Parkinson’s disease is a progressive nervous system disorder that affects movement and speech. About 17,000 adults in Colorado are living with Parkinson’s. More people in Colorado are expected to be diagnosed in the future as the state’s population grows older since the incidence of Parkinson’s increases with age, with an average age of diagnosis at about 59-60 years old.
While Parkinson’s cannot be cured, there are effective ways to manage your symptoms and improve quality of life or optimize mobility. Centura Health offers one of the nation’s leading deep brain stimulation (DBS) programs for Parkinson’s.
If you or a loved one had been diagnosed with Parkinson’s, it’s important to become informed of all treatment options so that you and your doctor can choose the appropriate treatment at the appropriate time. DBS surgery, for instance, is more effective at controlling symptoms when performed earlier.
Understanding the diagnosis
Parkinson’s disease is a neurologic disorder or a movement disorder. It develops when a person’s ability to produce two neurotransmitters. These neurotransmitters are needed for proper functioning of body movements, some of the body’s autonomic functions, such as digestion, heart rate, and breathing, and cognitive skills.
Diagnosing Parkinson’s is difficult since early symptoms can be overlooked or attributed to other disorders or even normal aging. Centura Health has neurologists with expertise in movement disorders who diagnose and manage the care of patients with Parkinson’s.
To make a diagnosis, your neurologist will ask about your medical history, including any family history of neurologic diseases. Your doctor also will conduct a neurological exam, review your symptoms, any medications you take, and any possible exposure to toxins. A computerized tomography (CT) or magnetic resonance imaging (MRI) scan also may be ordered to rule out other health conditions that might be causing your symptoms.
Getting an earlier diagnosis is important as early interventions can help delay worsening symptoms, allowing you to work and enjoy other activities longer.
When it comes to the management of Parkinson’s, medication and exercise are the main treatments that will help manage your symptoms. Your physician will select the appropriate medication based on the severity of your symptoms then adjust the dosage or try different medications depending on the effectiveness or side effects.
Parkinson’s medications help control symptoms by helping to stop the breakdown of dopamine or by helping the brain manufacture dopamine or mimic the effects of dopamine. Specific drugs also can help manage specific symptoms, including tremors, muscle stiffness, and dyskinesia (involuntary movements). Once you find a medication that works effectively, you may experience periods when your symptoms are diminished or stopped. These are called “on” times. Periods when the medications are not working as well are called “off” times. Many patients will experience on and off times. As the disease progresses, medications may lose their effectiveness for some patients who experience increasing and longer off times.
You also can help reduce the impact of your symptoms with a variety of exercises and rehabilitation treatments. Physical therapy and occupational therapy can help with walking and balance problems. Speech therapy can help with swallowing and speech problems. Centura Health offers comprehensive neurological rehabilitation programs to help people manage their Parkinson’s disease. As part of this program, we also a specialized service called LSVT (Lee Silverman Voice Treatment) Big & Loud. In the “big” portion of the program, physical therapists teach patients techniques and exercises to increase the size of the movements of their limbs to help improve balance and speed. In the “loud” portion of the program, speech therapists help patients practice increasing the clarity and volume of their voice when Parkinson’s causes them to speak softer or run out of breath.
Deep Brain Stimulation for Parkinson’s
Deep brain stimulation (DBS) is the main surgical treatment for patients with Parkinson’s disease. This surgery is typically recommended for a variety of individuals with Parkinson’s. Research shows that DBS is more effective when performed earlier in your disease progression, so it’s important to discuss whether you are a candidate for the procedure and the best timing with your neurologist and your neurosurgeon.
During DBS surgery, a neurosurgeon will implant thin wires, called leads, into the brain. A generator will be placed under your clavicle that then sends mild electrical impulses to the brain that block or change the abnormal activity causing your symptoms.
DBS will reduce or eliminate most of the major movement symptoms caused by Parkinson’s, including tremors, slowness, and rigidity. DBS also may improve lost facial expression in some patients. DBS does not, however, prevent cognitive decline.
The benefits of DBS include:
- Significantly increases “on” time per day without dyskinesia
- Significantly reduces medication use (although it does not eliminate the need for medication)
- Improves motor symptoms for better quality of life
DBS surgery typically is a three-part procedure, with the lead implantation performed while the patient is awake to test whether the leads are being correctly targeted. At Littleton Adventist Hospital, Centura Health neurosurgeons helped pioneer and now routinely use a two-step robotic-guided DBS procedure that allows the patient to remain asleep. This “asleep” DBS has several benefits over traditional awake DBS, including:
- No pre-surgery MRI required
- Shorter surgery time: 2 to 3 hours compared to 4 to 6 hours for awake DBS
Once you have had the leads and generator placed, your doctor will customize the programming of the generator specifically for your brain activity and symptoms. This programming can be adjusted over time as symptoms change. Littleton Adventist is one of the first DBS centers in the country to offer remote generator programming, which allows your neurologist to adjust programming for in-state patients through a telehealth visit rather than requiring you to come to their office. This service is particularly important for patients who live in rural areas without access to a neurologist or neurosurgeon. However, in-person programming is still recommended over remote programming if you are able to visit your neurologist.
Along with being the first in the world to use robotic-guided DBS with patients sedated, neurosurgeons at Littleton Adventist continue to research and advance the use of surgery to treat Parkinson’s.
Find a neurologist
People develop Parkinson’s when nerve cells that communicate instructions to the body are impaired. These cells control the body’s movements and also automatic systems, such as digestion, heart rate, and breathing.
Researchers don’t know what causes some people to develop Parkinson’s, although they have identified several gene mutations that play a role. Although a person’s risk of developing Parkinson’s cannot be calculated, there are certain factors that correlate to the incidence of the disease. About 50% more men develop Parkinson’s than women. It most often develops after age 60; however, about 10% of patients will be diagnosed with early-onset Parkinson’s before age 50 that may be inherited. It’s important, however, not to overlook symptoms just because you don’t fit these general descriptors.
Parkinson’s symptoms start gradually, typically with a tremor in the hand. Over time, it causes worsening tremors, slowed movement (called bradykinesia), cramping or twisting muscles (called dystonia), and a stooped posture. Parkinson’s also can cause speech problems, decreased facial expressions, cognitive impairment, and other symptoms. Some patients will experience mental health issues, such as depression, anxiety, and hallucinations. Not everyone will have every symptom, but symptoms in all patients will continue to worsen over time.
Parkinson’s is a progressive disorder, which means the symptoms develop over time. There is no way of predicting how quickly or slowly your disease will progress. Parkinson’s typically progresses in four stages from early to advanced. The four stages are early stage, mid-stage, mid-late-stage, and advanced stage. In early stage, the initial symptoms will be noticed but are sometimes so subtle that they are attributed to normal aging. In mid-stage, symptoms become more noticeable and activities of daily life are more difficult to perform. In mid-late stage, standing and walking become more difficult, but most people are still able to live at home and many continue to work if their cognitive skills have not been impacted. In advanced stage, most patients require a wheelchair or are bedridden. Most patients with advanced stage Parkinson’s require full-time nursing care.
No, currently there is no cure for Parkinson’s disease. Medications, rehabilitation, and surgery can help manage symptoms of the disorder.