My son is 27 years old and has for over 1 year noticed that his fingers on both hands have been shaking quite visibly. I might add that he has been a drinker of alcohol for some years and at times drank quite heavily. He had been prescribed some tablets whilst in Australia for these symptoms the tablets are Noten and they have stopped the shaking for periods of 24 hours at a time, but on returning to England our family GP is reluctant to prescribe anything for my son who I feel needs to have these symptoms investigated.

My question to you doctor is this, "does the symptoms my son has indicate Parkinsons disease or some other serious disorder. I would appreciate an early reply as we are quite concerned for our son's health.

Thank you for your attention to this matter.

There are a number of causes of tremor. The commonest form is benign essential tremor where the tremor is most obvious holding or reaching for an object. PD tremor is a rest tremor eased by action. Alcohol usually eases essential tremor for a brief while. For proper assessment the tremor needs to be seen.

Dr. T. Lynch

Is there a blood test that will confirm Parkinson's?

No. The confirmation of PD is based on clinical assessment looking for some of the cardinal signs - rest tremor, slowness, stiffness, poor balance, stooped posture or freezing. A definitive diagnosis can only be made by the demonstration of Lewy bodies (pink inclusions within neurons) within brain cells. Positron emission tomography (PET) is a brain imaging technique that can help to confirm PD.

Dr. T. Lynch

My dad started displaying the symptoms of PD quite early on but was not diagnosed with [juvenile] PD until age 55 and even then due to poor supervision of effects of Sinemet by his neurologist he truly had very poor quality of life. However, due to research on the internet plus additional research by my sister-in-law, Dr Lynda Sisson here in Dublin, he ended up going to Dr Robert Iacono in California for a pallidotomy. After a 20-min procedure at Loma Linda University Hospital, the change was amazing. Dr Iacono also checked my dad's medication and altered it to suit (adding Prozac to the list), plus gave him advice on his diet and exercise routines. This was a couple of years ago now and you know what he became a completely different person--no longer depressed all the time, no longer afraid to go out and meet people, no longer afraid to stand up and speak about how he was feeling, and even able to take care of his grandson (my son born in July 99 and actually his one and only grandchild) on his own whenever he comes to visit.

Of course the pallidotomy on its own would have been of no use if his medication was not continually monitored and upon his return to England, my sister has also managed to get him under the care of a much better neurologist in London, Dr Bain.

My question is this: why are doctors in England and Ireland so afraid to recommend this procedure and look at it as a solution only when "all else fails"?

My dad tried to get the op done in Bristol originally but ended up going home in tears since the doctor had been so negative about it. Thank God he didn't give up hope however, because when I look at the dad I got back -- ok so he'll never be what he used to be and my whole family has come to accept that BUT and it is a big BUT -- he is doing so much better than he was prior to the op! Quality of life has improved more than 100% (he'd tell you that himself), and so what if it has to be done again--I was there with him all through prep for the op and it was scary but certainly worth every single minute and every single penny!

I am sorry to hear that your father had early difficulties with his medications. Pallidotomy is an effective procedure for unilateral dyskinesias or tremor. It is less effective for poor balance and slowness. It is a good operation if done on the right patient. Some patients should not have this form of surgery because of confusion or poor memory. The physician should always look critically at these new treatments and select appropriate patients carefully. It seems that pallidotomy may soon be surpassed by deep brain stimulation operation. Therefore this kind of treatment for PD is continually evolving and patients should be cautious before opting for them.

We hope to be doing these procedures next year at Beaumont Hospital with Mr Pidgeon and myself coordinating the programme.

Dr. T. Lynch

Do people die of Parkinson's?

Is the last stage refusing to walk at all?

Does Parkinson's lower blood pressure?

The life expectancy of somebody with treated PD is probably normal so patients usually die of something else. It is hard to comment on the "last stage" as this varies. PD patients are more prone to immobililty especially following injury or surgery however they usually do not "refuse to walk". PD patients can have lightheadedness on standing because of a drop in BP especially when on the dopamine agonists (Permax, Requip, Parlodel, Symmetrel, Mirapexin).

