Treatment for Parkinsons Disease -- 718-246-8820

The Parkinson's Disease Program at New York Methodist Hospital offers the only comprehensive diagnostic and treatment program for Parkinson's and other movement disorders in Brooklyn.

Parkinson's disease is a disorder of the central nervous system, involving the degeneration and loss of nerve cells in the basal ganglia of the brain. With the loss of these cells an individual loses the ability to coordinate normal movement.

Parkinson's (which is sometimes called Lewy body disease) is diagnosed through a clinical examination and medical history; there are no radiological or laboratory tests for the disease. Patients who exhibit symptoms of Parkinson's disease or other tremor disorders receive a diagnostic examination, performed by a neurologist (doctor who specializes in the nervous system). Those who have already been diagnosed with Parkinson's or a related tremor disorder may also use this service to get a second opinion.

There are many common symptoms of the disease, but there is no way of knowing which ones a patient will have, or in what order they will occur. The most characteristic feature of Parkinson's disease (which was once called "shaking palsy") is a slow and rhythmic tremor at rest. Usually the tremor begins in one hand and then later spreads to the other. Feet, legs, the lips and jaw may also shake.

Other common symptoms of Parkinson's include: rigidity in the limbs, neck or trunk, hypokinesia (slow movement which involves a decrease in both large and fine motor coordination), impaired gait, which may eventually result in slow, small, shuffling steps and balance problems, and impairment of posture, Parkinson's most disabling symptom, which generally occurs late in the course of the disease.

Parkinson's is a chronic disease; that is, once symptoms appear, it can be treated, but it will not go away. It usually progresses slowly, but the rate of progression varies from one case to another and is unpredictable. Because there is not yet a cure for Parkinson's disease and because there is no medication which can stop or slow the progression of symptoms, treatment is designed to suppress or reduce the symptoms that are present.

While there is currently no cure, there are many available treatments that can improve quality of life, sometimes to the point where the disease has little impact. In the earliest stages of Parkinson's, if quality of life is not significantly impacted, there may be no reason to use medication.

When the disease symptoms result in a functional disability that interferes with everyday activities, it is usually time to begin medication. The most important and effective medication for Parkinson's disease is levodopa. It is often highly effective in reducing the symptoms of the disease. Other medications may be prescribed instead of or along with levodopa, at various times in the course of treatment.

Sometimes, the medications eventually stop providing significant relief of symptoms. When this happens, surgical interventions in the basal ganglia can sometimes be used to alleviate some of these symptoms, particularly tremor, rigidity and dystonic muscle pain and, to a lesser extent, hypokinesia. The procedures done to alleviate Parkinson's disease involve the implantation of deep brain stimulators, which allow patients to control tremors with the touch of a small magnet.

Surgery for Parkinson's disease is done stereotactically (areas of the brain are reached with the aid of a computerized guidance system through a small hole in the skull.) This type of surgery takes less than two hours and the patient can usually go home the next day.

Rehabilitation is another treatment option for Parkinson's disease and other movement disorders. The Parkinson's Disease Program at NYM offers an Inpatient Rehabilitation Program.

Other Movement Disorders

There are a number of related movement disorders, sometimes called Parkinson syndromes or atypical "Parkinsonisms," as well as other unrelated movements disorders that are not considered Parkinsonisms.

The most common related Parkinson syndromes include progressive supranuclear palsy, which may cause gait disorders, frequent falls, visual abnormalities, speech or swallowing problems, and multiple systems atrophy, which is a lump term for several disorders that manifest with a slight tremor, gait and balance problems. Other involuntary movement disorders include hemifacial spasms, Huntington's chorea, Tourette's and other tic syndromes.

It is important to differentiate between these disorders and Parkinson's in order to plan treatment appropriately. Botulinum toxin injections are among the many treatments available for movement disorders. In some cases, deep brain stimulation surgery used to treat Parkinson's disease may also be a viable treatment for these movement disorders.

For more information, please call 718-246-8820.

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