Our Approach to Movement Disorders
The Montefiore Einstein Comprehensive Movement Disorders Center is at the forefront of delivering the most advanced and innovative care for patients with all types of movement disorders. Our world-renowned, interdisciplinary specialists have among the most diverse expertise in a spectrum of related disorders, including Parkinson’s disease and related conditions, essential tremor, dystonia, tardive dystonia or dyskinesia, Tourette’s syndrome, spasticity, and other movement disorders.
We utilize advanced technologies, including precise, minimally invasive, surgical placement of electrodes into brain areas uniquely involved in mediating specific movement disorders, along with subsequent programming and refinement of stimulation parameters to optimally treat individual conditions. We are ranked in the top 1% of all hospitals in the nation for neurology and neurosurgery, according to U.S. News & World Report, and an international referral site for complex and challenging movement disorder cases.
Our highly specialized team of leading experts from neurology, neurological Surgery, neuroradiology, cognitive neuroscience, neurorehabilitation and biotechnology work together through consensus conferences and precision medicine initiatives, integrating AI into a comprehensive management plan, to optimize functional recovery and avoid debilitating side effects often associated with medical management alone.
Advanced Diagnostics & Treatments
Prospective patients are evaluated by movement disorder neurologists who devise a patient-specific therapeutic plan involving neuromodulatory paradigms to optimize outcomes and quality of life for patients and their families. At our center, each patient is an active participant in their ongoing care.
Innovative Complementary Surgical and Neurological Management
Our world-renowned neurosurgeons are the leading authority on deep brain stimulation (DBS) surgery for movement disorders, including Parkinson’s disease and dystonia. Patients at our movement disorder center are evaluated by experienced movement disorders neurologists to determine the correct diagnosis and provide medical therapy. Treatment regimens are individualized and can include optimal medical management and other forms of neuromodulation, such as DBS or minimally invasive surgical procedures, including pallidotomy and thalamotomy. Among the most common DBS surgical targets are the globus pallidus internus, the subthalamic nucleus and the ventralis intermedius nucleus of the thalamus.
Deep brain stimulation is a minimally invasive procedure that involves the placement of one or two thin wires or electrodes into parts of the brain, or nuclei, that are known to have abnormal patterns of activity in particular movement disorders. These wires are connected to a small pulse generator, similar to a pacemaker, which is implanted beneath the skin. The pulse generator delivers a mild electrical current to the affected nuclei thereby reducing the effects of the abnormal activity. As a result, patients often experience considerable relief from abnormal movements such as tremor, stiffness, and dystonia.
Treatment plans are designed to optimize patient care, returning them to health as quickly as possible. Some of the various nonsurgical and surgical treatment options we offer at the Montefiore Einstein Movement Disorders Center include the following:
- Neuromodulation
- Deep brain stimulation (DBS)
- DBS of the globus pallidus internus (GPi)
- DBS of the subthalamic nucleus (STN)
- DBS of the thalamus
- DBS of the ventralis intermedius nucleus (VIM)
- DBS of the centromedian nucleus (CM)
- DBS of the ventral capsule/ventral striatum (VC/VS)
- Pallidotomy
- Thalamotomy
- Selective dorsal rhizotomy
- Botox injections
Innovative Surgical Solutions
Montefiore Einstein has developed several effective neurosurgical treatments for movement disorders. By improving our understanding of basal ganglia circuitry and evolving neurosurgical techniques, we have contributed greatly to treatment approaches used in our center and at care facilities worldwide. With each discovery, we will move closer to fully restoring function for patients with Parkinson’s disease, dystonia, or tremors.
Your Comprehensive Movement Disorders Center Team
Nrupen Y. Baxi, MD
David M. Kaufman, MD
Our multidisciplinary team of movement disorder experts is at the forefront of movement disorder care and the development of therapies through seeking a better understanding of the interrelationships between movement and neuromuscular disorders, as well as the interrelationships between movement disorders and psychological conditions. Our specialists also have a keen interest in the genetics of movement disorders. From prevention to treatment options, we will propose an individualized treatment plan that fits your needs and lifestyle.
About Parkinson’s Disease
Parkinson's disease (PD) is movement disorder of the nervous system that gets progressively worse over time. Humans have about 200,000 dopaminergic neurons at baseline. With age, some of these neurons are lost. In some individuals, dopaminergic neurons are lost at a higher than normal rate leading to PD. Affected individuals may begin to notice problems with slowing of movement, tremor, stiffness or rigidity in the limbs or the trunk of the body, or impaired balance. As symptoms progress, people may have difficulty walking, talking or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. Hence an important facet of optimizing care is to arrive at an accurate diagnosis whether it is PD, or another disorder.
About Dystonia
Dystonia is a neurological movement disorder characterized by involuntary or unintended muscle contractions that cause intense and sustained movements or abnormal postures that can at times be painful. There are several different forms of dystonia that may affect only one muscle, groups of muscles or muscles throughout the body. The affected areas and severity of symptoms varies from person to person. Some types of dystonia are heritable, or genetic, while others arise without a known genetic predilection. Accurately diagnosing the type of dystonia is an important first step in providing the most effective treatment.