Ruvo center in Las Vegas recognized for Parkinson’s treatment

October 26, 2018

The exterior of the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas, on Wednesday February 8, 2012. The building was designed by architect Frank Gehry. (Las Vegas Review-Journal file) MARTIN S. FUENTES/LAS 

The Parkinson’s Foundation has designated the Cleveland Clinic Lou Ruvo Center for Brain Health in Las Vegas as a “Center of Excellence,” making it one of just 45 organizations worldwide with the title.

The designation bestowed last week on the Ruvo Center and the Ohio-based Cleveland Clinic headquarters, goes to hospitals and medical centers that provide specialized Parkinson’s care, according to a news release from the foundation. The neurodegenerative disease affects about 1 million people in the U.S. and about 10 million around the globe.

In order for a center to receive designation, it must see at least 700 patients with Parkinson’s annually, conduct research and clinical trials on the disease and employ a neurologist who specializes in movement disorders, a nurse, social worker, physical therapist, occupational therapist and speech-language pathologist, the release said.

The chosen center also must provide educational events for patients and families and provide access to wellness programs.

Added funding, extra clout

When Dr. Zoltan Mari, a movement disorders specialist, joined the Lou Ruvo Center team more than a year ago, he was tasked with applying for the coveted designation. Johns Hopkins University in Baltimore, Maryland, his previous employer, is also a Parkinson’s Foundation Center of Excellence.

For Mari and his team, it means about $60,000 in annual funding, which will be split with Cleveland Clinic Ohio to improve education and outreach to patients. The Lou Ruvo Center will use it to task an existing nurse practitioner with creating a patient-focused newsletter and increasing awareness of existing educational and support programs.

The designation also opens access to research opportunities and databases that are otherwise difficult to obtain, Mari said.

“Being a Center of Excellence opens doors,” he said. “This is a major step in changing that culture and changing the health value system in the city and in the state.”

Designated facilities must be recertified every five years, according to the release.

“It’s a huge recognition,” clinic founder Larry Ruvo said. “It’s another level of quality care that (Las Vegas) didn’t have before.”

It’s also a tool for the Las Vegas center to bargain for better reimbursement rates with local insurers, Ruvo said.

‘In a stronger position’

It’s not unusual for health care facilities to seek such recognitions and use them as leverage for funding and reimbursement, said Ernie Libman, a retired health care administrator who ran HMO insurance plans in Illinois and Colorado before moving to Las Vegas in 1977 to take over as director of planning and development at Sunrise Hospital and Medical Center.

He became CEO of Nathan Adelson Hospice and then Valley Hospital Medical Center before ending his career as the CEO of Lake Mead Hospital Medical Center, now North Vista Hospital.

“They’re in a stronger position,” he said of the Lou Ruvo Center receiving the Center of Excellence designation. “It’s going to give them a little mojo when they go in to talk to managed-care people about why they should be paid appropriately.”

And while it might look attractive to doctors looking to move to Nevada — a notoriously dry state for health care — it’s not enough alone.

“There’s what we offer in terms of residencies and the opportunities for people to bring their kids and have schools here that are equal to other parts of the country,” Libman said, referring to areas in need of improvement in the state. “And reimbursement rates. Reimbursement is a big issue.”

Contact Jessie Bekker at jbekker@reviewjournal.com or 702-380-4563. Follow @jessiebekks on Twitter.

https://www.reviewjournal.com/local/local-las-vegas/ruvo-center-in-las-vegas-recognized-for-parkinsons-treatment/

DOZENS WALK TO RAISE AWARENESS FOR PARKINSON’S DISEASE

by Webmaster  October 26, 2018

Over one hundred people participated in the Scott & White Plummer Movement Disorders Center’s “Walking to Awareness” community event, a one-mile Fun Walk and 5K, at Pepper Creek Trail on Saturday, October 13.

“This event is in place of our annual Parkinson’s Patient Symposium, which will be moving from the fall to the spring. We didn’t want not to have a patient-centered event, so we organized a walk. This event is possible thanks to the support and generosity of several community sponsors,” explained Samantha Beevers, Parkinson’s Outreach Coordinator. 

