Parkinson’s Disease Treatment

Board-Certified Neurology Specialists Treating Parkinson’s Disease

Parkinson’s disease causes a daily struggle to interact with the world in the way the person did before they were affected with this chronic, progressive movement disorder. Our multidisciplinary team of board-certified neurologists and neurosurgeons from Rutgers Health and RWJBarnabas Health works with a dedicated staff of experts in the fields of speech therapy, occupational therapy, nutrition, and more, to provide our patients with a better quality of life and improved independence. Our knowledgeable team of medical professionals is committed to supporting both the patient and their family throughout treatment.

Contact us for further information about our services. We provide the support our patients need to manage Parkinson’s disease and other movement disorders such as essential tremor, dystonia, gait dysfunction, tics and Tourette syndrome, and Huntington’s disease.

Request an appointment online or call 833-656-3876.

What Is Parkinson’s Disease?

Parkinson’s disease, sometimes simply called Parkinson’s or PD, is a chronic, degenerative neurological disorder affecting movement. Parkinson’s happens due to the gradual degeneration of nerve cells in the midbrain, which controls body movement.

The hallmark sign of Parkinson’s is rhythmic, involuntary tremors. Other common signs are stiffness and slowed movement. Symptoms generally develop slowly over years, but the course of the disease is different from one person to the next. The first signs are usually barely noticeable, such as a feeling of weakness or stiffness in the legs, or a slight trembling of the hand. Usually, a person with Parkinson’s begins to notice symptoms between the ages of 50 and 65.

What Is the Difference Between Parkinson’s Disease and Parkinsonism?

Parkinson’s disease is a type of parkinsonism, which is a general term used to describe the set of Parkinson’s symptoms that stem from other causes. This is an important distinction, because some of the other causes may have their own specific treatments which do not respond to the medications and surgeries used to treat Parkinson’s disease. Some of the other causes of parkinsonism include use of illicit drugs, stroke, thyroid disorder, brain tumors, and brain inflammations.

Although Parkinson’s disease is incurable, the symptoms are manageable with expert medical intervention.

Risk Factors for Parkinson’s Disease

The cause of Parkinson’s remains unknown, but several factors can contribute to its development, including:

• Genetics. A family history of the disease may indicate the likelihood of getting it.
• Being male. Men are more likely to develop Parkinson's disease than women in most populations.
• Age. Most people develop the disease around age 60 or older, although in 10 percent of cases it can begin as early as age 40.

Parkinson’s Disease Symptoms

The signs and symptoms of Parkinson’s disease are different for everyone, and some early signs may be mild and go unnoticed. In its early stages, those with Parkinson’s may notice their arms do not swing when they walk, or their speech becomes softer and slurred. Because Parkinson’s is a degenerative disease, symptoms become more pronounced over time.

Common motor symptoms or “cardinal features” of Parkinson’s disease:

• Tremor and involuntary, rhythmic movements of the limbs, hands and jaw; commonly occurs at rest in one hand
• Changes in speech
• Loss of spontaneous and automatic movement
• Slowed movement – not swinging one or both arms when walking, smaller steps, feet feel like they are “glued” to the floor
• Stiff or rigid muscles – similar to cramping
• Stooped posture
• Smaller handwriting, softer voice, face becomes less expressive

There are also a variety of “non-motor” symptoms which may occur years or even decades before a motor symptom and may include the following:

• Constipation and frequent urination, drooling at night
• Depression and anxiety
• Dementia
• Loss of sense of smell or taste
• Sleep disturbances – insomnia, daytime fatigue, restless leg syndrome, cramps, vivid dreams or nightmares, difficulty turning over in bed

Parkinson’s Disease Stages

Parkinson’s disease has stages, from mild, to moderate, to advanced. Some people never reach the advanced stage, however.

• Mild. The mild stage involves the least noticeable symptoms, which do not disrupt daily life, and it lasts about 3 to 7 years.
• Moderate. The moderate stage is more severe, and can change the way you speak, cause difficulty swallowing, make you more prone to falling, and you might take small, shuffling steps.
• Advanced Parkinson’s disease. Advanced Parkinson’s disease is usually unresponsive to most treatment, and many patients are limited to a bed or wheelchair and need round-the-clock care.

Parkinson’s Disease Diagnosis

Parkinson's disease is is primarily diagnosed based on the common symptoms displayed. Usually, the diagnosis can be made based on the clinical features and examination by an experienced clinician.

A diagnostic test, dopamine transporter scan (DaTscan), can be ordered to confirm the diagnosis.

Although PD is a progressive disease, it does not significantly alter life expectancy.

Commonly, Parkinson’s disease is diagnosed by the presence of two or more of the primary symptoms, and the patient should not display other neurological signs upon examination.

The patient should also not have any other possible causes of parkinsonian symptoms, such as using tranquilizer medications, head trauma or previous stroke.

Parkinson’s Disease Treatment Options

We provide our patients who have Parkinson’s disease (and other movement disorders including multiple sclerosis, traumatic brain injury, spinal cord injury, stroke, cerebral palsy and Lou Gehrig's disease) with state-of-the art therapies and treatment options and will craft a regimen that will help them along every stage of their disease’s progression.

Parkinson’s is incurable, but the symptoms can be managed as the disease progresses, with lifestyle changes, medications, surgery, or focused ultrasound treatments.

