Neuroscience

Parkinson’s and Movement Disorders Center

Now offering an advanced, incisionless treatment for tremor! Learn More.

Queen's
Neuroscience Institute

The Queen’s Medical Center
Neuroscience Institute Outpatient Center
Physicians Office Building 3 (POB3)

550 South Beretania Street
Suite 503
Honolulu, Hawaii 96813

Phone:
808-691-8866

Fax:
808-691-8865

Hours:
Monday – Friday, 8am – 4:30pm

Home » Conditions & Treatments » Neuroscience » Parkinson's and Movement Disorders Center

The Parkinson’s and Movement Disorders Center at The Queen’s Medical Center Neuroscience Institute provides a multi-disciplinary program dedicated to comprehensive diagnosis and treatment of movement disorders. We believe in a team-based approach, which includes highly trained movement specialists (neurosurgeons and neurologists), ancillary providers, and staff.

Our Parkinson’s and Movement Disorders Center is Hawai‘i’s first and only Comprehensive Care Center that is accredited by the Parkinson’s Foundation and a part of their Global Care Network. The Parkinson’s Foundation recognizes medical facilities with specialized, multi-disciplinary teams that provide evidence-based PD care. Each center is required to meet rigorous care standards, professional training, community education, and outreach criteria.

Additionally, our Parkinson’s and Movement Disorders Center is one of 30 centers to carry the CurePSP Center of Care (CoC) distinction. The CurePSP CoC program is a network of specialized medical centers across the United States and Canada that enhances equitable access to accurate and early diagnosis, high-quality clinical care, and comprehensive support for progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), and multiple system atrophy (MSA).

The Global Care Network and CurePSP Center of Care designations mean that patients in Hawai‘i do not have to travel to the mainland for advanced care for Parkinson’s disease and other movement disorders. We are able to provide all the services patients may need for the treatment of even the most complex movement disorders.

If you or your loved one is ready to explore treatment options for Parkinson’s and other movement disorders, contact the Queen’s Neuroscience department today at 808-691-8866.

What Are Movement Disorders?

Movement disorders include a wide range of neurological illnesses and conditions that affect the basal ganglia and movement circuit of the brain.

The best-known movement disorder is Parkinson’s disease, but there are many others:

Parkison’s and Movement Disorders Center Treatments and Services

The Queen’s Parkinson’s and Movement Disorders Center has the widest range of treatment for neurological movement disorders in Hawai‘i.

Physical, Occupational, and Speech Therapy

Our highly trained team of physical, occupational, and speech therapists work closely with community therapists to make appropriate referrals depending on your geographic location and treatment needs.

Complex Medication Adjustments

There are over 25 FDA-approved medications for Parkinson’s disease and other movement disorders.

But these medications can cause negative side effects. Dosages often need to be adjusted to help prevent complications. Medications for movement disorders also have a number of different delivery systems: tablets, capsules, dissolving tablets, skin patches, inhalers, subcutaneous injections, and dissolvable films.

For some patients with Parkinson’s and other movement disorders, it may be necessary to combine medications.

The complex medication management for your movement disorder is best handled by Queen’s neurologists who specialize in these disorders.

Botulinum Toxin Injection Therapy

Botulinum toxin (botox) is a relaxant injected directly into your muscles. If you suffer from blepharospasm, hemifacial spasm, cervical dystonia, writer’s cramp and spastic hemiplegia, you will likely benefit from botox therapy.

Botox therapy is considered safe when performed by a doctor.

Intrajejunal Continuous Dopamine Infusion (Duopa) Therapy

Duopa therapy is a continuous gel infusion of carbidopa/levodopa. Rather than taking a pill, dopamine is delivered through a tube into your intestine.

This therapy provides a smooth absorption of medicine and can reduce symptoms of motor fluctuations and dyskinesia if you have advanced Parkinson’s disease.

Focused Ultrasound

Focused ultrasound is an advanced, incisionless treatment for tremor. Tremor is an uncontrollable shaking, which usually happens in the hands and can interfere with writing, eating, and other manual tasks. The most common cause of tremor is Essential Tremor; another common cause is Parkinson’s disease. While neither of these conditions have a cure, there are numerous treatments that can help reduce symptoms, with oral medications being the most common. However, for people whose tremor doesn’t respond to medications or who have side effects, focused ultrasound can reduce their tremor and improve their function.

