Saturday, December 12, 2009

Asymetrical Arm Swings may Signal Parkinson’s Disease

Parkinson's disease is a neurodegenerative illness that can have devastating effects on motor skills, including walking. A new study found that arm-swing asymmetry while walking may be one of the first signs of the disease.
In this small study, researchers from University of North Carolina at Chapel Hill and Pennsylvania State University did a gait analysis among 12 older people with early stage Parkinson's disease, and eight people without the disease, who served as a control group. Before gait analysis tests, those in the Parkinson's group tapered off their Parkinson's medication so test results wouldn’t be swayed.
Each participant had the movement of their arms, pelvis and lower extremities analyzed via a 3-D motion capture system as they walked three ways: at a normal gait, at a fast gait and on their heels, the last to minimize push-off.
The Parkinson's group showed more arm-swing asymmetry than the control group in the normal and fast walking variations. But trunk rotation was basically the same for both groups, showing that it didn't factor into the arm-swing asymmetry. Arm-swing magnitude was the same for both groups as well.
"Our data suggests that this could be a very useful tool for the early detection of Parkinson's," Xuemei Huang, associate professor of neurology at Pennsylvania State Hershey College of Medicine, said in a news release. Huang, the study's co-author, added: "There are wide scale efforts to find drugs that slow cell death. When they are found, they could be used in conjunction with this technique to arrest or perhaps cure the disease because they could be given before great damage has occurred."

Parkinson's goes Big

The LSVT encourages a person with Parkinson's disease to really swing the arms, rock the heels and take large steps. LSVT also concentrates on the everyday activities important to the patients and for a golfer that meant working on his golf swing.
“The first thing we always focus on is doing everything really big,” Layhew said. “Then he gets used to it when he’s out in public.”
Parkinson disease typically causes tremors, slow movement, rigidity of limbs and poor balance. The disease can also affect speech and posture.
Speech and language pathologist Christine Garretson said many people with Parkinson disease initially aren’t aware of their condition until they learn about it from their spouses.
“One of the characteristics of Parkinson is the perception of how they sound,” Garretson said. “They think their spouse might need a hearing aid. It’s very common for them to think it’s their environment.”
She uses LSVT Loud to use those same principles of going big to get people with Parkinson to learn how to modulate their voices while speaking. The program begins with an “ahh” sound and then builds into homework that could include leaving voice messages or speaking to the receptionist.
“We get them to be intense and loud,” she said. “It’s bombarding them with being big and loud. We measure duration and level and then we adjust the pitch.”
The programs require a four-week commitment where a patient must attend four days a week during that month. He then performs the same exercises at home to get two sessions per day. Both LSVT programs include additional homework exercises.
“It’s retraining the brain,” Garretson said. “Voice problems affect the vast majority. Speech is what we do; it’s what makes us human — that ability to communicate.”
LSVT Loud also addresses swallowing problems frequently affecting Parkinson patients. Garretson said the exercises can help reduce the risk of choking and minimize embarrassment.
Sometimes a person with Parkinson makes it difficult to get in and out of his chair and cut his food so going out to dinner in public may be difficult aside from embarrasing and painful.
LSVT Big has conquered some of those problems.
LSVT Loud has been used for 15 years and many of the same principles are used for LSVT Big.
“LSVT is a great therapy for patients who need to improve their voice volume,” said Dr. Michael S. Okun, national medical director of the National Parkinson Foundation. “To make this therapy effective however, patients need to actively participate in many initial sessions and then in regular booster sessions.”
LSVT Big and LSVT Loud require regular exercise at home following the conclusion of the initial four-week sessions. During that time, one will continue tracking a patient's physical mobility, strength and balance during his booster session.
The improvements over the four weeks are enough to convince anyone to continue the exercises.
Both these exercises make a person with Parkinson's disease more confident in even simple activities like cutting his food and even getting out of his chair.

Stomach Hormone Can Boost Resistance To Or Slow Down Parkinson's

By: Catharine Paddock, PhD

US researchers report finding that ghrelin, a hormone produced in the stomach that regulates appetite and how the body deposits fat, may be used to boost resistance to or slow the development of Parkinson's disease.

The study is the work of Dr Tamas Horvath, chair and professor of comparative medicine and professor of neurobiology and obstetrics and gynecology at the Yale University School of Medicine, New Haven, Connecticut, and colleagues and was published earlier this month in The Journal of Neuroscience.

Parkinson's disease is a neurodegenerative disorder where dopamine neurons in an area of the midbrain known as the substantia nigra, which is responsible for dopamine production, start to die off.

As less dopamine is produced, the symptoms become more severe, so that eventually people with the disease have difficulty walking, have restricted and delayed movements, get tremors in their head and limbs, lose their appetite, can't eat properly, and have periods of immobility or "freezing".

We already know that ghrelin targets the hypothalamus and affects appetite, food intake and how the body deposits fat. The authors wrote that ghrelin receptors at sites outside of the hypothalamus also "promote circuit activity associated with learning and memory, and reward seeking behavior". And recent human studies have shown that body mass index (BMI), stored fat and diabetes are linked to Parkinson's disease.

In this study, Horvath and colleagues discovered that ghrelin also protects the neurons that make dopamine.

