Conditions and Treatments

Movement disorders are a group of conditions that interfere with your normal control of movement. They usually don’t have any effect on your thinking or memory. These conditions can be extremely debilitating, causing major disability and reducing the quality of your life. The most common conditions in this category are tremor (often called familial or essential tremor), Parkinson’s disease and a group of related diseases called dystonia.

These conditions can be challenging to tell apart from each other, and each requires a different treatment. It’s important to make sure you have care from knowledgeable, experienced specialists who work with these disorders every day and can help identify and correctly treat your condition.

At the Clinical Neuroscience Institute (CNSI) we have a team of specialists with extensive experience diagnosing and treating these disorders. The team includes:

  • Neurologists
  • Neurosurgeons
  • Neurophysiologists
  • Occupational and physical therapists

We work with you and your family to find solutions that will give you the best possible quality of life.

What Is Parkinson’s Disease?

Parkinson’s disease is a progressive condition (gets worse over time) involving brain cells that help organize your body’s movement. These brain cells manufacture a chemical called dopamine, which assists in the proper function of many other areas of your brain. As these brain cells are lost in Parkinson’s disease, the amount of dopamine your body makes also decreases. Without enough dopamine, other centers of your brain no longer work properly, leading to difficulty in many important functions. Some of the more common problems you may experience with Parkinson’s disease include:

  • Constipation and weight loss
  • Difficulty with speaking and swallowing
  • Poor balance and falls
  • Stiffness
  • Tremors

Other symptoms can include fluctuating blood pressure and loss of facial expression. Dementia can occur in some patients, but it is not a common feature of Parkinson’s disease.

What Is Tremor?

Familial or essential tremor is the most common type of tremor disorder and occurs to some degree in as much as 40 percent of adults older than 40.

In this disorder, the affected part of your body shakes when you try to hold it in a particular position. This shaking is often very mild, however in some people it becomes severe and progressive (gets worse over time). Tremor disorders can run in families.

Unlike the tremor of Parkinson’s disease, tremor disorder doesn’t show when you’re not using the affected part of your body. Instead, this kind of tremor appears when you try to maintain a position, such as holding a fork to eat or a glass to drink. It also affects movement and dexterity, for example when you button your clothes or sign a check. It can be very disabling and embarrassing.

Diagnosis of Parkinson’s Disease

Parkinson’s disease and several other movement disorders have similar symptoms. For most people with Parkinson’s disease or tremor, no laboratory or imaging test can confirm the diagnosis. The experience of your neurologist is critical for an accurate diagnosis. CNSI neurologists understand that differentiating among these disorders and establishing the correct diagnosis is essential to successful treatment.

Your neurologist starts the diagnostic process with a thorough physical examination and detailed interview with you and your family. Tests your CNSI doctor may order to help with the diagnosis include:

  • Balance and gait testing
  • Computed tomography (CT) scans
  • Magnetic resonance imaging (MRI) scans

Diagnosing Tremor

Familial or essential tremor is a diagnosis made by a neurologist based on a detailed history and physical examination. Usually, no other test is required. An image such as a CT scan or an MRI scan of the brain may be helpful.

Medications for Parkinson’s Disease

Medication is the foundation of treatment for Parkinson’s disease. The most common medications (levodopa and carbidopa) help the brain make more of the chemical dopamine which is lost in the disease. Some medications help slow the loss of brain cells, mimic the function of dopamine or improve the function of other brain centers affected by the loss of dopamine.

The Clinical Neuroscience Institute offers Duopa infusion therapy for the treatment of Parkinson’s disease. Duopa is a medication that can treat motor fluctuations in Parkinson’s disease patients. Those in advanced stages of the disease may qualify for this leading-edge treatment.

Medications work very well for many people but may have debilitating side effects. They can also stop working well when used for long periods. You may need a combination of medications taken on a precise schedule to achieve the best results.

Medications for Tremor

Many people with essential or familial tremor respond well to several classes of medications. These include beta blockers and medications used to treat epilepsy. Sometimes drinking alcohol can decrease your tremor, but this is obviously not a useful long-term therapy.

Incision-Free Brain Surgery For Tremors

If you are affected by essential tremor or tremor-dominant Parkinson’s disease, you may benefit from an incision-free brain surgery treatment called MR-guided focused ultrasound. The treatment uses focused sound waves guided by MRI to treat tremor, deep in the brain, with no incisions or permanent implants. It may be an option for patients who have not responded well to medications. More information about this treatment is available here.

To find out if you might be a candidate for MR-guided focused ultrasound, please:

Surgery for Parkinson’s Disease

If medication fails to effectively control your Parkinson’s disease symptoms or if medication side effects become intolerable, you may benefit from surgery. Like medication, surgery only treats symptoms of the disease. Most patients who have surgery need to continue taking some medication to get the best results. At this time, there is no cure for Parkinson’s disease. Stem cells and similar therapies offer hope for the future but remain unproven.

The usual surgery for Parkinson’s disease is called deep brain stimulation (DBS). This involves the precise placement of tiny electrodes into specific areas in your brain using a special technique (called minimally invasive) that uses specialized devices inserted into your body through small incisions. Wires on the electrodes are connected to a pacemaker-like device inserted under the skin of your chest. The electrodes stimulate parts of your brain and can relieve many of the most disabling symptoms of the disease.

Your CNSI neurologist will tell you if you may benefit from surgery. If so, you will have special tests, usually including an MRI scan. You’ll also have interviews with the surgeon to help make sure the surgery is as safe and effective as possible. You are awake for part of the surgery and asleep with anesthesia for another part. The surgical procedure takes place in an operating room and typically involves:

  • Placement of a special frame to hold your head still
  • Mapping the target area in your brain, during which you are awake and participating
  • Implanting the wires and pacemaker while you are asleep under anesthesia
  • You will have follow-up visits to your neurologist for programming the pacemaker and adjusting your medications.
  • If you are considering surgery, you should ask questions about the procedure and follow-up care. A clinical case manager is available to help you understand, make decisions and navigate the process.

Surgery for Essential or Familial Tremor

If medication fails to effectively control your tremor disorder, you may benefit from surgery.

These are conditions that may make you a candidate for surgery for tremor disorder:

  • Medication fails to effectively control your tremor
  • Tremor is so severe that it significantly reduces your quality of life
  • Medication side effects become intolerable

The usual surgery for tremor disorder is deep brain stimulation (DBS), a surgical procedure also used for Parkinson’s disease. DBS is not a cure for tremor. When the DBS device is turned off, you will still have tremor symptoms. But this treatment can greatly improve your quality of life by controlling your tremor.

About Dystonia

Dystonia is a set of related problems that originate in the brain and cause your muscles to maintain abnormal and undesired postures or movements. In many cases, these difficulties can lead to severe disability. Specialists at CNSI provide comprehensive diagnosis of dystonias and treatment options including medication and deep brain stimulation (DBS) surgical treatment.

For more information about Parkinson’s disease and movement disorders at CNSI, and for a referral to a neurologist, call CNSI at toll free (844) 277-2894(844) 277-2894.