Trim and in her Early Seventies

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She fell between two cars three years ago and just recently finished the final treatment to her jaw and teeth. The accident resulted in a fractured jaw and arm; not simple fractures but compound, and they didn’t heal well. The jawbone had to be rebroken, aligned and held in place with a titanium plate. Three years later, she noticed the tremors in her mouth and hands. At night, she felt her entire body twitching.

The first neurologist the patient saw diagnosed the tremors as Parkinson’s disease and prescribed Mirapex. The medication can increase patient compulsivity, and receives blame for instigating gambling habits in people ordinarily not prone to wagers. The husband of the patient vouches that the personality of his spouse changed when she began the drug. Now, when she gets an idea in her mind she must follow it to the end. Delaying or minimizing the chore is insufficient, the patient feels compelled to carry out whatever it is her mind has settled on.

Generally, the rule with prescribing levodopa containing medications is, not to begin treatment with Sinemet in patients younger than 60 years of age, because half all patients treated with levodopa medications develop dyskinesia in three to five years. Dyskinesia is uncontrollable, often fluid movements of the limbs. The patient in her early seventies might have received the drug and been more completely relieved of her symptoms. In the physician’s opinion, tremor is really a cosmetic issue, embarrassing to the patient but usually not disabling. The patient admits that when she becomes aware of her tremor there are things she does to subdue it.

The movement disorder specialist would like the patient to begin taking amantadine twice a day for symptoms, because it may slow progression of the disease. He relates he would like to taper to only one Mirapex, right before retiring for the night. He also states that if the patient feels symptoms are worse, she might try a course of Sinemet. Now confused by how many drugs the physician is recommending, the doctor clarifies; always take the amantadine twice a day, take the Mirapex before bed and if worse begin weaning onto Sinemet. Sinemet is one of the drugs best to begin gradually. He writes out a schedule, the first several days the patient takes a single pill at breakfast. After that, the patient steps up to taking a total of two pills, once at breakfast and again at lunch, this continues for several more days. The second step takes the patient up to three pills total, at breakfast, lunch and dinner.

The specialist notes the patient has mild symptoms of PD. She has rigidity in both arms and makes small excursions when performing repetitive fine hand gestures. Strolling in the hallway, the doctor notes her gate is solid and her arm swing full. Perhaps the course of illness will remain mild. He requests the couple return in three months, so he can check the status of the patient and make any changes in medications. Encouraged that she walks for an hour on the treadmill, the doctor emphasizes the role physical activity has in enhancing physical function.

Job

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Just because you may be plagued by one illness, does not exempt you from acquiring another. So it is that 5% of patients with HIV contract symptoms of Parkinson’s disease. Whether due to exposure of typical things like pesticides, well- water, or heavy metals, or because an HIV patient may have prior exposure to neuroleptic medications and opportunistic infections, it is unclear how and whether one illness relates to the other. Parkinsonism has also been reported as the presenting symptom of HIV. In a recent issue of the journal, Movement Disorders a healthcare team from the Salford Royal Hospital, UK reported on a patient with HIV who received a diagnosis of idiopathic Parkinson’s disease and suffered from dyskinesia. The patient underwent treatment with highly- active antiretroviral therapy and experienced resolution of the parkinsonian symptoms.

In 2001, the patient was a 40- year old homosexual man in a relationship, with no history of injectable drug use or foreign travel. He described a three-year history of parkinsonism on one side of the body. He reported having difficulty writing and noticed the loss of manual dexterity due to tremor in the left hand. Examination noted the presence of seborrhoeic dermatitis of the face. He had signs of upper and lower limb resting and postural tremor, though slowness of movement and rigidity were confined to the left side of the body. He had full facial expression, and no problems with eye movements.

Symptoms of right- sided illness and compromised balance were apparent approximately a year later. A clinician recommended dividing the 800 mg/ day of levodopa into smaller doses. The amendment made some improvement, though marked motor fluctuations, and dyskinesia appeared within six months. The patient began taking amantadine along with continuous subcutaneous apomorphine infusion. The method of delivering medication to the body allowed a reduction in levodopa to 300 mg/day and mildly improved motor complications.

