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Parkinson’s Disease Research, Education and Clinical Centers

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San Francisco

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San Francisco PADRECC Announcements

Center for Parkinson's Disease and Movement Disorders

The Center for Parkinson's Disease and Movement Disorders at the San Francisco VA Medical Center and the University of California, San Francisco is a nationwide referral center providing comprehensive care to patients with Parkinson's disease and other movement disorders. The Center specializes in applying advanced surgical techniques to the treatment of Parkinson's disease, essential tremor, dystonia, and other movement disorders.


Services Offered

Comprehensive Movement Disorder Evaluation

All patients referred to the San Francisco PADRECC receive an extensive evaluation of their movement disorder. Although Parkinson’s Disease is the most common reason for referral to the PADRECC, patients with tremor, muscle jerks, dystonia and other movement disorders are frequently evaluated and treated by our fellowship trained movement disorders specialists. Patients are evaluated by a multi-disciplinary team of physicians, nurses, and pharmacists. Depending on the diagnosis and specific needs of the patient, medication therapy, physical therapy, occupational therapy, speech therapy and/or treatment with Deep Brain Stimulation will be considered. Referring physicians will promptly receive a comprehensive consultation report by mail or e-mail detailing treatment options, which may include recommendations for specific medication trials or changes in the present medication regimen. [Back to Top]

Evaluation for Deep Brain Stimulation (DBS) Therapy

Patients referred to the San Francisco PADRECC for potential Deep Brain Stimulation (DBS) receive an extensive evaluation to determine how likely DBS will be to improve their symptoms. The San Francisco PADRECC has significant experience in the use of Deep Brain Stimulation for the treatment of Parkinson’s Disease, tremor and dystonia. The evaluating team consists of DBS nurses, movement disorders specialists, neuropsychologists, clinical pharmacists and other specialists as deemed necessary. All patients will receive a comprehensive evaluation and referring physicians will promptly receive a comprehensive consultation report by mail or e-mail detailing treatment options, which may include recommendations for specific medication trials or changes in the present medication regimen. An assessment of the patient's candidacy for surgical treatment will also be provided. Patients who have had surgery elsewhere with sub-optimal results may be referred for reassessment. [Back to Top]

Pre-Operative Testing

All patients deemed to be candidates for surgical treatment undergo systematic neurological, neuropsychological, neuroradiological, and functional testing. Many of these evaluations are performed both with the patient on-medication and off-medication. This extensive pre-operative evaluation is focused on determining the surgical treatment best suited for each patient and provides a reference point for intra-operative testing and post-operative follow-up. [Back to Top]

Surgical Treatment

All surgical procedures are performed by San Francisco's Neurosurgery team: Paul S. Larson, MD, PhD, Chief of Neurosurgery and Director for the Center for Advanced Neurosurgical Operative Procedures at the SFVAMC and Associate Professor of Neurological Surgery at UCSF; Daniel Lim, MD, Neurosurgeon at the SFVAMC and Assistant Professor and Director of Restorative Neurosurgery at UCSF; and Philip A. Starr, MD, PhD, Neurosurgeon at the SFVAMC and UCSF.  All are internationally recognized experts in the neurosurgical treatment of movement disorders and employ advanced neurophysiological localization techniques, including microelectrode recording, for all surgical procedures. [Back to Top]

Deep Brain Stimulation (DBS)

Chronic high-frequency electrical stimulation of deep brain structures involved in motor control is a means of functionally altering the activity of these structures without producing a permanent, destructive lesion. This is accomplished by implantation of a stimulating lead into the brain structure of interest; the lead is connected by an extension wire to a programmable impulse generator, implanted below the clavicle. The stimulation parameters are programmable using non-invasive radio-telemetry.  Thalamic DBS, in which the stimulating electrode is implanted into the ventral intermediate nucleus of the thalamus, is approved by the U.S. Food and Drug Administration for the treatment of medically refractory essential tremor and tremor associated with Parkinson's disease. The use of deep brain stimulation at other sites, such as the globus pallidus and subthalamic nucleus, is being investigated as a treatment for all cardinal signs of Parkinson's disease. The Center is actively involved in research protocols studying the efficacy and safety of these techniques.  The UCSF/SFVA Center is one of the world's most experienced DBS centers. [Back to Top]

Botulinum Toxin (Botox)

The San Francisco Veterans Affairs Medical Center has a Botulinum Toxin clinic that is a part of the Parkinson’s Disease, Research, Education and Clinical Care center (PADRECC).  It specializes in providing therapeutic botulinum toxin injections for:

  • Cervical dystonia (spasmodic torticollis)
  • Cranial dystonia
  • Focal limb dystonia (writer’s cramp)
  • Drooling (sialorrhea)
  • Spasticity due to stroke, multiple sclerosis, or other conditions

Our experts are fellowship trained and utilize state-of-the-art techniques, including EMG guidance and electrical stimulation, to specifically target the appropriate muscles for injection. [Back to Top]

Parkinson’s Disease Symptom Management Clinic

Advanced-stage PD patients often gain little to no benefit from medication adjustments. In fact, medications are more frequently withdrawn due to their side effects. Families often have feelings of abandonment for care and support in the final stages of care for patient with Parkinson's disease. With this in mind, the SFVA developed a new interdisciplinary clinic for advanced disease patients with the goal of improving the family's sense of support for this difficult phase of disease. Patients are seen in conjunction with their families or care team. The two hour visits start with an intake of key issues solicited by either the nurses, a social worker or chaplain. Patient and family goals are explored and a plan of care is made together incorporating recommendations from all involved parties. [Back to Top]