We all know and have heard mention the 4 cardinal motor symptoms of Parkinson’s upon which the diagnosis is based upon such as rest tremors, rigidity, balance /gait issues, and bradykinesia (slowness). We have also heard mention of many non -motor features now familiar to many as well such as constipation, visual problems, pain, fatigue, bladder issues etc.

But, over my last decade of living – with PD while learning more about the oddities of this disease- I have stumbled a cross a few symptoms that appear to be persistent or rather constant across the PD community. Yet, no one really makes much mention of them. I believe these should be included in the list of non- motor possibilities within the realm of PD which merit further research.
Today I will talk about one of those symptoms.

1)Vertigo/motion sickness– one of my presenting symptoms was inability to swing on a swing set something I loved to do since I was a young girl – symptoms commenced at first as a mild nausea when I undertook said activity with my daughter who was a toddler at the time. Then symptoms escalated to inability to self -park in the spiral parking lots which would trigger down right vertigo. Also, over time I have developed some phobia of heights because it triggers vertigo- nothing more dangerous than going over an extremely high overpass to discover that looking at the horizon causes severe vertigo.

Interestingly, symptoms subsided for a while when I began treatment for Parkinson’s disease. We have always assumed that the vestibular system was involved in PD especially as diseased progressed as evidenced by worsening stooped poor posture followed by increase falling and difficulty walking. But perhaps we have underestimated the early involvement of this key system in balance maintenance. Although, these were suspected as a culprit no proof had been found until recent studies demonstrate a pathology in the central vestibular system suggesting dysfunctional integration between the visual system and balance system in both PD and Lewy body disease. Having deficits in integrating the spinal sensory input to central balance center as well as deficit in visual input to same center can surely lead to disequilibrium. This why elderly people have balance issues. the hearing, visual and peripheral sensory systems get damaged as we age subsequently sending faulty information back to the brain causing the information that goes out to our spine and limbs be less than precise causing us to misstep or fall when trying to step down a curb or walk over an uneven surface.

It seems that our neurological forefathers understood that the source of the disequilibrium began in the brainstem (some make note of the medulla- which in fact houses one of the medial vestibular nucleiSchwalbe nuclei) intuitively when they prescribed carriage rides or horseback rides even boat rides. Thus instituting “vibratory therapy.” This is another way of saying ‘vestibular therapy’ which is now proposed as a new mechanism for treating balance issues.

Good news is that increasing levodopa and doing vestibular exercises helps alleviate this problem. I am able to drive and park on spiral parking lots for the most part yet not been able to swing yet. I guess I need more vestibular treatment or maybe I can find me a vibratory helmet somewhere to use. In the meantime, I will just have to go horse back riding (more like a carriage ride for me- since doubt I be able to climb a horse) or take a small shore trip on a boat.

Most centers offer “vestibular therapy”- talk to your physician if this is a possibility if having any type of dysequilibrium especially vertigo and motion sickness. Ent (ear, nose,throat)doctor offices also offer this type of therapy which is covered by most insurance.

2)Sleep attacks
3)Hyper startle reflex
4)Increase susceptibility to infection

The other 3 less known symptoms will be discussed separately so stay tuned.

References:

Smith, P. Vestibular functions in parkinsons disease- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297246/
The history of parkinsons https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3234454/

@copyright 2020
all rights reserved by Maria L. De Leon MD (Parkinson’s Diva)

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