Please note that no treatment should be altered without prior consultation with your specialist or GP.

I am trying to find information on Hemiparkinsonism Hemi Atrophy and also make contact with other persons who also have been diagnosed with this form of PD. Can you help me as I have just run out of options.

Hemiparkinsonism - hemiatrophy is a rare form of parkinsonism that begins usually in the 30's to 40's. There is one sided atrophy (shrinkage) of the body with same sided parkinsonism and dystonia. There is a very slow progression but a poor reponse to L-dopa (Sinemet or Madopar). Brain imaging shows atrophy (shrinkage) of the opposite half of brain. There may be a history of birth problems, e.g. blue baby, low oxygen. The following are references in the medical literature

Jankovic J - Neurology 1988;38:1815
Giladi N - Neurology 1990;40:1731-1734
Pazedbarski - Neurology 1994;44:1622-1628

There have been other enquires from people with hemiparkinson hemiatrophy - if you wish you could contact PALS directly to give permission for your email address to be forwarded to the other person(s) with hemiparkinson hemiatrophy.

Dr. T. Lynch

From a Physical Therapist:

Since I do not have this patient's chart with me, I cannot give you the year PD was diagnosed. She is in her late 50's. I have been treating her for chronic low back pain and left leg pain. Her orthopedic physician performed an epidural cortisone injection in the lumbar region. The following day, she began to experience anxiety attacks and they have continued now for six weeks. She feels it is an allergic reaction to the steroid. Is it possible that the anxiety attacks are a reaction to Sinemet? Or perhaps a reaction from the steroid and the Sinemet?

Sorry for the delay in replying. A difficult question - sometimes persons with PD do experience an increasing sense of anxiety as the Sinemet wears off. The anxiety is often relieved once they take another Sinemet. I usually get the person to keep a detailed diary day to day to monitor the anxiety/panic episodes in relation to the Sinemet doses. If a pattern of "wearing off" emerges then I add Entacapone or a dopamine agonist to avoid "wearing off". I do not think local steroid causes anxiety or panic.

Dr T. Lynch

I have had a continual migraine headache since 1985. I am now on depakote, amitryptIine and metroprolol. I have taken everything in the pharmacy, as my neurologist has put it. I have been told that votox injections might help. I cannot find any supporting data except in a magazine which was discussing briefly alternative types of treatment other than drugs.

Thank you.

am a bit unclear what the question is and whether it has relevance to Parkinson's disease. Migraine can be a very difficult headache to control. There are an array of medications and treatments that are recommended but each individual person may respond differently.

Dr. T. Lynch

My wife has had these symptoms with blood work and EEG all negative.

She starts with the right arm shaking (tremors) as well as the left side of her face. These tremors range from mild to rapid. She will also get tremors in her left leg, and on occasion the entire body will shake as if havong a fit or seizure. She has epilepsy as a child, but the doctors have ruled it out.

She went on celexa and oxazepam and the tremors stopped. She stopped the celexa, but the tremors returned. Back with the combination once more but now the tremors are worse. They sometimes bring on violent vomitting. My wife is scared, extremely.

Through my fitness training I believe it to be nerve related. Am I correct or should I shut up.

Thank you.

I am unclear what you mean by nerve related - "tremor" can be caused by a variety of causes including epilepsy, Parkinson's disease, familial essential tremor and stress-related. The pattern and appearance of the tremor provide your doctors with the best clues to the origin of the tremor. Without seeing the tremor I could not comment further.

Dr T Lynch

What is there to take if Sinemet is doing no good and causing dystonia.I have tried all the older drugs?

Dystonia is twisting of muscles or limbs aused by a variety of causes. Sometimes Sinemet can result in excessive movement either dyskinesia (writhing wriggling movement) or dystonia (twisting of an arm or crunching of toes or twisting of the foot). This is a difficult problem. I try a number of approaches.

1. I try to decrease the overall daily dose of Sinemet and perhaps divide the dose into more frequent dosing, e.g. instead of one pill three times a day perhaps half pill to four, five or six daily.
2. Amantadine (Symmetrel) in high dose can be effective in suppressing dyskinesia and dystonia.
3. If the foot dystonia occurs first thing in the morning often dissolvable (crushed Sinemet in orange juice or Madopar Dispersible) rapidly resolves the problem.

Dr T Lynch

I am embarassed by the vain nature of my question, but am concerned for future ramifications.

