Let’s Talk About Movement Disorders

Scientific analysis of Alzheimer's disease in hospital, conceptual image

One of the newest members of the Centra Neurology team, Dr. Kisha Young, MD, Ph.D., shares her passion and expertise in treating movement disorders and why she loves working with her patients. Get to know more about her and the new things coming to the neurology practices at Centra.

Note: Due to extra social distancing and masks being worn during recording for the safety of all parties, some audio may sound more muffled than normal.

Announcer:

Thanks for joining us for this episode of Centra Scripts, where we talk health and wellness and practical tips for your everyday life. And now here’s your host, Kate Kolb.

Kate Kolb:

Well, thank you so much for joining us again for this episode of Centra Scripts. I’m very excited to be here with Dr. Kisha Young today, who is one of our newest neurologists here at Centra. She’s board-certified, she’s fellowship-trained, and her specialty is in this thing that we call movement disorders. And so I’m going to let her tell us a little bit about herself and her background and kind of what brought you to Centra.

Kisha Young:

Thank you. It’s a pleasure being here today. So as was just stated, I’m board-certified in neurology. I went to University of Virginia for medical school, and then I went on to Vanderbilt University in Nashville, Tennessee for my neurology residency, followed by movement disorders fellowship. During that fellowship, I was able to concentrate a lot more on movement disorders and treating patients with these types of diseases.

Kate Kolb:

So what brought you to Centra after your education and kind of what is your passion behind this movement disorders that you work with?

Kisha Young:

So I was familiar with the Central Virginia area, of course, from my time at UVA. And when I was looking for a position out of fellowship, I was really excited to see that Centra was really interested in starting a movement disorder center, where patients could be exposed to not only the basic treatments for their movement disorders, but also the advanced therapies that are out there such as botulinum toxin injections, deep brain stimulation, and levodopa infusions. So my passion really is I love Parkinson’s and essential tremor. I love treating patients with those disorders, really being able to engage them and talk to them a little bit more about what’s going on, but also because there are so many new treatments out there it’s also really helpful to help patients now, when they maybe 10, 20 years ago may not have had as many opportunities for a similar treatment.

Kate Kolb:

Yeah. Well, let’s talk a little bit about what this movement disorders is. I think there are probably people that listen to this podcast who are wondering, okay, what exactly does that cover? So can you define what we call movement disorders?

Kisha Young:

So movement disorders are specifically disorders that come from a part of the brain that causes involuntary movements. So these movements can be slower movements or what we call hypokinetic movements, or they can be fast movements or hyperkinetic movement. So the sort of biggest movement disorder that most people will have heard about is Parkinson’s disease. And that’s a disease where patients have involuntary tremor, usually at rest, they may also have a lot of stiffness and slowness and some difficulty walking. So they make slower, smaller steps. They may also be bent over, or they may not move their arms or their legs as well as they normally would up before they started having Parkinson’s.

Kisha Young:

And then some other diseases would be like essential tremor, which typically the patients just have tremor. Typically, it’s more difficult for them when they’re eating or drinking or holding something. So writing can be very difficult. They may also have a little bit of balance problems as well, and it looks very different most of the time from Parkinson’s disease. And then we have other involuntary movements that things like chorea, which are really slow kind of dance-like movements, and those can be caused by medications. There are some genetic disorders that can also cause diseases like that. And then sometimes we have other kind of twitching movements. So there’s a whole host of different movements and usually they can either be related to a medication or another medical condition or some other disease state, or there can be a primary neurologic movement disorder that causes it

Kate Kolb:

Well, and it’s funny because I can remember years and years ago, I think when I was younger, I didn’t know a whole lot about any of these movement disorders. And then I remember a very famous actor, Michael J. Fox getting diagnosed with Parkinson’s years and years ago. And I remember that kind of starting a lot of this conversation in the medical community and even in the entertainment industry and elsewhere of people starting to kind of understand a little bit more about what this movement disorder is and kind of the different ways that those affect people. And so for you personally, you talked about being passionate about these diseases and your interaction with your patients. What brought you to that and what made you decide that this is really the field of study that you wanted to be in?