In 2004, the patient underwent an excisional biopsy of the parotid glands due to bilateral swelling. Results showed benign cystic changes in cells. An HIV test came back positive. Other testing provided a CD4 count of 150 (normal for HIV+ is 500) and a viral load of >750,000 (the very upper limit). Neuropsychological testing showed mild impairment of short- term memory. The patient began highly- active anti-retroviral therapy: lamivudine/ zidovudine and lopinavir/ ritonavir with a marked reduction in his viral load. Symptoms of parkinsonism improved over the following months allowing him to discontinue the apomorphine infusion, and gradually withdraw from levodopa. In a follow- up appointment in April 2008, the patient exhibited no resting tremor or bradykinesia. Rigidity was absent at rest and with co-activation.

HIV- infected patients with increased cell loss in the substantia nigra have been described, though these patients have been free of neurological abnormalities. PET studies have shown increased metabolism levels in the basal ganglia in early HIV infection, with reduced metabolism occurring in advanced illness. The authors concede the abnormalities they describe in the patient could be explained by reversible dopaminergic dysfunction secondary to HIV infection; though the span of time the patient suffered from symptoms, seems exceedingly long. They advocate HIV should remain in the differential diagnosis of young- onset PD, given its potential resolution by highly active anti- retroviral therapy.

Kobylecki C. et al. Letter to Editor HIV- associated parkinsonism with levodopa- induced dyskinesia and response to highly- active antiretroviral therapy. Movemnt. Dis. Early view 11 Nov. 2009.

Rasagiline- Induced Spontaneous Ejaculation

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Journals publish letters sent to their editors to enlighten clinicians, students and others about unusual patient cases. The following story describes an atypical response to the medication, rasagiline. Prescribed for patients with PD, it is thought to harbor neuro- protective effects.

The sixty- five year old patient was born with spina bifida, but had no dysfunction of bowel, bladder, or sexual function. The patient received a diagnosis of PD at age sixty- one and took 2mg rasagiline to treat his symptoms. A month after initiating treatment with levodopa he experienced spontaneous ejaculation occurring in clusters, every ten minutes for thirty minutes. Such episodes happened every two to seven days. Ejaculation took place without an erection and with no stimulation. In between these episodes he had regular sexual activity with no autonomic problems.

On his neurological exam, the clinician found left- sided rigidity, and slowness of movement without a resting tremor. The dorsiflexors were mildly weak, and he had decreased proprioception of vibration in the toes of both feet. The lower body had decreased reflexes.

The episodes of spontaneous ejaculation continued even when the dose of rasagiline dropped by half, but stopped when he discontinued the drug. Without rasagiline, the patient noted his symptoms worsened, and his clinician subsequently prescribed a four-month course of 10 mg of selegiline daily, to counteract additional movement concerns. After a period of four months, without sexual side effects, the patient began rasagiline anew, at 2 mg per day. Within a month spontaneous ejaculations re-occurred. The patient elected to stay on the medication, and still experiences unprompted orgasms. He also noted orgasms associated with planned sexual activity are more explosive, with less recovery time needed between such events.

Apart from hypersexuality, the prevalence and range of sexual dysfunction in those with PD, gets little attention. However, numerous reports of sexual problems occurring after the use of dopamine agonists, specifically apomorphine and ropinirole exist. This report, the authors believe, is the first of its kind.

Researchers noted dopamine’s role in inducing an erection when apomorphine was undergoing drug trials for the treatment of alcoholism. Apomorphine is a powerful dopamine receptor agonist and has been marketed as a treatment for human erectile dysfunction. Bromocriptine and ropinirole, two other dopamine agonists are reported to have improved erectile dysfunction, as well.

Experiencing ejaculation without an erection is curious. The author notes animal studies have shown dopamine aids ejaculation. For ejaculation to occur without an erection, different dopamine receptor sub types may come into play, as stimulation of D2 receptors in the rat’s pre- optic area by the D2/D3 receptor agonist, quinelorane, promotes ejaculation. Piribedil, another D2 and D3 receptor agonist significantly increases rat ejaculation with less effect on erection. Further support that D3 receptors in the brain modulate orgasm and the period between ejaculations, appeared when technicians injected a selective D3 receptor antagonist into the medial pre- optic area of the rat brain, abolishing ejaculations without affecting erections. It is also possible rasagiline increases central dopamine at either the brainstem or medial pre- optic area to increase signals to the spinal cord ejaculation center. The author concedes the patient is unique due to his underlying spina bifida, suggesting spinal cord or peripheral involvement is responsible for the aberrant reaction to rasagiline. As neurologists inquire more frequently into the sexual function of their patients, and with increasing use of rasagiline, more instances of the unusual side effect should occur.

