Talking to Your Doctor about ... Video Transcript

Participants

Ron Alterman MD, Odus Lynd , David R. Marks MD, Carol Polenberg , Michele Tagliati MD

Summary

Parkinson's disease poses tremendous challenges to both patients and their caregivers. Fortunately doctors have a number of effective treatments available to help alleviate symptoms and improve a patient's quality of life. An essential component of effective treatment is open and consistent communication between patients, caregivers, and their doctors. Join our panel as they talk about the latest treatment options and the importance of dialogue between doctors and patients.

Webcast Transcript

DAVID MARKS, MD: Hi and welcome to our webcast. I'm Dr. David Marks.

Parkinson's disease poses tremendous challenges to both patients and their caregivers. Fortunately, doctors have a number of effective treatments available to them. Now, these treatments can help alleviate symptoms and improve a patient's quality of life. One way to improve that is by open and consistent communication between patients, caregivers and their doctors.

Here to talk about the latest treatment options and the importance of dialogue between doctors and patients are four experts. First is Dr. Michele Tagliati, a neurologist from Beth Israel Medical Center in New York City. Welcome. And next to him is Dr. Ron Alterman. He's a neurosurgeon and he's also from Beth Israel. Thank you for being here.

We're also fortunate enough to have a Parkinson's patient, Carol Polenberg. Welcome. And Odus Lynd, he is the caregiver of a Parkinson's patient named Richard, who can't be here. But Odus is going to give us his expertise on the subject. Welcome.

Dr. Tagliati, what is Parkinson's?

MICHELE TAGLIATI, MD: Well, Parkinson's disease is caused by the premature death of a small area in the brain which produce a chemical that is called dopamine. And the brain needs dopamine to coordinate the movements of the body. And when dopamine is decreased because of the premature death of this small area, the symptoms of Parkinson's disease occur.

DAVID MARKS, MD: But how can you tell if someone actually has the disease? You're not necessarily looking in the brain always.

MICHELE TAGLIATI, MD: There are three fundamental symptoms that the patient can feel. One is tremor, the second one is unusual slowness or lack of dexterity in their movement or lack of coordination. And the third is a stiffness of the muscle that we call rigidity. There is a fourth symptom that usually occurs later on; that is a gait instability. A lack of balance while walking.

DAVID MARKS, MD: And they have to have all of these symptoms to be diagnosed with Parkinson's?

MICHELE TAGLIATI, MD: No, they don't. The definition of the disease is the presence of at least two of these four major symptoms. And there is a corollary of small other symptoms like a lack of expression of your face, a difficulty in writing -- the letters come out very small and very effortful -- and problems with sleeping or anxiety.

DAVID MARKS, MD: Dr. Alterman, as a neurosurgeon, it must be very exciting to you, because this is a time when we have an increasing number of treatments for Parkinson's. Tell us about them.

RON ALTERMAN, MD: Yes, it is a very exciting time. Because of advances in various technologies and in our understanding of the physiology, we've seen a renewal of the interest in surgery for Parkinson's disease. Nevertheless, the front-line treatment for Parkinson's continues to be medications.

The most successful of those medications is something called levodopa, which is taken up by the brain and literally replaces the dopamine that is being lost.

DAVID MARKS, MD: Now that's L-dopa.

RON ALTERMAN, MD: Yes L-dopa. Over time, however, we know that the levodopa will lose its effectiveness. That may be as short as five years for some people, but it could be as long as fifteen or twenty years for others. In addition to losing its effectiveness, many patients develop side effects from the medication. What we call levodopa-induced dyskinesias, which are abnormal, almost wriggly snakelike movements, which the patients experience when they have those medications.