Migraine Headaches: Types, Triggers and Treatments

Wednesday, June 25, 2014 2:48 PM comments (0)

migraine blogHeadaches can be more than just a pain; they can make work and day-to-day activities feel impossible. Headaches and migraines are as different as the individuals who experience them and the key to treating them is proper diagnosis.

Steven Meyers, MD, Neurologist and Headache Specialist at NorthShore, discusses common headache and migraine triggers and some treatment options that might help take the pain away:

How do you determine the cause of a migraine?
Many patients search for "the cause" when in fact most of the time there is no single cause. We believe migraine is a genetic disorder, meaning the tendency to experience migraine is passed down in your genes. Everyone wants a simple fix. If they can find the one thing to avoid or eliminate, they can eliminate their headaches but that rarely happens.

Migraine is a chronic illness and like all other chronic illnesses, the severity can vary from person to person. Treatment must be individualized to the specific patient, taking into account their individual desires regarding treatment options. I recommend always starting with your primary care physician. Schedule an appointment to discuss your headaches specifically. Don't wait for a yearly physical or when seeing your doctor for something else. If you cannot get the information you need then ask for a referral to a headache specialist.

How can you figure out what type of headache you are experiencing?
Proper diagnosis is essential for treatment. Your doctor should be able to make an appropriate diagnosis. If uncertainty persists, then you should see a headache specialist. Migraine, tension and cluster are the three most common primary headache disorders. Primary means no underlying cause, such as a tumor, aneurysm or other disorder, can be pinpointed as the cause of the headache.  Doctors have specific features and there are well-established criteria for making specific diagnoses. I cannot emphasize enough the importance of making a specific headache diagnosis. If your doctor cannot tell you the type of headache you have, get a second opinion.

Is there any evidence that migraines are genetic?
Yes. As I briefly mentioned earlier, migraine is definitely a genetic disorder. Most persons with migraine have a positive family history. In rare cases, specific genetic abnormalities can be tested for, but in the vast majority of migraine sufferers we don’t yet know what the genetic abnormality is.

What are some common migraine triggers?
There are many possible triggers and no two patients are the same. Why one trigger brings on a migraine in one person but not another is not known. Common triggers can include certain foods, though this has become somewhat controversial, with some recent studies questioning food as a trigger.

Alcohol, particularly red wine and beer, are common triggers. Missing meals, alteration in normal sleep patterns (too much or too little), weather changes, stress, and hormonal changes in women during the menstrual cycle are all possible triggers.

It is also important to keep in mind that triggers are rarely all or none. This means that a trigger may not trigger a migraine every time the patient is exposed; it may only happen every other or every third time. This makes identifying these triggers even more difficult.

What can you do about triggers that aren’t controllable, like weather and hormones?
In general I divide triggers into those you can control and those you can’t, like weather. Hormonal changes are potentially treatable but this can be tricky and there are pros and cons of pursuing this approach. Avoiding those triggers that are preventable could be helpful. When that is not sufficient, it’s time to speak to your doctor. If migraines occur frequently enough, then there are medications that can help prevent them or at least reduce the frequency of attacks.

What can a migraine sufferer do to shorten the duration of a migraine?
There are many options to treat migraine attacks. We refer to this type of treatment as abortive therapy. There are migraine-specific medications that we prefer to use. When these medications can’t be used for a specific reason or if they don’t work for a specific patient, we may prescribe other types of pain medications and/or anti-nausea medication. Some patients find relaxation, massage, or the use of ice or heat beneficial as well. Sleep, when possible, can also shorten the duration of an attack.

Is this normal to experience headaches at certain times of day, particularly in the morning?
Some patients do get headaches at very specific times of the day; however, it’s important that the type of headache be correctly diagnosed in order to come up with an appropriate treatment plan. Treatment of migraines that wake someone from sleep depends in part on how often this happens and under what circumstances. Sometimes a preventative medication at bedtime might be appropriate. 

Are there any new medications for migraines with minimum side effects?
Truthfully there is not much new out there at present. There are some very exciting new medications that we hope to see on the market in the not-too- distant future but drug development and research can be frustratingly slow. All medications have side effects, which vary greatly from person to person. There is some evidence that migraine sufferers are particularly prone to drug side effects and many persons will need to try a variety of medications before finding what works for them.

