Apomorphine Therapy

Myths and Truth About Nanavathi Hospital Parkinson Injection Video

December 19, 2023By 0 comment

A Video about Parkinson’s disease patient being treated with apomorphine injections at Nanavathi Hospital , Mumbai became an social media craze in early 2019  (well known as Nanavati hospital Parkinson injection ).  The video shows an dramatic improvement, which has made everyone to think that this is a cure for Parkinson’s disease.   Thousands of Parkinson’s disease patients / caregivers thronged hospitals to find out about this therapy.   Even medical fraternity were perplexed about this, and what was being conveyed.    As a medical fraternity, we do know that till now there is NO CURE for parkinson’s disease currently.   There are good treatments available for Parkinson’s disease including medications, injections and surgeries.   Apomorphine is usually used as treatment option in moderately advanced Parkinson’s disease.  The video shows basically an improvement seen after the injections, which could be similar to levodopa tablets or DBS.  What it missed out on telling was this response would last only for about 60-90 minutes and this is only an symptomatic therapy.

As this video is popping up seasonally, this section would give an idea about Apomorphine and remove the myths around it.

Nanavati Hospital Parkinson Injection Video showing dramatic improvement

Dr Prashanth LK responding to Nanavathi Parkinson Injection Video

Facts about Apomorphine Injection Therapy for Parkinson Disease

FAQ about apomorphine injections

What is Apomorphine?

Apomorphine is a medication which is classified under “Dopamine Agonists”.  This means it works towards increasing dopamine levels in the brain. Other medications under this category include Pramipexole, Ropinirole,etc.

Is Apomorphine similar to Morphine and causes addiction?

Apomorphine is derived from Morphine (Apo means “from”). It is produced by combining Morphine with acids like Hydrochloric acid at high temperatures. By this process, Morphine loses all its properties and a complete new chemical is formed. The chemical name of apomorphine is (C17H17NO2) and is significantly similar to Dopamine.

When was Apomorphine discovered? What are the conditions where Apomorphine is used?

Apomorphine was discovered in 1845. Since then it has been used in various medical conditions like :

i. Vomit inducing agent in poisoning patients,

ii. Sleep inducing agent,

iii. Anesthesia,

iv. De-addiction purposes

v. Respiratory distress disorders

vi. Sexual dysfunction

vii. Movement Disorders (Parkinson’sDisease)

How does apomorphine help in Parkinson’s disease?

In Parkinson’s disease patients, there is reduction of the brain chemical – Dopamine. Apomorphine increases the levels of dopamine and hence improvement in Parkinson’s symptoms.

Since when Apomorphine is used in management of Parkinson’s Disease?

The first use of Apomorphine for Parkinson’s disease is around 1935. Since then it has been used in various studies. Its utilization was not prominent in early years due to nausea/ vomiting issues. With introduction of domperidone to reduce the side effects of Apomorphine, in 1970’s apomorphine utilization has dramatically increased and since last 20 years it is one of the options for advanced therapies for Parkinson’s Disease along with Deep Brain Stimulation (DBS) surgery and Levodopa-Carbidopa Intestinal gel (LCIG).

What are the different formulations, in which Apomorphine is available currently?

Apomorphine is primarily marketed in the form of Injections. However, tablet formulations are also available. There are research studies going on for newer delivery methods with better patient adaptation

What is the advantage of Apomorphine injections as compared to oral levodopa tablets used for Parkinson’s Disease?

We all know that as Parkinson’s disease progress, the duration of benefits of oral levodopa tablets start reducing and people will also start to have erratic responses. Sometimes the oral medications does not work or take too long to work as they are not absorbed properly in our gut (Stomach, duodenum). This is due the changes happening in our gut due to progression of Parkinson’s disease. Apomorphine, which is taken in injection formulation, bypassess the stomach absorption and hence its limitations. This bypassing helps to overcome the limitation of medications and gives quick and predictable benefits.

What are Apomorphine Rescue Injections? How long does it take to work and last for?

Apomorphine rescue injections are “emergency injections” which can be carried by patients in their pockets like “Insulin Injection pens”. If at any time, any Parkinson’s disease patient develops severe slowness, he can take subcutaneous injections similar to insulin injections. This apomorphine injection usually starts working within 5-10 minutes and gives quick and predictable relief. This whole beneficial effect lasts for about 60-90 minutes, helping people to tide over acute worsening. Hence called Rescue injections.

What is Apomorphine Pump Therapy?

In advanced Parkinson’s disease, people who are in need of taking medications very frequently and limited by benefits of oral therapy (like ON-OFF phenomenon, dyskinesia) are suggested for advanced Parkinson’s disease therapies. Apomorphine pump therapy is an advanced Parkinson’s disease therapy. It involves slow release of apomorphine throughout the day and hence providing stable, predictable benefits. It is somewhat similar to Insulin Pump therapy used by diabetes patients.

Are Apomorphine Pump therapy available in India?

Yes, currently two different generations of Apomorphine pumps are available in India. These products are in use in India since 2019.  These are supplied by – Rusan Pharamceuticals and Ever Pharma (Celera India)

Can anyone with Parkinson’s Disease take Apomorphine?

Apomorphine is used in specific stages of Parkinson’s disease to get desired benefits and improve quality of life. Your treating doctor would be able to tell whether you would benefit from Apomorphine therapy.

In the initial phase Apomorphine is used to assess whether the givenParkinson’s disease / Parkinsonism patient would be having benefits with levodopa therapy. This is called the “Apomorphine ResponseTest (ART)”.

In mid-phase of Parkinson’s disease, Apomorphine is used as emergency medications to give quick benefits when certain dosages of levodopa are not working due to various causes. This is called as “Rescue Therapy”

In moderately advanced Parkinson’s Disease, Apomorphine is used in continuous injections in the form of “ApomorphinePumpTherapy ” to over come motor fluctuations (ON – OFF phenomenon) and Dyskinesias.

What is an Apomorphine Response Test(ART)?

Apomorphine Response test or ART is a test to see whether your clinical symptoms improve with Apomorphine. This is done as an elective procedure, where in certain blood tests are done prior to testing. You would also be given “domperidone” tablets to reduce the side effects of Apomorphine. During ART, you would be asked to come in the morning without taking any levodopa and you would be assessed by giving different dosages of Apomorphine injections (usually ranging from 1mg to 6mg). The whole process may last from 90mins to 4-5 hours depending on response and side effects. Your treating doctor/team, will explain about this in detail. If there is a good response to ART, then you can be recommended for rescue therapy OR pump therapy as required.

