medication

12 Medication Management Tips That May Save Your Life

December 1, 2017 Awareness, Education, Life

What can be done to help older adults take medications safely? Take care to avoid some of the more common medication mistakes, such as taking drugs incorrectly or taking more than is prescribed. Pill dispensers, organizers and even reminder services can also be useful tools for some.

That being said, nothing substitutes for responsible caregiver advocacy and being proactive about the drugs we and our loved ones are taking.

Here are some other tips to keep in mind:

1. Ask your provider if the dosage is age-appropriate.

Because of the way our bodies metabolize various drugs as we get older, seniors can be more sensitive to some drugs and less sensitive to others. They are also more likely to experience adverse effects. Double-check with your doctor or pharmacist to ensure that the dosage on the prescription is age-appropriate, and ask if it’s advisable to start with a lower dose and taper upwards.

2. Be aware of medications deemed unsafe for seniors.

The Beers Criteria for Potentially Inappropriate Medication Use in Older Adults, put together by the American Geriatric Society, is a list of medications that older adults should avoid or use with caution. Some pose a higher risk of side effects or interactions, while others are simply less effective.  For instance, commonly prescribed sedatives in the benzodiazepine category, like diazepam (Valium), are on the “avoid for certain conditions” list because older adults may be more sensitive to these drugs. Ask your pharmacist if any of your loved one’s medications are on the caution list, and whether you should be concerned.

3. Bring a medications list — or the medications themselves — to the doctor with you.

Take your list of prescription medications —  a list of over-the-counter drugs and any herbal supplements you might be taking — and bring it to the doctor’s office with you, or to a pharmacist. The more information your provider has, the more accurately they can pinpoint any potential adverse effects or drug interactions.

4. Check on prescriber behavior in Prescriber Checkup.

Rather alarmingly, Medicare may not monitor prescription safety as effectively or as closely as we might like, as noted in a ProPublica report. “In 2010 alone, health-care professionals wrote more than 500,000 prescriptions for the drug [carisoprodol] to patients 65 and older,” says the report — a drug that was pulled from the European market in 2007 and is on the Beers caution list. If you have concerns about a provider, or if you simply want more information about the drugs prescribed in your area, check ProPublica’s online Prescriber Checkup tool.

5. Closely monitor medication compliance in the cognitively impaired.

If your loved one shows signs of confusion about their medications, or has been diagnosed with cognitive impairment, Alzheimer’s disease, or another form of dementia,  do not allow them to manage or take their own medications. If they are simply having trouble tracking their medications, a reminder system may be helpful, but the situation is more serious if your loved one is cognitively impaired. Taking medications incorrectly can be harmful or fatal.

6. Create and maintain an up-to-date medication list.

American Nurse Today says, “keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency and reason for taking the drug.” This can help reduce the risk of polypharmacy.

7. Get a second opinion if you are uncertain.

Not all providers are alike, and there are, unfortunately, some doctors who prescribe medications inappropriately, in excess, or for unapproved uses. If you are concerned about a prescription or a diagnosis, don’t be afraid to seek out a second opinion.

8. Know the side effect profile of your medications.

Knowing the potential side effects and interactions can help you stay alert to any health changes that may occur in response to a new medication or combination of medications. If you do notice health changes, contact a physician right away. Some side effects can mimic other health conditions, including dementia, so make sure to bring a list of your medications to every doctor visit. This will help the provider properly diagnose the problem — and help the patient avoid unnecessary or dangerous medications.

9. Make sure the pharmacy label says why you are taking the prescription.

This is particularly important for older adults who are taking multiple medications, to ensure that they know what each medication is for and how to take it properly. It can also help caregivers police whether their loved one is being given too many medications to treat the same issue, or whether a less scrupulous provider has prescribed a drug for a purpose it wasn’t intended to treat.

10. Minimize the number of providers and pharmacists you use.

Keeping the number of doctors and pharmacies to a minimum is better for you and better for the providers who must coordinate care. “The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems,” says American Nurse Today. They also advise people to “use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions.”

11. Talk to the pharmacist and ask questions.

If you have any concerns at all about the combination of medications you or your loved one is taking, or how a new medication will affect you, ask your doctor or pharmacist. Learn about the potential dosage, proper storage, side effects and anything else that will help you take medications correctly. You should also talk to your provider if you are thinking of stopping a medication.

12. Tell your provider about any previous adverse drug effects.

This one might go without saying, but if you or your loved one has had a bad reaction to any medication in the past, let your doctor and pharmacist know.

 

Article from A Place for Mom.

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Gifting Appreciated Stock to WPA

December 1, 2017 Education, Exercise

A gift of stock to Wisconsin Parkinson Association may make sense for you. It’s a simple process that can have a big impact on WPA.

Why gift stock?
You can gift appreciated stock held over one year and receive a charitable deduction for tax purposes.

What is the procedure to gift stock?
You need to transfer your stock in writing. The date the stock is transferred is the date used for the calculation of your charitable contribution. For stocks, the average of the High and the Low Trading Price for the day is used.

The brokerage account WPA uses for appreciated stock is at the investment firm RBC Wealth Management. Please contact RBC (information below) to inform them that you will be transferring stock to Wisconsin Parkinson Association.

Then, contact your broker about transferring your stock to the Wisconsin Parkinson Association. Your broker will advise what documentation they require.

It is RBC’s policy to sell all securities when they are received. They will prepare a letter for you and WPA that shows the value of your charitable contribution for tax purposes.

Thank you for your generosity!