Dr. T. Lynch

What are the causes of Parkinson's disease and how does the disease affect the well-being and life style of the patient's family?

This is a very open ended question that is one of the main focus of research into PD. There is no one answer. However it is likely that there are genetic and envirnomental factors contributing to PD. The patient probably has an inherited predisposition followed by exposure to some envirnomental trigger. This results in progressive loss of dopamine-producing brain cells and ultimately the symptoms of PD.

PD can have variable effects on patient's family. It depends on the stage of disease, how severe the symptoms are and whether there is any cognitive impairment.

It is not possible to comment more without specific questions

Dr T. Lynch

I had a intermittent trembling in my left thumb for two years-only if I would hold it rigid. I am now on Wellbutrin and I have trembling in all my fingers and wrists only at times and in no way does it interfere with daily living. When I was holding a page from the paper, my thumb trembled and the paper shook slightly. My wrists were trembling too. What type of trembling would mine be classified as?

Thankyou.

Tremor can be present at rest, posture holding or action. Without seeing your tremor it is impossible to comment on the cause of your tremor.

The commonest cause of tremor is benign essential tremor (best characterised by Katherine Hepburn the actress). It is worse with posture holding (e.g. holding a paper) and action whereas PD tremor is present at rest and is usually eased by action.

Dr T. Lynch

I have been seeing a neurologist for the past year or so for symptoms of curling under of the toes on my left foot when exercising or walking, and rigidity in my left arm (lack of arm swing, fine motor skill problems, etc.).

I have been on medications of Mirapex, Sinemet, and Permax. I am currently on Sinemet and Permax. My doctor told me last week, after I put her on the spot, that she thinks I have left side Parkinsons. I am not sure if that meant she diagnosed me with it, or if she just "suspects" it.

Oh, I also have some shaking of the left hand and wrist, which I first noticed when I would get up in the morning and yawn, or when I was cold and would shiver -- my left arm would shake very noticeably. I also noticed over time that I had lost some of my fine motor skills in my left arm. On one occasion, I was playing basketball and went to make a "travel" call (ie. circling my hands rapidly) and my left hand/arm just kind of went up and down and I could not get it to circle around my right. It was very strange, and I must admit that since I have been on my current medication, this has gone away. Much of my shaking of the left arm/hand has also gone away, although it occasionally happens.

I would like to get your opinion on the following:

1. Are the symptoms in my left foot, ie. the toes curling down w/ exercise, a symptom of Parkinsons? This particular symptom first occured about 2.5 years ago, and has not yet gone away. It is what started me on a 2.5 year long search for an answer - starting at foot doctors, and ending up w/ my current neurologist.

2. Should I be seeking a second opinion? A specialist? Are there any in the Seattle area?

3. I am feeling lost at work and can't concentrate on anything but the PD. I seem to have the hardest time completing my normal tasks. Any suggestions on how to cope?

1. Toe curling is a common complaint in PD. It commonly occurs early morning when the patient is on Sinemet. It is likely the curling is related to malfunction of the basal ganglia (the automatic center for movement) resulting in dystonia (twisting/curling of muscles). The fact that your left arm movement has improved on medication supports a diagnosis of PD.

2. It is not for me to recommend a second opinion. However, it is important that you understand the disease so you can continue your life and regain your concentration at work. There is a group of Neurologists in Vancouver with a special interest in PD. Dr Donald Calne leads this group. Perhaps he/they could recommend somebody in the Seattle area or you could arrange to see him.

   Dr Donald Calne
   University of British Columbia
   Vancouver Hospital and Health Services Centre
   M36, Purdy Pavillion
   2221 Westbrook Mall
   Vancouver BC V6T 2B5
   Canada

   Phone: 604 822 7967
   Fax: 604 822 7866

3. People with PD can live a normal life with some limitations - I think understanding the disease and your limitations are the first step in coping.