Focused ultrasound was approved by the FDA for treatment of Essential Tremor in 2016, and for tremor due to Parkinson’s disease in 2018. The Queen’s Parkinson’s and Movement Disorders Center is the first and only center in the state of Hawai’i to offer this procedure.

Focused Ultrasound for Tremor FAQ

What is focused ultrasound?

Focused ultrasound uses sound waves to ablate (or burn) a specific part of the brain which causes tremor. This is performed while the patient is in a special MRI scanner. The patient is awake and does not need incisions.
Although focused ultrasound is not a cure, it reduces tremor on one side of the body, almost immediately.

Who can benefit? What are the benefits?

Patients over age 22 who have been diagnosed with Essential Tremor or over age 30 with Parkinson’s disease, and have disabling tremor, despite trying two or more oral medications.
After the procedure, a patient can experience up to 80% reduction in tremor on one side of their body.
For more than 70% of patients, they continued to have good tremor reduction three years later.
This is an outpatient procedure, and most patients return back to their normal activates within a day.

Who is NOT eligible for focused ultrasound?

A person who cannot get an MRI (due to metal or certain implanted devices), or who cannot lie comfortably on their back for up to three hours, cannot undergo focused ultrasound.
Certain medical conditions, such as pregnancy, kidney failure, brain or skull tumor, stroke, or bleeding disorder, may affect the ability to undergo focused ultrasound.
Patients with low skull density, measured on a special CT, cannot undergo focused ultrasound. About 15% of the population may have low skull density.

What happens during the procedure? What does recovery look like?

The procedure happens in a special MRI suite. The team is composed of a neurosurgeon, a neuroradiologist, a neurologist, an MRI technician, and a nurse.
Before the procedure, the patient’s entire head is shaved. Then local anesthesia is injected to numb the patient’s scalp and a frame is placed on their head.
During the procedure, the patient lies down flat in the MRI scanner with the frame on their head, which is connected to a helmet filled with cold water. The cold water helps to conduct sound waves and carry away heat. A nurse will monitor vital signs and ensure the patient is comfortable.
The treating team is in the next room, using controls to target the sound waves into the brain. The team uses multiple small doses of ultrasound energy, images from the MRI, and testing of the patient’s tremor, to target the precise area. Once the team finds the area, then a larger ultrasound wave is administered which then leads to immediate tremor reduction. During the large ultrasound wave administration, the patient may experience headache. The whole process may take up to three hours.
After the procedure, the frame will be taken off, and the patient will be monitored in the recovery room. After a brief period of monitoring, the patient will be discharged home.
Some patients may need some over the counter pain medications. Most can be return back to work and normal activities within days afterwards.

What are the possible side effects?

Most common side effects are irritation of the skin, headache, tingling, numbness, muscle soreness, weakness, and balance problems. Most side effects go away.
Sensory and balance symptoms could last for several days up to a few weeks afterwards.
There is a chance that tremor can return in the months or years after treatment.

I’m interested in focused ultrasound. What is the process to get it?

Ask your Primary Care Provider (PCP) for a referral to the Queen’s Neuroscience Institute. If you do not have a PCP, you can email us at tremor@queens.org for an inquiry.
You will be scheduled for a consultation with the Queen’s focused ultrasound team. During this visit, you will discuss your symptoms and undergo an examination, and you will learn about the focused ultrasound process, and decide together whether this is right for you.

How is focused ultrasound different from deep brain stimulation?

These are both procedures that can reduce tremor and other symptoms, and both are offered at Queen’s. Your team will discuss this with you and help you choose the right treatment.

Focused Ultrasound	Deep Brain Stimulation
One time outpatient procedure, with no incisions or operations involved.	Two brain operations with incisions in the scalp and chest, separated by a week. First operation usually requires one night hospital stay.
No implanted hardware.	Implanted hardware consisting of a neurostimulator in the brain, a battery in the chest wall, and a wire in the neck.
Immediate results.	Results are seen after a few weeks. Follow up visits over time can enhance the results.
The result is permanent and does not require adjustment.	The stimulator can be adjusted and programmed, leading to ability to provide flexibility in results.
Only one side can be treated at a time.	Either one side or both sides can be treated at once.

