Monday 19 March 2018

Dear Dr Nina: How can we help with a diagnosis of Parkinson's?

Photo posed
Photo posed

Nina Byrnes

My husband's brother - who he is very close to - has just been diagnosed with Parkinson's disease. He is only in his late fifties. Although our families are close, we don't have much information about the diagnosis as he doesn't want to talk about it. My husband is very worried about him and doesn't know what to expect in the years ahead. He's also concerned for our family - he is worried that the illness may run in families and that it might affect our own children later on in life. Can you give him any information about what he can expect for his brother, and are there any new treatments or breakthroughs which we could point his brother towards?

Dr Nina replies: Parkinson's disease is a chronic progressive neurological condition. It is thought to affect about one in 500 people and occurs more commonly in men than women. Symptoms more commonly occur in those over the age of 50 but it can also occur in younger people. The actor Michael J. Fox was diagnosed at a young age and has done a lot to raise the profile of this disease.

Parkinson's disease occurs due to the loss of nerve cells in a part of the brain called the substantia nigra, which results in reduced levels of the neurotransmitter dopamine. This hormone assists in smooth movement of the body. When levels of dopamine are reduced by 60pc to 80pc classic movement symptoms of Parkinson's may occur. It is thought to take many years for this reduction to occur so research today is trying to identify ways to diagnose this before dopamine levels have dropped so low.

There are many symptoms that may suggest Parkinson's disease. Losing your sense of smell may be an early symptom and can occur many years before others appear. Constipation may occur as movement through the gut slows. There may be some difficulty swallowing foods or a feeling of things occasionally catching in the throat. The arms tend not to swing when walking in those with Parkinson's disease. There may also be a change in facial features often referred to as a "masked face". This results in a stern look and lack of facial expression. This can be associated with a blank stare and reduced blinking. Speech changes occur. Speech may become soft or hoarse and occasionally slurred. Balance problems and dizziness can be symptoms of the condition or may also occur as a side effect of Parkinson's medication. Writing may become very small.

Mental symptoms include anxiety, depression, memory problems in some and sleep problems.

The classic symptoms of Parkinson's remain the presence of a tremor, slowness of movement called bradykinesia and rigidity

A tremor is an uncontrollable shake. This most commonly occurs in the hand or arm and is most noticeable when the limb is otherwise still. It may start with a back and forth rolling of the thumb and finger referred to as "pill rolling". Bradykinesia makes simple movements very difficult. It may be harder to initiate movement such as getting out of a chair or starting to walk. Steps become shorter and stiffer and may result in shuffling to move. There may be stiffness and soreness of muscles throughout the body.

The symptoms of Parkinson's are not specific to this disease and may occur in many other conditions and in healthy individuals.

However if several symptoms occur together it is worth considering. Parkinson's progresses at different rates in different people and it may or may not limit the affected person's life expectancy.

The majority of Parkinson's cases are not familial, but it is felt that about 10-15pc of Parkinson's may have a genetic origin. Research is ongoing into Parkinson's and its treatment. The neurological team caring for your brother-in-law will be able best advise you as regards new or experimental treatment options. There also a number of community based therapies. Exercise is important to maintain balance and mobility and there are a number of special dance and exercise classes for those with Parkinson's.

Beats Medical is an Irish company that provides app-based treatment to help maintain mobility, speech and dexterity in those with Parkinson's. Check out

Q. If I wake up during the night and stretch my legs in the bed, I get terrible cramps in my lower legs. This has only started in the last two weeks. What could be causing it?

Dr Nina replies: Nocturnal leg cramps are very common especially in those over the age of 50. The exact cause is not actually known. Risks include jobs that involve sitting for long periods of time or sitting improperly. Over-exerting muscles, standing or working on concrete floors also seems to increase the risk. Certain medical conditions such as pregnancy, Parkinson’s disease, conditions that affect nerves and muscles, and diabetes are associated with an increased risk. Certain medication such as diuretics (water tablets), cholesterol lowering medication and asthma meds may also be associated with cramps.

Whatever the cause there are a few possible remedies. Make sure you stay well hydrated drinking at least 1½ to 2 litres daily. Some find that ensuring adequate calcium and magnesium in their diet or taking supplements helps. Stretching the feet and calves before bed has been shown to reduce the frequency of cramps. An older remedy is quinine. This may help, but is should be used with caution as it can irritate the heart increasing the chance of an abnormal rhythm.  Cramps that occur when lying but get better when standing may suggest difficulty with the blood supply in your legs and this should be checked. If they go on much longer pay a visit to your doctor for an examination and a chat.

If you have any  health queries for  Dr Nina Byrnes, please email  Please note that Dr Nina cannot enter into individual correspondence

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