DTC #0235 Capital Markets
Account # 315-66414
Account Name: Wisconsin Parkinson Association

RBC Wealth Management
Bob Chernow – 414-347-7089
Linda Cowan – 414-347-7088
Jeanne Watson – 414-347-7087
Fax – 414-347-7670

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Tips on Traveling with Parkinson Disease

December 1, 2017 Caregivers, Life

Traveling soon? If you have Parkinson’s disease or are traveling with someone who has Parkinson’s, some extra planning can help make the trip run smoothly. Our social media community shared advice on topics like packing up medication, getting through airport security with ease and the best times to take breaks. Check out these tips for low-stress travel before you hit the road!

1. Tell the airport, train station, etc. that you have Parkinson’s disease or are traveling with someone with Parkinson’s. You may be able to board the flight early or get extra help from a flight attendant.

2. Try to add a rest day for your trip, and schedule long layovers when possible. Take stretch breaks and exercise breaks when you can.

3. Keep your medicine in a carry-on bag in case you’re separated from your luggage.

4. Pack comfort items, extra medicine and a list of your medications and doctor’s contact information. Even if you don’t normally use a cane, walker or wheelchair, consider bringing or using one if it’s convenient.

5. Prepare for airport security. Keep your medicine in a separate bag so it’s easy to pull out if necessary. Commenters also suggested taking along a certificate from the DBS manufacturer if you had the surgery and applying for TSA pre-screening so you don’t have to take off your jacket and shoes.

6. Ask for a wheelchair at the airport – whether you need one or not. Several people with Parkinson’s and family members shared this piece of advice. Even if you don’t need one or normally use one, being in a wheelchair helps put you on the fast track in an airport, which can help cut down on stress.

7. One Twitter follower suggested staying away from mobile check-ins at the gate.

8. Consider alternatives to flying. Airports can be stressful for anyone, with or without Parkinson’s disease, and planes generally don’t have much space to move around or stretch. Some of our Facebook fans have found traveling by train, car or boat to be easier and ultimately more enjoyable than flying.

9. Try to stick with your routine from home, including taking medicine at the same time and exercising a similar amount.

10. Enjoy yourself, even if it’s at a slower pace than you’re used to.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Parkinson’s on the ROPES: Exercise programs incorporating boxing skills

November 1, 2017 Education, Exercise

When Preston Moon was diagnosed with Parkinson’s disease at age 53 in 2008, he never dreamed he’d be bobbing and weaving in a boxing gym or pounding punching bags one year later. After learning that the condition would progressively impair his motor function due to a loss of brain cells that produce the chemical messenger dopamine, he thought he had little to look forward to but a steady decline. Then, in 2009, his next-door neighbor in Indianapolis mentioned Rock Steady Boxing, a local nonprofit program she’d attended that used boxing to manage the symptoms of Parkinson’s disease.

Moon was skeptical. “I’m a retired Army sergeant first class, and physical training was something I did but didn’t necessarily enjoy,” he says. “The last thing I wanted to do was work out again.” But with little to lose, he decided to check out the program. What he saw at the gym was surprising: People were punching small speed bags and large heavy bags, doing footwork and balance exercises, and performing calisthenics. “It was people of all ages, male and female, and they were—excuse my French—going balls to the wall,” Moon says. “I thought, ‘These guys have Parkinson’s?’ It changed my attitude immediately.”

He’s been boxing three or four times a week ever since. Eight years later, he feels strong, does push-ups, can run, and rides a motorcycle. His disease has affected him cognitively, slowing his thinking and making it difficult to come up with timely assessments and solutions in his work as a systems analyst, which is why he recently took long-term disability from his job. “But physically,” Moon says, “I don’t look or feel like I have Parkinson’s.”

GROWING STRONG

Moon was an early convert to an exercise regimen that’s expanding nationwide. The earliest proponent was Rock Steady, founded in 2006 in Indianapolis by Scott C. Newman, a community leader who was diagnosed with Parkinson’s disease and found that boxing helped with some of his symptoms. Together with Kristy Rose Follmar, a former professional boxer with world and Indiana state titles, he developed a program using a variety of training exercises—pummeling a speed bag, for example—to address symptoms such as loss of hand-eye coordination. Variety, fun, camaraderie, and intensity—but no actual fighting—are core elements of the program, with exercises designed for people of different abilities and in different stages of the disease.

Rock Steady now has affiliates around the country, and other programs have cropped up, too. These are often led by former professional fighters, such as Paul Delgado of Livramento Delgado Boxing Foundation (LDBF) and PD Gladiators in Atlanta, Mark Royce and Tate Wheeler of Knock Out Parkinson’s in four locations in Minneapolis-St. Paul, MN, and Paulie Ayala of Punching Out Parkinson’s in Fort Worth, TX.

TRAINING COACHES

The programs share many characteristics. For instance, the prospective instructors often have had experience working with people who have Parkinson’s disease, says S. Elizabeth Zauber, MD, associate professor of clinical neurology at Indiana University School of Medicine and an early member of Rock Steady’s board of directors. Further training for prospective coaches usually involves learning more about boxing and Parkinson’s, as well as how to structure a class.

MAKING ASSESSMENTS

All participants are assessed based on observations from coaches, as well as tests that measure abilities such as balance, gait, and grip strength. Boxers are then placed in classes appropriate for their level of function or follow customized workouts. “The assessment helps us get to know the people,” says Rock Steady executive director Joyce Johnson, whose mother had the disease. Coaches also factor in age, fitness level, other health problems, and cognitive abilities, says Dr. Zauber. “If someone can’t do something, instructors need to be able to adapt exercises and levels to that person’s needs.”

Patients may also undergo more thorough testing at their neurologists’ offices and/or with a physical therapist. Once they start, participants are assessed regularly. Knock Out Parkinson’s, for instance, performs assessments monthly, tracks the progress of each patient, and reviews the results with them. “Several of the patients in our program have neurologists who tell them they should keep doing what they’re doing with the boxing ‘because it’s working,’” Royce says.

