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Beyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s Symposium NeuroChallenge: Foundation for Parkinson’s

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Page 1: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Beyond the Shakes

Discussion of the Non-Motor Symptoms of Parkinson Disease

Wissam Deeb, MDJan 12, 2019Annual Parkinson’s SymposiumNeuroChallenge: Foundation for Parkinson’s

Page 2: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 3: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 4: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 5: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 6: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Breen KC, Drutyte G. Non-motor symptoms of Parkinson's disease: the

patient's perspective. J Neural Transm (Vienna). 2013 Apr;120(4):531-5.

doi:10.1007/s00702-012-0928-2.

Page 7: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 8: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 9: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 10: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Cognitive

changes

Page 11: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Early

visuospatial

deficits

strong

predictor of

dementia

development

Page 12: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 13: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 14: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 15: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 16: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 17: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Multimodality

50%

60% in 10 years

Not confined to PDD

16%

Page 18: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 19: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 20: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Neuro-

psychiatric

Page 21: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 22: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 23: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 24: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 25: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 26: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 27: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Sleep

problems

Page 28: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 29: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 30: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 31: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 32: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 33: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 34: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 35: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Autonomic

Page 36: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 37: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 38: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 39: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 40: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 41: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 42: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Sexual

dysfunction

Page 43: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 44: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 45: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Gut

Page 46: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Dental problems (poor oral hygiene,

loss of teeth…)

Drooling (can lead to aspiration

pneumonia)

Decrease taste

Swallowing problems (aspiration

pneumonia and weight loss)

Nausea, early satiety, fullness,

gastroparesis (weight loss)

Constipation (abdominal pain, and

perforation)

Page 47: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 48: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 49: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

✓ Relamorelin (not enough

recruitment)

✓ Lubiprostone (Amitiza)

✓ Not studied in PD though

promising: Linaclotide and

Plecanatide

✓ Botulinum toxin or Botox

✓ Others under FDA emergency

use

Page 50: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 51: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 52: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 53: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 54: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Double vision, mainly

when reading, can

be a problem

Double vision, mainly

when reading, can

be a problem

Page 55: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Improves sleep and quality of life

Improves

cognition,

apathy,

fatigue Improves quality of life

Improves

depression, quality

of life, sleep

Improves sleep,

quality of life,

fatigue,

depression,

apathy, anxiety

Page 56: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 57: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 58: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 59: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 60: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 61: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

Page 62: Discussion of the Non-Motor Symptoms of Parkinson DiseaseBeyond the Shakes Discussion of the Non-Motor Symptoms of Parkinson Disease Wissam Deeb, MD Jan 12, 2019 Annual Parkinson’s

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