Are feverfew and butterbur effective herbal treatments for migraine prevention?
Feverfew and butterbur are two plant-based supplements available without a prescription. They both have been used for decades, particularly in Europe, to prevent headaches. They both have been studied in good scientific research trials in the U.S. and both have been found to be effective, safe and with few potential side effects. Overall, they tend not to be as effective as prescription medications in my experience but can be beneficial in certain persons and do tend to have fewer side effects.

The main problem is finding out what dose to use, as every supplement may be different in terms of strength and purity. Additionally, there are potential interactions with other medications. I would definitely recommend speaking to your doctor before starting any treatment.

What are your thoughts on combining acupuncture and chiropractic adjustments with conventional treatments from a neurologist for migraines?
Both acupuncture and chiropractic treatments have been studied and found to be helpful in some individuals with migraine. I have many patients who use these therapies and find them helpful either alone or in combination with "conventional" treatments.

When suffering from a headache, does consuming a little caffeine help a headache or make it worse? Any other recommendations, suggestions or treatments do you have to help ease the pain of a migraine headache?
Caffeine is interesting. Consuming caffeine can be helpful.  Several common headache medications add caffeine to make them more effective. Many patients will drink some coffee or cola along with whatever medication they take when they get a headache. However, the frequent/regular use of caffeine can actually cause headache or make headaches worsen over time. 

If you use a medication that contains caffeine such as Excedrin, be careful to follow the directions very carefully. These medications should not be used more than 1-2 days per week. I usually recommend that frequent headache sufferers limit caffeine consumption to the equivalent of 2-3 cups of coffee per day. Short of medication, some patients use relaxation therapy, biofeedback, ice, heat or sleep to treat migraine attacks.

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Parkinson's Disease Research at NorthShore Strives to Lead to Better Patient Outcomes

Friday, April 11, 2014 1:11 PM comments (0)

parkinsons

As part of National Parkinson’s Disease Awareness Month, Demetrius Maraganore, MD, Chairman of Neurology at NorthShore, shared some of the findings of his ongoing research into the genetic factors that influence Parkinson’s disease progression and outcomes. He also tells us why research like this is so important for Parkinson’s disease patients and their families: 

Why is funding for and research into Parkinson’s disease so important? 
It’s important because the treatments that we have available don’t prevent Parkinson’s disease (PD) or slow or halt its progression.  PD is characterized by progressive motor and cognitive impairment.  PD patients have a seven-fold increased risk of nursing home placement and a two-fold increased risk of death.  The annual cost of PD in the U.S. exceeds $23 billion. Presently 2% of people will develop PD during their lifetime, and the prevalence of PD is expected to double by 2030. The cumulative burden of PD to society is and will be staggering.  Our patients and their families deserve methods to predict, prevent and halt PD and those will only come through research.

How long have you been conducting research into Parkinson’s disease?  
My research in Parkinson’s disease (PD) started in 1989, when I was an honorary clinical and research fellow to the late Professor C. David Marsden at the National Hospital for Neurology and Neurosurgery in London, England.  Dr. Marsden was the founder of the international Movement Disorders Society and its official journal, Movement Disorders.  His associate, Professor Anita Harding, was a pioneer in the field of neurogenetics.  Together, we launched the first genetic studies of Parkinson’s disease.  

That has remained the focus of my research, including for 20 years on the faculty of the Mayo Clinic in Rochester, MN, and in the four years that I have been Chairman of Neurology at NorthShore. While my research at Mayo focused on identifying genetic factors that contribute to the cause of PD, my research at NorthShore has focused on understanding how those genetic factors influence disease progression and outcomes.  Our research aims to develop methods to predict outcomes in PD, and to use that information to improve neurological health.

Why have you focused the bulk of your career on the study and treatment of Parkinson’s?  
As a clinician, it’s very gratifying that there are many treatments that we can employ in the first many years to reduce the burden of the disease on patients and families.  However, I recognize that the benefits of the existing treatments wane with time, and I’m driven by the sense of urgency to identify the factors that contribute to the progression of Parkinson's disease. Our goal is to target those factors so that every individual patient can have the best possible outcome. 

For more information on the NorthShore Neurological Institute and the research being done at NorthShore, click here. 

