Parkinson's Disease and Movement Disorders

Parkinson's Disease

Parkinson's disease, the second most common movement disorder in North America, is a progressive neurological disorder caused by the loss of specific groups of nerve cells in the brain. Chemicals in the brain called neurotransmitters produce signals that regulate muscle movement throughout the body. In people with Parkinson's disease, specific brain cells stop working properly, including those that produce a neurotransmitter called dopamine. As levels of dopamine fall, patients have increasing difficulty controlling their movements.

Specialists at NewYork-Presbyterian Hospital have the specialized training and expertise needed to help patients and their families manage the many facets of Parkinson's disease symptoms, as well as associated anxiety, depression, sleep disorders, and psychosocial issues. Patients may receive treatment from neurologists and neurosurgeons at our two movement disorders centers: Columbia's Center for Parkinson's Disease and Other Movement Disorders and Weill Cornell's Parkinson's Disease and Movement Disorders Institute.

Our team also provides comprehensive care for the 10 percent of patients with Parkinson's symptoms who have atypical Parkinson's or "Parkinson's Plus" syndromes. These rare disorders affect the nerves that control walking, balance, mobility, vision, speech, and swallowing. These illnesses progress faster than in Parkinson's disease, and patients often have more difficulty with thought processes than with classic Parkinson's disease.

Symptoms

Symptoms of Parkinson's disease may vary from patient to patient and may include tremors, muscle stiffness, slowness in starting a movement, poor posture, and problems with balance. Symptoms may worsen as the disease progresses, and eventually may include psychological symptoms, such as depression and emotional changes.

Diagnosis

NewYork-Presbyterian physicians are highly experienced in the accurate diagnosis of Parkinson's disease and Parkinson's Plus syndromes. The diagnosis is based primarily on a medical history and thorough neurological examination. Our doctors may order brain scans (computed tomography or magnetic resonance imaging) and/or lab tests to help rule out other diseases or conditions. NewYork-Presbyterian also offers the DaTSCAN, an advanced imaging test used to detect dopamine transporters (DAT) in patients with suspected Parkinson's disease and Parkinson's-like syndromes.

Medical Treatment

Our physicians tailor treatment to each patient's disease and symptoms. They may prescribe medications that replace dopamine and correct other chemical imbalances to help control Parkinson's symptoms. Current medications to treat Parkinson's include:

• Levodopa, which increases the levels of dopamine in the brain.
• Drugs which stimulate dopamine receptors in the brain.
• Drugs that decrease the activity of the neurotransmitter acetylcholine, which improves the balance between acetylcholine and dopamine.
• Drugs that help to make levodopa last longer in the brain.

Our team of specialists is also able to work with patients interested in pursuing complementary medicine as part of their therapy. In addition to treating involuntary movements, we provide referrals to our colleagues for therapy to address other related problems, such as blood pressure issues, subtle disturbances in vision, bladder control problems, digestive disorders, and memory difficulties.

We have special expertise in the care of performing artists who develop movement disorders, particularly through the Center for the Performing Artist at NewYork-Presbyterian/Weill Cornell.

Surgical Treatment

Patients in whom medications do not adequately control symptoms may be eligible for a neurosurgical procedure called "deep brain stimulation" (DBS), which has become an important tool in the treatment of Parkinson's disease. NewYork-Presbyterian is one of the busiest and most prestigious centers offering this treatment. With DBS, neurosurgeons implant a device that acts like a pacemaker for the brain, reducing or eliminating abnormal brain signals in regions that are overly active in Parkinson's disease. DBS is not a cure for Parkinson's disease and does not slow its progression. But for many people, it can dramatically reduce Parkinson's symptoms and improve quality of life.

For tremor-dominant Parkinson's disease, Focused Ultrasound, a minimally invasive MR-guided high-intensity procedure, may be an option to treat tremors. The procedure is performed while the patient is awake in an MRI scanner allowing our specialists to precisely plan and target specific brain cells with little to no harm to surrounding tissue and minimal side effects. Learn more here.

Rehabilitation

Physical, occupational, speech, swallowing, and nutritional therapy can all help patients with Parkinson's disease maintain function over time. Rehabilitation experts at NewYork-Presbyterian are available to:

• Evaluate muscle strength and motor skills and develop an individualized program to maintain existing physical function
• Improve the volume and clarity of speech.
• Evaluate swallowing function and teach safe swallowing techniques.
• Recommend devices (including neck supports, canes, walkers, and wheelchairs) and equipment for the home to ensure patients' safety and mobility.
• Discuss ways to modify activities, conserve energy, and simplify work.

Research and Clinical Trials

Neurologists, neurosurgeons, and other investigators at both NewYork-Presbyterian Hospital campuses are conducting basic science and clinical research to learn more about the causes of Parkinson's disease and to find new and more effective ways to diagnose and treat it.