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Understanding Parkinson's Disease
Parkinson's disease is a neurologic condition in which daily activities may become more difficult to complete. Dr. Tuhin Virmani, UAMS neurologist, discusses Parkinson's disease.
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Learn more about Tuhin Virmani, MD, PhD
Tuhin Virmani, MD, PhD
Dr. Virmani completed his medical training at UT Southwestern Medical School in Dallas, where he was in the Medical Scientist Training Program (MSTP), receiving a combined M.D/Ph.D degree.Learn more about Tuhin Virmani, MD, PhD
Transcription:
Understanding Parkinson's Disease
Scott Webb: Every year in America, healthcare professionals diagnosed 50 to 60,000 new cases of Parkinson's disease, neurologists and neurosurgeons at UAMS Health work to create the best experience for patients. Dr. Tuhin Virmani is a movement disorder neurologist and researcher here to talk with us about Parkinson's, its symptoms, and treatment options. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb. Dr. Virmani, thanks so much for joining me. When I think about Parkinson's, I think about someone like Michael J. Fox who has continued to live and work long after he was diagnosed. Let's start here. What is Parkinson's disease?
Dr. Virmani: So Parkinson's disease is a disease that most commonly affects elderly people. It's a neurologic condition where people start noticing that their activities of daily living start becoming more difficult because they're taking longer to perform them. They might start noticing that they are walking more slowly, their speech may get softer, others may notice that they're not making as much expression in their face when they're talking. Handwriting can get smaller and eventually balance can also be affected where people may start developing falls from the disease.
Host: So that gives us a good starting point there. And I know there are other movement disorders. So how does Parkinson's differ from these other movement disorders? Like essential tremor?
Dr. Virmani: We differentiate essential tremor from Parkinson's disease based primarily on the type of tremor. So in patients with Parkinson's disease more commonly they have a tremor where when they're sitting relaxed, say watching TV, they might notice that their hand is shaking a little bit. Quite often others will notice it because they may not even be aware of it initially. Whereas in essential tremor, the tremor is more interfering with activities. So it's usually a tremor that occurs when you perform a particular action. So like when you're feeding or when you're holding a cup or a newspaper, you might start noticing your hand is shaking and that gets better when you relax as opposed to in Parkinson's disease where the tremor is present again, when you are relaxed and gets better when you move. Compared to other movement disorders that we see, Parkinson's disease is probably the most common disorder. It's probably, you know, 70 to 80% of our daily practice. But there are many other disorders that affect how we move that can affect movement, in that they slow movement down like in Parkinson's disease. But there also are many disorders that make excess movements or faster movements or more movements that are not normal. And so that's a whole other class of movement disorders that we see in our clinic.
Host: And this is all really fascinating. So, do we know what causes Parkinson's?
Dr. Virmani: So yes and no. So, we do know that Parkinson's disease is due to a decrease of a chemical in the brain called dopamine. So there's a particular area of the brain that produces dopamine and the cells, and that part of the brain slowly die over time, and those cells project to a part of the brain that controls our movement. And that's why movement is affected predominantly in Parkinson's disease. Although it is a multifactorial disease, it affects many other parts of the body that we can talk about in a bit maybe. But we don't know why some people start having the loss of cells in that part of the brain. We have some thoughts that, you know, it may be due to oxidative stress of the cells in the brain, may be responding to certain chemicals that have been produced due to environmental exposures, for example. There's probably a small component of genetics involved, but for the most part we think it's just multiple things that you've sort of seen over your lifetime eventually accumulate and lead to the body no longer being able to compensate and causing this cell death.
Host: Want to talk about some of your research? I know you study Haitians Gait, I'd really like to you to tell us about that.
Dr. Virmani: In patients with Parkinson's disease, again, not in all, and the disease is very heterogeneous, that is it's different in different people and we don't really know why, but one of the features of walking in Parkinson's disease is some patients note that they develop something where when they're walking or when they're starting to walk or when they're turning, they feel like their feet get stuck or glued to the ground. And we call that freezing of Gait. And we don't really know why some people with Parkinson's get it and some people don't. We don't know why some people get it early in the disease and some people get it late in the disease. And even more interestingly, we don't know why some people show a very good response to the symptom, that is the symptom will get better if they take levodopa, which is the chemical that replaces dopamine in their brain. So it's improved by the medications that we use to treat Parkinson's. Whereas some patients actually don't have improvement in that particular symptom and can actually have worsening in that particular symptom.
