Parkinson's Disease: Deep Brain Stimulation

Tuesday, April 09, 2013 10:50 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Aikaterini Markopoulou, MD

What is DBS?
Deep brain stimulation is a type of surgical treatment for Parkinson’s disease. It involves the insertion of electrodes into specific areas of the brain that control movement. The electrodes are connected to a battery that is placed under the skin in the upper part of the chest. Electrical current that passes through the electrode stimulates these brain areas on one side of the brain. This stimulation results in improvement of tremor and slowness or stiffness on the other side of the body.

Who is a good candidate for DBS?
To be a candidate for DBS surgery a number of conditions have to be met:

  • A diagnosis of typical Parkinson’s disease that involves a combination of symptoms such as tremor, stiffness, slowness of movement or balance problems
  • Duration of disease symptoms for more than five years
  • Symptoms that respond well to treatment with levodopa
  • Presence of complications of levodopa therapy
  • Absence of dementia
  • No other diseases or conditions that significantly affect overall health (e.g., conditions that affect blood clotting, heart and lung disease, moderate to severe depression, pregnancy)

Is DBS covered by Medicare?
Yes, DBS is covered by Medicare.

When a patient has bilateral DBS is it necessary to have two stimulators, or will one suffice?
In the majority of Parkinson’s cases, symptoms affect both sides of the body; therefore, electrodes are inserted in both sides of the brain. In some cases where the symptoms affect mostly one side, the electrode can be inserted only in the opposite site of the brain.

If you have DBS, how does it affect your ability to get through airport checks, metal detectors, etc.?
Each patient is provided with an identification card that includes information about the implanted stimulator. The TSA agent should offer a private screening or screening with a manual wand instead of the patient walking through a metal detector.

What percentage of DBS surgeries result in complications? What complications might a patient encounter?
The DBS surgery may result in complications both during the implantation and after surgery, which include bleeding at the electrode insertion site that can be fatal, hardware malfunctioning, and infection and symptom worsening. In a large multicenter clinical trial, 7.5% of patients developed intracranial hemorrhage, 10.6% device-related infection and 8.1% one-sided weakness.

How long is DBS effective?
Studies that have followed patients for ten years have been published and the DBS remained effective throughout the ten-year interval.

Are there any long term risks associated with DBS?
DBS therapy remains a safe treatment option for Parkinson’s patients for at least ten years.

 

Parkinson's Disease: Genetic Risk Factors, Family History and Research

Thursday, April 04, 2013 11:47 AM comments (0)

April is National Parkinson’s Disease Awareness Month. All this month, we will feature a series of posts addressing Parkinson’s disease symptoms, genetics, treatment options and more from NorthShore neurologists—Demetrius Maraganore, MD, Aikaterini Markopoulou, MD, and Ashvini Premkumar, MD— to raise awareness about this common and often disabling neurological disorder.

by Demetrius Maraganore, MD:


laboratoryAre the children of a parent with Parkinson’s disease likely to inherit the disease? Is there a greater risk if the father or the mother has the disease?

My research team conducted family studies that defined the risk of inheriting Parkinson’s disease. The children of Parkinson’s disease patients carry a two-fold risk for Parkinson’s disease. They are twice as likely to get Parkinson’s disease compared to the children of persons without Parkinson’s disease. However, one needs to consider that the lifetime risk for Parkinson’s disease in the general population is 2%, so the risk of Parkinson’s disease for the children of a patient is 4%, or twice the baseline risk for the general population. That’s a pretty low risk and I wouldn't recommend any specific lifestyle changes or preventive therapies for the children of patients with Parkinson’s disease.
 
That said, about 5% of Parkinson’s disease cases are due to an inherited gene abnormality (mutation). In families where multiple members have Parkinson’s disease, the risk may be as great as 50% to the children of an affected person. When there are multiple family members with Parkinson’s disease, I refer patients for genetic counseling and in some instances we also perform genetic testing. 

What are the most important genetic risk factors for Parkinson’s disease?