TAILORING WORKOUTS

Creating customized workouts is key, says Adolfo Ramirez-Zamora, MD, associate professor of neurology at the University of Florida Center for Movement Disorders and Neurorestoration in Gainesville. Being in a wheelchair, for example, doesn’t have to be prohibitive. “Even if your balance isn’t good,” he says, “there’s still a lot you can achieve.”

If needed, coaches or volunteers provide one-on-one assistance. Participants who are at the lowest-functioning level are required to have a “corner man”—a trainer, volunteer, or care partner—to assist with the workout.

SPECIFIC MOVES FOR SPECIFIC SYMPTOMS

Boxing classes typically last 75 to 90 minutes and are designed to tackle symptoms in multiple ways. For example, warm-up exercises stretch muscles and relieve stiffness. Hitting heavy bags builds power and strength. Punching speed bags improves hand-eye coordination and posture. To stimulate cognitive processing, a trainer may hold “focus mitts” as targets and bark out varied instructions—“right, left, uppercut!” Shouting exercises and loud counting work on soft-voice disorders common in people with Parkinson’s disease. Calisthenics and isometric exercises build extremity and core strength critical for posture and gait. Footwork and drills such as moving sideways, jumping rope, or walking on a two-by-four improve balance and agility. Group games that involve tossing footballs, medicine balls, beach balls, or Frisbees encourage socialization and improve reaction time.

At LDBF-PD Gladiators, trainers call out punches using a number system that Delgado and his coach used when he was a pro fighter. “When I call out ‘one, two, three!’ that’s an intentional sequence—jab, right cross, left hook,” Delgado says. “Participants need to make these moves correctly.” Translating numbers to punches makes the workout mental as well as physical. Delgado recently switched the right-handed sequence to a left-handed version. “I’m making them southpaws,” he says. “That way they’re boxing from their weak side as well as their strong side, and the numbers apply to mirrored moves so they have to be cognitively sharper to throw those punches.”

PUSHING LIMITS

Rock Steady leaders say that “forced exercise”—demanding more effort than people would exert on their own at whatever level of function or fitness—is key to success. “We tell coaches-in-training that these guys can be pushed and don’t want to be treated like sick people,” Follmar says. “We’re respecting them by encouraging them with tough love, and that gives them confidence.”

FIGHTING A DISEASE

Anyone dealing with Parkinson’s disease is in some sense fighting it, but boxers feel like they’re fighting it literally and physically. “That idea is important,” Follmar says. “There’s a toughness about Rock Steady that makes people feel empowered.”

At Knock Out Parkinson’s, coaches sometimes keep the foe—Parkinson’s—front and center. “They’ll give us a series of drills while we recite ‘Knock! Out! Parkinson’s!’ and “I! Hate! Parkinson’s!’—punch, punch, punch—and scream as loud as we can,” says Lee Goderstad, who joined Knock Out Parkinson’s in March 2016. The drills also help participants work their vocal cords to strengthen them and combat loss of voice.

For Moon, boxing is an alternative form of therapy. “I was never one to go to support groups,” he says. “I was taught to adapt and overcome. We [boxers] don’t get in a group and moan about how rough we have it. Sure, we have challenges. So what do we do to get over them? I wanted to be part of something that would help me get over them, and I found that through boxing.”

WHAT THE SCIENCE SAYS

An early news story on Rock Steady motivated Stephanie Combs-Miller, PT, PhD, associate professor at the University of Indianapolis’ Krannert School of Physical Therapy, to investigate the benefits of boxing. In a preliminary case study of six participants published in Physical Therapy in 2011, she found that every participant improved on at least five of 12 measures, including balance, gait, walking speed, stride length, step width, get-up-and-go time, and ability to reach forward, over three months. “Some people improved on all of them,” Dr. Combs-Miller says. “It was a pretty strong indication that something positive was going on.”

VARIETY AND INTENSITY ARE KEY

That “something” may not precisely translate to boxing. “The regimen is a mix of aerobics, resistance training, balance exercises, and, for part of it, boxing-related activities,” says Ergun Uc, MD, professor of neurology at the University of Iowa Hospitals and Clinics in Iowa City, who has researched exercise and Parkinson’s disease. “While you can’t say boxing improves Parkinson’s, you perhaps could say that the training regimens boxers use might improve symptoms of the disease.”

In a follow-up clinical trial in 2013 published in the journal NeuroRehabilitation, Dr. Combs-Miller and colleagues recruited 31 people and assigned half to a boxing group and half to a control group that did more traditional resistance, aerobic, and balance exercises. Both groups showed significant improvements in balance, mobility, and quality of life, with variations on certain measures over three months. “My hunch is that it doesn’t matter if people box, play basketball, cycle, or dance, as long as they exercise at a high-intensity level,” Dr. Combs-Miller says. For example, traditional exercisers actually reported slightly more confidence in their balance than boxers.

That hunch is supported by earlier research published in Neurorehabilitation and Neural Repair in 2009. Cleveland Clinic investigators found that when people with Parkinson’s disease rode a tandem bike that forced them to pedal faster than they would normally, their motor scores on a measure called the Unified Parkinson’s Disease Rating Scale improved by 35 percent. Motor scores in a control group that pedaled at their preferred speed didn’t improve, even though aerobic fitness gains for the two groups were similar. The research seems to suggest that intense exercise has benefits beyond activity-specific fitness.

PROGRESSIVE CHALLENGES ARE IMPORTANT

What is considered intense depends on what kind of shape people are in. “Most people are so deconditioned that even lower-intensity exercise can push their boundaries,” says Lisa M. Shulman, MD, FAAN, professor of neurology and director of the University of Maryland Parkinson’s Disease and Movement Disorders Center in Baltimore. In a 2013 study published in JAMA Neurology, she and her colleagues showed that lower-intensity exercise like walking on a treadmill at a normal, comfortable speed was more effective than higher-intensity treadmill or resistance exercise in improving gait speed.

