Advances in living with Parkinson's

June 19, 2016

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  Dr. Robert Donnell
  
  

  
  

  
  

  
  

PORTSMOUTH – Parkinson’s disease slowly robs sufferers of even the most basic of body movements, while leaving the mind aware.

Most recently Parkinson’s was in the news because of the death of heavyweight boxing champion Mohammed Ali, who was diagnosed with the disease in the 1980s.

Parkinson's disease is chronic and there is no cure, meaning that symptoms continue and worsen over time. Nearly 1 million people in the United States are living with Parkinson's disease. The cause is unknown, but there are treatment options to manage symptoms.

The disease involves the malfunction and death of neurons, vital nerve cells in the brain. Some of the dying neurons produce dopamine, a chemical that sends messages to the part of the brain that controls movement and coordination. As the disease progresses, the amount of dopamine produced in the brain decreases, leaving a person unable to control movement normally.

Dr. Robert Donnell of Core Neurology in Exeter said the average age onset of Parkinson’s disease is about 70, and predominantly in men. It can strike both sexes at any age though. There may be a slight genetic component, but more often the disease is idiopathic, having no easily discernible cause.

Donnell said the classic, primary motor signs of Parkinson’s disease include tremor of the hands, arms, legs, jaw and face, bradykinesia or slowness of movement, rigidity or stiffness of the limbs and trunk, postural instability or impaired balance and coordination.

Dr. Davies

Dr. Gareth Davies, a neurosurgeon at Portsmouth Regional Hospital, said the symptoms can be quite hard on the family, too.

“The patient can develop a sort of droopy face,” Davies said. “Their family feels like they have lost their smile, their sense of humor because they don’t see it anymore. It’s not necessarily the case.”

Diagnosis is usually made through clinical observation. Davies said an astute primary doctor

will pick up on signs such as tremors or a shuffling gait.

“We treat the symptoms to improve the quality of life for as long as we can,” Donnell said. “The main goal in treatment is to replace the dopamine that is being lost.”

Medication is the usual course of treatment. The most common medication used is a combination of carbidopa/levodopa called by the brand name Sinemet. In some cases, surgery is indicated.

“The problem with medication is that over time there is a tolerance,” Donnell said. “Patients see less effect and require more medication because it lasts for a shorter duration. Too much medicine can cause dyskinesia, more problems with movement.”

Portsmouth Regional Hospital is the only facility on the Seacoast, one of only two in New Hampshire, to offer deep brain stimulation for patients with tremor and motion disorders. It is also done at Dartmouth-Hitchcock Medical Center in Lebanon.

Deep brain stimulation is a treatment used to reduce tremor and block involuntary movements in patients with motion disorders. Small electric signals are delivered to render parts of the brain inactive without damaging or destroying healthy brain tissue.

In patients with Parkinson’s disease, a neurostimulator is surgically implanted to deliver electrical stimulation to the areas of the brain that control movement, blocking the abnormal nerve signals that cause tremor. Doctors use magnetic resonance imaging (MRI) or computed tomography (CT) scans to identify exact locations within the brain where electrical nerve signals trigger the Parkinson’s symptoms.

Davies said DBS is not a cure. It can serve, however, to quiet Parkinson’s symptoms for a period of time.

Dr. Stephen Lee

Dr. Stephen Lee, a neurologist at DH and an associate professor at the Geisel School of Medicine, said they are participating in clinical trials that may lead to further advancements that could slow down or even stop the progression of Parkinson’s disease.

“We are looking at new forms of delivery for medication we have been using for dopamine replacement for 50 years,” Lee said. “We are looking at stem cell replacement therapies. We are looking at a certain protein (alpha synuclein) that is abnormal but appears in abundance in Parkinson’s patients. We are looking at ways to rid the body of that protein.”

Lee said they are working to determine the cause of Parkinson’s disease. He said several theories are being explored.

“We believe inflammation can play a role in damage to the brain,” said Lee. “That idea is part of the Michael J. Fox study group.”

Dr. Mary Feldman

Lee said a colleague, Dr. Mary Feldman, is studying the impact of exercise in Parkinson’s patients.

“I received a grant from the Parkinson’s Disease Foundation for the study,” said Feldman. “Parkinson’s involves all these motor features, like in the face. It also involves apathy, fatigue and depression. Exercise has already been proven to help in these areas. The future of Parkinson’s research is on ways to modify the disease, not just treat the symptoms.”

“Because there is no cure for Parkinson’s, we focus on ways to slow the onset of symptoms and help patients with what symptoms we can – focusing on quality of life,” said Davies. “The DBS treatment is a breakthrough – offering patients a return to normal activities without the constant interruptions of tremors and jerky movements. Walking, drinking a glass of water, hugging loved ones, reading a newspaper … we get to give those back.”

A second component of Parkinson’s disease is depression. Donnell said there is a high incidence of depression and some cognitive function disorders in many cases.

“There is a clear link to Parkinson’s and depression,” Davies said. “People are depressed obviously because they have the disease, but there is a direct link tied to the disease itself. The depression is part of neurodegeneration process and must be taken very seriously.”

Portsmouth Regional Hospital added its DBS offering this year, following great success with patients at major medical centers around the country. A team consists of a neurosurgeon, a neurologist, a physical therapist and an occupational therapist. Patients will have a pre-surgical visit for imaging, an overnight stay after surgery, and a visit to program the device once it is implanted. DBS is approved for patients whose symptoms cannot adequately be controlled with medications. Although most patients will still need medication after undergoing DBS, many have experienced a considerable reduction of their Parkinson’s symptoms and are able to significantly reduce their medications and some of the side effects that accompany the higher doses.

DBS can also be helpful to patients with essential tremor, dystonia and multiple sclerosis.

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