Transcript Towards an Understanding of Parkinson's Disease

Our Programme…………
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What is Parkinson’s?
Symptoms and Impact of Parkinson’s
Managing Parkinson’s
Information & Support Available / Resources
Dr James Parkinson (1755 – 1824)
Essay on the Shaking Palsy
“….involuntary tremulous motion, with
lessened muscular power, in parts
not in action …… with a propensity to
bend the trunk forward, and to pass
from a walking to a running pace ……
the senses and intellect being
uninjured.”
1817
Hoxton Square
Shoreditch, London
What is Parkinson’s…….
• Parkinson’s is a
progressive &
fluctuating
neurological condition
– non-terminal
• Parkinson’s occurs
when 80% of
dopamine producing
cells are lost from the
part of the brain that
controls movement
Dopamine
Pill Rolling Tremor (70%)
Gait, Shuffling, Short Steps, Freezing, Festination
What causes Parkinson’s…….
• We don’t know why nerve cells die in Parkinson’s, but
research has uncovered some pieces of the puzzle
Environmental
Factors
Lifestyle
Ageing
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Genes
Genes
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Parkinson’s – Incidence
127,000 in UK in 2012 > 162,000 in UK by 2020
Average age of diagnosis 55 - 74 years
Does not discriminate – all ethnic groups
Parkinson’s is rarely a hereditary condition (5% of cases)
General Practice Research Database (GPRD) 2009
NICE
(New Guidelines – Due October 2016)
• If Parkinson’s is suspected,
patients should quickly be
referred (untreated) to a
neurologist or to a
geriatrician with a special
interest in Parkinson’s
• Follow up every 6 -12
months to optimise treatment
and reassess the diagnosis
Diagnosis - Signs and Symptoms
• Slowness & Poverty of Movement
(bradykinesia) (hypokinesia)
Ability to start a movement (initiation)
Reduced size of movements (amplitude)
Coordination of movements (sequencing)
• Stiffness (rigidity) difficulty with fine movements: fastening
buttons, handwriting etc - often painful
• Pill Rolling Tremor (worse when rushed or excited)
Put Yourself In My Shoes…..
Impact of Parkinson’s (Slower & Smaller)
MDT Approach Needed
Communication problems
• Mask - Bradyphrenia - Voice
• Micrographia
• Eating & drinking difficulties
• Saliva, swallowing issues
Mobility problems
• Hypotension
• Falls & “Freezing”
Bladder & bowel problems
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Pain / Dystonia
Anxiety/Depression
Dementia
Sleep problems
Tiredness / Tremor
Deterioration
Loss of choice
General health
Complex medication
Parkinson’s Medications
Medication & GIOT (Day & Night)
• Levodopa
• Dopamine agonists
• MAO-B inhibitors
• COMT inhibitors
• Glutamate antagonist
• Anticholinergics
• DBS – Deep Brain Stimulation
NICE Medication Guidelines
• Given at appropriate times (for hospital,
may mean allowing self-medication)
• Adjusted only after discussion with a
Specialist in Parkinson’s
• Do not withdraw Parkinson’s medicines
abruptly or allow medication to fail
suddenly due to poor absorption
(gastroenteritis or abdominal surgery)
Drugs to avoid…………
Can bring on Parkinson’s-like symptoms:
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Chlorpromazine (Largactil)
Fluphenazine (Modecate)
Fluphenazine with nortriptyline (Motival)
Perphenazine (Fentazin / Triptafen)
Trifluoperazine (Stelazine)
Flupenthixol (Fluanxol / Depixol)
Haloperidol (Serenace / Haldol)
Metoclopramide (Maxolon)
Prochlorperazine (Stemetil)
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Domperidone (Motilium) is the anti-sickness drug of choice to
prevent and treat nausea and vomiting caused by levodopa
Challenges of Medication
• Fluctuations in response - “On/Off” effect
• Hallucinations, nightmares, confusion
• Impulsive / Compulsive Behaviour (ICB’s)
• Dyskinesia (involuntary movement)
Dyskinesia (Involuntary Movement)
Parkinson’s Information & Support
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Freephone Confidential Helpline (0808 800 0303)
Local Parkinson’s Nurse Specialists
Local Information & Support Workers (ISW)
Website & Website Forum (www.parkinsons.org.uk)
Peer Support Service (Telephone Service)
Local Group Network (See Website)
Information Resources / Publications
Local Information Events
Parkinson’s UK Membership - £4.00 per year
Social Media – Twitter, Facebook etc..
Join our Parkinson’s Mailing List
What you can do to help
• Please GIVE MORE TIME
• Understand communicating can be difficult
• Please don’t make assumptions
• Ask how you can help
• Take a little time to understand Parkinson’s
Parkinsonism
• Classic - Idiopathic Parkinson’s
• Atypical - Parkinson’s Plus syndromes
• Multiple-System Atrophy (MSA)
• Progressive Supranuclear Palsy (PSP)
• Other causes –
• Drug Induced Parkinson’s – Block the action of Dopamine
– Anti-emetics – Stemetil, Maxolon, prochlorperazine
– Neuroleptics – chlorpromazine, haloperidol, trifluoperazine