Parkinson's Clinic

A Movement Disorder


What is Parkinson's Disease?

Parkinson disease is a progressive neurodegenerative disease.People affected by Parkinson disease may develop various symptoms including tremor, stiffness or rigidity in their legs and arms, slowness of movements and /or imbalance.In the early stages there may be a slight shaking of hands or walking difficulty that is barely noticeable. Over time the symptoms may become more pronounced resulting in unclear speech and varied physical disability.


Who can develop Parkinsons?

Parkinson usually develops in people over the age of 60 years. The risk of developing Parkinson increases with age. It affects both men and women.


What is young onset Parkinsons Disease?

Rarely Parkinson disease develops in people at 40 years or so – called young onset Parkinson disease.


Why does Parkinsons Disease Develop?

Parkinson disease is a Movement Disorder.It results from loss of brain cells (neurons) in an area of brain called the substantia nigra that modulates movements. The cells of substantia nigra involved in Parkinson disease produce a chemical called dopamine.Deficiency of dopamine is believed to be responsible for most of the symptoms of Parkinson disease.


Warning Signs of Parkinsons

  • Shaking (tremor) of hand or leg
  • Loss of facial expressions or poker face
  • Fatigue
  • Muscle ache
  • Decreased speed in walking
  • Difficulty in getting in and out of a car
  • Difficulty in turning while walking
  • Leg getting ‘stuck’
  • Fear of falls while walking or unprovoked falls
  • Slowness of daily activities, for instance, dressing, bating, eating

How is Parkinson Disease Diagnosed?

Diagnosis of Parkinson disease is based on a through neurological examination and is best done by a neurologist who is a Movement Disorder Specialist. Many diseases may mimic symptoms of Parkinson disease and it is essential to exclude these through clinical examination and appropriate tests (blood tests, brain imaging).


What diseases can mimic Parkinson Disease?

Various diseases can mimic Parkinson disease. Treatment of these diseases is different from Parkinson’s Disease. Consultation with a Movement Disorder Specialist is essential for early diagnosis and prompt treatment.

Some of the diseases that may resemble Parkinson’s Disease are:

  • Essential tremor
  • Dystonic tremor
  • Neuroleptic drug use
  • Diffuse Lewy Body Disease
  • Multiple System Atrophy
  • Parkinson disease dementia
  • Progressive Supranuclear Palsy
  • Strokes
  • Brain infections
  • Huntington disease
  • Metal deposition disorders: Neurodegeneration from Brain Iron Accumulation (NBIA), Wilson Disease (WD)

Is treatment available for Parkinson disease?

There is effective medical treatment available to alleviate symptoms of Parkinson disease.


How effective is treatment?

With treatment people with Parkinson disease can lead a normal and active life. They can be independent and continue to work throughout their natural lives.


What is the principal or basis of treatment?

There a number of medications available to treat Parkisnon disease.

  • The principal basis of treatment of Parkinson disease is to replenish dopamine deficiency in the brain.For instance, levodopa gets converted to dopamine in brain, while drugs like carbidopa and entacapone prevent dopamine destruction, and thereby, increase the amount of dopamine available.
  • Various other drugs modify brain chemicals other than dopamine and help control various symptoms of Parkinson disease.
  • Treatment is tailored as per an individual patient’s problems.

How long the treatment for Parkinson should be continued?

Parkinson disease is a progressive disease and symptoms worsen over time. However, there is effective medical treatment available that can be modified over time to keep pace with the disease progression.


What is meant by motor fluctuation, freezing and dyskinesias?

Generally medications used to treat Parkinson produce a steady response that is sustained throughout the day.

  • However, in a few patients after many years of Parkison disease the response to medications becomes short lived.These people experience an ‘ON’ or drug effect after taking their medication.A few hours later the response wears off and they experience an ‘OFF’
  • During an ‘ON’ phase patients are normal, though some may have involuntary or excessive movements called dyskinesias.
  • The ‘OFFs’ are characterised by slowness of movements and in some cases ‘freezing’.

