Parkinson Q & a twenty-three: June 4, 2016 Q & A

1, I am male 54 years old, 6 years of disease, one of 8 copies of the 3 buy Madopar, every time I do not control end days, postoperative med


1, I am male 54 years old, 6 years of disease, one of 8 copies of the 3 buy Madopar, every time I do not control end days, postoperative medication is not preoperative efficacy, please help Ma Bo, thank you. Why control after a few days?

Ma feather doctor: if the state after taking the medicine is not as good as the state of the medicine before taking the medicine, the main reason is that the program is not correct. This is also the reason for several days after regulation.

Recently we have several changed the batteries for patients, one patient and the situation is very similar, 4 years after surgery, the symptoms of Parkinson's disease gradually increased, but also when the program is very good, just a few days to fail, patients to the hospital is to push the wheelchair to the families of patients accept the development of Parkinson disease in. But I changed the battery to replace him after the stimulus program, 7 days after discharge, is walking. If the basic elements of DBS, if satisfied, the evaluation of the right to do the surgery, the correct direction of the program after the operation, the effect can not be worse than before surgery, if this occurs, there must be a reason.

2, 2010 nine, October, basketball found the weakness in limbs, shoulder wrist soreness, that is arthritis, high blood pressure is 135/95, the target arthromyodynia treatment, six months to no avail. After half a year then check the blood routine, blood lipid was higher than that of other indexes is basically normal, considering the cerebral vascular problems, do brain CT normal brain MRI was normal. In December 2011 /2013 year in May two: C3/4,4/5,5/6 CT neck intervertebral disc backward median obvious C4,5 mild vertebral bone hyperplasia, the right finger on the keyboard is very difficult, numbness, left leg acid significantly rose. Shoulders also acid swelling, sexual ability began to decline, the movement began to slow. At the end of March 2014, 1: MR diagnosis of bilateral substantia nigra decreased NAA peak, NAA/CR value decreased, mainly in left side, suggesting that loss of neurons; 2, right occipital lobe short T2 signal range, considered as hemosiderin deposition, vascular lesions? Recommended SWI examination, Dongguan People's Hospital neurology diagnosis of Parkinson syndrome. At this time the action has been significantly slow, memory decline, people are very tired. Medication taishuda medication invalid; Madopar 15 days (1/4 each time, 3 times a day) is invalid, then taking Madopar (4 times a day, each time 1/4) is invalid, then because of invalid withdrawal, 14 years at the end of December taking Madopar (1/2 tablets, 3 times daily), people feel a little better, but not significantly, then by a business trip in Nanjing to buy a box of levodopa (3 times a day, 1 tablets each time) there is no obvious effect. 15 years already cannot do without the drug, medication in May Madopar (1/2 tablets, four times a day), the body suddenly rose urticant feeling, feel comfortable, feel more relaxed, I know the drug effect, but after 35 days of soothing the symptoms disappear, can not increase the dose, until February 16 a worsening of symptoms to use (4/3/, 2/1, 4/3 ", 2/1), still not alleviate the symptoms, do not take medicine better than medicine. Now stiff neck, feeling the neck artery rose, there is contraction feeling. Two years ago began stuttering, facial muscle twitch, sleep 10 hours before the spirit is good; after each exercise, the body feels a lot of comfort, but can only maintain about 1 hours. The shoelace, sweaty button has been more than two years, now with cervical periarthritis of shoulder, neck and shoulder pain. 2015 to do physical therapy department of intermediate frequency, low frequency, laser, acupuncture, physiotherapy can be maintained for more than a week, five months after the invalid. 2011-2012, chest and leg cramps easily, and now a lot less. In 2015, he had taken Sen, there is no obvious effect, due to expensive disable. It has been nearly three years since it was diagnosed with Parkinson's syndrome from mild symptoms to nearly five years. Now taking Forro Sen three times a day, one tablet each time, Madopar tablets 1/2, four times daily for twenty days, beginning three days later did not, in some sense, in medicine than not eat medicine, the effect is not very good. Excuse me, 1, do I suffer from Parkinson's disease? 2DBS surgery will be effective? 3 how to take medicine will have effect? 4 attached test results. 5 I am male.50 years old, height 175cm, weight 78kg.

Ma Yu doctor: whether it is Parkinson's disease, I did not see you, is not a good judge, from your reaction to drug treatment, the choice of DBS surgery or to be careful. My suggestion is to make sure whether it is primary Parkinson disease. Second, consider the drug treatment program, or surgical treatment options. From your medical history and medication history, I have some questions about the diagnosis of Parkinson's disease. The doctor suggested diagnosis, diagnosis.

