The Movement Disorders Program at Winthrop is staffed with experts committed to caring for and treating people afflicted with a wide range of conditions, including Parkinson’s disease, essential tremor, other types of tremor, diskinesia and dystonia, Huntington’s disease, ataxia, gait disorders, spasticity and Tourette syndrome. These experts are committed to providing relief, improving quality of life and renewing patients’ independence.
The Program entails close teamwork by neurologists, neurosurgeons, neuropsychologists, neurophysiologists, neuroradiologists and genetics counselors. Understanding that living with a movement disorder affects the entire family, and involves more than the patient’s medical and surgical needs, the team coordinates an integrated program of clinical nursing, nutrition, physical, occupational and speech therapies and social work.
What are Movement Disorders?
A group of complex neurological/neurodegenerative diseases, movement disorders include not only the involuntary slow or diminished movements manifested in conditions such as Parkinson’s disease and essential tremor, but also the fast-paced and frenetic movements seen in dystonia and Tourette syndrome.
Conditions we treat
Neurological consultation and treatments for movement disorders including but not limited to:
Parkinson’s Plus-Syndromes such as Multiple Systems Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal Syndrome (CBS)
Dystonia, both generalized and focal
Restless Legs Syndrome (RLS)
Huntington’s Disease and other hyperkinetic movement disorders
Evaluation & Diagnosis
Patients referred to the Program first receive in-depth evaluations and comprehensive diagnostic testing. The initial evaluation consists of a full medical history, thorough physical and neurological examinations and assessments of mental function, psychiatric health, gait, balance, motility, body function and overall health. The state-of-the-art technology available at Winthrop to help pinpoint a movement disorder includes magnetic resonance imaging (MRI), computed tomography (CT) and positron emission tomography (PET) scan brain imaging, as well as electroencephalography (EEG) to examine brain activity, electromyography (EMG) to look at nerve and muscle activity, somatosensory evoked potentials (SSEP) to test brain activity related to sensory stimulation and motor evoked potentials (MEP) to monitor areas of the central nervous system (CNS) controlling movement.
Once the diagnosis is made, the movement disorders expert confers with other team specialists, the patient, family and referring physician to create a treatment plan carefully tailored to provide the best therapy for the individual patient’s unique condition and special needs. Many medications work within the complex chemistry of the brain to compensate for some of the imbalances in the brain. These include: L-dopa, as well as newer drugs such as Mirapex and Requip to compensate for the lost dopamine-producing cells in Parkinson’s Disease. Conversely, botulinum toxin injections can selectively relax overactive muscles and spasms in patients with certain types of dystonias.
Medical management can be complex, with a great deal depending on the degree of functional and cognitive impairment, as well as the ability to tolerate the medication. No two patients react the same way to a given drug. Therefore, it takes time, patience and the type of expertise provided by the specialists in the Movement Disorders Program to achieve successful management.
If, or when, medications fail to control or reduce symptoms, or produce side effects that can no longer be tolerated, alternatives are dictated by the type and severity of the disease, as well as the patient’s age and disability level, desires and general medical condition.
While medical therapy is the first line of treatment, surgery is an option for selected patients. Surgical treatments, including thalamic, subthalamic (STN) and globus pallidus (GPi) deep brain stimulation (DBS), are a special area of expertise of the Movement Disorders Program. These procedures — in addition to radiofrequency and radiosurgical ablation, as well as intrathecal (Baclofen) pump surgical placement — can be options for patients who can no longer be adequately managed solely with medical therapy.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a leading functional neurosurgery procedure based on the premise that electronic stimulation of particular regions of the brain can improve the major symptoms of some movement disorders and may permit the team to reduce the amount of medication needed to manage symptoms more effectively.
FDA-approved, DBS is performed in two separate operations. They involve the implantation of a multi-contact electrode lead into the crucial part of the brain considered responsible for — or at least involved in — the pathology of a given disorder and connecting the lead to a pulse generator or “pacemaker” implanted under the skin in the chest. The pulse generator produces a high-frequency pulsed electrical current, which interferes with pathologic brain signals that produce the disabling motor symptoms, such as tremor, rigidity and dyskinesias.