Could you tell me a little about the computer implant system which stimulates the brain to stop the tremors associated with PD. I have heard of someone in the US who had this done and wondered if it would be suitable for my uncle (aged 62) who has severe tremors. Thank you.

Deep brain stimulation is a new technique where an electrical stimulator is placed into particular brain region(s) and hooked up to a pacemaker. It is an effective procedure for tremors, stiffness and slowness in WELL SELECTED patients. Mr Steven Gill, Consultant Neurosurgeon, Bristol, will be talking about this to the PALS this Saturday in the Marine Hotel, Sutton.

Dr. T. Lynch

The back of my neck has been feeling as if I have an ice pack on it I also feel sick when this happens. Is this connected with Parkinsons?

Sensory complaints do occur in PD. Often these happen down the same side as the Parkinsons, e.g. stiff painful frozen shoulder, aching in the upper arm or leg. However a cold neck is not a common complaint and may have a different cause. You should discuss your problem with your doctor.

Dr. T. Lynch

Hi - I was just thinking, are there any foods I should avoid?

Constipation is a common problem in PD. Therefore avoiding excessive sugar and snack foods and eating high fibre foods including wholegrain bread, porridge, brown rice, fruit (3 servings daily) and vegetables is advisable. Maintaining adequate (8-10 cups/day) fluid intake is important to avoid constipation. Adequate vitamins especially the antioxidant vitamins (vitamins C and E) is important for a balanced diet.

Overall there is no particular food to be avoided, however, grapefruit can alter the absorption of your medication. Therefore if you are going to eat grapefruit do so regularly.

Dr. T. Lynch

My father has been taking tablets for Parkinsons for the last five years, and I was just wondering will there come a stage when the tablets will stop working or have little effect?

Levodopa (Sinemet or Madopar) generally starts being less effective after five years of use - it "wears off" quicker and can result in side effects such as excessive movements (dyskinesias). However most PD patients can be maintained in good health with the battery of medication available for PD over many years. Therefore it is quite possible your father's medication may continue to work well for many years.

Dr. T. Lynch

I'm sixteen. Over the past year and a half or so ago, I've been noticing occasional tremors in my fingers and muscles all around my body.

My questions are:

1. Is this Parkinson's disease?
2. How serious is Parkinson's Disease?
3. Is PD normal in 16 year olds?
4. And what should I be doing about it?

No it is not common to see PD in 16 year olds. It is highly unlikely. There are many other causes of muscle twitching or tremors in teenagers that are more likely. I suggest you see your GP and tell him/her about your concerns. GPs are excellent primary physicians and will refer you on to a specialist if they are concerned.

Dr. T. Lynch

After two years of progressive dystonia in my right hand, I was dxed by a movement disorder specialist at a major teaching/research hospital as having "probable hemiatrophy hemiparkinsonism." The diagnosis was communicated to me in a memo, so I was unable to ask questions. There is very little information available. What can you tell me about this syndrome and how it may differ from regular PD?

Hemiparkinsonism - hemiatrophy is a rare form of parkinsonism. It usually starts between ages 30-40. One side of the body is smaller than the other with associated parkinsonism, dystonia, slow progression and a poorish response to levodopa. The side of the brain opposite to the parkininsonism is small possibly related to injury early in development (while in the womb). It usually is very slow to worsen and hence carries a good prognosis. There is little information as it is rare.

Dr. T. Lynch

Last week I was told I had Parkinson's. My doctor prescribed tetrabenazine. My symptoms got worse. Is this a new treatment? What is the usual treatment for a first-timer with tremor?

Treatment should be shaped for the individual. Therefore what is good for one may not suit the next.

Tetrabenazine (TBZ) depletes dopamine within the brain and usually makes parkinsonism (tremor, stiffness, slowness, imbalance) worse. Therefore I do not use TBZ for Parkinson's tremor. In a young patient, like yourself, I generally would try a dopamine agonist (Celance, Mirapexin, Requip, Parlodel, etc) or an anticholinergic (Artane, etc) or nothing if the tremor is mild and non-bothersome.

Dr. Lynch

Who is affected by Parkinsons? (statistics)

Parkinson's disease is more common in men (3:2) The incidence in the USA is 20 new cases per 100,000 population per year. The prevalence (amount of people alive with PD at any given time) is 187 cases per 100,000 population. These figures increase with age. There are approximately 5000-6000 people in Ireland with PD but this figure is an estimate.

There is a need to quantify the numbers in Ireland by setting up a neuroepidemiology centre. A proposal has been submitted to the Department of Health and we await a reply.

Dr. Lynch

My friend has been on Madopar 62.5 since April, in the last 7 weeks as suffered with terrible diarrohea, could this be a side effect of the drug?

Diarrhoea is not a common side effect of L-dopa (Madopar or Sinemet) but can occur. It is a side effect associated with Comtess (Entacapone) - Perhaps your friend was prescribed both? If she/he is on Comtess it will need to be stopped. If not your friend should recontact his/her physician to discuss the problem, exclude constipation with overflow diarrhoea, exclude infection or try stopping the Madopar under medical supervision.

Dr. T. Lynch

I have some of the most common symptoms but I'm am curious about one (by the way I am taking Sinemet). My question is why do I start smiling and then I begin to laugh. This may sound healthy but I don't always think its called for.

Thank you

I suspect you may be describing something we call emotional lability, i.e. the emotional brakes are looser than previously and people find they laugh or cry inappropriately. Usually emotional lability is more common in atypical forms of parkinsonism, (e.g. progressive supranuclear palsy, etc) or in stroke patients. However it can occur in PD and sometimes may be related to some of the medications, e.g. Sinemet, Madopar.

Dr. Lynch