Kisha Young:

So for a long time, even since high school, I always really thought I was interested in the brain and really wanting to learn more about how it works and what about the brain could become dysfunctional and how that presents in a patient. And then when I got into medical school and I learned a little bit more about different parts of the brain, especially the basal ganglia, which is a part of interest to most movement disorder specialists. I was really interested to see like all the different pathways that could be affected and how you could just change one thing about a pathway and it causes one movement and you’ve changed something else about the same pathway and it causes a totally different problem.

Kisha Young:

And as I started to see more patients with these diseases, I think the thing that really struck me is that there’s a lot of researches still going on. So there’s a lot of things we still don’t know, but there actually has been overdosing in the last 20 years, a much better development of better treatments for patients. I think the attention that comes to Parkinson’s disease has definitely grown over the last 20, 30 years. And though young patients are not the typical patient population that typically have Parkinson’s disease. You can see patients that do vary a lot in how they present. Some patients have a lot of tremor and they’re not really stiff and slow or have balance problems, but their tremor is really embarrassing or really problematic for them. And they have other patients where they may not even much tremor or even tremor at all. And they’re just really stiff and slow and balance becomes very much a problem.

Kisha Young:

And then the fact that I also have to manage a lot of other associated symptoms with Parkinson’s disease. It’s not just tremor and stiffness. Some patients develop trouble swallowing or they develop dementia and hallucinations, or they have a lot of mood disorder and anxiety and depression may be a very big problem. So being able to talk to patients and helping them to understand what part of this is part of the Parkinson’s disease syndrome versus what may be related to something else is something that’s really, really helped me.

Kisha Young:

I also just love that patient population. I mean, they’re always ready to get more knowledge. They’re always reading up on things. I’ll get questions a lot of times about what are the new therapies out there, or what are the new holistic methods that could be used for treatment. And honestly, I know there’s still a lot of research that we need to undergo, but I think it’s really important for patients to understand their disease a lot better. So I do a lot of education with my patients in the room, but also kind of steering them towards like what are the best websites to look at or being very mindful of, if something says it works, what are all the reasons why it may not potentially work. What is the data show in research studies for why it may or may not work.

Kate Kolb:

Okay. Well, I want to go back to something that you said to just a moment ago about the demographic itself, because I think, this field of neurology and all of the different things that go into it, it’s not really something that people talk about a lot. It’s probably not something that a lot of people have a kind of innate understanding of. So for something like movement disorders, what is the typical demographic that you see that are affected by that? And kind of what are the variances there?

Kisha Young:

So movement disorders can affect any age group. It just depends on the disease that’s causing it. So for Parkinson’s disease, most of those patients are usually 50 and older. The incidence of Parkinson’s disease actually increases more the older you get. So you’ll have more people in their 60s and 70s and 80s. If we teach decade of life, developing it then if they were younger. Patients who are in their 20s or 30s or early 40s, when they develop Parkinson’s symptoms are usually typically called young onset and they can present very similarly to the older population. Sometimes they present with a few more prominent symptoms, and then there are some little differences that may occur over the time span of their disease.

Kisha Young:

In general though, the other thing is Parkinson’s a very long disease, so someone who gets diagnosed in their 20s and 30s, they’re probably going to have to disease for 30, 40 years, maybe even more. And even my older patients, I go over those sort of things for the most part Parkinson’s is a slowly progressive disorder as balance becomes more of a problem or some of those other associated symptoms like hallucinations, dementia or swelling, difficulty become more of a that’s where they may have a lot more trouble, but Parkinson’s in general used, typically affects an older population.

Kisha Young:

But if you compare that to something like essential tremor, essential tremor can affect any age group. I mean, we have teenagers and people in their 20s who have pretty prominent tremor, and then there seem to be two peaks. So there are people in their like 20s and 30s, that kind of peak with the number of people kind of in the world that have it. And then there’s another peak in later age, around 60s. And they, once again, there’s some medications that can be used for that as well.

