The Queen's Medical Center

Parkinson’s and Movement Disorder Center at The Queen’s Medical Center

The Queen’s Medical Center
Neuroscience Institute Outpatient Center
Physicians Office Building 3 (POB 3)

Address: 550 South Beretania Street, Suite 503, Honolulu, Hawaii 96813

Fax:
808-691-8865

Hours:
Monday – Friday, 8:00 am – 4:30 pm

» Conditions & Treatments » Neuroscience » Parkinson's and Movement Disorder Center

The Parkinson’s and Movement Disorder Center at Queen’s Neuroscience Institute is a multi-disciplinary program dedicated to comprehensive diagnosis and treatment for movement disorders. We believe in a team-based approach, which includes highly trained movement specialists (neurosurgeons and neurologists), ancillary providers and staff.

What are Movement Disorders?

Movement disorders include a wide range of neurological illnesses and conditions that affect the basal ganglia and movement circuit of the brain.

The most well-known movement disorder is Parkinson’s disease, but there are others, such as:

Our Services

The Queen’s Parkinson’s and Movement Disorder Center is ready to provide the widest spectrum of treatments available:

Complex medication adjustments: There are over 25 FDA-approved medications for Parkinson’s disease and other movement disorders and many options are available. However, medications can cause side effects and dosage may need to be adjusted by careful feedback, trial and error. There are also variety of delivery systems such as tablets, capsules, dissolving tablets, skin patches, inhalers, subcutaneous injections and dissolvable films. In many cases, it may be necessary to combine multiple medications. Complex medication management is best handled by neurologists specializing in movement disorders.
Botulinum toxin injection therapy: Botulinum toxin is a relaxant that can be directly injected into the muscle. Patients with blepharospasm, hemifacial spasm, cervical dystonia, writer’s cramp and spastic hemiplegia can benefit from botulinum toxin injection therapy.
Deep brain stimulation (DBS) surgery: Deep brain stimulation surgery is a procedure where a neurostimulation device (similar to a pacemaker) is implanted in the brain and delivers electrical pulses. Electrodes are placed in specific areas of the brain depending on the symptoms being treated. They are connected by long wires that travel under the skin and down the neck to a battery-powered stimulator under the collarbone. The electrical pulses from the DBS device regulates the activity of key circuits involved in abnormal movements and reduces symptoms. DBS surgery was approved by the FDA for the treatment of essential tremor in 1997 and for Parkinson’s disease in 2002. Since 2002, we have been performing DBS surgery with our dedicated team of neurosurgeons, neurologists and anesthesiologists.

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Frequently asked Questions: Deep Brain Stimulation for Parkinson’s Disease

What is DBS?

DBS stands for Deep Brain Stimulation. It involves a surgical procedure that allows us to use electrical signals though electrodes in the brain to alter brain pathways and treat various symptoms of Parkinson’s Disease.
The surgery involves placing a thin, electrical lead into the brain, with the tip of the lead in a particular brain target (subthalamic nucleus or globus pallidus internus). The lead is then connected to a wire outside the skull and underneath the skin, which connects to a battery placed in the upper chest wall.
The battery continuously generates electricity that stimulates the brain tissue, and we can adjust the parameters of the electric signal to change its strength, location, and other features. The battery works like a “pacemaker” for the brain.

What are the benefits of DBS?

DBS is not a cure and will not change the underlying Parkinson’s disease.
DBS can treat several motor symptoms of PD, including:
- Tremor
- Slowness and stiffness
- Dyskinesias and painful dystonias
- Motor “on-off” fluctuations
DBS can allow us to lower the overall dosage of levodopa and other medications, which can also reduce the side effects and complications of medication therapy.

Who can benefit from DBS?

Most DBS candidates have moderate or advanced symptoms, have a history of good responsive to levodopa, and are either experiencing complications to medication, or not getting enough benefit from medications alone.
A good candidate should have good intellectual function, be healthy enough for surgery, and have reasonable day to day function. For example, someone who is working but has symptoms that put them on the verge of no longer working, may benefit from DBS and be able to work for longer.

