Since my diagnosis I have responded well as a PD outpatient to Madopar 250mg twice a day. I exercise and regularly go for short walks. But quality of life is not as good as I would like it to be.

I came across the a newspaper item on the experimental use of the drug GDNF at the Frenchay at Bristol.

My question: Is is possible to have this drug released for a a patient like me? If so how and from where could I obtain it? I normally live in Germany but am presently in Pakistan on a vacation.

Many thanks

Apologies for the delay. GDNF is presently only available on a research basis. Mr Stephen Gill, Consultant Neurosurgeon at Frenchay Hospital, Bristol is the researcher in charge of the study. We in Ireland do not have access to GDNF for patients yet. GDNF has to be directly infused in to the brain and cannot be taken by mouth.

Dr Lynch

Dear Dr Lynch,

I am currently participating in a clinical trial which is investigating a link between the stomach organism - Helicobacter pylori - and the existence of Parkinson's. So far there is evidence that the eradication of the organism by antibiotic treatment can lead to dramatic improvement in Parkinson's patients. In my case, I took a week's course of "treatment" last November which might have been genuine or a placebo. My condition re. the Parkinson.s is stable. Have you heard of this trial and can you give any opinion on the PD- h.pylori connection?

Sorry for the delay. I was unaware of this trial and am intrigued. After the brain the gut contains the most neurons. Helicobacter pylori is a chronic infection of the stomach and duodenum associated with gastritis, peptic ulcers and gastric cancer. I am unaware of any epidemiology link between PD and H-pylori. I would be interested to hear more.

Dr Lynch

Dear Dr Lynch,

my father in law was diagnosed with prostrate problems and also Parkinson's a little later. Then he had high blood pressure diagnosed and angina. Is it true that Parkinson's affects the heart, and could he have been diagnosed wrongly and all of the symptoms are of Parkinson's?

Some of the tablets he is taking seem to not agree with him, but the doctor has not seemed to notice - please advise.

Apologies for the delay. PD does not affect the heart. Some of the medications for PD can cause low blood pressure resulting in lightheadedness, but chest pain would be unusual. It can be difficult getting the right "cocktail" of medication - if he is unwell with the meds it certainly is worth reviewing them with his doctor again.

Dr. T. Lynch

Dear Dr Lynch,

Is there a new treatment out which involves an operation of liquid implants in the hip area and when is it most succesful?

Sorry I do not know of such a procedure. I would be interested in learning more.

Dr. Lynch

My father in law was diagnosed after his wife's death of Parkinson's disease in its very early stages we have read a few health books on the disorder and wondered if gingko bilbao was any good in helping the blood going to the brain he has also been diagnosed as having prostrate problems but I'm now wondering if this is a symptom of the Parkinsons'? Also I read about the grapefruit juice and he has on one of his tablets to avoid this. I think this is for high blood pressure or angina. Could he have been misdiagnosed with the prostrate/blood pressure/angina and could it all be to do with the Parkinson's?

Apologies for the dealy. Gingko Bilbao has been shown to be of some benefit in Alzheimer's disease not in PD. It would be important to check with your doctor that it is ok to use gingko with his other medication.

PD generally does not cause prostate symptoms (slow micturition, poor stream, hesitancy). Some people do find themselves going more frequently.

Grapefruit juice can increase the absorption of L-dopa (Sinemet or Madopar) in some people. I would check with your doctor possible interaction with his cardiac/BP medication before using it. In general angina and high BP are not due to PD and are common 74 year olds.

Dr. T. Lynch

Dear Dr Lynch,

My partner has been taking Cogentin for the past year and started on Mirapexin only three weeks ago. He has found no beneficial effects so far and if anything feels worse (he is very irritable and 'spaced' since taking it). He was advised to continue with cogentin also which he has done. Should we wait and see or change medication immediately to another dopamine agonist?

PS. Does the disease or medication affect our chances of having children? Our sex life is fine but in terms of fertility?

Many thanks for your time

Cogentin, an anticholinergic, blocks the effect neurotransmitter acetylcholine. As Acetylcholine is involved in memory function Cogentin can sometimes cause memory impairment. Mirapexin can cause lethargy, drowsiness and rapid onset sleep. The combination of Cogentin and Mirapexin could result in mood change and a "spaced out" feeling. I suggest you contact your doctor explaining the side effects so adjustments can be made. There is no data to suggest Cogentin or Mirapexin affect fertility. Sometimes anti PD medication can result in increased libido or decreased libido or impotence.

