Parkinson's Disease

UT Southwestern Medical Center offers full-service care for people with Parkinson’s disease. In addition to top-tier treatment and rehabilitation services, our physicians are active in ongoing research that improves the quality of life for people with Parkinson’s disease.

Our Movement Disorders team has a national reputation for Parkinson’s disease care and clinical trials, making UT Southwestern a referral hub for doctors across North Texas.

Effective Care and Advancing Research

Parkinson’s disease (PD) is a progressive, degenerative disorder of the nervous system that causes people to gradually lose control over movement and other functions. The cause of PD is unknown, and currently there is no cure.

The physicians in UT Southwestern’s Movement Disorders Clinic have advanced training and significant experience in managing PD. Our team collaborates with specialists across the medical center to help patients continue living their fullest possible lives, through a combination of treatment and rehabilitation.

UT Southwestern offers coordinated care for patients with Parkinson’s, providing the full range of services and support needed to diagnose this illness and manage its symptoms and complications.

Risk Factors for Parkinson's Disease

While a primary cause for PD is not yet known, certain risk factors can increase a person’s likelihood of developing the disease:

• Age: PD is rare in young people. People who develop the disease are usually around 60 or older, and the risk increases with age.
  
• Exposure to environmental toxins: Exposure to certain herbicides and pesticides can increase risk.
  
• Gender: Men are more likely to develop PD than women. On average, three men will develop the disease for every two women.
  
• Heredity: Having a close relative with PD increases the chances of developing the disease. However, that risk is still small unless family members develop the disease at a young age.
  

Parkinson’s Disease Symptoms

Everyone with PD will experience symptoms differently. For example, many people experience tremors as their primary symptom, while others might notice weakness, difficulty walking, or stiff muscles.

Early signs of PD can be mild and go unnoticed. The primary signs of PD include:

• Postural instability: A person with postural instability has lost some of the reflexes needed for maintaining an upright posture and might topple backward if pushed even slightly.
  
• Resting tremor: In the early stages of the disease, many people experience a slight tremor in the hand or foot on one side of the body. The tremor consists of a shaking or oscillating movement and usually appears when a person's muscles are relaxed. The tremor often spreads to the other side of the body as the disease progresses but usually remains most apparent on the initially affected side.
  
• Rigidity: The muscle tone of the limbs, neck, or trunk can become stiff. The muscles don’t relax, sometimes contributing to a decreased range of motion and causing pain.
  
• Slowed movement (bradykinesia): Slowing down and loss of spontaneous and voluntary movement is another sign of PD. The person might notice that once-simple tasks and movements are difficult and time-consuming. Steps might become shorter or the feet might drag when walking, and it can be difficult to get out of a chair.
  

In addition to the primary signs of Parkinson’s, many other symptoms are associated with the disease, such as:

• Constipation
  
• Handwriting changes, such as smaller letter sizes or more crowded words
  
• Reduced ability to make automatic movements such as blinking, smiling, or swinging the arms when walking
  
• Loss of the sense of smell
  
• Sleep disruption
  
• Speech problems, such as low-volume, rapid, slurred, hesitant, or monotone speech
  
• Trouble swallowing (dysphagia), usually in later stages
  

Diagnosis

PD can be difficult to diagnose because there’s no specific test for it. At UT Southwestern, our physicians base diagnosis on a patient’s medical history and a thorough neurological exam. We might ask patients to perform tasks to assess the agility of their arms and legs and evaluate muscle tone, gait, and balance.

Certain tests can help confirm a PD diagnosis or rule out other conditions with symptoms that imitate Parkinson’s. For example, DaTscan is an imaging test that reveals the level of dopamine in the brain, which is markedly decreased in patients with PD. DaTscan can help differentiate PD from essential tremor, in which brain dopamine levels do not change.

In addition to the examination, the patient might be given a medication commonly used to treat Parkinson’s. Significant improvement with the medication – such as better management of walking, movement, and tremors – often confirms a diagnosis of PD.

Treatments for Parkinson's Disease

Although PD has no cure, the symptoms of the disease are treatable.

