Parkinson’s Disease

Roughly 60,000 Americans are newly diagnosed with Parkinson’s disease each year, and more than 1 million Americans are affected at any one time. The specific cause of Parkinson’s disease is unknown but experts believe the symptoms are related to a chemical imbalance in the brain caused by the loss of dopamine-producing brain cells.

Dopamine is a chemical that helps the nerve cells in the brain communicate with each other. When dopamine is missing from certain areas of the brain, the messages that tell the body how to move are lost or distorted - resulting in movement disorders associated with Parkinson’s disease.

It is important to find specialists who are expert in the complexities of Parkinson’s care and who have access to the latest discoveries in the diagnosis and treatment of this disease.

Parkinson’s disease risk factors are:

• Age - The largest risk factor for Parkinson’s disease is advancing age. Although it may appear in younger patients, even teenagers, it usually affects people in their later middle ages – with an average onset of the disease at 60 years of age.
• Gender – Although the reason is unclear, men are at a 50 percent higher risk for developing Parkinson’s disease than women.
• Family history – People who have a parent or sibling who are affected by the disease have approximately two times the chance of developing Parkinson’s disease.

Researchers postulate that in most individuals, the cause of Parkinson’s disease is the combination of genetics and environmental exposure and certain toxins including insecticides and herbicides.

Every individual experiences symptoms differently, but the most common symptoms are:

• Muscle rigidity – Experiencing stiffness when the arm, leg, or neck is moved back and forth.
• Tremor – An involuntary movement from contracting muscles that can be most pronounced at rest.
• Bradykinesia – A difficulty and slowness when trying to move.
• Postural instability – Having poor posture, a compromised gait, and impaired coordination that can cause difficulty moving and falls.

There are other secondary movement and non-movement symptoms of Parkinson’s disease.

Additional movement symptoms:

• Decreased arm swing when walking
• Difficulty rising from a seated position
• Difficulty writing
• Lack of facial expression
• Slowed daily activities - eating, dressing, bathing
• Difficulty turning over in bed
• Staying in the same position for a long period of time

Additional non-movement symptoms:

• Weakening of sense of smell
• Low voice volume
• Difficulty speaking
• Painful foot cramps
• Sleep disturbances
• Depression
• Emotional changes
• Skin problems
• Constipation
• Drooling
• Increased sweating
• Increase in urinary frequency
• Male erectile dysfunction

The symptoms of Parkinson’s disease can resemble symptoms for other conditions or medical issues. It is important for symptoms, such as these, to be fully evaluated by a specialist who can provide a proper diagnosis.

Making an accurate diagnosis in the early stages of Parkinson’s disease can be more difficult, as the beginning signs and symptoms can be considered indications for other medical conditions or even the effects of normal aging. At Brigham and Women’s Hospital, our Parkinson’s specialists – neurologists and neuro-radiologists – provide expert evaluation and diagnosis utilizing the latest in advanced imaging technologies.

In addition to a thorough medical history and detailed neurological examination, diagnostic testing for Parkinson’s can include:

• Trial test of medications – when symptoms are significant, a trial test of medications may be used to further diagnose the presence of Parkinson’s Disease
• Computed tomography (CT) scan – a diagnostic imaging procedure that uses a combination of X-rays and computer technology to produce images, often called slices, of the body – for this application, the brain.
• Magnetic resonance imaging (MRI) – a diagnostic imaging procedure that uses a combination of large magnets, radiofrequencies, and computer technology to produce detailed images of organs – such as the brain – and structures within the body.

At Brigham and Women’s Hospital Parkinson’s specialists develop individualized Parkinson's disease treatment plans for patients based on:

• Age
• Overall health
• Medical history
• Extent of the disease
• Tolerance for specific medications or procedures
• Expectations for course of the disease

Because there currently is no cure for Parkinson’s, current treatments focus on easing symptoms and making day-to-day life more manageable for patients.

Parkinson’s disease treatment options may include medication or surgery along with supportive services such as psychiatry services, therapy services, and nutrition and wellness plans.

