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If you or someone you love has been diagnosed with Parkinson's Disease, there is help.
At the Miami Neuroscience Center at Larkin our Neurosurgeons specialize in treating the symptoms associated with Parkinson's Disease such as tremors, slowness, and rigidity. We seek to control your symptoms with the least invasive options available such as medications and physical therapy. However, if these treatments haven't worked for you we also offer advanced treatments such as Deep Brain Stimulation (DBS) and Gamma Knife which have shown phenomenal outcomes. Explore all of our diagnostic and treatment options and meet the top parkinson's disease specialists in Miami, call us today to learn more about managing your symptoms.
Parkinson’s Disease Diagnosis
First and foremost, our physicians will ask you about your medical and family history. Your medical history can help in ruling out certain Parkinsonisms which are conditions that cause parkinson-like symptoms and are commonly misdiagnosed for Parkinson’s Disease. For example, if you are on certain antipsychotic medications, they may be causing drug-induced parkinsonism or if you’ve suffered from blood clots or strokes this might indicate you have vascular parkinsonism. Although hereditary parkinson’s disease only accounts for 15% of cases, your family history may still help in our diagnosis.
Our physicians will then conduct neurological examinations of your cognitive and motor functions to identify if you are expressing any symptoms of Parkinson’s Disease such as tremors (resting or active), slowness, shuffling, rigidity, speech or writing impairment, muscles spasms, and personality changes. See a full list of PD symptoms by clicking here or to see the Stages of Parkinson’s click here.
Sometimes, Parkinson’s disease can be difficult to diagnose, particularly in the early stages so after an assessment of your medical history and symptoms, our doctor will use a combination of tests to make an accurate diagnosis. These tests may include:
This is an imaging technique that enables our doctor to measure the levels and function of dopamine in your brain. Parkinson's Disease is caused by the damage and death of dopaminergic (dopamine producing) nerve cells so this test will help determine if you have low levels of dopamine. After you are administered a radioactive agent which binds to dopamine-producing nerve cells, this test uses single-photon emission computed tomography (SPECT) to measure the brightness of these cells that transport dopamine. Our physicians will review these emissions and patterns to distinguish between Parkinson’s Disease and Parkinsonism such as Essential Tremors or Dementia with Lewy Body.
Magnetic Resonance Imaging (MRI)
In some cases an MRI may be useful to rule out conditions that mimic Parkinson’s symptoms and diagnose changes in brain functions. Some of these conditions include brain tumors, stroke, and hydrocephalus which can cause cognitive and motor impairment, such as memory loss, personality changes, problems walking, and loss of balance. MRIs do not use radiation, instead they use a magnetic field and radio waves produce clear images of soft tissue and structures within the brain.
Our physicians may prescribe dopaminergic medications and study what impact these medications have on your symptoms. If your symptoms remain constant this may indicate that other tests to diagnose parkinsonism’s should be performed.
Similar to MRIs, Blood Tests can help distinguish Parkinson’s Disease from conditions that cause similar symptoms.
The progression or stage of Parkinson’s Disease can be determined through the following rating scales:
Though the Hoehn and Yahr Rating Scale is not a diagnostic tool, it is often used to describe the progression of Parkinson’s. In its original form it had a scale of 1-5, more recently, stages 1.5 and 2.5 have been added to incorporate the onset of intermediate symptoms.
The Unified parkinson's disease rating scale helps to determine the severity of PD by performing a series of mental and physical assessments. The assessment is composed of four sections: Mental/ Behavioral, Activities of Daily Living, Motor Examination, and Complications of Therapy.
Each section contains a list of questions, each with options that are assigned a weight (0 through 4). The maximum score is 199 which means the patient is completely disabled.
Life-Changing Treatment Options
Our Parkinson's Specialists, Neurosurgeons, and Neurologists in South Miami and Hialeah have helped many patients take back their motor and cognitive control and if given the opportunity, would like to do the same for you.Schedule a Consultation
Call today at (786) 871-6856 to speak with a care coordinator to arrange an appointment.