Kisha Young:

And then all of those kind of like the slow movements, the twitching movements, all of those things can affect pretty much any age group. It just kind of depends on what the Z state is due to. So if it’s due to a medication, of course, that probably can affect any group. Typically, older patients are more at risk for side effects from medications. If it’s due to another medical condition that’s not related to, that’s not a neurologic condition that can also affect age group, just depends on what the disease is.

Kisha Young:

And then there are some primary neurologic conditions that usually affect people as they get into their 20s and 30s, depending on what the condition is. If the person seems really young for the type of movement that they’re making, we might consider some of the rare inherited disorders or rare metabolism disorders that can sometimes occur at a younger age. So it just kind of depends on kind of the overall person, but the most common ones being Parkinson’s and essential tremor. Typically you think about an older population with Parkinson’s and then it can be the younger population, but all the way up to older age for essential tremor.

Kate Kolb:

Okay, well that was going to be my next question then. With that demographic, you kind of have talked to the full spectrum. How much of these disorders, can you break down between, this is something that’s inherit, is it inherited? Is that something that’s hereditary? Or do you see most of these situations coming more from those side effects of medications and other neurologic disorders?

Kisha Young:

So Parkinson’s disease is not typically inherited. The vast majority of patients do not have an inherited type. I do think that because it’s common enough in our population, sometimes you’ll have a patient who says, Oh yeah, my grandfather had it or I had an aunt that had it. And so they may have some family history, but they didn’t typically have the typical inheritance pattern that we think about when we think of an inherited disorder. Now, there probably is some overall inheritance pattern that we haven’t quite teased out where maybe something about your genetics plus your environment plus other things may influence whether or not you develop Parkinson’s or when you develop Parkinson’s. And those are things that we’re still trying to understand a lot more through research.

Kisha Young:

Now with essential tremor, a large number of patients actually do have inherited type. Now I’ve a lot of patients though, who say, yeah, I don’t remember anyone in my family ever having tremor, but then I have other patients who say, Oh yeah, everybody in my family has tremor on one side of the family. And that’s the one that can affect the head, it can affect the hand when you’re trying to write or trying to eat or drink. So it does have really, a much stronger inheritance pattern. And then we have diseases like Huntington’s disease, which is definitely inherited that you may be considering sometimes some of the metabolic diseases may also have inheritance pattern, depending exactly what it is.

Kisha Young:

And then when it comes to drug-induced movement disorders, typically with most things involved in medications, I do find that older populations can tend to be a little bit more susceptible to side effects, but you can have young patients who have the same side effects. So one of the most common ones that I would see would be patients who are on certain medications known as neuroleptics or dopamine blocking agents. And those medications can sometimes cause patients to either look like they have Parkinson’s, even though they don’t typically have Parkinson’s disease. So we call it like Parkinsonism or drug-induced Parkinsonism, and then they can also have another condition called tardive dyskinesia where a lot of times it can affect their entire body, but it can also affect the mouth a lot. So they’ll make these kind of chewing or puffing or blowing movements a lot and they can’t control them.

Kate Kolb:

Okay. Very interesting. So if somebody is recognizing some of these symptoms that you have talked about, and if you don’t mind going over some of those again, what are those symptoms and when do they need to make a call to somebody if they’re noticing those?

Kisha Young:

I think for Parkinson’s disease and I talk about that one a lot, because it’s probably the one that most people will understand or have seen the most of. For Parkinson’s disease, if, if you or someone in your family is noticing that you’re having tremor at rest or that you seem stiffer and slower, and there’s not some other cause for that, I think it would be important to have a neurologist look at you. A lot of times, if the balance is a problem. Balance can be caused by so many different things and balance is not just Parkinson’s, it can be neuropathy, it could be a back issue. It could be some other nerve issue. And so I think it’s okay to get an evaluation by a neurologist and say, is this Parkinson’s or is this something else?

