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Inova specialist outlines medication, exercise and caregiver strategies for Parkinson's in Fairfax webinar
Summary
Dr. Abigail Lawler, a movement-disorder neurologist with Inova, told a Fairfax Area Agency on Aging webinar that care partners, timely medications, exercise and social engagement can substantially improve quality of life for people with Parkinson's; she also reviewed diagnostics, medication types and local resources.
Allegra Jaffee, supervisor of the caregiver and supportive service unit at the Fairfax Area Agency on Aging, opened a recorded webinar on Parkinson's care by introducing Dr. Abigail Lawler of Inova Health System. Lawler, a movement-disorder specialist, said care partners are essential to tracking symptoms and helping clinicians tailor treatments.
"It really does take a village," Lawler said, urging care partners to keep detailed histories and to help manage medication timing. She described Parkinson's as a deficiency of dopamine and explained that accurate diagnosis sometimes requires tests such as DAT scans or skin biopsy ("Syn-1"), while the umbrella term "Parkinsonism" indicates symptoms without definitive confirmation.
Lawler reviewed medication classes used to manage symptoms, calling carbidopa-levodopa the "gold standard" and explaining how adjunctive drugs — COMT inhibitors, MAO-B inhibitors and dopamine agonists — work to boost or preserve dopamine. She emphasized that formulation matters: extended-release capsule formulations (for example, Rytary and the newer Kaxant) and continuous-delivery options such as subcutaneous pumps often provide steadier symptom control than immediate-release tablets.
"Patients with Parkinson's do far better on extended release versions of medicines than the short-acting ones," Lawler said, noting that a continuous infusion pump can mimic the brain's steady dopamine release and that deep brain stimulation can dramatically reduce tremor for symptoms that respond to levodopa.
Lawler described both motor features (tremor, slowness, stiffness, shuffling gait) and non-motor symptoms — loss of smell, sleep disorders, mood and cognitive changes, autonomic symptoms such as urinary frequency, and skin problems — and urged families to be alert for sudden declines, which she said are often due to other causes (dehydration, infection) rather than a change in Parkinson's itself.
She warned that missed levodopa doses in an emergency setting can worsen motor function and swallowing, advising patients to bring their medications to the emergency room and, where permitted, to dose themselves if clinicians allow. Lawler also cautioned against changing Parkinson's regimens during acute illnesses, recommending treating the acute problem first.
Nonpharmacologic therapies received extended attention: Lawler recommended physical and occupational therapy, speech therapy (LSVT Loud) and the LSVT Big program for gait and balance. She highlighted the cognitive benefits of combining exercise with social engagement and recommended activities that involve dual-tasking and interaction, such as Rock Steady Boxing and group classes.
During a Q&A, participants asked about wheelchair-accessible exercise, caregiver burden and strategies for cognitive and mood symptoms. Lawler said many online programs offer chair-adapted classes and encouraged participants to contact Sonia Gaushi, the program and community care manager she named as a local point of contact, for referrals. On caregiver support, Lawler recommended case or care managers to coordinate complex care, noting that this service is often not covered by Medicare and may require out-of-pocket payment.
On sleep and mood, Lawler counseled conservative sleep-hygiene measures first; if problems persist, she said optimizing levodopa timing or using extended-release doses at bedtime may help. For depression and anxiety, she said movement-disorder specialists often try better-tolerated antidepressants such as escitalopram (Celexa), duloxetine (Cymbalta) or bupropion (Wellbutrin), chosen to avoid worsening Parkinson's symptoms.
Lawler pointed attendees to Inova Parkinson's and Movement Disorder Center resources, including online and recorded programs and a calendar at ipmdc.org, and closed by encouraging attendees to complete a feedback survey. The host announced a follow-up webinar on emergency preparedness for caregivers scheduled for July 15.
The session mixed clinical explanation with practical caregiving advice: diagnostic pathways and medication mechanisms; attention to formulations and timing; rehabilitation and social programs; and concrete guidance for hospital and emergency care.
