This Web page is designed for the general education of patients and their families.
Disclaimer: The answers provided are the opinion of Dr.
Tom Chelimsky. No patient should make any changes in their care without
first consulting their physician.
Question: Please help me with my mother. She has been treated for Parkinson's-type symptoms. My concerns is, is she being treated correctly ? She took herself off of 1 milligram a day Equip yesterday because she says she is no better. She now has a catheter and is declining fast. After reading about Shy Drager, I wondered is she may have these symptoms. Dry month, incontentinency, dizziness and has fallen in the past several months. Also, recently she has had her eyes examined and she says that her glasses don't help. Mom has had two brothers committ suicide and the last one was diagnoised with Parkinsons at age 42... As you see, we are concerned and want to be sure that she is properly diagnosed and treated. Can you help us?
Dr. Chelimsky: It does sound like your mother has involvement of the autonomic nervous system, with incontinence and dry mouth. Do you know if her dizziness is true faintness or is it a sense of imbalance? You could get a sense of this by checking her blood pressure and heart rate lying and standing to see if blood pressure drops at all. Also formal autonomic testing (the nearest center may be Vanderbilt University, Dr. Robertson) would be very useful.
It is difficult to know sometimes whether a particular movement disorder which looks like Parkinson's is really Parkinson's disease or multiple system atrophy. Some things that help are: (1) MSA responds less well to sinemet; (2) MSA causes a more rapid decline (3-10 years, rather than 15-30 years); (3) the autonomic nervous system is involved early in MSA, and usually quite late in true Parkinson's disease (> 10 years); (4) MSA usually has no dementia; (5) family history is more compatible with Parkinson's than MSA, unless we're talking about more unusual diseases that look like MSA, but are not really.
Your mom needs to see a well-respected movement disorders specialist to be diagnosed properly.
If you have a question, please submit it to Dr. Chelimsky.