What is Apomorphine Pump Therapy?

Apomorphine Pump therapy involves slow and continuous release of Apomorphine using a small pump, which can be carried in the pocket or sling bag or belt attachment. The continuous slow release of Apomorphine gives a predictable response throughout the day.

This takes away the side effects of excess medications and has the ease of quick adjustments. Usually pump therapy is given for about 10-16 hrs in a waking day period. However, in some cases night time use is also recommended.

What are the advantages of Apomorphine pump therapy in Parkinson’s Disease?

The advantages of Apomorphine pump therapy include:

i. It gives predictable responses

ii. Dosages can be easily modified as required

iii. No upfront cost like in DBS or LCIG gel therapies

iv. It is also used in patients in whom DBS is contraindicated and has shown good consistent benefits.

v. It has beneficial effects on cognitive function and can be used in people who are having mild to moderate cognitive impairment (where DBS is contraindicated)

vi. It is used in patients with resistant axial symptoms (Camptocormia – bending spine posture) with good benefits.

vii. It is also used in patients in whom DBS effects are reducing over the period of time to give add on benefits.

viii. It can be used for resistant Restless legs syndrome

What are the disadvantages of Apomorphine Pump Therapy?

The disadvantages of Apomorphine are similar to that of Levodopa, Pramipexole, Ropinirole etc. Specific disadvantage of Apomorphine pump therapy include:

i. It has to be managed on a daily basis to start and stop. Some patients may require assistance for the same.

ii. Some people are scared of needle pricks, which is a hurdle for utilization.

iii. Some people feel it is clumsy to carry.

iv. Skin injection sites small nodules are formed. Albeit they are temporary and non-concerning, rarely they can get infected causing problems.

v. Some people continue to have disturbing side effects of nausea, vomiting, drowsiness, blood pressure fluctuations in spite of domperidone.

Most of the dropouts in Apomorphine pump therapy have been noted in the first few months due to adaptation required. However once accepted, people have been using it over many years, with consistent benefits.

Are there any studies Indian / International on benefits of Apomorphine therapies?

Apomorphine therapy has been well accepted therapy for Parkinson’s disease for the last 30+ years. This is categorized under advanced therapies for Parkinson’s disease along with DBS and LCIG. There have been many publications on benefits and long term outcomes of Apomorphine therapy from various countries including India. There are guidelines published by International Movement Disorders groups on who should use apomorphine therapies.

Is Apomorphine injections / therapy available everywhere across India?

Theoretically Apomorphine should be available everywhere across India easily. However as this is an advanced therapy and used in a certain set of Parkinson’s Disease, the ease of access is limited to these advanced movement disorders centers in India. Usually you would be guided on how to procure after therapy initiation. Most of the time they are delivered to each patient on a requirement basis, without any major logistical issues. Even during COVID times, the logistics were maintained and even dispatched to patients who were struck abroad due to lockdown.

Where should I contact for Apomorphine pump therapy?

Your treating doctor will be able to guide you to the nearest Parkinson’s Disease center, who specialize in apomorphine therapies. Please speak to your treating Neurologist / Movement Disorders Specialist for further details.

Resources and Further reading

1. Prashanth LK, Jaychandran R, Seetharam R, Iyer RB. Apomorphine: The Initial Indian Experience in Relation to Response Tests and Pumps. Ann Indian Acad Neurol. 2020 Jan-Feb;23(1):20-24. doi: 10.4103/aian.AIAN_428_19. Epub 2019 Dec 19. PMID: 32055117; PMCID: PMC7001430.

2. Kukkle PL, Garg D, Merello M. Continuous Subcutaneous Infusion Delivery of Apomorphine in Parkinson’s Disease: A Systematic Review. Mov Disord Clin Pract. 2023 Jun 26;10(9):1253-1267. doi: 10.1002/mdc3.13810. PMID: 37772305; PMCID: PMC10525070.

3. Metta V, Borgohain R, L Kukkle P, Mridula R, Agarwal P, Kishore A, Goyal V, Chaudhuri R. Subcutaneous apomorphine in advanced Parkinson’s disease and its use in Indian population. Ann Mov Disord 2020;3:145-55

4. Trenkwalder C, Chaudhuri KR, García Ruiz PJ, LeWitt P, Katzenschlager R, Sixel-Döring F, Henriksen T, Sesar Á, Poewe W; Expert Consensus Group for Use of Apomorphine in Parkinson’s Disease, Baker M, Ceballos-Baumann A, Deuschl G, Drapier S, Ebersbach G, Evans A, Fernandez H, Isaacson S, van Laar T, Lees A, Lewis S, Martínez Castrillo JC, Martinez-Martin P, Odin P, O’Sullivan J, Tagaris G, Wenzel K. Expert Consensus Group report on the use of apomorphine in the treatment of Parkinson’s disease–Clinical practice recommendations. Parkinsonism Relat Disord. 2015 Sep;21(9):1023-30. doi: 10.1016/j.parkreldis.2015.06.012. Epub 2015 Jun 17. PMID: 26189414.

5. Jenner P, Katzenschlager R. Apomorphine – pharmacological properties and clinical trials in Parkinson’s disease. Parkinsonism Relat Disord. 2016 Dec;33 Suppl 1:S13-S21. doi: 10.1016/j.parkreldis.2016.12.003. Epub 2016 Dec 13. PMID: 27979722.

6. Todorova A, Ray Chaudhuri K. Subcutaneous apomorphine and non-motor symptoms in Parkinson’s disease. Parkinsonism Relat Disord. 2013 Dec;19(12):1073-8. doi: 10.1016/j.parkreldis.2013.08.012. Epub 2013 Aug 29. PMID: 24051336.

7. Dafsari HS, Martinez-Martin P, Rizos A, Trost M, Dos Santos Ghilardi MG, Reddy P, Sauerbier A, Petry-Schmelzer JN, Kramberger M, Borgemeester RWK, Barbe MT, Ashkan K, Silverdale M, Evans J, Odin P, Fonoff ET, Fink GR, Henriksen T, Ebersbach G, Pirtošek Z, Visser- Vandewalle V, Antonini A, Timmermann L, Ray Chaudhuri K; EUROPAR and the International Parkinson and Movement Disorders Society Non- Motor Parkinson’s Disease Study Group. EuroInf 2: Subthalamic stimulation, apomorphine, and levodopa infusion in Parkinson’s disease. Mov Disord. 2019 Mar;34(3):353-365. doi: 10.1002/mds.27626. Epub 2019 Feb 4. PMID: 30719763.

