Deep brain stimulation, continuous levodopa infusion among topics
Four fellowship-trained movement disorders neurologists from UT Health San Antonio will give talks Friday (Jan. 27) at the Parkinson’s Foundation Tri-State Symposium. These physicians will discuss the newest developments in research and clinical trials of Parkinson’s disease and other disorders. The symposium, free and open to the public, is offered in person and online. Register here.
The UT Health San Antonio speakers are from the Department of Neurology in the Joe R. and Teresa Lozano Long School of Medicine and see patients of the UT Health Physicians neurology practice. They are:
- Okeanis Vaou, MD, associate professor and movement disorders program director; specialties: deep brain stimulation and sleep medicine
- Juan Ramirez Castaneda, MD, associate professor; specialties include deep brain stimulation
- Sarah Horn, MD, assistant professor who occupies the Maj. Gen. Ret. Joe and Patty Robles Professorship in Parkinson’s disease; specialties: treatment of Parkinson’s dementia, treatment of hallucinations, deep brain stimulation
- Pablo Coss, MD, assistant professor; specialties: Huntington’s disease (he leads the division’s Huntington’s Disease Center of Excellence), deep brain stimulation
Vaou, fellowship-trained in movement disorders and in sleep medicine, joined UT Health San Antonio in September 2022. She discussed what the movement disorders program offers South and Central Texas patients.
“UT Health San Antonio is the only academic movement disorders center in the area,” Vaou said. “We treat Parkinson’s disease, essential tremor, dystonias, Huntington’s disease and other disorders. Therapies include botulinum toxin (Botox) injections, medications and deep brain simulation, which is surgical therapy for Parkinson’s, dystonias and essential tremor.”
The movement disorders program is soon to launch human clinical research studies of:
- Medications to control tremor.
- Medications to delay disease progression.
- Medications to prevent bone fractures from falls.
- Medications used in hallucinations and Parkinson’s dementia.
“Later this year we will have those clinical trials started and enrolling,” Vaou said. To see a physician of the center or inquire about clinical trials, call 210-450-9700.
The movement disorders program features a strong multidisciplinary team of physical therapists, occupational therapists, speech pathologists, inpatient and outpatient rehabilitation medicine specialists, and neuropsychologists for evaluation and counseling.
The center also provides a movement disorders fellowship to train new movement disorder specialists coming out of their neurology residency programs. Horn is the fellowship director.
Deep brain stimulation
DBS was approved for treatment of Parkinson’s disease in 2002. “We have tremendous knowledge compared to what we did back 10 years ago,” Vaou said.
The movement disorders program collaborates with Alexander Papanastassiou, MD, associate professor of neurosurgery in the Long School of Medicine. After extensive preoperative planning to pinpoint sites of the brain where DBS is needed, surgery is performed at UT Health San Antonio’s clinical partner, University Hospital. Papanastassiou implants DBS electrodes in the exact locations in the brain.
Entry is gained through two dime-sized holes. The surgery is minimally invasive to enhance rapid recovery with the least pain, blood loss and hospital time. Depending on the patient’s hairline, the only external mark may be a little bump on the skin.
“DBS has always worked very well, and the last five years have provided several leaps in technology,” Vaou said. “It’s kind of like the smartphones that keep on upgrading. We can steer the stimulation precisely to where we want it to go.”
This prevents stimulation of areas that would cause side effects.
“The other thing we are excited about is the ability of new DBS technology to capture sensor readings in the brain 24/7/365,” Vaou said.
“When the patient comes in, we can analyze their recordings over days, weeks and months, and we have an electronic diary of their movement symptoms. With that, we understand whether they are well-controlled or not well-controlled and adjust their setting, which allows for custom, individualized treatment.
Previously, DBS was programmed based on the patient’s memory and narrative of symptoms. “But now we have objective data,” Vaou said.
Anticipating FDA approval of another therapy option
Vaou and the other specialists are excited to soon offer movement disorders patients a new treatment alternative called subcutaneous, continuous infusion of levodopa. Levodopa is a frontline medication used to treat Parkinson’s disease and other disorders.
“Results of a multicenter clinical trial have come out and are really good,” Vaou said. “We await FDA (U.S. Food and Drug Administration) approval later this year. This is a pump implanted under the skin that keeps infusing levodopa while the patient is doing other things, not having to think about taking medications.”
The movement disorders program will add this therapy to its offerings once FDA grants approval, Vaou said.