Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Are Symptoms Of Parkinson's Disease?
Question: Respected Doctor,
I would like to discuss with you my grandmother's case which is worrying us a lot and finding no proper treatment and solution, your name finally came up as one of the best neurologists. Thus, I am herewith explaining you her condition and would be highly grateful and thankful if you could give us a valuable insight into her condition.
Case History:
My grandmother XXXX 78 yrs old, was diagnosed with Idiopathic Parkinsonism last year in the month of February. Since then she has been on T. Syndopa Plus, 3 times a day i.e morning, afternoon and night after food.
Before one month she was walking with the help of a walker, was able to go to the washroom by herself and was able to do other small activities. While walking she had difficulty in initiating her steps but once when she started it was a short and shuffling gait. Her body has become stooped and she is not able to write properly anymore i.e the letters become small and trails off. She has a stammering speech, though she does not have tremors or rigidity. Her movements are extremely slow and she has an extreme fear of falling on getting up and walking.
Recently we consulted a Dr. S. XXXXXXX XXXXXXX DM Neurology in XXXXXXX as we are based in XXXXXXX He ruled out Parkinson's Disease and said that my grandmother was suffering from disturbance of gait. He asked her to taper T. Syndopa Plus, from 3 to 2 to 1 and then completely stopping it and asked her to continue other medications and start T. Lonazep (0.25) in the night.
But after a week of tapering T. Syndopa Plus, her condition has gone from bad to worse. She is now not being able to get up from the bed, leave alone walking or going to the wash room. Seeing her condition we called up the same doctor and he asked her to take T. Syndopa Plus twice a day, in the morning and night. We have started the same but are very perplexed and confused. She is having extreme pain in both her knees and they have become slightly bent. She has momentary relief from the pain on taking an analgesic but the pain is there throughout the day and is extreme in the morning. We are planning on consulting an Orthopedic surgeon for the same.
Past History:
She has a H/O Hypertension, H/O Hypothyroidism (on medication T.Eltroxin 100mcg), H/O Recurrent UTI, H/O OA knee and lumbar Spondylosis (degenerative changes in L5 spine), H/O Anemia and H/O Hernia for which she was not operated.
Current Medication:
T. ELTROXIN 100mcg 1-0-0
T. Pan 40mg 1-0-1
T. Syndopa Plus 1-0-1
T. CCM 1-0-0
T. Amantrel 100 1-0-1
T. Kondro OD 1-0-0
T. Corcium- D3 1-0-0
T. Lonazep 0.25 0-0-1
Latest Investigations:
Hb - 8.7
total RBC count - 2.9
PCV - 27.8
MCV - 94.2
MCH - 29.5
MCHC - 31.3
Total WBC Count - 6500
RDW - 16.3
Platelets - 2.38
ESR - 38
HbA1C - 5.8
T3 - 73
T4 - 8.9
TSH - 2.50
ALP - 123
GGT - 11
SGOT - 15
SGPT - 10
Protein total - 6.9
albumin serum - 4.2
serum globulin - 2.7
ratio - 1.56
BIL TOTAL - 0.42
BIL DIRECT - 0.13
BIL INDIRECT - 0.29
CALCIUM - 8.2
PHOSPHOROUS - 3.9
TOTAL CHOLESTEROL - 139
HDL - 56
LDL - 66
TRIG - 71
LDL/HDL - 1.2
BUN - 10.4
CREAT - 0.83
URIC ACID - 5.69
VIT D, 25 Hydroxy - 9.6
IRON - 34
TIBC - 299.67
MRI BRAIN :
There are confluent as well as discrete hyperintense foci in white matter of both cerebral hemispheres in FLAIR & T2 weighted images appearing isointense in T1 weighted images. Cortical sulci, Sylvian Fissures, both lateral and III ventricles are widened.
Remaining parenchyma of both cerebral hemispheres, basal ganglia, thalami, internal capsules, corpus callosum, brainstem & cerebellum otherwise show normal morpho;ogy nadf signal characteristics. Both cerebello-pontine angles are clear. IV ventricle and basal cisterns are normal. Pituitary gland and para-sellar regions do not show any significant abnormality. No lesion with restricted diffusion is seen in the brain in diffusion weighted images.
IMPRESSION: Above findings are suggestive of ischaemic gliosis in white matter of both cerebral hemispheres with cerebral atrophy. There is no acute infarct.
