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Program includes emphasis on Parkinson's Three years ago, Robert Clark was driving from Boston to Georgia to play golf. He ended up turning around and going back because for some reason he couldn’t use his right arm. He figured it was all the hours of driving that made his arm act up like that. His doctor prescribed anti-inflammatory medication.   Then it happened again. This time it happened while he was in Circuit City buying some equipment. He tried to sign the credit card slip and couldn’t seem to make his hand work right. His signature was scanned for verification. It was rejected. The scanner said this was not Robert Clark’s signature.   At that point, he went in for tests. Through a process of elimination, it was determined that he suffers from Parkinson’s Disease (PD), a degenerative condition that compromises the central nervous system. At 64, Clark is one of more than 1.5 million Americans who suffers from the condition.   Parkinson's is a non-contagious disease that can appear at any age, though the risk of developing it increases with age. Men are slightly more likely than women to develop the condition.   Presently, only one side of Clark's body is affected by the disease. It’s difficult for him to use his right hand, arm and leg. One foot shuffles when he walks and writing remains difficult. Clark's symptoms are typical of the condition.   Recently, the Movement Disorders Program at MUSC was expanded to include a special emphasis on Parkinson's. Neurologist Kenneth Bergmann, M.D., joined the department in January as director of the Movement Disorders Program. His highly specialized training in Parkinson's has been a blessing for Clark, who describes Bergmann's manner and expertise as “absolutely golden.”   Clark takes two medications to keep his symptoms in check and also does special stretching exercises to keep his right arm and hand limber. “The combination has made a difference,” Clark said.   The expansion of MUSC's Movement Disorders Program includes the newly established autonomic dysfunction laboratory, which offers non-invasive diagnosis and treatment of disorders of the autonomic nervous system.   Autonomic function testing monitors reflexes as they change with each beat of the heart. This helps physicians in the diagnosis of a variety of disorders such as dizziness, fainting, exercise intolerance, and peripheral nerve disorders, including diabetes mellitus, and other diseases of the peripheral nerves and central nervous system such as parkinsonism.   Parkinson’s-like conditions can be seen as a result of a stroke, encephalitis, carbon monoxide or manganese poisoning and head trauma.   “Early symptoms often are misdiagnosed as signs of aging,” said Bergmann. “Timely treatment of these conditions can easily prevent expensive hospitalizations that occur because of injuries associated with falling,” said Bergmann.   No one knows for sure what causes Parkinson's, but, according to Bergmann, the causes are likely both genetic and environmental. “Genetic factors alone are not responsible for causing the disease,” he said. “It seems clear that environment is a trigger.”   Environmental factors such as infection or exposure to chemical toxins are thought to be the leading cause. There is a higher incidence among those exposed to the following environmental elements: well water, welding, wood pulp, and pesticides. “The fact is, Parkinson’s is in every society,” Bergmann said.   The Movement Disorders Program at MUSC is working to establish and maintain a data analysis process for identifying health risks to populations in the region. Because routine diagnostic tests are lacking, diagnosis depends upon a comprehensive clinical evaluation. Symptoms to look for include changes in speech, loss of fine motor control, trouble walking and balancing, and a change in ability to perform daily functions.   “It is important that the correct diagnosis of Parkinson’s be made as early as possible,” Bergmann said. “Failure to establish the correct diagnosis can lead to missed opportunities for potentially effective treatment and may in fact lead to inappropriate treatment.”   Of the two types of treatment options—drug therapy and surgery—drugs remain the most common choice. Other treatments, however, such as deep brain stimulation are showing promising results.    The MUSC Movement Disorders Program provides an individualized evaluation and treatment program that determines if, when and what treatment or combination of treatments is recommended.   For information on the Movement Disorders Program, call 792-3223. Primary symptoms of Parkinson’s Disease: Tremor is perhaps the symptom most commonly associated with PD. In fact, 25 percent of patients experience only very slight to no tremor at all. The tremor may appear in the limbs, head, neck, face or jaw and may only show itself on one side. Rigidity is increased tone or stiffness in the muscles and is responsible for the mask-like expression of the face that appears in some patients. Bradykinesia is slowness of movement. This symptom occurs as a result of the brain’s slowness in transmitting the necessary instructions to parts of the body. The slow transmission results in delayed movement. Poor balance is a common symptom of PD. It is especially evident with a sudden change in position. Walking problems commonly include short, shuffling steps and decreased or non-existent arm swing. How Parkinson’s patients can help themselves Parkinson's patients can make a measurable difference in their quality of life through exercise, activity and participation in support groups. Exercise: Regular exercise and physical therapy will make a demonstrable difference in maintaining and improving balance, mobility, flexibility, and range of motion. Staying active: Parkinson's seems to progress more slowly in those who remain active and engaged. Support groups: Connecting and sharing with others who suffer from Parkinson's helps to bolster the emotional well-being of patients and provides a caring environment to share information and concerns.