In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized Parkinson’s disease expert, provides an overview of the disease and current techniques for managing it.



Parkinson’s disease is the second most common neurodegenerative disease seen in the United States. Only Alzheimer’s disease is more common. They both share the common fact that they are progressive neurological diseases that result in patients losing functional ability. Alzheimer’s disease affects memory, the ability to remember how to do things and general loss of mental function. Alzheimer’s patients are mostly not aware of the fact that they are neurologically deteriorating. They will make excuses for their memory short comings. Like Parkinson’s disease it is important to recognize Alzheimer’s early so that treatment can be started and outcomes will be improved.

Parkinson’s disease is primarily a progressive loss of the ability to move normally. There is a gradual slowing of movements as well as doing routine tasks such as shaving, dressing and getting ready to go out. Walking is affected and patients tend to shuffle with a forward stoop. Although tremor is common in Parkinson’s patients, not all have this. The converse is true: not everyone with tremor has Parkinson’s disease. There are many treatment available for Parkinson patients to improve their quality of life.

Not everything that shakes is Parkinson’s. If you are concerned that you or someone you love may be suffering from this or another movement disorder, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a movement disorder specialist in your area.

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Recent studies have suggested that qualifying Parkinson patients benefit from earlier treatment with deep brain stimulation, as reported in Clinical Neurology News. The study indicates that younger Parkinson disease patients are more likely to benefit from early brain stimulator treatment. There is information that may suggest that this therapy may have a protective effect in delaying the progression of Parkinson’s disease. Deep brain stimulation (DBS) was FDA approved in 2002 for treatment of Parkinson’s disease. Symptoms that are best controlled include tremor and dyskinesias although brain stimulation can also help reduce freezing and off time. Younger Parkinson patients develop motor complications such as dyskinesias, off time and freezing much earlier than older patients with Parkinson’s disease. As reported by Dr. David Charles, a Vanderbilt University Medical Center Parkinson neurologist, “No therapy…has bee shown to slow the progression of Parkinson’s.” The previous thinking was to wait until a patient had severe motor complications that could not be controlled with medications prior to considering DBS therapy. The new thinking, and research, is exploring benefits of DBS in earlier stages of Parkinson’s disease. In various reported cases, patients not only benefited from better control of their Parkinson motor symptoms but also had improved quality of life. Added advantages is that Parkinson patients treated earlier with DBS used less medications over an 18 month period, as shown in one small study. There are two studies currently looking at the benefits of early DBS therapy in Parkinson patients: EARLYSTIM is a French study and a smaller study at Vanderbilt University are in progress. It should be noted that Parkinson’s disease is a progressive neurodegenerative disorder. Even patients with DBS therapy do have progression of their symptoms. Memory loss can be a part of the Parkinson syndrome and is not helped by DBS therapy. DBS is not a substitute for optimal neurological and medication management of Parkinson symptoms. Dr. Kassicieh, at Sarasota Neurology, provides medical and neurological management for patients with Parkinson’s disease and brain stimulators. For more information click here.

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Memory loss is a frequent patient complaint that I see in my office. Patients with this complaint are generally over the age of 65 but occasionally I will see someone in their 40s or 50s with this problem. For all patients, it is important to get a detailed history of when they first noticed the problem and has it been getting worse. What kinds of things do they forget. Does it happen all the time. A brief memory test, the MMPI can be performed. This simple test can give the physician a general idea on the degree of memory loss. Further tests should be performed such as a CT or MRI brain scan to look for stroke, hydrocephalus or other abnormalities. Simple lab screening for diabetes, low thyroid and vitamin deficiencies are commonly ordered.

Once testing has been completed, treatment can be started. For many younger patients, memory loss is due to a combination of stress, depression and other situational problems. It is rarely due to dementia or some other progressive neurodegenerative problem. Antidepressant medications are frequently helpful in these situations. By alleviating anxiety and depression, a patient’s “memory loss” can be cleared. Patient’s with persistent memory problems may need to undergo a further course of memory testing by a psychologist. This 4-6 hour testing session gives a detailed analysis of what type of memory problems a patient may be experiencing. This can range anywhere from depression to Minimal Cognitive Impairment to Alzheimer’s disease.

Minimal cognitive impairment is characterized by simple memory loss. Affected patient’s have difficulty remembering certain things, without having their global memory function and other aspects of thinking impaired. There is commonly underlying depression, but this is not the specific cause of their memory loss. In patients with Alzheimer’s disease or other dementias, short and intermediate term memory is more commonly affected. These patients can also have trouble with finding words, commonly misplacing objects and loss of social graces.

There are several medications that are used in treating memory loss. Aricept, Exelon and Razadyne are all similar in the was that they work to help slow down the progression of memory loss and dementia. Namenda is another memory loss medication that works differently than the other 3 medications. It can be used alone or in combination with one of the other memory drugs. The combination therapy has been shown to have a very significant, beneficial effect in some patients in improving their cognitive processing and memory function. It is important that a patient be evaluated as soon as a problem is suspected. Studies have shown that the earlier one of these medications is started, the better the patient does over the long run. While these medications do not have FDA approval for minimal cognitive impairment, some studies have shown that the memory loss medications are helpful in these cases as well.

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