Yet the benefits tend to be specific to the form of exercise. Walking improves gait but not strength. Strength training makes you stronger but not more aerobically fit. “There is good reason to believe that because boxing combines multiple types of activities, it has special benefits,” Dr. Shulman says.

These boxing programs also encourage participants to progress as their skills improve. “It’s well known in training research that you need to be adaptive and progressive,” Dr. Uc says. “You try to increase performance and not stay at one level. But boxing isn’t the only exercise that does that. Generally, anything that motivates patients and safely increases the level of physical activity improves a variety of symptoms.” Yet boxing may still be special, Dr. Uc allows. “There’s a coolness factor,” he says. “Perhaps it’s more interesting and motivating.”

It’s too early to say definitively that boxing or other forms of exercise slow the progression of Parkinson’s disease, says Dr. Shulman. And Dr. Uc says that more research is needed in larger samples of patients before boxing regimens become a recommendation for Parkinson’s patients. “But substantial evidence from animal studies suggests that exercise benefits brain pathways involved with the disease,” Dr. Shulman says.

EMOTIONAL EMPOWERMENT IS A BONUS

Camaraderie is another special ingredient of these programs, according to participants, coaches, caregivers, and researchers. A 2016 study published in the Journal of Applied Sport Psychology found that training with a group carried a variety of emotional benefits. It helped relieve anxiety by allowing participants to talk and joke about Parkinson’s with others who understood the disease. Participants also reported that they were inspired by their peers, felt like athletes, and found a sense of mutual support.

Researchers haven’t yet studied the impact of boxing’s social component in people with Parkinson’s disease. “But I think there’s something about the feeling of empowerment patients get from it,” Dr. Shulman says. “Boxing sounds strong, and they are proud to be involved.”

 

Article from Neurology Now.

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Longtime Antidepressant Could Slow Parkinson’s

November 1, 2017 Life, Research

Michigan State University scientists now have early proof that an antidepressant drug that’s been around for more than 50 years could slow the progression of Parkinson’s.

In a proof-of-concept study, published in the journal Neurobiology of Disease, the drug nortriptyline, which has been used to treat depression and nerve pain, stopped the growth of abnormal proteins that can build up in the brain and lead to the development of the disease.

“Depression is a very frequent condition associated with Parkinson’s, so we became interested in whether an antidepressant could modify how the disease progresses,” said Tim Collier, lead author of the federally funded study and a neuroscientist at MSU.

Collier and collaborator Katrina Paumier, an assistant professor of molecular medicine, began looking at previous patient data to see if individuals who were on antidepressants experienced any delay in their need to go on a standard Parkinson’s therapy called levodopa. This type of therapy increases levels of dopamine, a natural chemical in the body that sends signals to other nerve cells and can significantly decrease in cases of Parkinson’s.

The medication also treats many of the symptoms associated with the disease such as tremors and poor muscle control.

“We found that those on a certain class of antidepressant, called tricyclics, didn’t need the levodopa therapy until much later compared to those who weren’t on that type of antidepressant medication,” Collier said.

Collier then began testing rats with the tricyclic antidepressant nortriptyline and found that it indeed was able to decrease the amount of abnormal protein that can build up in the brain. This protein, known as alpha-synuclein, can cause the brain’s nerve cells to die when in a clustered state and is a hallmark sign of the disease.

To further back up his research, he enlisted the help of his colleague and co-author Lisa Lapidus, who in previous studies had already detected whether certain compounds could bind to alpha-synuclein and stop it from accumulating.

“Proteins are constantly moving and changing shape,” said Lapidus, a professor in the Department of Physics and Astronomy. “By using a test tube model, we found that by adding nortriptyline to the alpha-synuclein proteins, they began to move and change shape much faster, preventing the proteins from clumping together. The idea that this clustering effect is controlled by how fast or slow a protein reconfigures itself is typically not a standard way of thinking in research on proteins, but our work has been able to show these changes.”

Understanding how these proteins can clump together could point researchers in new directions and help them find other possible drugs that could potentially treat Parkinson’s.

“What we’ve essentially shown is that an already FDA-approved drug that’s been studied over 50 years and is relatively well tolerated could be a much simpler approach to treating the disease itself, not just the symptoms,” Collier said.

Collier is already looking for funding for the next phase of his research and hopes to lead a human clinical trial using the drug in the future.

The National Institutes of Health, as well as the Michael J. Fox and Saint Mary’s Foundations, funded the study.

 

Article from Michigan State University.

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What is Tremor?

October 1, 2017 Education, Life

Tremor is an involuntary, rhythmic muscle contraction leading to shaking movements in one or more parts of the body. It is a common movement disorder that most often affects the hands but can also occur in the arms, head, vocal cords, torso, and legs. Tremor may be intermittent (occurring at separate times, with breaks) or constant. It can occur sporadically (on its own) or happen as a result of another disorder.

Tremor is most common among middle-aged and older adults, although it can occur at any age. The disorder generally affects men and women equally. Tremor is not life threatening. However, it can be embarrassing and even disabling, making it difficult or even impossible to perform work and daily life tasks.

WHAT CAUSES TREMOR?

Generally, tremor is caused by a problem in the deep parts of the brain that control movements. Most types of tremor have no known cause, although there are some forms that appear to be inherited and run in families.

Tremor can occur on its own or be a symptom associated with a number of neurological disorders, including:

  • multiple sclerosis
  • stroke
  • traumatic brain injury
  • neurodegenerative diseases that affect parts of the brain (e.g., Parkinson’s disease).

Some other known causes can include:

  • the use of certain medicines (particular asthma medication, amphetamines, caffeine, corticosteroids, and drugs used for certain psychiatric and neurological disorders)
  • alcohol abuse or withdrawal
  • mercury poisoning
  • overactive thyroid
  • liver or kidney failure
  • anxiety or panic.