Because each patient experiences symptoms differently, physicians base each patient’s treatments on his or her specific symptoms. The Movement Disorders team works closely with other UT Southwestern specialists – such as those in psychiatry and speech, physical, and occupational therapy – to provide patients with individualized care to manage symptoms and maximize mobility, balance, and coordination.

Treatments for Parkinson’s disease include:

• Botulinum toxin injection: UT Southwestern specializes in the use of botulinum toxin (Botox^®) injections for a variety of conditions that result in involuntary muscle contractions. Botulinum toxin weakens the muscle that it is injected into, thus promoting relaxation of muscle spasm. These injections can be a particularly effective treatment for PD patients with dystonia (involuntary cramping movements of the limbs or neck), eye twitching, and drooling. Patients who might benefit from botulinum toxin are examined to determine which muscles are overactive. The botulinum toxin is injected into only those muscles. Benefits gradually develop over seven to 10 days. The treatment is usually effective for three to four months, so injections are repeated several times a year to maintain ongoing benefits.
• Deep brain stimulation (DBS): Another area of expertise at UT Southwestern is this surgical treatment, which improves symptoms such as tremors, slowness of movement, and rigidity by modulating electrical activity in selected areas of the brain. For patients who are candidates for DBS, the surgery often enables a reduction of medication dosage and can reduce side effects from medication, such as dyskinesias resulting from levodopa (Sinemet). The motor fluctuations that often occur with disease progression can also be reduced with DBS.
  
• Medication: Many experts now believe that medication should be initiated immediately after diagnosis. Medication can help manage problems with walking, movement, and tremor by correcting or compensating for dopamine deficiency in the brain.
  

The benefits and disadvantages of medications can be different for each individual. Medications that might be prescribed include:

• Catechol-O-methyltransferase inhibitors lengthen the half-life of levodopa in the bloodstream.
  
• Dopamine agonists work by directly stimulating the post-synaptic dopamine receptors.
  
• Levodopa has been the mainstay of treatment for PD since the 1970s. This drug is taken orally, transported to the brain, and, inside the dopaminergic brain cells, converted into natural dopamine.
  
• Monoamine oxidase type-B inhibitors inhibit the breakdown of dopamine in the brain, thus lengthening the clinical response to levodopa.
  

Patients often see significant improvement after beginning PD medication. Over time, however, the benefits of drugs become less consistent for many people.

Rehabilitation

Rehabilitation is a key element of an effective PD treatment plan. The UT Southwestern rehabilitation team includes nurses, neuropsychologists, psychologists, and occupational, physical, recreational, and speech therapists. This team approach maximizes each patient’s ability to take part in activities at work, at home, and in the community.

Whether a person’s symptoms are mild or severe, all Parkinson’s patients benefit from an exercise program. Exercise can help people with PD stay active and relatively limber, improve balance and motor coordination, and even slow the progression of the disease. UT Southwestern specialists customize exercise recommendations for each patient’s particular needs and abilities, whether it’s obtaining a gym membership or engaging in professional physical therapy.

Support for People With Parkinson's Disease

If a patient wishes, the Movement Disorders team maintains an ongoing relationship that includes follow-up appointments with physicians and advanced practice providers to monitor the condition as it progresses. Family members are included in discussions about the goals of a patient’s treatment and rehabilitation program. Caregivers have access to services such as psychological counseling, support groups, and educational programs.

UT Southwestern also hosts an annual Parkinson’s Disease Patient and Caregiver Symposium for patients, their families, their caregivers, and anyone interested in learning more about the disease. The symposium reviews the latest clinical treatments, ongoing research projects, new drugs, and leading-edge developments that are on the horizon.

Research and Clinical Trials

UT Southwestern research programs are addressing clinical questions such as how best to treat PD and how to slow its progression. Among the most important of these investigations is a long-term National Institutes of Health (NIH)-funded trial led by Richard Dewey, M.D., aiming to discover a biomarker for PD progression. Identifying a biomarker could accelerate the discovery of new therapies or perhaps even a cure.

Patients at UT Southwestern and their family members benefit from opportunities to participate in clinical trials. Clinical trials offer patients not only access to the latest advances in treatment and technology but also the opportunity to add to the knowledge about the disease and help improve treatment for others in the future.