"We also found that, in addition to its influence on appetite, ghrelin is responsible for direct activation of the brain's dopamine cells," said Horvath. He explained that because the hormone is made in the stomach, it circulates normally in the bloodstream, "so it could easily be used to boost resistance to Parkinson's or it could be used to slow the development of the disease".

For the study, which was supported by the Michael J Fox Foundation for Parkinson's Research, Horvath and colleagues gave one group of mice extra ghrelin, and while another group were genetically engineered to lack the hormone and its receptor.

When compared to a group of control mice, the mice that had impaired ghrelin action in the brain had more dopamine loss.

The authors explained that the mice that were given extra ghrelin lost fewer substantia nigra pars compacta dopamine cells and showed "restricted striatal dopamine loss", while the mice that were genetically engineered to lack the hormone and its receptors lost more substantia nigra pars compacta dopamine cells and showed "lowered striatal dopamine levels". The effect in the genetically engineered mice was reversed when they switched the ghrelin receptor on.

They concluded that their study supports the idea that ghrelin could be a new therapeutic strategy to fight neurodegeneration, loss of appetite and body weight linked with Parkinson's disease.

Horvath said they could see these results being applicable to humans because the ghrelin system is preserved through various species.

The researchers are now planning to find out how ghrelin levels differ between healthy people and people with Parkinsons disease, and whether changes in ghrelin levels might serve as a biomarker of disease susceptibility and development.

Parkinson’s sufferers find solace in group

By Chris Cobb
The Herald-Zeitung

It’s a life-changing and often debilitating illness, and one no one wants to go through on their own.

As they do twice each month, New Braunfels residents gathered Saturday at McKenna Events Center and talked about the importance of having support as they struggle to go through life while suffering from Parkinson’s Disease.

“Everyone needs this kind of support,” said Peggy Dubuque, whose husband Tommy started the local support group in 2007. “I can’t tell you how important it is.”

Around 60,000 people are diagnosed with Parkinson’s each year in the United States, and around one million people suffer from the disease in the United States alone, according to the National Parkinson Foundation.

It’s a neurological disorder that occurs when cells in the brain fail to produce dopamine. The lack of the chemical gradually impairs almost all of the body’s motor functions, often leading to shuffled walking, stiff facial expressions and tremors and shaking throughout the body.

Prior to 2007, residents in New Braunfels had to travel elsewhere to seek support or learn more about their disease.

“It can be so daunting to have to search for treatment,” said Connie Srote. “People don’t realize that when you have a disability, you can’t travel even the 30 miles to San Antonio comfortably.”

Tommy Dubuque started the group in July 2007, and the first Parkinson’s support group meeting in New Braunfels saw six people.

Today, the group has grown to 105 members who regularly attend meetings, according to Peggy Dubuque. They come to learn more from each other about treatment options, or discuss ways others suffering from Parkinson’s cope day-to-day.

“It’s important because people need to be getting all of the information that’s available,” said Pam Callia, a speech pathologist with Kirkwood Manor who presented residents Saturday with treatment options for people whose speech has been gradually stunted by the disease. “It’s definitely informative, but there’s also that component of being able to say ‘this worked for me,’ or ‘this didn’t work, what about that?’ People get a chance to interact with others going through the same thing.”

Although 15 percent of Parkinson sufferers are under the age of 50, the vast majority are over 65, according to foundation statistics — an age group that makes up a significant portion of Comal County’s population.

Around 25 percent of county residents are older than 55, according the United Way’s Comal County Community Needs Assessment.

With a large senior population and the disease so widespread, Srote stressed the importance of receiving treatment and seeking support from those in your community who can help.

“A lot of people don’t say they need help because they’re still functional, and it’s a hard thing to talk about,” she said. “But (support) can help, and having it here in New Braunfels is really a blessing.”

The group meets twice each month, once to have a group discussion and again to hear guests speakers present different treatment options or helpful tips for those with Parkinson’s.

Friday, December 11, 2009

Pilot randomised controlled trial of occupational therapy to optimise independence in Parkinson's disease: the PD OT trial.

Clarke CE, Furmston A, Morgan E, Patel S, Sackley C, Walker M, Bryan S, Wheatley K.
J Neurol Neurosurg Psychiatry. 2009 Sep;80(9):976-8. Epub 2008 Mar 13.

Clinical Abstract:

OBJECTIVE: To perform a pilot trial of occupational therapy (OT) to optimise functional independence in Parkinson disease (PD) to assess accrual/withdrawal rates, acceptability, outcome measures, and inform sample-size calculation. METHOD: Non-demented patients with idiopathic PD and difficulties with activities of daily living (ADL) were recruited provided they had not received OT in the last 2 years and/or physiotherapy in the last year. Patients were randomised to immediate OT or OT after completion of the trial. Patients randomised to OT were assessed at home by an experienced therapist and then received six home treatment sessions over 2 months. Interventions were targeted at functional independence and mobility goals. Outcome measures were: Nottingham Extended Activity of Daily Living Scale, Rivermead Mobility Index, Unified Parkinson's Disease Rating Scale ADL scale, Parkinson's Disease Questionnaire 39, EuroQol-EQ-5D, Hospital Anxiety and Depression Scale, and health economics analysis. RESULTS: 39 patients (25 male; mean age 73 years) were recruited from four centres over 16 months. The mean difference in NEADL at 8 months was 3.5 (95% CI -3.2 to 10.2). The mean difference in PDQ-39 Summary Score was 3.8 (95% CI -4.94 to 12.6). There were strong correlations between the PDQ-39 and other outcomes. The intervention was acceptable to patients, with a low withdrawal rate and good questionnaire completion. CONCLUSION: Randomisation to a trial of OT in PD is feasible. NEADL and PDQ-39 are relevant outcomes and provided data to inform sample size for an adequately powered randomised trial for which there is pressing need.

