Under the leadership of Medical Director David Kreitzman, MD, the Parkinson’s Disease and Movement Disorders Center at St. Charles Hospital has become a regional hub for expert diagnosis, treatment, rehabilitation and support services.
David Kreitzman, MD
Progressive, incurable and challenging to diagnose, Parkinson’s disease is also common, affecting 1 million Americans and more than 10 million people worldwide. On Long Island, David Kreitzman, MD, a neurologist with fellowship training in Parkinson’s disease and other movement disorders, established the Parkinson’s Disease and Movement Disorders Center at the Specialty Care Center at St. Charles Hospital in 2011. He attributes his growing patient load since then to greater physician and public awareness of Parkinson’s disease and the benefits of early diagnosis and treatment, as well as a localized population that is aging.
Dr. Kreitzman has responded to the needs of local patients with Parkinson’s disease by making the center a comprehensive source for outpatient diagnosis and disease management. Outpatients can receive a medical workup and diagnosis by a Parkinson’s disease specialist, as well as pharmacologic treatment, rehabilitative therapies and referral to support services at St. Charles Hospital and in Suffolk and Nassau counties.
“The process of diagnosing Parkinson’s disease can be challenging since the condition presents with numerous symptoms that can be associated with other, similar conditions,” says Dr. Kreitzman, one of the few board-certified, movement disorder fellowship-trained neurologists in the area specializing in the diagnosis and treatment of Parkinson’s disease.
Because the condition is typically diagnosed at age 60 or older, the stiffness and slowness of movement that is often the disease’s first symptom can be mistaken for a mild musculoskeletal injury. Resting tremor is another heralding symptom of Parkinson’s disease for many patients, but others show no tremor at first or have a mixed tremor that can be misdiagnosed as essential tremor or a side effect of medication. And although Parkinson’s disease is bilateral, its motoric symptoms are often asymmetric, prompting workups for stroke or Lyme disease.
Dr. Kreitzman’s diagnostic protocol uses the UK Parkinson’s Disease Society Brain Bank Clinical Diagnostic Criteria, an evidence-based tool that defines a Parkinson’s disease phenotype based on postmortem studies of patients with Lewy body pathologies in the brain. He also looks for ancillary, non-diagnostic symptoms that suggest Parkinson’s disease, including a history of constipation, sleep disturbance and masked facies.
“This cadre of symptoms may speak to a neurodegenerative process in which seeking a movement disorder consultation is absolutely worthwhile,” he says. “We typically have greater than 90% confidence that we made the correct diagnosis when we use these clinical criteria.”
“We offer a comprehensive approach to managing and treating Parkinson’s disease and all movement disorders. In a large majority of our patients, we can effectively suppress symptoms.”
— David Kreitzman, MD, Medical Director, Parkinson’s Disease and Movement Disorders Center, St. Charles Hospital
Partnering with Patients
When Dr. Kreitzman follows a patient at the Parkinson’s Disease and Movement Disorders Center, the two become partners on a journey. It begins where diagnosis and treatment intersect — “A meaningful improvement on medication is part of the diagnosis,” he explains — and goes beyond symptom management to address myriad issues that affect longevity and quality of life.
The medicines he uses in treatment, generally dopamine agonists and MAO inhibitors, vary in efficacy depending on the patient, he says. But levodopa, which every patient receives at some point, is “the ultimate litmus test” for differentiating Parkinson’s disease from multiple-system atrophy, which does not respond to medication.
Dr. Kreitzman’s approach to treatment is also holistic and highly individualized. His goal is to find the best combination of medications to suppress and stabilize motoric symptoms and the best rehabilitative therapies to support the patient physically, cognitively and psychologically. His multidisciplinary team of specialists at the Parkinson’s Disease and Movement Disorders Center includes neuropsychologists, who address issues such as mental fog, depression and anxiety, and physiatrists, who personalize therapies for patients with secondary conditions that affect mobility.
Dr. Kreitzman works with gastroenterologists, urologists and internists at St. Charles Hospital to identify corollary health issues and medical stressors as well. He can refer patients in-house for nutritional counseling or a sleep workup, and both St. Charles Hospital and its satellite locations throughout Suffolk County offer physical, occupational and speech therapy, including BIG and LOUD programs designed to improve strength and vocalization.
“By partnering with a patient,” Dr. Kreitzman says, “we normally can maintain a relatively good plateau for a number of years with this comprehensive approach.”
Supporting and Empowering
Patients at the Parkinson’s Disease and Movement Disorders Center are encouraged to take charge of their health. Dr. Kreitzman created the acronym SEEDS to remind them of the non-pharmacologic necessities of sleep, exercise, eating well, drinking well and socializing.
“Socialization is incredibly important to these patients,” he notes. “They need to know there’s a community out there that supports their needs.”
Patients can connect with support groups, sign up for educational programs and learn about Dr. Kreitzman’s clinical trials through the center, as well as through a hospital-based information and referral center sponsored by the American Parkinson Disease Association.
Dr. Kreitzman also counsels patients not to allow Parkinson’s disease to define them or keep them from favorite activities. He might suggest a golfer focus on playing nine holes rather than 18, for example.
He says helping patients reinvent their lives in meaningful ways and embracing the other challenges of treating movement disorders is part of “the art of medicine” — and part of why he loves his chosen profession.
“It’s understanding your individual patient, understanding the available treatments and assimilating those to make people more stable and functional and restore their quality of life,” he says.
Visit stcharles.org/parkinsons-disease for additional information about the Parkinson’s Disease and Movement Disorders Center.