T. Lynch

Please could you advise me on taking supplements glutathione and tyrosine which are amino acids help with my PD.

Glutathione consists of glutanic acid, cysteine and glycine. It is thought to be involved in destroying free radical toxins and maintaining the integrity of some brain proteins. There is evidence of decreased Glutathione in PD. Tyrosine is an amino acid precursor that forms brain catecholamines including dopamine.

It is not known whether supplementing Glutathione or Tyrosine in PD is of benefit.

T. Lynch

The patient with diabetes and on Madopar 250mg three times daily and recently compaining from following symptoms:

1. undependent on herself
2. internal temperature
3. urgent for urination with out urination
4. bradycardia before and after taking drug or during parkinsonism
5. external hypotemperature feeling and sweating
6. short life drug effect (2hrs only)
7. constipation
8. headache
9. nightmare dream and hallucination

The short effect of L-dopa after 7 years is common especially with constipation. The nightmares and hallucinations are being generated by L-dopa but it is important to check for a urine infection as any illness can often trigger hallucinations in PD. Therefore -

1. Check for a urine infection.
2. Treat constipation aggressively as this may lengthen the benefit from the L-dopa.
3. If hallucinations persist use an atypical antipsychotic (e.g. Quetiapine or Olanzepine) at night.
4. Consider adding entacapone to lengthen the action of L-dopa, but if you do decrease the Madopar dose by ~ 1/3.
5. Consider adding Selegeline to boost L-dopa affect once the hallucinations are resolved.

   T. Lynch

Dr. Lynch, I have PD for 28 years. I had surgery in 1998, and I would say it was successful. In the past few months my blood pressure is dropping very low. On a visit to my GP he was surprised at how low it was as I am normally on the low side. I get feelings of no strength or energy and lifelessness. I would definitely say that it a different feeling from an 'off' or fatigue with PD. Could you please tell me is this common with long use of PD medication? Can anything be done for low pressure that seems to be the cause of the problems? I take coffee with plenty of sugar when I get these unusual feelings and this brings me 'up' reasonably fast, in about 30 minutes, but if not, I have to rest for an hour or so. This does not happen on a daily basis but often enough to cause concern.

Thanking you and looking forward to your reply.

Many PD medications can lower blood pressure especially the dopamine agonists (Parlodel, Celance, Mirapexin, Requip, Carbogoline), L-dopa (Sinemet, Madopar), Eldepryl and Symmetrel. After 28 years of PD many people are on a combination of the above medications that can lead to low BP.

Management of this problem includes -

1. Treat constipation - it lowers blood returns to the heart and so lowers BP.
2. Wear support (Ted) stockings.
3. Increase salt in the diet.
4. Adjust PD meds - I will often decrease the daytime dose of the dopamine agonist or Symmetrel preceding the recognised low BP times of the day. If theh PD worsens the other meds might need changing.
5. I sometimes use Florinef (salt retainer) or Midodrine to increase BP if the above meaures fail to solve the problem.

T. Lynch

My husband has been suffering from symtoms of Facial and Cervical Myokyuia and Torsional Dystomia since May of 2001. He was a Hazmat Truck Driver that and was exposed to a various amount of chemicals. We have seen several doctors including top neurologists at UAB. He also suffers with rapid movement of the eye along with the non-stop muscle tremer of the SCM muscle in his neck. ( Does not stop even when sleeping) There was also a nerve conduction test that revealed that the nerves on the left side of his body are fighting each other. They have recentley suggested Botox injection into the SCM, to give him a break, because of the atrophy in his neck is starting to cause some breathing problems. Spinal tap, blood work, MRI, and PET scan have shown no pathons. No disease, no cancer. Our next step is seeing a toxiologist for hair sample to see if toxic chemicals from his job may play a factor.

Have you ever heard of such a condition without a disease causing these symptoms? Could it be chemical related?

He is unable to work, and he is extremely unbalanced when walking and moving at times. His medications include-celexa, klonpin, baclofen, and lamactil. Thus far no medications are helping.

A difficult problem. What you describe sounds like dystonia (involuntary twisting of muscles) affecting your husbands face, eyes and neck. Dystonia is most commonly an inherited disorder although it often skips generations resulting in unclear murky family histories of dystonia (torticollis, writer's cramp, foot twisting, eye blinking). Botulinium toxin (e.g. Botox) is the best treatment for the many dystonias, it weakens the nerve supply to the overactive muscles thus easing the twisting and spasms. Some toxins have been identified that can cause parkinsonism but there is less known about toxins and dystonia.

Dr. T. Lynch