New options for Parkinson's treatment

By: Kerstin Kealy, WDAY

Patients with Parkinson’s here in the Valley have a new option for treatment. MeritCare has started the L-S-V-T Big program and just a few months in, it's making a big difference in the lives of patients. Last night, our friend, former WDAY Anchor Marv Bossart shared his courageous story as he battles this difficult disease. Big and the L-S-V-T Loud program are giving Marv back and others like him what Parkinson's threatens to steal away.
As a News Anchor for 42 years, Marv Bossart was known for his voice. 7 years after a diagnosis of Parkinson’s, he is fighting to keep it.
“I hate the fact that my voice is fading, I made my living on my voice.”
He's among 89% of those with Parkinson’s who have problems with speech.
“His biggest complaint coming in to see me was that he was losing himself in crowds in people and not being heard and not understanding that.”
The Loud program is an intensive month long speech therapy that recalibrates your brain, teaching you to think loud and talk loud. It's showing dramatic results.
“You can see in one day, day one progress.”
From Loud to Big, Marv re-learns what many of us take for granted. Things like getting up from a chair, reaching, and walking.
“Marv has one of the best attitudes I’ve ever seen.”
Since the program started at MeritCare in May, Physical Therapist Laura Guse has used big to help Parkinson’s patients walk faster with bigger steps and have better balance, a serious safety issue for those with Parkinson’s.
“I was getting along just fine and one day all of a sudden I fell in our driveway and I fell hard.”
Laura says the results from big have shown twice the improvement for Parkinson’s patients than traditional physical therapy.
“They really feel empowered over their disease and they have a lot more confidence in the way that they move, they feel less fearful of falling.”
Marv's doctor, MeritCare Neurologist Dr. Tanya Harlow, says up to 70 percent of her patients here at NRI have Parkinson's.
“I could spend my entire time as a physician just seeing Parkinson’s disease because there are that any patients.”
She and Marv talked about another option for treatment, deep brain stimulation, but Marv decided it wasn't worth the risks, instead opting for physical therapy and medication.
“He’s becoming more advanced as far as his Parkinson’s disease goes so the motor complications I mentioned before as far as the diskinesias are starting to become more problematic for him.”
Dr. Harlow says the key to one day curing this brain disorder is figure out what causes it. Something she is hopeful will happen in the next decade.
“I think it's going to be a breakthrough. There's so much research going in I’m hoping it's going to be sooner rather than later.
For now the key to fighting this disease, something Marv knows well, staying active.
“I’m not going to give up without a fight of some kind.”

Neurologix completes all surgical procedures in Phase II Parkinson's disease study

US clinical-stage biotechnology company Neurologix Inc (OTC: NRGX) said today it has completed all planned surgeries in an ongoing Phase II study of its gene transfer approach to the treatment of advanced Parkinson's disease.

The controlled, double-blind, 44-patient Phase II trial is investigating the safety and efficacy of a novel non-dopamine approach to restore motor function in Parkinson's patients who are sub-optimally responsive to available drug therapy. The company expects to announce initial efficacy results from the trial in mid-2010.

The investigators are assessing each of the trial participants over time for treatment effects, with the primary trial endpoint being a clinical assessment of motor function at 6 months using the Unified Parkinson's Disease Rating Scale (UPDRS). All participants in the trial will also be monitored for safety for 12 months following their gene transfer procedure.

CEO John Mordock said that the company's gene therapy approach to Parkinson's aims to provide a safer and more effective alternative to either dopamine replacement therapies or deep brain stimulation for patients with advanced stages of the disease. Neurologix's strategy is to deliver a gene ("GAD") that reestablishes the production of GABA (gamma-aminobutyric acid), the major brain inhibitory neurotransmitter that helps "quiet" excessive neuronal firing, added Mordock and continued that scientists have determined this neurotransmitter to be deficient in the brains of patients in the advanced stages of Parkinson's disease.

Author who suffers from Parkinson's teaches innovative yoga class

By Katie Curley Katzman

Renee Le Verrier leads a group of five women in stretching, balancing and relaxation poses on a recent afternoon at the Yoga Center of Newburyport.

The only difference between this class and others is that a chair and variety of other props makes the class more accessible.

Blocks, straps, blankets and cushions all help to make stretches lighter and bring the distance from hand to foot closer for the participants.

"This isn't chair yoga because we are not just in the chair," Le Verrier said. "The chair is just a prop to bring the floor closer to us."

Le Verrier teaches yoga for movement disorders, a weekly class aimed at making yoga possible for individuals who have any restrictions, including those stemming from osteoporosis or Parkinson's disease.

But it is also geared at those who just feel a little "creaky."

"If you can breath, you can do yoga," Le Verrier said. "Yoga can be intimidating to people especially when you go to a yoga studio, but yoga is most beneficial to those with limitations and movement disorders."

