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• Newsletter January 2008
• Parkinson's New August 2007
• Parkinson's News May 2007
• Parkinson’s News May 2006
• Parkinson’s News August 2006
• Parkinson’s News December 2006
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News
from 2004
Parkinson's Disease: Managing Wearing-Off Symptoms
Effectively
Global, Jun 2004: Three to four hours after taking
his drug treatment for Parkinson’s disease
(PD), Tom – who has had PD for the past
nine years – gets a tremor in his right
hand that gradually affects the rest of his body.
More >> |
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| My
Educational Journey in the United States |
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To
further improve my expertise as a PD nurse
clinician, the Ministry of health sent me
overseas for an attachment at John Hopkins
Hospital and Columbia Presbyterian Medical
Centre in the United States of America.
I learnt about non-pharmacological management
strategies for Parkinson's disease which
focus on educating the patients and family,
empowering them to take control over the
disease through physical, occupational,
speech therapy, exercise and nutrition. |
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During
this attachment, I gained significant insights
into new and emerging therapies for Parkinson's
disease and a better understanding of the
deep brain stimulator implant and adjustment,
as well as my role in managing these patients.
I further understand
my important role in caring for patients
with Parkinson's disease and improving their
quality of life. I was able to co-ordinate
services as part of the care team, provide
patient education and support, and also
to identify and anticipate the various needs
of the patients.
Participation in their support group meetings
helped me to be a better facilitator in
our own support group meetings. The president
of the support group is the patient, the
nurse acts only as a facilitator, with the
patients very much involved in planning
their own activities for the year. Sessions
with the movement disorder specialists and
the nurse practitioner offered me greater
exposure to the various teaching methodology
in patient education.
With the newly acquired nursing skills,
knowledge, creative ideas and innovations,
I have learnt to be a more resourceful person
not only to my organisation but to the community
to serve the patients better. I would like
to thank the ministry and NNI for giving
me this wonderful opportunity. |
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| Stimulating
a Slow Brain |
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Parkinson’s
disease causes the patient to have
symptoms of tremor (trembling), rigidity
(stiffness), bradykinesia (slowness
of starting and continuing movement)
and postural instability (unsteadiness
during walking or turning). This disease
arises because a certain part of the
brain (called the substantia nigra)
is unable to produce enough of a certain
chemical called dopamine. The lack
of this chemical leads to severe imbalance
of the brain circuits which control
movement and this produces the symptoms
of Parkinson’s disease. The
traditional treatment for this has
been through medication to try and
restore the chemical balance in the
brain. This treatment is effective
but, in some patients, the disease
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despite
the treatment because of continuing loss
of cells in the brain. In such patients
medical treatment becomes very difficult.
Surgery can be offered to these patients
to restore the balance in the brain circuits
and thus improve the patients symptoms.
Two main areas in the brain have been shown
to be overactive in patients with Parkinson’s
disease. These are the globus pallidus internus
(GPi) and the subthalamic nucleus (STN).
The aim of surgery is to silence either
the STN or the GPi.
The choice of the best target will be individual
to each patient and depends on the symptoms
that are most significant for that patient.
This will be decided after the patient has
been reviewed by the neurologist and neurosurgeon
in charge.
The methods used to silence the hyperactive
nuclei are either by destroying it by heat
(lesioning) or by suppressing it without
destruction using an electrical current(deep
brain stimulation). Both are effective treatments
but differ because destroying a nucleus
is permanent, cannot be modified after it
is done but has the advantage of being cheaper
and not requiring any expensive hardware.
On the other hand deep brain stimulation
is not destructive, can be adjusted in slow
steps by changing the setting of the battery
and can be stopped(by switching off the
battery) if required. However it is more
expensive (because of the implanted electrodes
and batteries) and has the problems of possible
battery failure, electrode breakage and
infection of the implant.
Surgery for Parkinson’s disease is
only offered to those patients with severe
advanced Parkinson’s disease who are
not responsive to medication or suffer severe
side effects from medication.
