Parkinson’s disease is chronic, progressive movement disorder. The cause is unknown, and while there isn’t currently a cure, researchers are learning more every day.
Treatment options include medication and surgery to manage the symptoms.
Listen in as Dr. Okeanis Vaou, medical director for the American Parkinson Disease Association of Minnesota, talks about the latest advancements in treatment.
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Parkinson’s Disease: Advancements In Treatment Options
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Learn more about Okeanis Vaou, MD
Okeanis Vaou, MD- neurology
Okeanis Vaou, MD, is a board certified neurologist with Noran Neurological Clinic and Abbott Northwestern Hospital. She is fellowship training in Parkinson’s disease, dystonia, essential tremor, autonomic nervous system disorders and sleep-related disorders.Learn more about Okeanis Vaou, MD
Transcription:
Parkinson’s Disease: Advancements In Treatment Options
Melanie Cole (Host): Parkinson's disease is a neurological condition that affects about 1 million Americans. Even if you don't know someone with Parkinson's, you've probably heard of some famous people with this condition, such as Michael J. Fox or Muhammad Ali. While there isn't a cure for Parkinson's, there are number of ways to treat or manage it and researchers are learning more every day. My guest today is Dr. Okeanis Vaou. She's a board-certified neurologist with Noran Neurological Clinic at Abbott Northwestern Hospital. Welcome to the show, Dr. Vaou. Let's start with a little bit about Parkinson's. Explain to the listeners what it is.
Dr. Okeanis Vaou (Guest): Well, thank you for having me to the show. Parkinson's disease is a chronic neurodegenerative neurological condition which affects movement, coordination, balance and also some other symptoms of what we call “non-motor symptoms” - blood pressure, mood, sleep, and many more others.
Melanie: Do we know what causes Parkinson's disease?
Dr. Vaou: We don't really know what causes Parkinson's. We do certainly know that there are some triggers or some environmental factors that may cause Parkinson's, such as pesticides. Genetics can be part of it, only it's quite rare. If you see a young patient develop Parkinson's, then definitely we're thinking or suspecting genetic causes. We really don't know what might cause Parkinson's.
Melanie: The symptoms of Parkinson's are often difficult to diagnose. They kind of go together. Speak about the symptoms and the diagnosis based on those symptoms.
Dr. Vaou: The symptoms of Parkinson's disease, what we call the “cardinal symptoms” are tremor, rigidity, bradykinesia and unsteady gait. Unfortunately, we do not have a test to diagnose Parkinson's at the moment. So, there is no serum test or blood test or any imaging that can diagnose Parkinson's disease. We have to rely on the clinical appearance of the patient, the clinical symptoms.
Melanie: Do you get a detailed description of the symptoms as the family explains it to you or the patient?
Dr. Vaou: Clinical history is very important, so yes. We want to know when it started, how it progressed, and also when the patient is examined in the clinic or in the office, we can tell if they have a resting tremor, whether they're slow in their movement, when they're stiff--their muscles are stiff--and if they're unsteady in the gait. We add these things up, these symptoms up, and make a diagnosis of Parkinson's disease. Like I said, it's a clinical diagnosis, meaning we examine the patient and make a diagnosis. We don't really have a good test as of yet to diagnose Parkinson's. However, the scientific community is really working on trying to find a test and we're much closer now than we ever were before.
Melanie: Depending on the person's symptoms, is there a standard of treatment? What is your first line of defense when you have to tell somebody they have Parkinson's disease?
Dr. Vaou: That's a very good question. Basically, every patient with Parkinson's disease is different in terms of how they present with their symptoms. Some have more tremor. Some might be slower with their movement. Some may be more stiff with their muscles. You don't always get the same symptoms in one patient. Age also plays a role as to what medication you want to choose; how you want to treat the patient. We're talking about individualizing treatment for someone with Parkinson's disease. There are also side effects of medications that may need to be taken into account because if the patient, for example, is sleepy you don't want to give him medication that will make him more sleepy. You want to choose another medication. There is no gold standard of first line medication that you would go to. It's really customizing the treatment for a person with Parkinson's disease.
Melanie: And these medications are intended to deal with the symptoms, yes? They do not slow the progression of the disease.
