The majority of patients seen at the Parkinson's Disease and Movement Disorder Center are referred by their primary care doctors or other neurologists. A number of patients are referred by patient support networks. Reasons for referral include primary diagnosis of unknown movement disorders, second opinion and complex management of these diseases. A special focus is the patient with a very early or mild movement disorder.
At the Rush Parkinson's Disease and Movement Disorder Center, we care for patients with all types of movement disorders, including:
We see patients on several different bases:
- One-time consultation: Such patients are referred by their primary physicians for diagnosis or confirmation of a diagnosis or for suggestions about management. The consultation lasts approximately 60 minutes, comprising a detailed history of the movement disorder, a focused examination and a discussion of relevant issues regarding diagnosis and treatment. A summary letter is sent to the primary physician. All further contact with our clinic is made by the primary physician.
- Annual or infrequent visits: These patients are referred by their primary physicians for a consultation visit similar to that described above; following a thorough evaluation of the problem, the patient is referred back to the primary physician who conducts all aspects of evaluation and treatment. Patients return to our clinic on approximately an annual basis for re-assessment so that additional recommendations may be made to the referring physician. All interval contact with our office is made by the primary physician.
- Continuing care: Some patient elect to be regular patients of our group. Regular care generally requires a 15- to 20-minute visit every three to four months. More frequent visits may be necessary for complex problems. While contact is maintained with the primary care physician, changes in therapy are coordinated by the movement disorders physicians.
Evaluation procedures: The evaluation of a new patient is tailored to his or her individual needs, but may include any of the following:
The history: The history includes a review of pertinent symptoms, the nature of prior evaluations and treatment strategies and collateral information such as family history, history of other medical conditions, occupational or work history and other pertinent details.
The examination: The neurologic examination includes an assessment of cognition (thinking and memory), movement, sensation, and gait and balance. The specifics of the neurologic examination depend on the condition for which the patient is being examined.
Manual motor testing: Rating scales are employed to assess the severity and progression of the patient''s movement disorder. The patient is asked to perform certain motor tasks and these are assessed using an objective rating scale. The scores on these rating scales are kept as part of the patient record to monitor response to treatment and disease progression.
Videotaping: The diagnosis of movement disorders relies heavily on the presence of certain movements which are assessed visually. Recording the movement on videotape is an essential part of the clinical record. All new patients are videotaped. Patients may be videotaped at intervals to document changes in function in relation to disease progression and response to therapeutic interventions.
Neuropsychiatric testing: Changes in cognition and behavior are common accompaniments to most movement disorders. Detailed testing of these functions, performed by a neuropsychologist is often important in the understanding of the effects of the disease process on the patient. This is mostly a series of paper and pencil tests, which last anywhere from one to two and a half hours.
Other diagnostic tests: Movement disorders are generally diagnosed by history and physical examination. Occasionally, other tests may be required including X-ray or other imaging tests of the brain or spinal cord, electrical tests such as electroencephalogram and electromyogram, or blood tests. These tests can be scheduled by our office staff.