“This procedure is a game changer for our ability to treat patients with essential tremor and tremor-dominant Parkinson’s disease,” said Abigail J. Rao, M.D., stereotactic and functional neurosurgeon with Norton Neuroscience Institute. “Acquiring this technology advances our mission of giving patients the best possible outcomes, while further establishing Norton Neuroscience Institute as the regional leader in advanced neurological care.”

The treatment is an incisionless surgery, by which several ultrasound beams are focused down to millimeter accuracy, carefully creating a small lesion in a specific part of the brain. The patient lies in an MRI scanner that allows frequent scans to monitor the location, size and temperature of the lesion being created. During that process, the patient wears a helmet-like device filled with cool water that has more than 1,000 ultrasound transmitters, while the surgeon also tests the patient’s tremor and neurologic function. The newly created lesion provides immediate and dramatic relief of hand tremor and other symptoms of movement disorders, allowing for better motor control for life’s daily tasks or hobbies, as well as better quality of life.

The surgery does not require any anesthesia or hospital stay.

“This is truly groundbreaking technology that will allow us to help so many people in new ways,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “As focused ultrasound progresses, we hope to see its benefit in treating other conditions.”

The focused ultrasound surgery has been approved by the U.S. Food and Drug Administration since 2016 and is backed by years of data, which has shown most patients experience immediate, significant relief from tremor symptoms. The most common side effects include imbalance and numbness, but these usually subside within a few weeks.

To qualify for the treatment, a patient must have a confirmed diagnosis that is not adequately controlled by medication. The patient’s anatomy is carefully studied, and the surgery is planned, with CT and MRI scans taken prior to the day of the procedure. After the procedure, the patient receives a follow-up MRI to evaluate the lesion.

Start Your Journey With a Free Seminar

If you’re interested in learning more about high-intensity focused ultrasound treatment, be sure to join us for a free informational session. During this session, our team will address treatment options tailored specifically to individuals diagnosed with essential tremor and/or Parkinson’s disease.

The post Norton Neuroscience Institute acquires groundbreaking focused ultrasound technology appeared first on Norton Healthcare.

The first area of research moving into the space will investigate the connection between gut biology and the onset of several memory and movement disorders, including Parkinson’s disease as part of Norton Neuroscience Institute Cressman Parkinson’s Research. The group’s hypothesis is that changes in the gut’s biology can affect the progression of these cognitive diseases.

“We know how debilitating cognitive disorders like Parkinson’s and Alzheimer’s diseases are for patients and their families,” said Steven T. Hester, M.D., MBA, senior vice president and chief clinical and strategy officer, Norton Healthcare. “By establishing this research laboratory, it shows Norton Research Institute’s commitment to expanding our efforts both at the bench and the bedside. In other words, we are looking at taking basic scientific knowledge and turning it into something that can directly benefit patients.”

Efforts in the new laboratory will be led by Shirish S. Barve, Ph.D., chief research scientist, Norton Neuroscience Institute and Norton Research Institute, who is known internationally for his research on the connection between the gut microbiome and brain. His work has received sustained federal funding from the National Institutes of Health.

Besides wet bench laboratories, lab support space and state-of-the-art equipment, the highlight of the new facility is an eight-freezer biorepository capable of sorting, storing and analyzing hundreds of thousands of bio specimen for use in research, investigating the gut-brain connection.

“We know the gut is constantly influenced by lifestyle issues, including lack of sleep, stress and diet,” Dr. Barve said. “We want to understand these changes and their connection to the neuroinflammation and neurodegeneration that can lead to neurological disorders such as Parkinson’s and Alzheimer’s diseases. We are hopeful this will lead to the development and implementation of evidence-based preventative and therapeutic strategies that will significantly and positively impact patient care.”

Funding for the lab and technology was made possible with a $4.2 million grant from the Norton Healthcare Foundation, with support from the estate of Elizabeth Pahk Cressman, M.D., Ph.D., respected anesthesiologist and philanthropist.

Over her lifetime, Dr. Cressman donated more than $28 million to Norton Healthcare in support of critical care and the neurosciences. Her gifts have created greater access to medical expertise, expanded innovative clinical translational research and helped recruit, train and attract best-in-class specialists.

