Appointments

Movement Disorders & Parkinson's Care

Evaluation and ongoing care for tremor, Parkinson's disease, dystonia, and other movement disorders, led by board-certified neurologist Dr. Thomas Kurian, MD in Santa Clarita.

Parkinson's DiseaseEssential TremorDystoniaGait & BalanceSanta Clarita, CA

Practice highlights

Comprehensive
Movement Evaluation
Medication
Optimization
Therapy Coordination
PT • OT • Speech
Telemedicine
Follow-Up

overview

Care that focuses on movement and quality of life

Tremor, stiffness, slowness, and balance changes have many possible causes. Our role is to make the diagnosis precise, build the right plan, and stay with you over the years as the plan needs to change.

What we cover during a movement-disorder visit

The first visit is a thorough conversation followed by a focused neurological examination. We talk through what specifically has changed, when it started, which side of the body it began on, and how it is affecting your daily life. We ask about non-motor symptoms — sleep, mood, constipation, sense of smell, and cognition — because these are often clues to the underlying diagnosis.

Examination

The exam is non-invasive and takes about 15 minutes. We watch you walk, look at how you turn, examine tone and tremor, observe finger taps and hand movements, check facial expression and speech, and assess balance with appropriate safety. The pattern of findings often points clearly to one diagnosis or another.

Building a treatment plan

If Parkinson’s disease is the diagnosis, we discuss when to start medication, which medication to start with, and how to titrate it. If essential tremor is the diagnosis, treatment is different — and we discuss whether treatment is even necessary. For dystonia and other focal movement disorders, the plan often includes botulinum toxin or referral for advanced therapies. Therapy coordination — physical, occupational, and speech — is part of every plan.

defining the conditions

The most common movement disorders

Plain-language definitions of what the diagnoses mean and how they tend to look.

Parkinson's disease

A progressive neurodegenerative disorder caused by loss of dopamine-producing neurons. Classic features are resting tremor, bradykinesia, rigidity, and postural instability — usually starting on one side and progressing slowly over years.

Essential tremor

A common, often hereditary action tremor that appears when the hands are in use — holding a cup, writing, eating soup. Voice and head tremor can also occur. Frequently improves with alcohol; usually does not include slowness or rigidity.

Dystonia

Involuntary muscle contractions causing sustained or intermittent twisting and abnormal postures. May be focal (cervical dystonia, blepharospasm, writer's cramp) or more generalized. Botulinum toxin injections are often very effective for focal forms.

Atypical parkinsonism

A group of progressive disorders that look superficially like Parkinson's but follow different courses and respond less well to levodopa. Includes progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal syndrome (CBS). Distinguishing these from PD changes prognosis and management.

Drug-induced parkinsonism

Parkinson-like symptoms caused by medications that block dopamine — particularly some antipsychotics and anti-nausea drugs (metoclopramide, prochlorperazine). Often improves when the offending medication is identified and adjusted.

Restless legs syndrome

An uncomfortable urge to move the legs, worse at rest and at night, relieved by movement. Can be primary (often hereditary) or related to iron deficiency, kidney disease, or pregnancy. Treatment ranges from iron supplementation to specific medications.

treatment options for parkinson's

Modern, individualized Parkinson's treatment

A short overview of the categories we discuss and prescribe — recommendations are always individualized.

Levodopa/carbidopa

The most effective medication for the motor symptoms of Parkinson's. Usually given as immediate-release tablets multiple times per day; extended-release and inhaled formulations are available for specific situations.

Dopamine agonists

Pramipexole, ropinirole, and the rotigotine patch directly stimulate dopamine receptors. Sometimes used as initial therapy in younger patients or as an add-on. Important to monitor for side effects including impulse-control disorders.

MAO-B and COMT inhibitors

Selegiline, rasagiline, and safinamide (MAO-B); entacapone and opicapone (COMT). These extend the effect of levodopa and reduce 'off' time as the disease progresses.

Amantadine

Useful for tremor and especially for managing dyskinesia (extra involuntary movements that can occur years into levodopa therapy). Available in immediate-release and extended-release forms.

Deep brain stimulation

An FDA-approved surgical option for advanced Parkinson's, essential tremor, and dystonia. Best for patients with significant medication fluctuations whose symptoms still respond to levodopa. We refer patients to comprehensive movement-disorder centers for evaluation when appropriate.