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It’s Nap Time

Friday, March 07, 2014 11:22 AM comments (0)

nappingA lack of sleep can leave you feeling groggy and foggy all day, impairing your ability to focus on work and even retain information. That’s not all; lack of sleep also decreases libido, ages skin and can inhibit your ability to lose weight. Chronic sleep deprivation—regularly forgoing the recommended 7 to 8 hours or due to other sleep disorders—can have serious consequences on your health, including increased risk for heart disease, heart attack, stroke, high blood pressure, diabetes and depression. In other words, maintaining good sleep habits is an essential part of a healthy lifestyle. And, unfortunately, most of us aren't doing that. 

If done correctly, there is great power in a well-timed nap. While you should not rely on naps to repair the damage done by inadequate sleep or chronic sleep deprivation, naps can recharge your energy levels and improve your mood. The key is to time them just right. Short naps are preferable. Longer naps may be taken on occasion to make up for an occasional lapse in sleep schedule.

Thomas Freedom, MD, Neurologist and Program Director of Sleep Medicine at NorthShore, breaks down nap time to help you achieve maximum benefits from a little daytime shuteye:

10 to 20 minutes. Often called the “power nap,” this short rest period is a great way to recharge your personal energy battery, boosting alertness and increasing your midday focus. Keep your power naps to 10 to 20 minutes because you’ll stay in lighter stages of non-rapid eye movement (NREM), which means you won’t wake up feeling groggy and can get right back to work feeling refreshed. Also try to take the nap early in the afternoon.

30 minutes or more. Word of warning: Naps longer than 20 minutes could leave you with sleep inertia, or grogginess that can last up to 30 minutes after waking. If you need to be back on your feet right away, keep your nap to less than 20 minutes. Otherwise, after the fog wears off, you’ll enjoy the same restorative benefits of the power nap.

60 minutes. If you find yourself forgetting information halfway through your day, 60 minutes of shuteye might be able to help. A nap between 30 and 60 minutes will get you to slow-wave sleep, which can help improve your decision-making skills and recollection of information. You’ll need to give yourself a little recovery time after an hour nap, as the effects of sleep inertia could be more pronounced. There is a possibility that a nap of this length could also disrupt your sleep at night.

90 minutes. A 90-minute nap gives you a full sleep cycle—from the lighter stages of sleep all the way to REM (rapid eye movement). A nap of 60 to 90 minutes can improve decision-making skills and even enhance creativity. At this length, make sure to nap with care. You don’t want to disrupt your regular sleep schedule or keep yourself up at night by napping too long during the day. Sleep inertia may also be more of an issue.

Do you take day-time naps to boost your energy levels?

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Mind Games: Your Brain Needs a Good Workout, Too

Friday, November 22, 2013 1:08 PM comments (0)

mind exercisesEveryone knows your body needs exercise to stay in peak shape. But did you know your brain does too? Physical exercise is essential to the health of both your body and brain, but you can do even more to keep your brain in shape. Challenging your brain with cognitive exercises is another great way to keep your mind sharp.

Chad Yucus, MD, Neurology at NorthShore, answers questions and shares some ways to give your brain the workout it needs to stay sharp at any age:

Do brain teasers and puzzles actually help to keep your mind sharp? Are certain types of puzzles and activities better than others?
There are many types of cognitive activities that help to keep the brain sharp, involving word games and number games, such as crossword puzzles, Sudoku, computer games and board/card games.  There is no strategy that is particularly better than another, but learning a new hobby, game and/or language is a good way to keep the brain sharp.

Why would a new hobby be helpful?
Learning a new skill or starting a new hobby that requires skills you don’t typically use can be helpful because it challenges you to keep learning and function in a way that is not familiar. It’s a great way to stay mentally active whatever your age.

Who benefits from cognitive exercises and activities?
Everyone. 

How do you keep your brain healthy to prevent memory loss?
There is no strategy to truly prevent memory loss, but there are strategies to delay the effects of any pathology (changes caused by disease) that may be developing in the brain.  This is based upon building a cognitive reserve before any problems begin to develop. These strategies include the cognitive exercises above, physical exercise, social activities—spending time with friends, planning events—regular sleep patterns and a low-cholesterol Mediterranean diet.  

