Movement Disorders - Rockstars

Movement Disorders - Rockstars

Dr. Alberto J. Espay
Fellowship: Dystonia Medical Research Foundation (Electrophysiology of Movement Disorders)
Master's Degree: University of Toronto (Clinical Epidemiology and Health Care Research)
Fellowship: University of Toronto (Movement Disorders)
Residency: Indiana University (Neurology )
Medical Degree: Central University of Venezuela
Bachelor's Degree: Liceo de Aplicación

Dr. Michael S Okun
Fellow in Movement Disorders and Stereotactic Surgery for Movement Disorders (Emory University, 2000-2002)
Residency - Neurology (University of Florida, 2000)
Residency - Internal Medicine (University of Florida, 1997)
Medical Degree (University of Florida, 1996)

Dr. Joseph Jankovic
MD from University of Arizona College of Medicine (06/1973 - Tucson, Arizona United States)
Internal Medicine Residency at Baylor College of Medicine (06/1974 - Houston, Texas United States)
Neurology Residency at The Neurological Institute, Columbia University (06/1977 - New York, NY United States)

Dr. Kailash Bhatia
Neurogenetics and movement disorders (UCL)
Neurology degree (University of Bombay1988)
Doctor of Medicine (University of Bombay1988)
Doctor of Medicine (University of Bombay1986)
Bachelor of Medicine/Bachelor of Surgery (University of Bombay1982)

Dr. Anthony E. Lang 
Medicine and Neurology at the University of Toronto
Fellowship with Professor C.D. Marsden at UCL

Dr. Bastiaan R. Bloem
MD degree at Leiden University (1993), and PhD (1994)
Neurology training (1994‐2000) also at Leiden University
Movement disorders fellowships at The Parkinson's Institute, Sunnyvale, California (with Dr J.W. Langston), and at UCL

Dr. Francisco Cardoso
Escola de Ciências Medicas de Alagoas, in Maceio, Brazil
Doctorate from the Federal University of Minas Gerais, where he also completed his residency. Subsequently, Dr. Cardoso undertook a clinical fellowship in movement disorders at the Parkinson’s Disease Center and Movement Disorders Clinic at Baylor College of Medicine in Houston, Texas.

Dr. Alfonso Fasano
MD from the Catholic University of Rome, Italy, in 2002 and became a neurologist in 2007. After a two-year fellowship at the University of Kiel, Germany, he completed a PhD in neuroscience at the Catholic University of Rome.

Dr. José Fidel Baizabal-Carvallo
MD in Mexico
IM and neurology at the National Institute of Medical Sciences and Nutrition, “Salvador Zubirán” in Mexico City
Fellowships in cerebrovascular disorders and Parkinson´s disease at the University of Paris in France and a fellowship in Movement Disorders in la Pitié-Salpêtrière Hospital in Paris, France. He also completed a fellowship in movement disorders and deep brain stimulation at Baylor College of Medicine in the Texas Medical Center in Houston, Texas, mentored by Prof. Joseph Jankovic

Dr. Sanjay Pandey
Medicine and neurology (Mumbai University)
Fellowship in PD and movement disorders (NINDS)

Clinical trial - ICH & NSGY

Clinical trial - ICH & NSGY

Trials
Clinical management
FAST (2008)
- factor VII for ICH
- reduces growth, but does not affect mortality or functional outcome

PATCH (2016)
- Platelet transfusion in ICH for antiplatelet is worse than standard

Minimal invasive surgery 
MISTIE (2016)
- MIS & tPA increased asymptomatic bleeding

MISTIE III (2019)
- MIS no benefit for moderate and large ICH

Surgical treatment
STICH (1998)
- surgical treatment for ICH does not have benefit

STICH II (2013)
- surgical treatment for ICH does not have benefit

Clinical trial - alteplase (tPA)

Clinical trial - tPA

Trials
EXTEND (2019)
- tPA within 9h w/ mismatch
- worse mortality and no functional improvement

