Editors TN Mehrotra
Professor of Medicine (Neurology) Head, Department of Medicine (Retd) LLRM Medical College
Meerut
President PDMDS Kalyan B Bhattacharyya
Associate Professor Department of Neurology Calcutta National Medical College and Hospital
Kolkata
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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Parkinson's Disease and Movement Disorders
© 2005, TN Mehrotra, Kalyan B Bhattacharyya
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editors and the publisher.
First Edition: 2005
9788180615559
Typeset at JPBMP typesetting unit
Printed at Gopsons Papers Ltd., A 14, Sector 60, Noida
We dedicate this book to
Parkinson's Disease and Movement Disorder Society
as well as to our professional colleagues
who have shared with us their experiences
in coping with their patients of Parkinson's Disease
and have thus shaped this book
7Contributors
- Mathew Abraham
- Senior Consultant Neurologist
- Indira Gandhi Cooperative Hospital and Lakeshore Hospital
- Cochin
- E-mail: mathew_abraham2@rediffmail.com
- Atul Agarwal
- Professor of Neurology
- CSM Medical University
- (Upgraded K.G. Medical College)
- Lucknow
- Quincy J Almeida
- Behavioral Neuroscience Division and Department of Kinesiology
- University of Waterloo
- Waterloo, CN
- Canada
- Bawani Anand
- Consultant Neurologist
- Sagar Apollo Hospital
- Bangalore
- Deepak Arjundas
- Consultant Neurologist
- Vijaaya Health Centre
- Chennai
- G Arjundas
- Professor Emeritus
- MGR Medical University
- Chennai
- Tapas Kumar Banerjee
- Consultant Neurologist
- Head, Department of Neurology
- National Neurosciences Center
- Kolkata
- E-mail: kkbn@cal.vsnl.net.in
- BC Bansal
- Professor of Medicine
- Head, Division of Neurology
- Medical College Rohtak (Retd.)
- Senior Consultant and Head
- Department of Neurology
- Mool Chand Hospital
- New Delhi
- E-mail: bcbansal@hotmail.com
- Sagar Basu
- Assistant Professor
- Department of Neurology
- Calcutta National Medical College and Hospital
- Kolkata
- E-mail: sagar_mala@rediffmail.com
- Madhuri Behari
- Professor and Head
- Department of Neurology
- All India Institute of Medical Sciences
- New Delhi
- E-mail: madhuribehari@hotmail.com
- J Bhaskaran
- Consultant Neurologist
- The TS Srinivasan Department of Clinical Neurology and Research
- Public Health Centre, West Mambalam Chennai
- Arvind Bhateja
- Consultant Neurosurgeon
- Narayana Institute of Neurosciences
- Narayana Hrudayalaya
- Hosur Road, Bommasandra
- Bangalore
- Mohit Bhatt
- Consultant Neurologist
- Jaslok Hospital and Research Centre
- Mumbai
- Kalyan B Bhattacharyya
- Associate Professor
- Department of Neurology
- Calcutta National Medical College and Hospital
- Kolkata
- E-mail: kalyanbrb@rediffmail.com
- B Bindu
- Resident
- Department of Neurology
- Institute of Neurology, Madras Medical College
- Chennai
- Prithika Chary
- Senior Consultant Neurologist and Chief
- Division of Epileptology
- Director, Epicentre
- Head, Department of Integrative Medicine
- Apollo Hospital
- Chennai
- E-mail: prichar@vsnl.com
- K Ray Chaudhuri
- Consultant Neurologist, Hon. Senior Lecturer
- Department of Neurology
- Mapother House, King's College Hospital
- Denmark Hill, London SE5 9RS
- UK
- E-mail: Ray.chaudhuri@kingsch.nhs.UK