How much time should you devote each day to cognitive exercise?
Think of it in terms of regular physical exercise. Your brain and the rest of your body need about the same each day, approximately 30-60 minutes of cognitive and physical exercise every day is a good place to start.

How do you exercise your brain?

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The Importance of Sleep to a Healthier You

Friday, May 24, 2013 10:48 AM comments (0)

sleepThe importance of a good night’s sleep can’t be overstated and not getting enough can lead to more than simply waking up on the wrong side of the bed.  Prolonged sleep deprivation can raise your risk for serious health problems like heart disease, diabetes and high blood pressure. Sleep isn’t a waste of time; it’s an investment in your health.

The benefits of sleep are many. According to Thomas Freedom, MD, Neurologist and Program Director of Sleep Medicine at NorthShore, a good night’s rest can improve:

  • Your smarts. Sleep is essential to critical thinking and learning. Losing out a night’s rest impairs these processes, affecting attention span, problem-solving skills and alertness. Prolonged sleep deprivation takes a toll on long-term memory, too. It’s during your deepest sleep that the brain does its housekeeping, storing and consolidating learned information and long-term memories.
  • Your happiness. One sleepless night is depressing but multiple sleepless nights might be a symptom of depression. Insomnia and sleep disorders are strongly linked to depression and prolonged sleep deprivation can aggravate already existing symptoms of depression. Studies have shown that people diagnosed with depression were far more likely to sleep less than six hours a night.
  • Your looks. It turns out the fountain of youth isn’t a fountain at all. The key to healthy, youthful skin is plenty of rest. When you don’t get enough sleep, the body releases increased amounts of the stress hormone cortisol and excess cortisol can break down skin collagen— the protein responsible for supple, line-free skin. 
  • Your health. Chronic sleep deprivation is a contributing factor in a number of serious health problems, including heart disease, diabetes and high blood pressure. Those who regularly fail to get enough sleep are at a higher risk for heart attack, stroke and heart failure. Lack of sleep can also add to your waistline. Sleep loss is linked in an increase in appetite and cravings for high-carbohydrate and high-fat foods.
  • Your sex life. If the mood never strikes, your sleep schedule could be to blame. Sleep-deprived men and women often report less interest in sex. Lack of sleep leads to lower energy levels, higher stress levels and fatigue, which all have a negative effect on libido. To spend more time in the sack, spend more time in bed.

Remember that the amount of sleep required varies with each individual, but most adults need approximately 7-8 hours a night. 

Do you think you get enough sleep each night? Do you make sleep a priority?

 

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Parkinson's Disease: Symptoms and Progression

Thursday, April 25, 2013 11:32 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD, and Ashvini Premkumar, MD

symptomsIs it possible to detect PD before symptoms begin?

There is no established method of detecting Parkinson’s disease before symptoms begin.  Because patients with Parkinson’s disease may lose their sense of smell decades before the onset of their movement disorder, some investigators have explored the use of smell testing as a method of detecting Parkinson’s disease in at-risk subjects (e.g., persons who carry a rare gene mutation known to cause Parkinson’s disease). Persons can lose their sense of smell for many unrelated reasons though (e.g., following an upper respiratory infection, head trauma, or if they smoke). Loss of smell can precede other brain degenerations such as Alzheimer’s disease, so smell testing lacks the specificity needed for a predictive test.

A more promising approach is brain imaging using a radiopharmaceutical called DATSCAN. This is a compound that is injected into a vein and that binds to the endings of dopamine nerve cells in the brain. In Parkinson’s disease, dopamine nerve cells degenerate; hence, there is less binding of DATSCAN. The uptake and binding of DATSCAN can be measured using a single photon emission computerized tomogram or “SPECT” camera.  We are currently conducting a study at NorthShore to determine if persons with mild to moderate traumatic brain injury, who are at an 11-fold increased risk for Parkinson’s disease, have lower DATSCAN binding than persons without a history of brain injury. This study would demonstrate that it’s possible to detect Parkinson’s disease in at-risk subjects before symptoms begin. 