“This is the first year we are hosting this walk and its’ purpose is to raise awareness and get the community involved.  The Plummer Movement Disorders Center funds and assists local support groups located in Temple, Georgetown, and Waco. Exercise is one of the most crucial aspects of helping to slow the progression of Parkinson’s Disease. Parkinson’s affects more people than we realize and being able to provide support, education, and exercise is what we love.”

Alicia Prado put together a large team, appropriately called “Walking With Prado,” in honor of her husband, Bell County Constable Thomas Prado, who was diagnosed with Parkinson’s Disease in 2014.

“I saw on Facebook that we could invite our friends to the event, and Samantha encouraged us to put a team together. I thought it would be incredible to invite all of Tom’s friends and family to join us so that he can see how much we all support him. We sold almost 100 shirts for our ‘Walk With Prado’ team, and the support for Tom is overwhelming,” explained Alicia Prado. “Tom’s good friend, Little River Police Chief Lee Dixon was killed June 19, 2014, and we found out about Tom’s diagnosis on June 23rd, 2014. What a week that was for us – it was horrible. 

When we were first told about the disease, we were initially relieved to at least have a name to put on what was going on. We didn’t have a clue how difficult things could be. God is good though, and we have all grown so much in the years since Tom’s diagnosis – my faith has always been strong, but it’s even stronger now. Tom’s faith is so much stronger now, too. This disease has done some good things for all of us.”

On May 11, 2017, Constable Prado underwent DBS (Deep Brain Stimulation) surgery to implant two leads inside of his head. The neurostimulator sends out electrical impulses to certain parts of the brain.

“To me, this Parkinson’s Walk shows Tom and others that they are loved and supported. No one is alone. Before my husband was diagnosed, I’d never even heard of this disease. We are so grateful for this walk and the opportunity to help bring awareness to the public about this disease. We want people to be more aware of this disease – the symptoms especially.  Tom’s favorite saying is that he is ‘fighting crime and suppressing evil’ – I call him RoboCop now. He’s amazing. He hasn’t let this disease slow him down or take its toll on him at all. I’m so proud of him and his sincere desire to help the community.”

Approximately 60,000 Americans are diagnosed with Parkinson’s Disease annually, and more than 10 million people are living with the disease worldwide. It is estimated that nearly one million people will be living with Parkinson’s Disease in the United States by the year 2020. There currently is no cure for the disease, and the cause remains largely unknown. 

For more information on Parkinson’s Disease, visit 

http://www.parkinson.org/understanding-parkinsons/what-is-parkinsons.

 More details about the Plummer Movement Disorders Center can be found online at: https://www.bswhealth.com/specialties/neuroscience/Pages/plummer-movement-disorders-center.aspx.

https://beltonjournal.com/dozens-walk-to-raise-awareness-for-parkinsons-disease/

Is Your Trembling Caused by Parkinson’s — or a Condition That Mimics It?

October 26, 2018 / By Brain and Spine Team

    Why seeing a neurologist can save you time and money

You may first notice a tremor in your hands. Or that you walk a bit unsteadily. Or that you feel stiff and slow.

If you check the internet, you may conclude you have Parkinson’s disease. Even your family doctor might diagnosis this chronic and progressive neurological disease.

But other conditions closely mimic Parkinson’s. And because they are treated differently, it’s important to get a correct diagnosis as soon as possible.

“For a couple of conditions, the prognosis, treatment and advice are totally different from Parkinson’s,” says Hubert Fernandez, MD, Director of the Center for Neurological Restoration.

A neurologist is your best bet for sorting out whether you have Parkinson’s or something else, he says. Treatment decisions made early in the illness can affect your long-term success in managing the condition.

What looks like Parkinson’s, but isn’t?

Dr. Fernandez describes two main Parkinson’s mimics:

Essential tremor. Also known as benign essential tremor or familial tremor, this movement disorder causes brief, uncontrollable shaking.