Chuang R.S. and Lang A.E. Letters to the Editor Rasagiline- Induced Spontaneous Ejaculation. Movemnt. Dis. V.24 I.14 Oct. 30, 2009.

Going Solo

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A patient arrived for the first time at clinic today with striking symptoms of Parkinson’s disease. A very detailed history of when the first signs occurred followed, with acute insight into what presented and how the initial feeling of pain in one arm got interpreted as a muscle strain. After noticing the pain persisted throughout the day, for several days, then months the patient noted decreased strength in the arm. Objects once easily manipulated spilled onto the kitchen floor.

The patient lay on the bed at night wondering whether the spouse would notice the bed shaking. The inner tremor continued as did the pain in the arm. The specialist comments that studies have been done on patients who feel an inner sense of tremor, and that the symptom, once thought to correlate with anxiety, was shown to correspond with depression.

The patient nods in understanding and seeks to relate more of the history; bringing a foot into the air as one does in ascending a step, has become problematic. In order to perform the feat, the patient is forced to hang on to the railing. Akin to this issue, is the inability to rise from a chair without using the arms. In eating lunch, the patient finds his arm has lost the fluidity of movement it had. It is almost as though the arm and hand holding the fork, move in ratchet-like motion.

The physician states two over -the- counter measures may be useful are coenzyme Co Q10 at 900-1200 mg/day and creatine at 20 grams/day. The two have been found to improve mitochondrial function. The doctor comments the autonomic nervous system becomes involved in PD, and patients typically find themselves contending with constipation. The patient nods in agreement, relating some relief of the symptom through a remedy by Planetary Herbal Formulas, something called Triphala. Frequent urination is another symptom the patient notes, occurring at night. The doctor responds that many patients comment on this.

The patient concedes that the weight loss through healthy eating of many fruits, vegetable and whole grains was intended, thirty three pounds came off rather easily in the last year. The physician asks the patient to move to the examination table. While moving, the patient clasps every stable surface on the way to the exam table. The physician asks to see the patient walk, and the feet appear to be magnetically fastened to the floor. The patient has no arm swing. To gauge the ability to recover from a perturbation in balance, the physician cues the patient about what he plans to do, then jostles the patient’s shoulders. The patient throws the arms wide and has extreme difficulty righting the torso under the feet. Problems with recovering from a balance disturbance typically present themselves in Stage III illness.

Back in the confines of the small office, the specialist explains that when a patient’s signs or symptoms create impairments that conflict with working, or performing routine activities, he prescribes medications to dampen symptoms of PD. Most drugs have secondary affects. Though both creatine and Co-Q10 will do nothing to quiet the issues, they may delay the worst of the illness. Rasagaline, or Azilect is a prescription medication proven to delay the need for levodopa in PD patients. An MAO inhibitor, it carries a black- box warning because it may bring on a hypertensive crisis when combined with red wine and aged cheeses.

The patient stretches an arm over the notes the physician provides, and divulges that rather than taking the drugs more time needs to be given to an alternative method. The medications will be there, available when hope runs out that other means may alleviate the most troubling symptoms. Yes, the physician agrees, this is a patient decision; yet he wants the patient to return in four months to check on progress.