DATSCAN could prove useful as a method to develop asymptomatic Parkinson’s disease in at-risk subjects who could then be prescribed treatments or lifestyle changes that might delay or possibly even prevent the onset of Parkinson’s disease symptoms.  My research associate Dr. Ying Wu is also exploring the use of automated MRI brain measurements in the same brain injury population to see whether MRI may prove effective in detecting preclinical Parkinson’s disease changes in at-risk subjects.

Are PD symptoms or outcomes different between men and women? Between races?

My research collaborators and I have conducted several studies of gender differences in Parkinson’s disease. At every age men are 1.5 times more likely to develop Parkinson’s disease than women. We observed no convincing difference in survival for men and women with Parkinson’s disease. While there was no difference in motor outcomes, we observed that the risk for dementia was greater in men than in women with Parkinson’s disease. It's possible that estrogen protects against dementia in women.

My collaborators and I observed no important differences in the rates of Parkinson’s disease worldwide, and I’m not aware of any convincing data to suggest that symptoms of Parkinson’s disease or its outcomes differ according to race or ethnicity.

What are some of the later complications of Parkinson’s disease?

Typically we associate Parkinson’s disease with movement disorders. As the disease progresses, patients may develop balance difficulties that result in falls. As a result, patients become increasingly dependent on assistance in walking. For example, they may need a cane or a walker or someone to walk with them.  As the movement disorder progresses more, patients may be entirely unable to stand or walk even with assistance

Parkinson’s disease is not just a movement disorder though. About one in three patients develop a significant decline in memory and mental faculties, or what we call dementia.  Both falls and dementia are dreaded late complications of Parkinson’s disease because they are resistant to medical or surgical treatments and because they carry an increased risk for nursing home placement and even death. Predicting falls and dementia as late complications of Parkinson’s disease is a research priority of the Department of Neurology at NorthShore and a current focus of my research.

Is there a way to slow or halt the progression of PD?

There is no proven method of slowing or halting the progression of Parkinson's disease. Treatments that have been studied and that failed to provide evidence of neuroprotection are: selegiline, vitamins E and C, pramipexole, ropinerole, and COQ10.  There is some statistical evidence that carbidopa/levodopa therapy may slow motor progression in Parkinson's disease, but the benefits are trivial.

Azilect is being promoted as a neuroprotective agent, but it’s dubious because the beneficial effects were observed at smaller and not higher doses. The drug is also very expensive and prone to multiple drug-diet and drug-drug interactions. At best, the benefits are nominal. A recent medical advisory panel to the FDA voted 17 to 0 that Azilect should not be approved as a neuroprotective therapy in Parkinson's disease.

Inosine dietary supplementation, to increase blood uric acid levels, may be neuroprotective; however, it may also increase the risk for heart disease, stroke or dementia. There is some evidence that vitamin D deficiency is a risk factor for Parkinson's disease; however, there are no clinical trials to suggest that vitamin D therapy slows the progression of Parkinson's disease. Similarly, observational studies have suggested that non-steroidal anti-inflammatory drugs (NSAIDs) or cholesterol lowering medications (statins) are associated with a reduced risk for Parkinson’s disease, but clinical trials evidence of neuroprotection is lacking. There are some early clinical trials of the calcium channel blocker isradipine, which may have neuroprotective effects in animal models of Parkinson's disease. Though, the animal models of Parkinson's disease are not always informative, and some calcium channel blockers can actually cause reversible parkinsonism.

One big hope on the near horizon is therapies targeting the alpha-synuclein protein in Parkinson's disease, including a vaccine that is in early phase clinical trials.  However, while genetic studies have indicated that alpha-synuclein is neurotoxic prior to the onset of Parkinson’s disease symptoms, my research team recently provided genetic evidence that alpha-synuclein may be neuroprotective late in the disease process. So it’s unclear if therapies targeting alpha-synuclein in Parkinson’s disease will be effective and safe. 

Recent studies have suggested that exercise might slow the progression of Parkinson’s disease. Apart from exercise, I have no recommendations regarding neuroprotection at this time.

Once dementia starts is there anything that can be done to reduce the loss of memory?