Parkinson’s Disease Treatment
Unfortunately, there is no cure for Parkinson’s disease. However, a combination of medication and other treatments can help to manage symptoms.
Non-Surgical Options for Parkinson’s Disease
Sinemet is the most commonly used non-surgical treatment for Parkinson’s disease to reduce symptoms including muscle rigidity, tremors, and difficulty moving. Sinemet is a medication that combines Levodopa (L-dopa) and carbidopa. Levodopa is converted into dopamine to help improve neurotransmission within the brain. Carbidopa is combined to help reduce some of the side effects of Levodopa and ensure that a higher quantity of Levodopa reaches the brain. Some side effects associated with Sinemet include dizziness, confusion, hallucinations, low blood pressure, nausea, headache, and insomnia.
Physical Therapy for Parkinson’s Disease
In some cases, physical therapy can be a beneficial part of a Parkinson’s disease treatment plan. It can provide gentle exercises to increase a patient’s strength and improve flexibility. It may also help relieve muscle stiffness.
Surgical Options for Parkinson’s Disease
Deep Brain Stimulation (DBS)
Currently, the most widely used surgical option for Parkinson’s disease is DBS. This is a non-destructive surgical procedure unlike lesioning procedures (e.g. thalamotomy) that can help to reduce symptoms such as tremors, muscle rigidity, and slow movement. People who have undergone this treatment show an immediate improvement after the stimulation device is turned on 4 weeks after the procedure. Research indicates a 66 percent improvement in motor symptoms and around 70 percent reduction in tremor. The Miami Neuroscience Center offers Deep Brain Stimulation (DBS) at two convenient locations in South Miami and Hialeah.
You may be a good candidate for DBS if:
- You have suffered from Parkinson’s disease for five years or more
- Your symptoms prevent you from doing your normal daily routine
- You have no cognitive impairment
- Parkinson’s medications have helped you, but they are not as effective as they once were.
COMPONENTS OF THE DBS SYSTEM
Electrodes/Leads: this is the receptor of the electrical impulses. One (unilateral) or two (bilateral) electrodes can be implanted into the brain. Each electrode is placed within areas of the brain that control motor functions such as the Thalamus and Globus Pallidus. Specifically, the electrode is inserted into the subthalamic nucleus (STN) or internal globus pallidus (GPi)
IPG (Internal Pulse Generator): this is a neurostimulator (the source of the electric signals). It will be placed under your skin, near your collarbone. There are a variety of IPGs on the market including rechargeable (which last longer) and non rechargeable stimulators.
Extension Wire: This is a wire that runs underneath the skin, connecting and transmitting the signal from the IPG to the electrodes.
DBS Placement in the Brain - Side View
DBS Placement in the Brain - Front View
DBS enables brain activity to be controlled. It does this by sending electrical signals to areas of the brain that control motor functions to obstruct the neural circuitry that is causing tremors and other PD symptoms.
Specifically, the electric signals stimulate the brain to release more adenosine triphosphate (ATP) which is a chemical that provides energy for many cellular functions such as the transmission of neural messages. When ATP is released it activates the A1 receptor triggers. This inhibits the production of excitatory synaptic activity in the thalamus and other areas of the brain that transmit motor signals which reduces tremors and other symptoms.
Here at the Miami Neuroscience Center, our doctors uses the Boston Scientific Vercise Gevia™ DBS System. Benefits of the Vercise DBS system include:
- Wireless, rechargeable IPG
- Charger collar comfortably sits around your neck
- The charger plays a continuous single beep until it is connected and charging the stimulator
- When charging is complete it will play a distinct double beep to notify you
- Like other electrically powered devices you can choose the frequency you wish to charge and the device will notify you when the battery is low. Many patients integrate charging into their daily routines including watching TV, reading, eating, or working. Some charging options include:
- 3-4 hours every 2-3 weeks
- 15-25 minutes daily
- The rechargeable IPG has a 15 year life!
