¶ Intro / Opening
Another informational resource from
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Featuring conversations with our physicians and other healthcare providers.
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If you've ever known anyone with Parkinson's or any other movement disorder, you know How really it can affect the quality of that person's life, whether they're drinking a glass of water or eating soup or just getting up and walking around. Here to tell us about movement disorders today is Dr. Zayn Gaduru. He's a neurologist with UK Health. Dr. Gaduru, tell us a little bit about movement disorders. How prevalent are they? And really what do they encompass?
Sure. Thank you, Melanie. First of all, thanks for the invite and I'm excited to share about the specialty which I practice and how we hel help our patients. And I'm a neurologist at UK Healthcare and Specialized Movement Disorder.
¶ Defining Movement Disorders
No, before we answer the question, I want to introduce this term movement disorders. It's a it's it's a neurological disorder where we see some abnormal excess movement or there's some decreased movement which is bothering the patient significantly as you just heard. and uh a few of the movement reserves commonly which we see in our practice
are Parkinson's disease, essential tremor, Huntington's disease. You might have heard about Huntington's Korea and uh rare disorders like dystonia and their and we will be talking about some surgical options today too.
So they're classified in a certain way, yes. And you mentioned Parkinson's and Dystonia and Huntington's. So are these classified movement disorders based on the disease, or are they in and of themselves a classification?
There's no standard way of classification but just to make it easy, we classified this into anyone who is having excess movements, for example. tremor, you know, someone is having shaking or some for example myoclonus, someone is having jerking type of movement. That's excess movement. And the second w second is
decreased movement, low movement. Someone has dystonia, what it means is there's some abnormal contraction causing abnormal postures. They're not moving much. It's a fixed it's kind of a fixed deformity. So that way we can classify into two groups. But in general when we are talking, when we are diagnosing, it's more based on a disease. You know, we diagnose someone with Parkinson's disease, someone with essential tremor.
These must be so frustrating, doctor. I mean, like I said in the intro, they can really affect so many parts of a person's life. How do you diagnose what is causing them or the root cause of why they're having these tremors?
This is a tough question. You know, uh first of all when you know, as you have asked about tremor, tremor has different causes. Th there are different diagnoses in which tremor is a presentation. For example, if someone has fever, fever can be caused by thousands of diseases. Fever is just a presentation of that particular disease. In a similar way, tremor is also like that. In Parkinson's disease, for example, there's there's tremor or shaking in especially in the hand.
which significantly affects their daily living activities. They're not able to uh you know, do their daily living activities, they're not able to write properly, they write smaller and smaller. in Parkinson's disease they also have some stiffness and slowness which affects their again their daily living activities. These most of these syndromes which we diagnose, most of the diseases which we diagnose are clinical diagnoses.
It's hardly that we order any specific blood tests or brain scans and even if we order it is to look uh to rule out some other diseases. But in and all it's uh this is more a clinical s speciality. It's a clinical diagnosis.
¶ Botulinum Toxin Treatment
Let's talk about treatment then, Doctor. What are some treatment options and we've been hearing a little bit about Botox to help with some of these? Tell us some of the treatments and start with Botox for us.
So uh Botox is a brand name, I prefer the term botulinum toxin. Uh this is the toxin which we inject in patients with dystonia. As I just described, dystonia there's some abnormal pulling of some certain group of muscles uh for example if it happens in the neck neck is in is in is in abnormal posture or uh abnormal position and sometimes there w there can be associated pain. In order to relax these muscles we inject this botulinum toxin in those set uh group of muscles.
And uh the reason we prov uh you know this is very good treatment is these are local injections. That means the chances of having any systemic side effects the whole body getting affected with some some side effects is very unlikely. If there are even if there are side effects they can happen only in that specific region but uh just out of experience the ha the tendency to have these side effects are very minimal.
and uh we are trained in dystonia botulenum toxin injections We also use EMG, that's electromyography machine, to localize which muscles are affected, to localize which areas in those specific muscles are affected. Uh that way we can get the accuracy, we can get the right dose in that specific region, which will benefit the patient with the least side of
Isn't that amazing? And how this field is changing for movement disorders. There's also a new procedure, relatively new, not completely new, I suppose, deep brain stimulation. And we'll talk about medications as well, but tell us a little bit about surgical interventions. Who is it most effective for? Tell us about it.
¶ Deep Brain Stimulation Explained
So this is a very broad topic. D brain stimulation is a neurosurgical technique. I always whenever introduce this surgical options for our patients, I tell them that this is kind of minor surgical pro procedure because When a patient gets this surgery today, the patient is at in their home by the next day itself.
So that we don't cut open the brain, it's a very small hole which is drilled in the skull and there is a lead which is put in in the brain. And there's a small amount of pulsatile electrical electricity which we send in certain regions of the brain that will eventually help with the symptoms. Now the question is in whom do we do this kind of surgery? First of all, par in Parkinson's disease this is a surgical option. Again, please note that there are medication options.
Surgery is also one of the treatment options which is going to help with the symptoms in Parkinson's disease. this particular procedure has very less complication or side effect rate, I would say it this is only one to three percent. that too I can uh tell you that University of Kentucky healthcare is one of the leading centers in this kind of surgery with the surgeon having tremendous experience.
One very important thing to understand about this surgical technique is the timing of doing the surgery is the key here. Do not wait till o till you run out of all other options. Do not run out till you run out of
Medication options. That is not the time. We usually three to five years into the disease process in Parkinson's disease, that's the time when we start thinking about de brain stimulation. I all my recommendation here would be any person with Parkinson It's better to get at least one evaluation at the university healthcare where you can talk to your doctor about the possibility of de brain stimulation or other research options here.