Le Verrier should know. As a child, she suffered a stroke. Five years ago, at age 42, she was diagnosed with Parkinson's, a brain disorder affecting both men and women. She has been practicing yoga for eight years and teaching for three at the Yoga Center of Newburyport as well as Whittier Rehabilitation Hospital in Bradford and Massachusetts General Hospital.

"I've learned through yoga to live in the moment," she said.

Le Verrier was recently chosen as one of 25 people nationwide to attend the Parkinson's Disease Foundation's Clinical Research Learning Institute. The training prepares participants to serve as advocates for bringing new treatment information to their communities as well as serving as a formal representative on clinical research and advisory boards.

According to the National Parkinson' Foundation, the condition usually develops after age 65, but 15 percent of people, like Le Verrier, are diagnosed before age 50. About 1 million Americans suffer from Parkinson's, with an estimated 60,000 new cases diagnosed each year.

Le Verrier said yoga is an effective tool for Parkinson's because the disease affects certain dopamine-producing nerve cells (neurons) in one part of the brain that die or become impaired. Dopamine allows for smooth, coordinated muscle movement, so when it becomes limited in the body, symptoms such as tremors, shaking and rigidity are said to result.

Le Verrier credits yoga with aiding her not only physically, but spiritually as well. While her once excruciating back pain is now gone, she said she continues to benefit by the lessons yoga has taught her about breathing through hard times and noticing life more.

"When I feel myself being affected by something, I can go back to my breathing," she said. "I'm not dismissing whatever is happening, but I can breath it out."

Le Verrier said yoga also helped her unblock energy flow and allowed her to become more creative through painting.

"Before, I had a phobia of art," she said. "But one snowy day, I started painting with my first grader and I just let the creative energy happen."

As a yoga teacher, Le Verrier has pushed to provide classes for other students like herself and has also worked to educate teachers on how to work with individuals who have Parkinson's. Recently, she taught a large workshop for yoga teachers from area gyms, hospitals, rehabilitation centers and studios.

"Exercise is beneficial in managing Parkinson's," she said. "It gives a sense of well being, makes breathing easier, affects posture. I hope I can bring a little of that in."

When students with movement disorders or Parkinson's attend a typical yoga class, Le Verrier said teachers often don't tailor the class to their limitations or become too gentle with them, and they're unable to fully garner the benefits.

"The teachers get nervous and tell the student to sit a pose out," said Le Verrier, who gives instructors specific things they can do to change their teaching approach.

In addition to her work teaching, Le Verrier has published a yoga book, with another on its way to the printer. "Yoga for Movement Disorders," published by Merit Press, is a workbook with poses and stretches those with limitations can do at home or in a studio setting. "A, B, C ... X, Yoga, Z," a playful introduction to yoga for kids using the ABCs, is due out soon.

Le Verrier said many people stop doing the activities they used to when they are diagnosed with Parkinson's or a movement disorder, including playing with children and grandchildren.

"The ABC book is a wonderful way to do something and move together," she said. "Grandparents can do this with their grandchildren even though they may not be able to play soccer with them anymore."

Thursday, December 10, 2009

Sewing Support

By Lucretia Cardenas

The hands of Parkinson’s disease patients can tremble but they can still create a beautiful, meaningful quilt.

Proving that they are “not incapacitated, just disabled,” Parkinson patients from across the nation – who have become friends through an online chat room on – crafted a quilt now circulating from one home to another. Right now, the quilt is with Conroe resident Vic Lopez, 64.

He’s battled Parkinson’s disease since 1998. When the illness worsened, he underwent a deep brain stimulation treatment in 2006. The connections in the wired stimulation system, which sends signals to his body to control his symptoms, aren’t great and Lopez had it replaced Thursday.

The quilt, which has two squares Lopez sewed and a third he helped to create, have deep meaning for Lopez – a strength among friendships formed, a strength of overcoming stigmas and a strength in taking on challenges. One square of the quilt symbolizes those strengths, with a picture of two tulips tied together for support by a string.

Another square describes the struggle of Parkinson’s patients.

“We’re fighting for our dignity, each day an endless test,” the poem reads. “We’re searching for the cure, so we can ease our quest.”

Lopez’s individual square has his screen name “vig wig” written on it and states that he “writes, fishes, naps, chats online, plays oldies music – garbage waits.” He also placed pictures on it of a fish he caught in Lake Conroe, a man wearing a large sombrero napping against a cactus and an LP record.

The quilt took just over a year to make, Lopez said. Each member of the online forum contributed a square, and a professional quilter bound them all together.

No decision has been made about where the quilt will end up, but the chat room friends don’t want it to gather dust in an office building or raffle it off, Lopez said. For now, it will continue to circulate from member to member across the nation so they can share the message the quilt represents.

“I’ve got Parkinson’s but it hasn’t got me,” Lopez said. “We can do this in spite of the disease.”

Parkinson’s Disease Patients Treated with Autologous Bone Marrow Stem Cells May Improve Their Quality of Life

Eight Parkinson’s Disease patients were treated with their own bone marrow stem cells (BMSC) injected via minimally invasive non-surgical routes and discharged the next morning without complications.

“We show the clinical use of autologous BMSC in PD patients, not in animal tests” leader investigator Dr. Luis Geffner said.

