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

My father was diagnosed with Parkinsons in 1999, and his doctor has since concluded it was caused by exposure to cyanide dust which he used to kill honey-bees over a period of 15 to 20 years.

1. Does anybody have any experience of any other effects this exposure could have?
2. Are there any other treatments available to possibly cleanse the system of toxins?
3. Any prognosis as to when the sufferer would require personal care?

Thanks

Cyanide inhibits the main energy producing component (mito chondria) of cells in the body. This can result in death of cells. In acute poisoning headache, faintness, vertigo, anxiety, burning mouth, breathlessness, nausea, vomiting and sweating occur. Parkinsonism is not a reported complication of cyanide poisoning.

However could chronic exposure of cyanide cause PD? This is an interesting question as there is evidence that the power house (mito chondria) of brain cells is abnormal in PD. But there is no evidence that this is caused by cyanide. Perhaps a neurotoxicologist might be able to comment further, e.g. Dr Robert Feldman, Boston University Neurology Associates, 720 Harrison Avenue, Boston.

Dr. Lynch

Dear Dr. Lynch.

My "live-in" as we say here, was diagnosed with epilepsy in 1991 after having had 2 seizures. He was ordered not to drive and has been on Tegretol ever since. The doctors have said that he can discontinue the drug this fall since there has been no further indication of seizures. We have two questions:

1. Are the chances of repeat episodes predictable at all?
   
2. Is there any relationship between epilepsy and Parkinson's? (my live-in's father died of Parkinson's).

Epilepsy is not associated with PD. This probably reflects relative sparing of the cortex in PD. The exception to this is diffuse Lewy body disease, a different condition to PD.

Stopping anti-convulsants (AED) always is a cautiously taken step. If the patient has had no seizures for greater than two years, normal brain imaging, relatively normal electroencephalogram (EEG) then it is not unreasonable to wean off the AED under medical supervision. In this setting the risk of repeat seizures is low. The risk increases with some types of epilepsy, with an abnormal EEG and with a "lesion" on brain imaging.

Dr. Lynch

I have two questions:

1. Will this disease ever lead to death?
   
2. Is there any correct way of taking these meds?

Whether PD shortens lifespan is a controversial topic. Some studies suggest a shortened (mildly) lifespan and others suggest normal lifespan. In general many people with PD can live an active busy life and pass away from other causes. The correct way to take medication varies from person to person and from medication to medication. I could not be more specific without knowing the medication and the specific problem - your doctor is the best person to ask this question of.

Dr. T. Lynch

I just want to know if the disease in hereditary, my Gran has it and I'm worried that I could end up with it. I really would like to know - it's my right.

The majority of people with PD do not have other family members with the disorder. Therefore most are sporadic in onset. However, there are rare families where PD "runs in the family". The study of these families has led to the identification of 2 genes that, when abnormal, lead to parkinsonism.

The risk of you developing parkinsonism is extremely low as one affected grandparent does not imply heredity of disease.

Dr. T. Lynch

Is PD hereditary and if so is there any supplement that can be taken to help prevent it?

There are rare families where PD is passed from generation to generation. Mutations in two genes have been identified by studying these families - alpha synuclein and Parkin. However in the vast majority of cases there is no history in the family of PD. It is likely that there is both an environmental trigger (the seed) and a genetic/hereditary predisposition (fertile soil) in PD. The genetic component is strong in young onset PD and relatively weak in later onset.

To date no supplements have been proven to slow or prevent the development or progression of PD. This is an active area of research. However it is possible that antioxidants might help to slow PD as oxygen free radicals do appear to be involved in the substantia nigra at death. Therefore supplementing vitamin C and E to a healthy green vegetable and fruit diet is not unreasonable. Vitamin E alone does not help to slow progression. Caution is advised in taking supplements as excess vitamins A or D can have serious side effects. You should discuss any supplements with your doctor and pharmacist to ensure they do not interact with your other medication.

