Not all medical interventions for Parkinson’s disease (PD) involve drugs. Two other main treatments are deep brain stimulation (DBS) and focused ultrasound (FUS). DBS uses a surgically implanted electrical pulse generator connected to electrodes placed in the brain to stimulate areas involved in PD. FUS does not require surgery but aims ultrasound – high frequency sound waves – at a specific area of the brain to relieve Parkinson’s symptoms.

Each technology has its uses, advantages, and disadvantages. In this podcast episode, Kyle Mitchell, MD of Duke University in North Carolina discusses the two treatments, how each works, which patients may do best with either of them, and some caveats. He also looks ahead at what is in development.

Released: September 7, 2021

Two important issues regarding Parkinson’s medications are when to initiate them in the early phases of the disease and how to ensure that people use their medications on time, every time. Myths and misconceptions have surrounded the controversial question of when to start taking medication. Fortunately, research has provided some answers, indicating that early initiation of levodopa or other medications does not diminish their usefulness later on. In this episode, Dr. Indu Subramanian, Director of the Parkinson’s Disease Research, Education and Clinical Center at the West Los Angeles Veterans Affairs Medical Center, discusses what has been learned about the timing of the initiation of therapy.

She also provides strategies for getting the most benefit from medications, from taking them at the right time every time, to establishing other regular schedules, to working with your doctor at every visit to optimize benefits and minimize side effects. And as a neurologist who is also board certified in integrative medicine, Dr. Subramanian advocates for incorporating mind-body, movement, and breathing techniques, as well as connecting with nature when using medication and other traditional Western medical practices.

Released: July 27, 2021

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La estimulación cerebral profunda (DBS, por sus siglas en inglés) es un tratamiento neuroquirúrgico para los síntomas de la enfermedad de Parkinson (EP, o PD, por sus siglas en inglés). El procedimiento ha sido realizado en miles de pacientes. ¿Es este procedimiento adecuado para usted?

Si usted o un miembro de su familia con Parkinson está considerando la estimulación cerebral profunda, hay varias medidas importantes que debe adoptar. La primera es aprender todo lo que pueda sobre este procedimiento. Lea mucho, reúna opiniones y hable con su médico. Además, sería conveniente que hablara con alguien que ya se haya hecho una.

Después de aprender más sobre la estimulación cerebral profunda, la siguiente medida es pedir una cita en un centro que se especialice en el tratamiento quirúrgico de la enfermedad de Parkinson. Es importante que cualquiera que esté considerando esta cirugía sea evaluado por un neurólogo que esté familiarizado con el procedimiento, los beneficios esperados y los posibles riesgos.

Si su neurólogo piensa que usted es un buen candidato para la cirugía, y usted decide seguir adelante, su siguiente medida será conocer al neurocirujano para informarse más y prepararse para la cirugía. El típico paciente que se somete a una cirugía de estimulación cerebral profunda ha tenido Parkinson durante ocho a dieciséis años. Los mejores candidatos para la cirugía tienden a estar dentro de dos categorías. Una es la de los pacientes con temblores severos o discapacitantes, que no responden a la medicación antiparkinsoniana. La segunda es la de las personas que experimentan graves fluctuaciones motoras que no se logran controlar con ajustes a los horarios de medicación. A lo largo del día, tienen muchos momentos de discinesias importantes intercalados con desgastes rápidos y crisis de “off”.

No todo el mundo es un buen candidato para la cirugía. Es importante reconocer que algunos de los síntomas del Parkinson responden bien a la estimulación cerebral profunda y otros no. La decisión de someterse a la cirugía depende de una evaluación crítica de los síntomas específicos de cada persona. Los síntomas que responden bien a la intervención incluyen el temblor, la rigidez, la bradiquinesia, la distonía y las discinecias. Los síntomas que no responden bien a la estimulación cerebral profunda incluyen los trastornos del equilibrio, los bloqueos (“freezing” en inglés) y las caídas, la postura encorvada y las alteraciones del habla

El resultado de la cirugía estará influenciado por varios factores. Uno de los mejores pronósticos de un buen resultado es la respuesta que la persona tenga a la levodopa, es decir, las personas cuyos síntomas aún responden bien a las dosis individuales del medicamento y que tienen movilidad durante sus períodos “on”, pueden esperar beneficios de la estimulación cerebral profunda.

