The Newfoundland Newsletter
Selections from 1996/04St. John's Regional Chapter
Newfoundland and LabradorThe Parkinson's Foundation of Canada
Vol. 7, no. 1, April 1996
- Erratic response to Levodopa medication
- When you need support
- From TV: Deep brain stimulation
- Neural transplants in Halifax
- 8,000 attend second Satellite Symposium on Parkinson's
Erratic response to Levodopa medication
From "The Transmitter", January 1996, Parkinson's Association of Victoria, BC
Cisapride is a medication that increases gastro-intestinal motility in normal individuals and improves constipation in Parkinson's, but there are other benefits that extend beyond brisk bowel movements.
For example, there is evidence that Cisapride promotes levodopa absorption in the bowel. Sinemet taken by mouth has several barriers to cross before it can enter the brain, the first being the stomach itself. Erratic emptying of the stomach may contribute to poor response and motor fluctuations.
Administration of levodopa by a duodenal tube directly into the small intestine improves response fluctuations. Acceleration of stomach emptying can also be promoted by certain medications which block the D2 receptors in the gut, but unfortunately these medications also block the D2 receptors in the brain and worsen the symptoms of Parkinson's.
With the exception of domperidone (which does not worsen Parkinson's symptoms), such medications, composed of metoclopramide, should not be used with Parkinsonians. Cisapride is chemically related to metoclopramide - it does stimulate gut motility - but it does not block dopamine receptors.
A recent study (Diaz NW, Sanchez V, et al; 1995) demonstrated that Cisapride increased the mean and peak plasma levels of levodopa in constipated Parkinsonians with poor responses to levodopa. More important, Cisapride administration to these patients enhanced motor abilities, shown by better hand-eye coordination and improved gait.
Patients with Parkinson's and slow gastric emptying may keep the medication in their stomach for many hours and deliver significant amounts of levodopa erratically to the bowel several hours after its oral intake. This would produce an unpredictable response or even a lack of response when the stomach is closed. Conversely, dyskinesias or excessive involuntary movements may occur when the stomach suddenly empties excessive amounts of medication into the small intestine.
Cisapride appears to be a useful add-on medication for levodopa-treated Parkinsonians with slow gastric emptying.
When you need support
A few years ago one of our chapter members told me that she was attending the Bereavement Support Group at the Seniors Resource Centre in St. John's. My face must have revealed my thoughts because she went on to say that the meetings were not at all dismal, and when you understood the grieving process you coped better with your loss. She said there were about ten in her group, including a widower who was particularly interested in the session on learning to cook for one.
If you would like more information about bereavement support, call the Seniors Resource Centre. In St. John's the number is 737-2333. Outside the St. John's calling area call toll-free 1-800-563-5599.
From TV: Deep brain stimulation
Barbara Walters 20-20 March 17 1996
A short 2-8 minute clip from the ABC program describes the work of the neurology team in Kansas University Medical Centre (KUMC) with the experimental surgical procedure called deep brain stimulation (DBS). This has been developing since 1992-3 in several research centres (including the Movement Disorder Clinic at Toronto Hospital) as a means to control extreme tremor in Parkinson's and possibly other types of tremor like benign essential tremor (such as Katherine Hepburn has).
The relief of tremor can be dramatic and immediate. The clip showed several people with tremor so bad that it made simple tasks such as eating or pouring a glass of water quite impossible. One 77 year-old man explained that golf, pool, and bridge, recreational activities he really enjoyed had become impossible. Eating a meal was a disaster. He had the stimulator implant surgery a year and a half ago. For the camera, he turned off the unit using a small magnet and the tremor returned full force. He turned the unit back on and was able to do everything.
Dr. William Koller, neurologist at KUMC, explained the process. Basically, tremor is caused when areas in the movement control centre of the brain fire too many electrical impulses. High frequency stimulation jams the signals and the problem is largely eliminated.
The surgery looked quite similar to that of pallidotomy: a stereotactic frame is bolted to the person's head, a hole is drilled into the skull with only local anaesthetic, the surgeons carefully place the electrode in various places, testing it to see where it works best. The patient must be awake and alert, since the surgeon relies on the patient to do various physical actions to determine the best location for the electrode.
In the TV clip, the surgeon brought out a sample of the patient's "new" handwriting to show the wife the results of the implant. In the second part of the surgery the patient is given a general anaesthetic so the surgical team can embed the wires under the skin and implant the control unit in the region of the collar bone.
Dr. Koller and team have carefully assessed many patients for severe tremor and have implanted the electrode device in 50 patients. The risks seem minimal; he reports nothing other than slight scalp bleeding.
Neural transplants in Halifax
From the Nova Scotia Division
The Halifax Fetal Transplantation Program is the only program of its kind in Canada and is in the forefront of neural transplantation research in the country. Both the Faculty of Medicine at Dalhousie University and the Victoria General Hospital consulted with leading ethical and scientific experts before arriving at the decision to begin Phase I, which is now complete.
Phase I involved the implantation of fetal neural cells into the striatum of five Parkinson's disease patients and carefully monitoring their progress. The procedure was found to be safe (without mortality or serious complications). Tests indicated that the transplanted neurons survived, continuing to mature and function.
Phase II of the clinical trial is now underway and will last approximately 3 years. Updates will be printed when available.
8,000 attend second Satellite Symposium on Parkinson's
On March 7, 1996, an audience of more than 8,000 Parkinsonians and caregivers - in 113 locations - heard leading medical researchers discuss recent advances in understanding and treating Parkinson's. Due to prior commitments, the province of Newfoundland and Labrador was not represented in the audience. However, we now have an excellent videotape of this two hour event available at the Resource Centre for borrowing. Phone the Resource Centre at 709-754-4428 to enquire.
Return To News Page
If you have questions or comments contact Anne Rutherford at rutherford@nf.sympatico.ca
Website maintained by Janet Paterson
Last updated on 28 June 2000
