The Hillary collpase last Sunday has prompted a lot of speculation on her condition. Early on I was inclined to blame her neurological condition on her history of concussion and cerebral vein thrombosis.
That seemed logical, given her history. However, it does not explain her quick recovery. It also has nothing to do with pneumonia.
This video has now convinced me that she has Parkinson’s Disease, and it is fairly advanced. In the video, the physician mentions Apomorphine, which is not morphine but an alpha adrenergic drug used in Parkinson’s Disease.
Currently, apomorphine is used in the treatment of Parkinson’s disease.
What use does it have in Parkinson’s? It is used for “Non-motor symptoms.”
What does that mean ? Parkinson’s Disease is characterized by a serious of motor disabilities.
The cardinal symptoms of Parkinson’s disease are resting tremor, slowness of movement (bradykinesia) and rigidity. Many people also experience balance problems (postural instability). These symptoms, which often appear gradually and with increasing severity over time, are usually what first bring patients to a neurologist for help. Typically, symptoms begin on one side of the body and migrate over time to the other side.
These symptoms are typically controlled with Dopamine like drugs, such as L-Dopa. There are other symptoms less easily controlled.
For example, in advanced cases, difficulty swallowing can cause Parkinson’s patients to aspirate food into the lungs, leading to pneumonia or other pulmonary conditions. Loss of balance can cause falls that result in serious injuries or death. The seriousness of these incidents depends greatly on the patient’s age, overall health and disease stage.
There are also side effects of L Dopa.
L-DOPA therapy is further complicated by the development of movement disorders called dyskinesias after 5 – 10 years of use in most cases.
Dyskinesias are movement disorders in which neurological discoordination results in uncontrollable, involuntary movements. This discoordination can also affect the autonomic nervous system, resulting in, for example, respiratory irregularities (Rice 2002). Dyskinesia is the result of L-DOPA-induced synaptic dysfunction and inappropriate signaling between areas of the brain that normally coordinate movement, namely the motor cortex and the striatum (Jenner 2008).
One type of dyskinesia is called “Freezing” The video linked above had several clips showing what looks like freezing. I looked carefully for evidence of editing to simulate seizure like motion but saw none. The treatment for freezes, also referred to as “OFF episodes,” is Apomorphine, which can quickly control these reactions.
Of 19 patients, 15 (78.9%) achieved a full ON response. All 15 achieved a full ON response within 30 minutes and 6 of the 15 patients (40.0%) achieved a full ON response within 15 minutes. The mean (SD) duration of ON was 50 (19.4) minutes. Of the 15 patients, 9 (60.0%) remained fully ON for ?90 minutes. There were no discontinuations as a result of an adverse event. The most common adverse events were dizziness (36.8%), somnolence (31.6%), and nausea (21.1%).
This could explain her sudden recovery on Sunday and could also suggest the reason why she was not taken, as per USSS protocol, to an Emergency Room. The apomorphine can be given as a sublingual tablet and does not require an injection. The Secret Service has been protecting her since 1992 and should be well aware of her medical problems.
These episodes are a well known complication of Parkinson’s Disease and of L Dopa.
Although levodopa is the most effective oral PD therapy, many patients experience motor fluctuations, including sudden loss of dose effect and delayed benefit. CVT-301 is a levodopa inhalation powder with the potential for rapid onset of action. The objective of this study was to evaluate CVT-301 self-administered by PD patients to relieve OFF episodes.
The issue of blue sunglasses has also been raised and they are well known in the treatment of epilepsy. Their use in pure Parkinson’s Disease is limited to alternative medicine and chiropractic.
The video discussing Hillary Clinton and Parkinson’s has been attacked. That diagnosis of pneumonia does not explain the sudden recovery. The attacks on the physician also ignores that he is an anesthesiologist and should be well trained in pharmacology.
There is obviously no way to prove that this is the disease causing her collapse. We will have to see if anything else happens. The debates should be interesting. Freezing may be precipitated by stress.
Individuals with Parkinson’s disease (PD) commonly experience freezing of gait under time constraints, in narrow spaces, and in the dark. One commonality between these different situations is that they may all provoke anxiety, The conclusion ?
These results present strong evidence that anxiety is an important mechanism underlying freezing of gait and supports the notion that the limbic system may have a profound contribution to freezing in PD.
The debates will be interesting. The short “press conference” she had after the incident last weekend, was marked by individual reporters asking questions one at a time. The freezing episode was precipitated by a number of reporters asking questions at the same time. Stress.