Tingling and Numbness

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The patient feels she is walking on sponges. The tingling and numbness in the arms and legs never goes away. The movement disorder doctor comments both thyroid illness and diabetes can affect the nerves, resulting in sensations of numbness and tingling. The patient is relatively healthy, and does not have diabetes. To combat rheumatoid arthritis the patient takes methotrexate, which Wikipedia states received approval for that treatment in 1988. The online site does not mention changes in sensation, as a possible adverse effect on the central nervous system. Other sources of information do show that rheumatoid arthritis can result in peripheral neuropathy. Diagnosed with low thyroid function, the patient has taken synthroid for years. Emedicinehealth.com lists numbness and tingling of the hands or feet under hypothyroid symptoms, one might experience during pregnancy, an unlikely scenario for a patient over sixty years of age.
The specialist conducts the physical examination, finding some cogwheel rigidity in the muscles of the arms. Fine motor skills are slower than normal, though the patient demonstrates them well. Facial expression appears somewhat frozen, and speech lacks the whispered quality frequently heard in patients. The patient does not shuffle, though gait is slow and she admits she loses her balance quite easily. Neither the patient nor family member mention falls. While demonstrating gait in the hallway, the patient turns en bloc, not freely but turning the feet stepping repeatedly around an axis.
The physician notes the lower body symptoms are more expressive of Parkinson’s, than upper body symptoms, a hallmark of vascular Parkinson’s, or lower body PD. The subtype differs from true PD, in that the patient may not suffer from a lack of dopamine in the brain, though the symptoms resemble the true illness. He inquires whether the patient feels the prescribed medications have been helpful. The patient reports she had seen little change in her symptoms.
After some discussion, they agree to a plan; try to consume a vegetarian diet for two weeks to assess whether medications are effective. With little to no proteins in the diet, the levodopa should have better access to brain where it is made into dopamine and should have an effect if the patient is dopamine- depleted. If the patient has no lack of dopamine, the medications will do little to ameliorate symptoms. If there is no change the patient should increase the dose of medications and assess that effect. If after the increase in dose the patient still feels no reduction in symptoms, she will stop taking the Comtan, and gradually reduce the levodopa/ carbidopa until weaning herself from the drug. At this point, one may say with some certainty whether the patient has her own stores of dopamine, or if she has become depleted of the neurotransmitter, as is typical in Parkinsons disease.
The specialist addresses the tingling and numbness in the extremities by prescribing gabapentin, also called Neurontin and Gabarone. He says the drug is quite benign, in terms of its side effects, though initially it makes one drowsy. He advises the patient to begin taking it at nighttime, and to increase the dose by taking a pill during the day as she becomes tolerant to the sleepiness. The physician asks the patient to return in four months so they can reassess the situation.

Issues of Hope

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In the waiting room the older girl cares for her red- haired sister. The younger shines behind a fringe of bangs, her longer hair sweeps into a curl someone has taken the time to induce. She is not yet two and wears a pink dress. Her sister wears a white t-shirt with black graphics and her long pony tail hangs down her back. They are waiting for their mom. I am waiting for Parkinson’s patients. We are still waiting an hour and twenty minutes later. They’ve found the bathroom and changed diapers. The younger has eaten cookies, torn pages from a magazine, crawled around the floor, peered through the glass window, giggled, fainted repeatedly into her sister’s open arms, shrieked, cried, run out of the area provoking a chase, and tried to persuade her sister into taking off her bright pink belt, pointing to it, saying “Off. Mine.”
Their mother appears suddenly in a motorized wheel chair. Though her face is glazed, I hear her say, ‘shots in the back for pain’ as her left hand motions to her spine and the older girl nods, concern in her features as she picks up the diaper bag, and scans the seats as they leave.

The PD patient arrives at last. He asks whether his wife may accompany him. She has an unlikely Spanish name. They have been married fifty years. I learn this in a tense moment between them when the doctor asks a question and they both volunteer information. He is from Spain, and his tone is sharp towards his spouse. His head and gesture of hand accentuate his request for her to let him speak. They were not born married, how old can they be?

He is fit and walks upright. They have come with questions and down loads from the internet about a doctor in Valencia, Spain who stumbled upon an apparent way to treat PD with an acupuncture needle in the ear; a non- invasive approach. This sets the doctor on a tangent about how he used to refer patients to an acupuncturist for tremor, but found patients were not greatly improved and how he works with a physician who used to be a neurosurgeon in China. Though he now works with rats, the Chinese doctor described a very special type of acupuncture in which a needle is inserted through the base of the skull into the brain; it has been used to cure blindness. In this country we call that neurosurgery, the doctor tells us.

The couple wants information. Fetal cell transplants, newer drugs? It has been a year since they were here. What about stem cells? In Santo Domingo they are giving PD patients infusions of stem cells, the patient tells the clinician.

“These are issues of hope.” The doctor replies. If money is not an issue the doctor advocates 1200mg/ day of coenzyme Q10. Studies have shown some protective effects, but the pills are expensive and not covered by insurance. Azilect in place of selegiline will also improve slowing of the illness. Exercise is beneficial. The couple plans to travel to Valencia where they can obtain the Neupro patch in 8mg strength. The patch will also improve symptoms as the drug bypasses the digestive system and gets delivered through the skin continuously, avoiding pulsatile stimulation of dopaminergic neurons.

Though there is a patient in the room, the feeling is upbeat, healthy and striving. The disease has not settled in, and that is good.

