MDS Blog

Controversies and Hot Topics in Parkinson's Disease and Movement Disorders

Welcome to the MDS Scientific Issues Committee Blog. This is a forum for visitors to obtain the latest in scientific advances, new developments, and trends in the field of Movement Disorders. Comments are welcome and please return often to read about new topics.


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Cannabinoids in Movement Disorders

Date: October 2017
Authors: Nestor Galvez-Jimenez, MD, MSc, MHA; Camilo Garcia, MD; Ramon Rodriguez, MD; Connie Marras, MD
Blog Editor: Stella Papa, MD

The use of cannabis for medical disorders is a global issue, whether or not the drug is legalized for general use, only for use in some medical disorders or not legal in any setting.The use of cannabis for medical disorders is a global issue, whether or not the drug is legalized for general use, only for use in some medical disorders or not legal in any setting.  Where not legal, there is black market selling and purchasing and large scale use in many countries.  Social media has popularized the use of cannabis for many medical disorders, including pain, anxiety, wasting and appetite loss, all issues faced by our patients with movement disorders.  Laws in many countries are changing regarding the use of cannabis, prompting an influx of questions from many patients about its usefulness for them. Unfortunately, there is little evidence-based or even expert guidance for physicians.  Several American physicians offered thoughts on this controversial topic.  Go to Discussion

When Does Social Media, Email and Internet Use Cross the Line to a Psychiatric Disorder?

Date: August 2017
Authors: Francisco Cardoso, MD, PhD, FAAN, and Marc N. Potenza, MD, PhD
Blog Editors: Michael S. Okun, MD, Stella Papa, MD, and Daniel Weintraub, MD
 

Psychiatrists, neurologists and general practitioners commonly encounter patients who excessively use technology. However, our understanding of when the Internet and social media habits cross a line to become a psychiatric disorder remains murky. On August 6, 1991 a new era for communication was launched when Tim Berners-Lee posted a summary on the World Wide Web and launched what we know today as the Internet. Though email was invented in the 1970’s by Ray Tomlinson, it was not until the 1990’s that AOL, Prodigy, and CompuServe provided commercial Internet service and facilitated what became web-based mail. Social media was born more than a decade later in August 2003, first with Myspace, and then in February 2004 with Facebook. Twitter and the 140 character communication revolution arrived on March 1, 2006. This advance was followed in October 2010 by photosharing with the app called Instagram. Psychiatrists, neurologists and general practitioners commonly encounter patients who excessively use technology. However, our understanding of when the Internet and social media habits cross a line to become a psychiatric disorder remains murky.  Go to Discussion

Do-It-Yourself Transcranial Direct Current Stimulation (DIY tDCS): Is It Safe?

Date: June 2017
Authors: Jau-Shin Lou, MD, PhD, MBA; Robert Chen, MA, MBBChir, MSc, FRCPC; Velijko Dubljevic, PhD, DPhil
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD

 

The scientific literature has shown that tDCS improves memory, math skills, and academic performance in normal subjects and may be beneficial for patients with depression, Alzheimer’s disease and stroke.The scientific literature has shown that tDCS improves memory, math skills, and academic performance in normal subjects and may be beneficial for patients with depression, Alzheimer’s disease and stroke.  Because tDCS is non-invasive, simple and low cost, it has gained significant media attention and public interest.

Go to Discussion

 

 

Autonomic Issues in Parkinson's Disease

Date: April 2017
Authors: Nestor Galvez-Jimenez, MD, MSc, MHA; Ramon Lugo-Sanchez, MD; Tarannum Khan, MD
Blog Editors: Michael S. Okun, MD, and Stella M. Pappa, MD
 

Recent advances as well as experience accrued when caring for patients with Parkinson’s’ disease (PD) has revealed that autonomic disturbances are an integral component of the evaluation of patients and that their symptoms have often become a source of disability.Recent advances as well as experience accrued when caring for patients with Parkinson’s’ disease (PD) has revealed that autonomic disturbances are an integral component of the evaluation of patients and that their symptoms have often become a source of disability. Autonomic symptoms in PD include but are not limited to sweat, cardiovascular dysfunction, and gastrointestinal urogenital system failure, which together or in various combinations may affect quality of life (QOL) and also therapeutic outcomes. Three experts from the Cleveland Clinic address the common questions on autonomic PD dysfunction.  Go to Discussion

Cognitive Problems in Parkinson's Disease

Date: March 2017
Author: Beth A. Vernaleo, PhD
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD
 

In 2013, the Parkinson’s Disease Foundation (PDF) launched the Community Choice Research Award (CCRA), designed to advance research in areas that were identified as unmet needs within the PD community. People with Parkinson’s (PWP) and care partners (CP) were asked “what areas of research do you think scientists should be focusing on in order to make an impact in the PD community?” In 2015, over 300 people from eight countries responded with ideas.

One unmet need identified by many PWP and CP was addressing cognitive problems in PD and how to maintain cognitive function for as long as possible. As a result, the PDF organized a multidisciplinary working group of experts in several fields (Movement Disorders, Cognitive Neurology, Psychology, Social Work, Nutrition, Nursing, Physical Therapy, and Aging) as well as members of the PD community to address this need, with a focus on non-pharmacological interventions.  We asked Beth Vernaleo PhD, Associate Director of Research Programs for the PDF, to summarize the recommendations emerging from the meeting. 