At age 54, my Dad was diagnosed and had Parkinsons disease for 27 years. Although never able to pinpoint the cause, he was exposed to the suspicious contributors. Used fertilizers, chemicals, - extensively.

I have read extensively on the hereditary aspects of Parkinsons and although it is not an inherited disease, susceptibility to the disease may be carried by offspring. I have no symtoms of PD. I don't know if I am susceptible.

Finally, my question.... if susceptible, could injections of botox be a catalyst to the onset of pd? Are the toxins in botox in any way similar to those found in the tainted drugs?

The answer is no. Botox acts primarily at the nerve muscle junction and not within the brain where the site of cell death can occur in PD. There is no evidence that Botax causes PD and as it does not act centrally (brain) there is little likelihood of any such evidence appearing.

Dr. T. Lynch

Dear Dr. Lynch:

Can you if possible supply me with some info regarding Msa, Opca, or Parkinsons plus. My wife has had some form of degenerative malady since 1994. We moved from Belfast in 1972 to Canada and have been here since. She really was a very active person but now she cannot walk,stand,speech is very low and swallowing if very bad.

The timing of the flapper is badly off. Looking for to your reply and thank you in advance

Parkinsonism can be caused by idiopathic PD or atypical causes of parkinsonism. These causes include Parkinson's plus, stroke, etc. Parkinson's plus simply refers to the fact that the neurodegeneration is not localised solely to the substantia nigra (as found in idiopathic PD) but is more diffuse (multisystem degeneration). Multisystem atrophy is one of the Parkinson's plus disorders and can manifest with parkinsonism, unsteadiness, bladder urgency and incontinence, lightheadedness and poor response to PD medication. There are three types of MSA - striatonigral degeneration, olivopontocerebellar atrophy and Shy-Drager syndrome. Unfortunately MSA is more aggressive than PD and less responsive to L-dopa. Our understanding of the condition is increasing but is still limited.

Dr. T. Lynch

My mother was losing weight (about 30 kg) thro' loose motions, vomiting etc over last one year. Recently she has been said to have affected by Parkinson's. However none of the normal symptoms like memory loss, tremors etc have been observed with her. Could still she be affected by Parkinson's? What other details should I provide?

PD is associated with slowness, stiffness, stooped posture, tremor, poor balance and freezing of gait in variable combinations. Memory loss is not an early sign of PD. Neither is weight loss/diarrhoea/vomiting unless they are related to medication side-effects. It is possible that she has Parkinson's and some other gastrointestinal disorder. Sometimes they can co-exist, e.g. Whipple's disease, coeliac disease.

Dr. T. Lynch

My father who has Parkinson's has siblings that also have both Parkinson's and atypical Parkinson's and my question is actually about my daughter. My eleven year old daughter died suddenly in her sleep and on autopsy the only finding was acute focal necrosis of the globus palladum, which was explained to me as being the same area affected by Parkinson's, no other abnormality in toxicolology or anywhere else was found. Do you think there could be an inherited link between the Parkinson's in my family and my daughters sudden unexplained death?

Parkinson's disease is as a result of degeneration and Lewy body (pink inclusions within the brain cells) formation in the substantia nigra of the brain stem. This results in lack of dopamine within the brain including the globus pallidum. However there is no degeneration or necrosis of the globus palludum in typical PD. Your complicated family history makes it difficult to comment if there could be any relationship to your daughter's death. Globus pallidum degeneration can occur in various conditions including Hallervorden Spatz disease, Huntington's disease, Leigh's disease and rare familial/sporadic degenerative conditions. It is possible your daughter could have had one of the above disorders especially Leigh's disease which is a metabolic disorder that affects children.

It is important for your father and his siblings to consider consenting to an autopsy if and when they pass away in the future. By this means it will be possible to determine any familial connection.

Dr. T. Lynch

Thank you very much for your answer(Question 73).Because many doctors have visited my mother but just one of them named her problem Holmes, is it possible that I send you some information about her like her brain scan and physical state and then you give me a diagnosis?

The ataxic disorders are very complex. Therefore it is very difficult to make a diagnosis based on a brain scan. Like most neurological disorders it requires a detailed history, neurological examination and investigations to confirm the suspected diagnosis. Perhaps you could arrange for a videotape of your mother sitting, talking and walking to be sent with the scan. It may be possible to offer a list of possible diagnoses following review of the videotape.

Dr. T. Lynch