And so in the lab, our basic overall goal is to try and see if we can predict before it happens that say, if patient A will go on to develop freezing of Gait, say in the next couple of years or patient B will not. And then we can try and learn from that population of patients that we think will develop the freezing later on in their disease course and help develop treatments that either help prevent it from happening. And as we're already doing, try and help treat it, because it is a very difficult symptom to treat. It's important because often if you can think about someone walking and their feet get stuck but their upper body keeps going. It is a major cause of falls and falls lead to fractures and fractures lead to bed bound, and all those problems that are associated with it. So it is a major cause of decreased functioning long-term in patients with Parkinson's disease. So if we can treat it or stop it from happening, even, that would be really beneficial for patients with the disease.
Host: Really interesting. Their feet aren't actually stuck. They just feel like they are, it gives them the sensation that they, can't keep walking but they're trying to keep walking and thus that leads to the falls. Do I have that right?
Dr. Virmani: Their sensation is that it's stuck. And when we look at them walking in our lab, their feet actually are planted on the ground and they can't get them to move. Another thing about that particular symptom is we don't know where in the brain it's originating from. So I did some research when I was a fellow trying to look at people who had donated their brains after they passed away and look at how their brains were different in people who had the freezing phenomenon during the course of the disease. And in those who didn't. And unfortunately in that population out of 52 patients, we only had four who didn't have freezing. So we really were not unfortunately in the end, able to kind of define what parts of the brain are changing differently in those people. But that was the goal of that study. So we really don't know where in the brain this is happening, why it's happening.
And it's not just Parkinson's disease. So other disorders which we haven't talked about much, but there are other disorders like Parkinson's disease that cause Parkinsonism, which is we define Parkinsonism as four Cardinal features, which is the arresting tremor, a stiffness of the muscles, the slowness of movement, and a loss of a postural response or imbalance. And there are other conditions that cause Parkinsonism and cause freezing of gait, but they are not due to the protein that is misfolded in Parkinson's disease. They are due to another protein being misfolded and deposit in called tau in Parkinson's disease itself, it's the nucleon. So it's a very complicated phenomenon that we are trying to learn more about.
Host: I am just fascinated by all of this and you have such a great way of explaining all of it. What advice do you find yourself repeating the most to patients with Parkinson's and their families or even if not Parkinson's itself, these other movement disorders that we've talked about?
Dr. Virmani: The most important thing in Parkinson's diseases. While it is a progressive disorder, it is a very treatable disorder. And our goal in the clinic is to keep people functioning, have it as high a quality of life as we can for as long as possible. And when we're talking about progression in Parkinson's disease, we're usually not talking about weeks or months or even years. We're talking on the scale of a decade. So we really want people to keep upbeat because they can have a very productive life with quality treatment. One of the important things we're learning more and more is that the more you move, the better you do in the long run. And so if you get the diagnosis and you sort of resolve yourself, Oh, this is, this is it, and I'm just going to sit around at home now, that's really not what we want you to do.
We want you to get out, we want you to exercise. We want you to keep working for as long as you can because that in the long run is going to help keep your disease much better controlled for a longer period of time, then if you kind of stop moving. So the old adage of use it or lose it kind of really applies in Parkinson's disease. So we encourage people to go to the gym and exercise, they're multiple exercise classes that we offer some here on campus. But there are also other classes like rock steady boxing, which is a boxing program that has been designed specifically for patients with Parkinson's disease to help get them moving again and help improve their balance, their walking, their coordination, all of which are important to keep you as safe and as mobile and functional for as long as possible.
Host: That's really awesome. Doctor, I'm just thinking about what you said there. Use it or lose it and really interesting to know that an eye-opening really, that people with Parkinson's, they can use it, you know, that they don't have to lose it. And the work you're doing, the advice you're giving, really amazing. And thank you so much for your time today. For more information on Parkinson's disease and the work that Dr. Virmani and his colleagues are doing, visit UAMSHealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk. Thanks for listening.