Evaluations with UPDRS, Hoehn & Yahr scale and Schwab & England score showed encouraging improvements such as the graphologic tests performed before and after the trasplant that demonstrated significant differences.

Additionally the total L-dopamine dose could be decreased suggesting that stem cells may enhance endogenous dopamine synthesis. He also explained that they are very cautious and prudent emphasizing that they are not talking about cure but stem cells may possibly be a new tool to complement current treatments and delay the progress either of the illness or its complications such as the side effects of some medication.

This study showing safety and feasibility of autologous adult BMSC transplant in PD patients was presented in Baltimore on October 11th 2009 in the 23rd Annual Symposium of Etiology, Pathogenesis and Treatment of Parkinson’s Disease and other Movement Disorders organized by the Parkinson Study Group in affiliation with the American Neurological Association and published in September 2009 issue of Movement Disorders, a peer -review journal.

Geffner's team has already transplanted 144 patients suffering from different illnesses or trauma states and many of them have been followed up 5 years showing that autologous adult BMSC neither provoke tumors, immunologic rejection, infections nor arise ethical or religious controversies.

Wednesday, December 9, 2009

Constipation May Be Early Clue to Parkinson's Disease

By Charles Bankhead, Staff Writer, MedPage Today

Constipation may represent one of the earliest signs of Parkinson's disease, preceding the onset of motor symptoms by two decades or more, data from a case-control study suggest.

Patients with Parkinson's disease were more than twice as likely to report a history of constipation compared with a control population. The association remained significant after controlling for other factors associated with constipation, according to a report in the December issue of Neurology.

Though constipation is not specific for Parkinson's disease, the findings are consistent with the hypothesis that Parkinson's disease adversely affects autonomic function early in the course of pathogenesis.

"Our findings may suggest that constipation is an early manifestation of the neurodegenerative process underlying Parkinson's disease, and that it frequently precedes the classic motor signs of Parkinson's disease by several decades in both men and women," Walter A. Rocca, MD, of the Mayo Clinic in Rochester, Minn., and colleagues concluded.
Action Points

* Explain to patients that people with Parkinson's disease often report a history of constipation.

* Note that the findings came from a retrospective analysis of medical records and do not prove that constipation plays a role in Parkinson's disease.

However, they cautioned that "there are alternative explanations for this association."

Autonomic dysfunction is a recognized component of the pathogenetic process of Parkinson's disease, and Lewy bodies are consistently found in the autonomic nervous system of patients who have died with Parkinson's disease.

Constipation is one of the most common manifestations of autonomic dysfunction and often is present at the onset of motor symptoms or progression of Parkinson's disease, the authors noted.

In some cases, constipation may precede the onset of motor symptoms in Parkinson's patients. Data from the Honolulu-Asia Aging Study showed that men who reported less frequent bowel movements had an increased risk of Parkinson's disease during a 24-year follow-up period (Neurology 2001; 57: 456-62, J Neurol 2003; 250(suppl 3): III30-39).

Other reports from the Honolulu study described an association between constipation and incidental Lewy body disease and a reduced neuronal density in the substantia nigra (Mov Disord 2007; 22: 1581-86, Mov Disord 2009; 24: 371-76).

Consistent with clinical and pathologic findings, the Braak staging system of Parkinson's disease neuropathology predicts early involvement in the disease process (Neurosci Lett 2006; 396: 67-72).

Continuing this line of work, investigators reviewed medical records of participants in the Rochester Epidemiology Project. They identified all patients who developed Parkinson's disease (by conventional diagnostic criteria) from 1976 through 1995. Each case was matched by age and sex with a member of the general population of participants in the epidemiologic study.

Investigators defined constipation as a diagnosis of constipation in the medical records or use of drugs to treat constipation, even in the absence of a diagnosis.

The analysis revealed 196 patients who developed Parkinson's disease during the period reviewed. The authors found that 71 (36.2%) patients with Parkinson's disease had a history of constipation compared with 40 (20.4%) of the control group. The difference translated into an odds ratio of 2.48 for cases versus controls (95% CI 1.49 to 4.11, P=0.0005).

The association between constipation and Parkinson's disease remained significant after adjusting for smoking and coffee consumption and exclusion of possible drug-induced constipation.

Moreover, the association remained significant in an analysis limited to patients with constipation documented 20 or more years before the onset of motor symptoms of Parkinson's disease (OR 2.98, 95% CI 1.48 to 6.03, P=0.002).

The association was stronger in women (OR 3.38) than in men (OR 1.92) and in patients with rest tremor versus those without, but the differences did not reach statistical significance.

Although the data supported the biologic plausibility of constipation as an early nonmotor manifestation of Parkinson's disease, the authors offered several alternative explanations:

* Constipation and Parkinson's disease could be independent manifestations of an unknown risk factor
* The association might reflect a genetic susceptibility
* Constipation might have an indirect, but causal, role in Parkinson's disease, such as increased intestinal absorption of substances toxic to the substantia nigra

"However, the evidence in support of these alternative interpretations remains limited," the authors said.

