Movement Disorders

The clinical goal of the fellowship program is to train neurologists to become experts in the diagnosis and treatment of Parkinson’s disease and other movement disorders. The core component of their clinical education consists of evaluating outpatients and hospitalized patients at Columbia University Medical Center. The fellows perform clinical evaluations of patients under the faculty's direct supervision, review management decisions and write up the evaluation letter. Follow-up care is as important as the initial evaluation, and fellows follow the patients closely with subsequent outpatient visits and non-office contact (i.e. phone calls and electronic communication). Longitudinal follow-up of the same patient over time is particularly crucial for a chronic disease like PD. Senior fellows have the opportunity to manage a small number of patients independently, serving as the primary provider for these patients. Faculty remain readily available for immediate guidance as needed and cases are also discussed in division Video Rounds to ensure optimal clinical management. This senior fellow clinic provides continuity of care and graduated autonomy, helping to prepare graduating fellows for independent clinical practice. Fellows may also choose to do a 6-month elective in the multidisciplinary Huntington disease clinic. Our center’s combination of referral patterns (tertiary referral center and primary community center of care) provides a rich patient population. In both a published formal assessment and a more recent review of billing codes, we found that approximately half of the patients evaluated had PD, allowing for rigorous training in the diagnosis and management of PD. The other half of patients spanned a wide range of other movement disorders, including atypical parkinsonian syndromes, essential tremor, dystonia, ataxia, myoclonus, chorea, tardive syndromes, and functional disorders.  

The program trains fellows in specialized techniques and procedures for movement disorders, consisting primarily of DBS and botulinum toxin injections. Fellows learn these techniques during clinical sessions wholly devoted to each modality. This training typically begins during the second half of their first year, followed by more intensive training during their second year. The division has an active DBS program, and fellows are intimately involved in all aspects of DBS-related care: evaluation and selection of patients, intraoperative recording, and post-operative programming. Our multidisciplinary DBS team is comprised of movement disorder specialists dedicated to DBS (Kwei, O’Shea), functional neurosurgeons (Baltuch, McKhann, Youngerman), a DBS nurse (Winfield), a neuropsychologist (Cole), and a neurophysiologist (Pullman). Fellows also gain experience with other more intensive modalities for the treatment of PD, such as carbidopa/levodopa intestinal infusion and titration visit for apomorphine injection. Fellows learn botulinum toxin injections with EMG guidance, for treatment of dystonia and related disorders. 

We seek to provide innovative, multidisciplinary care to our patients, with efforts including several patient support groups (Delaney), our unique Music and Movement Disorders Initiative (Kim) which seeks to provide and optimize music-based interventions for movement disorders patients and provide specialized care to musicians affected by movement disorders, and Broadway for Ataxia foundation (Kuo) which uses performing arts interventions to improve quality of life for individuals with ataxia.

As a Parkinson’s Foundation Center of Excellence, our program provides fellows with opportunities for engagement with the PD patient community. These include participation in patient education and support groups, events such as the Parkinson Unity walk, and PF-sponsored conferences and events. In addition, our Center coordinator (Delaney) provides social work services and support, exposing our fellows to the breadth of ancillary and support services critical to our patients’ well-being. We are committed to our community of Upper Manhattan, including opportunities for participation in community brain health education fairs (Quinn, Shah). 

The division has a robust series of academic lectures and conferences. Fellows play a primary role in these activities, which are scheduled to avoid clinical duties. The core conference is our weekly “video rounds,” where division cases, including videotaped exams, are reviewed regarding phenomenology, differential diagnosis, diagnostic evaluation and management. Our conference series includes our unique monthly Pediatric Movement Disorders Rounds (Katus), uniting an international consortium of experts for both discussion of clinical cases and a clinical research lecture series. In conjunction with the New York Brain Bank, we have monthly clinicopathologic conferences (CPCs), which combine clinical histories, presented by fellows, with autopsy findings and neuropathologic diagnosis. The division also has monthly case conferences, with live presentation of patients. The DBS team conducts multi-disciplinary monthly “DBS rounds” to review cases proposed for surgical intervention. Monthly journal club is organized by fellows to discuss current research articles, emphasizing critical analysis. Two bimonthly research conferences are held, one for basic laboratory groups and one on a translational topic that includes both clinical and basic science groups. Speakers are invited widely within Columbia and from outside. In addition, fellows have the opportunity to present their work in progress at these conferences. 

 Upon starting the fellowship, fellows are assigned a faculty advisor (based on their preliminary interests) to help guide their research and overall career development. In particular, the advisor ensures that the fellow is formulating their research plans in a timely manner and assists in the selection of scientific and clinical mentors. All fellows are supported for the Aspen course in Movement Disorders, presentation at AAN and MDS meetings, and, if requested, Columbia’s summer course in biostatistics. In addition, Columbia sponsors numerous seminars on relevant topics, such as grant writing and IRB submissions

Our division, and the larger Columbia community, provide an extensive array of potential research training opportunities. This breadth of resources is a unique strength of our program. On the clinical side, we have initiated and participated in several industry- and government-sponsored clinical trials (Kuo, Kwei, Waters); conducted research on biomarkers (Agin-Liebes, Alcalay) and genetic contributions to PD (Agin-Liebes, Alcalay), quality improvement measures in dystonia in cerebral palsy (Katus), mechanisms of gait dysfunction in neurodegenerative disease (Kwei), neural circuitry in focal task-specific dystonia (Kim); and participated in WHO-sponsored public health efforts to improve global dementia and PD care (Shah). On the basic science side, our faculty has explored several facets of autophagy in the pathogenesis of PD (Kuo, Yamamoto, Tang), delineated abnormalities in cerebellar circuitry in ET and ataxias (Kuo), and investigated novel pathways involved in neuroprotection and mitochondrial dynamics, (Przedborski, Tang, Yamamoto). Epidemiology training is another unique strength of the program. Columbia offers an intensive 5-week summer course in statistics and research design.

The division, and in particular the fellowship program, works closely with the broader Columbia neuroscience community. For example, faculty from the following divisions have recently served as research mentors for fellows and collaborators: Dementia (Marder, Stern); Epidemiology (Rauh); Psychology (Shohamy); Engineering (Agrawal); Neurorehabilitation (Quinn). Other notable resources outside the division include The New York Brain Bank, located on site, has autopsy material from hundreds of patients with neurodegenerative diseases. With increasing awareness of cognitive impairment in PD, we maintain a very close relationship with our colleagues in the Aging and Dementia and Cognitive Neuroscience Divisions.