Dr. Vaou: Correct. What we have now basically treats the symptoms. Parkinson's disease is a lack of dopamine. The cells that are producing dopamine in the brain decrease and, therefore, we have a decreased level of dopamine. So, we're basically supplementing that level of dopamine in the brain, and that's what the medications do. They only treat the symptoms. It's symptomatic treatment and there is no cure or anything to slow down the course of the disease. Having said that, exercise is the only proven treatment that slows down the progression of the disease.
Melanie: That's fascinating. Is this a new development?
Dr. Vaou: Not so much. It is recent but I wouldn't say it's new. Just this year alone there were 5,000 publications about the benefit of exercise in Parkinson's disease and it has been picking up. It was first introduced about 5 or 10 years ago and there's more and more evidence about the importance of exercise in Parkinson's disease. Mostly, it's motor symptoms and their progression.
Melanie: When people have the tremors and these motor symptoms, is there a surgical treatment for Parkinson's? Tell us a little about deep brain stimulation.
Dr. Vaou: Deep brain stimulation improves the quality of life for patients with Parkinson's disease and it also helps them move. It is just another treatment option when medications alone are not as effective any more or there are side effects to them or patients can't tolerate them for one reason or another. If the patient develops dyskinesias, which are basically involuntary dance-like movements, we see in patients caused by one of the treatments for Parkinson's. That's when we usually start considering deep brain stimulation. What deep brain stimulation is, is it’s basically a continuous electric stimulation of the brain with electrodes which are surgically placed in certain targets of the brain and basically treat the symptoms similarly to what medications do, only deep brain stimulation doesn't have side effects. So, that's the benefit. Once you have someone have DBS, then you may decrease the medication that they're already on and provide much better and controlled relief and treatment of the symptoms.
Melanie: Is DBS FDA-approved? And, reassure the listeners about the fact that it is safe and effective.
Dr. Vaou: Right. It's definitely FDA-approved. The history of DBS goes back in the late 1980s when it was first discovered that electrical stimulation of the brain can help with tremors and the motor symptoms of Parkinson's. It was FDA approved for Parkinson's disease in 2002, and in 1997 reapproved for essential tremor. It's mostly safe. Of course, there are some very rare complications of brain hemorrhage and infection and these are only 1%. It's very well-tolerated and recovery is very fast. Like I said, in combination with medication, it improves quality of life and really provides very good control of motor symptoms. Having said that, it doesn't treat all symptoms of Parkinson's. For example, it doesn't treat dementia; it doesn't treat depression; it doesn't directly improve sleep or some of the sleep complications that some of the patients with Parkinson's have, but it definitely improves the stiffness, the tremor, the slower movement and the patient feels better overall.
Melanie: Are there some people for whom this is not an option? Are there some people that are not candidates for DBS?
Dr. Vaou: Yes. Patients who have dementia are not candidates. Patients who are severely depressed are also not candidates. Also patients who do not respond to dopaminergic medications like Levodopa, which is one of the most common medications taken for Parkinson's disease. If the patient does not respond to this medication, then they are not candidates for deep brain stimulation, because you might want to think dopamine controlling the same symptoms as deep brain stimulation will. So, if dopamine is not controlling it, then deep brain stimulation will not, so that patient is not a candidate.
Melanie: Dr. Vaou, what about the caregivers? Because Parkinson's can be quite a devastating disease, both for the patient and for their loved ones, what do you tell their loved ones about dealing with things like the depression and the insomnia and the facial masking and the things that go on when someone is progressing with Parkinson's?
Dr. Vaou: What I usually say, first of all, at this point is just to point out, Parkinson's is not just tremors, not just about feeling stiff or slow, it's about all the other things that come along with it: depression and sleep problems and dementia, other things such as constipation and frequent urination. It involves a lot of other systems in one's body. What I usually tell the caregiver is: first of all, education is key. I want both the patient and their caregiver to get as much education about Parkinson's as possible, for two reasons: one, to identify their symptoms as a result of being from Parkinson's and address them with a neurologist; two, by knowing these symptoms, to really know how to deal with them and to know whether there is treatment or not. You mentioned depression, for example. There are antidepressants medications that can help and treat those symptoms. With every individual symptom that the patient might have, there is also treatment that goes along with it that overall improves the patient's quality of life.
Melanie: Wrap it up for us, Dr. Vaou, if you will, about Parkinson's and what you tell patients and their loved ones everyday about this disease.
