>>>
>>> MANY
>>> MANY PEOPLE EXPERIENCE A TREMBLING IN THEIR HANDS OR
THEIR VOICE ONCE IN A WHILE,
WHEN THOSE TREMORS BECOME MORE
AND PRONOUNCED AND THEY LAST
LONGER CAN SIGNIFY A MORE
SERIOUS CONDITION LIKE
PARKINSON'S.
PARKINSON'S. HOW DO YOU TELL WHICH ONE IS
AFFECTING YOU AND WHAT TYPES OF
TREATMENTS ARE AVAILABLE?
DR. LEVINE A BOARD, FROM
SWEDISH.
SWEDISH.
SWEDISH. THERE'S A LOT OF CONFUSION,
LET'S START WITH PARKINSON'S.
WHAT IT IS, AN OVERVIEW, AND
WHAT THE SYMPTOMS ARE.
>> PARKINSON'S IS A
NEUROLOGICAL DISORDER.
NEUROLOGICAL DISORDER. AND, IT AFFECTS MANY PARTS OF
THE BRAIN AND BODY TRADE A LOT
OF PEOPLE WITH PARKINSON'S CAN
HAVE TREMORS, BUT A SMALL
MINORITY MAY NOT HAVE TREMORS.
IT CAN AFFECT BODILY FUNCTIONS
SUCH AS DIGESTION, BLOOD
PRESSURE REGULATION, BLADDER,
AND IN THE ADVANCED STAGES, IT
CAN CAUSE PROBLEMS WITH MEMORY
AND THINKING.
AND THINKING. THE OVERALL PROBLEM WITH
PARKINSON'S DISEASE IS A
GRADUAL DECLINE IN MOBILITY AND
MOVEMENT.
MOVEMENT.
MOVEMENT. >> HOW IS IT DIFFERENT THAN A
CENTRAL TREMOR?
CENTRAL TREMOR? >> GREAT QUESTION, BECAUSE BOTH
DISEASES CAUSED TREMORS. THEY
CAN BE OFTEN CONFUSED WITH EACH
OTHER.
OTHER.
OTHER. I'LL PARKINSON'S DISEASE CAUSES
ALL OF THESE CHANGES THAT I
JUST MENTIONED, ESSENTIAL TREMOR
CAUSES PRIMARILY TREMORS.
IN THE HANDS, OCCASIONALLY IN
THE HEAD, THE VOICE OR THE
TORSO.
TORSO.
TORSO. AND IN VERY FEW PEOPLE AS THE
TREMOR PROGRESSES IT CAN CAUSE
PROBLEMS WITH BALANCE. BUT
OVERALL, IT DOES NOT AFFECT ANY
OTHER BODILY FUNCTIONS.
>> SO, WHEN SOMEBODY COMES TO
YOU AND THEY HAVE TREMORS, HOW
DO YOU DIAGNOSTICALLY
DISTINGUISH BETWEEN THE TWO
THINGS?
THINGS?
THINGS? >> AGAIN, GREAT QUESTION
BECAUSE, TRULY THE DIAGNOSTIC
DISTINCTION BETWEEN THESE TWO
DISEASES IS DONE ON A CLINICAL
BASIS.
BASIS.
BASIS. THERE'S REALLY NO BLOOD TEST
THAT YOU CAN ORDER UP THAT WILL
TELL YOU IF A PERSON HAS
PARKINSON'S DISEASE OR CENTRAL
TREMOR.
TREMOR.
TREMOR. A
TREMOR. A GOOD HISTORY, DONE BY
SOMEBODY WHO IS TRAINED, IN
TREATING ESSENTIAL TREMOR AND
PARKINSON'S DISEASE.
PARKINSON'S DISEASE. >> THAT SOUNDS SCARY FOR THE
PATIENT, RIGHT, BECAUSE THEY
ARE NOT GOING TO KNOW UNTIL
THINGS PROGRESSED, WHICH ONE IT
LIKELY IS, IS THAT CORRECT?
>> NOT NECESSARILY COMING EVEN
IN THE EARLY STAGES, THERE ARE
CHARACTERISTIC DIFFERENCES
CHARACTERISTIC DIFFERENCES BETWEEN ESSENTIAL TREMOR AND
PARKINSON'S DISEASE.
PARKINSON'S DISEASE. IT BECOMES A LITTLE MORE
DIFFICULT TO DISTINGUISH THE
BETWEEN THE TWO IN THE MORE
ADVANCED STAGES.
ADVANCED STAGES. >> INTERESTING, AND THE
BEGINNING WHAT ARE THE
DIFFERENCES?
DIFFERENCES? >> ONE OF THEM IS IF A PERSON
WITH PARKINSON'S DISEASE HAS A
TREMOR, THEY SHAKE AT REST WHEN
THEY ARE NOT DOING ANYTHING.
AND, IN ESSENTIAL TREMOR,
PEOPLE SHAKE WHEN THEY ARE
TRYING TO DO SOMETHING, LIKE
WRITING, EATING, NOT TO SAY
THAT PEOPLE WITH PARKINSON'S
DON'T HAVE THOSE PROBLEMS, BUT
AT THE OUTSET WHEN YOU ARE
EXAMINING THE PATIENT, THE
FIRST THING YOU LOOK AT IS THE
TREMOR PRESENT WHEN THEY ARE
QUIET AND SITTING STILL OR IS
IT ONLY PRESENT WHEN THEY ARE
TRYING TO DO SOMETHING.