It most often affects your hands, but can also affect your head and neck, larynx (voice box) and other areas. In rare cases, it affects your lower body as well.

But one clue can help distinguish essential tremor from Parkinson’s.

“This is not an absolute rule, but if shaking occurs at rest, it often is Parkinson’s. And if shaking occurs in action, such as when you’re writing or eating, it is essential tremor,” Dr. Fernandez says.

About half of those with essential tremor have a family history of the condition. Unlike Parkinson’s, it is not a progressive disease and, if mild, may not require treatment.

Doctors can prescribe medications to reduce shaking, but they are not the same drugs used to treat Parkinson’s, he says.

Drug-induced Parkinson’s. Along with shaking, this condition may cause many symptoms similar to Parkinson’s disease, including stiffness, slow movement, a decrease in facial expression and a change in speech.

As the name suggests, taking certain drugs, most commonly antipsychotics and mood stabilizers, can trigger this condition. How long it takes to develop can vary greatly, depending on which drug you’re taking, how long you take it and the dosage.

Your doctor likely will treat drug-induced Parkinson’s by adjusting your medication.

“We always work with a psychiatrist as we taper off and try new drugs,” Dr. Fernandez says. “We want to do what is best for the body and what is best for the brain.”

Other neurological disorders fall into a category known as Parkinson’s plus syndromes, which can cause similar symptoms. Doctors typically treat these syndromes the same way they treat Parkinson’s disease.

“The medications we prescribe are about the same as what we use for Parkinson’s, but we expect different outcomes,” he says.

“However, a diagnosis of essential tremor or drug-induced Parkinson’s would call for a totally different treatment.”

The right diagnosis can save time (and money)

Because the symptoms of Parkinson’s vary and often overlap other conditions, it is misdiagnosed up to 30 percent of the time, Dr. Fernandez says. Misdiagnosis is even more common in the early stages.

Patients who don’t know where to turn may make appointments with a rheumatologist, or an orthopaedic or heart specialist, and undergo MRIs, EMGs and other expensive tests.

But only a neurologist can distinguish Parkinson’s from essential tremor, drug-induced Parkinson’s and Parkinson’s plus syndromes, he says.

“If patients come to us with typical signs of Parkinson’s, we don’t need to order expensive tests,” he says.

Instead, neurologists base their diagnosis on a detailed patient exam and medical history, along with other information from the patient, family members or caregivers.

“That’s all stirred into the pot,” he says. “Sometimes we can diagnose Parkinson’s with one visit. Other times, several follow-up visits are necessary.”

https://health.clevelandclinic.org/is-your-trembling-caused-by-parkinsons-or-a-condition-that-mimics-it/

MJFF and Blackfynn Collaborate on Parkinson’s Study to Discover Biomarkers

OCTOBER 26, 2018 BY MARY CHAPMAN 

The Michael J. Fox Foundation (MJFF) and Blackfynn are joining forces to make optimal use of an initiative that could uncover Parkinson’s disease biomarkers and bring about new therapies.

Called the Parkinson’s Progression Markers Initiative (PPMI), the MJFF-backed effort is an ongoing observational study of more than 1,300 volunteer participants both with and without Parkinson’s to validate biomarkers and, over time, identify disease risk factors. Participants undergo a battery of tests and assessments.

Biomarker discovery is critical in the quest for therapies that can slow or halt Parkinson’s progression. Specifically, it would allow for earlier diagnosis, better disease tracking, and more efficient therapy tests. Current treatments only temporarily ease symptoms.

To glean as much as possible from patient data, Blackfynn will lead the PPMI Advanced Analytics Core, established to analyze biomarker discovery. The firm has a data integration and analysis platform it uses to drive development of therapies, and advance translational research for neurological diseases.

“The goal of the Advanced Analytics Core is to accelerate our analysis of the comprehensive within-subject data collected through PPMI,” Kenneth Marek, PPMI principal investigator, said in a news release.