Therapy coordination

Physical therapy, occupational therapy, and speech therapy are evidence-based components of Parkinson's care that often make as much difference as medications.

what to expect

Your first movement-disorder visit, step by step

A clear sense of what will happen so you can come in feeling prepared.

Before the visit

Make a brief written timeline: what symptom started first, when, on which side of the body, what has changed since. Bring a current medication list — including over-the-counter and supplements — because some medications can cause or worsen movement symptoms. If you can, bring a short cell-phone video of the tremor or movement at its typical level.

During the visit

The neurological exam is the centerpiece. We will watch you walk, observe your face and arm swing, assess tremor at rest and with action, examine tone and rigidity, watch finger and foot tapping, and check balance with appropriate safety. Brain imaging (MRI) is usually ordered, and in selected cases additional studies (DaTscan, blood work) follow.

After the visit

You leave with a clear written plan, a follow-up timing plan, and referrals to physical, occupational, or speech therapy when appropriate. Many follow-up visits — particularly for medication titration — can be done by telemedicine for patients anywhere in California.

beyond medication

The other half of Parkinson's care

Medication matters — but exercise, therapy, sleep, and mood are often what make the biggest difference in day-to-day function.

Exercise

Regular vigorous exercise — aerobic, resistance, and balance work — slows symptom progression. Programs designed for Parkinson’s work especially well.

Physical therapy

Targeted PT with a Parkinson’s-trained therapist improves gait, balance, and confidence. We refer routinely.

Speech therapy

Speech therapy can address the soft, mumbling speech of Parkinson’s. Most patients see clear improvement after a structured course of therapy.

Sleep

REM sleep behavior disorder, restless legs, and insomnia are common in Parkinson’s and worth treating. Better sleep often improves daytime symptoms substantially.

Mood

Depression and anxiety are common in Parkinson’s and are not just a reaction to the diagnosis — they are part of the disease. Treatment improves both quality of life and motor symptoms.

Community resources

The Parkinson's Foundation (parkinson.org), Michael J. Fox Foundation (michaeljfox.org), and local Parkinson's support groups provide education, exercise classes, and community.

caring for the caregiver

Resources for partners and families

Movement disorders affect the whole family. We make sure spouses, partners, adult children, and other caregivers have the information and support they need.

Education at every visit

Caregivers are welcome at every visit. We encourage written questions in advance and make sure the most important practical issues — falls, sleep, medications, mood, and safety — are addressed openly.

Connecting to community

Local Parkinson's support groups, exercise classes, and movement programs reduce isolation and build community. The Parkinson's Foundation (parkinson.org, helpline 1-800-4PD-INFO) is an excellent first stop.

Recognizing caregiver burnout

Caregiving for someone with a chronic neurological condition is demanding. We routinely ask caregivers how they are doing — and connect them to respite, support groups, or their own clinician when needed.

frequently asked questions

Common questions from movement-disorder patients

Plain-language answers to questions we hear in clinic — also marked up as structured FAQ data so they can appear in search results and AI summaries.

What is the difference between Parkinson's disease and essential tremor?

Essential tremor is an action tremor — it appears when you reach for something, hold a cup, or write, and it usually goes away when the hands are at rest. Parkinson's disease tremor is typically a resting tremor — it appears when the hand is relaxed in the lap and quiets when the hand is in use. Essential tremor often runs in families and may improve with alcohol; Parkinson's tremor does not. Other features (slowness, rigidity, gait change, loss of smell, REM sleep behavior disorder) point toward Parkinson's.

How is Parkinson's disease diagnosed?

There is no single blood or imaging test that confirms Parkinson's. The diagnosis is clinical — based on a careful history, neurological examination demonstrating bradykinesia plus tremor and/or rigidity, and the response to dopaminergic medication. MRI is usually done to rule out other causes such as strokes or hydrocephalus. In atypical cases, a DaTscan (a brain imaging test that shows dopamine transporter activity) can help distinguish Parkinson's from essential tremor or drug-induced parkinsonism.

What is the typical first medication for Parkinson's?