There are certain “cognitive enhancing” medications that may be useful in improving cognitive symptoms and slowing the progression of dementia in patients with Parkinson’s disease. These include a class of drugs entitled cholinesterase inhibitors (rivastigmine, galantamine, donepezil). The Exelon patch in particular was specifically studied in Parkinson’s patients and obtained FDA approval for treatment of Parkinson’s related dementia. Memantine, an NMDA receptor antagonist, has been FDA approved for treatment of Alzheimer’s dementia; however, in clinical practice, it has also been found to be helpful in certain patients with Parkinson’s disease related dementia. In addition, nonpharmacological interventions including exercise, social stimulation, and cognitive rehabilitation can be helpful in the treatment of dementia in Parkinson’s disease.

Apart from genes, are there any environmental risk factors for PD? 

My research team was funded by the National Institute for Environmental Health Sciences for more than ten years to study both genetic and environmental risk factors for Parkinson’s disease. We found that pesticide exposure, both occupational and gardening-related, was associated with a two-fold increased risk for Parkinson’s disease. In particular, exposure to herbicides carried an increased risk. Of the herbicides recalled by our study subjects, the one most significantly associated with Parkinson’s disease was 2,4-Dichlorophenoxyacetic acid, a major component of Agent Orange. There have been reports that Vietnam War veterans are at an increased risk for Parkinson’s disease. Pesticides may contribute to an increased risk for Parkinson’s disease by causing the alpha-synuclein protein to misfold and form toxic accumulations within vulnerable nerve cell regions.

My research team also observed that head trauma may be a risk factor for Parkinson’s disease. A closed head injury that produced loss of consciousness or that required hospitalization was associated with an 11-fold increased risk for Parkinson’s disease.  Head trauma may contribute to an increased risk for Parkinson’s disease by causing an acute spike in alpha-synuclein levels.

While my research team observed no evidence for an interaction of pesticide exposures and alpha-synuclein gene variants, a research team from California recently reported an interaction of head trauma and alpha-synuclein gene variants in Parkinson’s disease. Currently, my research team at NorthShore is conducting a brain imaging study of mild traumatic brain injury to determine if there are Parkinson’s disease-like abnormalities in the brain scans of persons exposed to head trauma, even in the absence of symptoms of Parkinson’s disease. We will also consider the interaction of traumatic brain injury and alpha-synuclein gene variations in that study.

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Parkinson's Disease: Treatment

Tuesday, April 16, 2013 4:36 PM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Ashvini Premkumar, MD

treatmentWhat are the most effective medications for the treament of Parkinson’s disease?
The most effective medications for the treatment of Parkinson’s disease are the dopaminergic medications. Carbdiopa/levodopa is by far the most effective, followed by dopamine agonists and lastly mao-b inhibitors.  Non-dopaminergic medications include anticholinergics, which are sometimes useful for treatment of tremor but have to be used with caution because of the side effect profile, particularly in elderly patients.

What are the most common side effects of carbidopa/levodopa? 
The most common side effects for carbidopa/levodopa that we see clinically include: nausea/vomiting, lightheadedness, sleepiness, hallucinations, and dyskinesias.

Do you recommend the early use of carbidopa/levodopa? Delay its use?  
The early vs. delayed use of carbidopa/levodopa has been debated for many years.  The crux of the debate rests on the concern that early use of carbidopa/levodopa may increase one’s risk for motor complications, namely fluctuations (“on” and “off” periods) and dyskinesias. The risk is approximately 40 percent within four to six years, particularly among young patients. Whether or not to start carbidopa/levodopa has to be highly individualized decision, which will be based on many factors, including disease severity, age, co-existing symptoms (i.e. cognitive impairment) and occupational concerns.

Please discuss Neupro transdermal therapy
Neupro transdermal therapy, or the rotigotine patch, is dopamine agonist that is FDA approved for the treatment of Parkinson’s disease. It can be used in early Parkinson’s disease. It also can be used as an adjunctive medication in advanced Parkinson’s disease as it was shown in studies to reduce “off” time by roughly one hour a day. It has also been approved in the treatment of moderate to severe restless legs. The side effects include: nausea/vomiting, somnolence (sleep attacks), reactions at application site, dizziness, anorexia and compulsive behavior. The specific benefit of Neupro, like other extended-release dopamine agonists, is that it maintains as constant a level of drug as possible throughout the day.

