October 16, 2017 Ed Langlois
Progress against Parkinson’s
Danika Williams, a physical therapist at Sacred Heart Medical Center in Eugene, helps a Parkinson’s patient with balance and range of motion. Medication and rigorous exercise are seen as the best ways to slow the progress of the neurological disease. New surgical techniques that stimulate sections of the brain also help. (Courtesy PeacHealth)
Catholics around the world watched with sorrow and admiration as St. John Paul II, once a vibrant pope, deteriorated with Parkinson’s disease. There is still no cure for the neurological disorder, which is caused by a lack of the hormone dopamine in the brain, a situation that allows electrical signals between brain cells to go askew.
But since the pope’s death in 2005, researchers and clinicians have made advances in understanding and treatment.
“Proper medication plus targeted exercise is one way to slow down the disease’s progression,” said Michele Gladieux, a physical therapist who helped start an outpatient treatment clinic at Sacred Heart Medical Center in Eugene. In her 20 years in the field, Gladieux has seen progress, including a team approach to care that convenes speech therapists, physical therapists, physicians, social workers and chaplains.
With multiple workers paying attention, the many needs of Parkinson’s patients no longer get lost in the shuffle.
Primary care doctors now know more about early signs of the disease, including an altered sense of smell, muscle rigidity in the face and body, decreased coordination, posture changes, slowed movement, shuffling gait, poor balance or falls, reduced voice volume, trouble swallowing, and changes in sleeping patterns.
“We are seeing Parkinson’s clients earlier in their disease process,” Gladieux said. “This by far is what will help them the most in the long run.”
By the time tremors start, Parkinson’s is fairly advanced, but it’s still not too late for treatment. Physical therapists have found that Parkinson’s patients benefit remarkably from vigorous exercise, a finding confirmed by research, including studies from Oregon Health and Science University.
“Patients with this disease need to be challenged,” Gladieux said. “We need to push them hard to get their bodies to change.”
Gladieux’s team has been working with a retired physician in his mid 70s who has Parkinson’s — tremors, drooping head, loss of coordination. Once an active man, he consented to drills usually reserved for football players, plus active rhythmic exercises and coordination challenges. In just a month, his movement and coordination improved enough that he was able to make a long road trip to watch grandchildren play sports.
“The alternative is not good,” said Gladieux. “If one stops exercising, and exercising hard, it can accelerate the disease process.”
One problem: In some patients, the neurological damage might cause lethargy or depression. Physical therapists have responded by forming exercise groups, since people are more likely to work out when they are with others than when alone at home.
Gladieux and other physical therapists make sure the exercise is fun, even if strenuous. In place are walking groups, ping pong squads and tai chi collectives.
When it comes to medication for Parkinson’s, most drugs in use seek to replenish dopamine temporarily or mimic its effects. The drugs can reduce muscle tightness, improve speed, increase coordination and lessen tremors. Most have been in use for decades. Side effects like nausea are controlled with secondary medications. Long-term use may cause facial tics.
The National Parkinson Foundation cautions patients against using generic versions of the drugs, claiming standards are not high enough.
For some Parkinson’s patients, especially after years of treatment, drugs become less effective. At that point, physicians are now recommending a surgically implanted device that delivers modest doses of electric current to specific areas of the brain. The device, similar to a heart pacemaker and the size of a stopwatch, is placed near the collarbone. A wire smaller than a strand of spaghetti is carefully inserted through the skull into the correct part of the brain, which doctors have located with an MRI or CAT scan.
It’s not a particularly painful procedure and it’s best done while patients are awake.
Once in operation, the system sends pulses that disrupt electric signals that cause Parkinson’s symptoms. Surgeons once burned small parts of the brain to achieve similar effects, but burning is imprecise and irreversible. By contrast, electric current can hit much tinier targets and a miss does not cause permanent damage.
The procedure, called deep brain stimulation, doesn’t replace medications, but allows the medications to start working again, said Dr. Seth Oliveria, a neurosurgeon at The Oregon Clinic who has begun performing deep brain stimulation at Providence St. Vincent Medical Center in Southwest Portland. Many patients can begin taking smaller doses of medication after the procedure. That reduces side effects, Dr. Oliveria explained.
“The key to the surgery is that placement has to be very accurate,” he said. “The place you want to stimulate has very important structures around it.”
It’s important to have the procedure just as soon as possible after the effects of medication weaken. “That is the time to get a long period of benefit,” Dr. Oliveria said.
The newest wires have more electrical contacts and so surgeons can activate a greater number of combinations, increasing success. The same technology can be applied to other brain disorders, including obsessive compulsive disorder, schizophrenia and depression.
“The technology is moving fast,” Dr. Oliveria said, adding that deep brain stimulation alone does not provide nearly the benefit of the procedure done in tandem with medications.
Dr. Seth Oliveria
Reduced range of motion
Tremor
Drooping head
Muscle rigidity
Unclear thinking
Balance problems
Quieter voice
Difficulty swallowing
Sleep problems
Memory loss
Loss of coordination
http://www.catholicsentinel.org/Content/News/Local/Article/Progress-against-Parkinson-s/2/35/34330
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