Christopher Tolleson, MD, MPH is a movement disorder specialist at the University of Tennessee Medical Center and the Medical Director of The Cole Clinic as well as the Huntington’s disease clinic. Since arriving, Dr. Tolleson is working to expand the Movement Disorder program Dr. Michelle Brewer helped to develop. He has been involved with Parkinson’s disease research throughout his career.
“Growing up, medicine kind of was always in the back of my mind as a possible career. Then when I started training, because I had issues when I was a kid, neurology really stood out for me. I graduated from residency in neurology, and I’ve been doing Parkinson’s disease and different movement disorders since 2010.” – Dr. Tolleson
In line with our James Bond theme at KiMe, Chris has been assigned agent status 004: Neurologist for his determination to find a cure for Parkinson’s. There are seven total “00” status agents in this interview series.
We don’t know what causes Parkinson’s Disease, at least we don’t know what leads to the brain damage. We sometimes do genetic testing, particularly if there is a family history, but that’s not necessarily common practice. What’s actually happening in the brain on a very microscopic level, the cells are just not functioning right. Sometimes there are problems with cells dying off early or energy connections with cells.
In terms of the way we make a diagnosis of Parkinson’s, that’s a clinical exam. My patients have one of two features—either a tremor typically when they are sitting still, or changes when we move their arms or legs, some rigidity or stiffness.
People with Parkinson’s actually probably have a variety of different issues before they come in the clinic. Some things are kind of harbingers of the disease (like) acting out dreams, constipation, sometimes their blood pressure fluctuates, and loss of smell. You see these harbingers of Parkinson’s that tell us that the dying off of those neurons is happening long before, sometimes 10, maybe even 20 years before the patient comes to the clinic.
I would tell you, kind of the holy grail is to detect Parkinson’s earlier or develop a treatment that might slow down the disease. There’s lots of things that are being studied to potentially do that – types of imaging scans, skin biopsies, checking spinal fluid, blood tests, looking in peoples’ eyes.
We don’t have a way to concretely and easily identify patients before a clinical exam yet.
In terms of things that might slow down the disease, I think people are still focusing on attacking the protein deposit that we see in a microscope in Parkinson’s Disease, called Alpha-synuclein (αS). Some people are trying to modify or disrupt that protein.
When we are looking at a patient, we are trying to take in the whole picture to determine what’s the best thing to use. Every medication has potential for side effects. I don’t have a perfect drug. I wish I did. One of the things we do worry about is longer term side effects. So there’s a wiggling type movement that patients can get with medication. There’s also something I would call wearing off, motor fluctuations where the medicine works, but doesn’t work as long. There’s a lot of different things that we have to worry about like getting lightheaded or dizzy, hallucinations, cognitive changes, swelling in the legs, rash, sometimes patients get really impulsive, or they gamble, or they shop. Most of our drugs affect Dopamine because the problem in the brain is that the nerve cells that make that chemical are dying off and so our mainstay of treatment is Dopamine replacement.
Deep Brain Stimulation (DBS), is brain surgery for Parkinson’s, is constantly evolving, and technology is constantly improving. What I really emphasize to patients is this is an option and not a cure. Typically the things that medications help are tremor, stiffness, and slowing down of movement. When you use DBS and medication together, you typically have your best “on” a lot longer than just medicine alone. The other benefit is that it gets rid of some of those dyskinesia’s. You smooth out. It’s a great therapy. It’s not for everyone. What we really want, in terms of a DBS candidate, is someone who is healthy, who’s had a really great response to medication, but that medication is just not lasting enough from dose to dose, one that is really impeded by side effects from that, like dyskinesia or the wiggles, those are our best candidates.
If you want to highlight anything from this interview, exercise is the best thing patients can do for themselves. It makes a huge difference. I can tell when people are exercising or not exercising, they look that different. It’s not even comparable. I can tell when they walk down the hall or their balance. It makes a huge difference. There’s a lot of studies out there that suggest maybe it slows down the disease. But it will definitely delay disability. It will decrease your risk of falls. In one study I saw, it can affect life expectancy. It helps mood. It helps sleep. The benefits of exercise for patients is unbelievable. The best thing I can tell my patients to do is to exercise. Medicines have pros and cons. There’s not a lot of cons with exercise if you do it safely and don’t hurt yourself.
I’ve been involved with KiMe for two or three years. I think it’s a phenomenal foundation. Steve is just a fantastic leader. I’m just touched by the way that he’s fought Parkinson’s Disease. He’s done some great things for the community here in Knoxville and the surrounding areas in Tennessee. KiMe has given enormous amounts of money to help with research— I’m just very impressed since I’ve been a part of it.
Right now, we haven’t cured it, but we are treating it. And you can also fight it. I think Steve is a great example.
You can live a full, very good long life, fight it, get involved, exercise, see someone like me, or other neurologists. Live your life.
About Faith McGhee
After 17-year-old Faith McGhee graduated early from Oak Ridge High School in 2022, she sought out a new assignment—researching Parkinson’s disease. It was at a 2022 KiMe Fund Volunteer meeting the idea developed. Over the next few months McGhee made time to interview doctors, caregivers and patients, chronicling their stories of the neurological disorder that steals a person’s ability to move, eat and speak. What sparked her curiosity and concern? Faith’s grandfather has suffered from Parkinson’s her whole life. “The word I would use to describe him—it’s just strong,” she said. “He’s persevered through everything and he’s always been there for me and I try to do the same for him now.” Faith intends for these interviews to be a source of information, education and inspiration.
