Latest / Meaningful Medicine with Novant Health / How to Manage Parkinson’s and Other Movement Disorders

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How to Manage Parkinson’s and Other Movement Disorders · Meaningful Medicine with Novant Health

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  Gina Kaye (Host): Welcome to Meaningful Medicine, a Novant Health podcast,
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  bringing you access to leading doctors who answer questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips for
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  navigating medical decisions and building a healthier future.
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  I'm Gina Kaye, and with me is Dr.
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  John Mason, neurologist for Novant Health.
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  And today, we are talking about movement disorders.
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  Welcome, Dr.
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  Mason.
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  It's great to have you on the show.
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  John Mason, DO: Thanks for having me, Gina.
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  Host: Wonderful.
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  To begin our discussion, you specialize in treating movement disorders.
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  Can you give us a brief overview of movement disorders?
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  John Mason, DO: Of course.
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  So, movement disorders is a broad field of medicine.
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  Essentially, it has to do with anything that really affects movement.
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  This can range from many diseases, including Parkinson's disease, essential
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  tremor, dystonia, progressive supranuclear palsy, also known as PSP, multiple systems
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  atrophy, also known as MSA, Lewy body dementia, tics, Tourette's, and many more.
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  The interesting thing with movement disorders is those conditions vary a lot,
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  but they also vary in how they look, which is a big emphasis on our field is how
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  something looks and how we describe it.
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  Some of those conditions, patients move less, like in Parkinson's
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  disease, and some of them they move more, like in tremors and tics.
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  So, a wide variety of conditions.
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  Host: Yeah, there sure are.
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  Before we get to the treatments, is there anything we can do to lower our
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  risk of developing a movement disorder?
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  John Mason, DO: Yes.
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  There are several things.
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  Unfortunately, there's nothing we can do that we know of at this point that
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  truly prevents the movement disorders from occurring, and they're all very
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  different and occur for different reasons.
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  But as a general rule of thumb, the number one thing I typically recommend
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  to patients is exercise, exercise, exercise, so, there's been a number
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  of studies that have shown that pretty consistent exercise reduces the risk
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  of developing Parkinson's disease.
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  And this is applied to other neurodegenerative disorders
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  like Alzheimer's as well.
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  Diet is something of a hot topic right now in our field.
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  While there haven't been any studies that truly show that any one diet
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  significantly reduces risk, there's some evidence that suggests that
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  it can possibly have an effect.
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  The diets that are typically looked at are Mediterranean style diets.
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  There's one called a MIND diet right now.
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  These are diets that are rich in vegetables, fruits, nuts, fish, olive
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  oil, and they're low in processed foods such as like red meats and
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  really heavily processed foods.
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  Another interesting thing is avoiding certain types of exposures.
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  So, one of the exposures that's associated with developing Parkinson's disease,
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  for instance, is pesticide exposure.
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  So if you're going to be around pesticides, using the
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  appropriate protections as able.
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  I always tell my patients getting good sleep, non-interrupted
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  sleep is key and critical.
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  So, you really wanna practice good sleep hygiene, making sure
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  you're getting between seven to nine hours of sleep a night.
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  And then, lastly, I would say avoiding head trauma when possible.
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  That's kind of a no-brainer, but repeated head traumas is associated
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  with developing several different neurodegenerative disorders.
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  And so if you're going to be participating in an activity that
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  puts you at risk for head trauma, making sure you wear a helmet.
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  Host: Let's talk about medication therapy.
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  Can you share the latest on medication treatments available
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  for movement disorders?
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  John Mason, DO: Yes, it's an exciting time for movement disorders.
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  And there's quite a bit of medication, being looked at and developed.
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  I'll start with the most recent kind of ones that are released.
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  So, there's two medications for Parkinson's.
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  One is called Crexont.
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  So, this is a medication that is a long-acting formulation of
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  a classic and older medication called carbidopa/levodopa.
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  It's formulated a little bit differently in that it helps it last
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  longer and give patients benefit over a longer period of time.
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  Another interesting one that kind of looks at the same issue is called Vylev.
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  So, this is a medication that instead of taking it orally, it utilizes a pump and
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  is injected just underneath the skin.
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  It's a 24-hour, meaning that it's on all the time.
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  And essentially, what this medication does is prevent the fluctuations in
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  medication levels by delivering the medication at kind of a constant rate.
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  So, it's very interesting.
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  There's a few medications that are in the pipeline, that are currently
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  being under review for the FDA.
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  One of them is for essential tremor.
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  It's ulixacaltamide.
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  And then, there's another one being looked at for Tourette's, which is ecopipam.
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  And then, lastly, the most exciting ones, at least in my opinion, are
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  different types of medications.
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  Instead of helping with a specific symptom, these medications look at
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  changing the trajectory of the disease or modifying the underlying disease itself.
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  So for Parkinson's, there's a medication called prasenismab that's
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  currently being studied, where it actually targets the abnormal protein
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  that's found in Parkinson's disease.
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  This abnormal protein's called alpha-synuclein.
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  And so, that's currently being investigated right now.
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  And then, there's another group of medications that are being looked at
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  for Huntington's disease, where they're using gene therapy to reduce the amount
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  of Huntington protein that's present.
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  And so, both of these are thought to potentially change the course
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  of the disease, which would be huge for us because we currently
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  don't have anything that does this.
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  The one important thing to note with these is a lot of medications
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  are being studied, but what we look for is the more information
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  we have and the more medications we have, the more options we have.
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  And so, hopefully in the future, we'll have some additional therapies as well.