Clinical trial - EVT

Clinical trial - endovascular thrombectomy

Trials
Timing
DAWN (2018)
- EVT 6-24 h after stroke w/ mismatch
- EVT better functional outcome

DIFFUSE 3 (2018)
- EVT 6-16 h after stroke w/ mismatch
- EVT better functional outcome

Additional thrombolytic
DIRECT-MT (2020)
- EVT w/ & w/o tPA has no significant difference

MR CLEAN-NO IV (2021)
- EVT w/ & w/o tPA has no significant difference

Clinical trial - tenecteplase

Clinical trials - tenecteplase

TNK versus tPA

Trials
TAAIS (2012)
- TNK better reperfusion and clincial outcomes

ATTEST (2015)
- no difference

NOR-TEST (2017)
- no difference

EXTEND-IA TNK (2018)
- TNK before EVT better reperfusion and clincial outcomes

EXTEND-IA TNK (2020)
- TNK 0.25 mg/kg same benefit 0.4 mg/kg

AcT (2022)
- no difference

TRACE-2
- no difference for non-elegible EVT

Clinical trial - ROSC & temperature control

Clinical trial - ROSC & temperature control

TTM after cardiac arrest

Trials
HACA trial (2002)
- better neurological outcome

BERNARD (2002)
- lower mortality

TTM (2013)
- non-significant

HYPERION (2019)
- worsened neurological outcome

TTM2 (2021)
- non-significant

Clinical trial - spinal cord injury & streoids

Clinical trial - spinal cord injury & steroids

Basics
- early decompression and stabilization when indicated (within 24 hours)
- MAP goal from 75-80 to 90-95 for 3-7 days after injury
- steroids are controversial
> methylprednisolone 5.4 mg/Kg/h initiated within 8 hours of injury and continued for a 24h infusion may be beneficial

Is steroids effective?

Trials
NASCIS I (1984)
- no significant difference

NASCIS II (1990)
- no significant difference

NASCIS III (1997)
- no significant difference

Cochrane reviews (2012 & 2016)
- motor function improvement

AANS/CNS guidelines
- do not recommend steroids for spinal cord injury
- not approved by FDA

Clinical trial - MMA embolization

Clinical trial - MMA embolization

Basics
Chronic subdural hematoma
- repetitive bless from torn bridging veins + formation of inflammatory neovascular membranes with a propensity to reepated ooze
- cSDH recurrence rate of up to 20%
- MMA embolization is a therapeutic approach to reduce recurrence of SDH
- MMA embolization complications: periprocedural stroke, vision loss (anastomoses between the MMA and ophthalmic artery), facial palsy

MMA vasculature
- main function: vascular supply to the dura mater and cranial bone
- MMA arises from the maxillary artery (external carotid artery)
- it enters the middle cranial fossa via foramen spinosum
- branches:
> petrosal branch: superior tympanic and cavernous branch
> anterior division: medial branch of sphenodial branch and orbital branch
> posterior division: petrosquamosal branch and parieto-occipital branch

Trials
EMBOLISE
- onyx
- lower recurrence, and less neurological deterioration

MAGIC-MT
- onyx
- lower recurrence, and lestt adverse effects

STEM
- squid
- lower recurrence

Clinical trial - large core stroke

Clinical trial - large core stroke

Definition
LVO stroke, ASPECTS > 6, and 24 window

Trials
TENSION (2023)
- decrease mortality and improve functional outcome

LASTE (2023)
- decrease mortality and improve functional outcome

TESLA (2023)
- functional improvement

RESCUE-Japan Limit (2022)
- functional improvement, and more ICH

SELECT-2 (2023)
- functional improvement, and vascular complications

ANGEL-ASPECT (2023)
- functional improvement, and more ICH

Clinical trial - ICH & BP

Clinical trial - ICH BP management

Standard versus Intensive BP management

INTERACT2 (2013)
- no mortality and no functional improvement

ATACH-2 (2016)
- no mortality and no functional improvement

INTERACT3 (2023)
- intensive BP 6h of onset ICH
- improve mortality and functional outcome