Dear doctor I would be very glad if you could help us out in any way possible by telling us whether she is suffering from Parkinson's or not. And if she is then is the medication correct and is there any possibility of surgical correction by deep brain stimulation etc.
We will be eagerly waiting fir your response.
Thank You
Yours Sincerely
XXXX
I would like to discuss with you my grandmother's case which is worrying us a lot and finding no proper treatment and solution, your name finally came up as one of the best neurologists. Thus, I am herewith explaining you her condition and would be highly grateful and thankful if you could give us a valuable insight into her condition.
Case History:
My grandmother XXXX 78 yrs old, was diagnosed with Idiopathic Parkinsonism last year in the month of February. Since then she has been on T. Syndopa Plus, 3 times a day i.e morning, afternoon and night after food.
Before one month she was walking with the help of a walker, was able to go to the washroom by herself and was able to do other small activities. While walking she had difficulty in initiating her steps but once when she started it was a short and shuffling gait. Her body has become stooped and she is not able to write properly anymore i.e the letters become small and trails off. She has a stammering speech, though she does not have tremors or rigidity. Her movements are extremely slow and she has an extreme fear of falling on getting up and walking.
Recently we consulted a Dr. S. XXXXXXX XXXXXXX DM Neurology in XXXXXXX as we are based in XXXXXXX He ruled out Parkinson's Disease and said that my grandmother was suffering from disturbance of gait. He asked her to taper T. Syndopa Plus, from 3 to 2 to 1 and then completely stopping it and asked her to continue other medications and start T. Lonazep (0.25) in the night.
But after a week of tapering T. Syndopa Plus, her condition has gone from bad to worse. She is now not being able to get up from the bed, leave alone walking or going to the wash room. Seeing her condition we called up the same doctor and he asked her to take T. Syndopa Plus twice a day, in the morning and night. We have started the same but are very perplexed and confused. She is having extreme pain in both her knees and they have become slightly bent. She has momentary relief from the pain on taking an analgesic but the pain is there throughout the day and is extreme in the morning. We are planning on consulting an Orthopedic surgeon for the same.
Past History:
She has a H/O Hypertension, H/O Hypothyroidism (on medication T.Eltroxin 100mcg), H/O Recurrent UTI, H/O OA knee and lumbar Spondylosis (degenerative changes in L5 spine), H/O Anemia and H/O Hernia for which she was not operated.
Current Medication:
T. ELTROXIN 100mcg 1-0-0
T. Pan 40mg 1-0-1
T. Syndopa Plus 1-0-1
T. CCM 1-0-0
T. Amantrel 100 1-0-1
T. Kondro OD 1-0-0
T. Corcium- D3 1-0-0
T. Lonazep 0.25 0-0-1
Latest Investigations:
Hb - 8.7
total RBC count - 2.9
PCV - 27.8
MCV - 94.2
MCH - 29.5
MCHC - 31.3
Total WBC Count - 6500
RDW - 16.3
Platelets - 2.38
ESR - 38
HbA1C - 5.8
T3 - 73
T4 - 8.9
TSH - 2.50
ALP - 123
GGT - 11
SGOT - 15
SGPT - 10
Protein total - 6.9
albumin serum - 4.2
serum globulin - 2.7
ratio - 1.56
BIL TOTAL - 0.42
BIL DIRECT - 0.13
BIL INDIRECT - 0.29
CALCIUM - 8.2
PHOSPHOROUS - 3.9
TOTAL CHOLESTEROL - 139
HDL - 56
LDL - 66
TRIG - 71
LDL/HDL - 1.2
BUN - 10.4
CREAT - 0.83
URIC ACID - 5.69
VIT D, 25 Hydroxy - 9.6
IRON - 34
TIBC - 299.67
MRI BRAIN :
There are confluent as well as discrete hyperintense foci in white matter of both cerebral hemispheres in FLAIR & T2 weighted images appearing isointense in T1 weighted images. Cortical sulci, Sylvian Fissures, both lateral and III ventricles are widened.
Remaining parenchyma of both cerebral hemispheres, basal ganglia, thalami, internal capsules, corpus callosum, brainstem & cerebellum otherwise show normal morpho;ogy nadf signal characteristics. Both cerebello-pontine angles are clear. IV ventricle and basal cisterns are normal. Pituitary gland and para-sellar regions do not show any significant abnormality. No lesion with restricted diffusion is seen in the brain in diffusion weighted images.
