September 2011

Dr. Randolph Stephenson, Neurologist
Contact info:
Neurology Center of Fairfax
(703) 876-0800
3020 Hamaker Court, Suite #100, Fairfax, VA 22031
1830 Town Center Dr., Suite ## 305, Reston, VA 20190
http://neurologycenteroffairfax.com

Non-Motor Symptoms and Parkinson’s

Pain
Not always considered a part of PD.
Includes constant pain, cramps, dystonia (including foot and hand cramps), restless legs syndrome (RLS)
akathisia – inner restlessness
Neuropathy can cause burning, numbness and tingling.
What can help? Dopamine agonists, Levadopa help sometimes. Botox can help pain dystonia related pain

Bladder
Very common issue. Includes frequency, urgency, nocturia.
It’s important to determine if it’s due to aging or PD. Get urological testing to make sure it’s not due to something else that’s treatable.
Prostate issues affect bladder.
Incontinence is not typical of PD.
What can help? Ditropan, decrease fluid intake

Postural Hypotension
A drop in blood pressure upon standing causing one to feel faint, dizzy, weak or experience blurred vision.
Could be caused by overmedication, after eating (not enough blood going to the brain) and by dopaminergic medications.
What can help? increase fluid and salt intake, be careful standing up

Constipation
Almost universal with people living with PD.
Can be one of THE firsts signs of PD and develop years before.
Multiple factors: dehydration, immobility, medications (Sinemet, Requip, Mirapex)
Stalevo can cause diarrhea
Rancho Recipe (by Dr. Cheryl Waters) to help with constipation:
1 cup each of bran, apple sauce, prune juice. Take 2 tablespoons every morning.
What can help? exercise, hydration, fiber

Skin Conditions
Seborrheic dermatitis – red flakiness often on the face. Wash with dandruff shampoo.
Melanoma – More common in people living with PD. Not sure why but it’s not due to PD medications. Check with your dermatologist 1-2 times a year.
Excessive sweating – can be an “off” symptom if it’s like a sudden drenching. Can occur with dyskinesias. Dopamine agonists are sometimes helpful.
Drooling – Possible causes are because not enough extra saliva is being produced or not swallowing as effectively as possible. Chewing gum can help with drooling.

Sleep
Includes sleep fragmentation (caused by tremor, difficulty turning in bed, nocturia), sleep apnea, RLS, REM sleep behavior disorder (acting out dreams – not normal with aging). depression.
Studies show 50-60% of people with REM sleep behavior disorder go on to have PD but it is easily treatable.
Fatigue – can be caused by PD, poor sleep, medications (e.g. after taking Sinemet or Stalevo) and mood issues A sleep specialist can help to find the cause.

Mood
Is rarely addressed in the office. Anxiety is more common than depression.
Fairly easy to treat.
May predate physical symptoms.
People can lose the novelty seeking aspect to their personality and show a lack of interest in trying new things. This isn’t necessarily depression

Weight loss and PD
If there is unexplained weight loss FIRST check with your primary care physician, and follow-up with annual tests if the weight loss continues.
Possible PD-related causes: Sinemet can affect appetite and cause nausea. Dyskinesias can contribute to weight loss and sweating

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