Air Force doctor tackles movement disorders

  • Published
  • By Sue Campbell
  • 59th Medical Wing Public Affairs
LACKLAND AIR FORCE BASE, Texas (AFNS) --  A neurologist at San Antonio Military Medical Center-South, or Wilford Hall Medical Center, is currently working to provide relief for patients suffering from movement disorders, such as Parkinson's disease and essential tremor.

Maj. (Dr.) Maria Alvarez is the only movement disorders fellowship-trained physician in the Department of Defense who actively works to improve the quality of life for adults who have been diagnosed with movement disorders.

Parkinson's disease, or PD, is a neurodegenerative disorder of the central nervous system that often impairs the sufferer's motor skills, speech, gait, stiffness and other functions. Essential tremor, or ET, is a progressive neurological disease whose most recognizable feature is a tremor of the arms that is apparent during voluntary movements, such as eating and writing.

There is no cure for either disease and they tend to get worse over time.

"Patients with PD and ET receive medications to improve their symptoms, but the drugs become less effective over time," said Doctor Alvarez. "As the disease progresses, a higher dosage of medication is required and at higher dosages medications have their own potential side effects."

Deep Brain Stimulation, or DBS, is an alternative to taking medication when medications can no longer control the symptoms and/or the adverse effects become less tolerable.

DBS is a surgical treatment involving the implantation of a medical device, or brain stimulator, which sends electrical impulses to specific parts of the brain. A neurosurgeon opens a dime-sized hole in the skull, inserts an electrode (lead) about the size of angel hair pasta, and implants it into the targeted brain area. The electrode extends out and is guided down to the chest under the skin and eventually connects to the neurostimulator which sends electrical impulses to the target area which controls the movement.

The surgery is performed at a hospital downtown and is covered by Tricare.

"The electrode is turned on about a month after the surgery and I adjust the settings in my office here at Wilford Hall," said Doctor Alvarez. "I can see the effects of the stimulation immediately and make needed adjustments. It's quite amazing."

While stimulation can be initiated one day post-operatively, Doctor Alvarez usually waits one month since most patients experience transient post-operative improvement (microthalamotomy effect).

The most common symptoms of PD are shaking (tremor), stiffness and difficulty with walking.

"One of my PD patients called his strides 'baby steps' because he shuffled along taking forever to get from one place to another," said Doctor Alvarez. "His involuntary movements (medication side effects) and tremor have all but disappeared now, he walks without fear, and his quality of life is much improved."

Since her arrival at SAMMC-South in October 2007, Doctor Alvarez has seen five patients who received DBS. One had ET and four had PD.

Doctor Alvarez is also president of the San Antonio chapter of the American Parkinson's Disease Association. She gives talks to patients and their families and oversees support groups in the community.

In addition to DBS, Doctor Alvarez also offers an innovative treatment for patients who have spasticity or rigidity due to other neurological diseases, such as multiple sclerosis, stroke, brain and/or spinal cord injury.

Intrathecal baclofen, or ITB, therapy involves implanting a pump device in the patient that delivers medication directly to the target sites in the spinal cord. Like DBS, the device is adjusted regularly to ensure the correct dosage is delivered, providing optimum relief of symptoms.

"Oral medication can result in side effects, such as sleepiness, confusion, lightheadedness, and blood pressure changes. Use of local botulinum toxin or botox injection may not be enough if there are several body parts affected" said Doctor Alvarez. "The ITB delivers the medication directly to the target. Hence we can use higher dosages while avoiding side effects."

The ITB can be implanted at SAMMC-South. Since she arrived, Doctor Alvarez has two patients who underwent the procedure. One suffered from multiple sclerosis and the other from a stroke.

"It is so gratifying to see my patients improve after undergoing DBS implantation or ITB placement," said Doctor Alvarez. "Sometimes they seem like a totally different person. I just want to spread the word that these treatments are available so we can help as many people as possible." 

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