The Movement Disorder Specialist Will See You Now
When you live with Parkinson’s disease (PD), it’s critical to find a care team you trust, with a neurologist at the core. But some patients need to delve deeper. Seeing a movement disorder specialist, a neurologist with additional training working specifically with Parkinson’s patients, can be very beneficial. Andrew Feigin, MD, executive director of the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone, discusses why.
Q. As a movement disorder specialist, you tend to see PD patients more often than other neurologists. How does this give you a unique take on the condition?
A. Parkinson’s disease is extremely variable in how it presents in each person, and therefore may require a vastly different treatment approach for each individual. The more experience you have with Parkinson’s, the more likely you’ll be able to best tailor therapy for that individual.
Q. Are non-motor and motor symptoms equally challenging to treat?
A. In some ways, non-motor symptoms can be more challenging. We have pretty good medications for motor symptoms—they aren’t perfect, but they can be quite effective in many patients. Non-motor symptoms, however, including dementia, behavioral and psychiatric problems, autonomic problems (e.g., orthostatic hypotension, a form of low blood pressure that occurs when you stand up quickly), sleep problems, and others, can be challenging to manage and may require input from additional specialists. For example, for orthostatic hypotension, there are medical and non-medical therapies, but the treatment really depends on the individual and may become more complicated if the patient is being treated for other health conditions as well.
Q. How do movement disorder specialists optimize treatment compared to neurologists?
A. Because of our focus on and training in Parkinson’s, movement disorder neurologists have more experience with Parkinson’s therapies. We are therefore more familiar with dosing regimens, potential side effects and how to approach them, when to think about surgical interventions such as deep brain stimulation, and other aspects of managing the disease. An additional advantage of seeing a movement disorder specialist who is in an academic setting is the presence of other care providers—social workers, sleep centers, physical therapists, psychologists, and physicians with other relevant expertise.
Q. Can you give an example of how that works?
A. For example, at NYU Langone, we have social workers, physical therapists, occupational therapists, and individuals in many other disciplines who have experience with patients with movement disorders. They know about problems that Parkinson’s patients have and know how to approach those problems in their disciplines. I can tap into these groups, giving patients the comprehensive, wide-ranging treatments and care that they need.
Q. How have some of your own treatment recommendations evolved over time?
A. I emphasize the importance of exercise and physical activity more than I used to. I’ve always thought it was important, but I put extra emphasis on it now and talk to patients about it more. This is because more studies have appeared in the medical literature supporting the idea that regular aerobic exercise may be helpful for improving prognosis and sustaining functional abilities in patients with Parkinson’s.
Q. What are some therapies in development that you’re particularly excited about?
A. We really need therapies that can alter the course of Parkinson’s disease—that is, disease modifying therapies that can slow the rate at which PD worsens over time. An abnormal form of a protein in the brain, called alpha-synuclein, may be involved in causing PD. So therapies aimed at reducing alpha-synuclein may be beneficial. Several of these types of therapies are now in human clinical trials or will be soon. I believe that these approaches are novel and exciting, and I am hopeful that one or more will work.