- Neeraj Chhaya
- Clinical Assistant
- Department of Stereotaxy and Functional Neurosurgery
- Jaslok Hospital and Research Centre
- Mumbai
- Robert Chen
- Associate Professor of Medicine (Neurology)
- Toranto Western Hospital
- University of Toranto
- Canada
- A Chitnis
- Pediatric Neurophysiotherapist
- Bombay Hospital Institute of Medical Sciences
- Mumbai
- CP Das
- Assistant Professor
- Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh
- E-mail: dascp@glide.net.in
- Shaymal Kumar Das
- Professor of Neurology
- Bangur Institute of Neurology
- Kolkata
- E-mail: das_sk70@hotmail.com
- Paresh K Doshi
- Neurosurgeon
- In-charge, Department of Stereotaxy and Functional Neurosurgery
- Jaslok Hospital and Research Centre
- Mumbai
- E-mail: pareshkd@vsnl.com
- N Ghara
- Senior Resident
- Department of Pathology
- All India Institute of Medical Sciences
- New Delhi
- Malay Ghosal
- Associate Professor
- Department of Psychiatry
- Medical College
- Kolkata
- E-mail: gmalay@hotmail.com
- Manas Ghosal
- Medical Director
- Dr Nihar Munsi Eye Foundation
- Kolkata
- E-mail: manasghosal54@rediffmail.com
- Bhaskar Ghosh
- Consultant Neurologist
- B R Singh Hospital and Centre for Medical Education and Research
- Kolkata
- K Gohil
- Senior Resident
- Department of Pediatrics
- Bombay Hospital Institute of Medical Sciences
- Mumbai
- Vinay Goyal
- Assistant Professor
- Department of Neurology
- All India Institute of Medical Sciences
- New Delhi
- Roop Gursahani
- Consultant Neurologist
- PD Hinduja National Hospital
- Assistant Professor, Grant Medical College and JJ Hospital, Byculla
- Mumbai
- E-mail: roop_gursahani@hotmail.com
- Thimappa Hegde
- Director and Senior Consultant Neurosurgeon
- Narayana Institute of Neurosciences
- Narayana Hrudayalaya
- Hosur Road, Bommasandra
- Bangalore
- E-mail: thimappahegde@hotmail.com
- Mandar S Jog
- Movement Disorders Program
- London Health Sciences Center
- University Campus
- 339, Windermere Road
- London, ON
- Canada N6A 5A5
- E-mail: mandar.jog@1hsc.on.ca
- J Kalita
- Assistant Professor
- Department of Neurology
- Sanjay Gandhi Postgraduate Institute
- Rae Bareilly Road
- Lucknow
- JS Kathpal
- Head of the Department of Neurology
- CH & RC
- Indore
- E-mail: manjukathpal@satyam.net.in
- SV Khadilkar
- Consultant Neurologist
- Bombay Hospital Institute of Medical Sciences
- Mumbai
- E-mail: khadilkar@vsnl.com
- ES Krishnamoorthy
- Professor
- Madras University
- TS Srinivasan Institute Centre for Clinical Neurosciences VHS Medical Centre
- Taramani
- Chennai
- E-mail: krish@neurokrish.com
- JA Lalkaka
- Associate Professor
- Department of Neurology
- Bombay Hospital
- Institute of Medical Sciences
- Mumbai
- R Mannan
- Senior Resident
- All India Institute of Medical Sciences
- New Delhi
- A Khaja Mohideen
- Assistant Surgeon
- H Q Hospital
- Sangakiri
- Chennai
- TN Mehrotra
- Professor of Medicine (Neurology)
- Head, Department of Medicine (Retd)
- LLRM Medical College
- Meerut
- E-mail: drtnm@datainfosys.net
- Neeta A Mehta
- Honorary Professor and Head
- Department of Neurology
- Grant Medical College and Sir JJ Group of Hospitals and Dr B Nanavati Hospital
- Mumbai
- E-mail: shemin@hotmail.com
- UK Misra
- Professor and Head
- Department of Neurology