Falling into Open Arms

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It seems the patient needs little provocation to fall. He fell three times on Labor Day and twice this past weekend. The wife hesitates to let him use a walker. She fears the tip- toeing will escalate with wheels in front of him; the increased velocity will drive him into a more traumatic accident. Occasionally he’ll use a cane to get around, though mostly he just loses them, his wife relates.

Six months ago the patient’s blood pressure was dangerously low. He appeared today wearing compressive socks, a former suggestion they implemented. The spouse relays they are focusing on adding salt to the diet, and she’s concerned about the thirty pounds he has lost since January. She wonders whether the action of sinemet varies with weight and the doctor shakes his head no, as he asks the patient to copy his movements with his own hands.

The doctor opens the left palm of his hand, with the right he pats the palm then flips the hand over and pats with the back of the right hand. Quickly he flips the right hand down and over, down and over onto the left palm. The patient extends his left palm as well, and with the right he makes a downward chop motion. The doctor asks whether he sees a difference in what their hands are doing. The patient concedes the doctor is doing something different and amends the chopping motion with a slap. The new action resembles slightly more of what the doctor is performing.

‘There’s an apraxia here.. It’s indicative of problems with thought..’

The wife comments she has begun to shave her husband’s face. ‘He’s losing independent function…’

In a chair opposite her husband, the wife in a shirt of pale pink exhales and shrinks into herself, apologizing as an emotional wave passes and she sobs into her clenched hand. Wanting an unbiased opinion, she sought the advice of a social worker at the VA who informed her there are 2 total care nursing homes in Hernando County, and three more in West Pasco. The patient is considered 70% disabled, so the VA system should pick up the entire bill.

Frustration in her voice, the wife related the patient was into everything. Drawers, cabinets, closets; he turns the contents out, inspecting it all, reading the smallest print on a shredded discarded napkin. It’s hard when you are the only one making all the decisions, she admits. She recalls seeing her husband standing in front of the chest of drawers, then abruptly going down and she was running to catch him. The force of his body hit her and they both fell on the floor.

The doctor faces her and tells her she must guard her own health; consider taking antidepressants as well, because they can help, even though she has appropriate reasons to feel as she does. The doctor leans back in his chair. Two things I can suggest, he holds his thumb and index finger erect. Physical therapy may help with gait and balance, though he will not learn anything new, and will retain little. Seroquel, at night will dampen the hallucinations, paranoia and delusions. During the day a smaller dose will diminish odd behaviors. As they leave the room the wife takes her husband by the hand, leading him slowly with his shuffling steps.

Patients Old and Young

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The patient wears her straight white hair short like a flapper from the thirties. While she moves randomly in her chair, her face is mobile and her dynamic presence engages all in the room.
“I don’t like to think of myself as having Parkinson’s Disease”- she tells the medical student. She uses no term to describe her dyskinesias- she simply says, “When I am like this”- gesturing towards her body. The doctor is unsure whether the movements are due to levodopa levels peaking or subsiding. He encourages the woman to keep a medication journal for several days and to bring it when she visits again. With a week’s worth of hourly details listing medications and her physical symptoms, he will be better educated to tweak her drugs and reduce the unwanted movements.
In a restaurant no one wants to sit next to her; the movements are embarrassing. She describes her children’s response to her initial session with a physician; they thought she was cured. Levodopa quieted everything.
Now balance and freezing become problematic. She takes no antidepressants. She sleeps well, with one Vesicare she wakes only once to use the toilet. The doctor recommends physical therapy, as freezing can be a source of falling incidents. Sun City- a retirement community south of Tampa is her home for the winter half of the year, by April 30th she returns to New York.
“Try and get an appointment in April, I’d like to see you before you leave.”
The medical student has long golden hair, hanging loose and straight down her back. Beneath her white lab coat, she is curvy but tall. She reports on another regular patient providing key issues of his visit. The second student, still an undergraduate, is dark, slender and intense. Thick black thick hair comes low on his forehead. When he is not commenting, he takes notes. His assertive voice and commanding attitude give him an authoritative air.
Diagnosed in his late thirties, the patient has had PD for ten years. He notes he feels weak in the legs sometimes, as if lacking the muscle strength to hold his body erect. Dramatizing this he hops from the examination table, performing several steps with bent knees. The doctor nods but has no comment.
The wife notes when very happy or sad, the medications seem to have no affect. Neither the doctor nor students provide any explanation. The physician takes the patient’s arm, testing for cogging in the wrist or elbow and comments on the patient’s muscle tone, noting he must be active. The client concedes he cuts the lawn, but maintains his bicep with fishing.
The edges of the man’s mouth droop slightly at the corners, making him appear sad. Describing his experience with Amantadine, he saw the ceiling slant downward at an angle and the floor slant upward. He felt space would compress him. His hands felt enormous and his body barely fit through the doorway.
Addressing the cost of medications, Mirapex in particular, the doctor suggests switching to Bromocriptine. Used during the seventies, it is an alternative generic option. Expressing doubt about whether it will be as effective as Mirapex, the doctor leaves the room, returning with a white bag of sample bottles.
It is four o’clock. The patient swallows a pill as the doctor explains to his wife, which cold medications may combine safely with the drugs he is taking. Soon after, the patient freezes in the hallway. He turns his wide shoulders sideways performing a maneuver he hopes will unlock his frozen feet.