IMPRESSION: Above findings are suggestive of ischaemic gliosis in white matter of both cerebral hemispheres with cerebral atrophy. There is no acute infarct.
Dear doctor I would be very glad if you could help us out in any way possible by telling us whether she is suffering from Parkinson's or not. And if she is then is the medication correct and is there any possibility of surgical correction by deep brain stimulation etc.
We will be eagerly waiting fir your response.
Thank You
Yours Sincerely
XXXX
Brief Answer:
Diagnosis needs to be established first.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the clinical details of your grandmother. As of now, we are still in the stage of diagnosis. Her correct diagnosis needs to be established before we plan on the best line of treatment.
Parkinson's disease (PD) is a clinical diagnosis and the diagnosis is straight-forward in more than 95% of cases. If a person has tremors of hands, predominantly affecting one side of body, associated with slowness of movements and rigidity of hands/legs, then, we are confident in making a diagnosis of PD.
In the absence of tremors, we should be cautious in making a diagnosis of PD, as it could be multi-system atrophy (MSA).
In your grandmother, features favouring PD are slowness, change in handwriting, shuffling gait and stooped posture. Response to levodopa is also a feature for PD.
Rapid progression of symptoms to a stage of inability to get up/walk within a year of onset of symptoms is against a diagnosis of PD. Most patients with PD remain XXXXXXX even after 10 years of onset.
To sort out the diagnosis, we need to examine her without and with medications (levodopa). A good and definite improvement of symptoms with levodopa would be in favour of PD.
After that, a PET-CT brain may be done, if still there is doubt in the diagnosis.
As of now, she should be managed with medications, and DBS is not needed at present.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Diagnosis needs to be established first.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the clinical details of your grandmother. As of now, we are still in the stage of diagnosis. Her correct diagnosis needs to be established before we plan on the best line of treatment.
Parkinson's disease (PD) is a clinical diagnosis and the diagnosis is straight-forward in more than 95% of cases. If a person has tremors of hands, predominantly affecting one side of body, associated with slowness of movements and rigidity of hands/legs, then, we are confident in making a diagnosis of PD.
In the absence of tremors, we should be cautious in making a diagnosis of PD, as it could be multi-system atrophy (MSA).
In your grandmother, features favouring PD are slowness, change in handwriting, shuffling gait and stooped posture. Response to levodopa is also a feature for PD.
Rapid progression of symptoms to a stage of inability to get up/walk within a year of onset of symptoms is against a diagnosis of PD. Most patients with PD remain XXXXXXX even after 10 years of onset.
To sort out the diagnosis, we need to examine her without and with medications (levodopa). A good and definite improvement of symptoms with levodopa would be in favour of PD.
After that, a PET-CT brain may be done, if still there is doubt in the diagnosis.
As of now, she should be managed with medications, and DBS is not needed at present.
I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.
Wishing you good health,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear doctor, thank you for your reply. I would like to ask you whether we should give levodopa twice or thrice a day? We have seen that upon decreasing the dose her condition seems to worsen and on increasing she seems a little better. Again should we do a PET CT? and what is the use of giving T.lonazep, how is it going to affect her?
I know you said that we are still in the stage of diagnosis but what would you favor?
I know you said that we are still in the stage of diagnosis but what would you favor?
Brief Answer:
Levodopa should be used thrice daily
Detailed Answer:
Thank you for getting back.
As of now, we can give her levodopa three times daily, as she feels better with that. The decision about the number of doses is purely based on the clinical judgement (benefits versus any side effects).
Lonazep (clonazepam) is a medicine used for treating anxiety and sleep disturbance. In rare cases, we can also use it for tremors and myoclonic jerks. Based on the history provided, she does not have any of these, and lonazep may be avoided.
PET-CT may be postponed as it is only for diagnosis. More important is the clinical examination by a competent neurologist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Levodopa should be used thrice daily
Detailed Answer:
Thank you for getting back.
As of now, we can give her levodopa three times daily, as she feels better with that. The decision about the number of doses is purely based on the clinical judgement (benefits versus any side effects).
Lonazep (clonazepam) is a medicine used for treating anxiety and sleep disturbance. In rare cases, we can also use it for tremors and myoclonic jerks. Based on the history provided, she does not have any of these, and lonazep may be avoided.
PET-CT may be postponed as it is only for diagnosis. More important is the clinical examination by a competent neurologist.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
