Patient Care Services at University of Miami

Parkinson’s disease (PD) is a slowly progressive, chronic neurological condition that affects a small area of cells in the mid brain known as the substantia nigra. It is estimated that up to 1.5 million Americans are affected by the disease and 40,000 to 60,000 new cases are diagnosed each year.

The cause of Parkinson’s disease remains a mystery. 15% of patients are diagnosed before age 50 and the disease affects one of every 100 persons over the age of 60.

What happens is clearer than why it happens. Cells begin to die in a small deep area of the brain, the substantia nigra. These cells of the substantia nigra manufacture dopamine, a chemical messenger that is necessary for ease of movement. As the cells degenerate, the amount of dopamine in the brain decreases. Symptoms of Parkinson’s appear when about 70-80% of these cells die.

We now know the importance of recognizing and treating non motor symptoms of PD which are due to more widespread dysfunction in the brain. These symptoms may predate the motor symptoms of PD by decades.

Thanks to research and healthier lifestyle choices, many people now live well into their eighties, adding to the impression that the incidence of Parkinson’s disease is increasing. While there is, as yet no cure for this condition, progressive treatments allow many patients to maintain a high level of function throughout their lifetimes.

Parkinson’s Disease Symptoms

This decrease in dopamine can produce one or more of the classic signs of Parkinson’s disease:

• Resting tremor on one side of the body
• Generalized slowness of movement (bradykinesia)
• Stiffness of limbs (rigidity)
• Gait or balance problems (postural dysfunction)
• Other symptoms observed in some persons:
• Small cramped handwriting (micrographia)
• Lack of arm swing on the affected side or slight foot drag on the affected side
• Decreased facial expression (hypomimia)
• Lowered voice volume (dysarthria)
• Feelings of depression or anxiety
• Episodes of feeling “stuck in place” when initiating a step (freezing)
• Less frequent blinking and swallowing
• Few patients experience all of these symptoms and some may experience other signs.

Premotor/non-motor Symptoms: * Mood/anxiety disorders * Constipation * Anosmia * REM sleep behavior disorder (dream enactment behavior)

Parkinson’s Diagnosis

There is no definitive blood test or X-ray to confirm diagnosis. The diagnosis of Parkinson’s disease is one of clinical judgment, based on a thorough neurological examination. The diagnosis of Parkinson’s based on the person’s symptoms, medical history and response to medications. Tests such as magnetic resonance imaging (MRI), and/or blood work can help rule out conditions that may produce similar symptoms such as stroke or a brain tumor. A DAT (dopamine transporter) scan can be utilized to confirm or clarify a diagnosis of Parkinson’s disease by visualizing the dopamine deficit. Once a probable diagnosis is established, medications are prescribed, and the diagnosis is confirmed if the symptoms improve.

Parkinson’s Treatment

The goal of treatment is to maximize independence and quality of life for people who have Parkinson’s disease. This requires recognition and management of motor (e.g. tremor or balance issues) and nonmotor symptoms (e.g. mood problems, sleep difficulty, and constipation). We have at our disposal a wide variety of treatment modalities, which may include medications, surgery, and rehabilitation therapy, to help alleviate symptoms. Because every person with Parkinson’s has their own unique constellation of symptoms, treatment is tailored to the individual.

We have numerous medications available (and more on the horizon) to help with motor symptoms. Using different combinations for different purposes, we are able to provide substantial relief for most patients for many years. (add table of the list of drugs?)

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For those whose tremor does not respond to the usual medical treatments or who develop complications from high doses of these medications, surgery may be an option. Deep brain stimulation (DBS) surgery involves placement of a wire electrode into deep areas of the brain—different areas for different people. (include cartoon image of basal ganglia, highlight GPi, STN. Vim?) . This electrode is connected to a stimulator, somewhat like that of a cardiac pacemaker. The stimulator is then implanted beneath the skin under the collarbone. The patient and doctor can switch on the stimulator with a hand-held control, sending electronic pulses to the brain to interrupt the signals that cause tremor Research indicates that DBS can also control other symptoms, such as slow movement and rigidity, complications such as dyskinesia and can reduce the amount of medications needed to be taken each day.  Learn more about Deep Brain Stimulation.

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Duopa provides a different surgical option for patients with PD and treatment related symptom fluctuations. After a simple outpatient procedure, carbidopa-levodopa in a gel formulation can be infused via pump into a patient’s small intestine. This can provide a more stable day in terms of medication effect.

Exercise should be at the center of all treatment plans, as it has the potential to slow disease progression. Physical, occupational, or speech therapy combined with modifications in the home environment can help individuals with Parkinson’s achieve maximum comfort, safety, and independence.

Parkinson’s Disease Research

There are many ongoing clinical studies to develop newer and better therapies for people with PD. There are also studies to help us understand more about the disease itself. The more we learn the better treatments we can offer our patients. Hopefully soon there will be therapeutics to slow and one day hault progression. Learn more about Parkinson's Disease research at University of Miami.

‍Resources

As a Parkinson's Foundation Center of Excellence University of Miami Department of Neurology Parkinson's patients have access to special resources. Click here for these Resources and Support.

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