Thursday, June 16, 2022
Thursday, June 16, 2022
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How Do Neurologists Treat Parkinson’s

Review Your Treatment Plan

Watch this Neurologist working on a Parkinson’s Patient. There is a natural Treatment!

Besides these basic questions, the most important way to choose the neurologist you will work with is by listening to the treatment plan she puts together for you. Does it make sense? Does your doctor discuss it with you after considering your personal needs, goals, and symptoms? Does she mention that the treatment plan needs to be flexible and be re-evaluated over time? Does she try to integrate the plan into your everyday life and needs?

You need to use your common sense when choosing a Parkinson’s disease neurologist/specialist. You cannot doctor yourself. You need to trust at some point that this highly trained specialist knows what he or she is doing.

Treatments For Parkinsons Disease

Mount Sinai specialists are skilled in providing the full range of therapies for Parkinsons disease. While your treatment plan may include medications, and possibly surgery, we also believe in the importance of maintaining a regular exercise regimen and eating a healthy, balanced diet.

Medications: The most common treatment for Parkinsons disease is dopamine replacement therapy, usually levodopa, which generally produces significant improvements in walking and movement, as well as reductions in stiffness and tremors. We also use other medications that target either the synthesis or breakdown of dopamine in the body.

Deep Brain Stimulation: Mount Sinais Center for Neuromodulation is recognized for its excellence in performing deep brain stimulation surgery for selected patients with Parkinsons disease. In deep brain stimulation, electrodes are placed in the areas of the brain responsible for symptoms. We connect these electrodes through a wire to a neurostimulator, also called a battery pack, which delivers electrical stimulation to the brain and can modulate the symptoms of PD. We can adjust the electrical parameters of the device to obtain very good control over symptoms. Most patients experience dramatic improvement.

Testing For Parkinsons Disease

There is no lab or imaging test that is recommended or definitive for Parkinsons disease. However, in 2011, the U.S. Food and Drug Administration approved an imaging scan called the DaTscan. This technique allows doctors to see detailed pictures of the brains dopamine system.

A DaTscan involves an injection of a small amount of a radioactive drug and a machine called a single-photon emission computed tomography scanner, similar to an MRI.

The drug binds to dopamine transmitters in the brain, showing where in the brain dopaminergic neurons are.

The results of a DaTscan cant show that you have Parkinsons, but they can help your doctor confirm a diagnosis or rule out a Parkinsons mimic.

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Updating Approaches To Parkinsons

We know from the scientific literature that patients who see even a general neurologist have lower rates of morbidity, mortality and nursing home placement. But given that the majority of Parkinsons patients are under the care of general practitioners, internists and family medicine doctors, how do we help all of those who are affected by Parkinsons?

Based on studies that show that people are living longer with Parkinsons, one of the first messages we need to impart is that life is most certainly not over. A second important message is that new medications can and do make a difference.

These findings underscore the necessity of having doctors trained in Parkinsons.

For example, there is a myth that when you diagnose Parkinsons, you prescribe a medicine called carbidopa-levodopa three times a day, and thats all.

But Parkinsons is an incredibly complex disease with more than 20 motor and nonmotor features. The idea that dopamine, the main active ingredient in carbidopa-levodopa, is the only drug and the only treatment and theres nothing more you can do thats a myth. This is something we must make sure to emphasize and educate doctors in training and those seeing these patients in practice.

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movements and speech are also evaluated. The examiner may ask you to say “mama” or “papa” to test your lips. The examiner may ask you to say “Lulu” to test your tongue. The examiner may ask to say, “Ahh.” This tests your pharynx. The sensory examination includes an evaluation of your ability to perceive a light touch, a pin prick, and your ability to tell whether your thumb or great toe is being moved up or down. Testing for PD requires skill and practice on the part of the examiner.

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    Members Of The Healthcare Team

    Who should make up your care team? At a minimum you will need:

    • A primary care physician who looks after your day-to-day medical needs. This may be someone who you have seen for many years and knows you well, or you may need to find a primary care physician.
    • A neurologist who specializes in movement disorders. This is most important as a neurologist in movement disorders will likely be able to help you find others who are experienced in Parkinson’s disease to fill out your healthcare team.
    • A counselor or psychiatrist or psychologist who can help you manage potential emotional and mental health problems is they arise
    • Allied health professionals like physical therapists, occupational therapists, sleep medicine specialists and so forth. Your neurologist should be able to help you find the allied health professionals right for you.
    • Yourself – Part of being an empowered patient is playing an active role in your care.
    • Your partner – Parkinson’s disease can have a tremendous impact on relationships, and including your partner or other family members can be very helpful in managing the disease.

