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THE CITY REBORN FROM THE ASHES OF AMERICA'S MOST DISASTROUS FOREST FIRE
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Insight Into Parkinson's Conference in Menominee

Issue Date: September 13, 2018

The 3rd annual Insight Into Parkinson's Conference will be held Monday, Sept. 24 at Riverside Golf Club, 3459 14th Ave., Menominee. Doors open at 9 a.m. for registration. There will be displays, information, light refreshments, pharmaceutical representatives, and education from 10 a.m. to 2 p.m.

Speakers will be Dr. Paul Nausieda, MD, Medical Director, Red Horse Parkinson's Alliance, Dacy Reimer, APNP-C, Clinical Advisor to Red Horse Parkinson's Alliance, and Sheila Zelenski, retired Senior Executive.

Pre-register by Sept. 17 by calling Pat Ihler 906-863-9445, or Christine Pecard 715-938-1076. The event is free, however donations are accepted and appreciated. It is sponsored by Red Horse Parkinson Alliance and Marinette Menominee Area Parkinson Support Group.

Dr. Paul Nausieda was trained at the University of Chicago and received his BS in 1968 and MD in 1972. He served his internship at Michael Reese Medical Center in Chicago and his residence in Neurology at the University of Chicago and Rush University of Chicago.

He and his associate Harold Klawans established one of the first Parkinson Disease Clinics in the country and started a training program in Movement Disorders which is still active at Rush Medical Center in Chicago.

Dr. Nausieda moved to the Medical College of Wisconsin in 1981 as an Associate Professor of Neurology, Toxicology and Pharmacology, and in 1983 established the Wisconsin Parkinson Association as a non profit organization for patient education and support.

He has been the Medical Director of the Parkinson Research Center which has been located at a number of Milwaukee hospitals but was at Sinai Aurora from 1999 until the practice closed in 2015.

He was a Clinical Professor of Neurology at the University of Wisconsin, Madison for many years and has conducted multiple research trials of new anti Parkinson medications over the last 40 years in addition to his laboratory research studies looking at the effects of chronic levodopa treatment. His research in Parkinson Disease involved sleep alterations in the disease and he has published in this area as well as serving as the Chairman of Sleep Disorders Medicine for the American Academy of Neurology.

He and his associates have published over 120 scientific papers and numerous textbook chapters. He has an interest in Parkinsonism induced by manganese containing welding fumes and has testified on this work multiple times in Federal Court as an expert witness. Since his retirement in 2015, he volunteers as the Medical Director of the St. Ann's Bucyrus Center in Milwaukee and continues to see multiple patients with Parkinson Disease at this facility.

Dr. Nausieda has been married to Dr. Evonne Winson, a Dermatologist for over 40 years and has two sons, Tony and Ivan, neither of whom is a physician. He has two grandchildren who keep him busy visiting them in Grosse Pointe, Mich.

Dacy Reimer is a board-certified nurse practitioner, licensed to prescribe and treat in primary care. She specialized in neurology and movement disorders and has had more than 20 years experience in caring for individuals with Parkinson disease.

She practices at Lakeside Neurocare in Fond du Lac, with sub-clinics in Oshkosh and Ripon. She is inpatient medical consultant to acute neurological conditions such as stroke and seizure at St. Agnes Hospital, Aurora Oshkosh and Mercy Medical Center Oshkosh.

Dacy's clinical practice specializes in the diagnosis and . of individuals with Parkinson Disease. Prior to joining Lakeside, she was a nurse practitioner at the Regional Parkinson Center in Milwaukee. During her 17 years with the Parkinson Center, she was a founding member of the Parkinson Research Institute, developing its Life Span Database and Brain Bank Procurement Program. Dacy held the position of Education and Outreach Coordinator for the Wisconsin Parkinson Association.

She is author of multiple manuscripts on PD. She is certified as a research coordinator by the Association of Clinical Research Professionals and has managed more than 30 pharmaceutical studies using experimental therapeutic agents; many approved for use, and will be discussed at the conference.