“By combining this rich, multimodal data with Blackfynn’s platform and data science expertise, we hope to uncover insights into the determinants of [Parkinson’s disease] progression that will lead to new therapies and improved quality of life for patients.”

The Blackfynn infrastructure incorporates a full complement of medical and scientific data to enable swift assessment of data correlations and complex data visualizations. PPMI scientists plan to use the platform to interpret data, develop verifiable hypotheses, and better collaborate with the goal of more targeted translational research.

“Our work with MJFF and the PPMI investigators will maximize the value of this important patient dataset and help drive novel discovery with the potential to lead to the development of effective therapies for patients with PD,” said Amanda Christini, president of Blackfynn.

“Blackfynn will enable a new lens through which discoveries can be made, by looking at all raw and metadata together, in context, to find new patterns that are otherwise obscured when data are in isolation.”

Citing an unwieldiness caused by an abundance of Parkinson’s-related biomarker information, an editorial in the journal The Lancet Neurology heralded the efficiencies of collaborative research. Particularly, it applauded the Accelerating Medicines Partnership for its efforts to find a Parkinson’s cure.

As for the PPMI, five-year results have already shown that clinical trials in patients with early-stage Parkinson’s may benefit from assessing markers of disease progression — namely, changes in the Movement Disorder Society (MDS)-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and dopamine transporter imaging.

Launched in 2010, PPMI is underway in the United States, Europe, Israel and Australia.

The MJFF is dedicated to finding a cure for Parkinson’s by funding research and ensuring the development of improved therapies for those living with the disease. It has funded more than $800 million in research to date.

https://parkinsonsnewstoday.com/2018/10/26/michael-j-fox-foundation-partners-blackfynn-for-biomarker-discovery-parkinsons-disease/

Treatment options for Parkinson's disease

Brenda B. Spriggs, MD, MPH, FACP      25 October 2018

Parkinson's disease is a complex condition with a wide range of symptoms. There is currently no cure, but treatment can help relieve symptoms, slow disease progression, and improve quality of life.

Treatment approaches include medication, surgery, alternative and complementary therapies, occupational therapy, and speech therapy.

The symptoms of Parkinson's disease (PD) vary widely so no single treatment will work for everyone with this condition.

Medication

Medication is an important part of treatment for Parkinson's disease, as it can relieve symptoms.

The National Institutes of Health note that there are three types of drug available to treat PD:

• medications that raise dopamine levels in the brain, such as levodopa (also known as L-dopa), and drugs that mimic dopamine or stop it from breaking down
• drugs that reduce or relieve tremor, or shaking, and other symptoms affecting body movements
• medication for depression, psychosis, dementia, and other non-motor symptoms

Increasing dopamine levels

The symptoms of PD are mainly due to low levels of dopamine in the brain. Dopamine is a chemical messenger, or neurotransmitter. Most drugs for the condition aim to either replenish dopamine levels or mimic its action. These are called dopaminergic drugs.

Dopaminergic medications can:

• reduce rigidity and muscle stiffness
• improve the speed of movement
• help with coordination
• lessen tremor

Taking dopamine itself does not help because it cannot enter the brain, but drugs that enable the brain to create dopamine can be beneficial.

Doctors may prescribe the following medications for people with PD:

Levodopa

Levodopa is the most effective medication for PD. Nerve cells in the brain absorb the drug and turn it into dopamine.

The person will take levodopa orally in either tablet or liquid form.

Its side effects include:

• nausea
• vomiting
• fatigue
• dizziness

Carbidopa-levodopa

This combination drug, which is available under the brand name Sinemet, contains both carbidopa and levodopa.

Carbidopa prevents the destruction of levodopa by enzymes in the digestive tract and reduces some of its side effects, including nausea.

As Parkinson's disease progresses, long-term treatment with levodopa may become less effective.

The person's response to the drug may begin to fluctuate, and they might experience "off" times between doses, during which movement can be more challenging.

The doctor may have to change the dosage by amending the size or frequency of the doses. However, the individual will need to continue using the drug because stopping it suddenly can result in withdrawal symptoms.

