Positive Health Online

Parkinsons Disease and Cervical Dystonia

Reprinted from http://dramir.com/blog/archives/893-Parkinsons-disease-and-Cervical-Dystonia.html

I had a very Interesting Case Today

The patient is a 51 year old lady who presented with a diagnosis of ‘Parkinson's disease’ and ‘Cervical Dystonia’. She was very nervous with a huge tremor in both arms. She was very tearful and desperate to get some relief for her worsening symptoms and rapidly declining health.

The more recent medical history of the patient was that she had started having a tremor in her right hand at the age of 42, it progressively got worse and at age 43 she saw a neurologist who undertook various scans diagnosing and confirming ‘Parkinson's disease’. Her condition was manageable until age 44 when she started to have problems with her right foot, it failed to move and was limp. This was diagnosed as ‘foot drop’. A year later she started to develop ‘Dystonia’ of the neck. She was unable to tolerate conventional Parkinson's medication. She has limited mobility and has a wheelchair which she does not like using. Presently her neurologist was contemplating electrical ‘deep brain stimulation’.

Before I continue it is important to describe the conventional MEDICAL explanations of these two disorders:
Wikipedia explains Parkinson's disease (PD), as a degenerative disorder of the central nervous system mainly affecting the motor system. The motor symptoms of Parkinson's disease result from the death of dopamine-generating cells in the substantia nigra, a region of the midbrain. The causes of this cell death are poorly understood. Early in the course of the disease, the most obvious symptoms are movement-related; these include shaking, rigidity, slowness of movement and difficulty with walking and gait. Later, thinking and behavioural problems may arise, with dementia commonly occurring in the advanced stages of the disease;  depression is the most common psychiatric symptom. Other symptoms include sensory, sleep and emotional problems. Parkinson's disease is more common in older people, with most cases occurring after the age of 50; when it is seen in young adults, it is called ‘young onset PD’.

The main motor symptoms are collectively called parkinsonism, or a ‘parkinsonian syndrome’. The disease can be either primary or secondary. Primary Parkinson's disease is referred to as idiopathic (having no known cause), although some atypical cases have a genetic origin, while secondary parkinsonism is due to known causes like toxins. Many risks and protective factors have been investigated: the clearest evidence is for an increased risk of PD in people exposed to certain pesticides and a reduced risk in tobacco smokers. The pathology of the disease is characterized by the accumulation of proteins into Lewy bodies in neurons, and insufficient formation and activity of dopamine in certain parts of the midbrain. Where the Lewy bodies are located is often related to the expression and degree of the symptoms of an individual. Diagnosis of typical cases is mainly based on symptoms, with tests such as neuroimaging being used for confirmation.

Treatments, typically the antiparkinson medications L-DOPA and dopamine agonists, improve the early symptoms of the disease. As the disease progresses and dopaminergic neurons continue to be lost, these drugs eventually become ineffective whilst at the same time produce a complication marked by involuntary writhing movements. Diet and some forms of rehabilitation have shown some effectiveness at improving symptoms. Surgery and deep brain stimulation have been used to reduce motor symptoms as a last resort in severe cases where drugs are ineffective.

Research directions include investigations into new animal models of the disease and of the potential usefulness of gene therapy, stem cell transplants and neuroprotective agents. Medications to treat non-movement-related symptoms of PD, such as sleep disturbances and emotional problems, also exist.

In 2013 PD resulted in about 103,000 deaths globally, up from 44,000 deaths in 1990. The disease is named after the English doctor James Parkinson, who published the first detailed description in An Essay on the Shaking Palsy in 1817.

Wikipedia explains Dystonia as:

“A neurological movement disorder in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements may resemble a tremor. Dystonia is often initiated or worsened by voluntary movements, and symptoms may “overflow” into adjacent muscles. Treatment must be highly customized to the needs of the individual and may include oral medications, botulinum neurotoxin injections, physical therapy and/or other supportive therapies, and/or surgical procedures such as deep brain stimulation.”

Comment: Persons unlucky enough to be branded into these ghastly labels face a dire future. Could it be possible that there is a more valid and legitimate explanation? I shall try and relate my thoughts on the very first of such patients that I have seen but not treated yet.

I started the consultation by going through our very comprehensive questionnaire which she had completed in advance.

Her dental history showed that at the age of 11 she had her 2 upper central incisors extracted and these were replaced by a fixed bridge. At some stage she also had her four 1st molars extracted followed by the extraction of her wisdom teeth. Regular readers of this blog will note that such a history of dental extractions is absolutely disastrous for the health of a normally functioning Temporo-mandibular joint and seriously affects the symmetry of the skull especially in the occipital region disturbing the function of the cerebellum which controls the fine motor function of the body.

Her first symptoms started at age 12 with a poor breathing ability. At age 20 she developed mild asthma. She reports the onset of fatigue at age 30. At age 40 she deteriorated rapidly with additional symptoms such as sub-occipital and shoulder pains bilaterally, sleep problems and intermittent headaches. She also developed extreme sensitivity to bright lights. At age 43 she developed severe neck pain which was diagnosed as ‘cervical dystonia’. Bilateral tremor developed in both arms with the right arm worse than the left. A diagnosis of ‘Parkinson’s disease’ was confirmed in addition to ‘Cervical dystonia’.