New in Parkinson Disease continues to evolve in Parkinson Disease and involves multiple new approaches. The mainstay of treatment remains levodopa which was first used in the late 1960's and approved for use in 1972. The problem of chronic levodopa treatment has been the focus of most new drug in an attempt to improve short duration of response and the induction of involuntary movements by this agent.

In the last few years the initial enthusiasm for surgical treatment with Deep Brain Stimulation {DBS) has waned due to unpredictable results and the lack of long term efficacy of this approach.

Long acting levodopa delivery systems are now available in oral form (Rytary) and liquid gel preparations (Duopa) which are administered by pump into a tube inserted into the duodenum. These agents are far more predictable than the earlier levodopa products and last much longer. Adjustment is tricky with Rytary and requires a number of visits over a short time following initiation, but results are good once the appropriate doses are identified.

Duopa requires placing a tube through the abdomen into the duodenum and programming of the pump takes some trial and error adjustment but ultimate results are good in many cases. Both are more expensive than conventional generic levodopa which is a potential limitation for some patients. Using these agents many patients can come off synthetic agonists like mirapex, rotigotine or ropinirole which often cause undesirable side effects such as compulsive behaviors or psychiatric reactions.

Gocoviri (time release amantadine) is a relatively new agent that can greatly diminish the involuntary movements induced by levodopa. It is often useful in patients who have involuntary movements at doses of levodopa that are required to block wearing off of the effects at the end of doses. Two capsules {137 mg each) at bedtime is the usual dose and the agent works within days of initiating treatment. Dr. Nausieda has been impressed by the reduction in the severity of involuntary movements and the improved "on" periods that result from treatment.

Used with long acting levodopa products you can often achieve good response round the clock in advanced patients who were plagued by erratic control in the past.

For patients with bothersome hallucinations from levodopa a new drug, Nuplazid (pimavancerin) is now available.

This drug is easy to use and is less sedating than Seroquel (quitiapine) and less toxic than clozaril, which requires blood monitoring. This drug is easy to use and is less sedating than Seroquel (quitiapine) and less toxic than clozaril, which required blood monitoring.

Involved in the studies of this drug it offers an alternative to the prior agents which can avoid some of the limitations in treatment that we faced in the past.

From a research standpoint there have been ongoing studies looking at immunologic strategies for removing alpha synuclein from the brain.

This protein is the one which accumulates in the cells of the brain and constitutes the pathologic finding that identifies Parkinson Disease at autopsy.

Its specific role is not known so attempts to treat Parkinson Disease by reducing the deposition of this protein are based on the theory that the protein is harmful and not just a reaction to some other process causing cell damage. There is potential risk in immunizing a person to a constituent of the brain, and the potential for a fatal encephalitis is a real one. Initial trials are ongoing and although severe reactions seem rare, no definite benefit has been seen either. The problem is when to treat, and early treatment would appear to be most logical.

In Parkinson Disease the diagnosis is usually only made when 70% of the dopamine cells have been damaged, so early detection techniques are being actively studied to allow earlier treatment.

Given the potential risk, there is an ethical issue in asking a patient without symptoms to submit to treatment especially since the rate of development of symptoms seems to vary a great deal between patients. Treating someone with "early" Parkinson changes in the brain who may not ever develop symptoms during life is a tough obstacle. This is especially true given the lack of clear data to show that dropping the alpha synuclein levels translates into reduced symptoms.

The search for an agent that slows or halts progression of Parkinson Disease has failed and we have been involved in a number of unsuccessful trials of agents developed with this goal in mind. Antioxidants and various herbal agents have been marketed as a way to slow the disease but no data supports their use. Beware of internet ads claiming miraculous cures or "novel treatments" that ask for cash payment to receive a new agent.

This is true for a number of clinics advertising "stem cell" infusions using blood or skin cells as a source.

These programs operate on the fringe of the legal system and are not "research" studies other than research into how to pilfer money from naive patients and families.


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