8. Fernández-Pajarín G, Sesar Á, Ares B, Castro A. Evaluating the Efficacy of Nocturnal Continuous Subcutaneous Apomorphine Infusion in Sleep Disorders in Advanced Parkinson’s Disease: The APO-NIGHT Study. J Parkinsons Dis. 2016 Oct 19;6(4):787-792. doi: 10.3233/JPD-160886. PMID: 27662329.

9. Sesar Á, Fernández-Pajarín G, Ares B, Rivas MT, Castro A. Continuous subcutaneous apomorphine infusion in advanced Parkinson’s disease: 10-year experience with 230 patients. J Neurol. 2017 May;264(5):946-954. doi: 10.1007/s00415-017-8477-0. Epub 2017 Mar 31. PMID: 28364292.

10. Borgemeester RWK, van Laar T. Continuous subcutaneous apomorphine infusion in Parkinson’s disease patients with cognitive dysfunction: A retrospective long-term follow-up study. Parkinsonism Relat Disord. 2017 Dec;45:33-38. doi: 10.1016/j.parkreldis.2017.09.025. Epub 2017 Sep 29. PMID: 29032012.

11. Sesar Á, Fernández-Pajarín G, Ares B, Relova JL, Arán E, Rivas MT, Gelabert-González M, Castro A. Continuous subcutaneous apomorphine in advanced Parkinson’s disease patients treated with deep brain stimulation. J Neurol. 2019 Mar;266(3):659-666. doi: 10.1007/s00415-019-09184-5. Epub 2019 Jan 7. PMID: 30617907.

12. Menšíková K, Kaiserová M, Vaštík M, Nevrlý M, Kurčová S, Kaňovský P, Colosimo C. The long-term effect of continuous subcutaneous apomorphine infusions on camptocormia in Parkinson’s disease. Parkinsonism Relat Disord. 2020 Jun;75:14-16. doi: 10.1016/j.parkreldis.2020.05.015. Epub 2020 May 12. PMID: 32442812

Overall this Nanavati Hospital Parkinson injection video has been impressive in creating awareness about treatment options for people with Parkinson’s disease.   Many people have equated Nanavati Hospital Parkinson injection video to be synonymous with cure for Parkinson’s disease, which is a misinterpretation of the video circulated, leading to lot of myths associated around this therapy.  We hope our blog on Nanavati hospital Parkinson injection video gives an open insight into the indications, uses and limitations of this therapy and breaks down into some of the myths which are being interpreted from this video.

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Awareness

Navigating Choices: Factors Influencing Deep Brain Stimulation (DBS) Surgery Decisions in Developing Countries – India

December 17, 2023By 0 comment

What factors contribute to the significant difference in the rate of Deep Brain Stimulation (DBS) surgery for Parkinson’s Disease (PD) between developed and developing countries?  What influences the decision of patients with PD in the developing world to opt for or against Deep Brain Stimulation (DBS) surgery? What are the primary barriers hindering a larger proportion of eligible PD patients in the developing world from undergoing Deep Brain Stimulation (DBS) surgery?  These questions have been addressed in a recently published medical paper from India in the medical journal – Movement Disorders in Clinical Practice.   Let’s see what we as a general population can understand from this article.

Deep Brain Stimulation (DBS) Surgery for Parkinson’s Disease – The Developing World’s (India) Perspective:

  • Study focused on patients with Parkinson’s disease (PD) and motor complications in developing countries (India) spanned over 5 year period (2016-2020) involving 1017 Parkinson’s Disease patients.
  • Among 1017 Parkinson’s Disease people, 223 patients met the medical criteria for consideration of Deep Brain Stimulation (DBS) surgery.
  • Among 223 medically indicated for DBS surgery, Only 35% (78 patients) patients opted for DBS surgery.
  • Among these 78 Patients who opted for surgery, 37 patients were found to be unfit for DBS surgery during the Pre-operative workup and only 41 patients finally underwent DBS Surgery.
  • So in brief, in 1017 patients with Parkinson’s Disease, roughly 22% met the clinical criteria for DBS surgery.  From the whole cohort, 7% opted for DBS surgery and among them, only about 4% were deemed fit and underwent the procedure.

Let’s see what factor played a role in decision making for Deep Brain stimulation Surgery in these patients in India.

Characteristics of Patients Opting for DBS Surgery:

Demographics:

  • Older age: Patients choosing DBS were generally older.
  • Higher socioeconomic status: Those opting for surgery had a higher socioeconomic status.

Disease Duration and Motor Complications:

  • Longer duration of PD: Patients choosing DBS had PD for a longer period.
  • Longer duration of motor fluctuations: Opted-for surgery patients experienced motor fluctuations for an extended time.

Motor Symptoms:

  • More severe motor disability in the OFF state: Severity of motor disability was higher in surgery-opting patients when not on medication.
  • More severe freezing of gait in the OFF state: Patients choosing DBS experienced more severe freezing of gait without medication.

Psychiatric and Cognitive Symptoms:

  • History of hallucinations and psychotic symptoms: Opted-for surgery patients had a higher incidence of these symptoms.
  • Higher burden of cognitive symptoms: Prevalence of cognitive dysfunction was higher in surgery-opting patients.

Correlation Between Socioeconomic Status and Surgical Decisions:

  • Correlation found between higher socioeconomic status and the willingness to undergo DBS surgery.
  • Almost 40% of patients opting for medical management cited financial constraints.

Barriers to DBS Surgery:

Reasons for Not Undergoing Surgery:

  • Financial constraints: 39.3% cited financial limitations.
  • Concerns about risks and complications: 13.1% were hesitant due to surgical concerns.
  • Lack of conviction about benefits: 9% were not convinced about expected benefits.
  • Inadequate family support: 6.9% lacked sufficient family support.

Consideration for Future DBS Surgery:

  • 31.7% of patients opting for medical management kept DBS as an option for future consideration.