    All of these people will, of course, need to communicate with one another, but the key figure for management of your Parkinson’s symptoms will be your neurologist. So how do you find a neurologist who is right for you?

    Don’t overlook your own role as a very important member of your healthcare team, as well as that of your family.

    Preparing For The Initial Visit

    • Laboratory or other test results from previous treatment for Parkinsons symptoms.
    • Films or CDs of brain imaging.
    • Names and contact information for all doctors you see .
    • Lists of your movement and non-motor symptoms .
    • List of all medications you take and the actual pills, including over-the-counter drugs and supplements .
    • Your insurance or Medicare card.
    • Perhaps most importantly, bring a family member or friend who can take notes and help ask and answer questions. You will receive a lot of information during this visit. Later, it may help you to talk it over with the person who went with you.

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    Can Parkinsons Disease Be Prevented

    Unfortunately, no. Parkinsons disease is long-term disease that worsens over time. Although there is no way to prevent or cure the disease , medications may significantly relieve your symptoms. In some patients especially those with later-stage disease, surgery to improve symptoms may be an option.

    Finding The Right Movement Disorder Specialist

    What does a Neurologist treat?

    Having the right partnership with your doctor can make a difference, not just in managing your Parkinsons symptoms but also in how supported you feel overall. Its important for you to feel confident in that relationship and to have access to a treatment team that meets your needs.

    Finding a good movement disorder specialist is a lot like hunting for a good dentist or a good mechanic: You need to ask around. Your primary care doctor or neurologist may be a good place to start. Or ask people in your support group, if you attend one, whom they see. You can also try contacting one of the national Parkinson’s organizations.

    In choosing a doctor, consider how much the doctor knows and how well the doctor listens. Remember, no two cases of Parkinson’s disease are alike. Having a doctor who understands this, and who listens to you, is crucial.

    With any Parkinson’s doctor, you are a partner in your care. Educate yourself about PD. Parkinson’s is different for everyone, and you can’t get the best care unless you’re specific about what you are experiencing. It’s okay to ask why particular treatments or therapies are being recommended , and it’s okay to get another opinion.

    The MDS Movement Disorders Specialist Finder can help you locate a doctor in your area.

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    Symptoms Of Parkinson’s Disease

    Many patients with Parkinson’s disease may notice a slight tremor as their initial symptom, which usually begins in one arm or leg and slowly spreads to other areas of the body. Additional symptoms associated with Parkinson’s disease may develop over time and include the following:

    • Tremors or shaking
    • Constipation
    • Sexual dysfunction

    Blood pressure may also be affected by Parkinson’s disease and patients may experience pain in specific areas or throughout the body.

    What Causes Parkinsons Disease

    Parkinsons disease occurs when nerve cells in an area of the brain called the substantia nigra become impaired or die. These cells normally produce dopamine, a chemical that helps the cells of the brain communicate . When these nerve cells become impaired or die, they produce less dopamine. Dopamine is especially important for the operation of another area of the brain called the basal ganglia. This area of the brain is responsible for organizing the brains commands for body movement. The loss of dopamine causes the movement symptoms seen in people with Parkinsons disease.

    People with Parkinsons disease also lose another neurotransmitter called norepinephrine. This chemical is needed for proper functioning of the sympathetic nervous system. This system controls some of the bodys autonomic functions such as digestion, heart rate, blood pressure and breathing. Loss of norepinephrine causes some of the non-movement-related symptoms of Parkinsons disease.

    Scientists arent sure what causes the neurons that produce these neurotransmitter chemicals to die.

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    How Do You Find The Best Neurologist

    How do you find the best neurologist who is right for you? Here are some important factors to keep in mind.

    • Referrals Ask your primary doctor, friends, and family for referrals. Take the time to research the doctors credentials and experience.
    • Credentials Board certification is an important factor to consider when you are looking for a neurologist. It tells you that the doctor has the necessary training, skills, and experience in neurology.
    • Experience When youre facing a neurological issue, experience matters. The more experience a neurologist has with a condition, the better your results are likely to be. Larger neurology groups have more doctors and more experience to share.
    • Communication Choose a neurologist with whom you are comfortable talking to. Neurologic diseases are complex and demand accurate and trustful conversations between the neurologist and patient.
    • ReviewsPatient reviews typically reflect peoples experience with scheduling appointments, office staff, and the doctor.

    Does The Doctor Feel Threatened By My Questions

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    Self-education in Parkinsons and being current in new treatment options are critical. They help me to formulate intelligent questions and allow me to challenge my doctor about something they might suggest that I dont feel right about. I will not continue with a doctor that gets defensive when I ask them questions, or if a treatment suggestion must be their way or the highway.

