Parkinson Secrets
Expert Tips and Interviews on Living with Parkinson's Disease
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Michael Okun Indu Subramanian Jonny Acheson

 

Tips if you are dizzy with Parkinson's disease

How common is it for Parkinson’s disease folks to visit the emergency room or clinic because of dizziness and/or passing out?

  • It is very common for PD folks suffering from dizziness to present for care in multiple settings (ER, clinic, walk in care center).

  • In most cases, a complete heart evaluation will uncover no underlying cardiac factor influencing the dizziness. 

  • Many folks are referred to a vestibular physical therapist which is someone who specializes in gait stabilization; to fix vertigo. This will not help everyone with PD related dizziness. It is better for things like BPV.

  • Orthostatic hypotension is the most common cause of dizziness in PD. It is a manifestation of Parkinson’s itself and made worse by PD medications.

What is orthostatic hypotension and how common is it?

  • Orthostatic hypotension is common in PD and affects 15 to 50% of patients. 

  • It has been defined as a drop in systolic blood pressure of greater than 20 mmHg, or a decrease in diastolic blood pressure of greater than 10mmHg within 3 minutes of changing to a standing position. 

  • Symptomatic orthostatic hypotension occurred in “81% of patients with multiple system atrophy, in 18% of PD, and in 19% with non-multiple system atrophy (MSA) atypical parkinsonism.” -Jankovic et. al.

  • It seems to be more common in older patients with more advanced PD, and longer disease durations.  It is more common in people who have a history of stroke.

What are the options for treatment of orthostatic hypotension?

  • Reducing or eliminating the medications that contribute to the problem, including antihypertensive medications. This is one approach but may not be possible.

  • Dopaminergic medications (particularly the dopamine agonists) may worsen orthostatic hypotension.

  • Non-pharmacologic may help.

  • There are also a few prescription medications which can be used. 

Orthostatic Hypotension Treatment List:

  • Drinking 6-8 glasses of water per day

  • Compression stockings

  • Abdominal binders

  • Elevate the head of the bed

  • Arise slowly

  • Increase salt

  • Smaller meals

  • Fludrocortisone 0.1 mg once daily

  • Midodrine 5-10 mg three times per day

  • Ephedrine 25-50 mg q4-6 hours

  • Phenylpropanolamine 25 mg twice per day

  • Ergotamine/caffeine tablets

  • Droxidopa (Northera) 100 mg three times daily every 24 48 hours up to a maximum dose of 600 mg three times daily (Maximum total daily dose of 1800 mg

What are the Medication-induced Causes of Dizziness or Vertigo?

  • anticonvulsants

  • antihypertensives

  • antibiotics

  • antidepressants

  • antipsychotics

  • pain medications

  • anti-inflammatory drugs

Can Deep Brain Stimulation cause Dizziness?

  • DBS can rarely be associated with dizziness or vertigo.

  • Turning the device on and off can be helpful to see if device related.

  • ENT referrals are sometimes useful in these cases.

What about Benign Paroxysmal Positional Vertigo (BPPV)?

  • Sudden onset of vertigo, lasting only a few seconds

  • May occur after a sudden head movement such as turning in bed.

  • ~11% of people with PD with dizzy issues.

  • If BPPV your doc or therapist can teach you exercises to treat it.

What about Transient Ischemic Attacks or Strokes Causing Dizziness?

  • Sudden onset dizziness

  • May have other symptoms like weakness, numbness, changes in vision or speech.

  • In these cases we recommend going to a ER and having them call a ‘stroke alert’ so that you can have immediate treatments if a stroke is confirmed.

What are the ‘other’ less common causes of dizziness?

  • Low blood pressure which is not orthostatic hypotension.

  • Anxiety

  • Colds and flu

  • Dehydration

  • Heart issues

  • Migraine headache

Drs Okun and Subramanian provide the content for the parkinsonsecrets.com blog

Jonny Acheson is the parkinsonsecrets.com blog artist

Selected References

Okun M. Parkinson’s Foundation. parkinson.org Ask the Doctor and Blogs

Ha AD, Brown CH, York MK, Jankovic J. The prevalence of symptomatic orthostatic hypotension in patients with Parkinson's disease and atypical parkinsonism. Parkinsonism Relat Disord. 2011 Jun 18.

Mostile G, Jankovic J. Treatment of dysautonomia associated with Parkinson's
disease. Parkinsonism Relat Disord. 2009 Dec;15 Suppl 3:S224-32.

Okun MS, Fernandez HH.  Ask the Doctor about Parkinson’s Disease. Demos Medical Publishing, 2010. 

Michael Okun