Jump to content
helplinedonate
  • Announcements

    • ForumAdmin

      Frequently Asked Questions - Step by step guides

      Do you need assistance registering, logging in, posting, etc? Please visit the all new Frequently Asked Question Forum for step-by-step guides. Click the link below to access these helpful guides. Frequently Asked Questions
    • ForumAdmin

      Recursos Nuevos en Español

      http://www.parkinson.org/ayuda   http://www.parkinson.org/espanol    
    • ForumAdmin

      Línea de Ayuda 1-800-473-4636

      Línea de Ayuda 1-800-473-4636   ¿Qué es la línea de ayuda 1-800-4PD-INFO (473-4636) de la Fundación Nacional de Parkinson? Es un número de teléfono gratuito que ayuda a las personas con la enfermedad de Parkinson, sus familiares, amigos y profesionales de salud, a solucionar diferentes inquietudes.   La línea de ayuda ofrece: Información actualizada Apoyo emocional Referidos a profesionales de salud Recursos comunitarios Amplia variedad de publicaciones gratis    
Sign in to follow this  
malexander

Tremor-dominant subtype

Recommended Posts

I was diagnosed 6 years ago with tremor-dominant PD (following 3 years of misdiagnosis of essential tremor).  I was quite resistant to levodopa (or any other medication), and I had DBS performed a few years ago.  The STN DBS is quite successful in controlling my motor symptoms, and I am currently on no PD meds.  At this point I have a number of questions concerning the projected course of my disease.  I am particularly interested in what information may be gleaned from the study of PD subtypes. 
 
For instance, I do not—and have never had--problems with constipation.  However, my anosmia predates my motor symptoms by more than a decade.  Is this typical and imply a nasal route of tremor dominant PD?  I currently have mild problems with voice volume, urinary urgency, balance, and mental sharpness. What else should I expect?
 
Also, I wonder what an autopsy of my brain would show.  Where would Lewy bodies be concentrated?   I would think that some systems other than dopaminergic would by responsible for my tremors.  After all, I had been experimenting with up to 900mg./day of levodopa with little tremor relief prior to DBS.
 
I would greatly appreciate any references to literature or comments you may have.
 

Share this post


Link to post
Share on other sites

Thanks for the question.

20-40% of patients have some or total levodopa resistance to tremor and so far the autopsies look like the same areas of the brain are affected as in tremor dominant PD (slightly different preference of cells in the substantia nigra (black substance of brainstem). 

Most patients with the symptoms you prescribe have slow progression and several papers are coming out about this.  The GBA mutation may for example be a marker of faster progression especially in cognition.

The Parkinson's Foundation and several other researchers have been using large databases to get at your question and see how PD progresses and how subtypes shift.

One other thing to discuss is that most people need levodopa after DBS and it seems especially important for apathy, mood and neuropsychiatric symptoms.

Share this post


Link to post
Share on other sites

I am afraid I am still confused:

Is that 20-40% of all PD patients with tremor have some levodopa resistance.  Or 20-40% of all tremor dominant PD patients are medication resistant.  (AND is not this about the same percentage of all PD patients that are tremor dominant.)

Do autopsies show similar areas of the brain affected in "garden variety" PD, tremor dominant PD, and medication resistant PD.  If so, what begins to explain these differences?

Share this post


Link to post
Share on other sites

20-40% have some degree of resistance to tremor.

Autopsy shows differences in tiers of the brainstem affected (nigra) between patients with tremor dominant PD and akinetic rigid PD.

I am not aware of autopsies of medication resistant cases but this would be very interesting.

Thanks for the questions.

Share this post


Link to post
Share on other sites

I am sorry, but I am still confused:

Do you mean that 20-40% of all PD patients who have tremor (some percentage of PD patients--perhaps as high as 40%--do not manifest tremor) find their tremors to be medication recalcitrant?

Some percentage (I don't know how many) of PD patients are tremor dominant (TD).  Are you saying that 20-40% of these TD patients find their tremors to be medication recalcitrant?

In other words, is medication recalcitrance more common in TD patients than in other PD subtypes?

 

Share this post


Link to post
Share on other sites

I am only commenting on Parkinson patients with tremor.

Literature suggests that if you have tremor that 20% or more of cases will have an incomplete or no response to dopamine (only the tremor feature as the other features like rigidity usually respond).  I am so sorry if I confused you!

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now

Sign in to follow this  

×