Medication

Once the diagnosis of Parkinson’s disease has been established, the next step is to determine if medical treatment is appropriate and the best option for the patient. Our Parkinson’s specialists will look at the following factors when considering medical treatment:

• the degree of functional impairment
• the degree of cognitive impairment
• ability to tolerate the class of medications used in Parkinson’s disease

The common goal for all medications used to treat Parkinson’s disease is to compensate for the shortage of the brain chemical dopamine, which causes the symptoms of the disease.

Options for medication include:

• Levodopa - an oral medication that the body converts into dopamine
• Dopamine agonists - a category of medications that mimic the functions of dopamine
• Catechol O-methyltransferase (COMT) inhibitors – medications that allow a larger amount of levodopa to reach the brain, thereby raising the levels of dopamine
• Monoamine oxidase (MAO-B) inhibitors – medications that prolong the effect of dopamine
• Anticholinergics – medications that can reduce tremor and muscle stiffness
• Amantadine – a medication that can be used to reduce tremor and partially relieve other Parkinsonian symptoms

Every patient responds differently to medical management of Parkinson’s disease, therefore medications and their dosages often are adjusted until the right balance is found to alleviate symptoms.

Surgery

Surgical treatment for Parkinson’s disease is aimed at reducing the tremor or rigidity that accompanies the disease as well as the disabling side effects that can occur from prolonged medical treatment which actually make the symptoms worse.

The most common surgical procedure used for Parkinson’s disease treatment at Brigham and Women’s Hospital is deep brain stimulation (DBS), a type of brain surgery in which electrodes deliver electrical impulses to specific targets in the brain for the treatment of movement and affective disorders. The primary goal of DBS is to improve the patient’s quality of life by managing symptoms, not to cure the disease or disorder.

Brigham and Women’s Hospital, through the Deep Brain Stimulation Program, is one of only few centers in New England that provides this therapy and the only center in New England to offer both awake DBS and asleep DBS.

This procedure is typically offered to patients who have advanced Parkinson’s disease, whose symptoms cannot be well-controlled with medications, or whose medications have produced severe side effects.

Other surgical procedures that may be appropriate for Parkinson’s disease treatment include classic thalamotomies and pallidotomies, lesion surgery (burning of tissue in the area of the brain causing tremor), stereotactic radiosurgery, and experimental neural grafting. Also, research is ongoing to perform thalamotomies and pallidotomies without incision using high energy focused ultrasound.

If a surgery is indicated for treatment, the surgeon will work with the patient and their family to determine the best option and develop a treatment plan.

Psychiatry Services

Living with Parkinson’s disease does have an impact on mental health and often can lead to depression. At Brigham and Women’s Hospital, Parkinson’s disease patients have access to the services they need to cope with the challenges they face on a day-today basis.

Specialists within the Department of Psychiatry at Brigham and Women’s Hospital provide a broad range of programs, including specialized services that address the unique needs of patients living with chronic conditions, such as Parkinson’s disease.

Therapy Services, Nutrition and Wellness Plans

An integral part of Parkinson’s disease treatment is ensuring that each patient receives all the support services they need to help manage the impact the disease has on their overall health and well-being.

Part of the multidisciplinary care provided at Brigham and Women’s Hospital, many patients with Parkinson’s disease also benefit from:

• Speech therapy
• Physical therapy
• Occupational therapy
• Nutrition counseling
• Exercise plans

Brigham and Women’s Hospital provides a multidisciplinary approach to patient care, collaborating with colleagues in other medical specialties. If your neurologist or neurosurgeon discovers an underlying illness or concern, you will be referred to an appropriate Brigham and Women’s Hospital physician or allied health professional for an expert evaluation.

Parkinson’s disease specialists:

• Neurology
• Neurosurgery
• Psychiatry

The Deep Brain Stimulation (DBS) Program is composed of nationally known physicians from a variety of disciplines, all specializing in the treatment of movement and psychiatric disorders. Our integrated approach helps to ensure seamless patient care. The DBS team includes movement disorder neurologists, neurosurgeons, psychiatrists, neuropsychologists, and administrative staff.

Request an appointment.

• Go to our online health library to learn more about Parkinson’s disease.
• Visit the Kessler Health Education Library in the Bretholtz Center on the main Brigham and Women’s Hospital campus, where patients and families can access computers, printed information and guides, and a knowledgeable staff.
• Access a complete directory of patient and family services at Brigham and Women’s Hospital.