Comparison with Western Populations:

  • Difference in DBS surgery rates between Western and developing countries.
  • In India, limited access, insurance coverage, and socioeconomic factors contribute to the low rate (35%).
  • Western countries, with comprehensive health coverage, may have higher rates, but concerns about efficacy and safety still influence decisions.

Conclusion:

  • Understanding the complex interplay of socioeconomic, medical, and personal factors crucial for making informed decisions about Deep Brain Stimulation (DBS) surgery in developing countries.
  • Financial constraints, limited insurance, and familial support emerged as significant barriers.
  • Future research and policy considerations should address these barriers to ensure equitable access to DBS surgery in developing regions.
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Awareness

World Movement Disorders Day Awareness Program: Sharing Personal Experiences

December 7, 2023By 0 comment

The World Movement Disorders Day Awareness Program was recently conducted at the Parkinson’s Disease and Movement Disorders Clinic in Bangalore on 29th November 2023. The event was a great success, featuring talks by people with various movement disorders who shared their personal experiences, as well as researchers in the field of neurodegeneration and genetics from the Center for Brain Research, IISC, and Raj Rajeswari Medical Colleges.

The talks covered a wide range of topics, including Hemifacial spasm, focal dystonia, writer’s cramp, blepharospasm, Wilson’s disease, Young onset Parkinson’s disease, couples with Parkinson’s disease, Apomorphine infusion therapy, Deep brain stimulation therapy, uses of liquid levodopa, and botulinum toxin therapy. The event was a great opportunity for people to interact with each other, share their experiences, and learn more about these conditions and the latest treatments available.
The event was a great success, and we hope to continue to raise awareness about movement disorders and provide support to those who are affected by them. If you or someone you know is living with a movement disorder, we encourage you to reach out to us for more information and support.
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Lets understand a few of the movement disorders on this occasion :

1. Ataxia:
Ataxia is a neurological disorder characterized by a lack of coordination and unsteady movements. It affects the voluntary muscle movements, leading to difficulties in walking, speaking, and performing fine motor tasks. Ataxia can result from various causes, including genetic factors, head trauma, or damage to the cerebellum.

2. Hemifacial Spasm:
Hemifacial spasm is a condition characterized by involuntary contractions or spasms on one side of the face. These spasms are often caused by compression of the facial nerve, leading to twitching or blinking movements. While typically not life-threatening, hemifacial spasm can significantly impact a person’s quality of life.

3. Dystonia:
Dystonia is a movement disorder characterized by sustained or repetitive muscle contractions, resulting in abnormal postures or twisting movements. It can affect one specific part of the body or be more widespread. Dystonia may be genetic or caused by trauma, certain medications, or other neurological conditions.

4. Writer’s Cramp:
Writer’s cramp is a type of dystonia that specifically affects the muscles used for writing or fine motor skills. Individuals with this condition may experience difficulty in gripping a pen or pencil, leading to pain and impaired writing ability. It can be triggered by prolonged periods of writing or repetitive hand movements.

5. Parkinson’s Disease:
Parkinson’s disease is a progressive neurodegenerative disorder that primarily affects movement. It is characterized by tremors, stiffness, bradykinesia (slowness of movement), and postural instability. The disease results from a loss of dopamine-producing cells in the brain. While there is no cure, various medications and therapies can help manage symptoms.

6. Botulinum Toxin for Movement Disorders:
Botulinum toxin, commonly known as Botox, is used as a therapeutic treatment for certain movement disorders, including dystonia and hemifacial spasm. It works by temporarily paralyzing or weakening specific muscles, alleviating involuntary movements and improving overall function. Botox injections are typically administered by a qualified healthcare professional.

7. Role of Physical Therapy for Movement Disorders:
Physical therapy plays a vital role in managing movement disorders by addressing mobility issues, improving muscle strength, and enhancing overall motor function. Therapists work with individuals to develop personalized exercise programs, focusing on balance, coordination, and flexibility. Physical therapy can be particularly beneficial in the comprehensive care of individuals with movement disorders like Parkinson’s disease, helping to maintain independence and improve the quality of life.

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What are common movement disorders - Parkinson, dystonia, ataxia, tremrosAwareness

World Movement Disorders Day – Understanding Movement Disorders

November 29, 2023By 0 comment

World Movement Disorders Day is observed on November 29th to raise awareness about various movement disorders. The Movement Disorder Society has initiated this day to increase education and understanding of these complex neurological diseases. Movement disorders encompass a range of conditions, including Parkinson’s disease, dystonia, tremor, restless legs, chorea, and myoclonus. These disorders can affect a person’s ability to control their movements, leading to symptoms such as tremors, stiffness, and involuntary movements.

What are common movement disorders - Parkinson, dystonia, ataxia, tremros

The International Parkinson and Movement Disorder Society (MDS) has organized virtual events and an educational social media campaign to mark this day. The aim is to connect healthcare professionals, patients, and the general public to specialists who have the knowledge to provide proper diagnosis and management for these conditions. The MDS encourages global partners, healthcare professionals, and patients to participate in raising awareness by using the hashtag #MoveDisorder on social media.

To illustrate the significance of this day, the Movement Disorder Society has highlighted the need for increased awareness and support for research in this field. For instance, the Movement Disorders Specialists of India have formed a consortium to address specific issues related to movement disorders and are collaborating with other fields to find solutions tailored to the Indian community[5].

Research in the field of movement disorders is crucial for understanding the underlying causes of these conditions and developing effective treatments. By increasing awareness and support for research, it is possible to improve care and outcomes for patients worldwide. The global awareness initiative also provides a platform for those struggling with movement disorders to have a voice and seek the specialized care they need[4].

Daily recommendations for Parkinson's Disease

In conclusion, World Movement Disorders Awareness Day serves as an opportunity to educate the public about the various movement disorders and the challenges faced by individuals living with these conditions. Through increased awareness, education, and support for research, it is possible to improve the lives of those affected by movement disorders and advance the understanding and treatment of these complex neurological diseases.

