11/7/2016. Timothy Leichliter, MD. Teva speaker Parkinson s Foundation Western PA on board of directors Boston Scientific research investigator

Transcription

1 Timothy Leichliter, MD Teva speaker Parkinson s Foundation Western PA on board of directors Boston Scientific research investigator Movement Disorder Specialist with Allegheny Health Network Medical Director of the Cahouet Center for Comprehensive Parkinson s Care 1

2 Parkinson's disease is a chronic, degenerative neurological disorder that affects one in 100 people over age 60. Parkinson's disease is a disorder of the central nervous system that results from the loss of cells in various parts of the brain, including a region called the substantia nigra. The substantia nigra cells produce dopamine Dopamine is a chemical in the brain that helps control and coordinate movement. 2

3 Cardinal Symptoms Cardinal Symptoms Tremor resting, pill-rolling Cardinal Symptoms Tremor resting, pill-rolling Rigidity cogwheel 3

4 Cardinal Symptoms Tremor resting, pill-rolling Rigidity cogwheel Bradykinesia slowing down Cardinal Symptoms Tremor resting, pill-rolling Rigidity cogwheel Bradykinesia slowing down Postural Instability - falls There is no objective test (such as a blood test, brain scan or EEG) to make a definitive diagnosis of Parkinson s disease. Clinical diagnosis 4

5 3 of 4 cardinal symptoms tremor, rigidity, slowing down, balance problems At least 2 years No other cause Responds to medicine How do we measure progression? There are multiple scales used Unified Parkinson s Disease Rating Scale UPDRS 5

6 Very cumbersome to use 27 pages long 4 parts Non-Motor Aspects of Experiences of Daily Living Cognitive impairment, hallucinations, psychosis, depressed/anxious mood, apathy, sleep disturbances, GI/GU problems, pain Motor Aspects of Daily Living Speech, eating, dressing, hygiene, hand writing, hobbies, walking, balance, freezing Motor Examination Motor Complications There are multiple scales used UPDRS Hoehn and Yahr Scale Stage 0: No signs of disease Stage 1.0: Symptoms are very mild; unilateral involvement only Stage 1.5: Unilateral and axial involvement Stage 2: Bilateral involvement without impairment of balance Stage 2.5: Mild bilateral disease with recovery on pull test Stage 3: Mild to moderate bilateral disease; some postural instability; physically independent Stage 4: Severe disability; still able to walk or stand unassisted Stage 5: Wheelchair bound or bedridden unless aided 6

7 But what bothers you the most? Most common complaints that I hear: Most common complaints that I hear: Fatigue 7

8 Most common complaints that I hear: Fatigue Balance problems, Falls Most common complaints that I hear: Fatigue Balance problems, Falls Fine motor skills, coordination Most common complaints that I hear: Fatigue Balance problems, Falls Fine motor skills, coordination Difficulty eating, swallowing 8

9 Most common complaints that I hear: Fatigue Balance problems, Falls Fine motor skills, coordination Difficulty eating, swallowing Caregiver burdens Most common complaints that I hear: Fatigue Balance problems, Falls Fine motor skills, coordination Difficulty eating, swallowing Caregiver burdens Arthritis, Orthopedic Issues, GI/GU Issues Most common complaints that I hear: Fatigue Balance problems, Falls Fine motor skills, coordination Difficulty eating, swallowing Caregiver burdens Arthritis, Orthopedic Issues, GI/GU Issues Depression 9

10 Fatigue Constipation Dizziness Lightheadedness Fainting Sexual Problems Urinary Incontinence Drooling Oily Skin Sweating Problems Sleep Disruption Anxiety Dementia Falls Loss of Sense of Smell Speech Difficulties Hallucinations Restless Leg Syndrome Changes in Handwriting Swallowing Problems Vision Problems Depression Poor Posture Pain Why are these a big problem? Difficult to treat Not talked about What can we do? 10

