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Stem Cell Parkinson’s Treatment In India At Mumbai and Delhi At low Cost

October 6, 2011 By Leave a Comment

Stem Cell Parkinson’s Treatment In India At Mumbai and Delhi At low Cost

Article by Pankaj Nagpal









Parkinsons Disease

Parkinson’s disease develops gradually, often starting with a barely noticeable tremor in just one hand. But while tremor may be the most well-known sign of Parkinson’s disease, the disorder also commonly causes a slowing or freezing of movement.

Symptoms

The symptoms of Parkinson’s disease vary from person to person. Early signs may be subtle and can go unnoticed for months or years. Symptoms typically begin on one side of the body and usually remain worse on that side. Parkinson’s signs and symptoms may include : –

? Tremor : – The characteristic shaking associated with Parkinson’s disease often begins in a hand. A back-and-forth rubbing of your thumb and forefinger, known as pill-rolling, is common. However, many people with Parkinson’s disease do not experience substantial tremor.? Slowed motion (bradykinesia) : – Over time, Parkinson’s disease may reduce your ability to initiate voluntary movement. This may make even the simplest tasks difficult and time-consuming. When you walk, your steps may become short and shuffling. Or your feet may freeze to the floor, making it hard to take the first step.? Rigid muscles : – Muscle stiffness often occurs in your limbs and neck. Sometimes the stiffness can be so severe that it limits the range of your movements and causes pain.? Impaired posture and balance : – Your posture may become stooped as a result of Parkinson’s disease. Imbalance also is common, although this is usually mild until the later stages of the disease.? Loss of automatic movements : – Blinking, smiling and swinging your arms when you walk are all unconscious acts that are a normal part of being human. In Parkinson’s disease, these acts tend to be diminished and even lost. Some people may develop a fixed staring expression and unblinking eyes. Others may no longer gesture or seem animated when they speak.? Speech changes : – Many people with Parkinson’s disease have problems with speech. You may speak more softly, rapidly or in a monotone, sometimes slurring or repeating words, or hesitating before speaking.? Dementia : – In the later stages of Parkinson’s disease, some people develop problems with memory and mental clarity. Alzheimer’s drugs appear to alleviate some of these symptoms to a mild degree.

Causes

Many symptoms of Parkinson’s disease result from the lack of a chemical messenger, called dopamine, in the brain. This occurs when the specific brain cells that produce dopamine die or become impaired. But researchers still aren’t certain about what sets this chain of events in motion. Some theorize that genetic mutations or environmental toxins may play a role in Parkinson’s disease.

Risk factors for Parkinson’s disease include : -

? Age : – Young adults very rarely experience Parkinson’s disease. It ordinarily begins in middle or late life, and the risk continues to increase with age.? Heredity : – Having one or more close relatives with Parkinson’s increases the chances that you’ll also develop the disease, although your risk is still less than 5 percent. Recent evidence suggests a crucial role for small contributions from many different genes that program brain architecture.? Sex : – Men are more likely to develop Parkinson’s disease than women are.? Exposure to toxins : – Ongoing exposure to herbicides and pesticides puts you at slightly increased risk of Parkinson’s.

Treatments and Drugs

No definitive tests exist for Parkinson’s disease, so it can be difficult to diagnose, especially in the early stages. And parkinsonism – the symptoms of Parkinson’s disease – can be caused by many other types of problems. Examples include : – ? Other neurological disorders : – Essential tremor, dementia with Lewy bodies, multiple system atrophy and progressive supranuclear palsy each feature some symptoms common to Parkinson’s disease.? Drugs : – Antipsychotic medications – such as chlorpromazine (Thorazine) and haloperidol (Haldol) – block dopamine, as do anti-nausea drugs like prochlorperazine (Compazine) or metoclopramide (Reglan). If you take any of these drugs, you may develop parkinsonism, although it is reversible when the drug is stopped.? Toxins : – Exposure to carbon monoxide, cyanide or certain other toxins can produce symptoms similar to Parkinson’s disease.? Head trauma : – Both solitary head injuries and the repetitive variety of head trauma common in boxing have been linked to parkinsonism, although risks are small.? Structural problems : -Strokes or fluid buildup in the brain (hydrocephalus) may occasionally mimic Parkinson’s disease.