“Because of this space, our specialists are going to be able to conduct groundbreaking research that is going to change lives,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “We’re grateful to Dr. Cressman’s vision and, with the community’s ongoing support, look forward to working to change the narrative around diseases that affect so many in our community.”

Norton Research Institute has roughly 750 research studies currently underway, investigating medications, devices, outcomes, disparities and biology in multiple medical specialties. In 2023, researchers participated in studies reported in 167 publications across pediatrics and adult research.

The post Norton Research Institute unveils state-of-the-art research laboratory appeared first on Norton Healthcare.

“During her lifetime, Dr. Cressman’s vision has helped elevate the care for Parkinson’s patients  — helping to create a nationally known program through Norton Neuroscience Institute,” said Lynnie Meyer, R.N., Ed.D., FAHP, CFRE, senior vice president and chief development officer, Norton Healthcare. “She also was the catalyst behind funding Parkinson’s disease research that already has helped transform the lives of many patients and families through access to more groundbreaking treatments.”

Dr. Cressman was a respected anesthesiologist at what is now Norton Women’s & Children’s Hospital, while her husband, the late Frederick K. Cressman, M.D., was a pathologist at CPA Lab, a Part of Norton Healthcare. Both of the Cressmans understood the power of philanthropy and giving back to the community. Dr. Frederick Cressman died in January 2010 after a seven-year battle with Parkinson’s disease. Before her death in June 2021, Dr. Elizabeth Cressman provided $8 million to establish Cressman Critical Care Center at Norton Women’s & Children’s Hospital, as well as Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center on the Norton Brownsboro Hospital campus. This latest gift brings Dr. Cressman’s total support of initiatives at Norton Neuroscience Institute and Norton Healthcare to $28 million.

Nearly 1 million people in the United States have Parkinson’s disease, according to the Parkinson’s Foundation, and the number continues to increase. The movement disorder generally develops in people ages 55 to 75. While more men are affected, women have a higher mortality rate and faster progression of the disease, according to the National Institutes of Health. The main symptom of Parkinson’s disease is bradykinesia, or slowness of moment. It also can cause tremors and muscle stiffness.

“Parkinson’s disease can be extremely debilitating and, unfortunately, there currently is no cure,” said Justin T. Phillips, M.D., movement disorders neurologist with Cressman Parkinson’s & Movement Disorders Center. “With Dr. Cressman’s generosity, we are able to build upon the work we already do and offer even more options for patients. She has already had a great impact on people with Parkinson’s in our community, and that will continue for years to come.”

This $20 million gift will work to expand Parkinson’s programs within Cressman Parkinson’s & Movement Disorders Center and Cressman Parkinson’s Research. Donations also allow the Norton Neuroscience Institute team to provide exercise groups to help slow the progression of the disease, individual therapy through Cressman Neurological Rehabilitation and patient support groups through Norton Neuroscience Institute Resource Centers.

At Cressman Parkinson’s & Movement Disorders Center, specialists Dr. Phillips and Jason L. Crowell, M.D., work to provide the latest and most effective treatments to help patients. These include medications, therapeutic treatments and surgery such as deep brain stimulation. In the near future, emerging therapies may include neuron repair treatments, gene therapies and modulation of gut-brain interactions.  

Research into movement disorders is rapidly expanding and key to building knowledge that will lead to additional treatments. At Cressman Parkinson’s Research, Shirish S. Barve, Ph.D., chief research scientist, Norton Neuroscience Institute and Norton Research Institute, leads research efforts. Dr. Barve is known internationally for his research on the connection between the gut microbiome and brain. The work of Dr. Barve and his team, which includes Smita S. Ghare, Ph.D., senior research scientist at Norton Research Institute, has received sustained federal funding from the National Institutes of Health to investigate changes in gut-brain interactions.

“We know that the gut is constantly influenced by lifestyle issues, including aging, lack of sleep, stress and diet,” Dr. Barve said. “We want to understand the impact of lifestyle on gut bacteria and associated immune responses in the development of neuroinflammation and degeneration that lead to Parkinson’s disease and related neurodegenerative disorders that affect brain function. We are hopeful this translational research will lead to better preventive and treatment options for these disorders and improve patient care.”

The post $20 million gift will expand Parkinson’s disease programs and research appeared first on Norton Healthcare.

