Parkinson's Disease

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Parkinson's disease is a brain disorder. It occurs when certain nerve cells (neurons) in a part of the brain that controls movement become impaired. Normally, these cells produce a vital chemical known as dopamine. Dopamine allows smooth, coordinated function of the body's muscles and movement. When approximately 80 percent of the dopamine-producing cells are damaged, the symptoms of Parkinson's disease appear.

Parkinson’s disease usually affects people over the age of 50 but can occur at any age. It is a movement disorder that is chronic and progressive, meaning that symptoms continue and worsen over time. Nearly one million people in the United States are living with Parkinson's disease.

The cause of Parkinson’s is unknown. Although there is presently no cure, our specialists help patients manage its symptoms with treatment options such as medication and surgery. Our collaborative team of doctors includes movement disorders neurologists with expertise in Parkinson’s diagnosis and treatment.

Symptoms of Parkinson’s

Symptoms of Parkinson's disease vary from patient to patient. They appear slowly and in no particular order. Years may pass before symptoms interfere with normal activities.

The diagnosis of Parkinson’s requires a careful medical history and a physical examination to detect the primary signs of the disease, including:

  • Rigidity: Stiffness when the arm, leg or neck is moved back and forth
  • Resting tremor: Tremor when a body part is relaxed, such as in the hand, foot or chin
  • Bradykinesia: Slowness in initiating or maintaining movement
  • Loss of postural reflexes: Patients have poor balance and may fall

Other, more subtle symptoms of Parkinson's may include:

  • Small cramped hand-writing
  • Decreased arm-swing or scuffing of the foot on the affected side when walking
  • Decreased facial expression
  • Lowered voice volume
  • Feelings of depression or anxiety
  • Episodes of feeling “stuck in place” when initiating a step
  • Increase in dandruff or oily skin
  • Less frequent blinking or swallowing
  • Vivid or active dreaming
  • Loss of sense of smell

Diagnosis and Treatment

Sometimes an accurate diagnosis of Parkinson’s in its early stages can be difficult. You may have already experienced this frustration. If you think you may have Parkinson’s, it’s important to seek the care of a movement disorders neurologist who specializes in the disease.

Diagnosis

To diagnose Parkinson’s, our specialists will carefully review your health history and perform an examination. If felt needed, a nuclear medicine scan called at DAT scan, may be ordered.  This is a type of SPECT scan that specifically looks at dopamine level in the part of the brain where Parkinson’s disease occurs.

Our doctors may also perform a blood test and brain scan (MRI) to rule out other conditions that have similar symptoms.

Treatment of Parkinson’s

Doctors at Sentara are committed to helping patients facing Parkinson’s improve their quality of life. Sentara patients can work with fellowship-trained movement disorder specialists and even participate in research and clinical trials. And because our approach to treatment is uniquely holistic, a patient can explore medical treatment, physical therapy, speech therapy and occupational therapy as well as other options for helping with symptoms.

Medical Treatment

Many of the symptoms associated with Parkinson’s are caused by lack of dopamine and other organic chemicals produced by the brain. Current medicines work primarily on the dopamine system to improve rigidity and slowness associated with Parkinson's disease, and sometimes tremors. It is common for people with Parkinson’s to need a combination of medications to treat symptoms. Many new medicines are being studied that may work in different ways to treat symptoms and slow the progression of the disease.

Surgical Treatment and Deep Brain Stimulation

Currently, the most commonly used surgical treatment of Parkinson’s is a procedure called Deep Brain Stimulation (DBS). This procedure is performed by a neurosurgeon experienced in this type of surgery. Our specialists will help to determine if you are a good candidate for this surgery. A pre-surgical evaluation by the movement disorders team is needed to make that determination.

During this surgery, doctors will place electrodes in the specific areas of your brain. A device called an impulse generator or IPG (similar to a pacemaker) is implanted under your collarbone to provide an electrical impulse to a part of the brain involved in motor function.

While deep brain stimulation is not a cure for Parkinson’s, and it does not slow disease progression, it can dramatically relieve some symptoms and improve your quality of life. Studies show benefits lasting at least five years. We currently offer DBS clinics specifically for patients who have had this procedure. This allows us to finely tune your treatment, which may allow for reduction in medications.

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