HOW IS TREMOR CLASSIFIED

Tremor can be classified into two main categories:

Resting tremor occurs when the muscle is relaxed, such as when the hands are resting on the lap. With this disorder, a person’s hands, arms, or legs may shake even when they are at rest. Often, the tremor only affects the hand or fingers. This type of tremor is often seen in people with Parkinson’s disease and is called a “pillrolling” tremor because the circular finger and hand movements resemble rolling of small objects or pills in the hand.

Action tremor occurs with the voluntary movement of a muscle. Most types of tremor are considered action tremor. There are several sub-classifications of action tremor, many of which overlap.

  • Postural tremor occurs when a person maintains a position against gravity, such as holding the arms outstretched.
  • Kinetic tremor is associated with any voluntary movement, such as moving the wrists up and down or closing and opening the eyes.
  • Intention tremor is produced with purposeful movement toward a target, such as lifting a finger to touch the nose. Typically the tremor will become worse as an individual gets closer to their target.
  • Task-specific tremor only appears when performing highly-skilled, goal-oriented tasks such as handwriting or speaking.
  • Isometric tremor occurs during a voluntary muscle contraction that is not accompanied by any movement such as holding a heavy book or a dumbbell in the same position.

WHAT ARE THE DIFFERENT CATEGORIES OF TREMOR?

Tremor is most commonly classified by its appearance and cause or origin. There are more than 20 types of tremor. Some of the most common forms of tremor include:

Essential tremor

Essential tremor (previously also called benign essential tremor or familial tremor) is one of the most common movement disorders. The exact cause of essential tremor is unknown. For some people this tremor is mild and remains stable for many years. The tremor usually appears on both sides of the body, but is often noticed more in the dominant hand because it is an action tremor.

The key feature of essential tremor is a tremor in both hands and arms, which is present during action and when standing still. Additional symptoms may include head tremor (e.g., a “yes” or “no” motion) without abnormal posturing of the head and a shaking or quivering sound to the voice if the tremor affects the voice box. The action tremor in both hands in essential tremor can lead to problems with writing, drawing, drinking from a cup, or using tools or a computer.

Tremor frequency (how “fast” the tremor shakes) may decrease as the person ages, but the severity may increase, affecting the person’s ability to perform certain tasks or activities of daily living. Heightened emotion, stress, fever, physical exhaustion, or low blood sugar may trigger tremor and/or increase its severity. Though the tremor can start at any age, it most often appears for the first time during adolescence or in middle age (between ages 40 and 50). Small amounts of alcohol may help decrease essential tremor, but the mechanism behind this is unknown.

About 50 percent of the cases of essential tremor are thought to be caused by a genetic risk factor (referred to as familial tremor). Children of a parent who has familial tremor have greater risk of inheriting the condition. Familial forms of essential tremor often appear early in life.

For many years essential tremor was not associated with any known disease. However, some scientists think essential tremor is accompanied by a mild degeneration of certain areas of the brain that control movement. This is an ongoing debate in the research field.

Dystonic tremor

Dystonic tremor occurs in people who are affected by dystonia—a movement disorder where incorrect messages from the brain cause muscles to be overactive, resulting in abnormal postures or sustained, unwanted movements. Dystonic tremor usually appears in young or middle-aged adults and can affect any muscle in the body. Symptoms may sometimes be relieved by complete relaxation.

Although some of the symptoms are similar, dystonic tremor differs from essential tremor in some ways. The dystonic tremor:

  • is associated with abnormal body postures due to forceful muscle spasms or cramps
  • can affect the same parts of the body as essential tremor, but also—and more often than essential tremor—the head, without any other movement in the hands or arms
  • can also mimic resting tremor, such as the one seen in Parkinson’s disease.
  • Also, the severity of dystonic tremor may be reduced by touching the affected body part or muscle, and tremor movements are “jerky” or irregular instead of rhythmic.

Cerebellar tremor

Cerebellar tremor is typically a slow, high-amplitude (easily visible) tremor of the extremities (e.g., arm, leg) that occurs at the end of a purposeful movement such as trying to press a button. It is caused by damage to the cerebellum and its pathways to other brain regions resulting from a stroke or tumor. Damage also may be caused by disease such as multiple sclerosis or an inherited degenerative disorder such as ataxia (in which people lose muscle control in the arms and legs) and Fragile X syndrome (a disorder marked by a range of intellectual and developmental problems). It can also result from chronic damage to the cerebellum due to alcoholism.

Psychogenic tremor

Psychogenic tremor (also called functional tremor) can appear as any form of tremor. It symptoms may vary but often start abruptly and may affect all body parts. The tremor increases in times of stress and decreases or disappears when distracted. Many individuals with psychogenic tremor have an underlying psychiatric disorder such as depression or post-traumatic stress disorder (PTSD).

Physiologic tremor

Physiologic tremor occurs in all healthy individuals. It is rarely visible to the eye and typically involves a fine shaking of both of the hands and also the fingers. It is not considered a disease but is a normal human phenomenon that is the result of physical properties in the body (for example, rhythmical activities such as heart beat and muscle activation).

Enhanced physiologic tremor

Enhanced physiological tremor is a more noticeable case of physiologic tremor that can be easily seen. It is generally not caused by a neurological disease but by reaction to certain drugs, alcohol withdrawal, or medical conditions including an overactive thyroid and hypoglycemia. It is usually reversible once the cause is corrected.

Parkinsonian tremor

Parkinsonian tremor is a common symptom of Parkinson’s disease, although not all people with Parkinson’s disease have tremor. Generally, symptoms include shaking in one or both hands at rest. It may also affect the chin, lips, face, and legs. The tremor may initially appear in only one limb or on just one side of the body. As the disease progresses, it may spread to both sides of the body. The tremor is often made worse by stress or strong emotions. More than 25 percent of people with Parkinson’s disease also have an associated action tremor.

