Movement Disorders and Telemedicine: Q&A With Natalie Witek, MD, MS

May 21, 2020
Natalie Witek

Telemedicine connections are more important than ever during the COVID-19 pandemic. The Rush Parkinson's Disease and Movement Disorders Program has been offering telemedicine visits for patients since 2015, and its providers know how beneficial these visits can be.

Telemedicine visits have been a great resource and convenience for movement disorders patients who live far away from Rush or have trouble getting to the office in person. Since the COVID-19 pandemic began, scheduled video visits have been an essential way for Rush movement disorders providers to continue to offer excellent care while keeping their patients safe.

Neurologist Natalie Witek, MD, MS, answers questions about the benefits and challenges of telemedicine.

Q: Why did you decide to start offering video visits for movement disorder patients?

Witek: Telemedicine has been available through the U. S. Department of Veterans Affairs (VA) for decades and is becoming increasingly used by Rush and other health systems. Video visits are a fantastic way to provide convenient care to our patients without them having to make a trip to our main campus in Chicago. This is also a great way to provide specialty care to patients who live far from Rush, in areas without access to specialty care. Overall, it is a technology that will reshape the way we provide care to our patients.

Q: How have video visits for movement disorders grown since their inception?

Many experts have proposed the use of video telemedicine to improve access to neurologic care for patients in resource-limited regions. Previously, reimbursement from Medicare was limited to only reimbursing this service for patients in rural areas with limited access to providers. Now, due to the COVID-19 pandemic, telemedicine services are broadly covered by insurance and Medicare. Outpatient telemedicine is increasingly used to complement in-person visits, which decreases time between follow-up visits.

Patients with Parkinson's disease also have high rates of satisfaction with using telemedicine based on prior studies using this technology for follow-up visits. Telemedicine visits have been used for patients with Parkinson’s disease to make deep brain stimulation adjustments and for surgical consultations. In the past, there have been limitations to telemedicine, including reimbursements, limitations for practicing across state lines and having access to proper equipment — and some of these limitations still exist to some extent.— Since the start of the COVID-19 pandemic, the movement disorders program has rapidly expanded our volume of video visits, which has allowed our team to provide safe and effective care to our patients.

From 2015 to 2019, our program conducted under 30 video visits per year. In the first four months of 2020, we have completed over 350 video visits.

Q: What makes video visits valuable for patients and providers?

Telemedicine is a convenient, safe and fast way to provide real-time care to patients. Our patients can access video visits if they are new to Rush or existing patients who need a follow-up visit. For movement disorders, a large majority of the physical exam can be conducted over video. Other benefits of video visits include saving time in travel, caregiver burden and costs of traveling to in-person visits.

Personally, I’ve found that telemedicine allows us to provide a modern-day house call to our patients — without actually traveling to their homes. Most importantly, this technology allows us to safely provide care to our patients while stay-at-home orders are in effect for the COVID-19 pandemic.

Q: What are some challenges that your program has overcome in order to widely offer video visits for movement disorders?

Some limitations for conducting video visits in our practice include some technical challenges of using video technology through our current electronic health record. Our current system works best on an iPad or smart phone, and also requires internet access. Not all patients may have access to these resources. Also, many patients with neurologic disease may not be able to independently use these devices without assistance. To help address this, we offer telephone visits for those who do not feel comfortable coming into the clinic or who are unable to connect using video visits.

Tips for accessing video visits

Check out these resources with tips for accessing video visits:

To schedule a video visit with your provider, call Rush at (888) 352-RUSH (7874) or call your provider's practice directly.

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Brain Health & Conditions April 21, 2022
Statins

Statins are a class of drugs commonly prescribed to lower cholesterol and prevent severe illness from cardiovascular disease. New research indicates they may also help people with signs of parkinsonism.

In a study published in Neurology on March 23, researchers found that older adults who take statin drugs may have a reduced risk of developing signs of parkinsonism, a movement disorder. The drugs may also lead to a reduced risk of developing atherosclerosis, or hardening of the arteries, in the brain.

“Statins reduce plaques in the arteries that are formed by too much cholesterol found in the blood. This study shows that those who are using these drugs may have a lower risk of parkinsonism, and it may be caused by a protective effect that statins may have on arteries in the brain,” said Dr. Shahram Oveisgharan, study author and assistant professor in the Department of Neurological Sciences at Rush University Medical Center.