Prefecture level and provincial level two hospital specialist were diagnosed with Parkinson syndrome, that is secondary to the Parkinson, I am also confused.

Ma Yu doctor: Parkinson disease patients with Madopar, in fact, simple to understand, is a supplementary treatment, like diabetes insulin injections, how much will have much effect, make a major play a role, if you had two or three days, and the symptoms of Parkinson's disease is not very consistent. But the drug treatment effect, will be affected by a number of factors, such as sleep, spirit, diet, so your diagnosis is the first one now.

Will smoking and drinking affect the condition?

Ma feather doctor: do you have the abnormal stool? Do you have a balance disorder? Smoking and drinking are not advocated.

Thank you, you know. Plan to go to Beijing in September and October, please Ma Bo diagnosis. Not wrestling, onset of only 5 years, beginning in 2010.

Ma Yu doctor: if 5 years or so, balance disorder is not obvious, then the diagnosis of Parkinson syndrome need to be further clarified. Your situation, from your description of the history, a little complicated, I think you may need to make an assessment of the cognitive and psychological aspects of the comprehensive judgment. Everything has a reason because there is fruit, there will be a result of fruit, in fact, this is the truth of medical treatment. The appearance of symptoms must have its cause, the judgment of the medical treatment and the judgment of the common people are still different

3, Fujian asked the relatives, patient: April 18th this year by the Ma Bo regulation, the overall effect is good, but recently the illusion is serious, want to ask me to help him Ma Bo can fine tune? My father urinary urgency, need to separate the prostate to eat medicine?

Dr. Ma feather: hallucinations need psychiatric help diagnosis and treatment. If the symptoms are not good enough to fine tune, the illusion of adjusting the machine does not help. Some of the drugs used in prostate. The occurrence of hallucinations in patients after surgery should be considered from three aspects: side effects, side effects and severity of disease development. Specific reasons or the need for doctors to determine the actual situation of the patient.

Do I need to find a psychiatrist to diagnose?

Ma Yu psychiatric doctor: do not understand Parkinson's disease, so I suggest the neurologist to decide.

In 4 patients, female, 67 years old, at the beginning of the fingers of the left hand will shake, slowly become the whole hand, later foot joints pain, will shake, the two become more and more serious, the whole body will shake, sometimes serious difficulties even if get up, start to check the diagnosis of doctor is Parkinson to open "in recent years, aspirin began to eat, now also eat this medicine, now eat this medicine did not like what use, had to eat for a while, the times also eat more and more, a day to eat seven or eight, eat sometimes useless, sometimes stop ten minutes. Would like to ask this is not Parkinson? Is there any better medicine?

Ma Yu doctor: Parkinson's disease is very likely to be diagnosed, if the effect of drug treatment is not ideal, you can consider surgical treatment, for this type of tremor, DBS better than drug treatment.

Out of pain caused by cardiac factors after the diagnosis of Parkinson's disease should be a little access to current drugs for the treatment of Parkinson's disease, as long as the replacement scheme, the neurotransmitter dopamine is added in substantia nigra can not produce, so Madopar therapy is the most direct and effective.

5, I would like to ask Ma Bo: after the onset of the drug Zhang Ligao muscle (foot hook), when the efficacy of walking weak (drag step, fatigue) what is the reason? Whether through regulation to solve? Now, eat sinomet and Forro Sen, Sen is sinomet and Forro eat at the same time or separately in the morning and afternoon increase time to eat? Are these 2 drugs at the same time? Dark horse, if this is the case, the ability to control depends on whether there is room for surgical implantation target regulatory space.

Ma Yu doctor: sinomet Sen and Forro is to eat together, the main difference is the effect of onset time, eat separately, the onset time is not the same time, decreased efficacy is not the same, so some patients will have a long time feeling effect.

6. My father was diagnosed with Parkinson's syndrome in his hometown this year. I would like to ask Ma Bo, like my father less than 2 years from the discovery of walking a little difficult to completely go, in line with the development of Parkinson's disease? Muscle tension slightly increased without shaking without rigidity without swallowing and dysarthria, balance disorder (magnetic resonance without cerebellar atrophy), gait like Parkinson (curvature of the spine, freezing of gait) dopamine drugs did not improve obviously, I have other causes would be, want to go to Beijing to see a doctor.

