Movement Disorder Treatments
The Movement Disorders Center, part of the Cushing Neuroscience Institute at New York’s North Shore-LIJ Health System is committed to improving the lives of people with movement disorders through advanced treatment options. Below are some of the movement disorder treatments we offer for specific diseases and disorders.
Parkinson’s disease Medical Treatment
Fortunately, there are an increasing number of options for Parkinson's disease medical treatment. Most of the medications target the brain’s dopamine system and aim to supplement or enhance the decline in available dopamine. These dopaminergic medications are often used in combination with other types of medications to help releive Parkinson's disease symptoms that may occur in some patients, such as depression, sleeping troubles, constipation and other Parkinson’s-associated issues. While very effective, Parkinson’s disease medical treatment, like most medications, has potential side effects and should be reviewed with you by your movement disorder specialist.
When patients are diagnosed with Parkinson's disease, they are usually treated initially with a number of different medications in an attempt to control some or all of the Parkinson's disease symptoms. One commonly used medication is levodopa (Sinemet®) — which can partially replace the neurotransmitter known as dopamine, an essential chemical in the brain which is found to be deficient in Parkinson’s disease.
Many medications are quite effective in treating these Parkinson's disease symptoms however; they may lose their effectiveness or have unwanted side effects such as severe dyskinesias (abnormal movements). Additionally, patients can suffer from severe on/off motor fluctuations over time. Since Parkinson’s disease is a progressive disease, medications which may have been effective for a long period of time may become less effective as the disease progresses.
Parkinson's disease Surgical Treatment
Patients with significant disability despite optimization of their Parkinson's disease medical treatment regimen may be candidates for deep brain stimulation (DBS). DBS is a procedure in which tiny electrodes are placed into the brain with the help of computer guidance. These electrodes are connected to a pacemaker-like device implanted beneath the collarbone, much like a cardiac pacemaker. Continuous electrical stimulation effectively jams or blocks the abnormal circuitry of the brain that occurs in disorders like Parkinson’s disease. The result is an improvement of many of the most disabling symptoms, which can lead to an improved quality of life for patients suffering from these diseases.
Parkinson's disease surgery is performed in two stages:
Stage 1: Implantation of the electrodes in the brain. This typically requires a two to three day hospital stay.
Stage 2: Placement of the pulse generators, or brain pacemakers, is performed seven to ten days after the first surgery. This is typically performed as an outpatient.
In the week prior to the surgery, the patient will undergo pre-surgical testing that will include routine blood tests and a high-resolution brain MRI scan. At the time of the procedure, a halo-like frame known as a stereotactic head frame will be placed on the patient’s head, and a CT scan will be performed. The CT scan information will be transferred to a computer where it will be merged with the previous MRI scan, and the target will be identified.
Once in the operating room, the patient will be placed under local anesthesia, a small access hole will be made in their skull, and an electrode will be placed into the brain using computer guidance. Using sophisticated monitoring devices, the operating room team will listen to the activity of the brain's neurons, or nerve cells, to determine precisely where to place the electrode. If the patient is undergoing a bilateral procedure, the procedure is then repeated on the other side. Once both electrodes have been placed, they are left under the scalp and the surgery is complete.
In Stage 2, the generator (pacemaker) devices are placed under the skin near the collarbone, and connected to the electrodes with extension wires. The surgery takes approximately two hours.
The generator is not usually activated until a few weeks after the procedure when all the wounds have healed. Nevertheless, just placing the electrode in the correct location can result in a temporary improvement in some of the Parkinson's disease symptoms.
Our movement disorder team will activate the generators and determine the optimal settings to obtain the maximum clinical benefit with minimal side effects. Over the first few months, the patient may need a number of adjustments in order to determine the best settings. Once the optimal settings have been determined, the patient can turn stimulation on and off with a small remote control. For example, some patients turn the generator off at bedtime.
Battery longevity varies depending on the parameter settings and number of hours the pulse generator is turned on each day. Estimated battery life is about four years at typical settings. When the pulse generator battery needs to be replaced, the old pulse generator is replaced by an entirely new one, and the extension and lead are not replaced so there is no further brain surgery involved. The replacement procedure can be done under local anesthesia.
DBS is a safe and effective surgical procedure for Parkinson's disease patients. Nevertheless, like any surgery, there are a number of potential risks. The potential risks or discomforts include:
- Bleeding, infection or other damage to the brain or its surrounding structures
- Malfunction of the system which may require replacement or removal of the device
- Temporary side effects from stimulation that can be alleviated by changing the stimulator settings
It is important to keep in mind that currently, there is no cure for Parkinson’s disease. The goal of this surgery is to improve quality of life by minimizing some of the disabling symptoms of the disease. The effects of DBS are reversible — when the stimulation is turned off, the symptoms will eventually reappear. On the other hand, the latest publications have demonstrated that the beneficial effects continue for years following surgery.
Recent studies have demonstrated that DBS may be effective in treating other conditions such as Tourette's syndrome, depression and obsessive-compulsive disorder. DBS has been used for many years to treat chronic pain not relieved by other treatments.