A diagnosis of Parkinson’s disease is based on your medical history and a neurological examination. As part of your medical history, your doctor will want to know about any medications you take and whether you have a family history of Parkinson’s. The neurological examination includes an evaluation of your walking and coordination, as well as some simple hand tasks. A diagnosis of Parkinson’s is most likely if you have : -

? At least two of the three cardinal Parkinson’s symptoms – tremor, slowing of motion and muscle rigidity? Onset of symptoms on only one side of the body? Tremor more pronounced at rest, for example, when your hands are resting in your lap? Strong response to levodopa, a Parkinson’s drug

Treatments and Drugs[ Deep brain stimulation ]

Deep brain stimulation involves implanting an electrode deep within your brain. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your chest. A wire that travels under your skin connects the device to the electrode.

Your initial response to Parkinson’s treatment can be dramatic. Over time, however, the benefits of drugs frequently diminish or become less consistent, although symptoms can usually still be fairly well controlled. Your doctor may recommend lifestyle changes, such as physical therapy, a healthy diet and exercise, in addition to medications. In some cases, surgery may be helpful.

Medications

Medications can help manage problems with walking, movement and tremor by increasing the brain’s supply of dopamine. Taking dopamine itself is not helpful, because it is unable to enter your brain.

Levodopa : – The most effective Parkinson’s drug is levodopa, which is a natural substance that we all have in our body. When taken by mouth in pill form, it passes into the brain and is converted to dopamine. Levodopa is combined with carbidopa to create the combination drug Sinemet. The carbidopa protects levodopa from premature conversion to dopamine outside the brain; in doing that, it also prevents nausea. In Europe, levodopa is combined with a similar substance, benserazide, and is marketed as Madopar.

As the disease progresses, the benefit from levodopa may become less stable, with a tendency to wax and wane (“wearing off”). This then requires medication adjustments. Levodopa side effects include confusion, delusions and hallucinations, as well as involuntary movements called dyskinesia. These resolve with dose reduction, but sometimes at the expense of reduced parkinsonism control.

Dopamine agonists : – Unlike levodopa, these drugs aren’t changed into dopamine. Instead, they mimic the effects of dopamine in the brain and cause neurons to react as though dopamine is present. They are not nearly as effective in treating the symptoms of Parkinson’s disease. However, they last longer and are often used to smooth the sometimes off-and-on effect of levodopa.

This class includes pill forms of dopamine agonists, pramipexole (Mirapex) and ropinirole (Requip), as well as a patch form, rotigotine (Neupro). Pergolide (Permax) has been withdrawn from the market because of its association with heart valve problems. A short-acting injectable dopamine agonist, apomorphine (Apokyn), is used for quick relief.

The side effects of dopamine agonists include those of carbidopa-levodopa, although they’re less likely to cause involuntary movements. However, they are substantially more likely to cause hallucinations, sleepiness or swelling. These medications may also increase your risk of compulsive behaviors such as hypersexuality, compulsive gambling and compulsive overeating. If you are taking these medications and start behaving in a way that’s out of character for you, talk to your doctor.

MAO B inhibitors : – These types of drugs, including selegiline (Eldepryl) and rasagiline (Azilect), help prevent the breakdown of both naturally occurring dopamine and dopamine formed from levodopa. They do this by inhibiting the activity of the enzyme monoamine oxidase B (MAO B) – the enzyme that metabolizes dopamine in the brain. Side effects are rare but can include serious interactions with other medications, including drugs to treat depression and certain narcotics.

Catechol O-methyltransferase (COMT) inhibitors : – These drugs prolong the effect of carbidopa-levodopa therapy by blocking an enzyme that breaks down levodopa. Tolcapone (Tasmar) has been linked to liver damage and liver failure, so it’s normally used only in people who aren’t responding to other therapies. Entacapone (Comtan) doesn’t cause liver problems and is now combined with carbidopa and levodopa in a medication called Stalevo.

Anticholinergics : – These drugs have been used for many years to help control the tremor associated with Parkinson’s disease. A number of anticholinergic drugs, such as trihexyphenidyl and benztropine (Cogentin), are available. However, their modest benefits may be offset by side effects such as confusion and hallucinations, particularly in people over the age of 70. Other side effects include dry mouth, nausea, urine retention – especially in men with an enlarged prostate – and severe constipation.

Antivirals : – Doctors may prescribe amantadine (Symmetrel) alone to provide short-term relief of mild, early-stage Parkinson’s disease. It also may be added to carbidopa-levodopa therapy for people in the later stages of Parkinson’s disease, especially if they have problems with involuntary movements (dyskinesia) induced by carbidopa-levodopa. Side effects include swollen ankles and a purple mottling of the skin.

Stem Cell Therapy

About Stem Cells

Stem cells are the master cells of the human body. They can divide to produce copies of themselves and many other types of cell. They are found in various parts of the human body at every stage of development from embryo to adult.

