Rush University Medical Center in Chicago has a longstanding commitment to Parkinson's disease care. Treatment is presently divided into "protective" and "symptomatic" therapies. Protective therapies are those that aim to delay the degenerative process in the brain. Symptomatic therapies improve the symptoms of the degenerative process by amplifying dopamine, the major product of these cells, without directly affecting cell degeneration. Patients at Rush have the opportunity to receive state-of-the-art scientific treatments as well as participate in the evaluation of new investigational therapy trials.
Protective therapies: There are no proven drug treatments for halting or retarding the degenerative process of Parkinson's disease. At Rush, we have participated in research on candidate protective drugs for several years. Studies have focused on certain vitamins, nutritional supplements, agents that alter blood chemical levels and drugs that decrease stress on dopamine neurons. There have been interesting developments regarding the use of trophic factors in PD and the application of gene therapy. Trophic factors are naturally produced brain chemicals that may prevent or reverse cell degeneration. Human research on trophic factors is a major focus of Rush research efforts, and the genes controlling these trophic factors may offer new horizons for protective therapies.
Levodopa (usually taken as the combination drug carbidopa-levodopa; Sinemet) is the mainstay of symptomatic therapy for Parkinson's disease. While it dramatically improves the symptoms of Parkinson's disease, chronic therapy may have its pitfalls, including unpredictability, intermittent overmedication effects and a number of side effects. Careful adjustment of levodopa and the judicious use of other agents in combination with levodopa can lead to many years of good benefit.
Dopamine agonists may be used as the sole agent for the treatment of PD, but more often are used in combination with levodopa. Available dopamine agonists include pramipexole and ropinirole,which can be prescribed multiple times daily or in new long-acting, once-daily formulations.
COMT inhibitors entacapone and tolcapone enhance the effectiveness of levodopa by enhancing delivery of levodopa to the brain and, in the case of tolcapone, decreasing the breakdown of dopamine.
- Other medications used in the treatment of PD include selegiline, rasagiline, trihexyphenidyl, benztropine and amantadine.
Surgery and Parkinson's disease: Surgical interventions have been receiving more attention in Parkinson's disease therapy. Deep brain stimulation is a procedure that inserts an electrical wire into specific brain regions, and high-frequency stimulation is applied through a battery that is placed underneath the skin of the chest wall. These procedures are reserved in most instances for patients with issues related to their Parkinson's disease that are not adequately managed by medication. In addition to the FDA-approved deep brain stimulation program, special research protocols are also examining the role of gene therapy. Cellular implants of various types of cells into the brain have also been a major focus of brain surgery. At Rush, this program is staffed by a movement disorder neurologist, neurosurgeon and advanced nurse programmer.
Non-motor elements of Parkinson's disease: Research and clinical experience have confirmed that Parkinson's disease is far more than a physical motor problem of shaking, stiffness, slowness and disequilibrium. Non-motor features of Parkinson's disease include mood disorders (depression, anxiety), cognitive impairment (slowness of thought, difficulty with planning or multitasking, memory trouble, dementia), neuropsychiatric issues (hallucinations, apathy, behavioral changes), sleep disruption (acting out one's dreams, fragmented sleep), and autonomic disturbance (urinary dysfunction, constipation, blood pressure changes and dizziness).
In some patients, non-motor features such as acting out their dreams (also known as REM behavior disorder), depression, anxiety, constipation or loss of smell can occur many years before the onset of tremor or slowness. Other non-motor features such as cognitive impairment or dementia, visual hallucinations or autonomic changes develop later in the course of Parkinson's disease. Sometimes, the non-motor aspects may be more problematic than the classic motor signs typically associated with Parkinson's disease. Regardless of when these non-motor elements occur in the course of Parkinson's disease, they are an important and integral part of the comprehensive treatment of patients with Parkinson's disease and their caregivers.
The Rush Parkinson's and Movement Disorders Center provides comprehensive care for the Parkinson's disease patient, addressing both motor and non-motor features of the illness. Our program features a team of movement disorders neurologists and a psychiatrist who provide clinical expertise in the diagnosis and treatment of these non-motor issues in their care of Parkinson's disease patients. In addition, our staff includes a neuropsychologist who performs evaluations of Parkinson's disease patients' thinking, memory and mood and can also provide counseling and relaxation therapies. Further, ready contacts with specialists with social work, sleep, urinary, bowel and blood pressure expertise are part of our larger network at Rush. See videos of our movement disorders specialists answering frequently asked questions regarding Parkinson's disease.
In addition to our clinical services, the Rush Parkinson's and Movement Disorders Center conducts research to improve our understanding, diagnosis and treatment of non-motor elements of Parkinson's disease. For many years, our center has been recognized as a leader in research on hallucinations, cognition and sleep in Parkinson's disease. Our center continues to conduct pioneering research on these critical non-motor areas with ongoing programs focused on cognitive changes, hallucinations, behavioral issues, sexual dysfunction and other non-motor elements in Parkinson's disease.
Social support, exercise and education: Social support is available through the nursing experts within the Rush group and the program social worker referral program. Exercise and physical therapy are considered very important elements of good health maintenance for Parkinson's disease, and these programs are very active at Rush. Education of patient, caregiver and extended family is likewise an important anchor within the health network, and resource reading, contacts, support group information and an annual symposium for patients and families are all provided at Rush.
Research interventions: If you are particularly interested in an appointment for discussing research options, please phone the following special number: (312) 563-2900. When the message starts, press 1; when the next message begins, press 4 and you will be in direct contact with our nurse research coordinator.
General appointments for establishing care, second opinions and consultations: Because the practice is organized as a consultation service, all physicians (family doctor, internist, neurologist) requesting a movement disorder consultation may submit a signed, written consultation request on the doctor's prescription pad, and fax it to (312) 563-2024.
Patients with a new diagnosis of Parkinson's disease and not on any medications: We consider the first medication or treatment intervention decisions of utmost importance, so if you are not on any treatment for Parkinson's disease, we will provide an earlier appointment. Call (312) 563-2030 and tell the receptionist you are not on any treatment and a special appointment will be offered.
Rush Parkinson's Disease/CarePartner
Support and Educational Group
Meets every second Saturday of the month: Rush Oak Park Hospital (in back of cafeteria) 520 S. Maple Ave., Oak Park, Ill. For meeting details, call (312) 563-2900; press 7 for Luci.