Freddie Roach acts like a man by calling out columnist Alex Vidal

by: Samuel Rossi

Word has hit the internet that legendary trainer and Parkinson's victim Freddie Roach is being sued by writer Alex Vidal over comments and actions directed toward the reporter. In July of last year, Vidal wrote a story entitled, 'Sick' Roach Misses Conepcion's Final Workout in Wild Card Gym. In that story, Vidal reported that Roach, who has suffered from Parkinson's Disease as a result of his days inside the ring, had been hospitalized with flu-like symptoms days prior to Concepcion's fight against Adam Carrera due to his illness. Several outlets have reported that Vidal's lawsuit came about after Roach confronted the writer over his piece.

Vidal claims that, after apologizing to Roach for the piece, the trainer threatened to "kill" the writer if he were ever again to write about his illness, and approached him in a physical nature. Celebrity gossip site TMZ is reporting that the trainer is being sued for "assault, battery, and infliction of emotional distress."

While I was not anywhere near the Wild Card Gym on the day Roach is said to have threatened the writer, I wish only to offer an endorsement of Freddie Roach's overall character.

Roach - a future first ballot hall-of-fame trainer of fighters like Manny Pacquiao, Virgil Hill, James Toney, and Mike Tyson - is a treasure to our sport. The wise and energetic trainer represents all that is good in the world of boxing. Here is a man who stands in the face of adversity at the dawn of every new day. Here is a man who offers fighters his knowledge and know-how in hopes that they do not end up suffering from the same life-crushing disease that currenly plagues him. Here is a man who has experienced the best and the worst that boxing has to offer. Freddie Roach is a man with no complaints.

As he nears the age of 50, Freddie Roach continues to face a debilitating and life-wrenching disease on a daily basis; a disease in which no cure nor victor is known. He suffers from an illness that that takes away abilities and luxuries with absolutely no remorse. Yet, he continues to stand - he continues to fight.

I am reminded of the legendary college basketball coach Jim Valvano who once stood before an audience as a dying and cancer-riddled man and expressed his thoughts on the disease that weakened him. The former North Carolina State coach said that though his disease had the power to take away all of his physical abilities, it would never be able to touch his mind, his heart, nor his soul. Through his actions and demeanor, it is clear to me that Freddie Roach lives life by way of a similar mantra.

Roach is a man of strong mind. He is a genius in regards to the fight game, if there has ever been one. He is a man who understands the risks of this sport, as much as he knows the glory one can attain from it.

I think that Mr. Vidal, myself, and others in the boxing community should simply sit back and allow this man to continue passing along his wisdom to as many fighters as possible - with no commentary needed, other than words of praise.

In short, I am grateful to observe a world in which Freddie Roach is a teacher of men.

A carrier of courage's torch.

Tuesday, December 8, 2009

Understanding Parkinson’s disease

By Dr N. K. CHEW

THE most common reaction for most people first diagnosed with Parkinson’s disease would be one of disbelief. This would quickly progress to denial. Family members and friends would also be equally affected by the news.

It would be understandable if the first question that crops up is: “How are we going to cope?”

That denial kicks in almost immediately for many Parkinson’s sufferers and their families is a given. However, getting over the denial is a crucial if a sufferer and caregiver want to cope with the consequences of a positive diagnosis of this disease.

So it is paramount to learn as much about the disease, and understand how treatment can help sufferers improve their quality of life.

What is Parkinson’s disease?

Parkinson’s disease (PD) is a brain disorder that occurs when certain nerve cells or neurons in the brain die or become impaired. When this happens, these cells no longer produce a chemical called dopamine, which facilitate the smooth, coordinated function of our muscles. When about 80% of these neurons die or get damaged, that’s when Parkinson’s makes an appearance.
One of the misconceptions about Parkinson’s disease is that it’s a disease of old age. It’s not. Just ask Michael J. Fox, who was diagnosed with the disease when he was 30 years old.

The tell-tale signs include tremors, slowness of movement, rigidity, difficulty with balance, small, cramped handwriting, stiff facial expressions, a shuffling walk, muffled speech, and depression.

There is a misconception that Parkinson’s is an old-age disease but, in fact, about 15% of people diagnosed with Parkinson’s come from the 50-year-old and below age bracket. The disease strikes anyone regardless of gender, age, social status, culture, or profession.

And it gets worse as the process of diagnosing the disease is difficult, at best, as there is no one simple test when it comes to confirming the presence of Parkinson’s. A doctor can only arrive at a diagnosis for the condition only through a patient’s medical history and a series of physical examinations.

Magnetic resonance imaging (MRIs) and blood tests can help rule out other conditions that have similar symptoms, but those who are suspected to be suffering from Parkinson’s should seek out a neurologist who specialises in Parkinson’s Disease.

Parkinson’s is also not just a movement disorder as patients can also suffer from a long list of non-motor symptoms such as depression, confusion, hallucination, anxiety, and dementia as well as intestinal disorders, loss of sense of smell, and sleep disturbances.

It is also believed that several non-motor symptoms such as loss of sense of smell, depression, sleep disorders, fatigue, anxiety, and constipation may precede the motor symptoms of Parkinson’s by a few years, and thus can be considered as early symptoms of the disease.

Can it be treated?

Parkinson’s remains an incurable illness. Due to the progressive loss of brain cells, Parkinson’s progresses with time, resulting in gradual and inevitable deterioration of the initial motor symptoms. As the illness advances, the non-motor symptoms such as psychiatric disorders also become more frequent, especially during the advanced stage of illness.

