Movement Disorders Program at Rhode Island Hospital
Parkinson's Disease Program
What is Parkinson’s Disease?
Parkinson’s Disease (PD) is a common movement disorder that affects about one million Americans currently, with 60,000 new diagnoses each year. While the incidence of PD increases with age, about four percent of people with PD are diagnosed before age 50. Men are one and a half times more likely to be diagnosed.
Parkinson’s disease is a slowly progressing, degenerative neurological condition that is chronic, and worsens with age. It is caused by the loss of dopamine-producing brain cells. Dopamine is essential for smooth and coordinated muscle movement. Symptoms of the disease include:
- Tremor or trembling of the arms, jaw, legs, and face
- Stiffness or rigidity of the limbs and torso
- Slowness of movement (bradykinesia)
- Impaired balance and coordination
The non-motor symptoms include depression, anxiety, restlessness, sleep difficulty, memory problems, fatigue, soft speech, vivid dreams and dream enactment. Presentation, severity and progression of these symptoms can vary person to person. Because different movement disorders can have the same symptoms, careful diagnosis is vital for proper treatment.
How is Parkinson’s Disease Treated?
The Parkinson’s Disease Program provides advanced forms of neuromodulation, including deep brain stimulation (and other forms of brain stimulation), to treat Parkinson’s disease, as well as other movement disorders such as dystonia and tremor.
At early stages, oral medications are remarkably effective in alleviating the worst symptoms. Some common classes of medication used to treat Parkinson’s symptoms are designed to counteract the loss of dopamine in the brain. All medications have side effects and vary in effectiveness among patients, so are carefully prescribed and monitored by the neurologist. The most common classes of medication include:
- Dopamine agonists, which simulate the effects of the neurotransmitter dopamine in the brain, and alleviate the symptoms of the disease.
- Carbidopa-levodopa: Levodopa is a natural chemical that is converted to dopamine in the brain. It is combined with carbidopa to prevent levodopa from prematurely converting to dopamine outside the brain.
- MAO-B inhibitors to help prevent the breakdown of dopamine by inhibiting the brain enzyme monoamine oxidase B (MAO-B), which metabolizes brain dopamine.
Neurologists medically manage Parkinson’s disease symptoms until medications no longer work optimally, or cause severe side effects. Typically, within about ten years, many patients begin developing large swings in their symptoms as chronic use of medications leads to abnormal, involuntary movements (dyskinesias). When this occurs, it becomes difficult to determine medications and dosages that will work optimally.
A patient is then referred to the neurosurgical team, which determines if a patient is a good candidate for deep brain stimulation (DBS). DBS offers patients a proven option for eliminating or reducing symptoms of Parkinson’s disease, dystonia, tremor and other conditions. We offer the only multidisciplinary DBS fast-track clinic in the Northeast to provide patients initial screening for eligibility to surgery, coordinated one-on-one meetings and evaluations with multiple specialists during a single visit, and long-term follow-up care.
How Does DBS Work?
Movement-related symptoms of Parkinson’s disease, essential tremor and other neurological conditions are caused by faulty electrical signals in the areas of the brain that control movement. Unlike other surgical procedures that destroy brain tissue in order to eliminate the faulty signals, DBS does not damage brain tissue. Instead, it blocks the faulty signals that cause tremors and other movement symptoms.
DBS is a surgical procedure in which an electrode is implanted in the brain through a dime-sized hole in the skull. In some cases, electrodes are implanted on both sides of the brain when the patient’s condition affects movement on both sides of the body.
An extension wire is then attached and connected to a pacemaker-like device, called an implantable pulse generator, that contains the battery and the micro-electronic device for delivering electrical stimulation. The pulse generator is implanted in the chest or abdomen, and is later programmed monthly in the neurologist’s clinic to deliver electric current to the targeted brain tissue. Optimal DBS programming settings are achieved typically by three months, but can sometimes require up to six months of adjustments. The entire DBS system is placed under the skin and is not visible beyond a slight bulge.
What Is Duopa Therapy?
Another treatment for Parkinson’s disease is duopa therapy, which is a gel infusion of carbidopa/levodopa delivered directly into the intestine through a percutaneous gastrojejunostomy (PEG-J). The tubing goes into the intestine, while the pump and cassette containing the medication is outside the body.
Treatment options are determined by which symptoms are being addressed and a patient’s other medical and cognitive factors.