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  Host: I understand that some patients may be candidates for
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  surgical procedures as well.
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  Can you talk about how you collaborate with neurosurgery and
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  what these procedures look like?
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  John Mason, DO: This is a particular interest of mine,
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  so I'm glad you brought it up.
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  So, the first one is deep brain stimulation, which sounds very scary,
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  but it's an advanced therapy that we use for a variety of conditions,
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  including Parkinson's disease, essential tremor, dystonia, and very rarely for
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  Tourette's in severe refractory cases.
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  What this therapy involves is we implant electrodes into very
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  specific regions of the brain.
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  And from these electrodes, we're able to stimulate that area of
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  the brain and change how that underlying network is operating.
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  What's really cool about this is that it can help alleviate some of the symptoms
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  that the patient is experiencing.
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  We work really closely with neurosurgery, not only in selecting the correct
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  patient for this, but planning, planning it out, talking about what
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  area we're going to implant, and then the after portion about how they're
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  doing following the implantation.
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  Our role in it is more selecting the patient, "Okay, who's an appropriate
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  Parkinson's patient for this?"
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  And then, following the surgery, actually adjusting the programs and
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  adjusting the stimulation so that it provides appropriate amount of relief.
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  Now, there's another type of therapy called MRI-guided focused ultrasound.
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  That's also kind of a hot topic recently in neurology.
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  What this essentially is we focus ultrasound waves onto a specific
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  part of the brain where we heat it up enough to cause a lesion to
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  help alleviate certain symptoms.
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  The most common one is for essential tremor to help alleviate the tremor.
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  In both of these cases, we work very closely with neurosurgery, and we have
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  regular meetings to talk about these.
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  Host: I know you already touched upon exercise, but let's dive a
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  little deeper into that and tell me how important is ongoing exercise
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  or strength training for individuals living with movement disorders?
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  John Mason, DO: Yeah.
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  So, this is key.
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  For movement disorders, particularly I talk a lot about Parkinson's, it's about
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  80% of what we see, exercise is the only thing that we know that currently
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  slows down the disease, which is huge.
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  And there's a lot of different types of exercise, and it's
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  really important for patients to understand which exercise is best.
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  And I always tell patients, "I want you to do exercise that you
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  enjoy," because if you enjoy it, you're more likely to stick to it.
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  Now, some patients want more evidence-based.
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  And so, usually, what we recommend is around 150 minutes per week of
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  moderate to high intensity exercise, working up a little bit of a sweat.
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  And with this, doing a variety of training actually.
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  So strength training is great.
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  It's great to keep the muscles strong and help keep up your bone
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  density, and also help prevent falls.
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  Aerobic exercise is wonderful because it not only increases your heart rate,
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  but it also helps your brain release certain chemicals that help it kind
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  of keep active and stay healthy.
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  And then, balance and stretching exercises are really important for keeping
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  their balance and preventing falls.
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  So, all three of these in combination is the ideal that we want patients to do.
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  But again, I always emphasize, like if you like a type of exercise, you're
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  much more likely to stick to it rather than me forcing you to go lift weights
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  for 30 minutes, go run for 30 minutes, then go do 30 minutes of yoga, and do
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  that four times a week and we'll talk.
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  The other thing about exercise that is key is it's not just good for movement
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  disorders and neurologic conditions.
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  It's good for your overall health.
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  It can help improve mood.
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  It can improve sleep.
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  It helps your cardiovascular health.
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  And so, there's a plethora of benefits that people receive when
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  they perform regular exercise.
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  Host: As we prepare to close, I want to ask you how neurology became a passion of
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  yours and what drew you to this specialty?
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  John Mason, DO: I've always had an interest in neurology, but really
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  a lot of my interest stems from the human experience and the mind itself.
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  There's so much that we don't know about the human mind.
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  But also, everyone's experience of the world is different, and it's
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  interpreted differently by your brain.
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  And so, I've always found that to be really, really fascinating.
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  And then, when I got into medicine, you get to see that in
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  neurologic conditions, everyone's disease is a little bit different.
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  And this is especially true for movement disorders.
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  No two Parkinson's patients are the same.
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  They don't experience the world the same, and they present with different issues.
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  And one thing that I found that I've really enjoyed doing is finding out
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  what their individual issues are, and we work together to solve it.
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  And so, it creates unique problems that we have to come up with unique solutions.
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  And it really keeps the work interesting and it keeps it fun.
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  The other piece, and I think this is what really pulled me more into the
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  movement disorders direction versus other fields in neurology, is the connection
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  that you get to make with patients.
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  In movement disorders, you can see patients for 20, 30, 40, 50 years.
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  And you get to form these really special connections with patients,
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  and it keeps you motivated every single day to just come in and do your
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  best and continue working with them.
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  Host: Dr.
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  Mason, is there anything else on this important topic that you
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  would like to add before we close?
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  John Mason, DO: I love when patients read and do their due diligence and
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  know everything about the disease.
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  And they often teach me about the disease as well.
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  They know the up-and-coming therapies and what's new in the field.
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  And I would encourage people just keep educating yourself, keep reading about it.
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  It's important.
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  And we can both come together with our ideas.
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  Host: Great.
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  Thank you very much for sharing both your knowledge and your time today.
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  John Mason, DO: Awesome.
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  Thank you for having me, Gina.
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  Host: To find a physician, visit novanthealth.org.
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  And for more health and wellness information from our experts,
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  visit healthyheadlines.org.
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  This has been Novant Health's Meaningful Medicine Podcast.
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  If you found this information helpful, please share it on
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  your own social media channels.
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  Thanks for listening.