Dr. Vaou: I know it's hard when someone is newly diagnosed with Parkinson's disease but, like I said, education is key. They should not forget that exercise is very important and is the only thing that slows the progression of the disease. They should be very hopeful because there are a lot of treatment options to this day and we know that there are many more medications in the pipeline that seem very promising and I feel that a cure is not very far away.
Melanie: Thank you so much for being with us today. You're listening to The WELLcast with Allina Health. For more information you can go to wwwallinahealth.org, that's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.
Parkinson’s Disease: Advancements In Treatment Options
Melanie Cole (Host): Parkinson's disease is a neurological condition that affects about 1 million Americans. Even if you don't know someone with Parkinson's, you've probably heard of some famous people with this condition, such as Michael J. Fox or Muhammad Ali. While there isn't a cure for Parkinson's, there are number of ways to treat or manage it and researchers are learning more every day. My guest today is Dr. Okeanis Vaou. She's a board-certified neurologist with Noran Neurological Clinic at Abbott Northwestern Hospital. Welcome to the show, Dr. Vaou. Let's start with a little bit about Parkinson's. Explain to the listeners what it is.
Dr. Okeanis Vaou (Guest): Well, thank you for having me to the show. Parkinson's disease is a chronic neurodegenerative neurological condition which affects movement, coordination, balance and also some other symptoms of what we call “non-motor symptoms” - blood pressure, mood, sleep, and many more others.
Melanie: Do we know what causes Parkinson's disease?
Dr. Vaou: We don't really know what causes Parkinson's. We do certainly know that there are some triggers or some environmental factors that may cause Parkinson's, such as pesticides. Genetics can be part of it, only it's quite rare. If you see a young patient develop Parkinson's, then definitely we're thinking or suspecting genetic causes. We really don't know what might cause Parkinson's.
Melanie: The symptoms of Parkinson's are often difficult to diagnose. They kind of go together. Speak about the symptoms and the diagnosis based on those symptoms.
Dr. Vaou: The symptoms of Parkinson's disease, what we call the “cardinal symptoms” are tremor, rigidity, bradykinesia and unsteady gait. Unfortunately, we do not have a test to diagnose Parkinson's at the moment. So, there is no serum test or blood test or any imaging that can diagnose Parkinson's disease. We have to rely on the clinical appearance of the patient, the clinical symptoms.
Melanie: Do you get a detailed description of the symptoms as the family explains it to you or the patient?
Dr. Vaou: Clinical history is very important, so yes. We want to know when it started, how it progressed, and also when the patient is examined in the clinic or in the office, we can tell if they have a resting tremor, whether they're slow in their movement, when they're stiff--their muscles are stiff--and if they're unsteady in the gait. We add these things up, these symptoms up, and make a diagnosis of Parkinson's disease. Like I said, it's a clinical diagnosis, meaning we examine the patient and make a diagnosis. We don't really have a good test as of yet to diagnose Parkinson's. However, the scientific community is really working on trying to find a test and we're much closer now than we ever were before.
Melanie: Depending on the person's symptoms, is there a standard of treatment? What is your first line of defense when you have to tell somebody they have Parkinson's disease?
Dr. Vaou: That's a very good question. Basically, every patient with Parkinson's disease is different in terms of how they present with their symptoms. Some have more tremor. Some might be slower with their movement. Some may be more stiff with their muscles. You don't always get the same symptoms in one patient. Age also plays a role as to what medication you want to choose; how you want to treat the patient. We're talking about individualizing treatment for someone with Parkinson's disease. There are also side effects of medications that may need to be taken into account because if the patient, for example, is sleepy you don't want to give him medication that will make him more sleepy. You want to choose another medication. There is no gold standard of first line medication that you would go to. It's really customizing the treatment for a person with Parkinson's disease.
Melanie: And these medications are intended to deal with the symptoms, yes? They do not slow the progression of the disease.
Dr. Vaou: Correct. What we have now basically treats the symptoms. Parkinson's disease is a lack of dopamine. The cells that are producing dopamine in the brain decrease and, therefore, we have a decreased level of dopamine. So, we're basically supplementing that level of dopamine in the brain, and that's what the medications do. They only treat the symptoms. It's symptomatic treatment and there is no cure or anything to slow down the course of the disease. Having said that, exercise is the only proven treatment that slows down the progression of the disease.
Melanie: That's fascinating. Is this a new development?