Understanding Parkinson's Disease
Scott Webb: Every year in America, healthcare professionals diagnosed 50 to 60,000 new cases of Parkinson's disease, neurologists and neurosurgeons at UAMS Health work to create the best experience for patients. Dr. Tuhin Virmani is a movement disorder neurologist and researcher here to talk with us about Parkinson's, its symptoms, and treatment options. This is UAMS Health Talk from the University of Arkansas for Medical Sciences. I'm Scott Webb. Dr. Virmani, thanks so much for joining me. When I think about Parkinson's, I think about someone like Michael J. Fox who has continued to live and work long after he was diagnosed. Let's start here. What is Parkinson's disease?
Dr. Virmani: So Parkinson's disease is a disease that most commonly affects elderly people. It's a neurologic condition where people start noticing that their activities of daily living start becoming more difficult because they're taking longer to perform them. They might start noticing that they are walking more slowly, their speech may get softer, others may notice that they're not making as much expression in their face when they're talking. Handwriting can get smaller and eventually balance can also be affected where people may start developing falls from the disease.
Host: So that gives us a good starting point there. And I know there are other movement disorders. So how does Parkinson's differ from these other movement disorders? Like essential tremor?
Dr. Virmani: We differentiate essential tremor from Parkinson's disease based primarily on the type of tremor. So in patients with Parkinson's disease more commonly they have a tremor where when they're sitting relaxed, say watching TV, they might notice that their hand is shaking a little bit. Quite often others will notice it because they may not even be aware of it initially. Whereas in essential tremor, the tremor is more interfering with activities. So it's usually a tremor that occurs when you perform a particular action. So like when you're feeding or when you're holding a cup or a newspaper, you might start noticing your hand is shaking and that gets better when you relax as opposed to in Parkinson's disease where the tremor is present again, when you are relaxed and gets better when you move. Compared to other movement disorders that we see, Parkinson's disease is probably the most common disorder. It's probably, you know, 70 to 80% of our daily practice. But there are many other disorders that affect how we move that can affect movement, in that they slow movement down like in Parkinson's disease. But there also are many disorders that make excess movements or faster movements or more movements that are not normal. And so that's a whole other class of movement disorders that we see in our clinic.
Host: And this is all really fascinating. So, do we know what causes Parkinson's?
Dr. Virmani: So yes and no. So, we do know that Parkinson's disease is due to a decrease of a chemical in the brain called dopamine. So there's a particular area of the brain that produces dopamine and the cells, and that part of the brain slowly die over time, and those cells project to a part of the brain that controls our movement. And that's why movement is affected predominantly in Parkinson's disease. Although it is a multifactorial disease, it affects many other parts of the body that we can talk about in a bit maybe. But we don't know why some people start having the loss of cells in that part of the brain. We have some thoughts that, you know, it may be due to oxidative stress of the cells in the brain, may be responding to certain chemicals that have been produced due to environmental exposures, for example. There's probably a small component of genetics involved, but for the most part we think it's just multiple things that you've sort of seen over your lifetime eventually accumulate and lead to the body no longer being able to compensate and causing this cell death.
Host: Want to talk about some of your research? I know you study Haitians Gait, I'd really like to you to tell us about that.
Dr. Virmani: In patients with Parkinson's disease, again, not in all, and the disease is very heterogeneous, that is it's different in different people and we don't really know why, but one of the features of walking in Parkinson's disease is some patients note that they develop something where when they're walking or when they're starting to walk or when they're turning, they feel like their feet get stuck or glued to the ground. And we call that freezing of Gait. And we don't really know why some people with Parkinson's get it and some people don't. We don't know why some people get it early in the disease and some people get it late in the disease. And even more interestingly, we don't know why some people show a very good response to the symptom, that is the symptom will get better if they take levodopa, which is the chemical that replaces dopamine in their brain. So it's improved by the medications that we use to treat Parkinson's. Whereas some patients actually don't have improvement in that particular symptom and can actually have worsening in that particular symptom.