Kisha Young:

There are some conditions that actually can look very much like Parkinson’s that are actually completely different in Y in the etiology of it, or even in the treatment. I mean, we have some conditions that patients come in and they say, “Yeah, I think my mother or father has Parkinson’s.” And I say, “Yeah, they don’t have Parkinson’s, but maybe they have a different condition that actually might be treatable. And we might be able to prevent the progression of it.” And then there are other diseases that maybe aren’t treatable, but they’re not treated in the same way that Parkinson’s is either. So I think it would be important for someone to understand the differences between them.

Kisha Young:

So for Parkinson’s mostly I’m thinking of that resting tremor, usually on one side more than the other, but it can present in both sides, even early on. Stiffness, slowness difficulty kind of getting up from a chair. Maybe some small steps when they’re walking, maybe not moving their arms as well, walking with a slightly stooped posture. And it’s not really due to pain, those sorts of things. They can also get a lower voice. Some patients will notice a loss of sense of smell that maybe happened years before. And so I think a lot of times that would be one reason why I’d have patients come in.

Kisha Young:

For essential tremor, the biggest thing is just tremor when they’re trying to do a task. So a lot of times that’s eating, drinking, writing, maybe doing their hair, buttoning clothing. And I tend to find that early on, it can be milder. So patients may not also seek out a doctor till it gets worse. But if it’s at the point where it’s bothering you, where you want to know where you’re having difficulty doing a task, I think would be important to see a doctor. Sometimes patients may even just come early on, because they just want to kind of know what this is. Is this something I need to be worried about or is it something I just need to live with?

Kisha Young:

And for the most part, we don’t have a word cure essential tremor and it, over time it can progress to a point where it is more debilitating, but I think it’s okay to come and see a doctor and saying, look, I don’t necessarily want to be on medication. I can tolerate this, but I just want to make sure it’s not something else I need to manage. Do I need to stop a medication or do I need to be worried about some other medical condition? And sometimes that’ll be really important.

Kisha Young:

Some other conditions that I treat, so restless legs is another big one that I treat. So that’s the feeling of having to kind of move your feet at night. So you’re laying down in bed or sitting in a chair usually in the evening and you just get some uncomfortable feeling in your legs. Sometimes it’s not really like pain, but just kind of feel some people described like a creepy crawly feelings. Some people feel like kind of a tangling and it’s really only helped if you get up and walk around or if you move your feet. So a lot of times it can bother people when they’re trying to sleep because they spend minutes, an hour sometimes just trying to get into a position before they can go off to sleep. So I do treat restless legs and restless legs can be related to some medical conditions. And then there are some people who just have restless legs. There are some people who have other family members who have it, and we do have medications to help control that.

Kisha Young:

For things like Huntington’s disease, I think it’s be really important if for someone to come and get seen early on. Plastic finding for Huntington’s disease is sort of a slow dance-like movement people kind of look like the kind of weakly and moving around all the time and it’s could be due to a medication just like I talked about the neuroleptics before, or if they have other family members who had something very similar to that, then I’d be concerned that it could be something like Huntington’s. There are also some conditions that can mimic Huntington. So sometimes it’s important for us to know about those as well. I think if a patient has family members who look similar, that’s where there can be some question. And then if you’re new on a medication or if you’ve been on a certain medication, even for a while, but you’re starting to notice like just some involuntary movement, I think it would also be okay to come and see me.

Kisha Young:

Sometimes I get questions about like, what about things like multiple sclerosis or spinal muscular atrophy or something like that, or those movement disorders. Those aren’t technically movement disorders. I mean, every neurologic condition I think in my mind, I was thinking about it. They do usually involve some form of movement either you’re moving less or you’re moving more, but it’s not classically a movement disorder. However, I do see a lot of overlap. I mean, sometimes I get patients and they’re having more trouble walking. And so someone says, “Hey, is this a movement disorder?” And then I say, “Oh, maybe it’s not.” I do the exam. I might do get some tests. And it turns out it might be multiple sclerosis or it might be neuropathy or it might be some other conditions. So I think it’s really important sometimes to see a neurologist because they can help distinguish between what one would be one cause versus what is another cause.