Who is NOT a good candidate for DBS?

A poor candidate may be someone with dementia, psychosis or other severe psychiatric symptoms, major medical problems that place them at high risk for surgery, unreasonable expectations, or severely disabled status. For example, someone who is wheelchair bound or in a nursing home would be unlikely to benefit from DBS.

What are the possible risks/side effects/complications of DBS?

Surgical complications:
- There is a risk of bleeding, stroke, or infection (immediate or delayed).
- Risk may be higher in patients with more complicated medical conditions, such as diabetes, hypertension, heart disease, or any condition requiring blood thinners.
Therapy side effects:
- DBS can lead to worsening cognition or psychiatric symptoms.
- At high parameters, DBS can also worsen speech or balance, or lead to dyskinesias and dystonias. These effects are usually not permanent, but can limit the benefit of DBS.
Other important points:
- DBS is a lifelong therapy and requires regular follow up and maintenance.
- Patients will need battery replacements every 4-5 years (some batteries last longer depending on the model).

I am interested in DBS. What is the process to get DBS?

Step 1: evaluation by DBS team
- You will be seen and evaluated by each member of the multidisciplinary DBS team: movement disorders neurologist, neurosurgeon, neuropsychologist.
- You will also undergo a detailed motor examination while on and off medications by the neurologist.
- Multi-disciplinary team will meet to discuss each patient and make a decision regarding their candidacy for surgery.
Step 2: surgery
- Pre-operative visits and extensive education.
- 2-step surgery: 1^st surgery for the electrode placement in the brain (awake), 2^nd surgery for the battery placement (under general anesthesia).
- Easy recovery, typically with 1-night hospital stay, then discharge home.
Step 3: initial and subsequent programming sessions
- DBS is not turned “on” immediately after surgery, but is turned on during the 1^st programming session, typically 2-4 weeks after surgery.
- Some patients take some time and a few more sessions to receive symptom benefit. Maximal benefit of DBS is usually achieved within 4-6 months of surgery, although some patients may benefit from additional periodic programming sessions for years after their surgery.
- Your neurologist may start to reduce medications in the first few months after surgery.
- You should continue seeing your neurologist regularly for DBS battery checks and general maintenance for Parkinson’s disease.

Interjejunal continuous dopamine infusion (duopa) therapy: Duopa therapy is a continuous gel infusion of carbidopa/levodopa. In place of taking an oral pill, dopamine is delivered through a tube placed in the intestine. The therapy provides a smooth absorption of medicine and can reduce symptoms of motor fluctuations and dyskinesia in advanced Parkinson’s disease patients.
Physical, occupational, and speech therapy: Our highly trained team of physical, occupational and speech therapists work closely with community therapists to make appropriate referrals depending on individual geographic and treatment needs.
Telehealth service: If appropriate, save time, expenses and the effort of traveling to Queen’s from a neighbor island or remote area on Oahu by using our telehealth service.
The Queen’s movement disorder video conference (bimonthly): Since 2001, we have partnered with movement disorder experts at the University of Virginia to provide additional expertise for the people of Hawaii without requiring travel to the mainland.

Patient Support and Outreach

We strongly believe in self-empowerment. Exercise and lifestyle is one of the most important therapies for Parkinson’s disease and movement disorders. It allows patients to maintain the highest level of function possible. We highly encourage the discussion of lifestyle (diet, sleep and bowel habit) and exercise during visits as we tailor individualized programs. Through collaboration with:

The Hawaii Parkinson’s Association

Deep brain stimulation support groups and other support groups
The Annual Parkinson’s Symposium
The Annual Parkinson’s Walk
Various other community resources

And coordination of care through Queen’s Clinically Integrated Physician Network (QCIPN) and Queen’s Geriatric Services, our goal is to help patients achieve the best quality of life while living with Parkinson’s disease or other movement disorders.

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