Movement Disorders

Movement Disorders

Treating Neurodegenerative Diseases, Close to Home

Movement disorders include a variety of neurological conditions that are defined by the patient’s loss of control of voluntary movement. These illnesses can have quite different presentations and often result in excessive movement, a lack of movement or a combination of both. Common to most of these disorders is the dysfunction of a specific region of the brain known as the basal ganglia.

In most cases, diagnosis of a specific type of movement disorder depends on the skill and experience of the neurologist. Other specialists such as psychologists*, psychiatrists, neuroradiologists*, behavioral neurologists* and rehabilitation specialists are called upon when needed.

A team approach is the cornerstone of the comprehensive Movement Disorders Program at Vassar Brothers Medical Center where advanced diagnostic tools, and medical and surgical treatment options are available for movement disorders such as Parkinson’s disease and essential tremor among many others.

Health Quest’s comprehensive Movement Disorders Program is dedicated to treatment for all neurodegenerative diseases. Under the leadership of Michael Rezak, MD, PhD, a nationally recognized neurologist and movement disorders specialist, Health Quest’s Movement Disorders Program is at the forefront of this rapidly evolving field of study and treatment. Working collaboratively with an integrated and skilled team of neurologists, neurosurgeons*, rehabilitation specialists and neuropsychologists*, the program provides cutting-edge treatment including medical and surgical options such as deep brain stimulation (DBS).

Health Quest’s Movement Disorders Program is the first and only program in the mid-Hudson Valley and northwestern Connecticut to offer highly advanced treatments that can restore quality of life and ease symptoms in patients with movement disorders.

*In the spirit of keeping you well informed, the physicians identified are neither agents nor employees of Health Quest or any of its affiliate organizations. These physicians have selected our facilities as the place where they wish to treat and care for private patients.

Conditions We Treat

Movement disorders create unique needs. We have designed an interdisciplinary program to treat your immediate symptoms provide the integrated support that will help you lead the most comfortable and healthy life possible. We treat:

  • Parkinson’s disease (PD) – PD is a neurodegenerative illness that progresses slowly and results from the loss of pigmented dopamine cells in a specific part of the brain called the substantia nigra. Diagnosis is based on clinical signs and symptoms that include the presence of tremor, stiffness, slowness and gait difficulties. It is now well recognized that other neurotransmitter systems can be affected, resulting in the non-motor features of PD which can include sleep difficulties, mood changes, thinking problems and autonomic nervous system dysfunction (inability to regulate bowel, bladder, blood pressure and temperature regulation).
  • Essential tremor (ET) – ET often manifests as a tremor in both hands and is considered the most common movement disorder. It presents while performing a task like holding an object, writing or texting. ET can occur at any age, but is usually seen for the first time between ages 40-50. It is estimated that about 50 percent of ET patients have a genetic component with other family members manifesting the same symptoms. Less commonly, ET can be seen as a head or voice tremor.
  • Chorea – Chorea is a neurological disorder that is characterized by jerky, involuntary and irregular movements that flow from one part of the body to another. These movements are often compared to dance-like movements. Chorea is frequently associated with the presentation of another primary neurologic illness. Chorea may also be caused by exposure to toxins or metabolic derangements.
  • Dystonia – Dystonia consists of involuntary, sustained or intermittent muscle contractions that result in abnormal, sometimes painful, postures. Dystonic symptoms can be focused in one area or generalized throughout the body. Dystonia may be related to medications, have a genetic cause or be related to other neurologic illnesses.
  • Huntington’s disease (HD) – HD is a hereditary neurodegenerative disease that causes abnormal, involuntary movements. HD results in gait and balance problems and progressive cognitive decline. Psychiatric and behavioral difficulties such as personality changes, mood swings and depression often occur as the disease progresses.  Genetic testing is used to confirm the diagnosis.
  • Restless legs syndrome (RLS) – RLS is a very common and treatable movement disorder that is most often characterized by an irresistible urge to move one’s legs accompanied by uncomfortable sensations during periods of rest or inactivity. Movement such as walking often relieves the symptoms. However, because symptoms occur during periods of rest, RLS will interfere with sleep resulting in significant daytime fatigue. RLS can occur in the upper extremities as well, and during daytime hours impacting one’s ability to remain gainfully employed.  RLS is classified as a sleep disorder but does arise from disordered activity in the brain circuits involved with movement. Reversible causes need to be ruled out, but RLS is most commonly is considered an idiopathic disorder.
  • Tourette syndrome (TS) – TS is an inherited neurological disorder typically diagnosed in early childhood or adolescence (between the ages of 3 and 21). Symptoms of TS present as involuntary, repetitive movements called “tics” which may include frequent, involuntary motor movements and vocalizations. These are referred to, respectively, as motor or vocal tics. Patients can partially suppress tics. Psychiatric and behavioral problems are often a component of Tourette syndrome that requires treatment. Tics can also be seen in other neurological disorders.