Orthostatic tremor

Orthostatic tremor is a rare disorder characterized by rapid muscle contractions in the legs that occur when standing. People typically experience feelings of unsteadiness or imbalance, causing them to immediately attempt to sit or walk. Because the tremor has such a high frequency (very fast shaking) it may not visible to the naked eye but can be felt by touching the thighs or calves or can be detected by a doctor examining the muscles with a stethoscope. In some cases the tremor can become more severe over time. The cause of orthostatic tremor is unknown.

HOW IS TREMOR DIAGNOSED

Tremor is diagnosed based on a physical and neurological examination and an individual’s medical history. During the physical evaluation, a doctor will assess the tremor based on:

  • whether the tremor occurs when the muscles are at rest or in action
  • the location of the tremor on the body (and if it occurs on one or both sides of the body)
  • the appearance of the tremor (tremor frequency and amplitude).

The doctor will also check other neurological findings such as impaired balance, speech abnormalities, or increased muscle stiffness. Blood or urine tests can rule out metabolic causes such as thyroid malfunction and certain medications that can cause tremor. These tests may also help to identify contributing causes such as drug interactions, chronic alcoholism, or other conditions or diseases. Diagnostic imaging may help determine if the tremor is the result of damage in the brain.

Additional tests may be administered to determine functional limitations such as difficulty with handwriting or the ability to hold a fork or cup. Individuals may be asked to perform a series of tasks or exercises such as placing a finger on the tip of their nose or drawing a spiral.

The doctor may order an electromyogram to diagnose muscle or nerve problems. This test measures involuntary muscle activity and muscle response to nerve stimulation.

HOW IS TREMOR TREATED?

Although there is no cure for most forms of tremor, treatment options are available to help manage symptoms. In some cases, a person’s symptoms may be mild enough that they do not require treatment.

Finding an appropriate treatment depends on an accurate diagnosis of the cause. Tremor caused by underlying health problems can sometimes be improved or eliminated entirely with treatment. For example, tremor due to thyroid hyperactivity will improve or even resolve (return to the normal state) with treatment of thyroid malfunction. Also, if tremor is caused by medication, discontinuing the tremor-causing drug may reduce or eliminate this tremor.

If there is no underlying cause for tremor that can be modified, available treatment options include:

MEDICATION

Beta-blocking drugs such as propranolol are normally used to treat high blood pressure but they also help treat essential tremor. Propranolol can also be used in some people with other types of action tremor. Other beta-blockers that may be used include atenolol, metoprolol, nadolol, and sotalol.

Anti-seizure medications such as primidone can be effective in people with essential tremor who do not respond to beta-blockers. Other medications that may be prescribed include gabapentin and topiramate. However, it is important to note that some anti-seizure medications can cause tremor.

Tranquilizers (also known as benzodiazepines) such as alprazolam and clonazepam may temporarily help some people with tremor. However, their use is limited due to unwanted side effects that include sleepiness, poor concentration, and poor coordination. This can affect the ability of people to perform daily activities such as driving, school, and work. Also, when taken regularly, tranquilizers can cause physical dependence and when stopped abruptly can cause several withdrawal symptoms.

Parkinson’s disease medications (levodopa, carbidopa) are used to treat tremor associated with Parkinson’s disease.

Botulinum toxin injections can treat almost all types of tremor. It is especially useful for head tremor, which generally does not respond to medications. Botulinum toxin is widely used to control dystonic tremor. Although botulinum toxin injections can improve tremor for roughly three months at a time, they can also cause muscle weakness. While this treatment is effective and usually well tolerated for head tremor, botulinum toxin treatment in the hands can cause weakness in the fingers. It can cause a hoarse voice and difficulty swallowing when used to treat voice tremor.

FOCUSED ULTRASOUND

A new treatment for essential tremor uses magnetic resonance images to deliver focused ultrasound to create a lesion in tiny areas of the brain’s thalamus thought to be responsible for causing the tremors. The treatment is approved only for those individuals with essential tremor who do not respond well to anticonvulsant or beta-blocking drugs.

Surgery

When people do not respond to drug therapies or have a severe tremor that significantly impacts their daily life, a doctor may recommend surgical interventions such as deep brain stimulation (DBS) or very rarely, thalamotomy. While DBS is usually well tolerated, the most common side effects of tremor surgery include dysarthria (trouble speaking) and balance problems.

Deep brain stimulation (DBS) is the most common form of surgical treatment of tremor. This method is preferred because it is effective, has low risk, and treats a broader range of symptoms than thalamotomy. The treatment uses surgically implanted electrodes to send high-frequency electrical signals to the thalamus, the deep structure of the brain that coordinates and controls some involuntary movements. A small pulse generating device placed under the skin in the upper chest (similar to a pacemaker) sends electrical stimuli to the brain and temporarily disables the tremor. DBS is currently used to treat parkinsonian tremor, essential tremor, and dystonia.

Thalamotomy is a surgical procedure that involves the precise, permanent destruction of a tiny area in the thalamus. Currently, surgery is replaced by radiofrequency ablation to treat severe tremor when deep brain surgery is contraindicated—meaning it is unwise as a treatment option or has undesirable side effects. Radiofrequency ablation uses a radio wave to generate an electric current that heats up a nerve and disrupts its signaling ability for typically six or more months. It is usually performed on only one side of the brain to improve tremor on the opposite side of the body. Surgery on both sides is not recommended as it can cause problems with speech.

LIFESTYLE CHANGES

Physical therapy may help to control tremor. A physical therapist can help people improve their muscle control, functioning, and strength through coordination, balancing, and other exercises. Some therapists recommend the use of weights, splints, other adaptive equipment, and special plates and utensils for eating.

