Movement Disorders/Parkinson's Program

Overview

Pickup Family Neurosciences Institute’s Movement Disorders Program had its origins in 1994 with emphasis on specialized patient evaluation, advanced medical therapy and community support groups throughout Orange County. The program treats patients with movement disorders including Parkinson’s disease, dystonia, essential tremor and gait problems, enabling them to achieve their highest level of independence.

One of the latest innovations offered is the minimally invasive implantation of a small intestinal tube through which a constant infusion of Doupa, a new formulation of carbo-levodopa, provides a steady state blood level of the drug using a small wearable pump (just like in diabetics). This minimizes the “downtime” Parkinson’s patients feel between oral drug intake. For the 54 (39 in 2017) patients who have been treated with this device to date, the functionality improvement has been significant.

Additionally, our program has long incorporated a very active Deep Brain Surgery surgical treatment with our neurosurgical lead, Dr. Christopher Duma, who has longstanding experience with some of the highest annual volumes in Southern California. Targeted physical therapy is team based and provided in the Outpatient Rehabilitation Department with physical therapists, occupational therapists and speech therapists, who have extensive training and experience in assessment and treatment of movement disorders. Additionally, they offer several forced-use exercise classes and a driving rehabilitation program.

The Movement Disorders Program supports the community of people with Parkinson’s disease and their families by offering 10 support groups, an Annual Parkinson’s Symposium and Parkinson’s wellness patient education programs throughout the year.

Team

The Movement Disorders Program has three movement disorders neurologists with combined expertise of 50 years in managing patients with movement disorders. The program is led by Program Director Sandeep Thakkar, D.O. (neurologist), Janet Chance, M.D. (neurologist), Akash Shah, M.D.(Neurologist), Christopher Duma, M.D., F.A.C.S. (Neurosurgeon), and Julie Treat, M.S.N., R.N., Nurse Navigator.

Outcomes

To better understand patients’ needs over the time course of Parkinson’s disease progression, the Unified Parkinson Disease Rating Scale (UPDRS) scores of 667 Hoag patients in 2016 were recorded and analyzed. The UPDRS is a subjective test for symptom severity, and Parts I (non-motor-related symptoms) and II (motor-related symptoms) were specifically assessed to evaluate patients’ daily living experiences with Parkinson’s disease. As expected, patients who were older or further into disease progression showed more severity for most symptoms—notably except for tremors. Stable scores on tremor symptoms suggested that patient treatment with drugs, the standard at time of diagnosis, was effective. Other symptoms, such as impaired activities of daily living including swallowing ability, dressing oneself, maintaining hygiene, and walking, appeared stable until older age, at which point they declined.

Symptoms, such as impairment for motivation and initiative, dressing oneself, maintaining hygiene, and turning in bed and adjusting bed clothes, showed decline over the initial years after diagnosis, but then stabilized between 5 and 10 years into progression. One reason for this appeared to be treatment, as with tremors, possibly due to effective physical therapy. A subsample with 10 to 15 years progression after diagnosis revealed that those who received physical therapy reported better scores on most UPDRS symptoms. Based on this evidence for improved outcomes, our protocol is being updated to prescribe physical therapy earlier into the time course of progression and for all older patients. A longitudinal study will follow these patients and evaluate the new protocol’s effectiveness.

Support & Education

A multidisciplinary case conference is held each month to review complex patient cases. This unique forum offers the opportunity for members of all disciplines, including physicians, nurses, physical therapists, speech therapists, and other health care professionals to share information about innovative new therapies. All patients who are candidates for surgery are reviewed by this team to optimize care. Patients benefit from this combined expertise and experience.


ADL Scores by Age

Figures presented are scaled responses to UPDRS items as dots, by age (left four graphs) or disease progression (right four graphs). The regression line (solid line) shows the predicted relationship of symptoms across time, as compared to the local average (dotted line). Where the average pulls away from the regression line shows a change in symptom progression.

Symptoms, such as impairment for motivation and initiative, dressing oneself, maintaining hygiene, and turning in bed and adjusting bed clothes, showed decline over the initial years after diagnosis, but then stabilized between 5 and 10 years into progression.


MBMADL Scores by Years

To learn more, visit the Movement Disorders Program section or call 949-764-6066.