Focused Ultrasound Patient Education Series: From Dependent to Independent

Deep Brain Stimulation Surgery

Deep Brain Stimulation (DBS) surgery is a procedure where a neurostimulation device (similar to a pacemaker) is implanted in your brain to deliver electrical pulses.

Electrodes are placed in specific areas of the brain in order to treat the symptoms of neurological movement disorders. Connected by non-invasive wires that travel under the skin and down the neck to a battery-operated stimulator under the collarbone, electrical pulses from your DBS device regulate and lessen abnormal movements associated with movement disorders.

DBS surgery was approved by the FDA for the treatment of essential tremor in 1997, and it was approved for Parkinson’s disease in 2002. Since 2002, Queen’s Parkison’s and Movement Disorder Center has been performing DBS surgery with great success.

Deep Brain Stimulation for Parkinson’s FAQ

What is DBS?

DBS stands for Deep Brain Stimulation. It involves a surgical procedure to implant a neurostimulator. This sends electrical signals through the brain to alter brain pathways and treat various symptoms of Parkinson’s Disease, Essential tremor, and other disorders.
The surgery involves placing a thin, electrical lead into the brain, with the tip of the lead in a particular brain target (subthalamic nucleus or globus pallidus internus). The lead is then connected to a wire outside the skull and underneath the skin, which connects to a battery placed in the upper chest wall.
The battery continuously generates electricity that stimulates the brain tissue, and we can adjust the parameters of the electric signal to change its strength, location, and other features. The battery works like a “pacemaker” for the brain.

What are the benefits of DBS?

DBS can treat several motor symptoms of Parkinson’s disease, including:
- Tremor
- Slowness and stiffness
- Dyskinesias and painful dystonias
- Motor “on-off” fluctuations (wearing off from medications)
DBS can allow us to lower the overall dosage of medications, which can also reduce the side effects.
DBS is not a cure and will not change the underlying Parkinson’s disease.
In addition, DBS can also reduce tremor in patients with Essential tremor.

Who can benefit from DBS?

Patients with Parkinson’s disease who have moderate or advanced symptoms, have a history of good responsive to levodopa, and are either experiencing complications to medication, or not getting enough benefit from medications alone.
Patients with Essential tremor who have severe, disabling tremor, which has not responded adequately to at least 2 different medications.
The patient should have good intellectual function, be healthy enough for surgery, and have reasonable day-to-day function. For example, someone who is working but has symptoms that put them on the verge of no longer working, may benefit from DBS and be able to work for longer.

Who is NOT a good candidate for DBS?

Patients with dementia, psychosis or other severe psychiatric symptoms, major medical problems that place them at high risk for surgery, unreasonable expectations, or severely disabled status.
For example, someone who is wheelchair bound or in a nursing home would be unlikely to benefit from DBS.

What are the risks and drawbacks of DBS?

Since DBS is a type of brain surgery, there is a risk of bleeding, stroke, and infection.
The risks may be higher in people with certain medical conditions, such as diabetes, hypertension, heart disease, or any condition requiring blood thinners.
For patients with cognitive or psychiatric problems, DBS can make them worse. This can either be temporary (for a few days or weeks after surgery), or permanent.
The electrical stimulation from DBS can also cause side effects, such as speech or balance problems. These effects are usually not permanent, but can limit the benefit of DBS.
DBS is a lifelong therapy and requires regular follow up and maintenance. Patients will need battery replacements every 4-5 years (some batteries last longer depending on the model).

I am interested in DBS. What is the process to get DBS?

Step 1: Evaluation by DBS team
- You will be seen and evaluated by each member of the multidisciplinary DBS team: movement disorders neurologist, neurosurgeon, neuropsychologist.
- You will also undergo a detailed motor examination while on and off medications by the neurologist.
- Multi-disciplinary team will meet to discuss each patient and make a decision regarding their candidacy for surgery.
Step 2: Surgery
- Pre-operative visits and extensive education.
- 2-step surgery: 1^st surgery for the electrode placement in the brain (awake), 2^nd surgery for the battery placement (under general anesthesia).
- Easy recovery, typically with 1-night hospital stay, then discharge home.
Step 3: Initial and subsequent programming sessions
- DBS is not turned “on” immediately after surgery, but is turned on during the 1^st programming session, typically 2-4 weeks after surgery.
- Some patients take some time and a few more sessions to receive symptom benefit. Maximal benefit of DBS is usually achieved within 4-6 months of surgery, although some patients may benefit from additional periodic programming sessions for years after their surgery.
- Your neurologist may start to reduce medications in the first few months after surgery.
- You should continue seeing your neurologist regularly for DBS battery checks and general maintenance for Parkinson’s disease.