Kisha Young:

And then I’m trying to think if there’s any other conditions that are more popular ones. I mean, there’s some, we call them ataxia. So those usually affect people walking. There are some inherited ataxia, there are some acquired ataxia either from things like neuropathy or some other conditions. So usually it’s anything that causes an involuntary movement or there’s a lot of balance problems with people walking.

Kate Kolb:

Well, all really good information to know for sure. Now if they did feel like they were at a place where, okay, this is something that has affected me and I’m starting to notice it in a pattern in my life. Is coming to see you something that somebody would do just pick up the phone and call, or does that need to be referred from a primary care doctor?

Kisha Young:

So I do get most of my new patients through referrals. So they’ll see their primary care doctor, or sometimes they even have patients will see like an orthopedist doctor or I’ve had some cardiologists send patients over to me, just kind of depends on exactly who they’re seeing or why they’re seeing them. So that’s totally fine. And a lot of times also insurance companies may also prefer that referral come from a doctor that they’ve already seen, usually a primary care, but we do have patients self-refer. So sometimes I have patients who already have the diagnosis and maybe they were going out of town. Prior to me coming here, there wasn’t a specific just movement disorder specialist here in Lynchburg. So sometimes patients will find out about me and decide they want to switch care or they’ll have a question about something or they’ve just moved here and they want to find out if there’s a medical condition that they have, that I might be able to treat. So those are options.

Kisha Young:

The other thing is, and we do have, I didn’t talk about one other thing that I do treat, but those are spasticity conditions. So in patients who have had a stroke or a spinal cord injury, or even patients who have MS, they may have spasticity. So that’s kind of like a stiffness that usually occurs after an injury, either to the brain or the spinal cord. And they typically will have arm or leg tightness. And I will use botulinum toxin to help relax that muscle. A lot of times, sometimes patients come in expecting that that treatment is actually going to give them strength back, and it actually does not. Actually in a sense, weakens the muscle. But if you’re really tight in a muscle, it can be painful and it can be hard to do certain tasks.

Kisha Young:

So sometimes will have trouble putting on clothing because they can’t move their arm as well. And even if somebody else was moving them, they are really tight. So even the other person can’t move them passively. So we’ll use something like botulinum toxin, which will allow them to be able to move the arm. But once again, remembering, it doesn’t give you strength back. So any strength you have, you’ll be able to move it. But if you don’t have strength in that limb, then your caregiver or someone else who’s helping you, whether it be physical therapy or someone else might be able to move that arm through range of motions. Sometimes it does help for getting a better effect of physical therapy.

Kisha Young:

And then I didn’t talk about dystonia. So dystonias are also in that involuntary movement category. And so these are usually some sort of abnormal contraction of a muscle. Probably the most common one that most people will see would be like a neck dystonia or cervical dystonia, where someone’s neck is turning to one side and we will use botulinum toxin a lot of times for that to help relax those muscles and prevent them from sort of overworking. Sometimes cervical dystonia can also be painful because you basically have some muscles that are constantly contracting and other muscles that aren’t. So it can cause a lot of discomfort in the neck. So those are other things that I also treat.

Kate Kolb:

Okay. Well, and so if somebody comes to see you with one of these movement disorders and some of them, like you said, some of them are painful, some of them are not, it just sort of depends on the presentation. What would some typical treatments look like for these disorders? And then how do you kind of walk through that care plan with your patient?

Kisha Young:

So the typical treatments really, of course depend on what the condition is. So classically once again, going to Parkinson’s disease, there is a deficiency in dopamine production in the brain in a part of the brain called the basal ganglia. So typically first treatments involve manipulating dopamine in some way, either giving you back dopamine or preventing the early metabolism or degradation of your dopamine in your brain. And so that’s how we treat Parkinson’s disease. For essential tremor, we have different medications that work through different methods. One medication may work for other people, but it’s not because of really the cause of the disease. But we do have a few different medications that we’ll use.

