An alternative treatment for Parkinson's disease.

Parkinson's disease is a degenerative process involving the loss of over 70–80% of the dopaminergic neurons in the substan-tia nigra [1]. This results in progressive yet variable loss of freedom of movement , dexterity, mechanical ability, and often cognitive capacity. It afflicts people in various periods of their lives; it can devastate the careers and lives of young patients and incapacitate vigorous older, though active, patients [2]. The current standard medical strategies of treatment include medications such as combinations of carbidopa/levodopa, cathechol-O-methyl transferase inhibitors, monoamine oxidase inhibitors, bromocriptine and amantadine. They are administered in an attempt to raise dopamine levels in the central nervous system, thereby replacing the shortfall of dopamine [2,3]. As transfer of systemically delivered dopamine across the blood-brain barrier is severely limited due to polar, steric and physical barriers, the relative overdose of oral carbidopa/ levodopa combinations has substantial side effects. The other classes of drugs are often problematic as well. The neurologic, psychiatric, cardiovascular and gastrointes-tinal effects may be a great impediment to optimal dosing [2]. Additionally, timing can be a grave problem with on/off phenomena making a patient's situation that much more distressing. As patients age, other marginally or unrelated problems beset them, such as spinal stenosis. One of the treatments for the pain of spinal stenosis is epidural steroid injection. Though not a cure, it does provide great relief for many patients and can forestall surgery. We present a case of a patient who was afflicted with both these conditions and was treated in a novel fashion, with surprisingly good results. An 82 year old woman was referred for moderate lower back pain and leg aching when walking. The difficulty developed over many months, constricting her ability to complete activities of daily living without discomfort. She also had a several year history of Parkinson's disease diagnosed by her neurologist and managed with carbidopa/levodopa. The results were good initially but gradually began to deteriorate, requiring higher doses. She did not tolerate bromocriptine well or other dopaminerigic medications available in 2002–2004. Following physical examination , review of her radiologic studies and our discussion, it was suggested that she undergo epidural steroid injection. After consent was obtained, the first of these was performed with some improvement in the distance she could walk before she developed pain and heaviness in the legs. It was suggested she undergo a second injection. At this point she felt the absence of …