Go to Discussion

Immunotherapies in Parkinson's Disease

Date: February 2017
Authors: Howard E. Gendelman, MD, Martin Ingelsson, Vladimir Kostić, MD, PhD, Leonidas Stefanis, MD, PhD
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD
 

The relationship of the immune system to the pathogenesis of Parkinson’s disease (PD) and in particular to alpha-synuclein (α-syn) has been the focus of intense research efforts over many years.The relationship of the immune system to the pathogenesis of Parkinson’s disease (PD) and in particular to alpha-synuclein (α-syn) has been the focus of intense research efforts over many years.  This relationship has come recently to the forefront of interest of the PD community, as the first clinical trials in PD using immunization strategies against α-syn have commenced.  The apparent encouraging results from similar strategies targeting beta-amyloid (Aβ) in Alzheimer’s disease (AD) have spurred the interest further, and beyond to different strategies for immunologic therapies in PD. We have asked two experts in the field – Drs. Howard Gendelman and Martin Ingelsson – to comment on these issues.  Dr. Vladimir Kostić has provided an additional commentary from a clinical perspective.  Go to Discussion.

What Do Single Gene Mutations Really Tell Us About What Goes Wrong in Idiopathic PD?

Date: December 2016
Authors: Leonidas Stefanis, MD, PhD; Thomas Gasser, MD; Roger Barker, MBBS, MRCP, PhD
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD
 

MDS Blog: What do single gene mutations really tell us about what goes wrong in idiopathic Parkinson’s disease?Over the last 20 years there has been considerable progress in deciphering the genetic underpinnings of Parkinson’s disease (PD).  This has led to new insights into PD pathogenesis, the generation of new animal models of the disease, the implementation of experimental therapeutics in such models, and, recently, the design and initiation of clinical trials with potentially neuroprotective agents.  We have asked Drs. Thomas Gasser and Roger Barker to comment on the continuing progress in this field, and how it is shaping our views on Parkinson’s disease pathogenesis and treatment. Go to Discussion

Psychogenic Movement Disorders in the News and on the Internet

Date: January 2017
Authors: Mark Edwards, MD, Mark Hallett, MD, Susan Jeffrey, Executive Editor, Medscape Neurology
Blog Editors: Susanne A. Schneider, MD, Michael S. Okun, MD, and Stella M. Papa, MD

Online medical news is becoming a go-to for those looking for answers to their health problems.The Internet serves as an incredible source of information. Almost any subject imaginable can be found on search engines. More recently, a plethora of social media tools have been developed and led to a change in our communication. We not only send text messages or use instant messenger with personal friends or family; in addition people tweet, post messages on blogs and upload videos in order to reach millions of people. Their implementations are seemingly boundless. These tools have transformed and morphed into the medical profession. On the one hand, patients find useful (and sometimes less useful) information on the Internet about their disease and treatments; on the other hand, we see patients upload private medical information onto the net sharing their stories with others. These two scenarios have positive and negatives associated with them. Go to Discussion

Inflammation in Parkinson's Disease

Date: March 2016
Authors: Malú Tansey, MD, David Sulzer, MD, and David Standaert, MD, PhD
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD
 

Understanding the role of inflammation in Parkinson’s disease (PD) has attracted a large amount of interest in recent years.Understanding the role of inflammation in Parkinson’s disease (PD) has attracted a large amount of interest in recent years. Studies have identified various cellular and molecular components of the immune responses that seem to contribute to the pathology associated with α-synuclein accumulation. We asked Drs. Malú Tansey and David Sulzer to comment on the progress made on characterization of the inflammatory responses that are activated in PD, and on identification of potential targets for neuroprotection. Also we asked Dr. David Standaert to conclude by providing his expert opinion on the significance of these advances for PD therapy.
Go to Discussion

Role of Physical Therapy and Exercise in Management of Parkinson's Disease

Date: October 2016
Authors: Tanya Simuni, MD, Connie Marras, MD, PhD, and Terry Ellis, PhD, PT, NCS
Blog Editors: Michael S. Okun, MD, and Stella M. Papa, MD
 

There are a growing number of randomized controlled trials and meta-analytic studies supporting the benefits of physical therapy and exercise in the treatment of Parkinson’s disease.Current pharmacological management is incompletely effective at controlling the symptoms of Parkinson’s disease and patients are often seeking complementary approaches.  Exercise is a compelling strategy since recent evidence suggests both physical and cognitive benefits and, relative to many pharmacological therapies, it is inexpensive. Go to Discussion
 

Comments on this Blog Post

Title:
syncope in parkinsonism
By:
shakya bhattacahrjee
Date:
May-30-2017  6:39:40 PM
Comment:

You are right. Classically autonomic dysfunction like cardiac dysfunction, urinary symptoms respiratory symptoms or postural hypotension are late presentations of Idiopathic PD. Syncpe or autonomic features at early stage ( within 2 years of symptoms) are more suggestive of atypical parkinsonism especially MSA. Having said that constipation , an autonomic symptom can predate PD by a decade.In your patient, if the diagnosis is Idiopathic PD then syncope was coinicdental.

Title:
Syncope as a presentation for Parkinson's
By:
Audrey Yee
Date:
April-27-2017  4:16:11 PM
Comment:

My understanding of autonomic dysfunction in Parkinson's is that it is a relatively late finding. Is that correct?

For example, in a 58 yo patient with Stage III-IV Parkinson's (treated with sinemet, neupro, botox for dystonia) would two episodes of syncope (one at medical procedure) at age 30 be presenting features Parkinson's or just independent issues of syncope?

The Parkinson's was diagnosed at age 50--with initial symptoms of right UE tremor,

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