Gina Kaye (Host): Welcome to Meaningful Medicine, a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips for navigating medical decisions and building a healthier future.

I'm Gina Kaye, and with me is Dr. John Mason, neurologist for Novant Health. And today, we are talking about movement disorders. Welcome, Dr. Mason. It's great to have you on the show.

John Mason, DO: Thanks for having me, Gina.

Host: Wonderful. To begin our discussion, you specialize in treating movement disorders. Can you give us a brief overview of movement disorders?

John Mason, DO: Of course. So, movement disorders is a broad field of medicine. Essentially, it has to do with anything that really affects movement. This can range from many diseases, including Parkinson's disease, essential tremor, dystonia, progressive supranuclear palsy, also known as PSP, multiple systems atrophy, also known as MSA, Lewy body dementia, tics, Tourette's, and many more.

The interesting thing with movement disorders is those conditions vary a lot, but they also vary in how they look, which is a big emphasis on our field is how something looks and how we describe it. Some of those conditions, patients move less, like in Parkinson's disease, and some of them they move more, like in tremors and tics. So, a wide variety of conditions.

Host: Yeah, there sure are. Before we get to the treatments, is there anything we can do to lower our risk of developing a movement disorder?

John Mason, DO: Yes. There are several things. Unfortunately, there's nothing we can do that we know of at this point that truly prevents the movement disorders from occurring, and they're all very different and occur for different reasons. But as a general rule of thumb, the number one thing I typically recommend to patients is exercise, exercise, exercise, so, there's been a number of studies that have shown that pretty consistent exercise reduces the risk of developing Parkinson's disease. And this is applied to other neurodegenerative disorders like Alzheimer's as well.

Diet is something of a hot topic right now in our field. While there haven't been any studies that truly show that any one diet significantly reduces risk, there's some evidence that suggests that it can possibly have an effect. The diets that are typically looked at are Mediterranean style diets. There's one called a MIND diet right now. These are diets that are rich in vegetables, fruits, nuts, fish, olive oil, and they're low in processed foods such as like red meats and really heavily processed foods.

Another interesting thing is avoiding certain types of exposures. So, one of the exposures that's associated with developing Parkinson's disease, for instance, is pesticide exposure. So if you're going to be around pesticides, using the appropriate protections as able. I always tell my patients getting good sleep, non-interrupted sleep is key and critical. So, you really wanna practice good sleep hygiene, making sure you're getting between seven to nine hours of sleep a night.

And then, lastly, I would say avoiding head trauma when possible. That's kind of a no-brainer, but repeated head traumas is associated with developing several different neurodegenerative disorders. And so if you're going to be participating in an activity that puts you at risk for head trauma, making sure you wear a helmet.

Host: Let's talk about medication therapy. Can you share the latest on medication treatments available for movement disorders?

John Mason, DO: Yes, it's an exciting time for movement disorders. And there's quite a bit of medication, being looked at and developed. I'll start with the most recent kind of ones that are released. So, there's two medications for Parkinson's. One is called Crexont. So, this is a medication that is a long-acting formulation of a classic and older medication called carbidopa/levodopa. It's formulated a little bit differently in that it helps it last longer and give patients benefit over a longer period of time.

Another interesting one that kind of looks at the same issue is called Vylev. So, this is a medication that instead of taking it orally, it utilizes a pump and is injected just underneath the skin. It's a 24-hour, meaning that it's on all the time. And essentially, what this medication does is prevent the fluctuations in medication levels by delivering the medication at kind of a constant rate. So, it's very interesting.

There's a few medications that are in the pipeline, that are currently being under review for the FDA. One of them is for essential tremor. It's ulixacaltamide. And then, there's another one being looked at for Tourette's, which is ecopipam. And then, lastly, the most exciting ones, at least in my opinion, are different types of medications. Instead of helping with a specific symptom, these medications look at changing the trajectory of the disease or modifying the underlying disease itself.

So for Parkinson's, there's a medication called prasenismab that's currently being studied, where it actually targets the abnormal protein that's found in Parkinson's disease. This abnormal protein's called alpha-synuclein. And so, that's currently being investigated right now. And then, there's another group of medications that are being looked at for Huntington's disease, where they're using gene therapy to reduce the amount of Huntington protein that's present. And so, both of these are thought to potentially change the course of the disease, which would be huge for us because we currently don't have anything that does this.

The one important thing to note with these is a lot of medications are being studied, but what we look for is the more information we have and the more medications we have, the more options we have. And so, hopefully in the future, we'll have some additional therapies as well.

Host: I understand that some patients may be candidates for surgical procedures as well. Can you talk about how you collaborate with neurosurgery and what these procedures look like?

