Comprehensive Movement Disorders Program
The Comprehensive Movement Disorders Program at Delray Medical Center provides a personalized evaluation, diagnosis and treatment plan for patients with Parkinson’s disease, tremors, dystonia, Huntington’s chorea, Tourette’s syndrome, ataxia and gait disorders. Delray’s interdisciplinary team consists of neurologists, neurosurgeons, physical therapists, psychotherapists, social workers and nurses. The team collaborates to create individualized treatment plans for patients, integrating some of the latest medical, surgical and rehabilitative therapies.
Every body movement, from raising and lowering an arm to blinking, involves a complex interaction between the central nervous system (brain and spinal cord), nerves and muscles. Diseases affecting the brain may cause many movement disorders such as:
- Parkinson’s disease (PD): Parkinson’s disease is a slowly progressive nervous system disorder with symptoms that include tremors, stiff muscles, slow movement and difficulties with walking or balance. Parkinson’s disease affects about one million Americans. There is currently no cure for Parkinson’s disease, but early diagnosis and management can improve patient success. Surgical treatment can be successful in reducing symptoms in the later stages. We offer deep brain stimulation (DBS) surgery for patients with poorly controlled symptoms.
- Tremor: A recurring shaking of a body part caused by unintentional muscular contraction. The most common cause is essential tremor. However, other conditions including Parkinson’s disease, stroke and multiple sclerosis can also cause tremor. DBS surgery is offered to patients with severe tremor not responding to medications.
- Dystonia: Involuntary muscle contractions which force certain parts of the body into abnormal and sometimes painful movements or postures. These can affect the neck (cervical dystonia or torticollis), the eyes (blepharospasm and hemifacial spasm) or the limbs (limb dystonia). We offer medications and botulinum toxin (Botox) injections to reduce the severity of the dystonic spasm.
- Gait problems: A variety of gait (walking) problems can occur as part of a movement disorder. Parkinson’s disease and dystonia can affect walking. We emphasize a preventive strategy aimed at improving gait and reducing the risk of falls. Appropriate medications as well as physical therapy are used as part of the treatment.
Diagnosing Movement Disorders
A correct diagnosis of any movement disorder is essential to delivering the appropriate treatment. Our team will be using imaging technologies that include magnetic resonance imaging (MRI), computed tomography (CT) scan, electroencephalography (EEG) and electromyography (EMG) testing, as well as other neurophysiology assessment tools.
Treating Movement Disorders
Movement disorders show a large variation between patients, showing different symptoms at differing degrees of severity. Treatment plans are individualized and are created based on the patient’s symptoms. We emphasize the use of standardized rating scales and clinical criteria to improve diagnostic accuracy as well as to assist with developing a multi-disciplinary plan of treatment.
By changing lifestyle routines, such as regular exercise and stress reduction, patients will start seeing benefits by preventing the functional decline that often comes with Parkinson’s disease and related disorders. Working with a physical therapist for their physical medicine and rehabilitative services help Parkinson’s disease patients improve and maximize their mobility by incorporating the latest rehabilitation strategies they put into practice-tailored treatment plans.
Deep Brain Stimulation
Many Movement Disorder patients are unable to obtain sufficient relief through medications or physical measures. For these individuals, DBS surgery may be an option. While not a cure, this procedure may decrease the severity of the disease. Following the procedure, some patients can reduce medication doses thereby reducing the side effects. Tremor, involuntary movements (called dyskinesias) or muscle rigidity are symptoms that show most improvement following DBS.
The DBS procedure is performed in the following sequence:
- Following pre surgical imaging, the surgeon implants a small electrode into the targeted portion of the patient’s brain.
- In a separate procedure, days to weeks later, the neurostimulator is implanted under the skin and connected to the electrode
- After the neurostimulator is implanted, programming occurs to deliver an electrical signal. This typically takes place weeks following the implant of the neurostimulator.
Dependent on the patient, some individuals require inpatient rehabilitation following their procedure.
Quality of Life
Maintaining the quality of life for our patients is the ultimate goal. We work closely with each individual and alter the treatment plan as necessary. Ancillary measures such as physical and occupational therapy are used as needed. We will also advise on specific nutritional guidelines and assess existing medication regiments to minimize the possibility of drug and food interactions.