In Motion
A new Neurological Movement Disorders Program marches to the forefront of cutting-edge therapies for Parkinson’s disease, Tourette’s syndrome, restless legs syndrome, and more.

A slower step. A sluggish response. A tic, a twitch, a tremor. For the millions of people with neurological movement disorders, their road to diagnosis likely began with one of these red flags, or others like them. Marked by conditions in the brain that affect speed, fluidity, quality, and ease of movement—moving too much or too little involuntarily—neurological movement disorders emerge as a result of damage or disease deep in the brain, and often reveal themselves gradually over time. Now, staff at the new Movement Disorders Program at the Atlantic Neuroscience Institute are able to help patients determine the causes behind their disorders and develop effective treatment plans. “The program brings together a lot of fields and a diverse set of practitioners: neurosurgery, neurology, physical therapy, psychology, exercise physiology, physical medicine and rehabilitation, internal medicine, geriatrics, and pediatrics,” says neurologist Roger Kurlan, MD. “This is very specialized but also multidisciplinary care.”

Kurlan, the medical director of the new program, is internationally known for his work with movement disorders and comes to the Neuroscience Institute from the University of Rochester Medical Center in New York. Diagnosing a patient, he says, begins with “making sure you know exactly what the movement disorder is—there’s almost an art to sorting it out.” A patient with Parkinson’s disease, for example, will exhibit tremors, stiffness, and slowness, while a person with tics may make faces, jerk his or her head, demonstrate rapid eye blinking, or repeatedly sniffle or clear the throat. “The second step is to determine what’s causing the movement problem,” says Kurlan. “Is there a sign of some other disease?” To determine this, doctors perform a thorough examination, get a detailed medical history, and conduct an evaluation that may include blood tests and brain imaging.

Cutting-Edge Treatments

What separates movement disorders from other medical problems is that they are visible—they’re not worn on the inside like diabetes or asthma or cancer. “Patients feel embarrassed,” says Kurlan. “They know that their problem is on the outside, with people looking at them and seeing jerking and shaking or trembling or hearing noises. People don’t understand that these movement problems are related to brain disorders.”

Fortunately, most movement disorders are treatable. “If you’re lucky, there’s treatment for the underlying disease,” says Kurlan. “If not, there is usually treatment for the abnormal movement itself.”
Today, there is a wide spectrum of options available to help patients. Some of the treatments that are available at Overlook or will be expanding there include:

• Neurosurgical deep-brain stimulation (for Parkinson’s, essential tremor, and dystonia), in which a brain pacemaker sends electrical impulses to specific parts of the brain.
  


• Botox injections (for dystonia and tremor, and for treating tics that accompany Tourette’s syndrome), to weaken muscles so that they are less responsive to involuntary signals from the brain. As with more traditional uses, this is a temporary treatment, but it can be effective for up to six months.
  


• Gene therapy (for Parkinson’s); this is an exciting new treatment, and Kurlan is hopeful it will be available at Overlook within the next few years.


• Clinical trials (for Tourette’s). Overlook is applying to become the organizing center for a new, three-year National Institutes of Health trial in which six centers around the country are testing six medications to determine a best course of therapy. Kurlan estimates that Overlook will enroll patients in this study soon and expects Overlook to be a site for similar studies.

“We need more treatments that get at the underlying condition,” says Kurlan. “We need to find something that slows or prevents loss of brain cells to stop the degenerative process in conditions like Parkinson’s, or the abnormal brain development in such illnesses as Tourette’s syndrome. We’re not there yet, but I think we’ll get there in the not too distant future.”

For a referral to a specialist within the Movement Disorders Program, call 866-918-0998.