Because stem cells are so versatile, they could potentially be used to repair and replace damaged human tissue. The purpose of experimental stem cell therapy is to offer potential benefits of stem cells, which may be : – ? To slow down or stop further deterioration caused by the disease? To see if stem cells can reverse the effects of the disease

This procedure is considered experimental as it is being tested in clinical research studies, and is not yet available as a standard medical treatment.

The stem cells used in our experimental therapy are Mesenchymal stem cells, which are derived from your own bone marrow. These are multipotent stem cells that can transform into a variety of cell types, and thereby help in regeneration and repair of the diseased tissues.

Stem Cell Therapy for Parkinsons Disease in India

Parkinsons : – disease is a neurodegenerative disorder, symptomatized by tremors, rigidity, bradykinesia etc. There is selective degeneration of the dopaminergic neurons in the midbrain region of the brain. Our hypothesis is that the transplanted stem cells will home to the above said region based on the internal mileu and differentiate into dopaminergic neurons, thus alleviating the symptoms.

Physical therapy

Exercise is important for general health, but especially for maintaining function in Parkinson’s disease. Physical therapy may be advisable and can help improve mobility, range of motion and muscle tone. Although specific exercises can’t stop the progress of the disease, improving muscle strength can help you feel more confident and capable. A physical therapist can also work with you to improve your gait and balance. A speech therapist or speech pathologist can improve problems with speaking and swallowing.

Surgery

Deep brain stimulation is the most common surgical procedure to treat Parkinson’s disease. It involves implanting an electrode deep within the parts of your brain that control movement. The amount of stimulation delivered by the electrode is controlled by a pacemaker-like device placed under the skin in your upper chest. A wire that travels under your skin connects the device, called a pulse generator, to the electrode.

Deep brain stimulation is most often used for people who have advanced Parkinson’s disease who have unstable medication (levodopa) responses. It can stabilize medication fluctuations and reduce or eliminate involuntary movements (dyskinesias). Tremor is especially responsive to this therapy. Deep brain stimulation doesn’t help dementia and may make that worse.

Like any other brain surgery, this procedure has risks – such as brain hemorrhage or stroke-like problems. Infection also may occur, requiring parts of the device to be replaced. In addition, the unit’s battery beneath the skin of the chest wall must be surgically replaced every few years. Deep brain stimulation isn’t beneficial for people who don’t respond to carbidopa-levodopa.

Lifestyle and home remedies

If you’ve received a diagnosis of Parkinson’s disease, you’ll need to work closely with your doctor to find a treatment plan that offers you the greatest relief from symptoms with the fewest side effects. Certain lifestyle changes also may help make living with Parkinson’s disease easier.

Healthy eating

Eat a nutritionally balanced diet that contains plenty of fruits, vegetables and whole grains. These foods are high in fiber, which is important for helping prevent the constipation that is common in Parkinson’s disease.

If you take a fiber supplement, such as psyllium powder, Metamucil or Citrucel, be sure to introduce it gradually and drink plenty of fluids daily. Otherwise, your constipation may become worse. If you find that fiber helps your symptoms, use it on a regular basis for the best results.

Walking with care

Parkinson’s disease can disturb your sense of balance, making it difficult to walk with a normal gait. These suggestions may help : – ? Try not to move too quickly.? Aim for your heel to strike the floor first when you’re walking.? If you notice yourself shuffling, stop and check your posture. It’s best to stand up straight with your head over your hips and your feet eight to 10 inches apart.

Avoiding falls

In the later stages of the disease, you may fall more easily. That’s because Parkinson’s disease affects the balance and coordination centers in the brain. In fact, you may be thrown off balance by just a small push or bump. The following suggestions may help : -

? Don’t pivot your body over your feet while turning. Instead, make a U-turn.? Don’t lean or reach. Keep your center of gravity over your feet.? Don’t carry things while walking.? Avoid walking backward.

Dressing

Dressing can be the most frustrating of all activities for someone with Parkinson’s disease. The loss of fine-motor control makes it hard to button and zip clothes, and even to step into a pair of pants. An occupational therapist can point out techniques that make daily activities easier. These suggestions also may help : -

? Allow plenty of time so that you don’t feel rushed.? Lay clothes nearby.? Choose clothes that you can slip on easily, such as sweat pants, simple dresses or pants with elastic waistbands.? Use fabric fasteners, such as Velcro, instead of buttons.Please log on to : http://www.indiahospitaltour.com

Please log on to : http://indiahospitaltour.com/stem-cell/parkinsons-disease-treatment-india.htmlcontact Email : info@indiahospitaltour.com