There are two types of genetic factors that are important to Parkinson’s disease: 1) genes that rarely cause familial Parkinson’s disease (multiple affected members in the same kindred), and 2) genes that are not causal but that slightly increase the risk for Parkinson’s disease in populations worldwide (susceptibility genes). About a dozen genes have been identified as rare causes of familial Parkinson’s disease, and about a dozen genes have been identified as common risk factors in populations worldwide. The causal gene mutations are rare, accounting for less than 5% of all Parkinson’s disease cases. The susceptibility gene variants are common—e.g., occurring in 25% of persons in the general population—but they have small effects (no more than doubling the risk for Parkinson’s disease). 

Of all of the Parkinson’s disease genes, the most important is alpha-synuclein because it is both a causal gene in some families and also a susceptibility gene in populations worldwide. In other words, rare variants (mutations) cause Parkinson’s disease in rare families, while common variations (polymorphisms) increase the risk for Parkinson’s disease worldwide.

The alpha-synuclein gene holds the code for making the protein alpha-synuclein. The protein alpha-synuclein accumulates abnormally in the brain cells of every patient with Parkinson’s disease regardless of the causes. Many scientists believe that it holds the key to understanding and curing Parkinson’s disease. Our research team at NorthShore has led many of the most important studies of alpha-synuclein and Parkinson’s disease, including studies in families and in populations worldwide. We were also amongst the first to study the interaction of alpha-synuclein with other genes or environmental factors, or to study the association of the alpha-synuclein gene with motor and cognitive outcomes in Parkinson’s disease. 

Are there genetic research studies of Parkinson’s disease at NorthShore? How can I participate?

At NorthShore we are conducting a genetic study called the DodoNA Project. We aim to discover genetic factors that predict how neurological diseases progress in severity and that predict disease outcomes. We aim to use this information to individualize the care of our patients and to halt the progression of neurological diseases. One of the diseases we are studying is Parkinson’s disease. 

We will enroll at least 1,000 Parkinson’s disease patients into the study, and follow them at least annually for several years. To be eligible for the study you need to be new to our Movement Disorders practice within the past year, a resident of Cook or Lake County and willing to provide a blood sample for DNA extraction and storage. We also require your permission to compare your genetic code with the information that we collect in your medical record.

If you wish to participate, the best thing to do is to request an appointment to be seen as a patient in the Department of Neurology at NorthShore. We can then enroll you into the study after your office visit. You can also support the DodoNA project by joining forces with NorthShore’s Auxiliary and by supporting the Hospitals’ Gala

Hepatitis C – Transmission and Screening

Tuesday, April 02, 2013 10:48 AM comments (0)

hepatitisHepatitis C, a virus which can lead to chronic liver disease, is spread through contact of already infected blood.  Many individuals who are infected with the hepatitis C virus do not experience symptoms and are not aware of having the virus. 

Dhiren Shah, MD, a gastroenterologist at NorthShore University HealthSystem, shares some important information on transmission of hepatitis C and tips on minimizing your risk:

  • Do not come into contact with any non-sterile equipment where blood is involved. If you are getting a tattoo or body piercing, be sure to do so in a licensed facility. Additionally, DO NOT share toothbrushes or razors with anyone who has hepatitis C. Sexual transmission is an uncommon way of transmission; however, the risk increases in patients who have a history of a sexually transmitted disease, multiple sexual partners or men who have sex with men. 
  • Do not participate in the use of illegal intravenous drugs. The most common way that hepatitis C is passed to others is through sharing illegal drugs with used, contaminated needles. If you are a user, you should go to a facility where you can receive clean needles and DO NOT share needles with anyone.

Who should be screened for hepatitis C?