Her symptoms have continued to worsen with severe neck spasms, depression and gait problems.

On examination she had a severe limitation of opening her jaw with restricted bilateral excursions. Her teeth exhibited severe bruxism confirming a dysfunctional jaw joint. She had missing teeth as listed above. She had severe pain on palpation of all the muscles around her head. Her neck showed a severe asymmetry of her cervical vertebrae with a slight bulge on the right hand side. She had a very compromised breathing ability, restricted movement of her neck muscles and weakness of all muscles around the body. The tremor in her arm varied from slight to extreme throughout the consultation. Her upper limbs were also accompanied with a degree of rigidity. Her tremor appeared to settle down once she was comfortable with us.

On discluding her teeth slightly, her symptoms immediately abated somewhat, her walking ability improved demonstrating that there is possibly no permanent neurological deficit nor a chemical imbalance in the brain in need of dopamine. No wonder the drug made her worse. Deep brain stimulation would perhaps be an equally misplaced exercise.

Her breathing ability was about 20% of what one would expect in a normal patient. The poor ventilation results in poor oxygenation, blood and cerebro spinal fluid flow to the brain. This inevitably results in damage to various higher structures in the brain in the long term as described in Wikipedia "As the disease progresses and dopaminergic neurons continue to be lost, these drugs eventually become ineffective whilst at the same time produce a complication marked by involuntary writhing movements". Improving the breathing is of crucial importance. Her very first symptoms were a breathing problem which has been untreated for 40 years producing the present calamity.

Diagnosis: She was diagnosed as having severe TMJ dysfunction caused by the extraction of the upper incisors initially at age 11 and by the placement of a fixed bridge which restricted the proper development of both her jaws. Subsequent loss of teeth further propagated her symptoms by altering the balance of the head on the neck vertebrae which have to distort to accommodate the weight change of the skull. This explains the ‘cervical dystonia’. I hasten to add that such an asymmetry is seen in many patients presenting with neck pain but they remain free of the "Dystonia" label.

The breathing gets affected by the distortions of the mid cervical spine and altered jaw position. Correcting this improves the breathing pattern. The altered occipital shape affects the cerebellum adversely. This coupled with the cervical distortion affects the nerves emanating from the neck spine and supplying the upper limbs. This causes the tremors which we often see and successfully treat in MS patients. Furthermore the nutritional deficiencies due to altered blood flow with reduced oxygenation, reduced CSF flow to the brain probably gradually keeps damaging higher structures in the brain worsening the symptoms overtime.

I believe that the cause behind MS and Parkinsonism is very similar and perhaps amenable to Symmetry treatment.

The treatment is geared to achieve cranial, jaw and body symmetry and to improve all bodily organic functions. It involves the recruitment of undamaged nerves to reprogram them to effect correct movement - not botulinum neurotoxin injections to destroy the nerves. Some desired results are difficult to achieve in view of the long standing damage but experience shows that considerable improvements can still be achieved. My diagnosis was thoroughly discussed with the patient and it appears to agree with her history of symptoms. She was asked to mull over my thoughts on her condition and the treatment strategy I recommend. I am hoping that she will start treatment in the new year. Some of her symptoms should resolve rapidly while others may take longer. No warranties are ever given. Time will tell.

Concerns: It concerns me greatly that patients are being pigeon holed into nonsensical illnesses and syndromes when an early differential diagnosis would have helped obviate long term illness and disability. This very possible misdiagnosis has a phenomenal cost in terms of lost income, serious pain and suffering, mental anguish, loss of hope and indeed a lost life. Patients are being told that they have terminal illnesses when THEY DO NOT. Patients and their families are devastated. The cost to the rest of us in maintaining such patients, in paying for their hospital costs, in paying for futile often grossly overpriced and useless drugs and in paying for social costs is incredulous. Enough to make one's hair stand on end.

It is legally incumbent on those in charge of the care of these patients to exclude a dental origin in their differential diagnosis.

21st January 2016: The patient started treatment about 10 days ago.

Here is her Feedback:

Dear Dr Amir,

Since starting your treatment and wearing the appliances I have noticed the following:

1. Sleep has improved (80%) and I am waking up refreshed; before I was waking up in the middle of the night and or having problems getting to sleep;

2. My cervical dystonia is improving and I can sit upright in a chair without needing a cushion for support;

3. Footdrop, I walked around a shop for the first time in 2 years; it was for 15 minutes and at a slow speed.

Further Information

Posted by Doctor M. Amir in Parkinsons disease at 23:19

- See more at: http://dramir.com/blog/categories/102-Parkinsons-disease#sthash.wHCormlV.dpuf

Reprinted from http://dramir.com/blog/archives/893-Parkinsons-disease-and-Cervical-Dystonia.html