- Sanjay Gandhi Postgraduate Institute
- Rae Bareily Road
- Lucknow
- E-mail: ukmisra@sgpgi.ac.in
- M Modi
- Professor
- Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh
- Swapan Mukhopadhyay
- Lecturer, Pediatric Neurology
- Institute of Child Health
- Kolkata
- E-mail: kalyanab@rediffmail.com
- JMK Murthy
- Chief of Neurology
- CARE Hospital
- Exhibition Road, Nampally
- Hyderabad
- E-mail: jmkmurthy@satyam.net.in
- Uday B Muthane
- Associate Professor of Neurology
- NIMHANS
- Bangalore
- E-mail: ubmuthane@usa.net
- Uday Murgod
- Consultant Neurologist
- Manipal Hospital
- Bangalore
- D Nagaraja
- Director and Vice-Chancellor
- NIMHANS
- Bangalore
- E-mail: dnn@nimhans.kar.nic.in
- V Nagaraajan
- Senior Consultant Neurologist
- VN Brain and Neurocentre
- 72 Vakil New Street
- Madurai
- E-mail: naga.99@md4.vsnl.net.in
- Pramod Kumar Pal
- Assistant Professor of Neurology
- NIMHAS
- Bangalore
- E-mail: palpramod@hotmail.com
- S Prabhakar
- Professor and Head
- Department of Neurology
- Postgraduate Institute of Medical Education and Research
- Chandigarh
- Pralhad P Prabhudesai
- Consultant Pulmonoligst
- Western India Sleep Laboratory and Leelavati Hospital and Research Centre Mumbai
- Vinod Puri
- Professor and Head
- Department of Neurology
- GB Pant Hospital
- New Delhi
- E-mail: vpuri@bol.net.in
- RA Raghu
- Paul Hamlyn Fellow
- TS Srinivasan Centre for Clinical Neurosciences
- Chennai
- UR Raju
- Resident, Department of Medicine
- SN Medical College
- Agra
- R Ramdass
- Senior Lecturer
- Neurology Department
- Topiwala National Medical College and BYL Nair Charitable Hospital
- Mumbai
- Pratap Sanchetee
- Consultant Neurologist
- Sanchetee Hospital
- 429 Pal Link Road
- Jodhpur
- E-mail: psanchete@yahoo.com
- Milind Sankhe
- Consultant Neurosurgeon
- PD Hinduja National Hospital and Research Centre
- Mumbai
- E-mail: milsankhe@hotmail.com
- Charulata Sankhla
- Consultant Neurologist
- P D Hinduja National Hospital and Medical Research Centre
- Mumbai
- E-mail: ssankhla@vsnl.com
- Chitra Sarkar
- Professor, Department of Pathology
- All India Institute of Medical Sciences
- New Delhi
- E-mail: sarkarcs@hotmail.com
- Kapil D Sethi
- Professor, Department of Neurology
- Augusta, Georgia 30912
- USA
- E-mail: ksethi@neuro.mcg.edu
- Arun B Shah
- Hon Prof and I/C Neurology Department
- Topiwala National Medical College and BYL Nair Charitable Hospital
- Mumbai
- E-mail: shahbarun@hotmail.com
- Sudhir V Shah
- Consultant Neurologist
- Associate Professor of Neurology
- KM School of PG Medical Research
- Ahmedabad
- E-mail: sudhirshah@hotmail.com
- Rakesh Shukla
- Professor of Neurology
- CSM Medical University
- (Upgraded King George's Medical College)
- Lucknow
- Maneesh K Singh
- Lecturer in Neurology
- CSM Medical University
- (upgraded KG Medical College)
- Lucknow
- MC Sharma
- Associate Professor
- Department of Pathology
- All India Institute of Medical Sciences
- New Delhi
- Dhermendera Pratap Singh
- Senior Resident
- Department of Neurology
- GB Pant Hospital
- New Delhi
- BS Singhal
- Professor and Head
- Department of Neurology
- Bombay Hospital Institute of Medical Sciences
- Mumbai
- E-mail: bssingl@vsnl.com
- MM Singh
- Director Professor and Head
- PG Department of Medicine (Retd.)
