Parkinson's Disease

The Plummer Movement Disorder Center takes a team approach in treating Parkinson's disease. The care team includes a movement disorders specialist, a social worker, and physical, occupational, speech and therapists with specialized training in Parkinson's disease.

Parkinson's is a progressive brain disease characterized by the loss of dopamine cells. More than 1.5 million Americans are diagnosed with this condition. It is the most common form of 'parkinsonism,' a group of neurological disorders that include those people with tremor (shaking), rigidity (stiffness), bradykinesia (slowness), and postural instability (imbalance). Other causes of parkinsonism are trauma, stroke, drugs and infection. More people suffer from Parkinson's than multiple sclerosis, muscular dystrophy and amyotrophic lateral sclerosis combined.

The Scott & White Neuroscience Institute, Department of Neurology and Plummer Movement Disorders Center offers complete diagnosis and treatment for Parkinson's and other parkinsonism disorders. We recommend early referral to a movement disorders center for early team intervention. For more information, contact us at 254-724-6065.

Causes of Parkinson's

The cause of Parkinson's disease is unknown. What is known is that symptoms are related to a chemical imbalance in the brain caused by the death of dopamine-producing cells. A small percentage of PD cases are genetic. Most are sporadic. The symptoms worsen as the disease progresses slowly. Currently, there is no cure.

Risk Factors

  • Advancing age: The average age of onset is 60 years
  • Sex: Men have slightly higher risk than women
  • Family history: Those with an affected parent or sibling are more likely to develop the disease
  • Environmental factors: Findings indicate that rural living, exposure to well water, agricultural work, pesticides, and herbicides may increase the risk of getting the disease
  • Combination of family history and environmental factors


The three most common motor symptoms of Parkinson's are:

  • Muscle rigidity: Stiffness when the arm, leg or neck is moved back and forth.
  • Resting tremor: Shaking (involuntary muscle movement) that is most prominent at rest and initially affects one side of the body.
  • Bradykinesia: Slowness in initiating movement.

Other symptoms are divided into motor (movement-related) and non-motor symptoms. Motor symptoms include:

  • Freezing
  • Imbalance
  • Stooped, shuffling gait
  • Difficulty rising from a chair or bed
  • Decreased arm swing
  • Reduced dexterity

Non-motor symptoms include:

  • Diminished sense of smell
  • Low voice volume
  • Sleep disturbance
  • Depression, anxiety
  • Constipation
  • Urinary frequency/urgency
  • Drooling
  • Dizziness
  • Erectile dysfunction


Accurate, early diagnosis of Parkinson's can be difficult since early symptoms may mimic other conditions or may be perceived as the effects of normal aging. Therefore, individuals should be evaluated by a movement disorders specialist - a neurologist who had specialized training in the diagnosis and management of the disease. The diagnosis of the disease is based on the patient's history, clinical exam and response to dopaminergic agents. The patient should have two out of the three — tremor, rigidity and bradykinesia — and the symptoms are worse on one side, which improve when dopaminergic agents are given. Sometimes, the patient can be challenged with levodopa to confirm the diagnosis. Brain imaging scans are not officially recommended.


Treatment for Parkinson's disease is determined by your physician based on your age, overall health, and medical history. Furthermore, the extent and type of your condition are considered, along with your tolerance for specific medications, procedures or therapies.

While there is no cure right now, medications greatly improve symptoms. Depending on the patient, treatment protocol for Parkinson's may include:

  • Medications, depending on the degree of functional impairment, age, cognitive impairment, ability to tolerate antiparkinsonian medication.
  • Surgery, when medications have failed to control the symptoms. While surgery may improve some symptoms of Parkinson's, it does not cure or stop the disease's progression. Surgical procedures for Parkinson's are: lesion surgery, or burning of tissue and thus creating lesions in critical parts of the brain that help control movement; or Deep Brain Stimulation (DBS), wherein a small electrode is placed in the critical part of the brain that helps control movement and a stimulator is placed on the chest wall that is programmed to improve the symptoms. DBS placement is like having a “brain” pacemaker.
  • Complementary and supportive therapies, such as diet, exercise, and physical, occupational and speech therapy.

Learn More

You can find out more about Parkinson's disease and other forms of parkinsonism by visiting the National Institute of Health and the National Institute of Neurological Disorders and Stroke and the We Move website.

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Emmanuel A. Amulraj
Cardiothoracic Surgeon
Carl D. Boethel
John L. Boyd
Kendall Britt
John W. Calder