Robert Fitzgerald’s Story with Deep Brain Stimulation

Parkinson’s Research

The Parkinson’s and Movement Disorders Center at The Queen’s Health Systems Neuroscience Institute is engaged in cutting-edge research to better treat our patients.

Additionally, since 2001, we have hosted The Queen’s Movement Disorder Video Conference on a bimonthly basis. Partnering with movement disorder experts at the University of Virginia, we share our findings with people outside of Hawai’i.

TOPAZ

We are participating in the Trial of Parkinson’s and Zoledronic Acid (TOPAZ) to learn more about how to prevent fractures in those suffering from Parkinson’s.

Collaborating with researchers from such institutions as Duke University and the Parkinson’s Foundation, we seek to understand the effect of a single infusion of zoledronic acid-5 mg in preventing fractures.

Michael J. Fox Foundation Grant

Our research into racial and ethnic disparities in care for Parkinson’s among Asian American, Native Hawaiians, and Pacific Islanders will help ensure that these groups gain better access to high-quality care.

To facilitate this study, the Michael J. Fox Foundation recently awarded the Queen’s Parkinson’s and Movement Disorder Center a $387,000 grant.

Education

In partnership with Hawai’i Parkinson Association, our Center received a Hawai’i State grant to start a Movement Disorder Fellowship in 2023. We believe in educating the next generation of neurologists to become experts in assessment and treatment of movement disorders.

Patient Support and Outreach

We strongly believe in self-empowerment. Exercise and lifestyle are the most important therapies for Parkinson’s disease. It allows patients to maintain the highest level of function possible. We highly encourage the discussion of lifestyle (diet, sleep, and bowel habit) and exercise during visits as we tailor individualized programs.

Through collaboration with various organizations and coordination of care through Queen’s Clinically Integrate Physician Network (QCIPN) and Queen’s Geriatric Services, our goal is to help patients achieve the best quality of life while living with Parkinson’s disease or other movement disorders.

Some of our collaborative efforts include:

Hawai‘i Parkinson Association
Deep brain stimulation support groups and other support groups
The Annual Parkinson’s Symposium
The Annual Parkinson’s Walk
Various other community resources

And coordination of care through Queen’s Clinically Integrated Physician Network (QCIPN) and Queen’s Geriatric Services, our goal is to help patients achieve the best quality of life while living with Parkinson’s disease or other movement disorders.

A Guide For Parkinson's Disease

Have questions about Parkinson’s? Download this FREE guide from the Parkinson’s Foundation.

Meet our Parkinson's and Movement Disorders Center Team

Useful Links

Parkinson’s Foundation

Davis Phinney Foundation for Parkinson’s

The Michael J. Fox Foundation

Hawai‘i’s Best Hospital for Parkinson’s and Movement Disorder Treatment

If you or a loved one has Parkinson’s or another movement disorder, you are not alone. One of the major misconceptions about Parkinson’s is that it is hopeless.

With the right medication, exercise, and lifestyle, along with possible surgical interventions, you can live a full, rich life with Parkinson’s or any other neurological movement disorder.

Behavioral Health

Cancer Care

Heart Care

Neuroscience

Orthopedics

Pediatrics

Primary Care

Women’s Health

Ask a Specialist:

New Advances in the Treatment of Epilepsy with Dr. Leslie Rudzinski

Neuroscience

Parkinson’s and Movement Disorders Center

Parkinson’s and Movement Disorders Center

What Are Movement Disorders?

Parkison’s and Movement Disorders Center Treatments and Services

Focused Ultrasound

Focused Ultrasound for Tremor FAQ

Deep Brain Stimulation Surgery

Deep Brain Stimulation for Parkinson’s FAQ

Parkinson’s Research

TOPAZ

Michael J. Fox Foundation Grant

Education

Patient Support and Outreach

Meet our Parkinson's and Movement Disorders Center Team

Useful Links

Hawai‘i’s Best Hospital for Parkinson’s and Movement Disorder Treatment

Patients & Visitor Resources