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Dan McFarland

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About Dan McFarland

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  1. Dear Dr. Okun,

    I have been examined by Movement Disorder Specialists at a Major Medical Center. Although they've told me I'm a complicated patient, they ultimately decided I have the non-tremor dominant form of Parkinson's. One neurologist at the institute previously told me I would best fit into the PIGD subtype (I usually have very little tremor, but when it's present it's an action type). Although I experienced numerous Lewy Body Symptoms at onset and over the course of the last 2.5 years, as well as many Parkinson's symptoms, cognitive testing showed rather minor cognitive impairment. I recently stumbled upon the information below which has prompted me to ask you this question, and I would greatly appreciate your opinion. Based on the following, would you expect to see LBD type symptoms or overlapping manifestations in conjunction with PIGD (or non-tremor dominant) PD? Thank you!    

    “the cognitive deterioration occurring in non-tremor Parkinson’s disease PIGD subtype was associated with cortical Lewy body pathology instead of cortico-striatal dysfunction” Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits?  Pg. 3221 Rick C. Helmich,1,2 Mark Hallett,3 Gu¨nther Deuschl,4 Ivan Toni1 and Bastiaan R. Bloem2 (Williams-Gray et al., 2009).

  2. PIGD

    Hi Linda, You're very welcome. From what I've read this appears to be so... that Tremor-Dominant PD patients lose their relative advantage over the non-dominant ones over the course of several years. But, if I'm interpreting the information correctly, Tremor-Dominant patients have are much-less likely to develop dementia during the course of their disease. Please understand though Linda, I'm just another patient on this site (a friend) with a similar set of symptoms. While I have a good education, I'm certainly not an expert. I hope this has been helpful. I hope to hear from Kathy as I'd like to thank her for starting this thread. Blessings!
  3. PIGD

    Thank You Linda for your very kind words. I wasn't a healthcare professional in the normal sense of the word, however for the last 15 years of my professional life I was employed as the senior administrator of a few large continuing care campuses and taught graduate studies (part time) in Aging and Human Services. I noted that you developed PIGD symptoms in the last couple of years. I found this excerpt that may be of interest to you, especially the part about losing the "relative advantage" later on. "Another post-mortem study found that patients with tremor-dominant Parkinson's disease had a lower degree of disability (Hoehn and Yahr grade) than tremor-dominant patients at 5 and 8 years (Selikhova et al., 2009), using the subtyping scheme discussed earlier (Lewis et al., 2005). However, tremor-dominant and non-tremor patients with Parkinson's disease had similar disease duration at the time of death. This led to their conclusion that tremor alone does not predict a significantly longer survival: patients with tremor-dominant Parkinson's disease progress more slowly during the initial course of the disease, but lose this relative advantage later on (Selikhova et al., 2009). Finally, patients with tremor-dominant Parkinson's disease have better cognitive performance than non-tremor patients with Parkinson's disease (Vakil and Herishanu-Naaman, 1998; Lewis et al., 2005; Burn et al., 2006) and are less likely to develop dementia (Aarsland et al., 2003; Williams-Gray et al., 2007)." As for your question about your meningioma that abuts your cerebellum, I'm simply not qualified to answer. Sorry. My interest in the topic of PIGD stems from my desire to better understand what was happening with me personally, and to help others as best I can. Anyway, I hope this helps. All My Best! Dan
  4. Hallusinations

    Hello MD George, Having just gone through this myself with Neupro, I think I can offer some thoughts. I was on 6 mg Neupro patches for about a year, along with Levodopa. My wife sat me down one day and said do you realize how paranoid you've become. At the same time I was experiencing delusions and hallucinations. When I saw two neurologists (Movement Disorder Specialists) they rather quickly determined I was experiencing a medication-induced psychosis. Apparently this is rather common for PD patients who are 60 or older and being treated with Neupro, or any of the agonists. They eliminated the Neupro and everything greatly improved, the hallucinations, delusions, etc. However, I have still had a few minor hallucinations like floaters in my vision. Unfortunately, my movement problems got worse. even with higher doses of Levodopa. Fast forward to the present. Shortly after the Neupro was reduced I became very anxious and depressed, clinically so... it was bad. It corresponded with some neuropsychological testing which confirmed the same. My neurologist quickly called me and placed me on a good antidepressant/anxiety med. She explained that Neupro has an antidepressant quality to it and when they eliminated it, it "unmasked the underlying depression and anxiety that had developed in conjunction with PD." For now, I think we have things in hand and hope to be feeling better soon. Anyway, I hope this helps. All My Best! .
  5. PIGD