Citations:
[1] https://neurologyacademy.org/articles/first-ever-world-movement-disorders-day
[2] https://www.prweb.com/releases/announcing-first-ever-world-movement-disorders-day-to-be-observed-november-29-2022-842458991.html
[3] https://www.prweb.com/releases/events_will_recognize_first_ever_world_movement_disorders_day_on_november_29_2022/prweb19033042.htm
[4] https://www.movementdisorders.org/MDS/Moving-Along/2023-issue-1/First-World-Movement-Disorders-Day.htm
[5] https://www.movementdisordersclinic.com/world-movement-disorders-day/

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Awareness

Empowering Well-being: Daily Routine for Parkinson Disease

November 26, 2023By 0 comment

Incorporating a well-rounded daily routine for Parkinson Disease is crucial for well-being. Tailoring activities to address specific needs can enhance overall health and quality of life. Let’s explore daily recommendations under six key areas.

Aerobic Activities:

In the pursuit of holistic well-being, aerobic activities emerge as a cornerstone for seniors and individuals navigating Parkinson’s disease. These activities not only foster physical health but also contribute significantly to mental and emotional resilience.  Aerobic exercises, known for their rhythmic and continuous nature, are pivotal for enhancing cardiovascular health. For seniors and Parkinson’s patients, engaging in these activities promotes increased blood circulation, oxygenation, and overall endurance. This, in turn, contributes to improved energy levels and cognitive function.

Tailoring exercises to individual needs is crucial. Low-impact activities such as walking, swimming, and stationary cycling are excellent choices. These exercises are gentle on joints, reducing the risk of injuries. Aim for at least 30 minutes of moderate-intensity aerobic activity most days of the week.

Research suggests that aerobic exercises can have positive effects on motor functions and cognitive performance in individuals with Parkinson’s disease. These activities may help manage symptoms, enhance balance, and promote a sense of well-being.

Tailor activities to individual fitness levels and modify them as needed. Incorporating warm-up and cool-down sessions is crucial to prevent injuries.  The key lies in creating a personalized and sustainable aerobic exercise plan that aligns with individual capabilities and preferences. By embracing the power of movement, individuals can unlock a pathway to enhanced vitality, both physically and mentally.

#AerobicHealth #SeniorFitness

Meditation:

In the realm of holistic well-being, meditation stands as a profound practice with the potential to enhance the lives of seniors and individuals grappling with Parkinson’s disease. Beyond its calming effects, meditation contributes significantly to mental clarity, emotional resilience, and overall quality of life.

Various meditation techniques cater to different preferences. Pranayama, Mindfulness meditation, guided visualization, and loving-kindness meditation are popular choices.  Studies suggest that regular meditation can positively impact cognitive function, potentially slowing the cognitive decline associated with aging. For Parkinson’s patients, meditation may provide cognitive support, aiding in concentration and mental clarity.

Establishing a Meditation Routine:

Begin with short sessions and gradually extend the duration as comfort grows. Integrating meditation into daily life can be as simple as finding a quiet space, focusing on breath, and embracing the present moment. Consistency is key to reaping the full benefits.  Participating in group meditation sessions fosters a sense of community and shared purpose. For seniors and those managing Parkinson’s, this communal aspect of meditation provides an avenue for shared experiences and emotional support.

In the pursuit of well-being, meditation emerges as a transformative practice for seniors and individuals navigating Parkinson’s disease. By embracing moments of stillness, individuals can discover a profound source of mental and emotional strength. Whether practiced individually or in a group setting, meditation unveils a pathway to serenity, empowering individuals to navigate life’s challenges with grace.

#MindfulnessForSeniors #ParkinsonsWellness

Strength and Balance Training:

In the journey towards holistic well-being, the significance of strength and balance training cannot be overstated for seniors and those managing Parkinson’s disease. These targeted exercises not only enhance physical resilience but also contribute to improved mobility, reduced fall risks, and an overall sense of empowerment.

Crafting a personalized strength and balance training routine is essential. Include exercises that focus on major muscle groups, such as squats, lunges, and leg lifts. For Parkinson’s patients, incorporating exercises that enhance core strength can contribute to improved stability.  Consider low-impact options for those with mobility concerns. Water aerobics, tai chi, and yoga are excellent choices that provide a gentle yet effective approach to building strength and improving balance.  Participating in group strength and balance classes not only adds a social component but also provides a supportive environment.

Strength and balance training stand as pillars of physical well-being, offering seniors and individuals with Parkinson’s disease the tools to navigate daily life with confidence. By incorporating these exercises into a regular routine, individuals can not only enhance their physical capabilities but also cultivate a sense of empowerment and resilience.

#StrengthTraining #BalanceForSeniors #ParkinsonsWellness #SuryaNamsakara

Stretching Exercises:

In the pursuit of comprehensive well-being, the often-overlooked practice of stretching exercises plays a pivotal role for seniors and individuals managing Parkinson’s disease. Beyond enhancing flexibility, these exercises contribute to improved joint health, increased range of motion, and a heightened sense of physical comfort.

Emphasize gentle, gradual stretches, especially for seniors or those with limited mobility. Focus on major muscle groups such as the neck, shoulders, back, and legs. Incorporate both static and dynamic stretching techniques for a well-rounded approach.  Individualized stretching routines are key. Consider specific needs, such as addressing areas of discomfort or focusing on enhancing flexibility in particular joints. Seek guidance from healthcare professionals for personalized recommendations.

Stretching exercises offer a gateway to improved flexibility, joint health, and overall physical comfort for seniors and those with Parkinson’s disease.  Incorporating this daily routine for Parkinson Disease makes a dramatic change into the overall outcome of the disorder.

#FlexibilityRoutine #StretchingForSeniors #ParkinsonsWellness

Engaging Activities: 

In the pursuit of holistic well-being, engaging activities, such as gardening and participating in small chores, emerge as invaluable tools for seniors and individuals navigating Parkinson’s disease. Beyond providing a sense of purpose, these activities contribute to physical activity, mental stimulation, and an overall enhancement of daily life.

Gardening is a multifaceted activity that not only encourages physical movement but also provides exposure to nature, promoting mental well-being. Planting, weeding, and tending to a garden offer low-impact exercises that contribute to overall mobility.

Participating in everyday chores, even on a smaller scale, can be a form of functional exercise. Folding laundry, light cleaning, or organizing spaces contribute to physical activity and help maintain motor skills.

The goal is to create activities that are enjoyable, achievable, and aligned with personal interests.  or seniors and individuals with Parkinson’s, these activities infuse daily life with purpose, physical activity, and mental stimulation. By embracing active joy, individuals can cultivate a fulfilling and vibrant daily routine.

