Specialties

  • Parkinson's Disease

  • Parkinson's disease is a slow-progressing neurodegenerative brain disorder that leads to tremors or shaking, difficulty walking and compromised movement and coordination.


  • Causes

    Parkinson's disease generally develops in older adults, after the age of 50, and it's the most common nervous system disorder of the elderly.

    Parkinson's disease is the slow destruction of the nerve cells in the brain that make dopamine. Without enough dopamine, nerve cells in the affected areas of the brain can't properly send messages, leading to loss of muscular function. This nerve cell damage gradually worsens over time, up to 20 years.

    Scientists do not yet understand what causes these brain cells to waste away. In some cases, Parkinson's disease appears to be hereditary.

    Symptoms

    Generally, symptoms are quite mild at first, often a slight tremor or a feeling that one foot or leg is stiff. Parkinson's disease symptoms can affect one side of the body or both, and may include:

    • Movement-related problems, such as:
      • Slow movements
      • Difficulty starting or continuing movement
      • Loss of small or fine hand movements (handwriting may become small and hard to read)
    • Slow blinking
    • Constipation
    • Drooling or difficulty swallowing
    • Difficulty balancing or walking
    • Lack of facial expressions
    • Muscular aches and pains
    • Stiff muscles
    • Shaking (tremors)
      • Often when arms and legs are resting or held out
      • Stops with movement
      • May appear in the head, lips, tongue and feet
      • Can be worse when tired, excited or stressed
    • Slowed speech and monotone voice
    • Stooped posture

    Other symptoms include:

    • Confusion
    • Depression
    • Dementia
    • Anxiety
    • Memory loss

    Diagnostic Testing

    Healthcare providers generally diagnose Parkinson's disease based on medical history and the symptoms they observe during a physical examination. However, Parkinson's can be difficult to identify, particularly in its early stages and in the elderly. Identification becomes more clear as symptoms progress over time. Doctors may also request brain scans or other laboratory tests in order to rule out other diseases.

    During the examination, healthcare providers are looking for:

    • Shaking
    • Difficulty starting or finishing movements
    • Jerky or stiff movements
    • Muscular weakness or atrophy
    • Heart rate changes

    Treatments

    Currently there is no known cure for Parkinson's disease, so treatment focuses on controlling and minimizing symptoms. Because each person's disease progresses differently, with a unique set of symptoms, there is no single "best" treatment for Parkinson's. Treatment generally includes some combination of medication and surgical therapy.

    Medications for Parkinson's generally work by elevating levels of dopamine in the brain to improve muscular function. As medication wears off, symptoms can worsen or return. Because many medications for Parkinson's cause severe side effects, it's important to be monitored regularly by a healthcare provider.

    Patients are usually given two medications: levodopa combined with carbidopa. Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain. Nerve cells can then use levodopa to make dopamine. Levodopa is usually helpful for most people with Parkinson's, but not all symptoms respond well to drug treatment.

    Deep brain stimulation (DBS) is an effective surgical treatment for patients with Parkinson's disease. During DBS, electrodes are implanted deep into the brain to rebalance timing circuits that have been negatively impacted by Parkinson's.

    DBS can result in reduced tremor and stiffness, improved facial expression and significantly less need for medication. DBS has been used in more than 80,000 Parkinson's patients since 1995, and it has been proven to be more effective than treatment with medication alone.

    In addition, patients with Parkinson's disease can benefit from an array of healthy lifestyle changes including:

    • Good nutrition
    • Exercise based on changing energy levels
    • Regular periods of rest
    • Stress avoidance
    • Therapy, including physical therapy, speech therapy and occupational therapy
    • Assistive devices, including special utensils, wheelchairs, bed lifts and wall bars

     


  • Asleep Deep Brain Stimulation for Parkinson's Disease

  • Watch Dr. David VanSickle explain awake and asleep DBS


  • Making the Most of Every Moment

  • Denver-based actress Lucy Roucis doesn't let Parkinson's disease alter her positive outlook on life.

    "I was 27 years old, living in Los Angeles, and auditioning for a yogurt commercial, when my right hand wouldn't stop shaking," Roucis says. "I left the audition in tears. Shortly thereafter, I was diagnosed with early-onset Parkinson's disease. It took me six years to believe the diagnosis."

    Parkinson's is a neurodegenerative disease affecting the central nervous system. There is no known cause or cure for the condition, and symptoms can vary from one individual to another. As Roucis attests, "Once it starts, it never goes away."

    In Roucis' most recent role in the film Love and Other Drugs , she is cast as a speaker at a Parkinson's convention who talks about what it is like to live with the disease. The role is memorable because it helps the lead character, Maggie, who is living with early-onset Parkinson's, rethink her outlook.

    "Outlook is everything," Roucis says. "I consider myself upbeat and positive - a living, breathing, and trembling example of turning around something adverse and making it work."

    For 21 years, Roucis tried pharmaceutical management of her Parkinson's, but as the disease progressed, the effectiveness of the drugs waned and the side effects increased. In 2008, she made the decision to have deep brain stimulation (DBS) surgery.

    Getting Help
    While her initial DBS surgery was performed out of state, Roucis has chosen neurosurgeon David VanSickle, MD and neurologist Mihaela Alexander, MD - both based out of Littleton Adventist Hospital - to direct her ongoing care.

    During DBS surgery, a lead (also called an electrode) is implanted in the brain and then connected to a neurostimulator (battery pack) implanted under the skin near the collarbone. Impulses from the neurostimulator interfere with and block the electrical signals that are responsible for Parkinson's symptoms.

    Dr. Alexander manages Roucis' DBS frequency settings and medication dosages, and Dr. VanSickle recently performed a surgical procedure to replace her battery pack.

    "Parkinson's patients who have had DBS surgery experience a number of benefits," Dr. VanSickle says. "These include reduced tremors and stiffness, less bradykinesia [slowness of movement], less dyskinesia [tics], improved facial expression, and significantly decreased medication usage."

    For Roucis, the good in her life far outweighs the bad. She is surrounded by supportive family, friends, and "excellent doctors I know I can trust." She continues to enjoy a stage career with PHAMALY (Physically Handicapped Actors & Musical Artists League) in Denver and is also a writer and stand-up comic.

    From the August 2011 issue of Your Health Your Hospital.


    Learn more about treatments available for neurological conditions at Littleton Adventist Hospital.


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