And so in the lab, our basic overall goal is to try and see if we can predict before it happens that say, if patient A will go on to develop freezing of Gait, say in the next couple of years or patient B will not. And then we can try and learn from that population of patients that we think will develop the freezing later on in their disease course and help develop treatments that either help prevent it from happening. And as we're already doing, try and help treat it, because it is a very difficult symptom to treat. It's important because often if you can think about someone walking and their feet get stuck but their upper body keeps going. It is a major cause of falls and falls lead to fractures and fractures lead to bed bound, and all those problems that are associated with it. So it is a major cause of decreased functioning long-term in patients with Parkinson's disease. So if we can treat it or stop it from happening, even, that would be really beneficial for patients with the disease.
Host: Really interesting. Their feet aren't actually stuck. They just feel like they are, it gives them the sensation that they, can't keep walking but they're trying to keep walking and thus that leads to the falls. Do I have that right?
Dr. Virmani: Their sensation is that it's stuck. And when we look at them walking in our lab, their feet actually are planted on the ground and they can't get them to move. Another thing about that particular symptom is we don't know where in the brain it's originating from. So I did some research when I was a fellow trying to look at people who had donated their brains after they passed away and look at how their brains were different in people who had the freezing phenomenon during the course of the disease. And in those who didn't. And unfortunately in that population out of 52 patients, we only had four who didn't have freezing. So we really were not unfortunately in the end, able to kind of define what parts of the brain are changing differently in those people. But that was the goal of that study. So we really don't know where in the brain this is happening, why it's happening.
And it's not just Parkinson's disease. So other disorders which we haven't talked about much, but there are other disorders like Parkinson's disease that cause Parkinsonism, which is we define Parkinsonism as four Cardinal features, which is the arresting tremor, a stiffness of the muscles, the slowness of movement, and a loss of a postural response or imbalance. And there are other conditions that cause Parkinsonism and cause freezing of gait, but they are not due to the protein that is misfolded in Parkinson's disease. They are due to another protein being misfolded and deposit in called tau in Parkinson's disease itself, it's the nucleon. So it's a very complicated phenomenon that we are trying to learn more about.
Host: I am just fascinated by all of this and you have such a great way of explaining all of it. What advice do you find yourself repeating the most to patients with Parkinson's and their families or even if not Parkinson's itself, these other movement disorders that we've talked about?
Dr. Virmani: The most important thing in Parkinson's diseases. While it is a progressive disorder, it is a very treatable disorder. And our goal in the clinic is to keep people functioning, have it as high a quality of life as we can for as long as possible. And when we're talking about progression in Parkinson's disease, we're usually not talking about weeks or months or even years. We're talking on the scale of a decade. So we really want people to keep upbeat because they can have a very productive life with quality treatment. One of the important things we're learning more and more is that the more you move, the better you do in the long run. And so if you get the diagnosis and you sort of resolve yourself, Oh, this is, this is it, and I'm just going to sit around at home now, that's really not what we want you to do.
We want you to get out, we want you to exercise. We want you to keep working for as long as you can because that in the long run is going to help keep your disease much better controlled for a longer period of time, then if you kind of stop moving. So the old adage of use it or lose it kind of really applies in Parkinson's disease. So we encourage people to go to the gym and exercise, they're multiple exercise classes that we offer some here on campus. But there are also other classes like rock steady boxing, which is a boxing program that has been designed specifically for patients with Parkinson's disease to help get them moving again and help improve their balance, their walking, their coordination, all of which are important to keep you as safe and as mobile and functional for as long as possible.
Host: That's really awesome. Doctor, I'm just thinking about what you said there. Use it or lose it and really interesting to know that an eye-opening really, that people with Parkinson's, they can use it, you know, that they don't have to lose it. And the work you're doing, the advice you're giving, really amazing. And thank you so much for your time today. For more information on Parkinson's disease and the work that Dr. Virmani and his colleagues are doing, visit UAMSHealth.com. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for additional topics that may interest you. This is UAMS Health Talk. Thanks for listening.