Ma Yu doctor: rapid development, tend to Parkinson syndrome

Parkinson can try any medicine, such as Madopar + gold + Forro Sen Siping like, my father has a long-term use of Boliwei and Lipitor, no respect I dare not to mess medication orders. Parkinson's some do, the other just can't go bad symptoms yet, DOPA drugs can amount to try?

Ma Yu doctor: can try drug combinations, but if it is a syndrome, sometimes drug side effects, such as hallucinations, are more prone to drug, so you can try, but slowly, the best adjustment under the supervision of a doctor.

7, doctor Ma, torticollis DBS, if the implantation effect is not obvious, whether can change the target of re implantation?

Dr. Ma: Yes, but the risk of the two operation is relatively high.

What are the risks?

Ma feather doctor: surgery and the efficacy of the.

8, Dr. Ma hello. I have symptoms from the second half of 2012. At first, the ring finger of the left hand, stiff. Left hand trembling. 2013, the beginning of the second half of the neck stiffness, dizziness. Once the treatment of cervical spondylosis. Head neck CT nuclear magnetic resonance are no exception. 2015 in July, went to the hospital in Beijing, Professor Zhang Yuqing hung out of Xuanwu. Because of the short time Zhang can only say that Parkinson and Parkinson syndrome. At the end of last year, sudden angina, due to stiff severe, almost can not walk, to our local neurology hospital. With Madopar and Sen Forro treatment. 3 days later. Doctors diagnosed as primary Parkinson. Current medication. A piece of selegiline. 0.33 mg, Sen forro. Current main symptoms. Left hand, slightly stiff. Stiff neck. A slight back pain zhibuqiyao. Feel weak, weak. Besides, I had a car accident in 2009. Left ankle and right hip joint in Jishuitan Hospital. Right ankle, and implants. Dr. trouble to help me to judge whether it is Parkinson or Parkinson syndrome. Thank you

Ma Yu doctor: current medication. A piece of selegiline. 0.33 mg, Sen forro. Only these?

Yes, used to take Madopar, one tablet a day. Cnro 1.25 mg per day. Two months ago, Madopar stopped. Three pairs of Luo also reduced. Does not seem to have much impact?

Ma Yu doctor: on Madopar reaction is not good, most prone to Parkinson's disease syndrome.

9, Dr. Ma: hello! I consulted after DBS language pronunciation is not true, low voice, repeated regulation correct but 6 months after surgery, medication adjustment for 1/4 yesterday Madopar 2 times a day, 1. Taishuda 1/2 1 tablets 2 times a day. What can be done to correct. Thank you

Ma Yu doctor: postoperative problems, and not before the case, mainly related to the role of stimulation, to further improve, or to start from the causes.

10, Dr. Ma Hello: I was diagnosed in April early Parkinson eat today is Sijilailan, today had also need to continue to eat?

Parkinson: once diagnosed, is the need for lifelong medication. Like I said, it's a complementary therapy.

I need to eat selegiline for medication?

Dr. Ma feather: if the current medication plan for you, to meet your needs, you do not need to adjust the medication program.

11, Ma Bo, I was the family of patients in Guangxi, after the November commissioning back, the situation is very good, reducing the amount of 1/2, the efficacy of a long time, language ability has improved. Thank you very much! But there are still some problems, basically every day to eat a certain time, one with chopsticks on the whole body trembling, balance ability is slightly worse.

Ma feather doctor: eat every time attack?

Basically, it's like a conditioned reflex, to the point of eating, lunch and dinner will take one or two minutes, but will soon be over.

Ma feather doctor: is the time of meal fixed? As long as a meal on the attack?

In addition to eating time, there are things to do when it is easy to attack, such as cooking out to do things, a tense, to do the action, easy to attack.

Dr. Ma: you can take a little anti anxiety drugs. It's not something to stimulate and Parkinson's disease.

Meal time, the basic one hour after taking the drug is easy to attack, ah, what medicine can you give me the name of medicine?

Ma Yu doctor: effect of alprazolam is relatively weak, but the side effect is weak, you let your husband, before a morning, half a piece of first try, if not, I will carefully we psychiatrists, see what is suitable for the related drugs.

If you eat 1/4 Madopar morning, would attack, reduce the effect of Madopar slow, but had less to eat and do the action is only attack, this is still a little relationship with Parkinson's drug?

Ma Yu doctor: feeling little relationship, it is recommended not to reduce the drug.

The answering questions from the collation of Tsinghua Parkinson DBS (204150045) every Saturday night at the fixed point of eight questions

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