#EngagingActivities #ActiveLiving #ParkinsonsWellness # Daily Routine for Parkinson Disease

Social Activities:

In the realm of holistic well-being, the value of social activities and group events cannot be overstated for seniors and individuals managing Parkinson’s disease. Beyond mere socialization, these activities foster a sense of belonging, emotional support, and contribute to an enriched quality of life.  Engaging in group events provides a structured avenue to combat loneliness, fostering connections and meaningful relationships.  Sharing experiences, laughter, and camaraderie during group events create a positive atmosphere that helps alleviate stress and boost mood.  Engaging in conversations, playing games, or participating in group activities can help maintain mental sharpness, benefiting both seniors and individuals with Parkinson’s.

Group events offer a platform to celebrate milestones, whether personal or collective. Recognizing achievements, birthdays, or special occasions within a supportive community enhances a sense of joy and accomplishment.  Incorporating intergenerational activities can be especially enriching. Seniors and Parkinson’s patients benefit from the energy and perspectives of younger generations, creating a dynamic and inclusive social environment.

Social activities and group events are not mere pastimes—they are essential threads in the fabric of well-being. For seniors and individuals with Parkinson’s, these activities weave a tapestry of connection, support, and joy. By actively participating in social events, individuals can foster a community that uplifts and enhances the overall quality of life.

#SocialWellness #CommunityConnection #ParkinsonsSupport # Daily Routine for Parkinson Disease

To reap the full spectrum of benefits, strive to dedicate at least 30 minutes to each event, engaging in activities at least three days a week. This commitment ensures a consistent and impactful embrace of social well-being, promoting a fulfilling and vibrant lifestyle. By weaving the tapestry of connection and shared moments, we cultivate resilience, joy, and a community that uplifts us on this journey of well-being – Incorporate a healthy daily routine for Parkinson disease.

#SocialWellness #CommunityConnection #ParkinsonsSupport

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Falls Prevention in Elderly: Tips and Home-Based Therapies

November 20, 2023By 0 comment
The video is a recorded version of fall prevention in Elderly – covering important aspects on causes, Risks and simple home based modifications / exercises for falls prevention in elderly and Parkinson’s disease people.

🔍 Key Topics Covered:

Importance of Falls Avoidance:

Uncover the significance of preventing falls and its impact on overall well-being. Gain insights into how proactive measures can enhance the quality of life for individuals with Parkinson’s disease.

Common Causes of Falls:

Explore the various factors contributing to falls, from medical conditions to environmental hazards. Understanding these triggers is the first step towards effective prevention.

Fall Prevention Strategies:

Learn evidence-based strategies and practical tips to minimize the risk of falls. Discover how targeted exercises and lifestyle adjustments can significantly enhance stability and mobility.

Home-Based Modifications:

Dive into the importance of creating a safe living environment. Explore practical modifications that can be made at home to reduce fall risks and enhance overall safety.

Home-Based Therapy for Falls Prevention:

Unveil the power of physiotherapy in the comfort of your home. Discover tailored exercises and therapeutic approaches that empower individuals to maintain balance and prevent falls.
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Allan BorderAwareness

Australian Cricket Legend Allan Border Opens Up About His Battle with Parkinson’s Disease

November 15, 2023By 0 comment

Allan Border, the former Australian cricket captain, has revealed that he has been battling Parkinson’s disease for the past seven years. Parkinson’s is a progressive disorder of the nervous system that affects movement and causes unintended or uncontrollable movements. Border was diagnosed with the disease in 2016 but chose to keep it private until now. Parkinson’s is an neurodegenrative / Ageing disease that causes progressive brain damage, with common symptoms of loss of muscle control, tremors, muscle rigidity, and slowness of movement. Border said that he will continue to fight the disease and that he is not scared about the immediate future. Border played 156 Tests between 1979 and 1994 – 93 of them as captain – and was the first batter to score 11,000 runs, finishing with 11,174. He also led Australia to victory in the 1987 World Cup and ended up playing 273 ODIs. Since retiring, he has served as an Australian selector and been a broadcast commentator.

Here are the top 5 questions on Parkinson’s Disease being queried on Google search and their answers:

 

  1. What is Parkinson’s disease (PD)?

– Parkinson’s disease is a progressive neurological disorder or disorder of the brain. It affects men slightly more than women and Caucasians more than people of color. The cause of PD is still not clearly understood, with theories including genetic, environmental, and viral factors.

 

  1. What are the symptoms of Parkinson’s disease?

– The most common symptoms of Parkinson’s disease include tremor at rest, rigidity (stiffness), bradykinesia (slowness of movement), and postural instability (lack of balance). Individuals with PD may also experience difficulty walking, reduced facial expressions, small handwriting, soft and muffled speech, constipation, sleep disturbances, depression, anxiety, memory problems, difficulty swallowing, and reduced armswing.

 

  1. How does Parkinson’s disease begin?

– The characteristic brain pathology and motor symptoms of Parkinson’s disease are well established, but the details of the disease’s cause and course are much murkier. Many scientists are searching for blood- or urine-based biomarkers, or imaging agents, that could objectively identify the risk of Parkinson’s, but so far no leading contender has emerged.

 

  1. What other specialists or healthcare professionals should help me manage my care?

– It is important to ask about the other health professionals who can help manage Parkinson’s disease. This may include physical therapists, occupational therapists, speech therapists, and social workers, among others[.

 

  1. Besides taking medications, what else can I do to manage my Parkinson’s disease? Are there specific therapies, exercises, or lifestyle changes that can help?

– In addition to medications, there are specific therapies, exercises, and lifestyle changes that can help manage Parkinson’s disease. These may include physical therapy, speech therapy, occupational therapy, and regular exercise, among other strategies.

These questions cover a range of important topics related to Parkinson’s disease, from understanding the condition and its symptoms to managing care and seeking additional support from healthcare professionals.

