Dizziness or Fainting (Syncope) is among one of the associated symptoms of Parkinson’s disease (PD). About 15-50% people with PD complain about feeling dizzy or lightheaded on standing up or changing position. Some PD medications worsen the dizziness as they can make blood pressure drop suddenly. In PD, the nervous system is not able to release norepinephrine. This chemical sends the signal to blood vessels to tighten or constrict to raise blood pressure so that it reaches back to the brain. Hence, the reduced blood flow to the brain results in dizziness and occasional fainting.
PD patients who are passing out (syncope), or getting dizzy develop Orthostatic Hypotension (OH). Also known as Postural Hypotension, OH occurs when a person’s blood pressure falls when he suddenly stands up from a sitting or lying position. As a result, signs of dizziness, lightheadedness, blurred vision and feeling faint after standing become common at any stage of Parkinson’s disease. This happens due to 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.
Although OH occurs inconsistently for a few minutes or seconds, many cases of long-lasting orthostatic hypotension are often reported among PD fighters. Hence, PD patients should actively watch for signs of decreased circulation, which could include discoloration of the skin, pain or cramping, and numbness of the lower legs and feet. Apart from medication and physical therapy interventions, there are many effective strategies that may improve the PD fighter’s quality of life by preventing dizziness and passing out.
Once Orthostatic Hypotension is suspected, the physician should consider reducing or eliminating the medications such as Antihypertensive and Dopaminergic drugs that contribute to the problem. If dizziness or fainting becomes very frequent, Pharmacologic agents could be prescribed to raise blood pressure. Other commonly prescribed medications for treating OH include Fludrocortisone, Northera (droxidopa), Phenylpropanolamine and Ergotamine/caffeine tablets.
Many patients can be referred to a vestibular physical therapist, who can help them in gaze and gait stabilization to fix vertigo. However, this approach is useful for only a few patients. Alternatively, orthostatic training or tilt training can be prescribed, which usually works on gradually increasing the upright stance to prevent the condition. Standing against the wall is often prescribed to reduce the occurrence of fainting episodes and improve the toning of the lower extremity.
Increasing fluid intake, dietary salt and caffeine can improve orthostatic symptoms. Taking in extra amounts of salt can either be done by consciously adding salt into everything the patient eats or by increasing the intake of salt based beverages like Gatorade. The intake cannot be exceeded beyond 10gm/day, else it can lead to hypertension. Also, opting for small frequent meals over full meals can also help in lowering the blood pressure.