Can motor fluctuations be treated?

Motor fluctuations are best treated by modifying the doses and timing of various drugs. These are best done by a neurologist who is a Movement Disorder Specialist.


When is a surgical treatment required for Parkinson?

There is an effective surgical treatment for Parkinson disease. Surgery is indicated for patients who have symptoms despite best medical treatment. With surgery even people with disabling motor fluctuations can resume normal lives and return to work.


What are the types of surgical treatments available for Parkinson?

  • Deep Brain Stimulation of the Subthalamic Nucleus (DBS STN) is an FDA approved standard of care treatment for Parkinson disease.
  • There are other surgical modalities under research but these are experimental and not approved by FDA as of now
  • Stem Cell Therapy for Parkinson is under research and has not yet been scientifically tried in human being.Stem Cell Transplantation is not a scientific treatment option for Parkinson disease available as of now anywhere in the world.

What are the non motor symptoms of Parkinson disease?

People affected with Parkinson disease may experience pain in muscles, constipation, problems related to urine control, sleep, vivid dreaming, enacting dreams, impairment in smell, giddiness, weight loss, impulse control disorders, confusion or hallucinations.There is effective treatment available for these non- motor symptoms.


Why Kokilaben Dhirubhai Ambani Hospital?

Kokilaben Hospital offers the opportunity to consult world class experts and avail of the state of the art in technology to diagnose, treat and rehabilitate people with Parkinson and Movement Disorders.


Movement Disorders clinic

This is a specialist clinic for people with neurological problems resulting in Movement Disorders. The clinic offers a comprehensive screening and care program for Parkinson and other Movement Disorders including neurology consultation, physical and cognitive rehabilitation and, psychotherapy.
The mission of the Clinic is to provide state of the art multidisciplinary care to patients with Parkinson disease and their families.


How does Alzheimer’s develop?

Alzheimer is associated with deposition of abnormal proteins in the brain, brain cell death and brain shrinkage. The exact causes and risk factors of Alzheimer are subject of active research.

The Clinic offers following facilities:

3 Tesla MRI: Specialised MRI protocols like morphometric MR, volumetric MR, Diffusion tensor imaging (DTI), can help elucidate brain structure and networks and help identify conditions mimicking Parkinson.
Rehabilitation: Kokilaben Hospital has dedicated 30,000 sq ft of floor area equipped with cutting edge equipment to provide personalised and goal directed physiotherapy, speech therapy and gait retraining. Our specialised physical and cognitive occupational rehabilitation program ensures that patients achieve their full potential

Gait and Balance Lab

  • Dietary Advice: Many people with Parkinson develop nutritional deficiencies as they are unable to prepare their own meals, develop odd food preferences, decreased appetite or fear of eating. The Clinic offers dietary advice and counselling. In patients who are unable to eat well we advise on measures to prevent nutritional deficiencies.
  • Surgical Suite and Intraop MRI

Services available

Movement Disorder Clinic: Parkinson disease screening and care
Rehabilitation: This package is designed to design treatment and to rehabilitate patients with Parkinson and other movement disorders. Total parkinson care program: Launched by our Chairperson Mrs. Tina Ambani, in 2009.

  • Movement Disorder Specialist Consultation
  • Physiotherapy
  • Speech and swallowing therapy
  • Dietary Counselling
  • Psychology Consultation

Milestones of the movement disorder clinic

  • Dr. Mohit Bhatt has been providing Movement Disorders Specialist consultation in continuation of his service in this field for the last 22 years in the city of Mumbai. He is credited with introducing the specialty to India.
  • In the 4 years since the inception of Kokilaben Hospital, the Movement disorder Clinic services have been availed by 11000 patients from the Indian subcontinent.
  • The other milestones of the Clinic are providing botulinum toxin therapy for various Movement Disorders.At the movement it has the largest number of such procedures performed in the country on a daily basis.
  • The Clinic is quaternary referral central for Functional Neurosurgery for various Movement Disorders and a pioneer in the field.

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