Parkinson's Disease

UT Southwestern Medical Center offers full-service care for people with Parkinson’s disease. In addition to top-tier treatment and rehabilitation services, our physicians are active in ongoing research that improves Parkinson’s patients’ quality of life.

Our Movement Disorders team has a national reputation for Parkinson’s disease care and clinical trials, making UT Southwestern a referral hub for doctors across North Texas and beyond.

What Are the Risk Factors for Parkinson’s Disease?

While a primary cause for PD is not yet known, certain risk factors can increase a person’s likelihood of developing the disease:

• Age: PD is rare in young people. The disease is more common in people who are around 60 or older, and the risk increases with age.
• Exposure to environmental toxins: Exposure to certain herbicides and pesticides can increase the risk.
• Gender: Men are more likely to develop PD than women. On average, three men will develop the disease for every two women.
• Heredity: Having a close relative with PD increases the chances of developing the disease. However, that risk is still small unless family members develop the disease at a young age.

What Are the Symptoms of Parkinson’s Disease?

Everyone with PD will experience symptoms differently. For example, while many people experience tremors as their primary symptom, others might notice weakness, difficulty walking, or stiff muscles.

Early signs of PD can be mild and go unnoticed. The primary signs of PD include:

• Resting tremor: In the early stages of the disease, many people experience a slight tremor in the hand or foot on one side of the body. The tremor consists of a shaking or oscillating movement and usually appears when a person's muscles are relaxed. The tremor often spreads to the other side of the body as the disease progresses but usually remains most apparent on the initially affected side.
• Rigidity: The muscle tone of the limbs, neck, or trunk can become stiff. The muscles don’t relax, sometimes contributing to a decreased range of motion and causing pain.
• Slowed movement (bradykinesia): The loss of spontaneous and voluntary movement might make simple tasks and movements more difficult and time-consuming. Steps might become shorter, or the feet might drag when walking, and it can be difficult to get out of a chair.
• Postural instability: Losing some of the reflexes needed for maintaining an upright posture can lead to a person toppling backward if pushed even slightly. This is usually a later finding as PD advances.

In addition to the primary signs of Parkinson’s, many other symptoms are associated with the disease, such as:

• Constipation
• Handwriting changes, such as smaller letter sizes or more crowded words
• Urinary dysfunction
• Loss of the sense of smell
• Sleep disruption, including dream enactment behavior described as punching and kicking in sleep, as well as insomnia
• Speech problems, such as low-volume, rapid, slurred, hesitant, or monotone speech
• Trouble swallowing (dysphagia), usually in later stages

How Is Parkinson’s Disease Treated?

Although PD has no cure, the symptoms of the disease are treatable.

Because each patient experiences symptoms differently, physicians base each patient’s treatments on his or her specific symptoms. The Movement Disorders team works closely with other UT Southwestern specialists – such as those in psychiatry, and speech, physical, and occupational therapy – to provide patients with individualized care to manage symptoms and maximize mobility, balance, and coordination.

Treatments for Parkinson’s disease include:

• Medication: Many experts now believe that medication should be initiated immediately after diagnosis. Medication can help manage problems with walking, movements, and tremors by correcting or compensating for dopamine deficiency in the brain.
• Neurotoxin injections: UT Southwestern specializes in the use of botulinum toxin injections for a variety of conditions that result in involuntary muscle contractions. Botulinum toxin weakens the muscle that it is injected into, thus promoting relaxation of muscle spasms. These injections can be a particularly effective treatment for PD patients with dystonia (involuntary cramping movements of the limbs or neck), eye twitching, and drooling. Patients who might benefit from botulinum toxin are examined to determine which muscles are overactive. The botulinum toxin is injected into only those muscles. Benefits gradually develop over seven to 10 days. The treatment is usually effective for three months, so injections are repeated several times a year to maintain ongoing benefits.

Advanced treatment options include:

• Deep brain stimulation (DBS): Another area of expertise at UT Southwestern is this surgical treatment, which improves symptoms such as tremors, slowness of movement, and rigidity by modulating electrical activity in selected areas of the brain. For patients who are candidates for DBS, the surgery often enables a reduction of medication dosage and can reduce side effects from medication, such as dyskinesias resulting from levodopa (Sinemet). The motor fluctuations that often occur with disease progression can also be reduced with DBS.
• Dopaminergic infusion therapies: These treatments, including continuous levodopa and apomorphine infusions, can help patients with advanced Parkinson’s disease who experience motor fluctuations not well managed by oral medications.
• High-intensity focused ultrasound (HIFU): This incisionless MRI-guided procedure uses high-intensity ultrasound waves to heat and ablate a very small area of brain tissue. Depending on the target, it can provide relief from tremors or dyskinesia in patients with PD.

The benefits and disadvantages of medications can be different for each person.

The following medications might be prescribed:

• Levodopa has been the mainstay of treatment for PD since the 1970s. This drug is transported to the brain, and, inside the dopaminergic brain cells, is converted into natural dopamine.
• Dopamine agonists work by directly stimulating postsynaptic dopamine receptors.
• Catechol-o-methyl transferase inhibitors lengthen the half-life of levodopa in the bloodstream.
• Monoamine oxidase type-B inhibitors block the breakdown of dopamine in the brain, thus lengthening the clinical duration response to levodopa.
• Amantadine is an N-methyl-D-aspartate (NMDA) receptor antagonist that provides modest symptomatic benefit and may help reduce levodopa-induced dyskinesias.
• Anticholinergic medications can reduce tremors in younger patients but are generally avoided in older adults due to cognitive side effects.
• Adenosine A2A receptor antagonists, a newer class of medications, help reduce "off" time in patients already taking levodopa by modulating pathways in the basal ganglia indirectly involved in motor control.

Patients often see significant improvement after beginning PD medication. Over time, however, the benefits of drugs become less consistent for many people. Advanced treatment options (as listed above) are usually then considered.

Rehabilitation

Rehabilitation is a key element of an effective PD treatment plan. The UT Southwestern Rehabilitation team includes nurses, neuropsychologists, psychologists, and occupational, physical, recreational, and speech therapists. This team approach maximizes each patient’s ability to take part in activities at work, at home, and in the community.

Whether a person’s symptoms are mild or severe, all Parkinson’s patients benefit from an exercise program. Exercise can help people with PD stay active and relatively limber, improve balance and motor coordination, and even slow the progression of the disease. UT Southwestern specialists customize exercise recommendations for each patient’s particular needs and abilities, whether it’s obtaining a gym membership or engaging in professional physical therapy.