- Wireless communication to remote control that:
- Indicates the battery of your IPG
- Provides different stimulation programs (installed by neurosurgeon)
- Enables adjustable stimulation intensity
You will remain awake during DBS so that you can respond to our doctor’s questions and move certain parts of your body when asked to. You will feel no discomfort. During the procedure your head will be placed in a brace to prevent movement. Our doctor will inject an anesthetic into your scalp. He will then drill very small holes into your scalp so the electrodes (small wires) can be implanted.
The electrodes will be placed in one (or both) sides of your brain and a neurotransmitter close to your collarbone. A wire will pass under your skin to connect the electrodes to the transmitter. Once everything is in place, the holes in your scalp will be closed.
If our doctor recommends the placement of electrodes on both sides of your brain, you will require two separate surgeries. The second will take place 1-2 weeks after the first. After each surgery you will remain in the hospital overnight (either at Larkin Community Hospital in South Miami or Larkin Community Hospital Palm Springs Campus in Hialeah).
About 2-4 weeks after surgery, you will meet with our Neurosurgeon to begin programing your stimulation device. The neurotransmitter will be programmed precisely to treat your unique symptoms effectively. Our neurosurgeon will determine the stimulation level of your device, if different stimulation programs will be installed, and if you will be able to adjust the stimulation level on your own.
AIRO® MOBILE INTRAOPERATIVE CT
At the Miami Neuroscience Center our Neurosurgeons use advanced CT Guided Technologies that provide real time images of the Basal Ganglia and other structures of the brain to assist in the precise implantation of the electrodes. This technology enables our physicians to make corrections during the procedure which substantially reduces the risk of misplacement and reoperation. Browse through the photo gallery below of the detailed anatomical structures of the brain that our Neurosurgeons see during the procedure.
Advanced Intraoperative CT Imaging of DBS Procedure
(Illustrating the Electrodes placed within the Subthalamic Nucleus)
Gamma Knife (Stereotactic) Thalamotomy (GKT)
Gamma Knife is a form of stereotactic radiosurgery, which is a noninvasive procedure that uses precisely targeted radiation beams to selectively destroy any target within the brain such as a brain tumor or AVM. Stereotactic Thalamotomy or GKT is the use of gamma knife radiation to create a small lesion in the thalamic nucleus, an area of the brain responsible for involuntary movements commonly seen in Parkinson’s Disease. One study demonstrated that Stereotactic Thalamotomy improved tremor, handwriting, or drinking scores in 70 out of 86 patients (81%) that underwent this procedure.
Parkinson’s Disease Prevention
There are a number of lifestyle choices you can make to help reduce your risk of Parkinson’s disease. These include:
- Regular exercise, including stretching
- Consume Omega-3 fatty acids and tumeric
- Get plenty of vitamin D
- Drink green tea
- Avoid toxins & pesticides
- Minimize risk of head trauma
Learn more about our treatment options for Parkinson's Disease. Please call us at 786.871.6856 or schedule a consultation today!Request More Information
Parkinson’s Disease Frequently Asked Questions
A lot of current research into Parkinson’s disease is focusing on the possible use of stem cell therapy. In theory, pluripotent stem cells derived from a Parkinson’s sufferer’s blood could be used to create dopamine-producing nerve cells, which could be transplanted directly into the brain of a patient. If the transplant was successful, it could possibly last for the lifetime of the recipient. This would mean there would be no further need for medications. Medical experts are optimistic that this could be the treatment of the future, but there is still a long way to go before it becomes a viable option.
There are many qualified physicians in Miami that can help diagnosis and treat patients with Parkinson’s Disease. The Miami Neuroscience Center at Larkin possesses a comprehensive team of neurologists, neurosurgeons, movement disorder specialists, physical and occupational therapists, and nutritionists that can help in the rapid diagnosis and treatment of Parkinson’s Disease.
A quick diagnosis of Parkinson’s Disease is vital to preserve the health and wellbeing of patients because motor and cognitive challenges may lead to serious injury (including falls and accidents). In addition, Parkinsonism (conditions that mimic Parkinson’s symptoms) can present life-threatening complications to patients the longer they are not properly diagnosed such as strokes, brain tumors, hydrocephalus, or adverse drug reactions.
