the pd expertbriefing: parkinson’s disease and its ... · dispel myths and misconceptions ......
TRANSCRIPT
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The PD ExpertBriefing:
Parkinson’s Disease and its Treatment: Secrets, Myths, and Misconceptions
Presented by: Melissa J. Nirenberg, M.D., Ph.D. Weill Cornell Medical College
New York, NY
Will begin: Tuesday, September 29, 2009
at 1:00 PM ET
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Welcoming Remarks
Robin Elliott Executive Director
Parkinson’s Disease Foundation
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Parkinson’s Disease and its Treatment: Secrets, Myths,
and Misconceptions
Presented By: Melissa J. Nirenberg, M.D., Ph.D.
Weill Cornell Medical College New York, NY
On Tuesday, September 29, 2010
at 1:00 PM ET.
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Topics to be discussed
Secrets: Things you might not know
Myths: Pervasive but incorrect ideas
Misconceptions: Partial truths
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Goals:
Provide new information
Dispel myths and misconceptions
Reassure and empower you
Improve your quality of life
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Misconception: PD only affects movement
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“Non-motor” symptoms of PD
These are commonly overlooked
Reality: Many PD symptoms are invisible
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Non-motor symptoms: which systems are affected?
Sensory
Sleep
Cognitive
Autonomic
Mood
Fatigue
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Reality: people are biased towards what they can see
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Secret: Since non-motor symptoms are invisible
Write them down
Tell your doctor
Seek treatment
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Good news: most non-motor symptoms are highly treatable
Physical therapy & exercise
Medications – PD and others
Non-medical treatments
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Misconception: If someone with PD looks good, then they are doing well
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Reality: PD fluctuates (“ons” and “offs”)
People are usually seen at their best
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Secret: You need to tell your doctor
My medicine wears off
It lasts for _ hours
I am now at my best (or worst)
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Myth: wait as long as possible to take the next dose of Sinemet
“Less is more”
Wait until you need it
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Secret: If you wait too long, then it may never “kick in”
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Secret: Take your medications on time!
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Myth: You can blame PD for everything
Common assumption
Potentially dangerous
Use common sense
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Case #1: 80-year-old man with PD,
develops sudden, severe back pain
Highly functional at baseline
Chronic mild low back pain
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Over the next 5 days, his symptoms worsen dramatically
More severe back pain
Leg weakness
Unable to walk
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He went to a local ER
X-rays normal
Blood tests normal
Discharged home
Told that his symptoms were caused by PD
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What are the red flags here?
Time course - too rapid for PD
Symptoms - inconsistent with PD
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What was actually going on?
Slipped disc Unrelated to PD
Required emergency surgery
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Secret: some symptoms should not be attributed to PD
fever
weight loss
headache
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vision loss
true weakness
Secret: some symptoms should not be attributed to PD
back pain
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Myth: There are PD “exacerbations”
Common assumption
Potentially very dangerous
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Case #2: 75-year-old woman with
worsening PD over the past week
Moderate baseline symptoms
Had been doing well on Sinemet®
No recent medication changes
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Worsening PD symptoms
Stiffer, slower, more tremor
Easily fatigued
Difficulty walking
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The patient saw her internist
Diagnosed with “PD exacerbation”
Advised to increase her Sinemet® dose
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Sinemet® dose was increased
Lightheadedness
Confusion, hallucinations
PD symptoms just as bad
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Reality: PD changes slowly, not over days or weeks
Something else must be going on!
This cannot be attributed to the PD
Need to find the underlying cause
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What can cause rapid worsening of PD symptoms?
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Secret: What is one of the most common
silent causes for a “PD exacerbation?”
Urinary tract infection
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Secret: Which medication changes can worsen PD symptoms?
Nausea medications
Antipsychotic medications
Reduction of PD medications
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Myth: levodopa (Sinemet®) stops working after 5 years
Simply not true
Medical folklore
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Reality: levodopa (Sinemet®) continues to work for decades
Increases lifespan
Improves quality of life
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Myth: Different generic brands of Sinemet® are different colors
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Reality: Sinemet® 25/100 mg is always yellow
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Secret: a change in color often means a different form of Sinemet
25/100 mg regular
25/250 mg regular
25/100 mg extended-release
50/200 mg extended-release
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Myth: Your doctor can predict your future
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Secret: Your doctor can’t predict the future, but you can change it
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Research: Helping to change the future
Neuroprotection
Mood/anxiety
Gender
Imaging studies
Genetic studies
Early diagnosis of PD Stem cell research
Treatment trials
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Misconception: I don’t have PD, so I can’t participate in research studies
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Reality: There are research opportunities for caregivers as well
Another way that you can help
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428 East 72nd Street, Suite 400 New York, NY 10021
www.weillcornell.org/movement (212) 746-2584
Weill Cornell Parkinson’s Disease & Movement Disorders Institute
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Questions and Answers
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Closing Remarks
Robin Elliott Executive Director
Parkinson’s Disease Foundation
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The archive for this PD ExpertBriefing will be available on
Monday, October 5
Please visit www.pdf.org for more information
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PD ExpertBriefings Schedule
How to Take Care of the Caregiver Barbara Habermann, Ph.D.
Tuesday, November 17, 2009 at 1PM ET
Nutrition and Parkinson’s Disease January 2010 *
Understanding Legal for People with Parkinson’s February 2010*
What’s in the Parkinson’s Pipeline? April 2010 *
Fatigue, Sleep Disorders and Parkinson's Disease Joseph Friedman, M.D.
Tuesday, June 1, 2010 at 1PM ET
* Final date to be confirmed.
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