    Also Check: Stages Of Parkinson’s Disease Life Expectancy

    Physician Encounter And Referral Patterns

    Medicare provider specialty codes identified the physician specialty for each patient encounter. We restricted analysis to patients with PD who had claims generated by physicians specializing in neurology, internal medicine, family practice, or geriatric medicine . We calculated neurologist encounter rates over a 48-month period by examining carrier files for the cohort from January 1, 2002, to December 31, 2005 . Logistic regression with incident cases for the primary analysis was used to determine the odds of receiving neurologist treatment. In a second model, we assessed the effect of racesex combinations on the likelihood of receiving neurologist care. Both models included the following covariates: modified comorbidity index and socioeconomic deprivation.

    Diagnosis Of Parkinson’s Disease

    If Parkinson’s disease is suspected, symptoms are reviewed and a physical examination is performed. A neurological exam is also performed to determine how well the nerves are working. There is no definitive diagnostic test for this condition, so diagnosis may include ruling out any other conditions that may cause similar symptoms.

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    Finding The Right Doctor

    Managing Parkinsons disease well can be challenging. Finding a doctor whos well-versed in PD and will help guide you on the journey makes it easier.

    Its natural to begin by discussing initial symptoms with your family doctor or internist, who may refer you to a general neurologist or one specialized in movement disorders to rule out Parkinsons.

    The Parkinsons Foundation recommends people diagnosed with PD seek out a movement disorders specialist one who can become a key player on your healthcare team. For people living far from an academic medical center or a specialist in private practice, we recommend a knowledgeable, nearby general neurologist for most of your care and then traveling a longer distance two to three times each year to see a specialist. Finding a specialist can seem like a daunting task, but it doesnt have to be. The Parkinsons Foundation can guide you step by step through the process of finding one.

    My Top 6 Criteria For Choosing A Doctor

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    Finding the right doctor who meets your needs as a person with Parkinsons disease can be daunting. I have consulted with 11 neurologists, seven of whom were movement disorder specialists , in the five years since my initial diagnosis in 2015.

    Following are my top criteria in choosing what I like to refer to as my partner on this Parkinsons journey:

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    Treatment Of Parkinson’s Disease

    Although there is no cure available for Parkinson’s disease, there are many treatments available to help control symptoms. For most patients, medication is prescribed to increase the brain’s supply of dopamine, which helps to control tremors and problems with movement and walking. Levodopa is the most effective medication for Parkinson’s disease. This natural substance is converted into dopamine when it passes through the brain. Other medications commonly prescribed for Parkinson’s disease may include:

    • Dopamine agonists
    • Anticholinergics
    • Amantadine

    Patients with advanced stages of Parkinson’s disease who are not be responding to medication, may benefit from a surgical procedure known as deep brain stimulation. During this procedure, electrodes are surgically placed within the brain to deliver electrical stimulation and help control movement. Symptoms of Parkinson’s disease may be reduced as a result of this procedure, however, there are risks which may include infection, stroke or brain hemorrhage.

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    What Did The Study Find

    Almost one-third of patients with PD in the study never visited a neurologist. The authors found that certain groups of patients were less likely to see a neurologist. For example, African Americans and women were less likely to see a neurologist than white men. This effect could not be explained by differences in other factors such as income or education. This difference might be important because the authors also found that patients who saw a neurologist lived longer. Patients who saw a neurologist were also less likely to end up in a nursing home than those who did not.

    How Is Parkinson’s Disease Treated

    Parkinson

    Parkinsons disease is a progressive disease, and patients are sometimes not treated with medication initially, Dr. Tinaz says.

    Instead, patients are encouraged to participate in physical activity and it’s even better if it is done together with a group. “There has been a lot of evidence that exercise can help with symptom control and has potential to delay clinical progression of disease,” Dr. Tinaz says. Other lifestyle changes to try first include following a Mediterranean diet, getting enough sleep, and seeking intellectual stimulation.

    Once symptoms start interfering with daily life, patients will be prescribed a medication that will help boost levels of dopamine that diminish as nerve cell damage progresses. While there is no cure for Parkinsons disease, these medications have been proven to reduce symptoms.

    In some cases, such as for those with severe tremor or frequent off periods, the most effective treatment is a surgical procedure called deep brain stimulation. Here, surgeons implant small electrodes in specific sites in the brain, and a battery under the skin in the chest wall. The battery sends electrical signals to the electrodes, which then block targeted areas of brain activity without damaging healthy tissue.

    “I don’t give patients false hope, but I do tell them they still have agency over this. There are so many things patients can do to improve their quality of life,” Dr. Tinaz says.

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