulation implants a small battery-operated neurostimulator “to deliver electrical stimulation to targeted areas in the brain that control movement, blocking the abnormal nerve signals that cause tremor and PD symptoms.” The surgery can be reversed if other treatments are discovered that may help the patient, and the stimulation to the brain can be adjusted as time passes and the disease progresses.

Nutritional Supplements:

Many people have tried to use nutritional supplements such as Vitamin E as a way to improve or slow down the progression of PD symptoms. When researchers reviewed studies, they found no evidence that these nutritional supplements provide any health benefit. In other words, save money that would be otherwise spent on these vitamins and use it for other treatment possibilities.

Exercise  and  Patient Way of Life:

Exercise, however, can be beneficial to the PD patient. There is a great deal of research to support exercise as a healthy alternative to strengthening muscles and keeping them as flexible as possible. Since muscle rigidity is a serious issue for PD patients, it makes sense to keep muscles as toned as possible. There are many ways to do exercise, including walking; swimming; Tai Chi, a Chinese form of martial arts that focuses on toning muscles and balance;  and even housework or gardening. It is important that the PD patient have a companion when exercising, since freezing of the muscles can happen when least expected and could lead to a dangerous situation, especially in a swimming pool. While exercise won’t cure PD, it will give the patient better control over their muscles and slow the progression of the disease.

Speech therapy and facial exercises can also help with keeping facial muscles toned and working as well as possible. Practicing different facial expressions such as surprise or pleasure or even general disgust can keep muscles resilient. Speech therapy will help with some of the problems produced by PD such as slow speech, coarse or raspy voice, a low speaking volume, and other speech-related issues.

Eating a sensible diet is another mechanism that will help keep the Parkinson’s patient as healthy as possible. While discussed previously, there are no specific vitamins proven to have an effect on PD. Yet, eating a healthy diet can improve cardiovascular health and keep the person in good physical health. Since Parkinson’s is a progressive movement disorder, it makes sense to keep a person’s weight at a manageable level in order to keep movement issues at bay as long as possible.

The new guidelines for PD act as a set of protocols to better assist physicians in diagnosing, treating, and managing the disease. In addition, it provides patients and caregivers with information about standardized treatments that have been scientifically proven to provide some relief from the disease’s devastating effects. Since the guidelines are based on rigorous research and leave room for new scientific developments, doctors have the ability to deliver the best possible care to patients and their families. Patients can assume a more active role in the management of their disease.

Caregivers also benefit from the guidelines’ issuance because they have a better understanding of the basics of PD and what to expect during the diagnosis phase and with different treatment options. For example, caregivers will learn that depression is treatable and does not have to be endured as part of the disease. As a result, caregivers are better equipped to help their loved ones make informed choices about their medical care. Overall, the guidelines provide a better quality of life for patients and caregivers, while equipping physicians to make informed diagnosis, treatment, and disease management decisions.

 

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