Eliminating or reducing tremor-inducing substances such as caffeine and other medication (such as stimulants) can help improve tremor. Though small amounts of alcohol can improve tremor for some people, tremor can become worse once the effects of the alcohol wear off.

What is the prognosis?

Tremor is not considered a life-threating condition. Although many cases of tremor are mild, tremor can be very disabling for other people. It can be difficult for individuals with tremor to perform normal daily activities such as working, bathing, dressing, and eating. Tremor can also cause “social disability.” People may limit their physical activity, travel, and social engagements to avoid embarrassment or other consequences.

The symptoms of essential tremor usually worsen with age. Additionally, there is some evidence that people with essential tremor are more likely than average to develop other neurodegenerative conditions such as Parkinson’s disease or Alzheimer’s disease, especially in individuals whose tremor first appears after age 65.

Unlike essential tremor, the symptoms of physiologic and drug-induced tremor do not generally worsen over time and can often be improved or eliminated once the underlying causes are treated.

WHAT RESEARCH IS BEING DONE?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

Researchers are working to better understand the underlying brain functions that cause tremor, identify the genetic factors that make individuals more susceptible to the disorder, and develop new and better treatment options.

Brain Functioning

It can be difficult to distinguish between movement disorders such as Parkinson’s disease and essential tremor. These debilitating movement disorders have different prognoses and can respond very differently to available therapies. NINDS researchers are working to identify structural and functional changes in the brain using non-invasive neuroimaging techniques to develop sensitive and specific markers for each of these diseases and then track how they change as each disease progresses.

Other researchers are using functional magnetic resonance imaging technology to better understand normal and diseased brain circuit functions and associated motor behaviors. Scientists hope to design therapies that can restore normal brain circuit function in diseases such as Parkinson’s disease and tremor.

Genetics

Research has shown that essential tremor may have a strong genetic component affecting multiple generations of families. NINDS researchers are building on previous genetics work to identify susceptibility genes for familial early-onset (before age 40) essential tremor. Researchers are focusing on multigenerational, early onset families to better detect linkages.

Additionally, NINDS scientists are researching the impact of genetic abnormalities on the development of essential tremor. Previous research that has shown a link between essential tremor and possible genetic variants on chromosome 6 and 11; ongoing research is targeting the impact of other genetic variations in families.

Medications and other treatment methods

While drugs can be effective for some people, approximately 50 percent of individuals do not respond to medication. In order to develop assistive and rehabilitative tremor-suppressing devices for people with essential tremor, researchers are exploring where and how to minimize or suppress tremor while still allowing for voluntary movements.

Many people with essential tremor respond to ethanol (alcohol); however, it is not clear why or how. NINDS researchers are studying the impact of ethanol on tremor to determine the correct dosage amount and its physiological impact on the brain and whether other medications without the side effects of ethanol can be effective.

Other NIH researchers hope to identify the source of essential tremor, study the effects of currently available tremor-suppressant drugs on the brain, and develop more targeted and effective therapies.

Where can I get more information?

For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact BRAIN at 800-352-9424.
Information on tremor also is available from the following organizations:

International Essential Tremor Foundation
HopeNET
National Ataxia Foundation
Tremor Action Network

 

Article from Caregiver.com.

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First Drug Approved for Dyskinesia in Parkinson’s Disease

September 1, 2017 Life, Research

Adamas Pharmaceuticals recently announced U.S. Food and Drug Administration (FDA) approval of an extended-release formulation of amantadine (GOCOVRI) to treat dyskinesia in Parkinson’s disease. This is the first drug indicated specifically for dyskinesia — uncontrolled, involuntary movements that can develop with long-term levodopa use.

Extended-release amantadine is intended to be taken once daily at bedtime. In this way it can control dyskinesia during the day, when it typically is most prevalent. The new therapy’s approval is based on data from three placebo-controlled trials that demonstrated safety and efficacy. In addition to easing dyskinesia, the drug also may lessen total daily “off” time, when Parkinson’s symptoms return because medication is not working optimally.

The Michael J. Fox Foundation (MJFF) helped move this drug to market by supporting the creation and authentication of the Unified Dyskinesia Rating Scale, a tool that was used to measure the drug’s impact in trials.

“Dyskinesia can significantly compromise quality of life for people with Parkinson’s,” says Todd Sherer, MJFF CEO. “We are pleased that patients have another option to manage this aspect of the disease and glad the Unified Dyskinesia Rating Scale — a tool our support helped develop and validate — could show clinical efficacy of GOCOVRI for the treatment of dyskinesia.”

Extended-release amantadine is a reformulation of a currently available generic immediate-release version, which is approved to treat Parkinson’s symptoms.

 

Article from Michael J. Fox Foundation for Parkinson’s Research.

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Parkinson’s and malnutrition: what are the risks and how do you prevent it?

June 1, 2017 Caregivers, Education, Life

Parkinson’s is a complicated condition and while many people with Parkinson’s live a long and healthy life, this is not the case for everyone. A recent study found that possibly as many as 60% of people with Parkinson’s are at increased risk for malnutrition.1 “Increased risk” doesn’t mean that 60% of people with Parkinson’s will develop malnutrition, it just means that there is a higher possibility of malnutrition – but it is a good idea to be aware of all its possible causes, so that you can minimise the risk.

The risks and how to minimise them

Below are descriptions of some common nutrition-related concerns that may occur as a result of Parkinson’s, followed by suggestions that could help to resolve the problems.

Sense of smell
One of the first symptoms of Parkinson’s can be loss of the sense of smell, a sense that is necessary in order to taste food. While lack of taste and smell doesn’t always affect appetite, it can become a factor.

Suggestions: Choose favourite or especially desirable foods. Focus on flavour intensity – lemon, garlic, soy sauce, cinnamon, cloves, nutmeg, herbs; and “mouthfeel” – foods that are crunchy, creamy, chewy or have other appealing textures that make them more agreeable when scent and flavour are lacking.

