What’s next for DBS? Weight loss, Alzheimer’s

Deep brain stimulation surgery is quickly becoming the hot new treatment for an ever-widening array of ailments. Initially approved for treatment of motion disorders such as essential tremor and Parkinson’s disease, it was exciting to see the technology applied to other problems, such as epilepsy. Discussion then turned to using DBS for obsessive-compulsive disorder. Since then, we’ve seen the buzz building around DBS for depression. Humanitarian exemptions have been granted for DBS to treat severe Tourette’s. 

This morning’s mail brings word of efforts in Canada to extend DBS to people with weight-management problems, and even Alzheimer’s disease. Makes me wonder about how DBS might be used by otherwise normal people seeking a cognitive edge, like those who take the ADD drugs.

People Understand Risk of Falling, But Not the Risk Factors

For older people, and especially those with Parkinson’s, a fall-related injury is the first event in a chain that leads to ever-worsening problems. I’d say it’s probably the best indicator of how advanced a person’s progression is: the cane, the walker, the wheelchair, and the ability to negotiate even a door jamb or threshold.

A paper in the Journal of Neuroscience Nursing (reprinted at Medscape) describes interviews with 28 people with Parkinson’s. Nearly all of them knew that they were at higher risk for falling. However, many did not understand the factors that might lead to falling, especially the risk posed by medication:

Although our cohort recognized that their probability of falling was substantial, they lacked awareness of specific risk
factors for falling, particularly those associated with medication use. This was a surprising finding, considering that the participants enrolled in this study were taking numerous medications, and many of those medications are known to increase risk for falling. The fact that these individuals attended a movement disorder clinic led us to hypothesize that
their awareness of all risk factors would have been much higher. 

Maybe it’s simple denial, a willful whistle past the graveyard, or maybe there’s some pathological blind spot that leaves those of us with PD in ignorance of even the obvious. Hopefully our friends and partners are more aware of these problems, and are willing to look out for us.

Symposium Videos Now Available Via DHMC

I’m amazed at how efficient Diane and her colleagues at DHMC have become at communications. Video from the sessions at last month’s Parkinson’s Awareness Day symposium is now available, online and on DVD.

Point your browser to www.dhmc.org/goto/parkinson, then click “Events” on the left side of that page. You’ll see links to the presentation by Dr. David Roberts on deep-brain stimulation surgery; the panel discussion that followed; and Dr. Steven Lee’s presentation on cutting-edge research. You’ll need a high-speed network connection to view these files; or you can get the DVD. Enjoy!

Sleep Disorder as an Early Indicator of Parkinson’s

Researchers are still looking for ways to identify Parkinson’s and other neurodegenerative diseases before the physical symptoms become obvious. Recent attention has been on problems with smell — that a standard doctor’s office smell test can be a remarkably effective predictor of Parkinson’s. That, in turn, might allow doctors to prescribe substances that have a protective effect.

Researchers at the Mayo Clinic (including Dr. Bradley Boeve, who I’ve had the pleasure of meeting) are know looking at whether certain types of sleep disorders are associated with developing dementias, such as Parkinson’s. The studies (press releases at mayo.org) focused on REM sleep behavior disorder (RBD), a condition where people act out events in their dreams, sometimes violently.
RBD has long been anecdotally associated with Parkinson’s. These studies were apparently the first to examine this proposition in a larger population-based method. The studies determined that other neurological problems, such as cognitive decline, anxiety, apathy, and Parkinsonism, were statistically more likely to happen in people with RBD than in the general population. 
More study is definitely in order, especially regarding the co-incidence of Parkinsonism. But it does make me wonder if the cognitive problems are simply a result of poor quality sleep. I look forward to hearing more about it.

Exercise Helps Everything

Jane Brody’s column this week pretty much nails it: No matter if you’ve got Parkinson’s, cancer, or are simply getting older, exercise is going to help you. 

“The single thing that comes close to a magic bullet, in terms of its strong and universal benefits, is exercise,” Frank Hu, epidemiologist at the Harvard School of Public Health, said in the Harvard Magazine.

Study after study shows that moderate to vigorous exercise will help you. Haven’t been off the couch in a while? Get started, under the supervision of a personal trainer or physical therapist. Heart problems? Get busy — that’s the best way to pump oxygenated blood to where it’s needed. Depression? Exercise is arguably better than any drug, and it’s drug-free.

