Parkinson's disease: diagnosis and treatment

Nov 8, 2013

Parkinson's disease used to be something people didn't like to talk about. But celebrities like Michael J. Fox and Linda Ronstadt, who have been open about having the degenerative nervous disorder, have taken away some of the stigma. There is still much about Parkinson's that even the experts don't understand. Lorraine Rapp and Linda Lowen, hosts of WRVO's health and wellness show Take Care, recently spoke with Dr. Kelvin Chou of the University of Michigan Medical School about the current methods of diagnosing and treating the disease.

Lorraine Rapp: What is Parkinson’s disease?

Dr. Kelvin Chou: Sure, Parkinson’s disease is a neurodegenerative disorder characterized by tremor. And the tremor is more present when the hands are relaxed and at rest, and tend to improve when the hands are in use. It’s also characterized by bradykinesia, which is our medical term for slowed movements, and also rigidity or stiffness. And these symptoms in combination can cause all sorts of problems such as walking difficulties, where the steps are slowed and the leg drags. It can cause problems with handwriting, where the writing becomes smaller the longer you write. It can also cause some clumsiness with fine motor skills such as dressing or cutting food or combing hair—things like that.

Linda Lowen: How is the diagnosis made?

Dr. Chou: The diagnosis is really made clinically, and what I mean by that is we don’t really have a test that allows us to tell you whether you have Parkinson’s. We also don’t have a test that rules out Parkinson’s for sure. It’s based on history, meaning what kinds of problems someone has had and how long they’ve had those types of problems, how it’s developed over time, as well as the examination. So do you have the characteristic symptoms, like a rest tremor, slowness or clumsiness with movements, or stiffness on examination, or the typical walking pattern? In the hands of even an experienced neurologist, it can be difficult to tell, especially when someone doesn’t really have tremor and they’re just really slow. You have to make the judgment, if they’re slow enough, where you think Parkinson’s disease might be possible. Or, are these symptoms just explainable by someone getting a little bit older with a little bit of arthritis?

Lorraine Rapp: I know you’re doing a lot of work with deep brain stimulation. Talk about that and how it works.

Dr. Chou: What it is, really, is you surgically place an electrode, or a wire, into a specific part of the brain. The tip of the wire sits in this very small part of the brain which helps control movements in the body. The wires are then tunneled under the skin and then connected to a battery in the chest where a pacemaker would normally sit. This device actually uses pacemaker like technology, but instead of stimulating the heart, it’s stimulating the brain. When you turn on the stimulation, it actually helps the symptoms of Parkinson’s disease. It can help tremor, it can help improve slowness, it can help improve stiffness. Unfortunately, deep brain stimulation-like medications does not really slow down the progression, although people who have had it will say that it feels like the clock has been turned back a few years, “I feel like I was four or five years ago instead of the way I am now.” And so it can actually help symptoms for longer periods of time.

That was Dr. Kelvin Chou speaking with Lorraine Rapp and Linda Lowen. More of this interview can be heard on Take Care, WRVO's health and wellness show Sunday evening at 6:30. Support for this story comes from the Health Foundation for Western and Central New York.