INon responsiveness with Parkinson’s.

My wife was diagnosed with Parkinson's disease over 17 years ago and has also suffered a lacunar stroke. She was recently hospitalized for unresponsiveness brought on by her medication that was causing Neurogenic orthostatic hypotension (nOH) which is a chronic drop in blood pressure upon standing, typically \(\ge 20\text{\ mmHg}\) systolic or \(\ge 10\text{\ mmHg}\) diastolic, caused by nervous system disorders like Parkinson's. Symptoms include dizziness, fainting, "coat hanger" neck pain, and fatigue. Management includes increased fluids/salt, compression garments, and potential medications (e.g., droxidopa).

@tomcgauley Sounds like me! I have had Parkinson’s Disease for at least the last 10 years, and I, too have suffered, actually, from several lacunar strokes, recently. Just the last few weeks I’ve had several episodes of hypotension, one was 88/66. Anyway, the Doctor cut my Losartan medicine dosage in half, and my blood pressure has been within a normal range, this last week! Dealing with Psrkinson’s and stroke’s damaging effects has many challenges! I surely can empathize with how difficult this is for your wife! Wishing you and her the best of luck!

@foundryrat743 my wife's blood pressure varies from high of 242/118 to 66/43. Many people diagnosed with PD can develop the nOH without knowing it. My wife takes Amlodipine at bedtime and it seems to help. Another problem with blood pressure dropping is two of the medications my wife was taking for treatment of Parkinson's disease were Caridopa and pramipexole which were both contributing to her sudden blood pressure drop and unresponsiveness. After discontinuing these two medications she hasn't had any more issues. Best of luck!

@tomcgauley Thanks, sir, for your kind, and most informative reply! I sure appreciate your helping me to understand more, of why, maybe, I have been having low blood pressure problems. I take carb/levodopa for my Parkinson’s, and I will check with my Neurologist and find out what she thinks of carb/levodopa effect on possibly it being a causal factor, when one is diagnosed with low blood pressure. Just a side note. I suffer from Bradycardia at tines, too, which causes orthostatic hypotension! Sometimes my heart beat dips into the low 40’s per minute, and I have to be careful, not to stand up too quickly, cause if I do, I have had times where I feel lightheaded, like I might faint! Another interesting subject that you brought up, is that of unresponsiveness. There are a few times, over the last few years, usually when I’m very tired, like late in the afternoon, where I feel so weary, and worn out mentally, that I’ll just sit in my recliner, and not say anything, or think anything! It’s like, maybe, my brain needs a rest. I can be sitting there, with my eyes open, but looking drowsy, and seem to be unresponsive, to somebody who comes by and says something to me! Of course, if they stick around, and address me more directly, I do respond, acting like maybe I had just drifted off to sleep, momentarily! Thanks for being such an intuitive caregiver for your wife! Parkinson’s patients need consistent caretakers!

My wife was hospitalized in Japan and treated for Parkinson's disease. When she returned to the United States the neurologist here tried converting her Japan prescribed medication to USA equivalent. In the process her Caridopa and levodopa was changed from a 10/100 combination to a 25/100 combination. The neurologist said she would benefit from an additional 25mg dose of Caridopa and prescribed lodosyn. In Japan she was given a lower dose of Caridopa because Japanese are aware of the side effects and prescribed a Japanese medicine to prevent nausea caused by the levodopa. Over time she tolerated the extra dose until she suffered frequent blood pressure dropping and unresponsiveness to the degree she was hospitalized. My wife also has moderate atherosclerosis and tricuspid valve regurgitation. After she had her lacunar stroke her neurologist placed her on low dose asprin, lipitor and Januvia. Unfortunately, we are discovering that doctors in the United States do not aggressively treat the stroke due to treatments for one condition may aggravate the other, for instance, medication for high blood pressure (needed after a stroke) could impact the management of PD symptoms.

@tomcgauley Hi! So sorry you and your wife have had to go through all this! In my case, the lacunar strokes that I had, could have been caused by diagnosed atrial fibrillation, therefore it required immediate aggressive medical action. So I was put on a blood thinner, and a watchman heart implant is scheduled for me, next month! I have a family history of strokes. My Mom and Dsd died of strokes. My sister died of a massive stroke last year. My carb/levodopa Parkinson’s medicine dosage has stayed the same, and, according to my neurologist, that treatment has not affected my stroke, blood pressure, and cardiac treatments! I can’t speak for your not being pleased with thinking that treatment for one condition, might aggravate treatment for another condition. The problem is that each patient’s case is unique, along with prescribed dosages of medicines, treatments etc. So, while what my situation requires, as compared to what situation your wife requires may be similar, they are not identical, and while her medical providers, here in the USA decide treatments, they would, more than likely, not be identical to what my medical providers do for me, or what your wife’s Japanese medical providers, decided to do for her. My hope is that it will work out where your wife’s medical providers, will be able to treat her Parkinson’s Disease, and stroke, by doing what’s best for her, with her individual needs.