About the Author

Pankaj Nagpal – About the Author:Welcome to World Class Treatment and Surgery by We Care Health Services, India. Contact Us : http://www.indiahospital tour.com || E-mail us on : info@indiahospitaltour.com || Contact Center Tel. :( +91) 9029304141. The surgery and medical treatments offered by We Care Health Services at JCI Accredited / ISO Certified Hospitals are vast and varied; ranging from Heart Surgery in India, Cardiology to Cardio Thoracic surgery, Total Knee / Hip / Ankle / Shoulder Joint Replacement Surgery in India including ACL reconstruction Surgery to Birmingham Hip Resurfacing Surgery in India , Spine Surgery in India like Discectomy / Laminectomy Surgery, Cervical Decompression to Anterior / Posterior Spinal Fusion Surgery in India, Chemotherapy, Radiotherapy, Cancer surgery, Sterotactic Radiotherapy, Autologous / Allogenic Bone Marrow Transplant Surgery to Breast Cancer treatments, Near relative Kidney Transplant Surgery to Dialysis and Kidney Biopsy, Low Cost Liver Transplants Surgery, Hysterectomy (Vaginal / Abdominal) to Ovarian Cystectomy, Hernia repair Surgery to Cholecystectomy, Advanced Neurosurgery in India, Bariatric surgery, Gastric Bypass Surgery in India, Eye Surgery in India, Cornea Transplant, Cataract Surgery to LASIK Eye care Surgery, IVF, ICSI, Egg Donor to Surrogacy, Minimally Invasive surgery or Laparoscopic Surgery to Cochlear Implants, Breast Lift / Tummy Tuck, Face Lift to Low Cost Rhinoplasty Cosmetic Surgery, multi specialty Hospitals in India offering first world treatments with board certified highly qualified medical consultants in attendance at third world prices..










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Dementia and Delirium

September 23, 2011 By Leave a Comment

Dementia and Delirium

Dementia & Delirium

  

Introduction:

The term ‘organic mental disorder/syndrome’ in psychiatry is used when there is a ‘disease of the body’ which present with psychiatric symptoms. In contrast, ‘functional mental disorders’ are considered to be ‘disease of the mind’. Classifying psychiatric disorders in this way is becoming outdated now that more is known about the ‘organic’ basis of functional illnesses, such as abnormal brain structure in schizophrenia. However, the term organic is still commonly used in clinical practice and communication and is included in the ICD 10.

In the next section we will focus on two ‘organic disorders’ which effect cognitive function. Other organic disorders for example:

Organic hallucinosis Organic delusional disorders Organic mood disorders Organic anxiety disorders

Will not be mentioned here, as they present almost similar to their ‘functional’ counterpart  

Delirium and Dementia:

In both delirium and dementia, there is a generalized impairment of brain function which causes global impairment in cognitive function and altered mood and behaviour. The difference between the two is that delirium is an acute syndrome characterized by fluctuating levels of consciousness and attention whereas dementia is a chronic syndrome which occurs in clear consciousness without rapid fluctuations. Both conditions are more common in older people, but the diagnoses need to be considered in any patient who presents with a generalized impairment of brain function.

1. Delirium:

Delirium is more likely to occur in children, the elderly and individuals with brain insult when the brain ‘vulnerable’. People with dementia are particularly at risk and so it is always important to rule out superimposed delirium if the cognitive function of people with dementia deteriorates acutely. Another high risk group are people admitted to medical ward- studies have found 15-50% evidence of delirium.

The features of delirium will be summarized and contrasted with typical symptoms of dementia in a table below.

Management of delirium:

The primary goal is to investigate and treat the underlying cause. Some causes of delirium are:

Medications and drugs: Anticholinergic, anticonvulsant, anxiolytic, digoxin, corticosteroids, Alcohol , solvents, illicit drugs Infection Endocrine: hypoglycemia, hyperparathyroidism, Addison’s disease, thyroid disease. Metabolic: electrolyte imbalance, hypoxia, organ failure, vitamins deficiency (esp. thiamine), prophyria. Neurological: infection such as encephalitis or meningitis, raised intracranial pressure, space occupying lesions, head injury, epilepsy.

While trying to find the primary underlying cause, it will be necessary to manage the patient symptomatically.

Ø The patient should be nursed in a well lit room by as few people as possible, in order to reduce confusion. Ø Sedation with low doses of antipsychotic drugs may be required (prescriber should have knowledge about the prescribed medication( its side effect, its metabolism, half-life, dosage etc) Ø Orient the patient by gently calming them down and use cues to indicate time of day (window, clock). Avoid excessive ‘reminders’ if this cause patient’s distress.

