The effects of Parkinson’s disease and other movement-related disorders – neurological conditions that affect the speed, fluency, quality and ease of movement – which include dystonias (involuntary muscle contractions), restless leg syndrome, Tourette’s syndrome, and essential tremor (uncontrolled shaking) among others, can be debilitating.

“We are pleased and excited to now offer the most advanced care for patients suffering with Parkinson’s Disease and other movement disorders such as essential tremor,” said Malcolm Gottesman, MD, Chief of Neurology and Director of Winthrop’s Multiple Sclerosis Treatment Program.

“Winthrop now provides sophisticated care to these patients on par with the country’s finest neuroscience departments. This patient population is underserved and can benefit greatly from readily accessible expert care.” Recently, Winthrop’s Institute for Neurosciences expanded its medical management services and surgical treatment options with the launch of a new Movement Disorders Program. A joint effort initiated by Michael Brisman, MD, Chief of Neurosurgery at Winthrop, and Dr. Gottesman, the Program utilizes the expertise of two movement disorders specialists: neurologist Sakshi Bajaj, MD, Director of the Movement Disorders Program at Winthrop, and neurosurgeon Brian J. Snyder, MD, who are providing a full range of treatment therapies to patients with movement disorders.

Medical Management
Currently, there are no medical imaging studies or laboratory tests that can reliably diagnose most movement disorders.

And, because symptoms can sometimes mimic those of other conditions, a thorough physical and neurological evaluation by a movement disorder neurologist is needed in order to achieve effective diagnosis and treatment. “Movement disorders can be very complex,” said Dr. Bajaj. “For example, patients with Parkinson’s can have many non-movement related issues such as sleep problems, anxiety, depression, and hallucination, which in some cases are more disabling than the motor symptoms. These may not be recognized as a part of the same disease process and can be overlooked and under treated if not properly evaluated.”

In addition to optimizing medical treatment, Winthrop also offers botulinum toxin injections which are comprised of a protein that in small doses, can help stop muscle spasms.

Surgical Treatment
When medications fail to control or reduce symptoms or cause debilitating side effects, surgical treatment to areas deep within the brain via Deep Brain Stimulation (DBS) may present another option for select patients.

Deep Brain Stimulation delivers electrical stimulation to targeted regions deep within the brain that control movement-related communication such as the thalamus, subthalamus, and globus pallidus. Following Deep Brain Stimulation, many patients experience enhanced motor performance and quality of life, and, in some cases, marked reductions in medication.

“Deep Brain Stimulation is an exciting and innovative technology that allows us to modulate the neurocircuitry of the brain and achieve great results with low risk,” said Dr. Snyder, who also specializes in the treatment of seizure disorders and epilepsy.

DBS is typically performed in two stages. The first stage involves identifying the areas within the brain that require treatment with the assistance of computed typography (CT), magnetic resonance imaging (MRI), and an advanced technique called microelectrode recording (MER) in which Dr. Snyder and Dr. Bajaj are experts.

“Microelectrode recording enables us to more precisely and accurately pinpoint areas in the brain like the subthalamic nucleus which is about the size of an almond,” said Dr. Snyder.

Performed as an outpatient procedure under general anesthesia, the second phase of DBS involves the surgical implantation of tiny electrodes deep within the brain. The electrodes are connected to a pacemaker device called an impulse generator (IPG) which is implanted under the skin near the chest. When activated, the IPG delivers continuous electrical pulses to the brain, blocking signals that cause muscle tremor.

A hand-held device enables the physician to adjust and control the level of stimulation as needed to provide the highest degree of relief from symptoms while minimizing side effects.

Not every patient is a candidate for DBS, and all patients at Winthrop are thoroughly evaluated by their medical management team to determine the best course of treatment.

“A multidisciplinary team consisting of a movement disorders neurologist, a functional neurosurgeon, and a neuropsychologist can optimally select patients for DBS,” said Dr. Bajaj.

For more information on Winthrop’s Institute for Neurosciences, call 1-866-WINTHROP.