Things to Ask a Movement Disorder Specialist
Specially trained neurologists like Rebecca Gilbert, M.D., Ph.D., are the major-league head coaches of Parkinson’s care teams: They’ve seen every possible PD symptom and can administer an array of treatments. “We’re basically Parkinson’s doctors,” says Gilbert, a clinical associate professor of neurology at the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Medical Center. Here’s what that means foryou:
Q. So specialists offer treatments that regular neurologists don’t?
A. Yes. In the additional two years of training, we learn a lot about Parkinson’s and specific procedures to help manage it. We give special injections for dystonia, an uncomfortable twisting or cramping of body parts; manage very complex drug combinations; and program deep-brain stimulation devices.
Q. Since every PD case is different, how can you tailor the treatments so specifically?
A. Unlike regular neurologists, we see a higher volume of PD cases. About 70 percent of patients in my practice have PD. So, even general neurologists who feel comfortable initially treating a PD patient will look to us for further expertise as symptoms become complicated.
Q. Is that how most patients reach you? Referrals?
A. Yes, many come from neurologists who feel their patients need treatments they aren’t comfortable giving. PD patients can have cardiovascular, urinary, gastrointestinal and psychiatric problems in addition to movement problems. Figuring out the treatment for a combination of motor and non-motor symptoms, for example, can be tricky. But for Parkinson’s doctors, that’s something we do all the time.
Q. When do people benefit the most from seeing a specialist?
A. Some prefer to see us as soon as they’re diagnosed. But we can help at any point. Upon diagnosis, we address how best to exercise, when to start medications, the best choice of medications, and which clinical trials you should consider. As non- motor issues emerge, we also help patients manage those.
Q. Do you have a working knowledge of the newest therapies?
A. Yes. The Fresco Institute is a National Parkinson Foundation Center of Excellence, a designation that mandates that we conduct clinical research. We’re experimenting with trans-cranial magnetic stimulation (TMS), a noninvasive alternative to brain surgery, and have on our radar “focused ultrasound,” another potential treatment that is in clinical trials. What’s coming down the pipeline is very exciting.
Originally printed in MoreThanMotion, June 2016.