Kisha Young:

For both of those conditions Parkinson’s and essential tremor, if it gets to the point where medications aren’t helpful, or medications have too many side effects classically with Parkinson’s disease, as people progress through the disease, they may be more at risk for getting dyskinesia. Those are similar kind of those slow movements throughout their body that they can’t really control. So it’s kind of like the opposite of the kind of Parkinson’s feature. Then we might consider some advanced therapies because with Parkinson’s, patients may go from being stiff and slow one second, to moving too much in the next second. And they don’t really have that in-between phase where they can move voluntarily, but not have all these other side effects.

Kisha Young:

So then for those advanced therapies we might consider, we have something that’s like a levodopa infusion that they may through what looks like a feeding tube, or basically is a feeding tube, go into their belly. And they actually get an infusion of levodopa into their system throughout the day. And because they get a constant infusion versus having to depend on taking a pill, waiting for it to dissolve and be absorbed in the body, which can vary from dose to dose, you would actually expect that a lot of those fluctuations in their motor symptoms would actually improve.

Kisha Young:

Another big therapy, which is one thing that we’re developing here at Centra is actually deep brain stimulation. And so deep brain stimulation has been around for more than 20 years, but it’s growing in terms of its use all over the country. So for Parkinson’s disease, this is a therapy that we’ll use a lot of times when patients either don’t get enough benefit to their Parkinson’s symptoms, or if they have a lot of those motor fluctuations again, where sometimes they’re on and then other times they’re off, or maybe they’re too on, and they’re having these voluntary movements. So, and then deep brain simulation can actually also be used for essential tremor. So I’ll kind of just talk about what that is in general.

Kisha Young:

So for deep brain stimulation, we put electrodes in the brain, those are placed by a neurosurgeon, but the location that they’re placed in is actually discussed between myself as the neurologist and the neurosurgeon. So that is a surgery, almost a pretty big surgery when you think about brain surgery in general. Once those electrodes are in, there’s also like a battery pack that’s put into the chest. You can do deep brain stimulation for both sides of the body. So you can put it on both sides of the brain. And then we can use that stimulator to basically stimulate the brain or that part of the brain and help the tremor or help the slowness and stiffness that patients have in Parkinson’s disease.

Kisha Young:

So it’s a really great treatment for patients that have had it. They usually do get good benefit. A question I get a lot though is, having this done mean that I can come off my medication. That’s not a promise. There are some patients depending on what their reason for getting DBS is they may be able to lower the medication a little bit, but there are other patients who actually stay on the same exact dose. They just need a little bit more benefit and less fluctuations. And so that is definitely something to understand.

Kisha Young:

Also, the other thing about it is not every patient is a great candidate for deep brain stimulation. Some patients may have other medical conditions that might be preventative for them to get a brain surgery. They may have dementia. And we don’t like to do big brain surgeries and place objects in people’s brains if they have dementia or some signs that something else that’s going on. And then depending on what the cause is, if it’s not just a classic Parkinson’s disease, but if it’s one of the Parkinson plus syndromes, which I haven’t really talked about, but those are usually conditions that have other features that are also much more prominent then something like deep brain stimulation would not be appropriate for them.

Kisha Young:

There’s also a lot of questions a lot of times of, will deep brain stimulation actually stop the progression of the disease. And as of right now, we don’t have a lot of data to suggest that it would. So there is also ongoing research around the country and around the world to see if there are any features of Parkinson’s that don’t progress as fast, but that’s also not something that we can promise. So as the disease progresses, we can make changes to the stimulation program, but we wouldn’t have to go back into the brain. We just use it with the external stimulator programming equipment that we have, but it actually has been very helpful for patients. And I have patients who come to me who have been programmed already. Here at Centra, we’re not actively putting it in yet, but we do have a neurosurgeon and then myself. And so we’re hoping to kind of get that program started over the next few months.