The study followed 2,871 people for an average of six years, 936 of whom were taking statins at the time. Participants were part of the Rush Alzheimer’s Disease Center’s Memory and Aging Project, Religious Orders Study and Minority Aging Research Study. All three studies are decades-long efforts that recruit participants to undergo annual testing, sample collection and organ donation after their death.

Statin users had 16% lower risk

Researchers tracked participants’ statin use, as well as whether they used low-, medium- or high-intensity statins (based on the type of statin and dosage used). Participants were considered to show signs of parkinsonism if they had at least two of the following signs: tremor, or involuntary shaking; bradykinesia, or slowness in movement; rigidity, or stiffness in the hands, legs or neck; and parkinsonian gait, a decline in balance while walking or when standing up.

“These signs are most well-known in manifesting in Parkinson’s disease,” he said. “But parkinsonian signs have a wide range of causes, including rare syndromes, idiopathic Parkinson’s disease and others.”

After six years, participants who used statins had a 16% lower risk of developing parkinsonian signs than those who did not use statins. Researchers also performed autopsies on the brains of those who died during the course of the study (1,044 participants), and measured the levels of atherosclerosis in those who took statins versus those who did not. They found 37% lower odds of atherosclerosis in people who used statins than in people who did not.

Next steps

Oveisgharan said that the study was an encouraging step to demonstrating statins’ effectiveness in controlling parkinsonian signs.

“This was not a randomized controlled trial, so we can’t say for sure that this would be effective. That would be the next step,” he said. “But if a patient has some of these parkinsonian signs and their doctor doesn’t believe they have Parkinson’s or one of these other syndromes, it’s possible that statins may help them.”

Oveisgharan noted that the association between statin use and parkinsonian signs got stronger once the results were controlled for age, sex and vascular risks like smoking and diabetes, though not all potential confounders could be included in this particular study. He also mentioned that statins do have certain side effects, including muscle pain, and patients should consider their options carefully with their physicians. He hopes that working towards conducting a randomized controlled trial will provide more clarity and potentially help older people with movement disorders and their related symptoms.

“I was excited to see these results,” he said. “I expected that statins would have a role. But this is an observational study. There could be some things we didn’t measure for that we need to look at. We want to take the next step to really see if it’s the statins that can make a difference.”

Brain Health & Conditions
Parkinson's

Potential new treatments for Parkinson’s disease developed by researchers at Rush University Medical Center have shown success in slowing progression of the disease in mice.

In a study published in Nature Communications, Rush researchers found that two different peptides (chains of amino acids) helped slow the spread of alpha-synuclein, a protein that occurs in abnormal protein deposits called Lewy bodies in the brain. Lewy bodies are hallmarks of Parkinson’s disease, the most common movement disorder affecting about 1.2 million people in the United States and Canada.

“Currently, there are no treatments that slow the progression of Parkinson’s disease — they only treat the symptoms,” says Kalipada Pahan, PhD, the Floyd A. Davis Professor of Neurology at Rush University Medical Center and a research career scientist at the Jesse Brown VA Medical Center, who led the study.

Lewy bodies are also associated with the development of Lewy body dementia and a rare neurological disorder called multiple system atrophy (MSA). “At present, there is also no effective treatment for dementia with Lewy bodies and multiple system atrophy,” Pahan says. “Understanding how these diseases work is important to developing effective drugs that inhibit alpha-synuclein pathology, protect the brain, and stop the progression of Lewy body diseases.”

The lab-developed peptides tested in the study are known as TLR2-interacting domain of Myd88 (TIDM) and NEMO-binding domain (NBD). The drugs, which were delivered through the nose, were found to slow inflammation in the brain and stop the spread of alpha-synuclein in mice with Parkinson’s disease. The treatments also improved the mice’s gait, balance, and other motor functions.

“If these results can be replicated in patients, it would be a remarkable advance in the treatment of devastating neurological disorders,” Pahan says.

The research was supported by funding from the National Institutes of Health. Other authors of the article are Debashis Dutta, PhD; Malabendu Jana, PhD; Moumita Majumder, PhD; Susanta Mondal, PhD; and Avik Roy, PhD, all from Rush University Medical Center.