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Movement Disorders

Movement disorders encompass a variety of neurological/ neurodegenerative conditions that lead to either slowed down (hypokinetic) movement and mobility, such as Parkinson's disease, or sped up (hyperkinetic) movements that often manifest as tics, such as

• Tourette Syndrome and other tic disorders
• Huntington's Chorea (recurring, random twitches and jerks of many muscles)
• Dystonia (writhing or twisting postures)
• Myoclonus (isolated muscle jerks)
• ataxia

NewYork-Presbyterian Hospital's first Parkinson Clinic was started by Dr. Lewis Doshay in the 1950's. At the time, treatments for Parkinson's disease were limited, but Dr. Doshay introduced many of the anticholinergic drugs which remain useful for the treatment of tremor and dystonia. Over the decades, this clinic became renowned and grew into a premier clinical and research movement disorders center.

Today, NewYork-Presbyterian Hospital cares for one of the world's largest populations of patients with Parkinson's disease, dystonia, tremors, ataxia, Tourette syndrome, myoclonus, and other movement disorders. We serve the population of the metropolitan New York region, but many patients are referred from all over the United States and other countries. Neurologists at NewYork-Presbyterian Neuroscience Centers have a wealth of expertise in diagnosing and treating both common and rare movement disorders, and are on the forefront of both basic and clinical research geared towards developing novel therapies. Staff is based at centers at both NewYork-Presbyterian Hospital/Columbia University Medical Center and NewYork-Presbyterian Hospital/Weill Cornell Medical Center:

• Center for Parkinson's Disease and Other Movement Disorders located at the Neurological Institute at NewYork-Presbyterian/Columbia University Medical Center
• Movement Disorders Program located at NewYork-Presbyterian/Weill Cornell's Department of Neurology

Diagnostic Innovations

At NewYork-Presbyterian Hospital, we offer MRI, CT and related tests to evaluate structural anatomy as well as the most advanced functional neurological diagnostic tests to evaluate how the nervous system works. These include:

• Electroencephalography (EEG) – an examination of spontaneous brain activity.
• Electromyography and nerve conduction studies (EMG/NCS) – examinations of nerve and muscle activity.
• Evoked potentials (EP's) – examinations of brain activity related to sensory stimulation. Three common varieties are performed: sight (VEP's), hearing Brainstem Auditory Evoked Potentials (BAEPs) and Somatosensory Evoked Potentials (SEPs) evaluate the sensory areas of the brain, brainstem, and spinal cord.
• Motor Evoked Potentials (MEPs) monitor the areas of the central nervous system that control movement. NewYork-Presbyterian pioneered the use of MEPs during surgery to correct spinal deformities, and is one of a handful of medical centers that routinely uses this monitoring technique during surgery.
• Polysomnography (PSG's) – This is an examination of brain, eye movements, breathing, and other activity during sleep.

Therapeutic Excellence

Our physicians have extensive expertise in the comprehensive treatment of Parkinson's Disease and other movement disorders such as

• Dystonia
• Tremors
• Ataxia
• Tourette's and other tic disorders
• Myoclonus, and
• Huntington's chorea

Our multidisciplinary team of specialists includes neuropsychologists, therapists and allied health personnel to optimize each person's care. Staff at the Neuroscience Centers also provides valuable resources for patients, families and caregivers.

Both centers offer botulinum toxin injection therapy for patients with dystonia and other involuntary movements, a treatment which effectively relaxes dystonic muscles for up to three to six months, allowing more normal posture and movement.

The Center for Parkinson's Disease and Other Movement Disorders is one of the nation's leading treatment and research centers for both Parkinson's and Huntington's Diseases. Researchers there were instrumental to a large coordinated effort that resulted in cloning the Huntington's gene.

Surgery for movement disorders, such as Parkinson's disease and essential tremor, involves a team of physicians, nurses and therapists.

