Seeing A Movement Disorder Specialist
A movement disorder specialist will work closely with your neurologist or current doctor to plan your care and follow-up. A movement disorder specialist also is likely to have relationships with other specialists and allied care professionals who have experience with PD, including physical, occupational and speech therapists. A team of professionals can help provide more holistic care and address your specific needs.
Even if youve been treated for Parkinsons for some time, you may want to consult a movement disorder specialist to:
- review your current medications and recommend adjustments if needed
- assemble a team of health care professionals who will work together to determine the most appropriate treatment for your changing condition
Hear what our community suggests for preparing for an MDS appointment.
What Happens At The Exam
If your doctor thinks you might have Parkinsonâs disease, theyll recommend that you see a specialist who works with nervous system issues, called a neurologist. One whoâs also trained in movement disorders, like Parkinsonâs, may be able to make the right diagnosis faster.
Your neurologist will probably want to see how well your arms and legs move and check your muscle tone and balance.
They may ask you to get out of a chair without using your arms for support, for example. They also may ask a few questions:
- What other medical conditions do you have now or have you had in the past?
- What medications do you take?
- Has your handwriting gotten smaller?
- Do you have trouble with buttons or getting dressed?
- Do your feet feel âstuckâ to the floor when you try to walk or turn?
- Do people say your voice is softer or your speech is slurred?
Tell your doctor if youâve noticed a change in your sense of smell or you have trouble with sleep, memory, or mood.
Parkinsonâs disease can look different from person to person. Many people have some symptoms and not others.
Parkinson’s Disease And Movement Disorders Center
Wang Ambulatory Care Center
Parkinson’s Disease and Movement Disorders Center 8th Floor, Suite 835
To schedule an appointment:
Appointments can be scheduled by calling:
Prior to your first appointment, ask your primary care physician or referring doctor to fax pertinent medical records to the office.
Translation services are available. Please inform us if you need the assistance of a translator.
If you are a new patient to Mass General:
Call to obtain a registration number:
What to bring to your appointment:
- Your registration card, insurance card, and co-pay
- Any medical records and MRI scans that have not been sent to the office
- List of your current medications
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A Multidisciplinary Approach To Care
Parkinsons disease is a condition that can affect different aspects of your life, including your mobility, mood, and sleep. We work with a highly trained and dedicated team of specialists that are all focused on helping you live better with Parkinsons.
- A Nurse Practitioner can help your physician provide you the best care and address issues about medications and other Parkinsons-related issues.
- A Physical Therapist can evaluate and treat you to optimize your mobility, physical activity and exercise, and safety.
- An Occupational Therapist can help you stay active and independent in your daily activities.
- A Speech Therapist can evaluate you and provide recommendations and treatment if the Parkinsons is affecting your speech or swallowing.
- A Social Worker can answer your questions and provide counseling about lifestyle transitions, options if you need help with your care, and financial and work-related issues.
Working With Your Care Team
Once you have chosen members of your care team how can you best interact with them? You and your team want the same thing: They want to give you the best possible care they can and you want to receive the best care available. Why then do so many persons with PD not get the best possible care available? One reason is that communication between patient and care team breaks down.
How can you keep the communication lines between you and your healthcare team open? Here are a few tips.
For every visit to a health professional try to have the following information written down so that you can hand it over to the secretary instead of having to repeat it ad infinitum:
- Your name
- Insurance information and member number
- Date of birth social security number
- Current medications, including over the counter medications and any nutritional supplements you use, the dose you take, and the purpose of the medication
- Known allergies or adverse reactions to medications or common medical equipment
- Current health problems and dates of onset
Don’t forget that medication errors are all too common. You should learn a few ideas to reduce the chance of a medication error.
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Building On A Rich History
The Parkinson’s Disease and Movement Disorders Center is one of four entities comprising the Mass General Movement Disorders Unit. Our hospital has a long history of conducting research into Parkinson’s disease and caring for patients with this and other movement disorders. Robert Schwab, MD, laid the groundwork for the Movement Disorders Unit in the 1940s when he published his first research paper on Parkinson’s disease.
John Growdon, MD, serves as director of both the Parkinson’s Disease and Movement Disorders Center and the Movement Disorders Unit. His clinical interests include the cognitive and behavioral aspects of Parkinson’s disease and related disorders. Our staff includes over a dozen neurologists who specialize in the treatment of Parkinsons disease and movement disorders.
Mass General has earned the prestigious quality of Center of Excellence from the Parkinsons Foundation. In addition, our clinics physicians serve of advisory committees for the Parkinson Study Group and Michael J. Fox Foundation.
