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Finding the cure

Parkinson’s Education & Training – South West. Finding the cure. Presentation 23.02.10. Our Programme…………. What is Parkinson’s? Symptoms and Impact of Parkinson’s Managing Parkinson’s Information & Support Available / Resources. Dr James Parkinson (1755 – 1824)

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Finding the cure

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  1. Parkinson’s Education & Training – South West Finding the cure Presentation 23.02.10

  2. Our Programme………… What is Parkinson’s? Symptoms and Impact of Parkinson’s Managing Parkinson’s Information & Support Available / Resources

  3. 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

  4. 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 What is Parkinson’s……. Dopamine

  5. Pill Rolling Tremor (70%)

  6. Gait, Shuffling, Short Steps, Freezing, Festination

  7. Genes Environmental Factors What causes Parkinson’s……. • We don’t know why nerve cells die in Parkinson’s, but research has uncovered some pieces of the puzzle Genes Lifestyle ? Ageing ?

  8. 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) Parkinson’s – Incidence General Practice Research Database (GPRD) 2009

  9. 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

  10. 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) Diagnosis - Signs and Symptoms

  11. Terry & Jean Kavanagh Finding the cure Presentation 23.02.10

  12. Put Yourself In My Shoes…..

  13. Impact of Parkinson’s (Slower & Smaller) Communication problems Mask - Bradyphrenia - Voice Micrographia Eating & drinking difficulties Saliva, swallowing issues Mobility problems Hypotension Falls & “Freezing” Bladder & bowel problems MDT Approach Needed • Pain / Dystonia • Anxiety/Depression • Dementia • Sleep problems • Tiredness / Tremor • Deterioration • Loss of choice • General health • Complex medication

  14. Medication & GIOT (Day & Night) Levodopa Dopamine agonists MAO-B inhibitors COMT inhibitors Glutamate antagonist Anticholinergics DBS – Deep Brain Stimulation Parkinson’s Medications

  15. 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)

  16. Can bring on Parkinson’s-like symptoms: Chlorpromazine (Largactil) Fluphenazine (Modecate) Fluphenazine with nortriptyline (Motival) Perphenazine (Fentazin / Triptafen) Trifluoperazine (Stelazine) Flupenthixol (Fluanxol / Depixol) Haloperidol (Serenace / Haldol) Metoclopramide (Maxolon) Prochlorperazine (Stemetil) * Domperidone (Motilium) is the anti-sickness drug of choice to prevent and treat nausea and vomiting caused by levodopa Drugs to avoid…………

  17. Fluctuations in response - “On/Off” effect Hallucinations, nightmares, confusion Impulsive / Compulsive Behaviour (ICB’s) Dyskinesia (involuntary movement) Challenges of Medication

  18. Dyskinesia (Involuntary Movement)

  19. 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 Parkinson’s Information & Support

  20. 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 What you can do to help

  21. 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

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