Going Green

The fluorescent lights in the examination room turned the patient’s skin a strange yellowish- green color, comparable to someone with chronic hepatitis C. Diagnosed with PD about eight years ago the patient’s main problem was gait. Navigating corners had become tricky, and resulted in the patient executing a series of fast little steps; in people with PD the shuffling gait is also called festinating gait. The specialist noted the same sort of issue applies to speech, with PD patients stuttering, unable to progress beyond a certain repeated syllable. Speech also softens in PD, becoming whispery and losing volume due to increasing rigidity of the diaphragm and muscles that span the ribs. While speech therapy helps the patient make sentences with sequential words, physical therapy can focus on gait, and balance to avoid falls.
The movement disorder physician questioned the patient about whether problems in gait coincided with times in which medication had not been working, for example, upon waking in the morning. The patient commented there was no obvious change in symptoms, in instances where medication was taken later than usual. Stalevo and other dopamine yielding drugs may not be very helpful when sudden immobility or freezing complicates the picture. The specialist informed the patient and partner that surgeons at the University of Florida and at the University of Toronto are placing stimulators in the brain, at the site called the pedunculo- pontine nucleus, PPN for short. The procedure is still in experimental trials to uncover its level of effectiveness in improving gait for patients with Parkinson’s disease.
The physician also mentioned a group of Japanese investigators who experimented many years ago with L-threo-dihydroxyphenylserine or droxydopa, claiming the compound had symptomatic beneficial effect for patients with freezing syndromes. Currently being used in Asia for various conditions, and has completed stage two clinical trials for orthostatic hypotension in the USA, the medication is a precursor of the neurotransmitters norepinephrine and epinephrine, and is used generally to increase the concentrations of the neurotransmitters in the brain and body. Recent studies have found it effective in raising the blood pressure of patients with Multiple System Atrophy, who suffer with orthostatic hypotension; large drops in blood pressure due to abrupt changes in physical position. From wikipedia, …’ works by increasing levels of norepinephrine and epinephrine in the peripheral nervous system inducing tachycardia or increased heart rate and hypertension or increased blood pressure, thus enabling the body to maintain blood flow upon and while standing.’
The patient and caregiver listen as the researcher describes what he feels will be the next breakthrough for Parkinson’s disease. In his opinion, the next innovation will not come in the form of surgery, but as scientists discover ways to harness the brain’s capacity to replenish its own neurons.

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