Case 4

1. Case 4 By Hailey Nealen, Naomi Belcher, and Alexis Beyke

2. Patient Number Four John, 55 years old, comes in to your office with his wife, Rita. She is concerned because she has seen some changes in her husband. She reports that at some points he seems to be moving in slow motion. Getting dressed and ready to leave the house in the morning seems to take longer every day. She has also noticed that he often loses his balance and when he thinks she is not looking, he often keeps a hand on the wall for support. John keeps relatively quiet and when asked, claims nothing is wrong, but as he passes you his paperwork, you notice that his hand is shaking. You look down at the paper and notice that his handwriting is so tiny that it’s almost illegible.

3. Signs and Symptoms He seems to move in slow motion. He takes longer to do simple tasks. He loses his balance and often needs support. His hands shake/he has tremors. He is relatively quiet. https://www.youtube.com/watch?v=SpbvqqgCHe8 1:38-4:04

4. Steps to Identify the Disease First we identified his symptoms and researched what diseases the diseases were associated with the symptoms. Then we researched the diseases that we found in order to determine the disease that most related to the symptoms. After we determined the most relevant disease we went into more exclusive research in that disease.

5. Possible Diseases We believe that John has Parkinson's Disease. Other possible diagnosis include Dystonia, and Progressive Supranuclear Palsy.

6. Dystonia • Dystonia is involuntary muscle contractions that cause repetitive or twisting movements. • Symptoms associated with Dystonia that led us to believe that it was a possibility: • Involuntary muscle contractions that can affect handwriting. • Becomes more noticeable over time- he took more and more time to get ready in the mornings. • Affects muscles in vocal cords, causing whispering or tight voice - He’s been quiet lately.

7. Progressive Supranuclear Palsy • PSP is a degenerative disease involving the gradual deterioration and death of specific volumes of the brain • Symptoms associated with PSP that led us to believe that he could possibly have Progressive Supranuclear Palsy: • Loss of balance while walking- He held a hand on the wall to balance himself. • Can even in rare cases cause tremors- He was shaking as he handed the doctor his paperwork.

8. Types of Parkinson’s • Idiopathic Parkinson’s • Most common type • Main symptoms are: tremor, rigidity, and slowness of movement • Vascular Parkinson’s • One of the atypical forms of Parkinsonism • Affects people with restricted blood supply to the brain • Symptoms include: difficulty speaking, making facial expressions, or swallowing • Drug-induced Parkinsonism • Neuroleptic drugs (used to treat schizophrenia and other psychotic disorders) block dopamine. • Dopamine is a chemical in the brain that allows messages to be sent to the parts of the brain that co-ordinate movement. • Symptoms appear when dopamine level falls • Inherited Parkinson’s • 5% of people with Parkinson’s may have genetic cause • Still research about it • Juvenile Parkinson’s • Used when condition affects people under the age of 20.

9. Inconsistencies • Inconsistencies may have lead to incorrect diagnosis causing the patient to never truly know what is wrong. • Inconsistencies include: • Many diseases contain the same symptoms leading to unsure diagnosis. • Some symptoms such as being quiet or tiny, illegible handwriting could be caused from personality traits or style, not medical reasons. • Incorrect results from testing or reports could lead to incorrect conclusions.

10. Tests Used in Diagnosis • There are no specific tests that are available to determine whether or not you have Parkinson’s Disease, but there are tests to rule out other diseases or determine Parkinson's as a possibility. • Doctors may perform observational test such as examining tremor of the arms, ability to regain balance, gait, ability to move and stiffness in your limbs and neck. • Tests and scans on the brain might also be preformed in order to eliminate diseases or find the source of a problem. Scans such as MRI, an ultrasound of the brain, SPECT, CAT, and PET scans.

11. Prognosis Parkinson’s disease is not a fatal illness. However, it’s a degenerative disorder that usually progresses until it leaves its patients completely debilitated. The condition usually worsens over an average of 15 years. The rate of progression and its course varies among patients. The course is relatively began in some patients with little disability after twenty years and may be more aggressive among others who may be severely disabled after ten years. Those with an early onset Parkinson’s disease have shorter life spans than those with later-onset disease.

12. Untreated Prognosis Untreated, Parkinson’s disease worsens over years. Parkinson's may lead to a deterioration of all brain functions and an early death. Life expectancy however is normal to near normal in most treated patients of Parkinson’s disease.

13. Prognosis with Medication Most people respond to medications. However, the extent of responsiveness and the duration of how long the efficacy of the drug lasts varies from person to person. The side effects of medications are another deterrent in their use. Movement disorder symptoms differ from person to person. For some they are more bothersome than others depending on what a person normally does during the day. In some the mild symptoms may last for many years while in others they may develop more quickly. Non-motor symptoms may also vary from person to person. They affect most people with Parkinson's at all stages of disease. Some people with Parkinson's find that symptoms such as depression or fatigue may be more cumbersome to deal with that the movement disorders themselves.

14. Errors in Communication In Parkinson’s Disease the area of error most occurs in the midbrain, more specifically in the Substantia nigra, cerebellum, and the motor cortex. One error in Parkinson’s Disease is that Lewy Bodies (unusual clumps of alpha-synuclein, a protein in the brain) form in the neurons, damaging the flow of impulse within the cell causing information to be fractured or move slower. Lack of dopamine within the neurons in another error. When neurons become impaired or die, as they do in Parkinson’s Disease, they don’t produce enough dopamine causing movement impulse to be impaired or not occur throughout the body. An over production of acetylcholine within the motor cortex causes an increased number of muscle impulses, causing people with Parkinson’s Disease to have tremors.

15. Errors in Communication

16. Biomedical Professionals Movement Disorder Specialist may be used when dealing with Parkinson’s Disease. They are a special type of neurologist who diagnose and treat people with movement disorders. Occupational Therapists may also be used in order to help cope with the disease. They help people mentally recuperate from a disease, and create programs and treatments in order to help people carry out ordinary daily tasks. Physical Therapists treat people who have medical conditions, such as Parkinson’s Disease, that limit their ability to move and function in their daily lives. They develop plans and treatments that may help to reduce pain and restore function of movement. They also help prevent the loss of mobility.

17. Treatment • Parkinson’s Disease cannot be cured, but its symptoms can be controlled and suppressed. • Amantadine is an antiviral prescription drug that is used to subdue the uncontrollable muscle movements caused by Parkinson’s Disease. It produces chemicals in the brain which help to combat Parkinson’s Disease. • Physical Exercise is also a great way to deal with the symptoms of Parkinson’s, it reduces stiffness, improves mobility, posture, balance and gait, and can increase oxygen delivery to neurotransmitters. • Benztropine is a prescription drug that controls tremors and stiffness of muscles by decreasing the effects of acetylcholine which is a chemical in the brain that activates muscle movement of motor neurons.

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