While coronavirus disease (COVID-19) has paused many of our usual activities, patient care, research analysis, and training of new movement disorder specialists (Parkinson’s doctors) continues. Recently, a distinguished group of movement disorder clinician-researchers in training, The Edmond J. Safra Fellows, and their mentors met virtually to discuss research progress and share insights about caring for their patients. The Class of 2021, which is midway through training at centers around the world, led the conversation. Descriptions of their presentations, with an editor’s note for context, follow:
Whitley Aamodt, MD, MPH; University of Pennsylvania; Philadelphia, Pennsylvania
Whitley described her research on how specialized brain scans (called DaT scans), smell loss and other non-movement symptoms might help predict the development of Parkinson’s disease (PD) in people who have drug-induced parkinsonism. This is a condition that looks like Parkinson’s, but arises because of long-term use of certain medications for nausea or psychiatric disease. Whitley found abnormal DaT scans and smell loss in a small group of people with drug-induced parkinsonism, and continues to observe them for signs of PD.
It can be difficult to separate Parkinson’s from other conditions that have similar symptoms, especially in early disease. Understanding this overlap can lead toward earlier and more accurate diagnosis.
Amir Badiei, MD; University of California San Francisco; San Francisco, California
Amir presented his work on how deep brain stimulation (DBS) impacts apathy (lack of motivation) in Parkinson’s. He asked a small group of people with PD to play a computer game while their DBS was both on and off. The game measured the amount of effort each person applied to gain a reward. Amir found that the effort to reward ratio (a marker of apathy) improved with DBS on.
Apathy is a difficult-to-treat non-movement symptom, and DBS is the most common surgical treatment for movement symptoms. Identifying how DBS may affect apathy is important in guiding treatment decisions.
Chris Caughman, MD; Emory University; Atlanta, Georgia
Chris discussed a patient with hemidystonia, an abnormal, sometimes painful, muscle cramping and limb position on one side of the body. (The hand and foot turn in, for example.) The patient’s brain MRI scan showed a smaller-than-expected basal ganglia, which is responsible for normal movement, on the side opposite to the dystonia. In discussion (one of the benefits of this forum), mentors and fellows suspected the condition was lifelong (congenital).
Movement disorders, such as Parkinson’s and dystonia, share symptoms and brain pathways. Researchers use this correlation to better understand these conditions and develop treatments for both.
Neil Shetty, MD; Northwestern University; Chicago, Illinois
Neil detailed his research to determine differences in patients who use deep brain stimulation or levodopa/carbidopa intestinal gel (Duopa), therapies available for advancing PD. In his observational study, Neil found those who use DBS tend to be younger, have less significant symptoms and are less likely to have a regular care partner, among other factors.
Recognizing who uses a specific therapy when and why can help doctors understand who may be the ideal candidate as well as what opportunities and challenges a treatment poses.
Judith van Gaalen, MD; Radboud University; Nijmegen, Netherlands
Judith described a patient with several years of swallowing and breathing problems. While the patient did not have movement changes, she had an abnormal brain (DaT) scan, which often indicates a movement condition. After detailed consideration, Judith diagnosed this patient with a rare presentation of multiple system atrophy (MSA), a disease related to Parkinson’s.
The diagnosis of MSA, like Parkinson’s, can be challenging because there are no objective measures and some symptoms overlap with PD. In rarer presentations, literature review and expert discussion (to learn about similar cases) can help.
Anne Weissbach, MD; University of Lübeck; Lübeck, Germany
Anne presented her research using transcranial magnetic stimulation (TMS), a non-invasive form of brain stimulation. She tested it alone in people who carry a genetic risk factor for PD and with DBS in people who have Parkinson’s. Anne evaluated how TMS might interrupt irregular brain signals to prevent abnormal brain cell interactions in people at risk for PD and how TMS might, with DBS, restore normal brain cell interactions in people with the disease. Additional research is ongoing in a longitudinal follow-up study. (Because Anne started training on an earlier schedule, she will graduate this summer.)
New ways of stimulating the brain, including TMS and DBS innovations, are an active area of research to potentially prevent movement changes or restore normal movement.
The Edmond J. Safra Fellowship in Movement Disorders is a collaboration between The Michael J. Fox Foundation and longtime partner the Edmond J. Safra Foundation to increase the global network of movement disorder specialists — neurologists who are expertly trained to care for people with Parkinson’s — and lead research into better understandings and treatments for the disease. Each year, the program awards funding to five academic centers around the world to each train a new clinician-researcher over a two-year period. By the year 2025, the fellowship will have trained 41 new specialists around the world.