Intraoperative neurological monitoring consists of EEG, EMG, or EP's (see above) performed during surgical procedures. These techniques provide an assessment of function of the nervous system during a surgical procedure, and help the surgeon minimize the risk of damage. NewYork-Presbyterian Hospital maintains the most advanced intraoperative neurophysiological monitoring system worldwide. Continuously monitoring the electrical activity of the brain and spinal cord during surgery diminishes the risk of neurological injury in two ways: First, neurophysiological monitoring helps the surgeon clearly identify – and avoid – portions of the brain and spinal cord that control key functions such as movement and sensation. Second, monitoring in real time allows physicians to detect – and possibly reverse – injury to the brain and spinal cord.

NewYork-Presbyterian Hospital offers two types of surgery for movement disorders, both of which are designed to reduce or eliminate the functioning of hyperactive target areas of the brain.

• Lesioning surgery, in which a target area of the brain is heated with an electrode until the cells in this area are destroyed. When this is performed in the GPi it is called a pallidotomy, while lesioning the STN is called a subthalamotomy.
• Deep brain stimulation (DBS), a surgical procedure pioneered at The Center for Movement Disorder Surgery (CMDS) at NewYork-Presbyterian Hospital/Columbia University Medical Center, is now an indispensable technique that has helped numerous patients suffering from movement disorders to manage their symptoms more effectively. Medications for movement disorders can cause side effects that increase over time; deep brain stimulation has allowed many patients to minimize their dependence on medications. This procedure involves inserting a device that acts like a pacemaker for the brain. After extensive neurophysiological tests to determine the precise location, electrodes are surgically placed into specific points of a brain region called the thalamus. In a second surgery, wires are then run from these implanted electrodes into a battery pack in the patient's chest. A physician can regulate the device without any further need for surgery, and the stimulation provided to the brain minimizes the tremors that so plague patients with movement disorders. In DBS surgery, a permanent electrode is implanted in the brain. The tip of the electrode is placed within the target brain region (GPi or STN), and this is then connected under the skin by a wire running behind the head, down the neck to a pulse generator placed in the chest above the pectoralis muscle. This pulse generator is similar in size and appearance to a cardiac pacemaker. It sends signals to the electrode, which results in electrical stimulation of the target brain region. This electrical stimulation blocks the functioning of the target brain region, resulting in improvement in symptoms of Parkinson's disease.

Research

Our scientists are involved in many studies providing interested patients with the opportunity to participate in developing a better understanding and treatment of Parkinson's disease and other movement disorders. Ongoing pharmacotherapy trials, in conjunction with other research centers, also provide the option for patients to try new therapeutics.

Research projects at the Center for Parkinson's Disease and Other Movement Disorders and at the Movement Disorders Program are testing the efficacy of several new drugs for patients in both early and moderate-to-advanced stages of Parkinson's. They are examining better methods for assessing Parkinson's Disease progress with positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), and comparing the risk factors for PD in men versus women and blacks versus whites, with the objective of improving care for each of these groups.

Researchers at the Neuroscience Centers are also investigating the basic biology of the disease with the use of imaging techniques, as well as its genetics.

Patients who do not respond to medical treatment are evaluated for the latest surgical therapies such as tissue transplantation techniques; physicians from the NewYork-Presbyterian/Weill Cornell Movement Disorders Program are conducting trials for the first gene-therapy-based treatment for Parkinson's. Experimental therapeutics are being tested for patients with advanced Parkinson's disease, including a clinical surgical trial implanting fetal dopamine cells, which has resulted in a marked reduction in symptoms, especially in patients younger than 60. This research builds on a long and distinguished history in the field, beginning in 1965 with the first controlled studies testing levodopa ("L-dopa") as a treatment for Parkinson's Disease.

Huntington's Disease is named for the scientist, George Huntington, MD, who published the first detailed clinical description of the disease's symptomatic progression. George Huntington was a graduate of the College of Physicians & Surgeons at Columbia University in the 1870's. Current researchers at the Neurological Institute constructed a genetic history of 12,000 Venezuelans living at a single site, all descendants of a woman who died of Huntington's Disease in the 19th century. It is the largest group ever followed for HD-pertinent genetic data. In 1993, aided by this study, the international Huntington's Disease Collaborative Group discovered the gene and the mutation that cause this disorder. Now, physicians can test young adults from an HD family to determine if they are carriers of the disease. Eventually, researchers anticipate that presymptomatic testing will allow effective treatment, perhaps elimination of the abnormal gene, before symptoms appear.