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Ask The Expert: Parkinson’s Disease

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Ask The Expert: Parkinson’s Disease

David Kreitzman, M.D., is a neurologist and medical director of the Outpatient Parkinson’s disease and  Movement Disorders Center at St. Charles Hospital.  He is board certified in neurology and  completed his  fellowship training in Movement Disorders at Boston University Medical Center.

What are the symptoms of Parkinson’s and  how do I know when it’s time to see a doctor?   
Dr. Kreitzman: Parkinson’s disease (PD) is characterized by slowly progressive symptoms such as stiff muscles, known as rigidity, and slow movement. One side of the body is usually more affected than the other.  Many individuals notice a resting tremor--a slight but persistent shaking in hands or feet, especially when they are not being used. If a tremor is not the presenting symptom, a change in handwriting (typically smaller) and a shuffling walk may be the first signs of PD.   

What kind of doctor should I see? 
Dr. Kreitzman: If you are experiencing these symptoms and they are progressing with no other clear explanation, it is important to seek a physician evaluation.  The physician of choice would be a neurologist.  A specialized group of neurologists who see Parkinson’s disease patients are known as movement disorders specialists.

If I see a movement disorders specialist about my symptoms, what kind of testing should I expect?     
Dr. Kreitzman: There are no specific tests that diagnose Parkinson’s disease but there are conditions that mimic PD symptoms. It is vital for a movement disorders specialist to obtain a patient’s medical history and conduct a physical exam. The specialist often orders an imaging study, such as a brain MRI, and blood tests to exclude other conditions that may mimic Parkinson’s disease.  A very specialized test called a DaTscan can sometimes be helpful in establishing a diagnosis for Parkinson’s disease but the test is not specific for PD. Sleep testing can help rule out the possibility that an underlying sleep disorder may be contributing to some symptoms, such as associated fatigue. Finally, a patient who may have PD is given a “trial” of medication to see if the medication is effective. A meaningful response to PD medication can help differentiate between Parkinson’s disease from Parkinsonism, a term for someone who is exhibiting stiffness and slowness but who may not have Parkinson’s disease.

What advances in treatment and research give those with PD reason to be hopeful? 
Dr. Kreitzman: We have made significant progress in the past fifty years. There are now several medications, as well as surgical options, to improve and manage the symptoms of Parkinson’s disease. Four new treatments were approved in the last two years. Many public figures, physicians, patients, family members and support groups have increased awareness of Parkinson’s disease and helped raised money for research. Ongoing trials are looking into the causes, prevention, treatments and restoration therapies for PD. Other recent discoveries are increasing our knowledge base significantly; potentially leading to more therapies.

For more information about the Outpatient Parkinson’s disease and Movement Disorders Center at         St. Charles Hospital, please call (631) 474 - 6797