Parkinson Voice

what the Neurologists ARe saying...

Q: What are the newest studies or trends you are seeing?

Ryan Barmore, MD Matthew Mian, MD

We spoke with two members of our Medical Advisory Board to find out what your doctors want you to know about Parkinson’s disease (PD).

Dr. Barmore (RB) is a neurologist at Banner Health Clinic in Greeley, CO who specializes in movement disorders including Parkinson’s disease, tremor, dystonia, Huntington disease, gait disorders as well as the use of advanced therapies including deep brain stimulation (DBS).

Dr. Mian (MM) is a neurosurgeon at CarePoint Neurosurgery and Spine in Englewood, CO. His practice spans general neurosurgery, including brain tumors and degenerative spinal disorders, and functional neurosurgery, including surgery for epilepsy, chronic pain conditions such as trigeminal neuralgia, and movement disorders such as Parkinson’s disease and essential tremor.

RB: There is a growing emphasis on exercise - more research lately reinforces the importance of regular exercise. Physical and occupational speech therapy and music therapy are really being pushed as well. There have been recent studies using music as strategy to improve motor skills and movement. It has shown to help freezing gait by focusing on keeping rhythm and timing of movement.

MM: With regard to surgery for Parkinson’s, the major advancements lately have been in remote DBS programming (the ability to have your DBS programmed by video without the need to travel to a neurologist’s office) and in device sensing (the ability of the DBS system to sense changes in your brain rhythms and symptoms). The latter advancement (sensing) is exciting because we will soon have DBS systems that automatically adjust their settings based on a patient’s changing symptoms throughout the day.

Other advancements include a new procedure called focused ultrasound that can be used for treating tremordominant patients, robotic technology for implanting DBS leads precisely and efficiently, as well as studies on a different brain target for treating Parkinson’s.

Q: Are you seeing any changes in the average age of your clients? More Young-Onset?

RB: Not here in the Greeley, Loveland area, but the number of Young-Onset cases are increasing nationally. We are still seeing most clients that are in their mid 60’s.

MM: I have seen a slight shift towards younger patients, though it has not been dramatic.

Q: What are the questions every patient should ask at their first appointment?

RB: It’s important to just start by asking about the basics of the disease.

1. Ask about the fundamentals: why this disease happens, how does it progress?

2. When do we use meds and why? Because medications vary by patient, it’s important to really understand your personal medication path.

3. What are some treatment strategies besides medication, such as exercise and physical and occupational therapies?

4. What are some good trusted resources for us to learn more on our own?

As a general principle, having a close family member with you at the appointment to help identify changes that you may not have noticed. Often the people around us notice things before we do.

MM: These questions are for patients who are considering or planning on having deep brain stimulation (DBS) surgery:

1. What can I expect the experience of surgery to be like? How do you perform the procedure?

2. Which of my PD symptoms are most likely to improve with DBS? Which may not?

3. Do I want to have both sides of my brain treated at the same time, or should I start with just one?

4. Should I get a rechargeable or nonrechargeable battery?

5. What does the recovery from surgery look like?

Q: Understanding every patient is different, is there one piece of advice you would give to all your patients?

RB: Exercise! Do 150 minutes per week using a variety of exercises -aerobic, strength, balance and stretching. Getting your heart rate up is key.

MM: Be your own advocate. Seek a second opinion if you’re struggling and your team doesn’t have options, or if you think you might be a candidate for a treatment (surgery, medication) that isn’t being offered to you. Read online about different therapies, and ask friends, family, and other PD patients about their experiences and recommendations. Think carefully about your symptoms on a typical day and which are the most disabling/which you would like to see treated the most. And exercise! Exercise is one of the single most impactful therapies we have for patients with PD. It’s free, and it’s good for your overall health, too!

Q: What else would you like People with Parkinson’s to know?

RB: It is so important to get in to see a movement disorder specialist. Educating yourself on the importance of therapies like, speech, occupational, physical, etc., but make sure it is someone who specializes in Parkinson’s MM: PD can be a scary and difficult diagnosis. We do not (yet) have a cure, but there are many therapies today that can help improve quality of life. Seek out a care team that you feel comfortable with.