Usted puede haber escuchado que la estimulación cerebral profunda no debe ser considerada hasta que los medicamentos del Parkinson se hayan vuelto completamente ineficaces. Esto no es verdad. Cuando los medicamentos dejan completamente de funcionar, la estimulación cerebral profunda tampoco funcionará. La cirugía promete más eficacia para aquellos pacientes que experimentan complicaciones con sus medicamentos, por ejemplo, discinecias, pero que continúan respondiendo bien a las dosis individuales de levodopa.

Los mejores candidatos para esta cirugía son personas que tienen un Parkinson típico con temblor, que responden a la levodopa, que están en buen estado de salud, que tienen la mente ágil, y que poseen una buena red de apoyo de familiares y amigos. La edad avanzada no excluye a quienes de otra manera son personas sanas que pueden ser un posible candidato para la estimulación cerebral profunda.

Los peores candidatos para la cirugía son las personas que no tienen un Parkinson típico y no responden bien a la levodopa. Los pacientes con demencia, apatía, depresión, mala salud y escaso apoyo familiar no deben someterse a una cirugía de estimulación cerebral profunda.

Cada persona es única, y para cada una, los objetivos de la cirugía van a ser diferentes. Para algunos, la necesidad más apremiante podría ser controlar el temblor discapacitante. Para otros, podría ser la necesidad de reducir las discinecias. Es muy importante que cada persona que esté contemplando la cirugía tenga una idea clara de lo que puede o no lograrse con esta intervención.

El rol del neurólogo, en colaboración estrecha con el neurocirujano en un centro médico especializado, es hacer una cuidadosa evaluación de cada persona que esté considerando la estimulación cerebral profunda. Basándose en una cuidadosa historia clínica y examen neurológico, el equipo puede determinar quién debería (o no debería) someterse a esta cirugía y predecir con precisión el resultado que se espera.

Es importante recordar que la estimulación cerebral profunda es un procedimiento electivo. Los neurólogos y los neurocirujanos harán sus recomendaciones, pero serán los pacientes y sus familiares los que tienen la responsabilidad de la decisión final. La estimulación cerebral profunda no es una cura para el Parkinson y no retrasa su avance, pero para muchos, puede reducir dramáticamente algunos síntomas del Parkinson y mejorar significativamente la calidad de vida de la persona.

Seis medidas a considerar

1. Hable con su neurólogo
2. Consiga información sobre la estimulación cerebral profunda
3. Hable con alguien que ya se haya hecho una estimulación cerebral profunda
4. Visite un centro que se especialice en cirugía para la EP
5. Haga una cita con un neurólogo del centro
6. Conozca al neurocirujano

La impresión ha sido posible gracias a una subvención educativa otorgada por Medtronic. El contenido ha sido creado independientemente por la Parkinson's Foundation.

There is increasing interest in the Parkinson's patient and research community about the potential for cannabis-based products to treat PD. In this expert briefing we will review what cannabis is, how it works in the brain and why there is so much excitement about its potential in PD. We will then review animal and basic science studies suggesting some promise in treating motor symptoms and slowing the progression of PD. We will conclude by reviewing the evidence to date in human studies, suggestions for future research and practical advice for persons interested in trying cannabis-based products.

At the end of this presentation, participants will:

1. Define cannabis, cannabinoids and endocannabinoids
2. Review the basic science of the potential of cannabinoids to affect Parkinson's and other movement disorders
3. Understand the current state of the evidence of cannabinoids as a treatment for Parkinson's
4. Know the most common side effects of cannabinoid-based therapies

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Presenter

Benzi M. Kluger, M.D., M.S
Associate Professor
University of Colorado Hospital

Medication options for Parkinson’s disease (PD) are constantly evolving and vary for each individual. Choosing medications depends on many variables; including motor fluctuations, symptom variability and other existing health issues. In this webinar, Dr. Rajesh Pahwa shares new treatment options to be on the lookout for within the next two years and explains who would be the best candidates for these new therapies available.

Presenter

Rajesh Pahwa, MD
Laverne and Joyce Rider Professor of Neurology
Chief, Parkinson and Movement Disorder Division
Director, Parkinson’s Foundation Center of Excellence
University of Kansas Medical Center

As most people with Parkinson’s disease (PD) and their care partners know, medication management is crucial for controlling PD symptoms. Given that many people need to take medication multiple times a day, “on time every time” becomes a way of life, regardless of where one is – at home, at work, visiting with friends, shopping, or traveling. Ironically, one of the most difficult places to get medications on your individual schedule is in the hospital. Hospitals have set times to dispense medications, so a hospitalized person with Parkinson’s or their care partner needs to impress upon the staff that Parkinson’s medicines have to be given on the patient’s schedule, not the hospital’s.