Dystonia Medical Treatment
Dystonia medical treatment depend on the underlying cause. When the dystonia is due to another disease, treatment of that disease is the first step. When no evident cause is identified, dystonia treatment focuses on improving the function of the involved body part. Conservative measures, particularly for focal dystonias, can involve physical and occupational therapy. When this alone is insufficient, medications can be used. The most common dystonia medical treatment is medications that reduce the intensity of the overactive muscle groups. These include anticholinergic medications like trihexyphenidyl, benzodiazepines like clonazepam and muscle relaxants like baclofen. If the dystonia is focal (e.g., involving just the neck), botulinum toxin can be injected into the overactive muscles. This generally needs to be repeated every three to four months.
Dystonia Surgical Treatment
For more debilitating cases of dystonia, especially generalized dystonia, surgery is often used as treatment. Baclofen pumps can be inserted into the spine for patients with severe lower extremity dystonia. For more generalized dystonia or for upper body dystonia that doesn’t respond well to medications, deep brain stimulation (DBS) is another treatment option.
Huntington's disease Medical Treatment
Management of Huntington’s disease involves a multidisciplinary approach. There are currently no Huntington’s disease treatments specifically designed for Huntington’s disease, but there are many medications that can improve individual symptoms such as medications that improve chorea (the abnormal movements), depression and psychosis, as well as memory impairment. There are also several drugs in study that may be specifically helpful for Huntington’s disease treatment.
Medications most frequently used in the management of Huntington’s disease include medications that block the dopamine in the brain, a chemical in the brain (neurotransmitter) that is associated with some of the excessive movements and behavioral abnormalities. Examples include risperidone, olanzapine and haloperidol. Medications that can improve memory and help with depression are also commonly utilized.
Surgical Treatment for Huntington's disease
For severe cases of chorea (excessive movements), deep brain stimulation (DBS) can be an effective treatment.
Essential Tremors Treatment
The treatment of essential tremors generally depends on the cause and severity of the tremor. If essential tremors are not disabling, they do not always require specific treatments. If the tremor is due to an identified, correctable cause (like hyperthyroidism or a medication) the underlying problem should be addressed first. Conservative essential tremor treatment options include occupational therapy. Several medications can often be tried to reduce the severity of the tremors. The most common include primidone and beta-blockers like propranolol and metoprolol (also used for high blood pressure). Some patients find their tremors improve with alcohol. In some cases, this can be used sparingly for specific situations in consultation with your doctor. Essential tremors that affect the head can sometimes be treated with botulinum injections into the overactive neck muscles. For more severe tremors, medications and injections are often insufficient in controlling the symptoms. For these cases, deep brain stimulation (DBS) can be an effective essential tremor treatment.
Tourette’s syndrome Treatment
Tourette’s syndrome does not always require treatment, and many individuals live normal lives with Tourette's. When the tics are debilitating, however, Tourette's syndrome treatment is often warranted. Non-medications options include cognitive approaches like habit-reversal therapy and biofeedback. Medications that can be effective include drugs that block the excessive dopamine activity. These dopamine-receptor blockers include medications like risperdal, haloperidol, pimozide and olanzapine. Medications like clonidine (also used for lowering blood pressure) can be helpful in some cases, as well. Psychiatric follow-up and medications are sometimes necessary when attention-deficit and/or compulsive behaviors are an issue. For severe cases of Tourette's sydrome, deep brain stimulation is being investigated as a Tourette's syndrome treatment, but is not yet approved by the Federal Drug Agency.
Hemifacial Spasm Treatment
A common treatment for hemifacial spasm involves injecting the affected, overactive facial muscles with low doses of botulinum toxin. This generally needs to be repeated every three to four months. In some cases, when the injections are not effective and an obvious cause can be found (such as a blood vessel pressing on the nerve), surgery can be performed as a hemifacial spasm treatment to relieve the pressure of the facial nerve.
Restless Leg Syndrome (RLS) Treatment
Before initiating restless leg syndrome treatment, underlying causes like iron-deficiency should be ruled out and treated, if present. If no underlying cause is found, restless leg syndrome treatment often involves using low doses of medications also used in Parkinson’s disease treatment, even though the conditions are different. They include classes of medications that target the brain chemical dopamine and includes dopamine agonists (like pramipexole and ropinirole) and carbidopa/levodopa. Mild opioids like codeine are also sometimes used, as are other medications when the above medications are not effective.
Spincerebellar Ataxia (SCA) Treatment
Unfortunately, at this time, spincerebellar ataxia treatment for imbalance is somewhat limited. Physical, balance and occupational therapy can be very helpful. There are some medications that have demonstrated some benefit in select cases. These can be reviewed with your movement disorders specialist to determine if they may be appropriate.
Normal Pressure Hydrocephalus Treatments
Normal pressure hydrocephalus treatments involve placing a shunt to help drain the fluid. Sometimes this is preceded by a drain trial during which time the patient is evaluated in the hospital to see the effect of draining spinal fluid before placement of the permanent shunt. For more information on normal pressure hydrocephalus please visit our Normal Pressure Hydrocephalus Center.
Cushing Neuroscience Institute’s Movement Disorders Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply fill out our Request an Appointment form, email us at email@example.com or call us at (516) 325-7050.
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