Citations:

[1] https://www.foxsports.com.au/cricket/australian-cricket-legend-allan-border-has-parkinsons-disease/news-story/c96d056bd549403184ec81a1ac66d72f

[2] https://youtube.com/watch?v=o51v2az8mgo

[3] https://www.smh.com.au/sport/cricket/allan-border-reveals-he-has-parkinsons-disease-20230630-p5dky9.html

[4] https://apnews.com/article/allan-border-cricket-ad78339b79c704dfb315b10100aba538

[5] https://www.espncricinfo.com/story/allan-border-reveals-he-has-parkinsons-disease-1385094

[6] https://www.movementdisordersclinic.com/

[7] https://www.apdaparkinson.org/article/common-questions-from-caregivers/

[8] https://www.nature.com/articles/538S17a

[9] https://www.parkinson.org/library/fact-sheets/questions-doctor-visit

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news

Stay Strong, Stay Safe: Essential Falls Prevention Strategies for Older Adults

November 13, 2023By 0 comment

Falls prevention is a critical aspect of healthcare for older adults and aging related disorders like Parkinson’s Disease, Arthritis, Dementia to name a few.  It involves a multifaceted approach encompassing exercise, home safety, regular health checkups, and more. The World guidelines for falls prevention and management for older adults: a global initiative, published on the National Center for Biotechnology Information (NCBI) website, provides evidence- and expert consensus-based recommendations applicable to older adults. These guidelines emphasize a person-centered approach, considering the perspectives of older adults, caregivers, and other stakeholders. They also address the challenges of implementing falls prevention guidelines in low- and middle-income countries (LMIC) and the importance of feedback from older adults to tailor the guidelines to their needs

Falls Prevention Techniques:

Falls prevention techniques are essential for older adults to maintain their independence and avoid injuries. Here are some elaborative techniques from the search results:

  1. Exercise and Physical Activity: Regular physical activity can improve strength, balance, coordination, and flexibility, reducing the risk of falls. Activities such as walking, water workouts, or tai chi are recommended
  2. Home Safety: Removing home hazards such as clutter, loose rugs, and poor lighting can prevent falls. Installing grab bars in bathrooms and handrails on stairs can also help
  3. Regular Health Checkups: Regular health checkups can help assess fall risk, manage medications, and recommend vitamin D supplements
  4. Occupational Therapy: An occupational therapist can help older adults brainstorm other fall prevention strategies and create a custom exercise program aimed at improving balance, flexibility, and muscle strength
  5. Footwear: Wearing sensible shoes with good support and non-slip soles can help prevent falls
  6. Vision: Regular eye checkups can help detect vision problems that increase the risk of falls
  7. Medication Review: Reviewing medications with a healthcare provider can help identify those that increase the risk of falls and adjust dosages or switch to safer alternatives
  8. Assistive Devices: Using assistive devices such as canes, walkers, or wheelchairs can help older adults maintain their balance and mobility

    By implementing these techniques, older adults can reduce their risk of falls and maintain their independence.

Home Exercises for Falls Prevention :

Are you or someone you know experiencing frequent falls or a fear of falling? Here are some simple home exercises to follow in order to prevent falls. (Follow the cues in the image)
1. Heel lifts
2. Single knee lift
3. Alternate step marching
4. Leg extension
5. Knee curl
6. Sit to stand
7. Walking
8. Heel to toe walking
9. Keeping a fall dairy
Let us help you regain your independence and improve your quality of life. Don’t wait, book your appointment today!
📞+91 7026603300.
We are located at NEURO CLINIC / Parkinson’s Disease and Movement Disorders Clinic, No. 15, 1st Floor, Royal Plaza, Dr. Rajkumar Road, Opposite to Theresa Hospital, Above ICICI Bank, Rajajinagar, Bangalore. https://maps.app.goo.gl/vVYDgegbAoZWwJeW9

Comments / suggestions Whatsapp to : +917026603300

Subscribe to our Whatsapp Channel : https://whatsapp.com/channel/0029Va53s2N3bbVCdsUkKz2n

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Progressive Supranuclear Palsy - PSPAwareness

Lets Learn About Progressive Supranuclear Palsy (PSP)

October 22, 2023By 0 comment
Progressive Supranuclear Palsy - PSP

Progressive Supranuclear Palsy (PSP)

On October 19-20, 2023, a significant global event brought together leading specialists to address the pressing issues surrounding Progressive supranuclear palsy (PSP) in London, UK

Progressive supranuclear palsy (PSP) is a rare and complex neurodegenerative disorder.

Here are 10 important things to know about PSP:

  1. Rare Condition: PSP is a relatively uncommon condition, affecting approximately 5-6 people per 100,000 in the population.
  2. Onset and Age: It typically affects individuals in their 60s or 70s, but early-onset PSP can occur in individuals in their 40s or 50s.
  3. Motor Symptoms: PSP is characterized by motor difficulties, including stiffness, slowness of movement, and frequent falls. This can make it resemble Parkinson’s disease, but PSP has distinct features.
  4. Eye Movement Problems: One of the hallmark features of PSP is difficulty controlling eye movements, leading to issues with looking up and down. This can cause falls and difficulty with balance.
  5. Cognitive Changes: Individuals with PSP may experience cognitive changes, such as difficulties with memory, decision-making, and problem-solving. However, these changes are usually less severe than those seen in Alzheimer’s disease.
  6. Behavioral and Emotional Changes: PSP can lead to changes in behavior and emotions, including irritability, apathy, and mood swings.
  7. Speech and Swallowing Issues: Speech problems, such as slurred speech, and difficulties with swallowing are common in PSP.
  8. No Cure: Currently, there is no cure for PSP. Treatment primarily focuses on managing symptoms and improving the patient’s quality of life.
  9. Abnormal Brain Protein: PSP is associated with the buildup of an abnormal protein called tau in specific areas of the brain. This protein accumulation is a key feature in diagnosing the condition.
  10. Diagnosis Challenges: Diagnosing PSP can be challenging because its symptoms overlap with other neurological disorders, like Parkinson’s disease. A definitive diagnosis often requires a combination of clinical evaluation, medical history, and specific neurological tests.

Supportive Care: PSP patients benefit from a multidisciplinary approach involving neurologists, physical therapists, occupational therapists, and speech therapists. Supportive care and therapy focus on symptom management and maintaining the patient’s quality of life. CurePSP and PSPA (Progressive Supranuclear Palsy Association) are two organizations dedicated to supporting individuals and families affected by Progressive supranuclear palsy (PSP) and related disorders

It’s important to note that PSP is a progressive and challenging condition that can significantly impact a person’s quality of life. Raising awareness and understanding of the disease is crucial for providing better care and support for individuals living with PSP and their families.

www.movementdisordersclinic.com

Bangalore, India

Appointments : +91 7026603300

Join our Whatsapp Channel for similar information:  https://whatsapp.com/channel/0029Va53s2N3bbVCdsUkKz2n

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Stigma of Parkinson diseaseAwareness

Stigma in Parkinson Disease : How to overcome it

October 13, 2023By 0 comment
Stigma of Parkinson disease

What is Stigma in Parkinson Disease? What are the types of Stigma?

