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Essential Tremor & Parkinson Disease


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#1 4laurant2

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Posted 17 March 2011 - 12:03 AM

I am a 56 year old male who had essential tremor since the age of 17. I have been seeing a neurologist for the past 8 years regarding my essential tremor, but recently I missed seeing my neurologist for a year. I just got an opportunity to visit him two weeks ago, and during my visit he noticed I had a tremor at rest plus my arm wasn't swinging. I wasn't aware that my right arm wasn't swinging, but he prescribes Mirapex. I have been taking it for the past two weeks. I noticed it help on the resting tremor but not on the action tremor. The drugs isn't effective, therefore I am still taking Mysoline to help with my essential tremor. Is it possible to have both ET and PD at the same time?

#2 Dr. Okun

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Posted 17 March 2011 - 08:14 PM

It is definitely possible.

We see people with ET at the same time their PD presents....

We also see people with long-standing ET who develop PD.

Finally we see people with ET who develop a resting tremor but not PD.

Hope that helps a little.

Best to see someone really experienced and see how things progress....or don't progress.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#3 4laurant2

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Posted 27 March 2011 - 07:34 PM

It is definitely possible.

We see people with ET at the same time their PD presents....

We also see people with long-standing ET who develop PD.

Finally we see people with ET who develop a resting tremor but not PD.

Hope that helps a little.

Best to see someone really experienced and see how things progress....or don't progress.


Thank you Dr. Okun for your reply. I seen my Neurologist, who increased Mirapex to 1.5mg, to be taken .5mg three times a day. I have had some relief from my tremor, but not the action tremor. He advised that I continue taking Mysoline to control my Essential Tremor.

#4 Dr. Okun

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Posted 28 March 2011 - 06:08 AM

By the way....If the combination of sinemet, agonist and anticholinergic at maximally tolerated doses does not control tremor we may begin the discussions about DBS.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#5 Dr. Okun

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Posted 28 March 2011 - 06:08 AM

By the way....If the combination of sinemet, agonist and anticholinergic at maximally tolerated doses does not control tremor we may begin the discussions about DBS.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#6 4laurant2

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Posted 28 March 2011 - 10:24 PM

By the way....If the combination of sinemet, agonist and anticholinergic at maximally tolerated doses does not control tremor we may begin the discussions about DBS.


I seen a Chiropractor who advised that adjustment of my c1 & c2 can relieve tremors and some symptoms of Parkinson and Essential Tremor. Could this be possible? Another thing my wife is always fussing at me about my lack of sense of smell. Is this any way assocaited with PD or ET? Thank you in advance for your answer. :shock:

#7 Dr. Okun

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Posted 29 March 2011 - 02:11 PM

Lack of smell is associated with PD.

Chiropractic treatment to the neck does NOT treat PD or ET or tremor. It can however CAUSE stroke if it injures the vertebral artery.

Hope that helps.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#8 4laurant2

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Posted 29 March 2011 - 09:22 PM

Lack of smell is associated with PD.

Chiropractic treatment to the neck does NOT treat PD or ET or tremor. It can however CAUSE stroke if it injures the vertebral artery.

Hope that helps.


Thank you very much for your reply Dr. Okun. :)

#9 Dr. Okun

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Posted 30 March 2011 - 07:51 AM

Thanks to you.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#10 gbmorr13

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Posted 02 April 2011 - 01:44 PM

Dr. Okun,

My father is 77 years old and has had PD since he was 60. As far back as 2007 he was taking Sinemet 25/100 3 to 4 times per day with .5mg of Azilect (Resagline). Taking him once to Cleveland Cinic's PD group they advised he had both PD and ET.

A year ago he started with a new local Neurologist which took him off everything but a single dose of Sinemet 25/100 in the morning and .5 mg of Pramipexole at lunch; which I guess is the generic MIRAPEX. In all fairness Dad's tremors have not been under control for many years and have only increased. Dad's condition has progressed slowly over all these years to now walking with a cane for balance and stability; slow shuffle; tremors and stiffness so bad that he cannot hold a spoon or fork stable enough to eat many foods; and cannot really dress or undress himself.