Some say that exercise eases Parkinson's diease symptoms. What exercises or physical activities are recommended for people with Parkinson’s disease?
We recommend an exercise program that combines aerobic activity and core muscle strengthening. And this should preferably be complemented by exercises aimed at balance and stretching (i.e. yoga and Tai Chi). 

Is it safe to ride a bicycle with PD? 
This question needs to be routinely addressed by the patient’s treating neurologist. In general, in the early stages of PD, where balance is not significantly affected, it’s considered safe. However, once postural instability becomes noted, either by reported falls or upon routine examination, then it would be advisable to ride only stationary bicycles.

How can I prevent falls if I have PD? 
Prevention of falls should be emphasized at each clinic visit with one’s treating neurologist. The best way to prevent falls is to be educated as to what causes falls in Parkinson’s disease and then to take every precaution to avoid those “missteps.” 

 

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Parkinson's Disease: Deep Brain Stimulation

Tuesday, April 09, 2013 10:50 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Aikaterini Markopoulou, MD

What is DBS?
Deep brain stimulation is a type of surgical treatment for Parkinson’s disease. It involves the insertion of electrodes into specific areas of the brain that control movement. The electrodes are connected to a battery that is placed under the skin in the upper part of the chest. Electrical current that passes through the electrode stimulates these brain areas on one side of the brain. This stimulation results in improvement of tremor and slowness or stiffness on the other side of the body.

Who is a good candidate for DBS?
To be a candidate for DBS surgery a number of conditions have to be met:

  • A diagnosis of typical Parkinson’s disease that involves a combination of symptoms such as tremor, stiffness, slowness of movement or balance problems
  • Duration of disease symptoms for more than five years
  • Symptoms that respond well to treatment with levodopa
  • Presence of complications of levodopa therapy
  • Absence of dementia
  • No other diseases or conditions that significantly affect overall health (e.g., conditions that affect blood clotting, heart and lung disease, moderate to severe depression, pregnancy)

Is DBS covered by Medicare?
Yes, DBS is covered by Medicare.

When a patient has bilateral DBS is it necessary to have two stimulators, or will one suffice?
In the majority of Parkinson’s cases, symptoms affect both sides of the body; therefore, electrodes are inserted in both sides of the brain. In some cases where the symptoms affect mostly one side, the electrode can be inserted only in the opposite site of the brain.

If you have DBS, how does it affect your ability to get through airport checks, metal detectors, etc.?
Each patient is provided with an identification card that includes information about the implanted stimulator. The TSA agent should offer a private screening or screening with a manual wand instead of the patient walking through a metal detector.

What percentage of DBS surgeries result in complications? What complications might a patient encounter?
The DBS surgery may result in complications both during the implantation and after surgery, which include bleeding at the electrode insertion site that can be fatal, hardware malfunctioning, and infection and symptom worsening. In a large multicenter clinical trial, 7.5% of patients developed intracranial hemorrhage, 10.6% device-related infection and 8.1% one-sided weakness.

How long is DBS effective?
Studies that have followed patients for ten years have been published and the DBS remained effective throughout the ten-year interval.

Are there any long term risks associated with DBS?
DBS therapy remains a safe treatment option for Parkinson’s patients for at least ten years.

 

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Parkinson's Disease: Genetic Risk Factors, Family History and Research

Thursday, April 04, 2013 11:47 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD:


laboratoryAre the children of a parent with Parkinson’s disease likely to inherit the disease? Is there a greater risk if the father or the mother has the disease?

My research team conducted family studies that defined the risk of inheriting Parkinson’s disease. The children of Parkinson’s disease patients carry a two-fold risk for Parkinson’s disease. They are twice as likely to get Parkinson’s disease compared to the children of persons without Parkinson’s disease. However, one needs to consider that the lifetime risk for Parkinson’s disease in the general population is 2%, so the risk of Parkinson’s disease for the children of a patient is 4%, or twice the baseline risk for the general population. That’s a pretty low risk and I wouldn't recommend any specific lifestyle changes or preventive therapies for the children of patients with Parkinson’s disease.
 
That said, about 5% of Parkinson’s disease cases are due to an inherited gene abnormality (mutation). In families where multiple members have Parkinson’s disease, the risk may be as great as 50% to the children of an affected person. When there are multiple family members with Parkinson’s disease, I refer patients for genetic counseling and in some instances we also perform genetic testing. 

