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Neuroscience Institute

Diagnosis and Treatment

The specialty of movement disorder neurology focuses on a large number of neurological disorders that share the common clinical feature of involuntary movements of either hypo- or hyperkinetic character. Movement disorders are classified first phenomenologically and then etiologically. The involuntary movements generally occur in the absence of weakness, and therefore these disorders were originally termed extrapyramidal, although this term has been largely dropped from current nosology.

Hypokinetic movement disorders include Parkinson's disease, several other conditions with Parkinsonian features, and rare disorders like stiff-person syndrome. The large number of hyperkinetic movement disorders are divided into several categories including tremors, chorea, dystonia, tics, stereotypies, and myoclonus. The ataxias and movement abnormalities associated with cerebellar system disorders and gait disorders also fall within this specialty. Finally, dyspraxias that affect the successful execution of movements involved in complex tasks or movement patterns are considered movement disorders.

Movement disorders are also classified by their causative process, and include neurodegenerative, genetic, infectious, metabolic, nutritional, toxicological, and vascular etiologies. Movement disorders may be considered primary when they occur as an isolated neurological syndrome or secondary when they occur as part of a larger process of known cause. Because many movement disorders are drug-induced and iatrogenic, experts must be particularly aware of the agents that are associated with their induction.

Movement disorder neurology encompasses several aspects of basic science, including neuroepidemiology, molecular biology, neurochemistry, neuropharmacology, and neurophysiology. Because most movement disorders are chronic conditions, treatment expertise also incorporates elements of neurorehabilitation. Treatment for movement disorders includes medications, injection of botulinum toxin, and neurosurgery.

The Botulinum Toxin Treatment Center makes available treatment for hyperkinetic conditions when oral medications alone is not successful. It has become an important addition for many patients in maintaining their daily activities. There is an increasing emphasis on neurosurgical interventions for the treatment of Parkinson's disease, dystonia, and various forms of tremor. Movement disorder specialists must be skilled in identifying candidates for surgery and regularly participate in pre- and post-operative neurological management. Movement disorders have typical magnetic resonance imaging patterns, especially secondary movement disorders. Neuroimaging expertise is an important aspect of the daily practice of movement disorders as a neurological specialty.

Functional Neurosurgery

Functional neurosurgical procedures are designed to reduce or eliminate spasticity, tremors, and chronic pain, thereby improving the patient’s ability to function and regain a more independent lifestyle.

Allegheny General Hospital neurosurgeons in combination with specialists in neurology, anesthesiology, pain management, electro physiology and physical medicine have joined to bring the latest medical advances to people who are disabled by spasticity, movement disorders, and pain.

The Division of Neuromodulation is designed to provide thorough, coordinated care to patients with increased muscle tone and abnormal body movements resulting from Parkinson’s disease, tremors, spasticity, stroke, brain injury, multiple sclerosis, dystonia, cerebral palsy and other medical causes. The Division of Neuromodulation also provides innovative therapies for the surgical treatment of chronic pain.

Medical treatments available through the division include standard and recently approved medications. Additional experimental and investigational medications are also available for patients who do not respond to conventional medical therapies. New surgical treatments are being investigated for patients who cannot be adequately helped by medication alone.

The current and latest surgical and medical techniques available in the Division of Neuromodulation include:

Deep Brain Stimulation

AGH neurosurgeons were the first in the region to use deep brain stimulation to treat patients with essential tremor and tremor resulting from some forms of Parkinson’s disease as well as dystonia. This therapy involves the placement of electrodes deep in the brain. The electrodes are then connected to an implantable device that can generate various amounts of electrical current to the exact areas of the brain responsible for the tremors. Using a handheld magnet, the patient can turn on the device which is implanted in the upper chest and the electrical current blocks the signals in the brain that cause the tremor.

Allegheny General Hospital is the only center in Western Pennsylvania with FDA permission to undertake direct brain stimulation in an attempt to relieve patients from chronic neck and head pain that has not responded to other medical or surgical treatment. This procedure offers the potential for eliminating pain in patients who are otherwise untreatable.

A better understanding of pain mechanisms has led to more sophisticated approaches to pain management. Two therapies offering potential relief for intractable pain are spinal cord stimulation and intraspinal drug delivery via an implantable pump.

Other treatment modalities being explored by the Division of Neuromodulation include therapies for disabling intractable angina, epilepsy, depression, Tourettes syndrome, and obsessive compulsive disorder.

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