Rose Lang’s husband, John, fell and broke his hip, resulting in his transport to a local hospital and several hours in the emergency department. Fortunately, he brought some of his pills with him and took them while waiting to be admitted to a room in the hospital. But even then, Rose, a retired pharmacist, had to educate the medical and nursing staff about the need for John’s “pills on time, every time.” She is also a Parkinson’s Foundation Ambassador, so John arrived at the hospital with his Aware in Care kit, and Rose made ample use of the resources within the kit to inform and educate the hospital staff caring for her husband.

The Parkinson’s Foundation Hospital Safety Guide is the updated and improved version of the former Aware in Care Hospital Safety kit, which you’ll hear referenced in this episode. The Guide has new, vital information, based on research and feedback, prioritizing what is most important — staying safe and empowered when hospitalized with Parkinson’s.

To learn more about the updated Hospital Safety Guide, or for information about becoming a hospital safety focused Parkinson’s Foundation Ambassador, visit Parkinson.org/HospitalSafety.

Released: June 29, 2021
Updated: July 9, 2024

Parkinson's disease (PD) is complicated by a number of comorbid psychiatric symptoms that often overlap with the motor and other physical aspects of PD or may be caused by PD medications used to treat motor symptoms (e.g., impulse control disorders and dopamine agonists). In this webinar, Dr. Marsh will focus on the overlap of motor, cognitive, and psychiatric aspects of PD. Additionally, she will describe the features of comorbid psychiatric disturbances, including depression, anxiety and psychosis along with general approaches to treatment.

Learning Objectives: At the conclusion of this webinar, the participants will:

1. Understand the relationships between motor, cognitive and psychiatric dysfunction in PD over the course of the disease.
2. Understand the common psychiatric diagnoses seen in patients with PD.
3. Be familiar with appropriate treatments for neuropsychiatric disturbances in PD.

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Presenter

Laura Marsh, MD
Professor of Psychiatry and Neurology, Baylor College of Medicine
Director, Mental Health Care Line
Michael E. DeBakey VA Medical Center

In this webinar, Dr. Pfeiffer will focus on the detection and effective treatment of non-motor symptoms other than traditional PD medications. He will address how non-motor symptoms, such as impaired sense of smell, sleep behavior changes, constipation and depression may be present years before the classic motor features of PD appear. You will take away specific recommendations on how to cope and live optimally with these non-motor symptoms.

Learning Objectives: At the conclusion of this webinar, the participants will:

1. Recognize that non-motor symptoms, such as impaired olfaction, REM sleep behavior disorder, pain, constipation and depression may be present years before the classic motor features of PD appear.
2. Understand that non-motor features frequently become the most troublesome features of PD as it advances.
3. Be aware that treatment other than traditional PD medications may be needed for non-motor features of PD.

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Presenter

Ronald Pfeiffer, MD
Oregon Health and Sciences University
OHSU Parkinson Center
Parkinson’s Foundation Center of Excellence

Medication is a mainstay of treatment of Parkinson’s disease (PD), and can vary for each person with PD. Each medication has its own properties, and healthcare professionals have reasons to choose certain ones at various times as conditions warrant. At those times, people with PD and their care partners need to ask questions about the reasons for starting specific medications, what they can expect, and whether they will interact well with other medications. This advice applies to all medications, not just ones for PD. All healthcare providers need to be aware that someone has PD and what medications they are taking because not only can they interact with other medications, but they may also affect what procedures can be performed and when.

Emily Peron, PharmD, of Virginia Commonwealth University School of Pharmacy in Richmond discusses these issues and more, with advice about medications, their effects and adverse effects, and medication changes.

Released: February 25, 2020
Updated: July 9, 2024

It is estimated that about one in six people with Parkinson’s disease (PD) taking dopaminergic medication will develop an impulse control disorder (ICD) sometime during the course of their disease. Such impulsive behaviors may include uncontrolled gambling, eating, shopping, sexual activity, or punding, a purposeless activity in which a person repetitively organizes, sorts, or collects items. ICD’s are more likely to occur in older people on dopamine agonists than in younger people. Some forms of ICD can have devastating outcomes personally or within the family. Fortunately, these adverse effects of the drugs can often be managed well, especially if they are caught early, and in this regard, the family and care partners are key to recognizing and discussing them with the person with PD and the neurologist.

In this podcast, Dr. Gregory Pontone, Director of the Parkinson’s Neuropsychiatry Clinic at Johns Hopkins School of Medicine, a Parkinson’s Foundation Center of Excellence, discusses forms of ICD’s, some means to recognize them, and tools for communicating about them.

Released: February 9, 2021

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