Kristi K: In the worl of neuroscience and neurology.

Parkinson's disease affects approximately 1 million Americans today.

Essential tremor, also a movement disorder, is even more common than Parkinson's disease.

Well, let's head out now to talk with two renowned expert in neuroscience and neurology.

Doctor Alister Hoyt is a boar certified neurological surgeon at the University of Toledo Medical Center and an associate professor of surgery at the College of Medicine and Life Sciences at U. Toledo.

Also joining us is Doctor Jennifer Amstell, a board certified neurologist and movement disorder specialist, and is also an assistant professor of neurology at the College of Medicine and Life Sciences at U. Toledo.

And now let's head out on location.

Thanks for joining us today on business 368.

We're really looking forwar to hearing about the innovations as you've been a part of doctor AMS.

Give us an understanding of kind of definitionally, what is Parkinson's disease?

What are movement disorders?

Dr. Amsdell: Sure.

So movement disorders are a very broad category of neurological conditions.

Generally they're chronic problems where the primary symptom or problem for the patient is going to be related to their movement, whether that's extra involuntary movements like tremors, shakiness, or other extra movements that someone might have or lack of movement or difficulty moving.

And that encompasses a lot of different diseases.

Two of the most common, and one that we're talking about today are going to be Parkinson's disease and essential tremor.

Parkinson's disease is actually from a part of the brain that creates a chemical called dopamine that slowly makes less and less of that dopamine chemical with time.

That chemical, dopamine is very important for us to be able to control our movements and move in the ways that we want to.

Kristi K: And, Doctor Hoyt, tell u more about the surgical options that are availabl for those who are coming to you for essential tremors or Parkinson's, for example.

Dr. Hoyt: So these diseases hav been around a long time, okay.

As long as humanity's been around.

And while they're probably more prevalen now because of some exposures, people have been thinking about ways of treating them for a long time as well.

So actually, beginning in the late 1800s, people began to think about surgeries to trea symptoms of Parkinson's disease because there were no good drugs for treating those problems.

At that point.

By the time we got to the 1920s, the most kind of modern iteration of that surgery had come about, where peopl put probes down into particular areas of the brain and lesion, little areas of the brain specific regions.

And by doing that they could substantially improve the symptoms of Parkinson's disease or a central tremor in the 1980s.

People said, hey, instead of destroying that bit of tissue, how about we leave electrical contacts in that space and we stimulate that tissue with electricity?

And then when we turn the stimulation off, we have not lost that tissue.

It's still there.

And that's exactly what deep brain stimulation is.

It's leads that go down into these specific parts of the brain and stimulate those specific parts to produce the effect that we want.

Kristi K: As you see patients in the office after they've had DBS let's say, how are their results and what are the outcomes they're seeing.

Dr. Amsdell: So generally excellent.

So after a patient has surgery, we actually don' turn the device on right away.

So they go home and they have everything implanted and in place.

But we actually don't turn the device on until 3 or 4 weeks later.

That allows for time for them to heal up, and for any swelling or irritation created on the brain from the surgery to kind of go away.

And then we see them in the clinic by myself, or where one of my colleagues sees them in the clinic, and we actually turn the device on for the first time.

That's generally a long appointment where we spend a few hours together, checking the different amounts of stimulation and stimulating in different ways to find out the best areas that will be beneficial for the patient without creating any kind of side effect.

And most often, after that first visit, they have significan improvement in for Parkinson's, either their stiffness, shakiness and tremor, or for essential tremor patients in their tremor.

Dr. Hoyt: So while that ends up being a very large amount of work for the neurologist to do that, individualize programing and and modification of the stimulation for each patient when we have good placement of the electrodes and good programing in broad terms, we can usually see about a 50% reduction in the severity of Parkinson's symptoms, sometimes greater when we're talking about tremor, either in Parkinson's or an essential tremor.

We can often do better than 70 or 80% reduction.

Kristi K: And when we talk about the Midwest and the prevalence of Parkinson's and some of these disorders that we've just you've just described, why is the number higher here than perhaps in the East or in the South?

Dr. Amsdell: Sure.

So we think that it's most likely related to being a part of the area of the country called the Rust Belt, where we have higher exposure to different chemicals, both industrial chemicals as well as different chemicals associated with farming or pesticides, although we can't say 100% for sure.

There's definitely a higher rate of exposure here, than other places in the country.

And we're learning more and more that likely Parkinson's is related to exposure.

So some of these chemicals at some point in life for some folks.

Kristi K: How much does genetics play a role.

Dr. Amsdell: Sure.

So there are probably in th realm of 30 plus different genes that have been identified tha can cause Parkinson's disease.

However that actually makes up the minority of patients with Parkinson's that actually have a genetic cause.

Most patients we don't find any genes.

And we think that it's most likely related to some exposure at some point in their life.

Krist K: Something that I would like to leave our viewers with is this this notion that it's going to be okay so what is it that you could say to patients that mayb helps them to feel, a bit less anxious about some of those those steps that may be to come?

Dr. Hoyt: What I can sa is, well, surgery is not easy.

Peopl do it all the time and do well.

And these are not all Olympic athletes that are going through the procedure.

These are normal people with normal fears, normal diseases, normal frailties, and those people are the people who leave the hospital one day after their brai surgery, being the same person with some new sore spots.

So the biggest thing that I try to do when we're talking to people in and about surgery is not only lay out those risks and benefits, but explain to them that, yes, it's going to be difficult.

It's difficult like so many other things in life, but it's very achievabl and that the payoff can be big if w if we go through that process.

Kristi K: So thank you both for all you are doing for those patients who need you most.

You are really impacting our world for the better.

Thanks for being on business life 36 day to day.

Dr. Amsdell: Thank you.

Happy to be here.

Dr. Hoyt: Thank you for having us.