  1. Any person born between 1945 to 1965
  2. Anyone with elevated liver enzymes
  3. Any person who has ever used illegal intravenous drugs and/or any history of snorting cocaine
  4. HIV patients
  5. Children born to women who have hepatitis C
  6. Dialysis patients
  7. Anyone who had an organ transplant before 1992
  8. Anyone who received a blood transfusion before 1992

Is there a vaccine for hepatitis C?  To date, there is no vaccine for hepatitis C; however, you should be screened for hepatitis A and B, and get vaccinated if you have not been previously exposed.  

What other questions do you have about hepatitis C?

 

Discovering a New Normal: Living with Multiple Sclerosis

Thursday, March 28, 2013 9:45 AM comments (0)

MSThe diagnosis can be hard and may leave you wondering if you’ll ever be able to return to your regular activities. Not everyone with multiple sclerosis (MS) experiences the same symptoms—ranging from fatigue, numbness, loss of balance and coordination, to speech or muscle problems—and most people with this disease do not suffer paralysis or become severely disabled.

According to the National Multiple Sclerosis Society, more than 2.1 million people in the world are affected by MS. Given that in many cases the signs of MS can be difficult to detect, it’s hard to know exactly how many in the United States are impacted by the condition.

We do know that for those who do have MS, the journey through the disease can be very debilitating. Zulma Hernandez-Peraza, MD, neurologist at NorthShore, shares her advice on how to cope with the diagnosis and adapt your life accordingly:

  • Don’t lose hope and stay stress free. As hard as it may be, it’s best to take each day at a time. Try not to dwell on the unknown and uncertainity. Unnecessary stress can aggravate some of your MS symptoms, so be sure to take time to relax and unwind.
  • Get moving. Staying active and engaging in moderate activities and stretching can be very helpful. Be sure to discuss the best workout regimen with your physician.
  • Eat right. It’s important to keep your body healthy, as this will help prevent other illnesses and keep up your strength. You’ll want to eat plenty of fruits, vegetables and foods rich in fiber.
  • Be yourself. Don’t let your condition get you down. As best as you can, try to stay involved and social. Keep up with your hobbies, family and friends. Not only will this keep your support network in place but it will also help keep your spirits up.

Do you know someone living with MS?

Colorectal Cancer – Early Screening Can Save Lives

Tuesday, March 26, 2013 9:30 AM comments (0)

colon cancerColorectal cancer is one of the leading causes of cancer deaths in both men and women in the United States. However, if everyone over the age of 50 were regularly screened, it might be possible to reduce deaths associated with colorectal cancer by as much as 60 percent.

Many women believe that colorectal cancer is a disease that affects more men than women, so they might not be aware of or believe they need to follow current screening recommendations. National Colorectal Cancer Awareness Month this March is the right time to spread the word that colorectal cancer affects men and women equally and that screening saves lives.

Joel Retsky, MD, Gastroenterologist, shares some important information about colorectal cancer everyone should know, men and women:

  • Your risk increases with age. More than 90% of colorectal cancer cases occur in those who are 50 or older. Everyone over the age of 50 should follow national screening guidelines and continue screening at regular intervals at least until 75 years of age.
  • You should not wait for symptoms. Colorectal cancer rarely causes noticeable symptoms in the early stages. Symptoms of colorectal cancer—bleeding from the rectum, change in bowel habits, noticeable weight loss—often do not appear until the cancer is advanced and more difficult to treat. Most colorectal cancers come from polyps, or abnormal masses, that grow in the inner lining of the large intestine. With screening, polyps can be removed before they even become cancerous.
  • Family history is important. If you have a family history of colorectal cancer, you may need to begin screening earlier, perhaps at 40 or even younger. You will also need to be screened more frequently than currently recommended by the national guidelines. 
  • Personal history is important. Some studies have shown that women who have had ovarian, uterine or breast cancer have a higher-than-average chance of developing colorectal cancer. Crohn’s disease and ulcerative colitis are also risk factors. Talk to your physician about how these risk factors might affect the frequency of your screenings.
  • There are several screening options. There are many tests for colorectal cancer, including fecal occult blood test (FOBT), sigmoidoscopy, colonoscopy, virtual colonoscopy and barium enema. Colonoscopy is the most effective test for colon cancer screening. Talk to your physician about which screening option is best for you.