No one wants to lose the independence and freedom that comes with driving, but you have to consider safety for yourself and your loved ones. One way to know whether it’s safe to drive when you have Parkinson’s is to have a driving assessment.

Driving assessment for people with Parkinson’s

Common symptoms of Parkinson’s that can affect driving include shaking, stiffness, slower response time and issues with balance. “A driving simulator is helpful for people with Parkinson’s, so we can help you stay safe” said Xaviera J. Leak-Cotton, APRN, movement disorders neurology nurse practitioner with Norton Neuroscience Institute. Driving simulators can give your health care team an idea of your driving skills and how your Parkinson’s might be affecting how you drive.

READ MORE: High-intensity Focused Ultrasound for Parkinson’s Disease and Essential Tremor

The Virage car simulator at Cressman Neurological Rehabilitation looks at many aspects of driving skill, including:

• Driver’s ability to control the vehicle
• Ability to anticipate and manage risk
• Visual attention and acuity
• Staying in the correct lane, turning and braking appropriately
• Driving in a variety of situations, such as rain, snow or heavy traffic

“The good news is that once we understand your strengths and weaknesses, there are things we can do to help you stay safe behind the wheel for as long as possible,” Xaviera said. “That might be adaptations for your vehicle such as panoramic rear and sideview mirrors or occupational therapy to help with flexibility or other physical restrictions.”

 “We can help you find specific resources for transportation if that becomes necessary,” Xaviera said. “The goal is to keep you and everyone else safe.”

To support projects like this, make a donation now.

The post Staying safe behind the wheel with Parkinson’s appeared first on Norton Healthcare.

Signs of essential tremor include:

• Shaking on both sides of the body
• Shaking that usually happens during activity, such as writing or eating
• Tremors without other symptoms
• Symptoms that vary in age of onset, intensity, duration, progression and resulting disability
• Shaking mainly in the hands, but can include head and voice tremor

There are several key ways essential tremor is different from Parkinson’s disease.

“In people with essential tremor, that’s really the main symptom,” said Justin T. Phillips, M.D., movement disorders neurologist with Norton Neuroscience Institute.

READ MORE: High-intensity Focused Ultrasound for Parkinson’s Disease and Essential Tremor

Signs of Parkinson’s disease include:

• Shaking mainly on one side of the body
• Shaking that happens when the body is at rest
• Slowness of movement (bradykinesia)
• Muscle rigidity and stiffness
• Average age of onset 60 years old; typically with increased disability over time
• Shaking occurring in the upper and lower extremities; usually not in the head

“Early signs of Parkinson’s and essential tremor can overlap,” Dr. Phillips said. “A patient can have both conditions, so it’s important to understand the differences in these disorders. People sometimes assume that if they shake at all, it’s Parkinson’s. That isn’t the case.”

If you have any of the symptoms associated with Parkinson’s disease or tremor, talk to your health care provider— not only to diagnose your condition but also to rule out other causes for your symptoms.

The post Shaky hands don’t always mean you have Parkinson’s appeared first on Norton Healthcare.

Pouring a beer, Jason recalled first being diagnosed.

“It was shock because people think it’s an older, generational issue,” Jason said. “I’m sitting there going, ‘I’m 40. This can’t be true.’”

According to a recent study supported by the Parkinson’s Foundation, about 90,000 Americans receive a Parkinson’s disease diagnosis each year, a number that is 50% higher than previous estimates.

Justin T. Phillips, M.D., is a neurologist who is medical director of movement disorders at Norton Neuroscience Institute. According to Dr. Phillips, an aging population could explain much of the increase in the incidence of Parkinson’s, although young people also can be diagnosed with the disease.

“When we look at Parkinson’s as a whole, probably 5% to up to 10% of people with Parkinson’s have young onset Parkinson’s, so under the age of 50,” Dr. Phillips said. “It’s not exceedingly uncommon, but when you look at the population as a whole, it’s relatively uncommon to have Parkinson’s at a young age.”

Jason was at the doctor for an unrelated issue when he found out he had Parkinson’s. One of the symptoms of the disease is a tremor, which he had in his right hand for some time.

“I drink a ton of coffee,” Jason said. “I just always thought I was over-caffeinated.”