Stigma in Parkinson’s disease, like many other chronic medical conditions, is a significant challenge that individuals with the condition and their families face. Stigma can be broadly categorized into seven types, as defined by Link and Phelan in their influential work on the subject. These seven types can help us understand how Parkinson’s disease is stigmatized and the impact it has on those affected.

Public Stigma: This type of stigma involves the negative beliefs, attitudes, and stereotypes held by society at large towards people with Parkinson’s disease. These attitudes can manifest as fear, misunderstanding, or avoidance. Public stigma can make it difficult for individuals with Parkinson’s disease to socialize or access the support they need.

Self-Stigma: Self-stigma refers to the internalization of the negative stereotypes and beliefs that society holds about Parkinson’s disease. People with Parkinson’s may start to believe these stereotypes and feel ashamed or inferior, which can lead to a decrease in self-esteem and overall well-being.

Structural Stigma: Structural stigma pertains to societal and institutional practices that discriminate against or disadvantage people with Parkinson’s disease. This can manifest in healthcare disparities, limited access to quality care, or difficulties in obtaining insurance coverage for treatment and support services.

Affiliated Stigma: Parkinson’s disease doesn’t just affect the individual diagnosed; it also has an impact on their family and caregivers. Affiliated stigma involves the negative attitudes and discrimination experienced by the family members and friends of someone with Parkinson’s. They may face judgment or feel isolated, which can strain their relationships and well-being.

Courtesy Stigma: Individuals who care for or interact with people living with Parkinson’s disease can also face courtesy stigma. This occurs when people are treated unfairly or with disrespect because of their association with someone who has the condition. Healthcare providers, for instance, may experience this form of stigma.

Label Avoidance: Label avoidance stigma refers to individuals’ reluctance to be identified as having Parkinson’s disease due to the negative consequences they anticipate, such as potential discrimination or social rejection. This can lead to people avoiding diagnosis and treatment, which may result in delayed intervention and poorer outcomes.

Perceived Stigma: Perceived stigma is the fear or anticipation of experiencing stigma based on one’s condition. People with Parkinson’s may anticipate discrimination or negative reactions from others, which can lead to anxiety, depression, or reluctance to seek social support.

Addressing stigma in Parkinson’s disease is crucial to improving the lives of those affected. This can be accomplished through a combination of education, awareness campaigns, and policy changes. Increased public understanding and empathy can help reduce public stigma, while empowering individuals with Parkinson’s to share their stories and experiences can combat self-stigma. Moreover, healthcare systems and institutions should work to reduce structural stigma and ensure equitable access to care.

In conclusion, understanding the seven types of stigma in Parkinson’s disease provides a comprehensive framework for addressing the complex challenges faced by individuals with the condition and their loved ones. By actively working to reduce these stigmas, we can create a more inclusive and supportive environment for those living with Parkinson’s disease.

How to overcome Parkinson Disease Stigma?

Stigma in Parkinson

Reducing stigma in Parkinson disease is essential to improving the quality of life for individuals affected by the condition. Stigma can have a profound impact on mental health, social relationships, and access to healthcare. Here are some strategies and approaches to reduce stigma in Parkinson’s disease:

A. Education and Awareness:

Public education campaigns: Conduct public awareness campaigns to provide accurate information about Parkinson’s disease. These campaigns can dispel myths and stereotypes, helping to increase understanding and empathy.
Schools and communities: Introduce educational programs about Parkinson’s disease in schools and local communities. Promoting understanding from a young age can foster a more accepting society.
Media and Representation:

Encourage accurate portrayal: Work with media outlets to ensure that depictions of Parkinson’s in movies, television, and news are accurate and respectful. Avoid sensationalizing the condition or using it for comedic effect.
Highlight positive stories: Share stories of individuals with Parkinson’s who have achieved remarkable accomplishments, demonstrating that the condition doesn’t define their entire life.

B. Open Dialogue:

Support groups: Create and promote support groups where people with Parkinson’s, their caregivers, and family members can share their experiences, challenges, and triumphs. Open dialogue can reduce self-stigma and affiliated stigma.
Personal testimonials: Encourage individuals with Parkinson’s to share their personal stories, either in person or through written or online platforms. Personal narratives can be powerful tools for challenging stereotypes.
Healthcare and Policy:

Equal access to care: Advocate for policies that ensure equitable access to healthcare services, including specialist care, therapies, and medications. Reducing structural stigma in the healthcare system is crucial.
Training for healthcare professionals: Offer training to healthcare providers to help them understand the physical and emotional challenges faced by people with Parkinson’s. This can improve patient-provider relationships and reduce courtesy stigma.

C. Language Matters:

Use person-first language: Encourage the use of person-first language, where the person is emphasized over the condition. Instead of saying “a Parkinson’s patient,” say “a person living with Parkinson’s.”
Avoid derogatory terms: Educate people about the importance of avoiding derogatory or insensitive language that perpetuates stereotypes.

D. Empower Advocacy:

Support advocacy organizations: Join or support organizations that advocate for the rights and well-being of people with Parkinson’s. These organizations often have the resources and platforms to combat stigma effectively.
Political engagement: Engage with policymakers to promote legislation that protects the rights and dignity of individuals living with Parkinson’s disease.
Mental Health Support:

Address the emotional impact: Acknowledge the emotional and psychological challenges associated with Parkinson’s and provide access to mental health support and resources. This can help individuals cope with self-stigma and perceived stigma.

E. Promote Inclusivity:

Encourage social inclusion: Promote social activities and events that are accessible and welcoming to people with Parkinson’s. Inclusive environments help reduce perceived stigma and encourage participation.

Celebrate Achievements:

Recognize achievements: Highlight the accomplishments of individuals living with Parkinson’s, showcasing their resilience and contributions to society.
Reducing stigma in Parkinson’s disease is an ongoing process that involves the collective efforts of individuals, healthcare providers, policymakers, and communities. By fostering understanding and empathy, dispelling misconceptions, and promoting inclusivity, we can create a more accepting and supportive environment for those living with Parkinson’s disease and work towards reducing the stigma in Parkinson disease.

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