In addition, many patients also develop involuntary body movements and suffer reduced effects of medications towards the later stage of the illness. All these complications result in long-term disability in Parkinson’s patients and in almost all aspects of life – physical, mental, occupational, and social.

There are, however, a number of effective medicines that help ease the symptoms of the disease. Most symptoms are caused by a lack of dopamine, and medicines most commonly used will attempt to either replace or mimic dopamine, which help to reduce tremors, lessen rigidity, and improves slowness of movements associated with Parkinson’s disease. Several new medicines are also being studied that may slow the progression of the disease. Many promise to improve the lives of people with the disease.

Medications used in the treatment of Parkinson’s disease in Malaysia

When it comes to treating Parkinson’s disease, there are different classes of drugs used at different stages of the disease – most often in combination or sometimes on its own depending on the severity of the condition, the age of the sufferer, and tolerance to medication. Initial treatment is individualised.

The classes of drugs used are levodopa, dopamine agonists, COMT-inhibitors, MAO-B-inhibitors, and anticholinergic drugs. Constant monitoring by the neurologist, patient and caregiver is crucial in determining the right dosages and types of medications to treat the condition. And each case is unique.

For early (initial) to moderate stages of Parkinson’s (five to 10 years), most patients (especially younger Parkinson’s patients) are prescribed dopamine agonist drugs such as ropinirole and can live a reasonably good quality of life while delaying the onset of motor complications or dyskinesia and the need for levodopa treatment. Levodopa will be used at a more advanced stage.

Dopamine agonist medications help to enhance the activity of dopamine in the brain to relief the symptoms of Parkinson’s. As the disease advances, they can also be used to treat motor fluctuations.

However, as the physical disability of Parkinson’s patients become more severe with time – after 10-15 years – many of them have difficulty carrying out daily activities despite taking maximum medications – a combination of many of the classes of medications.

Also, it has to be emphasised that Parkinson’s patients can only expect up to 90% level of improvement even with the best medications. Parkinson’s treatment cannot completely compensate for the dopamine deficiency in the brain. It is important that Parkinson’s patients be realistic in their expectations – there are no ideal medications for this illness. When the illness advances, and when patients’ symptoms are no longer well-controlled with medications (e.g. uncontrollable tremors), brain surgery can be effective in relieving the main symptoms of Parkinson’s such as slowness of movement and tremors. Currently, surgical treatment or Deep Brain Stimulation (DBS) surgery is available in Malaysia, but the treatment is costly.

Living with the treatment – its side effects

The side effects generally associated with Parkinson’s drugs are nausea, vomiting, and dizziness. The most serious side effects are involuntary body movements, which usually manifest as uncontrollable and unpredictable jerky body movements, and are triggered via prolonged use of levodopa.

The problem about the involuntary body movements is their irreversibility – once they have started, they persist for life. They are also an important cause of social stigma, as Parkinson’s patients frequently feel embarrassed by the stares of the general public – the involuntary body movements make Parkinson’s patients look “odd”.

As such, levodopa is best avoided during the early stages of Parkinson’s in order to prevent the development of the involuntary body movements or dyskinesia.

This has led to the suggestion that dopamine agonists should be used for initial treatment in newly-diagnosed Parkinson’s patients. A dopamine agonist drug has longer duration of effect on brain cells than levodopa and reduces the “wearing off” phenomenon while improving the 24-hour control of symptoms when taken regularly.

Dopamine agonist drugs can cause side-effects such as nausea, dizziness, sleepiness (sleep attacks), confusion, and low blood pressure. Fortunately, new medications like ropinirole appear to have a significantly lower frequency of side-effects and perhaps future drugs will lower the frequency even more.

Still, it is very important for Parkinson’s patients to follow a schedule of medications strictly, especially the timing of medication. Medications have to be taken at regular intervals in order to avoid or minimise the “on” and “off” periods.

When medication wears off, patients will experience stiffness and trembles – the “off” period. These fluctuations occur during the more advanced stages of the disease when the effect of medications is no longer sustained or consistent.

Other possible treatments

The discovery of Deep Brain Stimulation (DBS) surgery in the late 1990s was a major breakthrough in the treatment of Parkinson’s. The improvement in the symptoms of Parkinson’s following DBS surgery is dramatic. This surgery is suitable for those in the advanced stages of Parkinson’s after the effects of medications have diminished.

Apart from DBS surgery, there have not been many breakthroughs in treatment for Parkinson’s disease.

Stem cell treatment (through transplantation) for Parkinson’s has received a lot of attention recently. However, stem cell treatments overseas have not been proven effective. Many technical issues still need to be resolved before it can be recommended to Parkinson’s patients.

There are too many issues attached to stem cell treatment, namely on ensuring the survival of transplanted brain cells and the use of aborted human foetus. The procedure itself is also very expensive as it requires the highest level of technology and medical expertise.

Muhammad Ali attends opening of Parkinson's center

Boxing legend Muhammad Ali made a rare public appearance Thursday at the opening of a newly expanded treatment center for Parkinson's disease.

Ali, 67, and his wife, Lonnie, regularly donate to the Barrow Neurological Foundation and are largely responsible for the more than $2 million that the Muhammad Ali Parkinson Center gets every year from Celebrity Fight Night, a glitzy Phoenix gala that raises funds and awareness for the illness, said Mary Jane Crist, the foundation's CEO. The Parkinson's center at the Barrow Neurological Institute first opened in 1997 with the ability to treat about 60 patients a year. Officials say the expansion has doubled its size and that it now has six doctors and expects to treat 1,600 new patients a year -- an evolution largely due to Ali's involvement.