What are the most important genetic risk factors for Parkinson’s disease?

There are two types of genetic factors that are important to Parkinson’s disease: 1) genes that rarely cause familial Parkinson’s disease (multiple affected members in the same kindred), and 2) genes that are not causal but that slightly increase the risk for Parkinson’s disease in populations worldwide (susceptibility genes). About a dozen genes have been identified as rare causes of familial Parkinson’s disease, and about a dozen genes have been identified as common risk factors in populations worldwide. The causal gene mutations are rare, accounting for less than 5% of all Parkinson’s disease cases. The susceptibility gene variants are common—e.g., occurring in 25% of persons in the general population—but they have small effects (no more than doubling the risk for Parkinson’s disease). 

Of all of the Parkinson’s disease genes, the most important is alpha-synuclein because it is both a causal gene in some families and also a susceptibility gene in populations worldwide. In other words, rare variants (mutations) cause Parkinson’s disease in rare families, while common variations (polymorphisms) increase the risk for Parkinson’s disease worldwide.

The alpha-synuclein gene holds the code for making the protein alpha-synuclein. The protein alpha-synuclein accumulates abnormally in the brain cells of every patient with Parkinson’s disease regardless of the causes. Many scientists believe that it holds the key to understanding and curing Parkinson’s disease. Our research team at NorthShore has led many of the most important studies of alpha-synuclein and Parkinson’s disease, including studies in families and in populations worldwide. We were also amongst the first to study the interaction of alpha-synuclein with other genes or environmental factors, or to study the association of the alpha-synuclein gene with motor and cognitive outcomes in Parkinson’s disease. 

Are there genetic research studies of Parkinson’s disease at NorthShore? How can I participate?

At NorthShore we are conducting a genetic study called the DodoNA Project. We aim to discover genetic factors that predict how neurological diseases progress in severity and that predict disease outcomes. We aim to use this information to individualize the care of our patients and to halt the progression of neurological diseases. One of the diseases we are studying is Parkinson’s disease. 

We will enroll at least 1,000 Parkinson’s disease patients into the study, and follow them at least annually for several years. To be eligible for the study you need to be new to our Movement Disorders practice within the past year, a resident of Cook or Lake County and willing to provide a blood sample for DNA extraction and storage. We also require your permission to compare your genetic code with the information that we collect in your medical record.

If you wish to participate, the best thing to do is to request an appointment to be seen as a patient in the Department of Neurology at NorthShore. We can then enroll you into the study after your office visit. You can also support the DodoNA project by joining forces with NorthShore’s Auxiliary and by supporting the Hospitals’ Gala

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Discovering a New Normal: Living with Multiple Sclerosis

Thursday, March 28, 2013 9:45 AM comments (0)

MSThe diagnosis can be hard and may leave you wondering if you’ll ever be able to return to your regular activities. Not everyone with multiple sclerosis (MS) experiences the same symptoms—ranging from fatigue, numbness, loss of balance and coordination, to speech or muscle problems—and most people with this disease do not suffer paralysis or become severely disabled.

According to the National Multiple Sclerosis Society, more than 2.1 million people in the world are affected by MS. Given that in many cases the signs of MS can be difficult to detect, it’s hard to know exactly how many in the United States are impacted by the condition.

We do know that for those who do have MS, the journey through the disease can be very debilitating. Zulma Hernandez-Peraza, MD, neurologist at NorthShore, shares her advice on how to cope with the diagnosis and adapt your life accordingly:

  • Don’t lose hope and stay stress free. As hard as it may be, it’s best to take each day at a time. Try not to dwell on the unknown and uncertainity. Unnecessary stress can aggravate some of your MS symptoms, so be sure to take time to relax and unwind.
  • Get moving. Staying active and engaging in moderate activities and stretching can be very helpful. Be sure to discuss the best workout regimen with your physician.
  • Eat right. It’s important to keep your body healthy, as this will help prevent other illnesses and keep up your strength. You’ll want to eat plenty of fruits, vegetables and foods rich in fiber.
  • Be yourself. Don’t let your condition get you down. As best as you can, try to stay involved and social. Keep up with your hobbies, family and friends. Not only will this keep your support network in place but it will also help keep your spirits up.

Do you know someone living with MS?

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