Treatment and Technology

Treatment Options
Effective treatment varies based on the type of movement disorder, severity of symptoms and other medical conditions that exist. An interdisciplinary, comprehensive approach using a combination of rehabilitative therapies, pharmacological interventions and, when necessary, advanced surgical options are carefully considered for each patient.

Treatment of movement disorders is truly a combination of art and science. It is the joining of experience in treating and diagnosing patients and understanding the patient’s real-world life, including work, family and social activities that shape decisions regarding appropriate therapeutic options. The goal of our treatment is to maximize functionality and improve quality of life, while minimizing immediate and long-term side effects of treatment. It is our philosophy that patients and families become educated treatment team members and fully participate in all decisions based on a thorough understanding of the goals, benefits and risks of offered treatments.

Advanced diagnostic and treatment options available at Health Quest include:

Diagnosis

  • Diagnosis is determined by experienced movement disorders neurologists.
  • Comprehensive neuropsychological testing assesses memory and cognition.
  • MRI of the brain and spinal cord and other neuroimaging techniques provide detailed visualization of areas of interest in the brain such as the basal ganglia.

Surgical Treatments

  • Deep Brain Stimulation (DBS) to reduce symptoms of Parkinson’s, essential tremor and other movement disorders.

DBS can reduce the symptoms of movement disorders and often allows for reduction in medications. DBS is a neurosurgical procedure that contributes to the relief of symptoms through the delivery of high-frequency electrical impulses to various brain sites. The impulses regulate the abnormal brain signals that produce the unwanted symptoms.

The DBS program consists of a dedicated team of experienced neurologists, neurosurgeons*, neuropsychologists* and neurophysiologists* who help determine if DBS is appropriate for a patient. If a patient is deemed a good candidate after preoperative screening, the team works together to achieve precise placement of electrodes in specific regions of the brain. DBS helps restore more normal movement. In Parkinson’s disease, placement of electrodes in the subthalamic nucleus (STN) or internal globus pallidus (GPi) can relieve tremor, rigidity, slowness and dyskinesias (involuntary extra movements). For essential tremor, electrodes placed in the ventral intermediate nucleus (Vim) of the thalamus can remarkably reduce tremor severity reduction.

When to Consider DBS in PD?

  • If medications for PD are not fully controlling your symptoms or cause undesirable side effects.
  • If medications that should control PD symptoms result in dyskinesias (involuntary extra movements) or produce erratic benefit (on and off episodes).
  • If symptoms are resistant to medications.

Other Services and Treatment Modalities

  • Botulinum toxin injections (Botox®, Myobloc®) to reduce muscle spasms and contractions in dystonia or other movement disorders
  • Second opinion evaluations
  • Neuropsychological evaluations for memory disorders
  • Counseling for patients and families
  • Specialty classes including:
    • Falls prevention
    • Wellness and exercise
    • Advance care planning
    • Healthy eating
    • Coping with memory changes

*In the spirit of keeping you well informed, the physicians identified are neither agents nor employees of Health Quest or any of its affiliate organizations. These physicians have selected our facilities as the place where they wish to treat and care for private patients.

Meet Michael Rezak, MD, PhD

Director, Movement Disorders Program