If you’re 50 or over and have never been screened for colorectal cancer, make National Colorectal Cancer Awareness Month the month you schedule your first appointment.


Have you been screened for colorectal cancer?

Dieting: What Works, What Doesn’t

Friday, March 22, 2013 9:45 AM comments (0)

There seems to be a diet out these days to appeal to everyone trying to trim down. And, with the barrage of different diets in the media, it's hard to know which diets work and which fall short.

What's important in a safe and healthy approach to weight loss? Before starting a diet be sure that your plan includes the following:

It’s balanced. By excluding food groups, your body is at risk of being deprived of the nutrients it needs to function. For example, the popular Atkins Diet drastically reduces carbohydrates. Carbohydrates are a major source of energy for the cells of the body and also are a main source of your daily fiber needs.

It focuses on portion control. Have you ever seen the MyPlate icon? MyPlate focuses on portion control and balanced meals by dividing a standard dinner plate into four food groups—fruits, vegetables, grains, and protein, with a side of dairy. Portion control is important to avoid overeating and can help reduce caloric intake.

It teaches lifelong, healthy eating habits. Longevity is impossible with impractical fad diets like The Hollywood Cookie Diet and The Grapefruit Diet, which severely restrict calories and lack the nutrition (not to mention the variety) that your taste buds crave. By eating balanced meals and controlling portions, weight loss is achievable and can be maintained throughout your entire life without having to crash diet.

For a healthy, balanced diet with controlled portions always remember to:

  • Load up on fruits and veggies
  • Eat whole grains
  • Choose fat-free and low-fat dairy products
  • Pick lean sources of protein
  • Drink plenty of water throughout the day
  • Make exercise part of your daily routine


Which diet approaches have worked for you?

This article was submitted by Lindsay Sankovsky, Dietetic Intern, and reviewed by Kimberly Hammon, MS, RD, LDN.

Creating a Healthy Meal Plan with Healthy Food Substitutions [Infographic]

Tuesday, March 19, 2013 4:28 PM comments (0)

Eating healthy and staying healthy is something that millions of Americans strive for every day. Unfortunately, it's not always so easy to eat healthy on a daily basis. With 36% of adults in U.S. considered obese, it's becoming more important for both adults and children to start eating healthier. The experts from NorthShore University HealthSystem have provided some general guidelines for the recommended intake of each food group, suggestions for creating a healthy meal plan every day, as well as some healthy food substitutions.

Click on our infographic for more ideas on creating a healthy meal plan with great healthy food substitutions.

Perfect-plate

 

Proper Dosage: Medication and Children

Friday, March 15, 2013 10:48 AM comments (0)

Peds-DosageWhen children get sick, the simple solution isn’t always just a pill or spoonful away. Aside from the fact that many medications are not recommended for children, it's also much easier for a child to overdose on medication than an adult.

In most cases, the amount of medicine a child should receive is determined by age, weight and height. When it comes to children and medication, reading labels is very important.

Dirk Killelea, Manager of NorthShore Evanston Hospital Pharmacy, shares the following “must-know” tips for giving children medications:

  • Do not give your child a reduced dosage of a medication meant for adults. Most medicine labels provide a recommended dosage that is based on age. If your child’s age isn’t reflected on this label, then it is not appropriate to give to him or her. Even liquid medication for infants is more concentrated than liquid medication meant for older children. When in doubt, ask your pharmacist or physician.
  • Avoid giving your child over-the-counter cold medicine. Cold medicine should definitely be avoided in children under the age of two, and the same may also be true for older children. These medications can cause more harm than good, and home remedies--humidifier, steam baths and elevation--may prove more effective.
  • Steer clear of some medications. Unless otherwise instructed by a physician, avoid giving children Aspirin, over-the-counter laxatives, herbal or natural supplements and expired medications.
  • Use appropriate measuring devices. Don’t use a household teaspoon or tablespoon to measure doses of liquid medication.  Ask your pharmacy for an oral syringe or graduated measuring spoon. These devices measure the appropriate amount of medication and don’t vary in size like household silverware.

