Category Archives: Parkinson’s

Finally, there’s a neurologist who is an autonomic specialist in the Bay Area.  His name is Safwan Jaradeh, MD.  He’s at Stanford.  (Neurology appointment phone is 650-723-6469.  New patient appointment phone is 650-725-5792.  New patients will need a referral from a neurologist.)  He used to be at the Medical College of Wisconsin.  A patient’s family who saw him in WI wrote a very positive review of him on POTSplace (www.potsplace.com/physicians.htm).

The only other MD in the Bay Area who sees patients with autonomic dysfunction is a cardiologist named Karen Friday, MD.  She’s at Stanford (Cardiology) and the Palo Alto VA.  A couple of years ago one of our MSA group members was receiving inadequate treatment for OH (orthostatic hypotension) from a movement disorder specialist.  The group member took her husband to see Dr. Friday and was very impressed with the care received.  Also, someone wrote a positive review of her on POTSplace.

Years ago, someone told me:  “Many of the autonomic specialists are cardiologists rather than neurologists, because of the close association between the autonomic system and blood pressure.”

If any of you are dealing with or have dealt with SEVERE symptoms of orthostatic hypotension and you are receiving excellent care for these challenging symptoms from your neurologist, please let me know.  Thus far, I’ve only heard negative stories about neurologists and OH treatment.

Robin

PS. There are three directories of autonomic specialists in the US:

www.potsplace.com/physicians.htm
www.ndrf.org/physicia.htm
www.mc.vanderbilt.edu/gcrc/aas/AAS_referals_by_state.htm#CA

This Italian paper notes that many people develop RBD (REM sleep behavior disorder) and, on average, 25 years later many of them develop a neurological disorder, such as Lewy body dementia (LBD), Parkinson’s Disease (PD), or multiple system atrophy (MSA).  Authors say:

“The estimated 10-year risk of neurodegenerative disease for…RBD is about 40%.” 

Obviously, it would be good to identify who is in that 40% bucket.  The authors indicate that potential markers of neurodegeneration include:

(1) marked EEG slowing on spectral analysis;
(2) decreased striatal 123I-FP-CIT binding and substantia nigra hyperechogenicity;
(3) impaired olfactory function;
(4) impaired color vision.

I was in a meeting once with a neurologist and a local support group member.  The neurologist was reviewing the late husband’s neuropathology report.  I remember the neurologist being very interested in finding the EEGs done on the husband early on as he said that a certain finding on an EEG would’ve been an indicator the husband was going to develop a neurological disorder.”

This is the first time I’ve seen “impaired color vision” as a potential marker.

I’ve copied the abstract of the medical journal article below.

Robin

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Sleep Medicine. 2011 Dec;12 Suppl 2:S43-9.

Does idiopathic REM sleep behavior disorder (iRBD) really exist? What are the potential markers of neurodegeneration in iRBD?

Ferini-Strambi L.
Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.

Abstract
REM sleep behavior disorder (RBD) may be idiopathic or associated with other neurologic disorders. A strong association between RBD and a-synucleinopathies has recently been observed, with the parasomnia often heralding the clinical onset of the neurodegenerative disease. The idiopathic form accounts for up to 60% of the cases reported in the three largest series of patients with RBD. Some clinical follow-up studies revealed that a large proportion of these patients will eventually develop a parkinsonian syndrome or a dementia of the Lewy bodies type in the years following the RBD diagnosis. The estimated 10-year risk of neurodegenerative disease for idiopathic RBD is about 40%. Moreover, it has been reported that the median interval between RBD and subsequent neurologic syndrome is 25years. Several studies have looked at neurophysiologic and neuropsychological functions in idiopathic RBD and have found evidence of CNS dysfunction during both wakefulness and sleep in a variable proportion of these patients, challenging the concept of idiopathic RBD. Identifying subjects with a high risk of developing a neurodegenerative process may be crucial to develop early intervention strategies. Prospective studies in idiopathic RBD showed that potential markers of neurodegeneration include: (1) marked EEG slowing on spectral analysis; (2) decreased striatal 123I-FP-CIT binding and substantia nigra hyperechogenicity; (3) impaired olfactory function; (4) impaired color vision.

PubMed ID#: 22136899  (see pubmed.gov for this abstract only)