Medication For Parkinsons Disease
Once the doctor diagnoses Parkinsons disease, the next decision is whether a patient should receive medication, which depends on the following:
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The degree of functional impairment
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The degree of cognitive impairment
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Ability to tolerate antiparkinsonian medication
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The advice of the attending doctor
No two patients react the same way to a given drug, therefore, it takes time and patience to find an appropriate medication and dosage to alleviate symptoms.
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Look For A Parkinsons Specialist
Both general neurologists and movement disorders specialists care for people living with Parkinsons. It takes about 12 years in the U.S. to become a general neurologist a doctor who works with brain and central nervous system conditions. This includes a four-year undergraduate college degree, four years in medical school and three to four more years of specialized training in a neurology residency. General neurologists typically work in a hospital, or private or group practice. Some neurologists treat many people with Parkinsons and are knowledgeable about the disease. However, most neurologists have diverse practices, of which PD represents only a small percent.
Most movement disorders specialists are neurologists who have completed another one or two years of movement disorders training, a neurology sub-specialty. Movement disorders specialists may see patients in a private practice or at university medical centers. They often perform clinical or basic science research in addition to caring for patients. They may also teach doctors who are becoming specialists.People with Parkinsons may constitute 50 percent or more of a specialists practice. With this level of experience, a movement disorders specialist will be more familiar with the range of available Parkinsons medications, how they work and possible side effects. A movement disorders specialist is also more likely to discuss the role of clinical trials.
Risk Factors For Parkinson’s Disease
While a primary cause for PD is not yet known, certain risk factors can increase a persons likelihood of developing the disease:
- Age: PD is rare in young people. People who develop the disease are usually around 60 or older, and the risk increases with age.
- Exposure to environmental toxins: Exposure to certain herbicides and pesticides can increase risk.
- Gender: Men are more likely to develop PD than women. On average, three men will develop the disease for every two women.
- Heredity: Having a close relative with PD increases the chances of developing the disease. However, that risk is still small unless family members develop the disease at a young age.
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What Causes Parkinson’s Disease
PD is a disorder of the nervous system. A small part of the brain, called the substantia nigra, is mainly affected. This area of the brain sends messages down nerves in the spinal cord to help control the muscles of the body. Messages are passed between brain cells, nerves and muscles by chemicals called neurotransmitters. The brain cells in the substantia nigra produce dopamine, the main neurotransmitter.
If you have PD, a number of cells in the substantia nigra become damaged and die. The exact cause of this is not known. Over time, more and more cells become damaged and die. As cells are damaged, the amount of dopamine that is produced is reduced. A combination of the reduction of cells and a low level of dopamine in the cells in this part of the brain causes nerve messages to the muscles to become slowed and abnormal.
Getting To A Movement Disorder Specialist
If you live in a rural area or have difficulty traveling, it may be challenging to find or visit a movement disorder specialist. One option might be to travel to see a movement disorder specialist once or twice a year and follow up with a local general neurologist or primary care doctor more frequently. Any time spent with a specialist may be helpful.
Technology, too, may help. Some hospitals and services can connect you with a Parkinson’s specialist without you having to leave your home. Parkinson’s Disease Care New York, for example, offers people in the state of New York video calls through a computer, tablet or smartphone with a movement disorder specialist, a neurologist or a Parkinson’s-trained nurse at no cost. Ask your doctor or support group about telemedicine opportunities.
Be Part of the Answer
You have the power to impact your future and the future of millions living with Parkinson’s disease. Explore clinical research participation today.
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Consider The Age And Time Factor
Doctors also keep in mind other factors when diagnosing Parkinson’s. For instance:
- The disease is not common in people younger than 50.
- Diagnosing Parkinson’s can be tricky and may take time.
- Other diseases can cause similar symptoms. Your doctor will try to rule out other diseases that mimic Parkinson’s such as .
When To See A Doctor
If you observe at least two or three of these main early signs of Parkinsons disease or your daily tasks become more difficult and lengthy to do, then you need to seek a Neurologist. Dr. Pankaj Singh can help you find out if Parkinsons disease is the reason behind the symptoms and will diagnose the disease and treat it accordingly.
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Surgery For Parkinsons Disease
Based on the severity of the condition and the medical profile, the doctor may recommend surgery as one treatment option for Parkinson’s disease.
There are several types of surgery that may be performed that can help patients with Parkinson’s disease. Most of the treatments are aimed at helping the tremor or rigidity that comes with the disease. In some patients, surgery may decrease the amount of medication that is needed to control the symptoms.
There are three types of surgeries that may be performed for Parkinson’s disease, including the following:
It is important to remember that surgery may help with symptoms of Parkinson’s disease, but does not cure the disease or stop the progression of the disease.