Feeling nauseous
Medications used to treat Parkinson’s often cause nausea.

Suggestion: Ginger is very effective at counteracting nausea. Keep some fresh ginger in the freezer and use it to make ginger tea, or chew a slice of ginger. Keep a container of crystallised ginger handy, to take while on errands or travelling. Even powdered ginger can be used to make tea.

Medication regimes
Medications may cause loss of appetite.

Suggestion: Discuss this with your physician. If medication-induced, it may be possible to try a different medication.

Low mood
Depression is common among people with Parkinson’s and can affect willingness to eat.

Suggestion: Discuss this with your physician. Depression can be due to deficiency of B vitamins, vitamin D, omega-3 fatty acids, or other nutrients – a blood test will show whether this is the case and, if so, supplements should help. In some cases, depression can be alleviated by attending regular counselling sessions, however, some people may require antidepressant medication.

Late-stage Parkinson’s
The stage of Parkinson’s can be a factor, because as it progresses, symptoms often become more severe. In addition, motor fluctuations are more likely to occur in later-stage Parkinson’s. ‘Off’-time, dystonia, and dyskinesia can make it difficult both to eat, and to time medications and meals.

Suggestion: Ask your doctor about a longer-lasting medication, such as Stalevo, or Rytary, or a pump, so that ‘off’ time is reduced and the timing of medications and meals is more regulated closely.

Calorie deficit
Tremor and dyskinesia can burn extra calories.

Suggestions: If using levodopa, divide the day’s protein needs between morning, midday, and evening meals, taking levodopa about 30 minutes before each meal. In between meals, eat small, non-protein or low-protein snacks, such as fruits and juices, whole-grain crackers or biscuits, tomato or vegetable soup. These add extra calories without blocking levodopa absorption.

Swallowing and choking issues
Swallowing problems increase fear and risk of choking.

Suggestions: Ask your doctor for a referral to a speech pathologist, who can evaluate your swallowing function, and determine whether you are at risk for choking. If so, the therapist can demonstrate safe swallowing techniques, and recommend chopped, puréed, or otherwise altered foods and liquids. You should also be referred to a dietitian, who can assess your needs and ensure you are getting enough protein and other nutrients.

Motor problems in hands
Rigidity and loss of manual dexterity makes it hard to manage eating utensils.

Suggestion: Ask your doctor for a referral to an occupational therapist, who can recommend specially designed plates, bowls, drinkware, and eating utensils that are easier to manage.

Slowed eating
Chewing and swallowing become tiring, cause slowed eating and inability to finish meals. It may take several hours to finish one meal, so the person is unable to consume enough calories during a day to maintain health.

Suggestion: Choose foods that require little chewing. Include nutrient-rich blended smoothies, minced, mashed or pureed meats, fish, vegetables and fruits such as meatloaf, applesauce, mashed peas, potatoes, carrots, or baby foods. If this is insufficient, ask your doctor about placement of a feeding tube. In many cases, individuals can still eat and enjoy food by mouth; but the feeding tube ensures sufficient fluids to prevent dehydration, and enough protein, vitamins, and minerals for complete nutrition.

Seeking helpFor some people, Parkinson’s may present barriers to good nutrition. These can be difficult to deal with. Being aware of such possibilities is important, so that you can prepare as needed. That includes close communication with your neurologist, and the help of specialised health professionals, for their advice and support. With preparation and an experienced healthcare team, you can overcome, – or even prevent – common causes of malnutrition and related illness.

References
1Tomic S1, Pekic V2, Popijac Z3, Pucic T3, Petek M2, Kuric TG2, Misevic S3, Kramaric RP2. What increases the risk of malnutrition in Parkinson’s disease? J Neurol Sci. 2017 Apr 15;375:235-238.

Kathrynne Holden, a registered dietitian, has specialised in Parkinson’s disease nutrition for over 20 years. She has contributed to two physicians’ manuals on Parkinson’s, written the booklet ‘Nutrition Matters’ for the NPF (with some of her work for them archived here). Now retired, she maintains a website on Parkinson’s topics.

http://parkinsonslife.eu/parkinsons-and-malnutrition-risks-and-prevention/

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31st Annual Parkinson Disease Symposium | June 23, 2017

June 1, 2017 Awareness, Caregivers, Community Outreach, Education, Life, Research

WPA will host its 31st Annual Parkinson Disease Symposium on Friday, June 23, 2017 at Country Springs Hotel & Conference Center in Pewaukee, Wisconsin.

Beginning at 8:00am, attendees can check in and visit with vendors at the Resource Fair where health and community agencies will display valuable information throughout the day. Beginning at 9:00am, the first main session will be “Understanding Parkinson Disease from a Scientific Perspective”, presented by Giuseppe P. Cortese, PhD, Postdoctoral Research Associate, Department of Neurology, University of Wisconsin-Madison. The morning breakout sessions will follow Dr. Cortese’s interactive presentation, and participants will choose from three options: “Caregivers: Being prepared for an emergency”, “Grieving ‘life as we have known it’”, and a Panel on PD exercise programs.

During lunch, the resource fair will again be open for participants. After lunch, the afternoon breakout sessions will include “Are you caring too much and laughing too little?”, “Causes and prevention of falls” and “Exercise: A targeted attack on Parkinson’s.” The closing session for all attendees will be “Nutrition for Parkinson Disease” presented by Michelle McDonagh, RD, CD, Froedtert & The Medical College of Wisconsin. The Symposium will conclude by 3:30pm.

The registration fee is $30 per person and includes educational materials, continental breakfast, and lunch. To register, CLICK HERE or call our office at 414-312-6990. Registration is required and must be received by Wednesday, June 14.

The event is sponsored by Abbvie, Medtronic and US WorldMeds.

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