Working through Parkinson’s

Jason has not let the disease slow him down. He continues to work a very full schedule and expects to have many more years ahead of him. Jason also focuses on both mental and physical fitness.

“Positive mental attitude is 90% of the wellness,” he said. “I’m fully optimistic. I love what I do. I’m looking forward to more successful years ahead. I’m not going to let it hold me back.”

According to Dr. Phillips, his patients with that that kind of attitude typically do better when managing and slowing the progression of the disease.

“When I look at my patients who have been really successful, they’re the people who have said, ‘I got Parkinson’s. That’s a setback perhaps, but I’m going to keep doing what I want to do. And I’m going to have a great quality of life, and I’m not going to let it get me down,’” Dr. Phillips said.

In addition to a positive outlook, medicine, physical rehabilitation, and in some cases surgery can help patients manage their symptoms or slow the progress of their disease. The Norton Neuroscience Institute Cressman Parkinson’s and Movement Disorders Center is a comprehensive program designed to provide patients with a variety of treatment options in one convenient location.

Supporting the cause

There is no cure for Parkinson’s, but doctors continue to do extensive research. Norton Neuroscience Institute offers many programs and services for the thousands of local patients with the disease and other neurological conditions.

With the help of Jason and other local chefs, the Norton Healthcare Foundation will host the 16^th annual Denim & Diamonds Gala Celebration this fall. Guests will savor signature appetizers and a main course provided by Louisville’s finest chefs — while enjoying live music, tasting tables, a specialty cocktail, open bar, photo booth, and live and silent auctions.

“Denim & Diamonds started out as a chef-driven event, and I’ve been in the food and beverage industry for over 30 years,” Jason said. “It only made sense for me to be involved.”

Funds raised will help support Parkinson’s support services at the Norton Neuroscience Institute Resource Centers. All ticket purchases go toward offering free programs, services, and education to those living with Parkinson’s disease in our community.

The post Louisville man with early onset Parkinson’s gives back appeared first on Norton Healthcare.

With an implant that interrupts uncontrolled movements, Mike has regained control of his body and can now get postoperative visits and treatments without having to go to his neurologist’s office.

In July, Mike underwent deep brain stimulation (DBS) surgery by Abigail J. Rao, M.D., functional neurosurgeon with Norton Neuroscience Institute. DBS is like a pacemaker for the brain. It delivers gentle stimulation that can change abnormal circuitry, which causes uncontrolled movements. With the surgery, the stimulator is implanted into the brain, with wires running under the skin. Those wires then connect to a battery under the skin of the chest.

A new program called NeuroSphere Virtual Clinic allows Mike’s neurologist to adjust the device remotely so it provides optimal stimulation. Mike can be hundreds of miles away enjoying his new freedom when Justin T. Phillips, M.D., neurologist and director of Norton Neuroscience Institute Cressman Parkinson’s & Movement Disorders Center, tunes his stimulator.

After surgery, Mike and Dr. Phillips met for a virtual visit. Dr. Phillips saw the live video of Mike’s hands having tremors. After pressing a few buttons on a tablet device, Dr. Phillips sent signals to Mike’s DBS implant, using Bluetooth and cloud technology. In a matter of moments, Mike’s tremors stopped.

“Before the visit, I was shaking all over the place, but now that Dr. Phillips got it calibrated … nothing,” Mike said. “It’s amazing.”

According to Dr. Phillips, the virtual clinic gives him more options to support his patients.

“As Parkinson’s progresses, patients have more challenges getting around,” he said. “Being able to help patients in their own homes can make the experience better for them and their families.”

The technology also allows patients, like Mike, to make certain adjustments on their own.

Mike’s ability to get his stimulator programmed remotely is just part of the breakthrough advances provided at Norton Neuroscience Institute.

Dr. Rao was first in the Louisville area to use advanced techniques that don’t require the patient to be awake during DBS surgery. Historically, the surgery required the patient’s brain cells to be sampled and patient movements to be tested during surgery. However, advances in surgical technique and high resolution imaging no longer require this and actually allow for reduced surgical risks with the patient under general anesthesia.

“DBS can help patients regain smoother, more normal movements, less slowness and less excessive movements that can develop as a side effect or consequence of long-term medication use,” Dr. Rao said. “We typically see very positive outcomes.”