    Since there appears to be a lack of concise information on the web about PIGD (Postural Instability Gait Disorder), I have decided to create a website about this Parkinson's phenotype. I hope to publish it very soon. In the meantime, here is some additional information I've discovered: PIGD is thought to affect only about 2 to 7 percent of Parkinson's patients. It tends to occur in older patients. According to experts, PIGD affects only a subset of Parkinson's patients, but is associated with highly troubling clinical features such as a malignant and faster-progressing disease course; greater psychological disturbances including anxiety and depression, as well as significant balance, walking, other motor and autonomic challenges. PIGD patients have a three-fold increase in the likelihood of developing dementia and are much more likely to require care facility placement. Their risk of falling is 10 times greater than the normal aging population. PIGD encompasses a constellation of Parkinson's symptoms including speech problems, freezing of gait, difficulty initiating movement, shuffling, falling and other specific problems with balance. No currently available PD treatments alleviate these symptoms. Their biological causes are not well understood and may originate outside the dopamine system, as these symptoms respond inconsistently or not at all to dopamine replacement therapy. PIGD patients commonly have greater bulbar challenges, as well as more autonomic and pain complaints. Anxiety is said to be three times more prevalent in this form or expression of Parkinson's.
  6. PIGD

    The tremor subtype of PD is associated with preserved mental status, earlier age at onset, and slower progression of the disease compared with the PIGD subtype, which is characterized by more severe bradykinesia, cognitive impairment, and a more rapidly progressive course. Furthermore, the PIGD-dominant type of PD had a higher risk of reaching an end point, the degree of disability necessitating levodopa treatment. The association between axial (PIGD) impairment and incident dementia has been demonstrated also by other studies. Our longitudinal follow-up study provides support for the hypothesis that, based on total UPDRS scores, the PIGD group has a less favorable prognosis, showing a steeper slope of progression than the tremor-dominant group. Furthermore, the late-onset subtype is characterized by rapidly progressive motor and cognitive disability. In this study we confirmed that patients 57 years or older with late onset of symptoms had a more rapid progression of disease than those whose symptoms began before the age of 57 years. We also showed that men and older patients progress at a more rapid rate than female patients and patients with young-onset PD. Furthermore, our and other studies have shown that patients with predominantly axial involvement (such as those with the PIGD-dominant type of PD) are more likely to manifest cognitive decline compared with the more typical form of PD. This subset of patients may have additional nondopaminergic degeneration, thus explaining the poor response to treatment with levodopa and dopamine agonists. -- JAMA Neurology Dr. Joseph Jankovic describes Parkinson's PIGD in this video "What Are The Different Forms and Stages of Parkinson's Disease." Link: https://youtu.be/pf6BGBl8-0U -- National Parkinson's Foundation (PIGD), a troubling constellation of symptoms that are poorly understood and respond inconsistently or not at all to dopamine replacement therapies. -- Michael J. Fox Foundation PIGD progresses rapidly, and often does not respond well to Levodopa; as a result the prognosis for this type is not as favorable as with the tremor dominant type. -- Health-Stories.org o "What Are The Different Forms and Stages of Parkinson's Disease." Link: https://youtu.be/pf6BGBl8-0U -- National Parkinson's Foundation (PIGD), a troubling constellation of symptoms that are poorly understood and respond inconsistently or not at all to dopamine replacement therapies. -- Michael J. Fox Foundation PIGD progresses rapidly, and often does not respond well to Levodopa; as a result the prognosis for this type is not as favorable as with the tremor dominant type. -- Health-Stories.org
  7. PIGD

    Kathy, I was diagnosed with PIGD by two different neurologists at one of the country's best known Movement Disorders Clinics. 2.5 years into this illness and I have a lot of information to share if you or anyone else is interested.
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