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Adjusting and adapting to a movement disorders is an ongoing process that changes as the disease progresses. The comprehensive Parkinson’s and Movement Disorders Program offers a complete range of treatment options to meet each patient’s needs over the course of their disorder. Treatment is tailored to the unique needs of each patient, and team physicians work with patients’ referring physicians to coordinate care.
Treatment may include:
MedicationMany medications are available today to relieve the symptoms of movement disorders, and many patients respond well to these medications. The Parkinson’s and Movement Disorders Program team is up-to-date in prescribing the latest, most effective medications.
Most symptoms of Parkinson’s disease are caused by a lack of dopamine within the brain. Most PD drugs are targeted at replenishing or mimicking dopamine. These drugs reduce muscle rigidity, reduce tremor, and improve speed and coordination of movement. Medication may be changed or the dose may be adjusted depending on the severity of symptoms.
If a patient with Parkinson’s disease is experiencing problems with medication controlling symptoms, “on/off” testing may be done. This involves examining the patient with and without the medication to determine the level of symptom control.
If medication is ineffective for controlling symptoms, appointments for urgent symptom control needs will be accommodated in the clinic on a case-by-case basis. In certain cases, inpatient care may be required for drug monitoring and aggressive rehabilitation for patients struggling with symptom control and medications.
In some cases, patients have the opportunity to participate in various clinical drug research trials to test new medications aimed at controlling the symptoms of movement disorders. Participation is strictly voluntary.
Non-Medication Treatments In addition to medication, many other therapies are available to enhance care for people with Parkinson’s disease. The Parkinson’s and Movement Disorders Program offers all of these treatments.
Depending on a patient’s needs, treatment may include exercise, nutritional support, wellness support (holistic and complementary medical treatments), physical therapy, occupational therapy and speech therapy. Therapists are specially trained in the needs of patients with movement disorders.
Because patients with movement disorders often have many emotional and psychological needs, team members include a geriatric neuropsychiatrist — a physician who assesses cognitive, emotional and behavioral problems related to nervous system disorders — and neuropsychologists who assess cognitive problems, and who, in collaboration with speech therapists, identify ways to help patients relearn and/or compensate for impaired neurological functions.
To help patients who have speech problems related to their disorder, the program’s speech-language pathologist uses Lee Silverman Voice Treatment® (LSVT), an effective treatment that can help to restore speech in people with Parkinson’s disease (beyond what medication and surgery can offer). LSVT has also been used successfully to help people with other movement disorders. The LSVT approach focuses on increased vocal loudness.
Botulinum toxin injections may be used to treat painful muscle spasms associated with Parkinson’s disease and other movement disorders. The neurotoxins, injected in small amounts, disrupt the flow of nerve impulses to excessively contracted or spastic muscles, reducing movements for a period of weeks or months. Two forms of botulinum toxin — BTn-A (Botox) and BTn-B (Myobloc) — are approved by the Food and Drug Administration for use in selected medical conditions.
Collagen injections may used in the treatment of voice and/or speech impairment for patients with Parkinson’s disease.
SurgeryCertain patients who have a movement disorder that is no longer responding to medication may benefit from deep brain stimulation (DBS) surgery. Froedtert & The Medical College of Wisconsin have the only program in the area to offer DBS surgery. The surgery is offered as part of the Restorative Neurosciences Program. Drs. Kopell, Hiner, Hung and Blindauer have a combined experience with more than 600 DBS patients. In properly selected patients, these procedures can offer hope when other treatments fail.
This highly specialized brain surgery involves surgically implanting one or more electrodes in the brain. The electrodes are connected to a device called a neurostimulator, which is implanted in the upper chest under the collarbone, like a heart pacemaker, but for the brain. The wires travel under the skin and scalp. When the battery is turned on, small amounts of electricity are delivered to the brain. This has the effect of modulating any abnormal brain activity that the disease is causing. The device can then be programmed during an outpatient visit to tailor DBS for each patient’s needs.
DBS can improve certain symptoms for patients with symptoms associated with Parkinson’s disease, essential tremor, dystonia and other movement disorders. For patients with Parkinson’s disease, the major symptom that improves is tremor, followed by muscle rigidity or stiffness.
The Parkinson’s and Movement Disorders team meets weekly to review patient cases, including patients who may be candidates for the deep brain stimulation procedure.
Author: Marla Fraunfelder Date: Feb. 7, 2008 |
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