Please, read the article. It could save you life — and it will certainly improve the quality of it.

Jamming the Signal: The Effect of Diagnosis on Cognition

The simple act of receiving the diagnosis of Parkinson’s disease blew me out of the water. I’ve met quite a few people in support groups for whom the diagnosis was a singularly traumatic event.

And now comes a study of “chemobrain,” the cognitive problems associated with breast cancer therapies, that indicate that the therapies have little to do with it. The Australian doctors presented their findings at the annual meeting of the American Academy of Neurology earlier this month.
They found that women who were diagnosed as having breast cancer began showing signs of impairment of attention and learning prior to the start of chemotherapy. And most of the women regained most of the lost function by the end of the chemotherapy regime.
There’s no doubt in my mind that the delivery of a grim diagnosis causes problems in and of itself. My mind reeled for weeks after that day in December, 2001, as if the events of Sept. 11 were not upsetting enough. I know the diagnosis was similarly disturbing to Suzanne.
My capacity for evaluating the thicket of choices that confronted me — medication options, implications for my career and family — was definitely limited. Looking back on that time, I wonder how the choices I made would have been affected had I been given the chance to review some comprehensive info from someone who had been there and done that (memo to self …).
But I will be always grateful to my support group friends, who were (and are) there, month after month, eager to help the newly dazed as they search for a way forward.

Problem with Sleep? Only When I’m Not Sleeping

I am so tired.

Knowing that sleep problems are a part of having Parkinson’s disease doesn’t make having a problem any more tolerable. It could be worse: I could be getting no relief at all.

I sleep with a C-PAP, basically a compressor that shoots air under pressure through my nose and into my lungs. The system keeps my upper airways from collapsing at the instant an exhale turns to inhale.

Without it, I would suffer an average of 67 “waking incidents” per hour, all night long, every night. The day after my first night in a sleep lab was bliss, and it only got better as the months went by. My long twilight of ill temper and dulled thought receded into long-term memory.

Every so often, the new routine is disrupted. Maybe it’s the congestion from low-level, seasonal allergies. It could be the new headgear, which gets replaced every few months (the tubing develops pinholes in regular use).

Whatever. The last few days have been tough. I’m slowly gaining more uninterrupted hours each night, but the cumulative effect has been increasingly apparent. Here’s hoping for a good night.

Neupro Patch Recall

From Drugs.com:

[Posted 04/09/2008] Schwarz Pharma informed healthcare professionals and patients of the recall of Neupro, a transdermal delivery system worn on the skin and used to treat early stage Parkinson’s disease, at the end of April 2008, because of the formation of rotigotine crystals in the patches. When the drug crystallizes, less drug is available to be absorbed through the skin and the efficacy of the product may vary. Healthcare professionals should not initiate any new patients on Neupro and should begin to down-titrate all patients currently using the product per the guidelines in the product labeling. Patients should NOT abruptly discontinue therapy. Abrupt withdrawal of dopamine agonists has been associated with a syndrome resembling neuroleptic malignant syndrome or akinetic crises.

Treadmill, Exercise Helps Body and Mind

It’s long been said that exercise is vital to helping people with Parkinson’s. One bit of scientific evidence is a study published last fall that studied the effects on Parkinsonians of walking on a treadmill.

The objective: to see if gait and instability could be helped by walking regularly on a treadmill. After all, falling — or the fear of falling — can dramatically affect a patient’s quality of life. 

Treadmill training has long been used to help rehabilitate people after strokes and spinal cord injuries, in part because it’s easier to build up strength if one can use the treadmill’s rails for support.

The study involved nine patients walking on a motorized treadmill four times a week, 30 minutes at a time, for six weeks, under the close supervision of a physical therapist. The speed of the treadmill was reevaluated each week; patients started out at a relatively slow speed that was gradually boosted.

The benefits were significant, both in the short and long term. Mobility improved by the end of the six-week period, and the patients were all enthusiastic about continuing an exercise program. 

Several weeks after the study ended, patients were interviewed again. Not only were gait and mobility better than before the test, but their Parkinson’s rating scores were lower (better). Basically, everyone felt better, more confident, less likely to fall. Something about the rhythm, perhaps — which is echoed in the findings of other studies of the benefits of dancing and tai chi for Parkinsonians.

Bottom line: any exercise performed with rhythm and vigor is gonna help you feel better.