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2. Dementia:

Dementia is a chronic usually progressive generalized impairment of the brain function. The risk increase with age: 5% >65 and 20% >80

Typical symptoms of dementia include:

Memory (amnesia): is virtually always affected, with short term-memory and memory for recent events being lost first. Memory of events from the distant past is usually preserved until the very late stages of the illness. Orientation in time and place: are lost relatively early in the illness which may result in the person becoming lost and wandering aimlessly. In the later stages of the illness, orientation in person may be lost with the person not recognizing familiar people or themselves. Praxis: the ability to coordinate complex motor function is affected. The person may not be able to perform acts on command but still perform spontaneously., or may be unable to carry out a sequence of tasks despite being able to perform each task individually. Language function (Dysphasia): is impaired, initially with finding words(nominal dysphasia or anomia), progressing to difficulties generating speech (expressive dysphasia), comprehending speech (receptive dysphasia) or combination of the two (mixed dysphasia). Abstract thinking and judgment: are impaired, leaving the person unable to deal with problems or unfamiliar situations. Personality changes: are common, often involving a coarsening of pre-existing personality traits. Social behaviour: deteriorates, often becoming shallow or inappropriate. Mood changes: are common with depression irritability and anxiety all occurring in some cases

The above are just some of the symptoms and the presentation will depend largely on the cause and type of dementia. It is important to attempt to establish the type of dementia as this will influence treatment and prognosis. The four commonest causes are:

Alzheimer’s disease, Vascular dementia, Mixed dementia (usually vascular & Alzheimer’s) and Lewy body dementia

Other causes and types:

Degenerative: Parkinson’s dementia, Huntington’s dementia, Pick’s disease, Normal pressure hydrocephalus Infections: Creutzfeld-Jacob Disease (CJD), HIV, Neurosyphilis, cerebral abscess, UTI Space-occupying lesions: tumors, subdural hematoma Traumatic: severe head injury, boxing Endocrine: hypothyroidism, Cushing’s disease, hypopituitarism Metabolic: anemia, hypoxia, organ failure Toxic: heavy metals (lead, mercury, iron), chronic alcohol abuse (alcohol dementia), medication with anticholinergic propensity. Autoimmune: SLE, sarcoidosis.

The above list (like in delirium) is short and by no means extensive as the causes are many and the above are only a short examples ( think common sense: any insult to the brain can cause you to have any number of psychiatric symptoms be it dementia, psychosis, depression or any other)

Management of dementia:

Ø History & mental state examination: as the patient with dementia is often unable to give a full account of their problems, an informant presence is important. Scales such as the Mini-Mental State Examination (MMSE) are useful screening tests and quick to administer. Much detailed scales and psychological testing may be needed to confirm or establish the diagnosis. Ø Physical examination & investigations: are important to establish cause and therefore treatment (reversible or irreversible). Ø Medications: the current drugs can be divided into two groups. First the drugs which increase acetylcholine (Aricept, Galantamine). The second group is the works through receptors affecting GABA (Memantine). Both groups are licensed for Alzheimer’s, but in practice are worth trying in the most of the dementias. The clinical effect appears after months and monitoring done by history taking and MMSE score. Antidepressants may be useful, as well as antipsychotic (but due to anticholinergic side effect, they showed be used by a person aware of their advantages and disadvantages). Ø Psychological & social treatment: simple behavioural techniques such as prompts can be useful for mild memory impairments. Revalidation and reminiscent therapy also could be tried. Social support especially for carer is extremely important and is one of the major management targets

Features of delirium and dementia (comparison):

In the next table a simplified approach comparing delirium vs. dementia (remember that the two can co-exist esp. in the elderly)

Feature

Delirium

Dementia

Onset

Acute, usually within hours or days

Gradual, usually within months

Diurnal variation

Yes, usually worse at night

Maybe worse at night

Duration

Days or weeks, usually less than 6 month

Months or years

Consciousness

Drowsy or hypervigilant

Normal

Attention

Usually poor

Usually maintained

Orientation

Disoriented in time, often place and person

Disorientation usually in time then place, in person much later

Instant recall

impaired

Usually intact until late

Memory

Impaired STM & LTM

Impaired STM, LTM much later

Thinking

Muddled, confused

Reduced, slow

Delusions

Common

Less common

Illusions/Hallucinations

Common usually visual

Only in later stages

Sleep

Reversal of sleep-wake cycle

Insomnia

  

References:

Stevens L, Rodin I. Psychiatry: An illustrated colour text, Churchill Livingstone 2001 Steple D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

 

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Prof. Saoud Al Mualla (M.B, MSC, M.D, Dip, MRCPsych)

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