11 Some things we can do Excessive drooling Botulinum Toxin Injections Anxiety/Depression Antidepressants Fatigue Exercise regimens, medications (stimulants) Dizziness/Lightheadedness medications (midodrine, fludrocortisone, droxidopa) Sexual Dysfunction medications (Viagra) Other people that help This becomes a group effort Sleep specialists Urologists GI specialists Ophthalmologists Surgeons Family Doctors Psychiatrists Pain Specialists Dermatologists Speech Therapists Physical Therapists Occupational Therapists 11

12 BIG Program Exercise regimens Tai Chi Dance Boxing Speech difficulty Lee Silverman Voice Treatment/ Loud Program 5 basic concepts of program: Think loud; Think shout Speech effort has to be high Must be intensive treatment Must be able to recalibrate loudness level Quantifiable improvements over time Swallowing difficulty Chin Tuck, speed, exercises Anxiety/Depression Dementia Family therapy 12

13 Constipation Urinary incontinence Sexual dysfunction Duopa Monitor for skin cancer Oily Skin/Other skin issues REM behavior sleep disorder Restless Leg Syndrome Periodic Leg Movement Disorder Obstructive Sleep Apnea 13

14 Why haven t we been paying attention to this part? Why haven t we been paying attention to this part? Motor symptoms are more obvious Stage 0: No signs of disease Stage 1.0: Symptoms are very mild; unilateral involvement only Stage 1.5: Unilateral and axial involvement Stage 2: Bilateral involvement without impairment of balance Stage 2.5: Mild bilateral disease with recovery on pull test Stage 3: Mild to moderate bilateral disease; some postural instability; physically independent Stage 4: Severe disability; still able to walk or stand unassisted Stage 5: Wheelchair bound or bedridden unless aided 14

15 Involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported; with a propensity to bend the trunk forwards, and to pass from a walking to a running pace: the senses and intellects being uninjured. Why haven t we been paying attention to this part? Motor symptoms are more obvious Non-motor symptoms do not respond as well to medications 15

16 Non-motor symptoms of Parkinson s Disease Non-motor symptoms of Parkinson s Disease 724 articles Non-motor symptoms of Parkinson s Disease 724 articles 663 of these articles were from 2006 and on 16

17 Non-motor symptoms of Parkinson s Disease 724 articles 663 of these articles were from 2006 and on Clinical trials Non-motor symptoms of Parkinson s Disease 724 articles 663 of these articles were from 2006 and on Clinical trials 36 published trials Non-motor symptoms of Parkinson s Disease 724 articles 663 of these articles were from 2006 and on Clinical trials 36 published trials 33 of those were from 2006 and on The first one was on sialorrhea and was in

18 Why do we have to pay attention to it? Why do we have to pay attention to it? Non-Motor Symptoms affect up to 97% of patients with PD Why do we have to pay attention to it? Non-Motor Symptoms affect up to 97% of patients with PD At least half the time they are not asked about in a routine office visit 18

19 Why do we have to pay attention to it? Non-Motor Symptoms affect up to 97% of patients with PD At least half the time they are not asked about in a routine office visit These symptoms directly impact Disability and Quality of Life More than half of disability is related to the non-motor symptoms What can you do? What can you do? Bring things that bother you up to the treating physician 19

20 What can you do? Bring things that bother you up to the treating physician Do not anticipate or expect them to ask What can you do? Bring things that bother you up to the treating physician Do not anticipate or expect them to ask Do not minimize how much anything is affecting you What can you do? Bring things that bother you up to the treating physician Do not anticipate or expect them to ask Do not minimize how much anything is affecting you Recognize that these things are very common, and potentially treatable 20

21 What can you do? Bring things that bother you up to the treating physician Do not anticipate or expect them to ask Do not minimize how much anything is affecting you Recognize that these things are very common, and potentially treatable Talk about these things with loved ones, care takers, etc. Thank you QUESTIONS? 21