Parkinson Care: An Evolving, Multi Stage Disease

Parkinson's disease, the most common movement disorder, affects one percent of the population older than 65. Originating in the basal ganglia, it typically announces itself subtly: loss of facial expression, once-fine penmanship becoming small, cramped handwriting, or a shuffling gait. Because it has been associated with a deficiency in the neurotransmitter dopamine, Parkinson's disease is one of few neurological disorders that respond well, in early stages, to medications: dopamine replacement therapies. As the disease inevitably progresses, the Movement Disorders Program keeps patients apprised of next stage treatments and promising new developments.

Early stage patients. When symptoms initially are recognized, patients are prime candidates for a second opinion at the Movement Disorders Program. Our experts, in consultation with the referring physician, will develop individualized, long-term treatment strategies.

Early-stage patients can benefit from the team's lifestyle expertise in discussions of potential protective effects, for example, of exercise and a diet rich in Vitamin E. Dr. Michele Tagliati - who has written more than 60 articles in peer-reviewed medical journals, 20 chapters in medical textbooks and is co-author of "Parkinson's Disease for Dummies" - can tap a wealth of information in counseling patients.

Patients also can consider participating in innovative, potentially beneficial research conducted at Cedars-Sinai. Some research might aim at exploring protective strategies like gene therapy or growth factor to help dopamine cells survive better; other areas of research may involve new medication strategies to alleviate the symptoms of the disease.

Middle stage patients. Dopamine replacement therapies have improved patients’ quality of life for four decades. This element of care is key because Parkinson’s medications progressively lose their efficacy as the disease continues its degenerative course.

More than half of patients see changes in response to dopamine replacement therapies after five to 10 years. This shift varies with patients, so the Movement Disorders Program always tailors its care to the individual, monitoring and adjusting it.

Patients eventually can stop responding to medication altogether or develop unpredictable responses, making Parkinson’s more complicated to treat.

The care options, at this stage, may include: more intense medical management to control symptoms and maintain function; botulinum toxin injections (also known by trade names: Botox®, Dysport®, Myobloc®, Xeomin®) to gain control of specific problem areas, such as involuntary drooling; or surgical implantation of an electrical stimulation device, programmed remotely, which, along with medications, may provide symptom control. Patients in the program, throughout treatment,receive individual counseling, long-term follow-up care and information on treatment advances and current, relevant clinical trials.

Late stage patients. In later disease stages, medications can become ineffective or unpredictable. Patients can develop non-motor symptoms, such as anxiety, depression, agitation, dementia or hallucinations and experience disabling constipation, urinary and sexual problems, insomnia and pain.

Our team of experts can assist with the array of late-stage physical, mental and emotional problems. Our team's experience can be brought to bear on medication options or highly individualized dosing regimens and some patients may be good candidates for Deep Brain Stimulation.