Dr Lynch

My father has PD and has recently started to develop Hallucinations and Paranoia. I have been doing a ton of research on the internet trying to find any and all information I can. My father lives in a small town and there is only one neurologist. He is currently on the following medications:

1. Seroquel 25 mg (new drug they just started him on)
2. Mirapex 1 mg, 3 x day
3. Paxil 20 mg, 1 x day Sinemet 50 mg 4 x day (he has been on this one since he was first diagnosed)
4. Flexeril 10 mg, as needed (none of the doctors are sure why this helps him but it does help tremendously with his tremors when they get bad)

Hallucinations can be a real nuisance in PD. some people do not mind them and are not upset by them (I usually do not treat the hallucinations in these patients). Others get paranoid, deluded and upset by the hallucinations. In these you need to use antipsychotics. The problem is that most of the antipsychotics make PD worse except Seroquel (Quetiapine), Zyprexa (Olanzepine) and Clozapine. Therefore Seroquel is an excellent antipsychotic to use for your father.

The hallucinations are sometimes aggravated by the medications including Sinemet, Mirapexin, Paxil and Flexeril in addition to infections, insomnia and constipation.

Some patients with PD go on to develop diffuse Lewy body disease which is characterised by fluctuating parkinsonism, cognitive impairment, hallucinations and myoclonus/jerking "tremor" of hands). It is possible that some of the "tremor" you describe is myoclonus as Flexeril can ease myoclonus but also aggravate sedation and confusion.

There are many neurologists in Texas who specialise in movement disorders and PD. These include:

1. Dr Joe Jankovic, Bayler College of Medicine 713 7986556,
2. Dr Naarden Allan, Human Medical Centre, Dallas, 214 6617684,
3. Dr Malcolm Stewart, Dallas, 214 6963383, Dr Esperanza Wagner, Dallas, 214 3457980 and
4. Dr Maureen Wooten, Dallas 214 2655600.

Hi, I'm Adam, a 17 year old high school senior with a Parkinsonian grandma. She's inspired me to do something with myself to help her and people like her. I've undertaken a large-scale research project to be submitted to Intel's Science Talent Search. All of my research and information has come from my own resources and therefore, I have a lot of pride in it. The title of the survey based paper is Behavioral and Attitudinal Effects of Youth and General Onset Parkinson's Disease. The problem I've encountered is finding a decent number of people from both categories to fill out the survey. It is anonymous, which makes it easier to find addresses rather than names, but my luck is in a dearth. I was wondering if you could help me in any way.

Thank you in advance for reading this.

Dear Adam

I am a little unclear what you are looking at in your project. I would be happy to review and comment on your proposal further if you wish to e-mail a copy of it. In addition the PALS Support Group might be interested in helping you recruit people for your survey. Let me know more of what you want.

Dr T Lynch

Both my wife and I have been diagnosed with Early Parkinson's disease. We both have been diagnosed within the last 18 months. We are in our mid forties and have had second opinions regarding our situation and we will soon see a new Neurologist as we have relocated to another state.

I was wondering if any studies have been done or if there are any numbers associated with both a husband and wife being diagnosed with the disease. I have found several brief articles of such cases but have had no luck in finding any major information on the subject.

Thanks in advance for your response.

My apologies for the delay in replying.

These are few studies looking at couples with PD. This is primarily because it is rare. A husband and wife in their 40's with PD is extremely rare. It either suggests a common environmental trigger or pure coincidence.

The various risk factors for the development of PD include

• heredity (a detailed family tree is important) especially in young onset PD,
• environmental exposures including rural living, farming, well water drinking, pesticide exposure, lack of dietary vitamin E, head trauma and others.

Does being exposed to fumes of dry cleaning solvents cause PD?

There is no data to show dry cleaning fumes causes parkinsonism. Asphyxiation from strangulation or carbon monoxide can result in acute parkinsonism that behaves differently from PD.

Dr. T. Lynch

I'm been having symptoms of twitching thumbs, tingling hands and feet, severe dizziness, rapid temperature changes, fullness in ears, and stiff neck. My MRI and CAT scan were both clear, my neurologist thinks it could be Meniere's disease. What about Parkinson's? Is tingling hands and feet and some of my other symptoms early signs of Parkinson's? What is the best way to discover if it is?

My apologies for the delay in replying.

PD can sometimes cause stiffness, aches and pains and tingling but usually down one side rather than generalised. Dizziness, temperature changes and fullness in ears suggest a different diagnosis. The best way of excluding PD is having an assessment by your neurologist - he/she will be very tuned into picking up signs of PD.

Dr T Lynch