Anna (Moderator) - 11:53 AM:
Welcome! Today’s chat: Parkinson’s Disease: Signs, Symptoms & Treatment Options will begin shortly. Please start submitting your questions and Aikaterini Markopoulou, MD, will begin answering as soon as we get started. While you are waiting for the chat to begin, feel free to visit the NorthShore Neurological Institute page http://www.northshore.org/neurological-institute/neurological-diseases-and-specialties/parkinsons-disease/. As this is a popular chat, Dr. Markopomay may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.
Nathan (Tinley Park) - 12:01 PM:
Why does DBS work for some if the problem stems from dopamine deficiency? If you do decide to have the surgery, how long do the benefits last?
Dr. Aikaterini Markopoulou (NorthShore)
The exact mechanism for how DBS works is not totally clear. The dopamine deficiency is an important part of the problem but not the whole story. The brain regions that produce dopamine are affected in Parkinons's but there are a lot of downstream effects. In a way, DBS compensates for some of the downstream effets of the dopamine deficiency.
There have been published large clinical trials that have shown that the clinical benefit last for at least 10 years. So far,a longer follow-up has not been published.
Matt (Chicago) - 12:07 PM:
What's the relationship between bipolar disorder (lack of dopamine), alcoholism (lack of dopamine) and PD (lack of dopamine)? If there is no Parkinson’s disease history in the family, are you at an increased risk if there is alcoholism and bipolar disorder in your family history?
Dr. Aikaterini Markopoulou (NorthShore)
The cause of each of these conditions is a lot more complex than a simple dopamine deficiency. Dopamine is involved in a number of different circuits in the brain that are affected differently by these different conditions. So far there have been no reports that show an increased risk for Parkinson's disease if the family history is positive for bipolar disorder or alcholism
Beth (Evanston, IL) - 12:13 PM:
How important is timing in addressing and/or preventing both the physical and more importantly cognitive issues of PD?
Dr. Aikaterini Markopoulou (NorthShore)
There is no evidence to suggest that treating early slows down the disease course. As neurologists we treat the symptoms when they interfere with a person's daily activities and are bothersome to the patient. The aim of the treatment is to treat the sympotms as effectively as possible with the least side effects. Presently we have no way to predict whether a Parkinson's patient will develop cognitive problems
Carol (Wilmette, IL) - 12:19 PM:
Are you doing any studies on diet and PD?
Dr. Aikaterini Markopoulou (NorthShore)
Not at this point.
Angie (Oak Park, IL) - 12:20 PM:
If 10% of PD patients are candidates for DBS—what does that mean? Ever in there lifetime? Or at any point in time in a community? Or at a clinical practice? Does being a candidate mean that you should have the surgery? Or just that you could have the surgery?
Dr. Aikaterini Markopoulou (NorthShore)
Being a DBS candidate means that the neurologist and their team conclude that a patient could benefit from the surgery and that there are no contraindications to having the surgery.
The 10% is an estimate based on the number of Parkinson's patients who are experiencing levodopa complications that cannot be treated adequately by medication adjustment and do not have contraindications for surgery.
This percentage may increase after the results of a recent European trial that has shown that DBS+ best medical therapy leads to better quality of life compared to medical therapy alone in younger patients (average age 55-60 years)
Craig (Chicago) - 12:29 PM:
I’ve read that Parkinson’s disease medications like levodopa become less effective over time. Why would the medication stop working? What can you do to ensure that it keeps working?
Dr. Aikaterini Markopoulou (NorthShore)
Levodopa does not become less effective over time. The brain's requirement for levodopa increases with time because more dopamine producing cells die off as the disease progresses. As a result more levodopa is necessary to make up for the deficit. It is very important to determine the appropriate levodopa dose and dosing invervals for each patient. Each patient is different and the disease progresses with different speed in each individual.
Mike (Glen ellyn) - 12:35 PM:
My mom was diagnosed with Parkinson’s when she was 57. She died a couple of years later after a heart attack so I never witnessed the progression of her disease or learned much about it during those two years. Is it hereditary? Is this something I’m more likely to develop?
Dr. Aikaterini Markopoulou (NorthShore)
Approximately 10% of Parkinson's cases are hereditary. At least a third of the Parkinson's patients have a first degree relative with the disease, so their risk is increased compared to the general population. When there are multiple cases in the extended family, the risk is higher, but it is not certain that the person will develop the disease even if they inherit the genetic change from their parent.
Jennifer (Evanston) - 12:40 PM:
My father (73) was recently diagnosed with PD. Does the disease advance faster if the patient is older? How long is the life expectancy of an older Parkinson’s disease patient?
Dr. Aikaterini Markopoulou (NorthShore)
It is reported that the disease advances faster in older individuals. However, young age at disease onset is often associated with a more severe course. The life expectancy of Parkinson's patients is similar to the general population with the advent of levodopa therapy. LIfe expectancy also depends on whether there are other medical conditions (e.g. heart or lung disease, diabetes) that compromise a person's health further.
Ben (Glenview) - 12:47 PM:
Do head injuries increase your risk for PD? I played football in high school and college and I heard multiple concussions could increase my risk.
Dr. Aikaterini Markopoulou (NorthShore)
Yes, repeated head injuries and concussions increase the risk of developing Parkinson's disease. At our institution we have an ongoing study to address this question further. Last month, the American Academy of Neurology issued guidelines for how to deal with concussion in sports.
Stef (Wilmette) - 12:50 PM:
Why does Parkinson’s affect some people so severely and so quickly and others can live with the disease for several years before the symptoms become difficult to manage?
Dr. Aikaterini Markopoulou (NorthShore)
The short answer is that we do not know why this happens. Parkinson's disease is not a single disease. There are different forms of the disease. Some forms are "atypical" and progress more rapidly and the response to treatment is not great. It is important to remember that the treatment is symptomatic and not curative. It needs to be adjusted over time to get a good benefit. Sometimes the more rapid progression may reflect inadequate treatment.
Anna (Moderator) - 12:53 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 5. Please submit your final questions.
R. (Libertyville) - 12:55 PM:
I’m only 36 years old and about a year ago I started feeling some numbness in my legs and sometimes my legs feel like I’ve run for miles when I really haven’t done any at all that would make me tired. My doctor seems to think that it could be Parkinson’s but said he can’t make the diagnosis yet. Had MRIs and CT scans, which show nothing. Could this be something else? Is Parkinson’s normal this early? How long will I have to wait for a diagnosis?
Dr. Aikaterini Markopoulou (NorthShore)
Parkinson's disease can start as early as the second decade of one's life. Sometimes early diseaes onset is associated with family history of Parkinson's.
It is important to be evaluated by a neurologist who specializes in Parkinson's disease and movement disorders. The diagnosis of the condition requires a combination of symptoms and examination signs. In addition, in the last year a specific brain scan became available called DATSCAN that can help in the diagnosis of Parkinson's.
Anna (Moderator) - 1:01 PM:
Thank you all for participating in our online chat today and thank you Dr. Markopoulou. An online transcript will be available shortly. To learn more about NorthShore’s Neurological Institute please visit http://www.northshore.org/neurological-institute/.