The former heavyweight champ, who was diagnosed with the brain disorder in 1984, receives some of his treatment at the center. He retired in 1981 from a career during which he won the world heavyweight championship three different times.

Center officials say the facility is now the most comprehensive in the nation for the treatment of Parkinson's. It now has medical, rehabilitation, research, and social and educational services in one location.

Center officials say the idea is for a Parkinson's patient to get all the services and treatment they need in one spot, instead of having to go to different locations.

Lonnie Ali said that's very important for people who have a tough time getting around, adding that it makes living day-to-day easier. The disorder causes tremors, slowed movement, and muffled speech.

Abraham Lieberman, the center's director, said doctors and other staff spend hours with new patients, explaining the disease and offering comfort.

"When they leave the office, they're not scared out of their minds that they're going to be in a wheelchair or they're going to die or something terrible is going to happen to them," he said. "If you tell people the truth and you explain it carefully and people know what they're confronting, most people can deal with this."

He said he couldn't say enough about what Ali means to the center, especially for patients.

"I tell patients, 'Look, Muhammad Ali was the greatest athlete in the 20th century. He's got Parkinson's and he's not desperate, he's not dejected, he's not depressed,"' Lieberman said. "The center is named for him because he's such a recognizable figure and he's given so much inspiration to people."

Ali toured the center with his wife and his sister-in-law, who held his hands. The three stopped frequently to look at some of the most memorable images of Ali in large frames along a hallway, including one of him with a ferocious look on his face towering over downed opponent Charles "Sonny" Liston.

The photos are a reflection of his life, Lonnie Ali said.

"I'm so excited for patients to come through this door," she said. "The environs are very comforting and calming and welcoming ... Just because you're in a hospital and you're here for treatment doesn't mean it has to look like a hospital."

Monday, December 7, 2009

Worm could offer Parkinson's clue

Scientists believe that worms could hold the key to why some people develop Parkinson's Disease.

Worms share 50% of their genes with humans, including those involved with inherited Parkinson's.

Dundee University researchers will study a simple worm called C. elegans to try to work out why the condition causes patient's brain cells to die.

The Parkinson's Disease Society has given the university £190,000 to carry out the research.

Eventual cure

There are about 120,000 people with Parkinson's in the UK. In up to 5% of those cases, the disease is believed to be directly inherited.

Parkinson's is a progressive neurological condition affecting movements such as walking, talking and writing. It occurs as a result of a loss of nerve cells in the brain.

Dr Anton Gartner, who is leading the study, said: "Research leading to an eventual cure for Parkinson' s disease is a daunting task and requires a very broad and multidisciplinary approach.

"I am grateful to the Parkinson's society to recognise this and to so generously support our research."

It's fascinating that such a simple animal as a worm can be an excellent model for Parkinson's researchers
Dr Kieran Breen
Parkinson's Disease Society

Worms will be used in the study as they are one of the simplest organisms with a nervous system.

The way worms' nerve cells communicate with each other is also similar to how it works in humans.

Several genes, including one known as LRRK2, have been linked to the hereditary form of Parkinson's Disease.

Dr Gartner's team want to understand how changes or mutations in this gene lead to the development of Parkinson's - and how drugs could stop the damage that these mutations cause to nerve cells.

Dr Kieran Breen, from the Parkinson's Disease Society, said: "It's fascinating that such a simple animal as a worm can be an excellent model for Parkinson's researchers to study what happens in specific nerve cells.

"We are delighted to be funding this research with Dr Gartner in Dundee. It will help us to understand better what causes nerve cells to die in Parkinson's, and will help us to develop new treatments for the condition."

Man walks for Parkinson's awareness

By AnneMarie Knepper, Albany Democrat-Herald

Lee Grimm said he was a metal worker for 25 years. A diagnosis of Parkinson’s disease made that kind of work impossible, so he decided to take a walk.

Grimm said he can’t work anymore and wanted to do something constructive with his time, so he is walking to help raise awareness about Parkinson’s disease and the Michael J. Fox Foundation.

That was a year and a half ago. Grimm, 45, and his boxer, Rocky, 4, average 10 miles a day, depending on Grimm’s Parkinson’s.

Rocky, a service dog, helps steady him, especially when he needs to get up from bending or kneeling.

“I can’t live without him,” Grimm said of his canine companion.

The duo began their journey in Laramie, Wyo.

Grimm said his address book is as thick as a New York phone book, with names of the many friends he met during his quarter century of metal working. He is finally taking them up on offers to stop by if he’s ever in the area.

The website is another great way to find shelter, Grimm said, although he prefers to sleep outdoors.

The trekker has little baggage. He tows 200 pounds of supplies including two weeks of food, water and kibble, a laptop computer and some camping equipment, in a modified bike trailer.

Grimm’s next stop is Eugene and he would like to be in San Francisco by Christmas. Portland, Maine, is his ultimate destination — by way of Oklahoma.

He said the people he has met along the way have been generous, “Old hippies have been picking me up.” But he has also had 63 encounters with law enforcement, most recently after pitching a tent in Crawfordsville.