General Strategies For Getting The Most Out Of Your Care Team
It’s important to be an active partner in your care. Try to resist adopting the role of a passive patient who just follows the orders of the doctors. Ask questions. But ask them in a cordial way in order to learn. Ask questions so that you can maximize the benefits of any treatment you undergo. Try also to avoid the opposite danger of asking too many questions and of taking over the role of doctor yourself. You will have to learn to accept the care of others. Let them do their job. Learn from them. Partner with them. If you can establish this kind of partnership with your care team you and your family will find it easier to cope with all the challenges that PD will throw at you over the years.
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What Lifestyle Changes Can I Make To Ease Parkinsons Symptoms
Exercise: Exercise helps improve muscle strength, balance, coordination, flexibility, and tremor. It is also strongly believed to improve memory, thinking and reduce the risk of falls and decrease anxiety and depression. One study in persons with Parkinsons disease showed that 2.5 hours of exercise per week resulted in improved ability to move and a slower decline in quality of life compared to those who didnt exercise or didnt start until later in the course of their disease. Some exercises to consider include strengthening or resistance training, stretching exercises or aerobics . All types of exercise are helpful.
Eat a healthy, balanced diet: This is not only good for your general health but can ease some of the non-movement related symptoms of Parkinsons, such as constipation. Eating foods high in fiber in particular can relieve constipation. The Mediterranean diet is one example of a healthy diet.
Preventing falls and maintaining balance: Falls are a frequent complication of Parkinson’s. While you can do many things to reduce your risk of falling, the two most important are: 1) to work with your doctor to ensure that your treatments whether medicines or deep brain stimulation are optimal and 2) to consult with a physical therapist who can assess your walking and balance. The physical therapist is the expert when it comes to recommending assistive devices or exercise to improve safety and preventing falls.
Doctors Who Treat Parkinsons Disease
Primary care physicians are often the first to see patients with symptoms of Parkinsons disease. Symptoms of Parkinsons disease mimic those of other conditions, and Parkinsons disease is widely misdiagnosed. Since early and expert intervention can ensure proper diagnosis and effective treatment, it is important to be evaluated at an advanced brain center as soon as possible.
The multidisciplinary team at the Weill Cornell Medicine Brain and Spine Centers Movement Disorders service expert neurosurgeons along with their team of physicians, nurse practitioners, physician assistants, nurses, physical therapists, and pain management specialists provide comprehensive, integrated care for patients with Parkinsons disease and many other conditions of the brain. Patients receive a complete continuum of care, from diagnosis to treatment and recovery.
We generally begin with nonsurgical, non-invasive options to treat Parkinsons disease, usually managed by one of our expert movement disorders neurologists . For patients who do need surgery, we offer the latest in minimally invasive and non-invasive surgical techniques using state-of-the-art equipment. Patients respond faster, have less pain, and get back to their normal daily activities sooner than they could with older surgical methods.
At the Weill Cornell Medicine Brain and Spine Center, patients with Parkinsons disease may also be seen by:
- Associate Professor of Clinical Neurological Surgery 718-780-5176
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Brain Imaging Can Help With Diagnosis
Doctors use two tests that take detailed pictures of your brain. Each one may help your doctor make a diagnosis. These tests are:
- PET scan: This shows how your brain functions. It shows how the brain uses sugar. This scan can help tell the difference between Parkinson’s and .
- DaTscan: This shows problems with brain cells that make dopamine. Healthy brain cells light up during the test. Cells without enough dopamine appear dark. This scan can help your doctor tell the difference between Parkinson’s and a brain disease called .
Imaging studies are a newer way to diagnose Parkinson’s. However, not every healthcare facility can do them. It takes an experienced doctor to interpret the scans accurately. These scans also can be very expensive. Be sure to check with your insurance company ahead of time to see whether you are covered and what your out-of-pocket costs will be.
What Is A Movement Disorder Specialist
Unlike a broad-scale neurologist, a movement disorder specialist focuses specifically on conditions, like PD, that affect movement. Movement disorder specialists may also help treat tics, tremors, chorea , and dystonia . Like any other specialist, a movement disorder expert will work with your existing healthcare team, to provide a holistic approach to your care. Most, if not all, of the experts on your team can collaborate to help develop the best care plan for you.1
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Deep Brain Stimulation Surgery
As Parkinsons disease progresses, deep brain stimulation surgery may become an option. Our team is one of the most experienced in the United States. Under the direction of Dr. Delaram Safarpour, Dr. Kim Burchiel, an OHSU neurosurgeon, pioneered asleep DBS so you dont have to be awake during surgery.
For this procedure, our team places tiny electrodes in your brain. The electrodes are connected to a small pacemaker-like device placed under the skin of your chest. The device sends mild electrical pulses to regulate movement and control Parkinsons symptoms such as:
- Tremors
- Slowness
- Imbalance
In some parts of the state, you can have follow-up care at a doctors office in your community.
Colin Halstead had deep brain stimulation surgery at OHSU to treat his Parkinsons. It gave me my life back, he says.
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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