Dr. Vaou: Not so much. It is recent but I wouldn't say it's new. Just this year alone there were 5,000 publications about the benefit of exercise in Parkinson's disease and it has been picking up. It was first introduced about 5 or 10 years ago and there's more and more evidence about the importance of exercise in Parkinson's disease. Mostly, it's motor symptoms and their progression.
Melanie: When people have the tremors and these motor symptoms, is there a surgical treatment for Parkinson's? Tell us a little about deep brain stimulation.
Dr. Vaou: Deep brain stimulation improves the quality of life for patients with Parkinson's disease and it also helps them move. It is just another treatment option when medications alone are not as effective any more or there are side effects to them or patients can't tolerate them for one reason or another. If the patient develops dyskinesias, which are basically involuntary dance-like movements, we see in patients caused by one of the treatments for Parkinson's. That's when we usually start considering deep brain stimulation. What deep brain stimulation is, is it’s basically a continuous electric stimulation of the brain with electrodes which are surgically placed in certain targets of the brain and basically treat the symptoms similarly to what medications do, only deep brain stimulation doesn't have side effects. So, that's the benefit. Once you have someone have DBS, then you may decrease the medication that they're already on and provide much better and controlled relief and treatment of the symptoms.
Melanie: Is DBS FDA-approved? And, reassure the listeners about the fact that it is safe and effective.
Dr. Vaou: Right. It's definitely FDA-approved. The history of DBS goes back in the late 1980s when it was first discovered that electrical stimulation of the brain can help with tremors and the motor symptoms of Parkinson's. It was FDA approved for Parkinson's disease in 2002, and in 1997 reapproved for essential tremor. It's mostly safe. Of course, there are some very rare complications of brain hemorrhage and infection and these are only 1%. It's very well-tolerated and recovery is very fast. Like I said, in combination with medication, it improves quality of life and really provides very good control of motor symptoms. Having said that, it doesn't treat all symptoms of Parkinson's. For example, it doesn't treat dementia; it doesn't treat depression; it doesn't directly improve sleep or some of the sleep complications that some of the patients with Parkinson's have, but it definitely improves the stiffness, the tremor, the slower movement and the patient feels better overall.
Melanie: Are there some people for whom this is not an option? Are there some people that are not candidates for DBS?
Dr. Vaou: Yes. Patients who have dementia are not candidates. Patients who are severely depressed are also not candidates. Also patients who do not respond to dopaminergic medications like Levodopa, which is one of the most common medications taken for Parkinson's disease. If the patient does not respond to this medication, then they are not candidates for deep brain stimulation, because you might want to think dopamine controlling the same symptoms as deep brain stimulation will. So, if dopamine is not controlling it, then deep brain stimulation will not, so that patient is not a candidate.
Melanie: Dr. Vaou, what about the caregivers? Because Parkinson's can be quite a devastating disease, both for the patient and for their loved ones, what do you tell their loved ones about dealing with things like the depression and the insomnia and the facial masking and the things that go on when someone is progressing with Parkinson's?
Dr. Vaou: What I usually say, first of all, at this point is just to point out, Parkinson's is not just tremors, not just about feeling stiff or slow, it's about all the other things that come along with it: depression and sleep problems and dementia, other things such as constipation and frequent urination. It involves a lot of other systems in one's body. What I usually tell the caregiver is: first of all, education is key. I want both the patient and their caregiver to get as much education about Parkinson's as possible, for two reasons: one, to identify their symptoms as a result of being from Parkinson's and address them with a neurologist; two, by knowing these symptoms, to really know how to deal with them and to know whether there is treatment or not. You mentioned depression, for example. There are antidepressants medications that can help and treat those symptoms. With every individual symptom that the patient might have, there is also treatment that goes along with it that overall improves the patient's quality of life.
Melanie: Wrap it up for us, Dr. Vaou, if you will, about Parkinson's and what you tell patients and their loved ones everyday about this disease.
Dr. Vaou: I know it's hard when someone is newly diagnosed with Parkinson's disease but, like I said, education is key. They should not forget that exercise is very important and is the only thing that slows the progression of the disease. They should be very hopeful because there are a lot of treatment options to this day and we know that there are many more medications in the pipeline that seem very promising and I feel that a cure is not very far away.
Melanie: Thank you so much for being with us today. You're listening to The WELLcast with Allina Health. For more information you can go to wwwallinahealth.org, that's www.allinahealth.org. This is Melanie Cole. Thanks so much for listening.