The Miami Neuroscience Center offers the latest technology in the treatment of Parkinson’s Disease including Deep Brain Stimulation (DBS) and Gamma Knife Radiosurgery.
Dr. Jose Valerio is a Neurosurgeon in Miami that specializes in the treatment of Parkinson’s Disease using Deep Brain Stimulation (DBS). The patients he has treated with DBS surgery have shown phenomenal results in the management of their Parkinson’s symptoms. Patients that are tired of taking numerous pills a day to control their symptoms or can no longer perform simple motor tasks are excellent candidates for DBS.
Dr. Valerio strives to increase every patient’s quality of life by restoring their functional abilities so they can continue living life to their fullest. As soon as the DBS device is turned on after surgery, patients that previously struggled to stand up from a chair are running, dancing, and performing tasks they never thought possible.
The Miami Neuroscience Center at Larkin is equipped with a state-of-the-art Gamma Knife machine, used in the treatment of Parkinson's Disease and Essential Tremors. Gamma Knife is a non invasive and painless procedure that can be performed on an outpatient basis. Prior to scheduling a Gamma Knife session, you will meet with our Neurosurgeons for a comprehensive neurological assessment and undergo imaging studies, if needed. Our Neurosurgeon and Physicist will then determine the dosage of radiation required, the intracranial coordinates, and customize the procedure to your symptoms.
During the procedure a helmet will be placed to ensure the precise delivery of the gamma rays to the target. If you are suffering from motor disturbances such as tremors, the Gamma Knife will be programmed to make a lesion in the subthalamic nucleus. The procedure requires a mild sedative so many patients sleep through the procedure. When patients awake following the procedure and are resting in the recovery area they immediately experience the results of the procedure including a reduction in debilitating tremors and improved control of motor functions.
If you are looking for an experienced neurosurgery center in South Miami to treat your Parkinson’s with Gamma Knife, the Miami Neuroscience Center is here to help.
Living With Parkinson’s Disease
As well as managing symptoms and exercising, there are other things you can do to improve your quality of life and make living with Parkinson’s disease a little easier. These include:
Join a support group: Whether you are a caregiver or a sufferer, joining a support group can help you get in touch with other people who are living with Parkinson’s, so you won’t feel so isolated. There are many helpful organizations out there including:
- American Parkinson Disease Association, Inc.
- National Parkinson Foundation, Inc.
- Parkinson's Resource Organization
Maintain emotional wellbeing: Counseling sessions for an individual or group of family members can make it easy to deal with the anxiety of living with Parkinson’s and alleviate stress.
Occupational therapy: An occupational therapist can help make your home a safe place for living with Parkinson’s.
National Institutes of Health (NIH) "Parkinson disease" Novemebr 2019. https://ghr.nlm.nih.gov/condition/parkinson-disease#inheritance
Allison Wright Willis; Bradley A. Evanoff; Min Lian; Susan R. Criswell; Brad A. Racettea "Geographic and Ethnic Variation in Parkinson Disease: A Population-Based Study of US Medicare Beneficiaries" National Center for Biotechnology Information (NCBI), January 2010. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865395/
Darrin J. Lee, M.D, Ph.D; Robert F. Dallapiazza; Philippe De Vloo; Andres M. Lozano "Current surgical treatments for Parkinson's disease and potential therapeutic targets" National Center for Biotechnology Information (NCBI), August 2018. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6108190/
S. J. Groiss; L. Wojtecki; M. Südmeyer; A. Schnitzler "Deep Brain Stimulation in Parkinson's Disease" National Center for Biotechnology Information (NCBI), November 2009. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3002606/
Kooshkabadi A; Lunsford LD; Tonetti D; Flickinger JC; Kondziolka D. "Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era." National Center for Biotechnology Information (NCBI), February 2013. https://www.ncbi.nlm.nih.gov/pubmed/23373801
To learn more about our treatment options for Parkinson's Disease, please call us at 786.871.6856 or schedule a consultation today!