Kate Kolb:

Well, that’s all very progressive and very, very interesting for sure. What does this look like for patients in terms of longevity of care for these treatments and then also kind of long-term prognosis with living with these diseases?

Kisha Young:

So for essential tremor, there isn’t any decrease in lifespan due to essential tremor, but essential tremor also ranges from just mild symptoms to pretty debilitating symptoms. I have some patients who say, Oh yeah, I have a little bit of tremor. When I write a check or something, I have a little bit of trouble. And then I have other patients who can barely eat or drink or do much for themselves because they’re shaking so much. And so treatment of the tremor is really important for them so that they can do things in their life.

Kisha Young:

Now, as some people with essential tremor progress, they may also get some more balance problems. So then balance is something that you also want to consider because if someone’s falling a lot that could also affect the lifespan. If someone falls and breaks a hip or breaks their leg, or hits their head and has a brain bleed those are going to have different outcomes and different prognosis for how they’re going to progress from there. So there can be some secondary effects that we do worry about, but in general, we can’t use the medications for a long time. Sometimes if someone develops a new medical condition that might require a different medication, we might have to change what we use for their tremor, because of course there are drug interactions between some medications.

Kisha Young:

I think about that a lot when some patients get older and they start being on some of the blood thinners, some of the blood thinners can’t be used with some of those essential tremor medications. Or if they, sometimes we have patients who their tremor get so bad that the medications we’ve used, but in the past don’t really work and now I have to try other options. That a lot of times might be when we’re start to consider things like deep brain stimulation. And there are patients who had stimulators in for many, many years. So there’s not a problem with longevity in terms of being able to have a stimulator in.

Kisha Young:

For Parkinson’s disease, kind of the same thing. We know that patients tend to have more other symptoms that come on more than just essential tremor. Essential tremor we typically think of tremor has debilitating and then maybe the balance problems, but with Parkinson’s, as the disease progresses, they get stiffer and slower. They might need increasing doses of the medication or shorter duration between dosing times. They also may start having some other associated symptoms. So sometimes patients have more trouble with swallowing and we have to try to manage that, make sure that they’re not becoming malnourished or losing weight, because they’re not able to take in enough food. We also worry about things like choking or getting food in their lungs and setting up for an infection. So those would be things that we’d worry about.

Kisha Young:

If they have dementia and they start having hallucinations, that can be really bothersome to them and to family members to manage throughout the day. So we do have to manage that. And then we have some patients with Parkinson’s who have orthostatic hypotension, which is lowering of the blood pressure when they stand up. And that can also cause them to feel very lightheaded and they can even fall or pass out. And so that could be another reason why, if somebody falls, they could hit their head or break something. So for both essential tremor and for Parkinson’s typically things that affect longevity are not direct conditions of the disease. Parkinson’s does not affect the heart or the lungs directly, but there are some secondary effects that, if someone falls or if they’re getting an infection in their lungs, because they can’t swallow food properly, that we do have to worry about those.

Kisha Young:

Typically for Parkinson’s, those are later on in the disease. They’re not very early on, but we do manage that. And I do ask questions about that at every visit. If they are occurring much earlier in the disease, like within the first year or two, then sometimes I might consider, is this truly general Parkinson’s disease? Or is this one of these Parkinson plus syndromes where the disease, those things occur very early on? So we have conditions like multi-system atrophy where patients will have the orthostatic hypotension. They might pass out very early on. They tend to also have a lot more voice and swallowing difficulty early on and a lot of balance problems. We have progressive supranuclear palsy where patients will also tend to have much more falls very early on. They tend to fall backwards very often. They can also have a lot more stiffness and they can have early dementia.

Kisha Young:

And then we also think about things like Lewy body dementia, where patients have early dementia and hallucinations and they may also tend to have a lot of balance problems and they can have a lot of Parkinson’s symptoms. And then there were a few other like dementias that also have some Parkinsonian symptoms. So that’s I think why even early on with Parkinson’s disease, it’s always good to see a neurologist because you want to be able to distinguish between is this Parkinson’s disease, or you have this longer time of just motor symptoms before you get a lot of those other associated symptoms, or is this one of these other conditions where we’re going to be managing things like dementia and falls very early on.