>> THAT'S INTERESTING.
WHAT IS THE TREATMENT PROTOCOL?
>> VERY DIFFERENT FOR BOTH OF
THESE DISEASES BECAUSE WHAT
CAUSES PARKINSON'S IS VERY
DIFFERENT THAN WHAT CAUSES
ESSENTIAL TREMOR.
ESSENTIAL TREMOR. THE EXACT CAUSE IS BEING
RESEARCHED.
RESEARCHED. IN PARKINSON'S DISEASE, THERE
IS A FUNDAMENTAL PROBLEM WITH
THE PRODUCTION OF A CHEMICAL
SIGNAL CALLED DOPAMINE, AND
DOPAMINE IS REALLY CRITICAL FOR
NORMAL MOVEMENT.
NORMAL MOVEMENT. THE BASIC TREATMENT, THE FIRST-
LINE TREATMENT FOR PARKINSON
DISEASE IS TO REPLENISH
DOPAMINE THROUGH MEDICATIONS.
IN ESSENTIAL TREMOR, THERE'S NO
SUCH CHEMICAL SIGNAL.
THERE ARE A COUPLE OF DRUGS
THAT ARE REALLY GOOD AT
TREATING ESSENTIAL TREMOR, ABOUT
50% OF PEOPLE RESPOND TO THOSE
DRUGS, THE REMAINING 50%, NOT
AS MUCH.
AS MUCH.
AS MUCH. >> SO, WHEN YOU FIRST DIAGNOSE
A PATIENT, AND YOU DECIDE WHAT
KIND OF TREATMENT THEY ARE ON,
ARE THERE SEVERAL DIFFERENT
PATHS, DEPENDING ON THEIR AGE,
THEIR GENDER, OR IS IT KIND OF
THE SAME THING REGARDLESS?
>> ABSOLUTELY, THIS IS VERY
IMPORTANT, THAT THE AGE AND
STAGE OF THE DISEASE, BOTH NEED
TO BE TAKEN INTO ACCOUNT WHEN
DEVISING A TREATMENT PLAN FOR A
PATIENT.
PATIENT.
PATIENT. IT NEEDS TO BE CUSTOMIZED FOR
THE INDIVIDUAL WHO COMES INTO
THE OFFICE FOR TREATMENT.
THERE ARE CERTAIN DRUGS IN
PARKINSON'S DISEASE THAT CAN
HAVE SIDE EFFECTS IN OLDER
INDIVIDUALS.
INDIVIDUALS. WE TRY AND AVOID THOSE DRUGS.
AND THEN WE CHOOSE DRUGS THAT
HAVE A BETTER SIDE EFFECT
PROFILE.
PROFILE.
PROFILE. >> DOES THIS TEND TO HAPPEN
MORE TO WOMEN OR MEN?
>> IN PARKINSON'S DISEASE, IT
HAPPENED 1.5 TIMES MORE IN MEN,
THAN IN WOMEN TRADE IN
ESSENTIAL TREMOR, IT'S PRETTY
MUCH SIMILAR BETWEEN THE TWO
GENDERS.
GENDERS.
GENDERS. >> AND, IS THERE ANYTHING TO DO
WITH AGE, DOES IT STRIKE AT
PARTICULAR YOU KNOW, TIMES
DURING A PERSON'S LIFE?
HE MET WITH PARKINSON'S
DISEASE, WE KNOW BEYOND A
DOUBT, AGING IS A RISK FACTOR.
SO, OVER 60 YEARS OF AGE, THE
RISK OF DEVELOPING PARKINSON'S
DISEASE REALLY INCREASES
EXPONENTIALLY.
EXPONENTIALLY. WITH ESSENTIAL TREMOR, WE NOW
BELIEVE THAT I CAN HAPPEN
EITHER EARLY ON OR MUCH LATER
IN LIFE, AND IT ENTIRELY
DEPENDS ON HOW LONG YOU HAVE
THE TREMOR, THE SEVERITY OF THE
TREMOR DEPENDS ON HOW LONG
YOU'VE HAD IT FOR.
ANYBODY CAN DEVELOP ESSENTIAL
TREMOR AT ANY TIME.
>> ARE THERE BREAKTHROUGHS TO
LOOK FORWARD TO?
IS THE RESEARCH MOVING QUICKLY?
>> SIGNIFICANTLY.
>> SIGNIFICANTLY. I'M HAPPY TO SAY THAT UP UNTIL
A FEW YEARS AGO THE TREATMENT
OF PARKINSON'S WAS FOCUSED ONLY
ON REPLENISHING DOPAMINE, AND
THE NEW ERA OF RESEARCH, IT'S
FOCUSED ON ACTUALLY GOING
DEEPER AND DETERMINING WHAT IS
THE CAUSE AND SPREAD OF
PARKINSON'S DISEASE, SO THE NEW
RESEARCH IS GEARED TOWARDS
SLOWING DOWN THE PROGRESSION OR
STOPPING THE PROGRESSION OF
PARKINSON'S DISEASE, AND
ESSENTIAL TREMOR AFTER A LONG
HIATUS, WE ARE NOW RESEARCHING
OTHER DRUGS THAT CAN BE EVEN
MORE EFFECTIVE THAN THE DRUGS
WE CURRENTLY HAVE.
>> THAT'S VERY GOOD.
THANK YOU SO MUCH FOR HELPING
US OUT WITH THIS.
FOR MORE INFORMATION