While Mike continues to receive treatment for his Parkinson’s disease, he has plenty to look forward to, like hitting the golf course and returning to boxing class. His message to others with Parkinson’s or similar diseases is to ask about DBS.

“I thought it was my best chance at having a normal life,” Mike said. “I’m already noticing a vast improvement.”

The post Easier follow-ups for movement disorders patients after deep brain stimulation surgery appeared first on Norton Healthcare.

According to the National Institutes of Health, as many as 1 million Americans have Parkinson’s disease, and many people go undiagnosed or are misdiagnosed. This is because the symptoms of Parkinson’s disease are very similar to those of other health issues.

The Syn-One Test aims to help doctors confirm or rule out the diagnosis. The test, which takes about 15 minutes, involves taking three small skin samples from the patient. These skin biopsies then go to a lab and are evaluated for a specific protein (phosphorylated alpha-synuclein) found in individuals with Parkinson’s disease.

Norton Neuroscience Institute is one of about 50 health care organizations in the country using the test. Movement disorder specialists Justin T. Phillips, M.D., and Jason L. Crowell, M.D., have given the test to dozens of patients over the past year.

“Parkinson’s has been, and remains, a disease that needs to be diagnosed by a health care professional, but this is a secondary test that can aid in confirming or disproving the diagnosis,” Dr. Crowell said. “One advantage of this test is that it is more specific than the other tests currently available, so it is better able to distinguish Parkinson’s disease from other conditions that mimic Parkinson’s.”

“What we like about this test is that it’s quick for the patient and has many different applications,” Dr. Phillips said. “In some instances, we’ve even been able to determine the diagnosis of dementia with Lewy bodies as the cause of dementia.”

Parkinson’s symptoms

Parkinson’s disease often can be difficult to diagnose in its early stages due to mild symptoms and a gradual onset. Typically, the disease initially is diagnosed through symptoms and physical exam findings, which may include:

• Changes in movement, including slowness of movement or tremors (shaking) of an arm or leg
• Muscle stiffness
• Impaired balance
• Voice changes, including softness of speech
• Difficulty with memory and thought processes
• Trouble with swallowing

These symptoms are caused by destruction of certain cells in the brain, resulting in slowness and difficulty in controlling one’s movements.

How to treat Parkinson’s

Treatment for patients with Parkinson’s is directed at relieving symptoms, usually through medication or surgery. Other treatment approaches include general lifestyle modifications, physical therapy, support groups, occupational therapy and speech therapy.

The post Skin test may help confirm Parkinson’s disease, other neurological conditions appeared first on Norton Healthcare.

“I was in quicksand, going down,” Holly said. “Your world gets smaller instantly, physically and mentally.”

Following her diagnosis, Holly spent much of the next six years on medication to help alleviate some of the symptoms. While the medications allowed her to accomplish many of the tasks she had once taken for granted, they also came with side effects, including a severe loss of appetite. Holly started to drop weight, which only made her condition more challenging.

“I was taking medicine every two hours,” Holly said. “I knew when those two hours were up because the tremors would start coming back. I scheduled my entire life in two-hour increments.”

Justin T. Phillips, M.D., neurologist with Norton Neuroscience Institute, believed Holly could be a good candidate for deep brain stimulation (DBS) surgery. He consulted with Abigail J. Rao, M.D., neurosurgeon, Norton Neuroscience Institute.

What is DBS?

Parkinson’s is a degenerative disease in which parts of the brain start to function suboptimally, disrupting the chemistry and circuitry of the brain. Deep brain stimulation surgery involves implanting wires to each side of the brain, which are connected to an implanted device in the chest. The device then generates electrical pulses that change the movement circuitry of the brain, helping regulate control over movement.

The surgery typically is recommended for those in the moderate stage of the disease who experience movement symptoms like tremors and stiffness.

“DBS helps to return the patient to smoother, more normal movements, less slowness and less excessive movements that can develop as a side effect or consequence of long-term medication use,” Dr. Rao said. “The surgery isn’t for everyone, but we see very positive outcomes.”

