Innovations in Parkinson’s Diagnosis & Treatment: A Personal Story

Dr. Kenneth E. Keirstead

Excellence in Aging Care Symposium

September 25-27, 2013

Why Me?

72 year old Stage I diagnosed nine months ago

Born in South Africa overdosing on DDT!

No direct family history, but have outlived most of my forebears

Biggest first issue – denial

“Symptoms are mostly all in your head” “You’re not kidding!”

What is Parkinson’s Disease?

A neurodegenerative disease with progressive loss of motor neuron cells

First described in 1817 as “Shaking Palsy”

“Idiopathic” condition or syndrome

Some indication of hereditary genetic factors (5-10%)

Recently about ten genes have been identified that link to PD

External chemical influence? Pesticides and insecticides

Symptoms

Problems with walking and balance

Muscle aches and pain

Movement problems – difficulty starting movement such as walking or getting out of a chair

Slowed movement

Rigid or stiff muscles often beginning in legs

Anxiety, stress, depression and tremor

Truly idiopathic!

Diagnosis

Medical history

Thorough neurological examination

No screening or lab tests to confirm diagnosis

MRI detection of Lewy Bodies

Response to replacement medication

Progression of Disease

Stage I:

• Slight tremor in one limb, often a hand. Walk may be a little unstable, slight stoop, some differences in facial expression.

Stage II:

• Tremors spread to both sides of body. Increasing difficulty walking because of unsteady gait. Difficulty completing tasks.

Stage III:

• Marked increase in symptoms (tremors, jerking). Movement visibly slowed. Difficulty standing upright or walking steadily.

Progression of Disease (continued)

Stage IV:

• Walking very difficult, increasingly slow responses, rigidity and stiffness that impair movement, difficulty swallowing. Living alone not advised.

Stage V:

• Signs of increasing dementia, difficulty swallowing and speaking, unable to live alone – probably chair or bed-bound.

Insidious Symptoms

Anxiety Depression

Fear Fatigue

Frontal Lobe Theory

Command Center Challenges

Affected processing

A possible precursor to more definitive diagnosis

“It’s all in the head”

Understanding brain plasticity

A new opportunity

Bring on the Dopamine!

Carbidopa-levodopa – drug of choice

Other agents

Need for precise control (dosage, timing, etc)

Alleve (naproxen sodium)

Self medication hypothesis

Rehabilitation and exercise

Other Treatments

Research pipeline

Deep brain stimulation

Stem cells

Accurate assessments of disease state