My concern is that the current medications with the current dosages do not seem to be effective at all; and the doctor seems satisfied with his current status. He made a commment to Dad that he was surprised that he is doing as well as he is for as long as he had the disease. I live out of state and am just at a loss as to where to go from here or how to advise my Dad and his wife. To compound the issue, he lives an a very rural area of SE Ohio with very few options for qualified PD Doc's.

What medications and dosages would seem logical for him to try? His quality of life would be so much better if we could just get his tremors somewhat under control.

Thanks in advance!

Bruce

#11 Dr. Okun

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Posted 03 April 2011 - 07:13 PM

Bruce,

It is best to try to get him in with a specialist.

In a 70+ year old you have to be careful.

We generally increased slowly sinemet 25/100 by half tablets until it reaches 3 tablets 3 to 4 times a day or until side effects make intolerable.

We are careful with the next steps which are adding agonist and also anticholinergic. We are doubly careful in a 70+ year old.

If tremor still doesn't respond we consider deep brain stimulation.

Note that if he truly has ET and PD, ET meds like primidone should be tried, but many of these patients end up with DBS.

I can't stress seeing a specialist is critical.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#12 4laurant2

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Posted 05 April 2011 - 10:42 PM

Dr.Okun, I experience the freezing of my left hand without moving it. This is painful at times, but I use a ball to relieve the stiffness. Is this related at all to PD? :-|

#13 Dr. Okun

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Posted 06 April 2011 - 07:24 AM

It could be. You should check with your doc about adjusting medication doses and in some cases botox.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#14 4laurant2

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Posted 06 April 2011 - 11:33 PM

It could be. You should check with your doc about adjusting medication doses and in some cases botox.


Thank you Dr.Okun.

#15 4laurant2

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Posted 16 April 2011 - 10:50 PM

Thank you Dr.Okun.


Dr. Okun congrats on your award! I have a question, today I gave blood after taking mirapex, I passed out at the site. Could the mirapex be the cause? I have given blood in the past without any problems. Thank you in advance. :shock:

#16 Dr. Okun

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Posted 17 April 2011 - 02:30 PM

Usually it is a combination of factors. PD itself can lower BP. Mirapex can lower BP. Reducing blood volume by giving blood can lower BP. Most PD patients can give blood if they don't have trouble with low blood pressure but they need to be super well-hydrated and not stand up too fast. Also they need to have someone there in case they fall.

If you have PD and baseline low blood pressure it may not be a good idea to give blood.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#17 4laurant2

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Posted 22 April 2011 - 12:12 PM

Dr. Okun, I took your advice and left a message for my neurologist concerning the cramps I am having in my hand. As of today, I haven't heard from him, but I do have an appointment in June. The sense of urgency I am having it is affecting my job performance, of acourse the tremors ae not helping as well. I work in a call center which demand high call volume, where I am expected to make over 120 dials a day. It is becoming hard to do, I am considering a different vocation. If the neurologist increase my dosage on my mirapex will that help the cramping?

#18 Dr. Okun

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Posted 22 April 2011 - 02:18 PM

Possibly. I suggest a second opinion with someone who can 1- see you sooner, 2- has expertise in PD.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips


#19 4laurant2

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Posted 23 April 2011 - 05:50 PM

Possibly. I suggest a second opinion with someone who can 1- see you sooner, 2- has expertise in PD.


Dr. Okun, thank you for your response. I will see if I could get an appointment to see Dr. Michael Rezak of Central Dupage Hospital in Winfield, Ill, which is a 30 minutes drive from where I live. Are you familiar with him? Once again thanks for your advice. :grin:

#20 Dr. Okun

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Posted 23 April 2011 - 07:20 PM

Yes, he is a very nice man.

Michael S. Okun, M.D.
Author of the Amazon Bestseller Parkinson's Treatment: 10 Secrets to a Happier Life
National Medical Director | NPF
UF Center for Movement Disorders & Neurorestoration
Read More about Dr. Okun at: http://movementdisor...hael-s-okun-md/
or Visit Parkinson's Disease treatment and research blogs at:
NPF's What's Hot in Parkinson's disease
or his parkinsonsecrets.com blog for treatment tips





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