For most patients with bothersome motor symptoms, levodopa/carbidopa is the most effective and best-tolerated first medication. In younger patients with mild symptoms, a dopamine agonist or MAO-B inhibitor is sometimes started first. The decision depends on age, symptom severity, other medical conditions, and patient preference. We discuss the trade-offs openly so you can make an informed choice.

What is 'on/off' fluctuation and what causes it?

Years into Parkinson's treatment, some patients begin to notice that medication wears off before the next dose ('off' time) or causes extra involuntary movements at peak effect (dyskinesia). This usually reflects the natural progression of the disease combined with how levodopa is absorbed. Treatment options include adjusting the dose schedule, adding a COMT or MAO-B inhibitor, switching to extended-release levodopa, adding amantadine, or in advanced cases considering deep brain stimulation or continuous infusion therapies.

Is deep brain stimulation (DBS) right for me?

Deep brain stimulation is an FDA-approved treatment for selected patients with advanced Parkinson's disease, essential tremor, and dystonia. It is most useful when motor symptoms still respond to levodopa but with significant 'on/off' fluctuations or dyskinesia. DBS is performed at specialized centers and we make referrals when appropriate. It is not usually recommended for patients with severe dementia or for symptoms that don't respond to levodopa.

What non-motor symptoms come with Parkinson's?

Many. Common ones include constipation (often years before motor symptoms), loss of smell, REM sleep behavior disorder (acting out dreams), depression, anxiety, fatigue, daytime sleepiness, urinary urgency, lightheadedness on standing (orthostatic hypotension), drooling, and cognitive changes later in the disease. Recognizing and treating non-motor symptoms is often as important as motor symptom control for quality of life.

How important is exercise in Parkinson's?

Very. Multiple studies show that regular vigorous exercise — particularly aerobic exercise, resistance training, and Parkinson-specific programs — slows symptom progression and improves balance, gait, and mood. Many patients also benefit from physical therapy, occupational therapy, and speech therapy. We recommend exercise to every patient at every visit.

What is dystonia?

Dystonia is a movement disorder in which involuntary muscle contractions cause sustained or intermittent twisting, abnormal postures, or repetitive movements. It can affect one body part (focal dystonia — for example cervical dystonia / torticollis, blepharospasm, writer's cramp) or be more generalized. Treatment options include medications, botulinum toxin (Botox) injections for focal forms, physical therapy, and in selected cases deep brain stimulation.

Can a movement disorder be caused by medication?

Yes — drug-induced parkinsonism, tardive dyskinesia, and medication-induced tremor are all important to recognize. Common culprits include certain antipsychotics, anti-nausea medications (metoclopramide, prochlorperazine), and some mood stabilizers. A careful medication review is part of every initial movement-disorder visit, and sometimes simply adjusting the medication resolves the symptoms.

Local movement-disorder care in Santa Clarita

Los Angeles Neurosciences is located at 23861 McBean Parkway, Suite E-12, Santa Clarita, CA 91355. We see patients with Parkinson’s disease, essential tremor, dystonia, restless legs, and other movement disorders — and we coordinate physical, occupational, and speech therapy to support every patient.

For appropriate situations, telemedicine follow-up is available throughout California — especially useful for medication adjustments and check-ins between in-person visits. To ask about appointments, call (661) 857-7100.

Care is delivered by Dr. Thomas Kurian, M.D., who is certified by the American Board of Psychiatry and Neurology. View Healthgrades profile.

questions before you schedule

Have a quick question? Call us first.

Many families call before scheduling — wanting to know whether their concern is appropriate for our practice, what insurance we accept, or how to get records sent in advance. Our front desk is happy to walk through any of that. Reach us during office hours Monday through Friday, 9 AM to 5 PM (closed for lunch 12:30 to 1:30) at (661) 857-7100, or send a message through the contact form at any time. Same-day or expedited appointments are sometimes available for urgent neurological concerns — let the front desk know what is going on and we will do our best to fit you in. For new patients, please have your insurance information, primary care physician’s name, and a brief description of your concern ready when you call. We verify benefits in advance so there are no surprises at check-in. Existing patients with a treatment question between visits should call the office; non-urgent questions are also welcome through the patient portal.

Get Started

Need to schedule a neurology visit?

Call the office or request an appointment online. New patients are welcome — for in-person visits in Santa Clarita or telemedicine throughout California.

Request AppointmentCall (661) 857-7100