Heather Russell, RN, has 26 years of experience as a Neuro nurse. After 18 years of shift work, which included working at a children’s hospital and in an Epilepsy unit, she saw the opportunity for her current position as Movement Disorder Clinic Nurse for Dr. Mandar Jog and started her role at London Health Sciences Centre in 2015. Currently, her focus is on patient care and providing information on Advanced or Device Aided Therapies available. Heather is the Coordinator of the Parkinson’s Foundation Center of Excellence at the London Health Sciences Centre in London, Ontario, Canada and a CANN Member.

Host Dan Keller and Dr. Guttman discuss several levodopa delivery methods that are designed to help reduce “off” time. Everyone’s Parkinson’s journey is unique, so whether these methods are right for you will be a decision for you and your health care team. There is a PD myth that levodopa works for a few years and then stops. This is not true; you just need to work with your doctor to find the right frequency, dosing, and delivery methods. In general, the delivery methods Dr. Guttman describes are for people who have had Parkinson’s for years and experience “on-off” fluctuations.

Here is some more information on many of the topics Dr. Guttman brings up:

• A continuous gel infusion of levodopa is available in the U.S. as Duopa (it is called Duodopa in other countries). Visit our Duopa page for more information. Carbidopa is included in the formulation to prevent the nausea that can be caused by levodopa alone.
• What you eat and when can affect the absorption of levodopa. Listen to our nutrition podcast with Dr. Bas Bloem for more information.
• Rytary is carbidopa-levodopa that has both immediate-release and extended-release forms in one pill and is supposed to reduce “off” time. It is not interchangeable with dosages of other carbidopa-levodopa products, so share this Rytary dosing guide with your provider.
• This interview was recorded at the World Parkinson Congress. Dr. Guttman mentions a presentation by Dr. Jay Nutt: Levodopa Over the Last 50 Years: Where We’ve Come and Where We Are Going? (Free registration to watch.)

Dr. Guttman is a movement disorder neurologist at the Centre for Movement Disorders in Toronto, Canada. He provides specialized neurological services to people with movement disorders and is involved with clinical research at the Centre and at the University of Toronto.

Dr. Benjamin Walter is the head of the Section of Movement Disorders and medical director for deep brain stimulation at Cleveland Clinic in Ohio, a Parkinson’s Foundation Center of Excellence. Prior to this role, he held the Penni and Stephen Weinberg Chair in Brain Health at University Hospitals and was an associate professor of neurology and biomedical engineering at Case Western Reserve University School of Medicine.

He is board-certified in neurology. Special interests include DBS, dystonia, functional magnetic resonance imaging (MRI), intrathecal baclofen, the mechanism of effect of DBS, movement disorders, Parkinson’s disease and tremors.

He earned his medical degree from MCP-Hahnemann School of Medicine in Philadelphia. He completed his internship in internal medicine and residency in neurology at Emory University Hospital, as well as fellowship training in movement disorders with an emphasis on intraoperative mapping and deep brain stimulation.

In his research laboratory, Dr. Walter uses functional MRI to study mechanisms underlying changes in Parkinson’s disease and dystonia, participating in several projects funded by the National Institutes of Health (NIH). He is currently an investigator on an NIH-funded project exploring intracortical control of arm and hand function restored by functional electrical stimulation in people with spinal cord injury (Brain Gate). He has also served as an investigator on the Enhanced Exercise Study for Patients with Parkinson’s Disease (EXCEED) study of how exercise and education affects people with Parkinson’s disease and depression, as well as on an NIH-funded project to develop an “intelligent” bicycle for rehabilitation in Parkinson’s patients.

Dr. Walter is the author of more than 20 articles in peer-reviewed medical journals, as well as five book chapters. He has presented posters and abstracts at more than 20 international and national peer-reviewed medical conferences.

In addition, Dr. Walter has served as an invited lecturer/instructor at national and international medical education conferences and colloquia. He is grant reviewer for the NIH and the American Association for the Advancement of Science and also reviews manuscripts for several prominent medical journals. He is a member of the Organization for Human Brain Mapping, Society for Neuroscience, American Academy of Neurology and the Movement Disorder Society.

John L. Lehr leads the Parkinson's Foundation as president and chief executive officer. John guides the overall Foundation’s strategy of mission programs and resources that make life better for people with Parkinson’s. He works to expand the Foundation’s reach, research initiatives and presence, while working to improve health equity among the Parkinson’s community and the underserved. He ensures that all Foundation programs and resources aim to improve care and advance research toward a cure.

Dr. Irene H. Richard is Professor of Neurology with a secondary appointment in Psychiatry at the University of Rochester in Rochester, NY. After graduating from Cornell University in 1987 and receiving her MD from the Yale University School of Medicine in1991, Dr. Richard completed neurology residency at the University of Rochester in 1995, followed by NIH-funded fellowship training in Movement Disorders and Experimental Therapeutics in 1997. She joined the faculty of the University of Rochester in 1997. Dr. Richard provides neurological care for patients with Parkinson’s disease and related conditions and her clinical research program focuses on the psychiatric aspects of these illnesses. More recently, with support from a PF community grant, she has also been working with her team on efforts to optimize hospitalization for patients with PD. She is the author of numerous scientific articles, editorials and book chapters and has been the recipient of career development awards and research grants, including one from NIH to lead a multi-center clinical trial evaluating the treatment of depression in PD. Dr. Richard is Director of the University of Rochester’s Movement Disorders Fellowship Program, LBDA Research Center of Excellence, and Parkinson Foundation Center of Excellence.

Dr. Lynda Nwabuobi is an Assistant Professor of Clinical Neurology at New York Presbyterian/Weill Cornell Medical College, specializing in Parkinson’s Disease and Movement Disorders. She diagnoses and treats individuals with Parkinson’s disease, tremors, and other neurological diseases with the goal of delivering compassionate and individualized care using a holistic and multidisciplinary approach. In addition to her clinical work, Dr. Nwabuobi has interests in health disparities research, teaching, advocacy, and community engagement/outreach. She has published several articles in peer-reviewed journals and has presented her work at national and international conferences. She is actively involved in educating underserved communities about Parkinson’s disease with the goal of improving access to care.

Dr. Taylor Rush is a Clinical Health Psychologist at the Cleveland Clinic’s Center for Neurological Restoration. She graduated with a Bachelor of Science degree in psychology from the University of Florida, a Master of Arts degree in clinical psychology from the Forest Institute and a PhD in clinical health psychology from East Carolina University. She has been on staff with the Cleveland Clinic since 2015 and is a Clinical Assistant Professor of Medicine in the Lerner College of Medicine at Case Western Reserve University. Currently, she serves as Director of Behavioral Health Services, leading a team that supports patients with Parkinson’s and other movement disorders. Dr. Rush helps individuals adjust to diagnosis, manage depression and anxiety, improve communication, prepare for surgery like DBS, and incorporate mindfulness to support emotional and physical well-being.