   Dr. T. Lynch

My mother has recently been treated for Parkinson's with Sinemet Plus (thrice daily). Her only symptom is a tremor in her right arm. The tremor is quite violent and results in cramps and upper arm pain. Emotion, types of movement, exercising weight on the arm act as triggers.

The speed with which the tremor developed was three months, as opposed to a slow progression, which I believe is the norm. The drug worked initially, however after 5 days the tremor was as bad as ever, even immediately after taking the drug.

She is very frightened, and is now prone to panic attacks. The fear of the unknown is terrifying.

I would like to have her reassessed.

My questions are:

1. What does the Sinemet Plus wearing off so quickly tell you? Could this be a false positive, screening some other problem?

2. My family live in Kerry, and I myself in London. Can you give me some information as to where I can have a second opinion.

3. Your talk posted on this page was immensely helpful. Are you available for consultation? Is it only through the Mater?

Tremor is one of the most difficult symptoms to treat. Not uncommonly Sinemet fails to suppress the tremor of PD. With anxiety the tremor will invariably "break though" the medication.

It is not for me to recommend alternative opinions I would be happy to see your mother if you wish. Her GP could write a letter of referral. Alternatively Dr Brian Sweeney and Hugh Harrington in Cork have a keen interest in Parkinson's disease. Also Dr Liston in Tralee General Hospital has a lot of experience in PD.

Dr. T. Lynch

I was sent to a neurologist for confirmation on my having P.D. and the doctor told me I was too young to have it. Is this true? I thought that young onset could happen to people before they were 40 years old? My general practioner said I have most the symptoms of P.D. then the Neuro says I am too young no matter what my symptoms are. I felt like he just wanted me out of the office. Is he right? am I too young? (I am 39).

Parkinsonism (slowness, stiffness, tremor and poor balance) can occur before the age of 40. There are different causes of parkinsonism including Parkinson's disease. It can occur before 40, although rarely.

I have started a study into young onset Parkinson's disease at the Mater Hospital. We would like to identify patients with young onset and assess them. We also plan to take a blood sample (with permission) for DNA extraction and storage. We would like to look at genetic factors in Parkinson's disease.

Dr. T. Lynch

Our mother has not got severe disease, and, in fact, only recently, she has a shake in her hand but it is obvious in her walk. Last year she suffered from depression and was prescribed Cipramil 10mg which worked for a time. This summer she experienced more severe depression and is now on 30mg of Cipramil. She also takes Sinemet 275 - 4 times a day along with Serc 16mg 3 times a day and Dulax and Senokot for bowels. She has been referred to the local psychiatric hospital where they prescribed Xanax 3 times a day along with sleeping tablets Zimovane 7.5mg.

Even with all this, she is still extremely distressed and anxious, she feels that life is not worth it. She wants the Doctor regularly and needs reassurance constantly from medical persons.

We would appreciate any help and/or assistance you could give us, it breaks our hearts to see her like this and we know she wants to go to hospital where she can feel safe but no one seems to want her.

Please could you recommend someone or somewhere for our mother.

I await your response,
Thank You.

This is a very difficult problem. Anxiety and depression commonly occur as part of PD. Sometimes as the medication wears off the anxiety increases as part of the "off" time period. Your mother probably needs to be seen by a psychiatrist and a neurologist who work close together. By a combined approach a combination of medication may be found that suits her. It is difficult to be more specific as the management at this stage in the disease has to be individualised. I note she is on a moderately high dose of L-dopa (1000mg), Serc, Xanax and Zimovane. Serc is usually of limited benefit in PD but can be of help in vertigo. Xanax and Zimovane can have an addictive effect and high dose L-dopa can result in agitation, confusion, paranoia and hallucinations. Therefore a careful reassessment of all these medications may help. Finally exclusion of an atypical form of parkinsonism should be done.

Dr. T. Lynch