Surgery for Parkinson’s disease is
safe with a low risk of complications. It
can improve most symptoms of Parkinson’s
disease. It can reduce tremor by up to 80%,
dyskinesias (abnormal involuntary movements)
can be reduced by up to 80%. The problems
of bradykinesia (slowness of movement),
rigidity (stiffness), variability in the
effectiveness of medication (on-off effects),
freezing usually improve by 50 to 60% in
most patients (i.e. the patient will have
a more constant state of improvement throughout
the day). Surgery will also allow more room
for further medical therapy. In some patients
it will allow the use of more medication
with less side effects and in others it
will allow medication to be reduced without
any loss of effectiveness. However the total
degree of improvement will be different
for different patients.
In conclusion, the patient with Parkinson’s
disease is now offered new hope for a better
life with the latest advances in surgery.
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| The
Editor’s Voice |
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After
a two year hiatus, we have revived our PD
newsletter. This is the official newsletter
of the PD Society of Singapore. The main
objective is to serve as a platform for
communication, exchange of ideas and education
for all our members. In this issue, we have
educational articles on eye related problems
in PD by a neuro-ophthalamologist and options
in PD surgery by a neurosurgeon. In addition,
there is an interesting discussion on the
role of leisure activities by our therapists.
A nurse clinician shares with us her personal
experience on her overseas training attachment.
To make the newsletter more personal and
interactive, we will start a Doctors’
Corner, where we will take medical or non-medical
questions from our members. We will also
introduce a Patients’ Corner, for
any patients who want to write, to discuss
on any issues related to their disease,
share ideas or simply to vent their frustrations.
Please address your queries or articles
to: The Editor, Parkinson’s News,
Email:
gnrtek@sgh.com.sg, fax 6 220 3321. |
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| Information |
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There
have been a recent spate of new drugs being
introduced for the treatment of Parkinson's
disease (PD). Are these medications more
efficacious than the ones we are already
familiar with? These new medications can
be divided into two major categories: Catechol-O-methyltransferase
is an enzyme which breaks down levodopa
and dopamine.
By inhibiting this enzyme, the duration
of action of levodopa is prolonged. There
are two main COMT inhibitors: Tolcapone
and Entacapone. Studies show that they increase
the percentage of 'on' time and reduce significantly
'off' time, when patients are taking levodopa.
The total daily levodopa dosage can also
be lowered. Tolcapone differs from Entacapone
in that it can penetrate the central nervous
system. Side effects of COMT inhibitors
that can occur include worsening dyskinesias,
nausea, vomiting, postural hypotension,
insomnia, confusion, and hallucinations.
COMT inhibitors are not available in Singapore
yet. Recently, two new dopamine agonists
were approved by the Food and Drug Administration
in US. They are Pramipexole (Mirapex) and
Ropinorole (Requip).
The
'older' dopamine agonists which most patients
are familiar with are bromocriptine and
pergolide. Pramipexole acts on both the
dopamine D2 and D3 receptors, while ropinorole
is a non-ergoline agonist of the D2 receptor.
Both are able to reduce the severity of
'off' periods and improve motor score of
PD patients. Side effects include nausea,
dizzyiness, sleepiness, headache, confusion
and hallucinations, which are the usual
adverse effects seen with other dopamine
agonists. As a whole, pramipexole and ropinorole
have not been demonstrated to have any significant
advantage over the older dopamine agonists
as yet. We look forward to the introduction
of these new medications in Singapore. They
add to the treatment options in PD, and
it is hoped that many more novel compounds
can be tested and found useful in the treatment
of Parkinson's Disease |
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Helpful
hints for the Parkinson’s patient
from a caregiver. |
All
PD sufferers should have annual eye
and ear examinations so that early
cateracts, other eye problems and
hearing loss can be detected. These
impediments may worsen the overall
functioning of the patient. |
Good
lighting in the home is essential.
Sufferers may have impaired balance
and easily stumble in the dark. |
Unobstructed
passageways, with small items put
aside so that sufferers can have adequate
freedom of movement. |
Even
flooring which is not smooth and slippery.
Carpets are not advisable because
they can cause the patient to trip
and fall. |
Firm
bed mattresses and chairs so that
the sufferer can get up easily or
turn better in bed. |
Steel
bars around the shower area and toilet
which assist the sufferer with balance,
and getting up and down. |
Marking
the edge of the steps on the stairway
with luminous strips. This will ensure
that the patient will not miss a step
and fall. |
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