Dr. Rao uses a newer DBS surgery technique in which the patient, instead of being awake, is fully anesthetized. In fact, she performed Louisville’s first “asleep” DBS surgery on a patient with Parkinson’s disease in late 2018. This method has many benefits, including for patients who aren’t comfortable with the idea of being awake during brain surgery.

Dr. Phillips, Dr. Rao and the Norton Neuroscience Institute movement disorders team determined Holly was indeed a good candidate for DBS, though Holly was a little hesitant at first.

“I had some reservations,” she said. “But it was the best decision I could have made.”

Getting back to life

Holly underwent the surgery in late October 2021 at Norton Brownsboro Hospital. She went home the next day.

“Dr. Rao did an excellent job,” Holly said. “Brain surgery was much easier than getting a double mastectomy.”

In early November, about two weeks after the surgery, Dr. Phillips and his team turned on the device. With the brain stimulation, Holly’s condition significantly improved.

“I can gush on and on about how marvelous it was to leave that appointment standing tall,” Holly said. “My appetite came back. My inner angst was gone.”

Nearly nine months after having DBS surgery, Holly said she feels like a completely different person. She’s off all her Parkinson’s medications and is showing very few symptoms of the disease. Holly has regained weight, a huge goal for her. Now, she spends time volunteering at Yew Dell Botanical Gardens in Crestwood, Kentucky, but when she’s not planting and weeding, she’s hitting the boxing gym several times a week.

“Before, I was punching like a kitten — I just couldn’t punch at all,” Holly said. “Now I’m back up to my fighting weight. I now just need to work on my muscles.”

The post Deep brain stimulation surgery helps Parkinson’s patient get her life back appeared first on Norton Healthcare.

One of the newest neurologists on staff at Norton Neuroscience Institute, Dr. Crowell grew up watching his grandfather, a long-time physician, care for the members of his small Alabama community. Dr. Crowell saw firsthand, he said, “the relationships my grandfather built with his patients.”

When his grandfather was diagnosed with Parkinson’s, a nervous system disorder that impacts movement and causes tremors, Dr. Crowell was already in school learning about the brain. He decided then to pursue neurology.

“A lot of what I was hearing at the time was secondhand from my aunts and grandmother,” Dr. Crowell said. “It was sad in many ways because he had always been, in our family, the one who had all the medical answers. I just wanted to understand [Parkinson’s] better.”

Dr. Crowell completed medical school at the University of Alabama at Birmingham, where he went on to complete a fellowship in movement disorders after his residency at the University of Virginia, Charlottesville. He especially took an interest in deep brain stimulation, a procedure in which electrodes are implanted in the brain to combat the symptoms of Parkinson’s.

He also wanted to learn more about improving patient care and the delivery of health care, which led him to earn a master’s degree in public administration with a focus on health care policy from the prestigious Harvard Kennedy School in Cambridge, Massachusetts.

All that led to Dr. Crowell arriving at the intersection of medical and scientific curiosity and personal connection.

Norton Healthcare’s need for a second Parkinson’s specialist met Dr. Crowell’s desire to be closer to family in Alabama and Tennessee, and to treat people with the kind of personal care his grandfather demonstrated. His schedule filled out two-plus months before he even set foot in the office. Dr. Crowell said his first few months “have been really gratifying getting people help faster.”

“I try very hard to not treat a lab finding or an exam finding, and instead treat the patient,” he said. “I can prescribe medicines or tests all day, but if I haven’t answered the patient’s questions, have I done anything? I had a mentor who would say, ‘It’s only a good pass if your teammate catches it.’ Sometimes that’s just listening. People come to us with concerns; it’s our job to address them and provide them with reassurance.”

Dr. Crowell’s recently published research

• Rising Drug Costs for Neurologic Diseases
• A crisis in US drug pricing: Consequences for patients with neuromuscular diseases, physicians and society, part 1
• A crisis in US drug pricing: Consequences for patients with neuromuscular diseases, physicians, and society, part 2
• Awake Testing during Deep Brain Stimulation Surgery Predicts Postoperative Stimulation Side Effect Thresholds
• MM1-Type Sporadic Creutzfeldt-Jakob Disease With Early Behavioral Changes and Prolonged Symptom Duration

The post Doctor’s passion led to neurology after grandfather’s Parkinson’s diagnosis appeared first on Norton Healthcare.