Kisha Young:

And then for some of the other conditions. So if it’s drug-induced dyskinesia or chorea, there are medications to help that. Sometimes it’s as simple as taking them off the medication that’s causing it. If the symptom doesn’t go away, then we may have to try a medication. If it’s Huntington’s disease or medications, there’s also a lot of monitoring we may want to do for Huntington’s patients because it’s not just the movements. They tend to have a lot of problems with balance and walking as well. They also get dementia. They have a lot of mood problems. Sometimes the mood problems can even happen many years even before they ever had the movement disorder. So we do want to manage that.

Kisha Young:

For things like I mentioned, restless legs before we talked about the, we have medications and we also want to make sure the patient doesn’t have certain medical conditions that are contributing, that we might need to manage in a different way. And so I think I’ve covered most of them, but yeah. And then there’s things like the advanced therapies for a lot of them. And then we have the botulinum toxin as well like I mentioned for things like spasticity and dystonia.

Kate Kolb:

Well, that is extremely comprehensive. And I think it’s really good for people who are listening to know that all of those things can be treated right here. And you’ve talked a little bit of brief insertions here and there in our conversation of kind of building this clinic here that you’re looking to do. And so is there anything else that you would want people to know about the clinic itself or your practice or how you interact with your patients?

Kisha Young:

So I think in general, if someone has a movement disorder and they’re really concerned, they can first talk to their primary care doctor or make the referral themselves to come out and see me. Sometimes people just need reassurance is this one a condition or is this something else? Or I need to figure that be worried and monitor this over a long time, or is it kind of a once in a blue moon sort of thing, and I don’t have to worry about it. And then for patients who are struggling with spasticity after an injury from a stroke or from a spinal cord injury, I think considering something like toxin injections would be great. We do have our clinic is set up and I do injections pretty frequently. So that would be another great way to just get some pain relief and hopefully a little bit better mobility.

Kisha Young:

If a patient already has DBS placed and if they are having to travel far away to get that program or to have that looked at, or even for battery replacements. I mentioned before that we don’t have to do anything again with the brain, but the battery is actually in the chest. And sometimes it does need to be replaced every few years. If they already have DBS, I can program, even if we don’t have everything else set up. And when I say everything else set up, that just means that we’re not implanting people right now. We hope to be doing that in a few months, but I can do programming readjustments. So I think that’s mostly it. And then the infusion therapies for Parkinson’s, typically we have a surgeon who would place the feeding tube, and then we do the setup of the actual programming to their infusion apparatus here in the office.

Kisha Young:

So there’s not many things that we’re not doing. There are few therapies that are kind of newer out there. So I do get a lot of questions about things like focused ultrasound for tremor. We are not a place that we’re not doing that right now. There’s only a few places in the country that do that. But if a patient has a question about that and seems like an appropriate patient for it, then we could direct them to the centers that are doing that.

Kate Kolb:

Yeah, very good. Well, and again, just like Dr. Young has already said, if you feel like maybe some of the things that she’s talked about today are things that are affecting your life and you have more questions about it. Please definitely reach out to either your primary care doctor or you’re also welcome to just call directly (434) 200-3600 and get more information about the clinic and Dr. Young’s practice and that sort of thing as well because we definitely want you to get your answers and we have a great team here at Centra that can help you out with that. So, Dr. Young, thank you so much for being here with us today. And is there anything else that you would want to tell anybody before you head out?

Kisha Young:

Nope. That’s it. Hopefully something that I’ve said today can help you or help someone else that you know. And so if you have any questions, just like we said, just give us call.

Kate Kolb:

Yeah. Great. Well, thank you so much again for listening and you can find all this information on our website at centrascripts.com or on our regular website at centrahealth.com. And again, feel free to call that number, (434) 200-3600 to get more information about anything that you’ve heard today. And we’ll talk to you next time.

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