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

• Father diagnosed at age 40
• His sister (Aunt) diagnosed Dementia at age 76

CT or MR imaging are usually normal in Parkinson's disease. The changes that occur in the brain are at a microscopic level and cannot be seen by a scan. It is difficult to comment about your symptoms as many things can cause memory problems and twitching. Also, familial essential tremor can commonly be passed on from generation to generation and this is different from PD.

Dr. T. Lynch

Hello, please can you tell me if this disease is passed on through generations what signs do I check for if I am concerned that my husband is starting with this as well as my father-in-law ? Thank you.

Parkinson's disease is rarely passed on from generation to generation. There is a familial tendency but it can skip generations. The 6 cardinal features of PD include tremor, slowness, stiffness, stooped posture, imbalance and gait freezing (feet getting stuck to the ground).

Dr. T. Lynch

What is "Benign Essential Tremor"?

Benign essential tremor is a condition that is best exemplified by Katherine Hepburn, the actress. It is a slowly progressive neurologic disorder that results in worsening tremor of hands, head or voice. The tremor is worse with action and eased by rest, the opposite to that found in PD. It is eased by alcohol or holding an object in two hands. There is no pathology to be found at autopsy and it is thought that the tremor results from misfiring or poor communication of the cerebellar pathways.

Dr. T. Lynch

Ever since participating in a Pharmaceutical study (Circa 10/08/99) my life has become a misery. My eyes, face and body throb with pain. The most severe pain is located in the corners of my eyes, also behind my eyes, and in my temples , head, neck and cheekbones. Additionally, I am sensitive to natural or artificial light. I experience weakness and fatigue in areas of my body e.g. in the ankles and wrists. My jaw seizes with pain, and I have developed an annoying habit of grinding my jaw and cracking my fingers and joints. The symptoms are daily (since 10/08/99) and the only respite is when I sleep.

I have had a neurological scan (all clear) and an Ophthalmologist merely offered me eye drops, which has had no long-term benefit. I believe that because of the above, coupled with the fact that my condition shows no visible or external symptoms (e.g. discharge from the eyes) that my General Practitioner thinks I am a hypochondriac or at worst a crank.

My condition has seriously affected my quality of life and I would be grateful for some advice: refer (me) to other case studies? is it viral or an Othamological problem? What should I do next? Is it "Uvitus"? or is there more relevant websites?

Even with these symptoms I had to lie about my health to participate in other studies with the same research clinic, through economic necessity.

Hoping for a reply

I am unclear if you are - a volunteer for research studies, have Parkinson's or what drug was being studied.

It is difficult to offer advice without this information. In general if you have a problem during/after a research trial you should discuss that with the researchers and the pharmaceutical company and your doctor.

Dr. Lynch

Do you have information about votox injections for the treatment of essential tremors????? I understand they are being used at Baylor College Of Medicine In Houston, Texas.

I assume you are refering to "Botox" injections. Botox is a sterile very dilute form of Botulinium toxin, which is the strongest neurotoxin known. Injection of Botox into a muscle disrupts the nerve supply to the muscle and weakens it - therefore it can weaken the muscles generating tremors and can be of benefit in essential tremor. However this treatment for ET is relatively new and definatively proven.

Dr. T. Lynch

Do you really think foetal transplantation is safe?

Foetal cell transplantation for PD has been shown to increase brain dopamine levels over time. However it seems to can be overly successful as some patients developed marked dyskinesias (excess movements) months to years post transplant. In addition because of the need to harvest tissue from many foetuses for one transplant and the ethics involved it is unlikely it will have a major role in the surgical management of PD. Use of stem cells carries more promise.

I get tremors on my left hand. Also I am in deep depression, loss of memory and not able to perform my tasks efficiently - that makes me feel worse. I feel tired all the time and feel weak. I have stiffness in my left hand fingers. My movements, thinking power have become slow and a fear grips me all the time. I have started talking very little and do not grasp things as I used to earlier.

My doctor has prescribed the following medicines which I started just a week ago after diagnosing it as PD.

1. Capsule Ammantrel- 1 capsule twice a day
2. Tablet Pacitone- half tablet twice a day
3. Tablet Practonol- 2.5 mg- half twice a day
4. Epitril (anti-depressant)- half SOS

The names of medications often differ from country to country. I presume Ammantrel is Amantadine 100mg twice daily. This can be a very effective agent for tremor and stiffness but has a very variable response. I do not know what Pacitone, Practonol or Epitril are. Do you know their pharmaceutical names?

PD does slowly progress over time and to date there is no cure. In general healthy living including diet, physical activity and staying mentally busy is important. The medications usually relieve symptoms but do little to alter the progression of the disease. Selegiline known as Eldepryl here may slow the disease progression but this remains slightly controversial.

Dr. T. Lynch

My mother has Holmes disease and going to use tetrabenazine by her doctor's order. Please inform us if you have any information about the effectiveness of this medicine over Holmes disease or any information that help us to care with this kind of cerebellum degeneration.

Cerebellar degeneration of Holmes is an older term for progressive cerebellar ataxia. More recent terms include autosomal dominant cerebellar ataxia or the spinocerebellar ataxias. There are also autosomal recessive, sporadic and metabolic ataxias. So I am unclear what type of cerebellar degeneration your mother has (it depends on family history, examination and investigations). Tetrabenazabine can sometimes help severe tremor but is unlikely to help unsteadiness or slurred speech. Treatments for cerebellar ataxia are few.

Dr. T. Lynch

Can someone who is only 17 have PD? She shakes all the time, and it appears to be getting worse and other symptoms as well,where can I get information? I think my family is in denial, and won't discuss it openly!

Someone aged 17 can very very rarely get PD. Usually there is a genetic cause for juvenile PD. However there are other causes of tremor including essential tremor. Your relative should be seen by your family doctor (or neurologist) to determine the type of tremor and problem. A diagnosis is needed first as it may not be PD.

Dr. T. Lynch

Why are there no laws against allowing people with Parkinson's disease to drive? Our 20 year old son was killed in March. The man has Parkinson's and was driving on the wrong side of the street, killing our son head-on.

Firstly I would like to offer my condolences to you and your family on your recent terrible bereavement.

Laws regarding disability and driving vary from state to state and country to country. Therefore it is difficult to comment on this important question.

Most patients with Parkinson's are safe while driving. However if a PD patient develops dementia they should not drive. I often have PD patients take a driving test arranged by the Irish Wheelchair Association to assess their safety.

Dr. T. Lynch