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lynnj1602

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Hello everyone.

I was wondering if any of you had Parkinsonism type symtoms along with your ALS.
Please see the article below.
Lynn




Co-Mingling Conditions: Parkinsonism in Alzheimer’s, Lou Gehrig’s


19 September 2009. One of the challenging features of neurodegenerative diseases is that they tend to defy the clinician’s desire for neat categorization, as many patients suffer a range of symptoms across intersecting conditions. Two recent papers find evidence of extrapyramidal symptoms (EPS), a hallmark of Parkinson disease, in a subset of people with Alzheimer disease or amyotrophic lateral sclerosis (ALS). Extrapyramidal neurons do not send signals directly down the spinal cord but communicate with the neurons that do, and they are involved in coordinating subconscious movements such as swinging one’s arms while walking. In a paper in the September issue of the Archives of Neurology, scientists report that EPS are a bad sign in Alzheimer’s because they are correlated with a faster rate of cognitive decline. And in a report posted online September 4 in the journal Movement Disorders, another group of researchers present data for EPS in some people with ALS, showing this disorder affects parts of the nervous system beyond just motor neurons themselves.
Led by Florence Portet of the Montpellier University Hospital Center in France, researchers at Columbia University in New York City searched for extrapyramidal symptoms in 388 people who participated in the seven-year, longitudinal Washington Heights Hamilton Heights Inwood Columbia Aging Project (Tang et al., 2001). The current study focused on people who did not have AD at their first visit, but were later diagnosed with the disease. Extrapyramidal symptoms were present in more than 10 percent of people after diagnosis with Alzheimer’s; in some cases, the EPS appeared before the AD diagnosis was even confirmed. By their final visit to the center (participants were followed for an average of 3.6 years), more than one fifth of these participants showed evidence of extrapyramidal signs such as tremors and muscle rigidity. Cognition in people who had EPS along with AD declined more steeply than those who had AD alone.

Without pathological data from autopsies, one can only surmise what might link Alzheimer’s and EPS. “What struck me the most is the parallels that are in this paper with what we know about dementia with Lewy bodies,” said David Salmon of the University of California in San Diego, who was not associated with the report. DLB, which includes parkinsonian motor symptoms such as rigidity, is present in 15 to 25 percent of people with AD, Salmon noted, similar to the percentage of people with EPS in the current study (see ARF Related news story.)

The authors noted that one possible explanation for the extrapyramidal symptoms in this subgroup of people with AD could be that the plaques and tangles classically associated with AD might be invading extrapyramidal areas or the substantia nigra, the movement-associated brain area where dopaminergic neurons die in people with Parkinson’s. The death of neurons in those locations could also explain the symptoms. Alternatively, the protein α-synuclein, which accumulates in PD and forms Lewy bodies, could also be abnormal, Salmon suggested. “Maybe [these abnormalities] are just not at the level to lead to a full parkinsonian syndrome,” he said. The extrapyramidal symptoms likely have the same root as the Alzheimer’s symptoms, Salmon said. While it is possible that some people are unlucky enough to develop both AD and PD, he said, parkinsonism and DLB are present in people with AD at higher levels than the individual disease rates would suggest.

As for ALS, extrapyramidal symptoms are not part of the classic definition of this disease, either, but perhaps they should be. Pierre-François Pradat led a group of researchers at the Pitie-Salpetriere Hospital in Paris, France, in assessing EPS in 39 consecutive cases of ALS. “Our experience, based on more than 7,500 patients examined at the Paris ALS Center since 1989, has convinced us that careful examination of patients with typical ALS reveals that some signs and symptoms are due to a combination of pyramidal and extrapyramidal involvement,” Pradat wrote in an e-mail to ARF.

For the study, the scientists recruited people who did not experience significant motor problems in their legs, but nonetheless found that more than half exhibited extrapyramidal signs such as muscle rigidity. People with EPS, despite having functional legs, had more trouble with day-to-day activities such as getting dressed and climbing stairs. “ALS is a multisystem degenerative condition affecting the extrapyramidal system,” Pradat wrote. “Mild extrapyramidal symptoms should not exclude the diagnosis of ALS.”

It’s becoming clearer to the field that neurodegenerative diseases lie across a broad spectrum and their overlapping symptoms can confound early diagnosis of neurodegenerative disease. The current studies show that extrapyramidal symptoms are a factor worth considering in the clinic. “It is important to know, because there may be different implications for treatment,” Salmon said. —Amber Dance.

References
Portet F, Scarmeas N, Cosentino S, Helzner EP, Stern Y. Extrapyramidal signs before and after diagnosis of incident Alzheimer disease in a prospective population study. Arch Neurol. 2009 Sep;66(9):1120-6. Abstract

Pradat PF, Bruneteau G, Munerati E, Salachas F, Le Forestier N, Lacomblez L, Lenglet T, Meininger V. Extrapyramidal stiffness in patients with amyotrophic lateral sclerosis. Mov Disord. 2009 Sep 4. [Epub ahead of print] Abstract
 

lynnj1602

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Hi,

I ask this question because I have early stage Frontotemporal Dementia with Parkinsonism and am now experiencing muscle loss (chest girth and shoulders) plus muscle weakness in my arms and legs.

Lynn
 

peter57

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Hi Lynn,
I was initially diognosed with Parkinsons for 10 months before i saw a different nero who did a lot of tests etc. and changed it to PLS.
(i am however suspect of the first diognose as it only took 1 visit and a couple of motion type tests in the room for him to come to the conclusion. A total visit of app 20 min. I was put on medication for it but it didnt do any thing)

cheers
Peter
 

Big Mike

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I read somewhere that it could turn out that ALS, Parkinson's, and Alzheimer's could all be just different forms of the same disease. That could be true considering the overlapping that occurs with some patients.
 

BethU

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Linni ... thanks for posting that article. It's very timely for me, as I've been discussing my "leftover symptoms" with another PALS.

My bulbar onset started with slurred speech and blurred and double vision. My eyesight has contined to deteriorate at about the same speed as my bulbar symptoms. The double vision is now only experienced in near sight; I still read with one eye closed. This led to my being diagnosed with Progressive Supranuclear Palsy (PSP), one of the "parkinsonian" cluster of diseases. As I understand it, it is closely related to ALS, but is itself a form of dementia. No treatment. No cure, but you live a little longer with PSP than with ALS.

Also, I have had one really memorable hallucianation ... it was a dandy ... and three violent seizures that woke me up in the middle of the night with my arms and legs flailing and pumping uncontrollably. It was scary to not be able to stop them or slow them down in any way. Hallucianations and seizures are not characteristic of ALS, but are of Parkinson's, so there's another connection.

I have volunteered to give ,my brain and spinal cord to UCLA for "tissue reasearch," so I hope something will be learned someday soon about what's going on.
 

peter57

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Hopefully Beth, the donations will not happen for many years.


cheers
Peter
 

BethU

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Thank, Peter! Me, too!

I forgot to say that the PSP diagnosed was discarded in favor of ALS, but the ocular symptom continues and we all just pretend it doesn't exist.
 

lisaann1170

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Interesting...

My paternal grandfather had Frontotemporal Dementia with Parkinsonism and Dad now has ALS with suspected Dementia.

Suddenly my genetic future is looking a bit less appealing!
 

BarryG

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My mom had Parkinson's and I have always been told that there is no relationship between her having Parkinson's and me having ALS. All a big coincidence? I dont know about that....
 
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