PARKINSON’S CONFERENCE TO HIGHLIGHT INNOVATIVE THERAPIES AND QUALITY OF LIFE

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SARASOTA, Fla., September 28, 2012 — Nationally recognized researchers and clinicians, including fellowship-trained movement disorders specialist, Juan Sanchez-Ramos, MD, PhD and world-renowned neurosurgeon, James M. Schumacher, MD will present at this year’s Parkinson Research Foundation “Move It with Parkinson’s” educational conference on October 13. The conference will allow attendees to participate and interact with presenters on subjects ranging from medical and surgical therapy advances, to empowerment, nutrition, voice exercises, dance and other proactive ways to keep your body, mind and spirit up and moving with Parkinson’s disease.

Parkinson’s disease affects approximately 7,500 people in Sarasota and the surrounding communities. The Parkinson Research Foundation has presented annual educational conferences on a state-wide level since 2007. The conference will be held in the Fete Ballroom at the Polo Grill in Lakewood Ranch, October 13, 2012 from 8:00am to 4:00pm. A $20 per person donation is suggested with scholarships available. For more details and to register, visit  www.ParkinsonResearchFoundation.org or call 941-893-4389.

The Parkinson Research Foundation is a national nonprofit health organization. The mission of the organization is to cure Parkinson’s and to improve the lives of those living with the disease through education, support and advocacy. To fulfill this mission, the Parkinson Research Foundation funds research, publishes scientific findings, and provides funding for informational and other services to people with Parkinson’s, as well as their caregivers, families and healthcare professionals.

CROWD OF 350 GATHERS FOR GRAND OPENING OF PARKINSON PLACE

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SARASOTA, Fla., September 21, 2012—An estimated 350 patients, caregivers, and members of the healthcare community attended the grand opening reception and ribbon cutting at Parkinson Place in Sarasota on Sept. 13.

Celebrating the official grand opening of Parkinson Place, the festivities offered guests refreshments, a chance to tour the new facility, and the opportunity to meet some of the facility’s program instructors.

Parkinson Place offers a variety of education, empowerment and participation programs for patients, caregivers and healthcare providers connected to the disease.

“In our years of experience working with the Parkinson’s community here in Sarasota, we have never seen anything as exciting as the development of Parkinson Place.” said PRF Executive Director Marilyn Tait. “Parkinson Place has been designed from the ground up to be a fun and positive environment where people struggling with Parkinson’s can be proactive and engaged on a daily basis.”

Created by the Parkinson Research Foundation (PRF) in conjunction with the University of South Florida, Parkinson Place is working to provide an additional level of support and expertise to help the local medical community provide excellent care for patients living with Parkinson’s.

“Sarasota is fortunate to have such a facility and we are proud to have this opportunity to lead a program that will be followed closely by the global Parkinson’s community,” she added.

There is no cure, but people with Parkinson’s are able to enhance their quality of life through positive attitudes, lifestyle changes and individualized medical management.

“Parkinson Place brings together a nationally recognized movement disorders specialist, Dr. Sanchez-Ramos; the top regional Parkinson’s educator and advocate, Marilyn Tait; and the national resources of PRF to create a first-of-its-kind destination for the Parkinson’s community,” said PRF Chairman Larry Hoffheimer. “Our center will lead the nation in delivering the latest evidence-based programs to the community, as well as studying the effects of various programs to contribute to the body of knowledge.”

Parkinson Place is open Monday through Friday from 9:00am to 4:30pm, and membership is free.

For more information, visit ParkinsonPlace.org or call 941-893-4188.

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