The side effects of this combination drug may include:

• mental disturbances, such as confusion, delusions, and hallucinations
• involuntary movements, such as jerking or twisting

People taking this drug may also have a higher risk of liver, kidney, and cardiovascular problems and be more likely to develop glaucoma.

The long-term use of levodopa, either alone or in combination with carbidopa, increases the risk of:

• fluctuating motor responses
• uncontrolled, involuntary movements known as dyskinesia

For this reason, a doctor may prescribe a dopamine agonist instead.

Dopamine agonists

These drugs mimic the effects of dopamine in the brain. The neurons react to them as they would to dopamine.

Dopamine agonists can be a good alternative to levodopa as they have a lower risk of long-term complications.

However, they can have similar side effects to carbidopa-levodopa.

The side effects may include:

• mental confusion
• nausea
• low blood pressure
• sleepiness
• muscle cramps

Dopamine agonists may not be suitable for people with a history of cardiovascular disease, depression, or psychosis.

A doctor usually prescribes these medications in tablet form, but they are also available as an injection or a skin patch.

Monoamine oxidase-B inhibitors (MAO-B inhibitors)

MAO-B inhibitors are another alternative to levodopa. Examples include selegiline and rasagiline.

These drugs work by blocking the effects of an enzyme called monoamine oxidase-B (MAO-B), which destroys dopamine in the brain. Blocking MAO-B allows the dopamine to last for longer in this organ.

MAO-B inhibitors have a less significant effect than levodopa, but it is possible to take them together with levodopa or dopamine agonists.

There is a risk that MAO-B inhibitors will have adverse interactions with some depression medications and certain narcotics. They also have some side effects, including:

• dizziness
• headaches
• stomach pain
• vivid dreams
• fever
• conjunctivitis

Catechol O-methyltransferase (COMT) inhibitors

This type of medication blocks COMT, an enzyme that breaks down levodopa. By doing this, it can prolong the effect of carbidopa-levodopa therapy.

Anticholinergics

These medications control tremor. Examples include trihexyphenidyl (Artane) and benztropine (Cogentin).

However, some people prefer not to use these drugs because of the side effects, which can include:

• urine retention, especially in people with an enlarged prostate
• severe constipation
• nausea
• dry mouth

Depression, psychosis, and dementia

Depression is a common problem for people with PD.

The American Academy of Neurology (AAN) recommend amitriptyline for treating depression, stating that there is currently insufficient evidence to support the use of other treatments.

Psychosis can also occur, and this becomes more severe as the disease progresses. Clozapine (Clozaril) can treat psychosis, but doctors should monitor the person carefully as this medication can have severe adverse effects.

Dementia develops over time in many people with PD, especially if they have PD with Lewy bodies.

Lewy bodies are abnormal deposits in the brain. Rivastigmine (Exelon) is a treatment option for dementia, but the AAN point out that the benefits can be small, and it may make tremors worse. Donepezil (Aricept) is another option.

Speech and occupational therapy

Physical therapy can help people with PD to regain skills and find new ways of doing things.

Treatment for PD may also involve speech and occupational therapy.

Speech therapy: PD can cause a person to have slurred speech and abnormal body language. It can also be difficult for a person with PD to swallow.

A speech and language therapist can provide muscle-training techniques that help people overcome some of the common problems relating to speech and swallowing.

Occupational therapy: An occupational therapist can pinpoint everyday tasks that PD can make problematic, and they can help find practical solutions.

Examples include helping people with techniques for getting dressed, preparing meals, performing household chores, and doing the shopping.

Deep brain stimulation

This procedure can treat many of the symptoms that make it hard for a person with PD to function, such as tremor, rigidity, stiffness, slowed movement, and walking difficulties.

A doctor will implant an electrode inside a part of the brain that controls movement. The electrode will provide stimulation to the brain.

Next, they will place a pacemaker-like device, or neurostimulator, under the skin in the upper chest. This device will control the amount of stimulation that the electrode delivers.