Lifestyle Changes

A Parkinson’s disease specialist may recommend lifestyle changes such as:

• Aerobic exercise
• Healthy diet
• Neuropsychological and psychiatric care
• Pain management
• Physical, occupational and speech therapy
• Taking measures to avoid falls, such as installing railings and grab bars, removing hazards from the living space, using canes or walkers

Medication for Parkinson’s Disease

There are several medications used to treat Parkinson’s disease symptoms:

• Carbidopa-levodopa (Sinemet®): Sometimes simply called Levodopa, is the most effective Parkinson’s disease medication and has been since its breakthrough in the late 1960s. It is an effective first-line treatment for Parkinson’s and comes in many formulations, including slow- and extended-release pills, and infusions. It works by introducing a natural chemical to the body which converts into dopamine in the brain. This helps reduce symptoms of stiffness and tremors. The medication does not slow the progression of the disease.
• Catechol O-methyltransferase (COMT) inhibitors: These pills can boost the effectiveness of carbidopa-levodopa. It helps block the brain’s dopamine breakdown to help reduce some of the tremors and motor symptoms of Parkinson’s.
• Dopamine agonists: This medication mimics the effect of dopamine in the brain and may be used with carbidopa-levodopa. It can be prescribed in the early stages of Parkinson’s, and it can lengthen the effectiveness of carbidopa-levodopa.
• MAO B inhibitors. This medication has been shown to have moderate benefits for the disease and is usually used as a standalone therapy in the early stages, and as an add-on with other medications as the disease progresses.
• Anticholinergics. This drug can effectively help control tremors, but it does not affect other symptoms. This is the oldest medication class to be used to treat Parkinson’s, first introduced in the 1900s.
• Amantadine. In the early stages of Parkinson’s, amantadine can help control tremors.
• Cannabis (medical marijuana). There is strong interest in the therapeutic properties of medical marijuana, but several clinical studies have not fully demonstrated the effectiveness of cannabis as a Parkinson’s disease therapy. Benefits can include mood improvement, help with sleep dysfunction, and helping nausea. Some patients have anecdotally stated a marked improvement in tremors. If you decide to try cannabis as a therapy for Parkinson’s, you should inform your doctor, to weigh the risks and benefits.
• Alternative medicine. Holistic medicine can help Parkinson’s patients suffering from pain, fatigue or depression. Alternative therapies are often recommended to Parkinson’s patients. You should tell your doctor about any alternative medicine you wish to try. Alternative therapies include:
  • Massage
  • Yoga
  • Meditation
  • Pet therapy

Innovative Surgical Options to Manage the Symptoms of Parkinson’s Disease

Surgery is used for severe or late-stage Parkinson’s disease. For many patients, medication alone is enough to maintain good symptom relief. Surgery is used only on patients who previously showed improvement taking carbidopa-levodopa. Symptoms previously improved with medication are the same symptoms that have the potential to improve through surgery.

Deep brain stimulation (DBS) is the primary surgical method for treating Parkinson’s disease. It was first approved in 1997 to treat Parkinson’s tremors, and again in 2002 to treat advanced symptoms. Then, in 2016, deep brain stimulation surgery was approved for use in earlier stages of Parkinson’s.

Focused Ultrasound

Focused ultrasound for essential tremor and Parkinson’s disease offers a leading-edge treatment option for patients seeking relief from tremors in their hands without undergoing traditional brain surgery. The procedure is incisionless, requires minimal recovery time, and is highly effective in reducing symptoms of essential tremor and tremor-dominant Parkinson’s disease.

Parkinson’s Disease Clinical Trials

Several new Parkinson’s treatment options are in the testing phase. These include new surgical procedures looking into other areas to target in the brain, as well as new medications to slow the progression of Parkinson’s disease. Embryonic stem cell research is another promising field.

For Parkinson’s Disease Patients Going to a Hospital

If you have Parkinson’s disease and need to go to the emergency room or spend time in a hospital, here are some tips from RWJBarnabas Health, developed in consultation with the Parkinson’s Disease Patient Family Advisory Council at Cooperman Barnabas Medical Center:

• Bring a list of all medications including dosages and specific times you take them.
• Bring contact information for the neurologist or movement specialist who is treating your Parkinson’s.
• If possible, pack Parkinson’s medications in the original packaging for use if they are not available in the hospital pharmacy.
• Verbalize or have a list of key symptoms you experience when medications are wearing off, so the staff is fully aware of what to look out for when doing assessments.
• Bring an emergency contact list, your contact information and, if applicable, a health care proxy card or living will.
• Ensure physical therapy is ordered during a hospital stay to prevent muscle de-conditioning.
• Don’t hesitate to advocate for yourself.

Our Medical Professionals Work Together to Provide the Care You Need

Our expert team of neurologists and neurosurgeons work closely with our physical therapists, speech therapists, occupational therapists, nutritionists, social workers and nurses to provide our patients suffering from conditions like ataxia, dystonia, essential tremor or spasticity with the care they need to begin reclaiming their independence. This multidisciplinary approach ensures that we can provide comprehensive care.

Our expert team of medical professionals have decades of experience working with patients suffering from all types of movement disorders, and we remain committed to keeping up to date with the most advanced treatment options. Chronic neurologic disorders like Parkinson’s disease can be incredibly difficult to manage for patients, as well as their families and loved ones. Contact us today.

Request an Appointment online or call 833-656-3876.