John Mason, DO: This is a particular interest of mine, so I'm glad you brought it up. So, the first one is deep brain stimulation, which sounds very scary, but it's an advanced therapy that we use for a variety of conditions, including Parkinson's disease, essential tremor, dystonia, and very rarely for Tourette's in severe refractory cases.

What this therapy involves is we implant electrodes into very specific regions of the brain. And from these electrodes, we're able to stimulate that area of the brain and change how that underlying network is operating. What's really cool about this is that it can help alleviate some of the symptoms that the patient is experiencing. We work really closely with neurosurgery, not only in selecting the correct patient for this, but planning, planning it out, talking about what area we're going to implant, and then the after portion about how they're doing following the implantation.

Our role in it is more selecting the patient, "Okay, who's an appropriate Parkinson's patient for this?" And then, following the surgery, actually adjusting the programs and adjusting the stimulation so that it provides appropriate amount of relief.

Now, there's another type of therapy called MRI-guided focused ultrasound. That's also kind of a hot topic recently in neurology. What this essentially is we focus ultrasound waves onto a specific part of the brain where we heat it up enough to cause a lesion to help alleviate certain symptoms. The most common one is for essential tremor to help alleviate the tremor. In both of these cases, we work very closely with neurosurgery, and we have regular meetings to talk about these.

Host: I know you already touched upon exercise, but let's dive a little deeper into that and tell me how important is ongoing exercise or strength training for individuals living with movement disorders?

John Mason, DO: Yeah. So, this is key. For movement disorders, particularly I talk a lot about Parkinson's, it's about 80% of what we see, exercise is the only thing that we know that currently slows down the disease, which is huge. And there's a lot of different types of exercise, and it's really important for patients to understand which exercise is best. And I always tell patients, "I want you to do exercise that you enjoy," because if you enjoy it, you're more likely to stick to it.

Now, some patients want more evidence-based. And so, usually, what we recommend is around 150 minutes per week of moderate to high intensity exercise, working up a little bit of a sweat. And with this, doing a variety of training actually. So strength training is great. It's great to keep the muscles strong and help keep up your bone density, and also help prevent falls. Aerobic exercise is wonderful because it not only increases your heart rate, but it also helps your brain release certain chemicals that help it kind of keep active and stay healthy.

And then, balance and stretching exercises are really important for keeping their balance and preventing falls. So, all three of these in combination is the ideal that we want patients to do. But again, I always emphasize, like if you like a type of exercise, you're much more likely to stick to it rather than me forcing you to go lift weights for 30 minutes, go run for 30 minutes, then go do 30 minutes of yoga, and do that four times a week and we'll talk.

The other thing about exercise that is key is it's not just good for movement disorders and neurologic conditions. It's good for your overall health. It can help improve mood. It can improve sleep. It helps your cardiovascular health. And so, there's a plethora of benefits that people receive when they perform regular exercise.

Host: As we prepare to close, I want to ask you how neurology became a passion of yours and what drew you to this specialty?

John Mason, DO: I've always had an interest in neurology, but really a lot of my interest stems from the human experience and the mind itself. There's so much that we don't know about the human mind. But also, everyone's experience of the world is different, and it's interpreted differently by your brain.

And so, I've always found that to be really, really fascinating. And then, when I got into medicine, you get to see that in neurologic conditions, everyone's disease is a little bit different. And this is especially true for movement disorders. No two Parkinson's patients are the same. They don't experience the world the same, and they present with different issues.

And one thing that I found that I've really enjoyed doing is finding out what their individual issues are, and we work together to solve it. And so, it creates unique problems that we have to come up with unique solutions. And it really keeps the work interesting and it keeps it fun.

The other piece, and I think this is what really pulled me more into the movement disorders direction versus other fields in neurology, is the connection that you get to make with patients. In movement disorders, you can see patients for 20, 30, 40, 50 years. And you get to form these really special connections with patients, and it keeps you motivated every single day to just come in and do your best and continue working with them.

Host: Dr. Mason, is there anything else on this important topic that you would like to add before we close?

John Mason, DO: I love when patients read and do their due diligence and know everything about the disease. And they often teach me about the disease as well. They know the up-and-coming therapies and what's new in the field. And I would encourage people just keep educating yourself, keep reading about it. It's important. And we can both come together with our ideas.

Host: Great. Thank you very much for sharing both your knowledge and your time today.

John Mason, DO: Awesome. Thank you for having me, Gina.

Host: To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, visit healthyheadlines.org. This has been Novant Health's Meaningful Medicine Podcast. If you found this information helpful, please share it on your own social media channels. Thanks for listening.