Parkinson’s Disease Research, Education and Clinical Centers
|San Francisco PADRECC
VA Center for Excellence: 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. We became a Center of Excellence-PADRECC in 2001: Parkinson's Disease Research, Education, and Clinical Center and continue to offer a consortium of VA providers with interest and expertise in improving health and well being of Veterans with Parkinson's disease and associative movement disorders.
All patients referred to the San Francisco Veteran’s Affairs: Parkinson’s Disease, Research, Education and Clinical Care center (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. We have physical, occupational and speech therapists who specialize in the treatment of movement disorders, and work closely with many of our patients. Referring physicians will promptly receive a comprehensive consultation report detailing treatment recommendations. [Back to Top]
Deep brain stimulation (DBS) involves the use of 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. DBS is currently FDA approved to treat essential tremor, Parkinson’s disease and dystonia. The UCSF/SFVA Center is one of the world's most experienced DBS centers, and is actively involved in research to study additional indications for DBS, and optimize targeting and implantation techniques.
Patients referred to the San Francisco PADRECC for potential DBS receive an extensive evaluation to determine how likely this therapy will improve their symptoms. 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 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.
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.
All surgical procedures are performed by the San Francisco Veteran Affairs Health Care System (SFVAHCS) PADRECC’s neurosurgery team: Paul S. Larson, MD, PhD, Chief of Neurosurgery and Director for the Center for Advanced Neurosurgical Operative Procedures at SFVAHCS and Professor of Neurological Surgery at University of California San Francisco (UCSF); Daniel Lim, MD, Neurosurgeon at the SFVAHCS and Assistant Professor and Director of Restorative Neurosurgery at UCSF; and Doris D. Wang, MD, PhD, Neurosurgeon at the SFVAHCS 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]
The San Francisco VA has a Botulinum Toxin (Botox) injection clinic that is a part of the PADRECC. It specializes in providing therapeutic botulinum toxin injections for:
Our experts are fellowship trained and utilize state-of-the-art techniques, including EMG and ultrasound guidance, as well as electrical stimulation, to specifically target the appropriate muscles for injection. [Back to Top]
Advanced-stage movement disorder 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 the disease. Patients are seen in conjunction with their families and/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]
Patients with movement disorders can be seen by our clinic staff using the technology that allows in-home clinic visits (connecting through a computer with high speed internet) or going to their local community based outpatient clinics (CBOC) and connecting through a video teleconference screen. These two services avoid long distance travel for evaluations by movement disorders specialists. Many of our out-of-state deep brain stimulation implant referrals are from VA centers hundreds or thousands of miles away and can be initially seen using telemedicine technology. [Back to Top]
The SFVA offers a monthly support group for people with Parkinson’s and their caregivers . The support group is open to all people affected by Parkinson’s disease, including non-veterans. The group meets to provide information, education, and support. The meetings provide an opportunity for people to discuss experiences and feelings, and to share information and solutions to common problems. The meeting is guided by advanced practice nurses who are specialists in Parkinson’s disease. Additionally, guest speakers including physicians, nurses, physical therapists, speech therapists, social workers, neuropsychologists, and community specialists are occasionally invited to present talks on educational topics of interest to the group. [Back to Top]