- SN Medical College
- Agra
- E-mail: mmsingh5@rediffmail.com
- KK Sinha
- Consultant Neurologist
- Mansarovar
- Booty Road, Bariatu
- Ranchi
- E-mail: rch_adcran@sancharnet.in
- Ashok M Sirsat
- Consultant Neurologist
- Leelavati Hospital and Research Centre Mumbai
- E-mail: asirsat@hotmail.com
- Krishamoorthy Srinivas
- Chairman
- The TS Srinivasan Department of Clinical Neurology and Research
- Public Health Centre, West Mambalan Chennai
- Emeritus Professor of Neurology
- Sri Ram Chandra Medical College
- Chennai
- E-mail: srinivas@neurokrish.com
- AV Srinivasan
- Professor of Neurology, Institute of Neurology
- Madras Medical College
- Chennai
- E-mail: avs19502000@yahoo.com
- Deepak Srivastava
- Senior Resident
- Department of Neurology
- All India Institute of Medical Sciences
- New Delhi
- Nirmal Surya
- Consultant Neurologist
- Surya Neurocentre
- 310 Lotus House
- 33-A New Marine Lines
- Mumbai
- E-mail: suryaneuro@mtnl.net.in
- K Thiruvarutchelvan
- Resident
- Department of Neurology
- Institute of Neurology
- Madras Medical College
- Chennai
- M Tripathi
- Assistant Professor
- Department of Neurology
- All India Institute of Medical Sciences
- New Delhi
- E-mail: mantrips@hotmail.com
- SC Vaidya
- Consultant Neurologist
- Bombay Hospital Institute of Medical Sciences
- Mumbai
- S Yogaraj
- Assistant Professor
- Department of Neurology
- Institute of neurology
- Madras Medical College
- Chennai
OFFICE BEARERS
- President
- Dr TN Mehrotra
- Meerut
- Hon. Secretary
- Dr BS Singhal
- Mumbai
- Vice-Presidents
- Mr Divakar V Deo
- Cochin
- Mr BK Parekh
- Mumbai
- Mr Vinod Shah
- Ahmedabad
- Hon. Treasurer
- Dr JA Lalkaka
- Mumbai
GOVERNING COUNCIL MEMBERS
- Dr Madhuri Behari
- Delhi
- Dr K Bhattacharyya
- Kolkata
- Dr Rupam Borgohain
- Hyderabad
- Dr JS Kathpal
- Indore
- Dr SM Katrak
- Mumbai
- Dr Uday Muthane
- Bangalore
- Dr S Prabhakar
- Chandigarh
- Dr KK Sinha
- Ranchi
FOUNDER MEMBERS
- Dr AB Shah
- Dr Charu Sankhla
- Dr BS Singhal
- Dr JA Lalkaka
- Dr SV Khadilkar
- Dr N Surya
- Ms Katie Vania
Parkinson's disease is a common disorder. Most physicians as well as neurologists have patients of parkinsonism in their practice. The care of patients with parkinsonism is complex.
In the early stages when the diagnosis is made many patients may only need education about the disease and reassurance. Over the ensuing years, however, the clinicians may be orchestrating pharmacologic interventions and a variety of community and medical services to cope with a diversity of problems that may be associated with parkinsonism.
There are number of monographs on parkinsonism and movement disorders. However, there is none published by experts in this field from our country. In this book we have attempted to gather experiences of our colleagues engaged in handling these patients.
Optimal care of parkinsonian patients requires more than just intelligent use of antiparkinsonian drugs and hence we have also discussed often less appreciated aspects of management.
I hope that this publication will help our fellow colleagues, physicians and neurologists alike to offer better care to the people suffering from Parkinson's disease.
T N Mehrotra
Kalyan B Bhattacharyya
16Acknowledgements
We are thankful to Professor BS Singhal who has guided us from time to time to enable us to present this book in its present form.