The second disease where we use the same surgery is essential tremor, where we target different area of the brain. shaking which runs almost runs in every generation in a family and uh medication helps very good with this tremor. There are only few people who don't respond to medication or who have side effects to the medication.
They are the ones who eventually end up having surgery and uh these people almost they have completely different life as soon as the surgery is done, right from the next day of the surgery. They're able to eat, they're able to drink. They're able to write themselves. We can see the tears flowing as soon as the surgery is done and when they start doing all these activities.
Wow, that's so cool, doctor. And it is amazing that people are able to see results that quickly. Very briefly, just touch on some of the medications that you might use. For movement disorders, tremor, essential tremor and just really what are they intended to do? Sure.
¶ Pharmaceutical Treatment Options
I'll start off with uh the common uh disease which we see in our clinic, that's Parkinson's disease. Before we go on to the medications, I wanna let you know that this particular disease is the second most common neurodegenerative disorder in United States.
And uh
by the time they they present to the hospital or the doctor They have almost lost seventy percent of neurons in one specific area of the brain called substantia nigra. And there is a tremendous burden globally because of Parkinson's disease.
almost six million individuals have Parkinson's disease globally. The medications which we are gonna talk about in Parkinson's are the ones which are going to help the symptoms. There are no medications at this time which are F D approved Which slow down or stop the progression of the disease.
But there's significant amount of research going on right now where they're concentrating on discovering some medications which is going to slow or stop the progression of the disease. This is the future of
At this time
The gold standard treatment for Parkinson's disease is a medication called Levodopa. It's combined with carbidopa, it's called carbidopa levodopa and the trade name is Cinemat. And this is this has been the gold standard for more than fifty years. There are other other medications which we try in Parkinson's disease are
Seligeline or Rasagelline, Primipexol, Ropenerol, there are different there are almost twelve to thirteen types of medications available. All of these are going to help with your syndrome. Moving to the next disorder which we see commonly is essential tremor. Not every person with this kind of tremor needs treatment. The key here is we start treatment in only those people where the shaking affects their daily living activity.
And in them, the FDA approved medication is called proprenol, and there is another medication called Primidone which also has similar efficacy, and most of the patients do respond to these two drugs. If they do not respond to these two drugs, then we have other alternatives, but that is the time we also start thinking about is this person candidate for deep brain stimulation surgery too.
And the last one which we also see here is Huntington's disease. Here Whenever someone has abnormal movements in th with this particular disorder, there are medications like tetrabenazine, deuterbenazine and valbenazine, which is going to help with the abnormal movement. And these are called Huntington's chorea. In addition to that, these people also have significant psychiatric symptoms like depression and anxiety, which are treated with selective serotonin reuptake inhibitors like surrelein.
Wow, what a great educator you are. That was an excellent lesson.
¶ Research and Patient Support
in the medications available. As we wrap up, Dr. Gaduru, what are some ongoing movement disorders research going on at UK and and tell us about Lexington Area Parkinson's support group? Sure.
In terms of Parkinson's disease, as I just mentioned, there's significant burden globally and also uh you know, if you think about the economic burden of Parkinson's disease it's almost fourteen billion dollars. Uh and the indirect cost is also added up to this, which is six billion dollars, which reduces the payment. The treatment of Parkinson's disease revolves around a comprehensive and multidisciplinary treatment pattern.
So you need a neurologist, you need a psychiatrist, you need a psychologist, physical therapist, occupational therapist, speech therapist, University of Kentucky offers all this comprehensive team approach to treat our patients. In addition to that, fortunately in this city, Lexington, we also have the support group where patients and their caregivers go there, participate in a lot of activities which include
yoga, rock study boxing, which is going to help with uh many symptoms, physical therapy. They're also going to do some uh lecture series where sometimes physicians go there and teach and the patients and caregivers in a simple language so that they can understand recog how to recognize, how to uh you know, what are the things they have to talk to the doctor.
what is new going on in the research field, all these are educated and everything is almost free, which is served by Lexington Area Parkinson Support Group. In addition to this, I would I would like to point out few other things in terms of research. The two big things in the research field as of now in Parkinson's diseases They're trying to
see if we can diagnose Parkinson's disease early enough. As I just mentioned, that by the time person develops their first symptom in Parkinson's, they've already lost seventy percent of neurons in substantial nigra. The goal here is see if we can diagnose early enough so that we can start thinking or start developing some medications to prevent this neuron loss, neuron damage that's for
Second important research field is discovering the treatments. It can be medical treatment or a surgical treatment which slows down or stops the progression of the In the same context, University of Kentucky is the only center where we are doing research for more than six years. where we implant some peripheral nerve cells into substantial nigra in the brain at the time of deep brain stimulation and uh this is
The thought here is it's going to slow down the progression of the disease. So far the results we have seen that it is a safe procedure and uh we are seeing this might help slow down the progression of the disease.
Wow, that's a lot of information. Doctor, thank you so much for being with us today and sharing your incredible expertise on movement disorders and Parkinson's and all of the conditions that can cause tremor and various movement disorders. Thank you for really educating us today. It was very informative. This is UK Healthcast with the University of Kentucky Healthcare.
For more information, you can go to uk healthcare dot uky dot edu. That's uk healthcare dot uky dot edu. I'm Melanie Cole. Thanks for tuning in.