Early parkinson's detection

Jerry Clayton claytonj at essex.hsc.colorado.edu
Sun Apr 30 01:04:50 EST 1995

lee at xmission.xmission.com (lee) wrote:
>I have some questions about Parkinson's disease, both for personal and
>family reasons.  Apparently, for many years before a patient manifests
>clinically-detectable symptoms, there are frequently complaints (general
>loss of fine-motor coordination, non-specific chest pains, etc.) which go
>undiagnosed and continue to worsen until the clinical symptoms (e.g.
>shaking) appear.  Is there any reason to believe that a patient with
>preclinical complaints might respond favorably to L-Dopa, as a
>nonexpensive and early probe for dopaminergic dysfunction?
>Any thoughts are appreciated.
Your concerns are valid and actually your idea on the surface sounds pretty valid at first.  The other response to your post addressed some of the issues and there are indeed problems.  Current opinion says that the more gross signs of Parkinson's don't occur until a very large percentage of dopaminergic neurons degenerate.  L-dopa works because it feeds dopamine precursor in large quantities to the remaining fibers.  Clinically, l-dopa treatment can be tricky because to much dopamine can cause hyperkinesia (rather than bradykinesia) in patients.  At very early stages of the disease (given a diagnosis can be made) it would be even more difficult to titrate a dose that would eliminate subtle symptoms without causing hyperactivity.  Although motor activity is what most think of when considering Parkinson's other emotional/behavioral symptoms can and do occur.  This reflects the areas of the basal ganglia that are being deprived of dopamine.  Some have more to do with motor activity while other areas are more involved with other types of behavior.  There are things (non-pharmacological) that patients with early parkinsons can do and neurologists that deal with this disease can be a great source of help with this.  Also, suggest you try to look up any support groups in your local area as they are a wonderful source of information.  It is a difficult disease to deal with and unfortunately we don't know what causes it yet but reasearch in treatment and elucidating a cure is the focus of many a research group world wide.  Hope this info helps somewhat. Best of Luck!
Jerry Clayton, PhD
Dept. Neurology
Univ. of Colorado Health Sciences Center
claytonj at essex.hsc.colorado.edu

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