A wire travels under the skin and connects the neurostimulator to the electrode.

The neurostimulator sends electrical impulses along the wire and into the brain via the electrode.

These impulses prevent symptoms by interfering with the electrical signals that cause them.

Doctors typically use deep brain stimulation during the later stages of PD, when medications become less effective.

The risks of this procedure include brain hemorrhage and infection. People who do not respond to carbidopa-levodopa therapy will not benefit from deep brain stimulation.

Thalamotomy

This is a type of surgery that was common in the past but is rare nowadays.

The surgeon uses a local anesthetic to numb the area. They then make a small hole in the skull, insert a hollow tube, and use liquid nitrogen to destroy the thalamus, a tiny part of the brain that is responsible for the tremor.

The surgeon will operate on the side of the head opposite to the affected side of the body. If a person has a tremor in their right hand, for example, the surgery will take place on the left side. It is possible to operate on both sides, but this can lead to other problems.

A thalamotomy may help if a person has a severe tremor on one side, but it does not relieve slow movement, walking difficulties, speech problems, or other symptoms.

Blood pressure treatment

Many people with PD experience fluctuations in blood pressure. Low blood pressure is common, especially when standing up or changing position.

Some medications can help stabilize blood pressure.

Other tips that may help include:

• avoiding caffeinated products in the evening
• eating several small meals a day
• abstaining from alcohol

Alternative remedies

Tai chi, relaxation, and yoga may improve overall well-being in people with Parkinson's, as well as helping them to relax.

People have tried a wide range of complementary therapies for PD, and there is anecdotal evidence that these can help with relaxation and reduce stress and depression. However, there is little scientific proof to support these claims.

Alternative therapies that may be beneficial include:

• massage
• yoga
• tai chi
• acupuncture
• osteopathy
• chiropractic manipulation
• herbal remedies
• hypnosis
• the Alexander Technique, which can help with posture and muscle activity

However, more research is necessary to confirm the effectiveness of these treatments.

Supplements

Some people believe that supplements can benefit people with PD, but there is limited research to support their effectiveness.

Proponents recommend the following supplements:

Velvet bean: Also known as Mucuna pruriens, this supplement contains levodopa, but it is not clear if it has any effect as a PD treatment.

Vitamin C: There is some evidence that vitamin C can increase levodopa levels, but researchers have not yet confirmed that it can help people with PD.

Folic acid: This may help, but more research is necessary.

Vitamin E: Some people recommend vitamin E supplements, but the AAN statethat they are ineffective as a treatment for PD.

Anyone who is considering using herbal remedies or supplements should speak with their doctor first, because some may interact with PD medications or make symptoms worse.

Diet and exercise

There is no evidence that any specific diet will help people with PD, but a healthful diet comprising plenty of fresh fruit and vegetables will enhance a person's overall health.

A high-fiber diet and adequate fluid consumption can help reduce constipation, which is a common problem with PD.

Weight loss can often occur too. A dietitian should be able to offer advice on how to prevent this.

Exercise

Physical therapy can help people manage their symptoms and feel better. A 2013 review in Reviews in the Neurosciences reported that exercise improves gait, mobility, and balance in people with PD.

Exactly how exercise can help a person with PD is unclear, but animal studies have suggested that it may offer some neuroprotection.

Moderate activities, such as walking, gardening, and swimming, are suitable for many people. They can often improve emotional well-being too, especially if the individual can do them with a friend, family member, or another person in the community.

It is essential that people with PD speak to their doctor before making any changes to their level of exercise.

Takeaway

Parkinson's disease affects individuals in different ways, and a doctor will prescribe or recommend appropriate therapies to relieve the symptoms.

These include a range of medications, lifestyle changes, and other interventions.

It can take time to get the treatment right, and symptoms can also change over time. Staying in touch with the doctor is important for maintaining a suitable treatment regime.

This, in turn can improve the quality of life of a person with PD and their loved ones.

https://www.medicalnewstoday.com/articles/323462.php