The best remedy for most kids is rest and hydration. If your child has a fever or cold, keep activities to a minimum and make sure they aren't too strenuous. Coloring, drawing or reading stories is a great way to spend time until he or she feels better. If your child is experiencing loose stools or diarrhea, make sure to provide plenty of water or electrolyte-containing drinks like Pedialyte to prevent dehydration.   

How do you manage your kids’ illnesses? What remedies work best for you?

 

A Silent Killer – Carbon Monoxide

Wednesday, March 13, 2013 9:49 AM comments (0)

Carbon-MonoxideKeeping tabs on the safety of your home often falls by the wayside with all the other tasks and chores in our daily lives. However, failure to take the proper safety precautions can lead to injury, illness and sometimes even death.

While it’s easy to ensure that common household items are out of way and properly stored, used and discarded, there are some risks that you can't see at all. Carbon monoxide poisoning is very dangerous and because the gas is odorless and colorless, it's hard to detect without proper monitoring.

Jerrold Leikin, MD, Medical Toxicologist, shares the following tips for reducing your carbon monoxide poisoning risks:

  • Get a UL-approved carbon monoxide detector. First and foremost, if you don’t already have a carbon monoxide monitor installed in your home, do so immediately. If you do have one, be sure to check and change the batteries frequently. You should also plan to test it on a regular basis.
  • Install your detector properly. Detectors should be placed away from windows and drafty areas. Outside air can offset readings and reduce effectiveness. You should also avoid installing a detector in your bathroom, over your oven range or any another high-humidity area.
  • Place all detectors within several feet of sleeping areas. It is recommended to have a detector on every level of your home. A basement detector should be installed at the top of the stairs.
  • Get your furnace and other gas appliances checked out annually. Having an expert evaluate your appliances can help identify leaks and other health hazards. Make sure you’re using appliances correctly; outdoor grills should never be used inside your home.
  • Know the symptoms and act fast if you suspect you may have poisoning. Some of these symptoms include dizziness, headache, nausea and confusion. Symptoms may not always be present and/or may not be distinguishable. If several members of the household notice similar symptoms, seek medical attention immediately.

 

Do you have a carbon monoxide detector in your home? How frequently do you check it?

 

Don’t Sleep through the Signs: Recognizing Sleep Disorders in Children

Friday, March 08, 2013 11:00 AM comments (0)

pediatric-sleep-disordersA good night’s sleep can be the difference between night and day with children. Frequent lack of sleep can greatly impact a child’s physical, mental and social well-being. It's also hard on the entire family.

It's recommended that children between the ages of six and twelve get 10-11 hours of sleep each night. This allows them to be better rested for school, and to further their growth and development. The challenge with childhood sleep disorders is that they aren’t always easy to recognize. In fact, since the symptoms are so similar to other conditions (such as ADD and ADHD), sleep disorders often go misdiagnosed.

Mari Viola-Saltzman, DO, Sleep Medicine specialist, who sees both pediatric and adult patients, identifies some of the secondary effects childhood sleep disorders may have:

  • Lack of focus in school work. This may lead to poor performance, impaired learning/memory and an inability to concentrate on academic tasks.
  • Short temper and moodiness. Children may not “act like themselves” if they are not getting enough sleep. This can often be misidentified as a behavioral problem or depression.
  • Excessive daytime sleepiness. Children with sleeping disorders often have a more difficult time sleeping through the night, which can lead to drowsiness during the day and also slower reaction times to daytime activities.
  • Appetite and metabolic changes. Studies have indicated that sleep disorders in children may cause obesity, likely due to sleep deprivation affecting the part of the brain called the hypothalamus that regulates hormonal changes, metabolism, hunger and energy expenditures.

How many hours of sleep do your children get each night? Do they have a nightly routine?

 

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