Movement Disorders Clinic:
Better Access and Novel Therapies Improve Outcomes
When you ask Helen Bronte-Stewart, MD, about Stanford’s Movement Disorder Clinic, her eyes light up. She says patients with movement issues are finding new life with improved medications, surgical interventions and exercise. When you ask her about the long waiting list to get into Stanford’s Clinic, the relief on her face is palpable. With the addition of two new clinicians, Kathleen Poston,MD and Pravin Khemani,MD, Stanford’s Movement Disorders Clinic has relieved its backlog, and is booking new patients within a few weeks of calling for an appointment.
“We’ve gone from one doctor, me, to three, and our backlog is all but gone,” says Bronte-Stewart, an associate professor of neurology at Stanford, who until recently was the sole provider available to see the plethora of patients who come to Stanford to be diagnosed and treated for movement disorders. “It’s an exciting time at the clinic,” she adds, citing Stanford’s comprehensive range of services as its standout quality, and the reason for its success.
Stanford provides one stop care for patients, and one easy call for referring physicians who need a comprehensive range of services for their patients with movement disorders. “We offer advanced diagnostic capabilities, medical and surgical treatments, balance and gait testing to monitor how patients are responding to therapies and an enhanced emphasis on exercise therapy,” says Bronte-Stewart. “We also work together with a number of other medical specialists at Stanford for patients with more complex, multi-symptomatic conditions.”
For years, a Parkinson’s diagnosis was considered a direct route to a wheelchair. With no known cure, many physicians and patients didn’t hold out much hope for managing the chronic progression of the disease. But early intervention, especially exercise, has been proven to slow down the disease and improve a patient’s quality of life, says Bronte-Stewart. “Patients with Parkinson’s are not on a path to a wheelchair. We want them to realize they can have a normal life.” Stanford sees patients with every type of movement disorder, including tremors, dystonia, multiple system atrophy, corticobasal degeneration (CBD), progressive supranuclear palsy (PSP), Huntington’s, Parkinson’s, ticks, Tourette’s syndrome,Wilson’s disease, restless legs syndrome and ataxia.
The Movement Disorder Clinic offers a comprehensive range of services
- Medical treatments
- Deep Brain Stimulation (DBS)
- Exercise Therapy
- Neuropsychological testing
- Balance and gait testing
- Botulinum toxin therapy for patients with blepharospasm, hemifacial spasm, dystonia, tremor and/or spasticity
- Feedback
Exercise: It’s good for the body and the brain
One area of increasing emphasis at the Movement Disorders Clinic is exercise therapy. Beginning with their very first appointment, patients at Stanford are started on an exercise regimen. Patients who exercise are less stiff and more toned, says Bronte-Stewart. Because Parkinson’s disease affects a patient’s ability to move, exercise helps to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson’s disease from progressing, she adds, but it can improve balance and prevent joint stiffening. Davis Phinney, a professional cyclist who developed Parkinson’s Disease in his 30s, is also an ardent subscriber to exercise as therapy. Phinney underwent deep brain stimulation surgery at Stanford with remarkable results, and has since incorporated regular exercise into his treatment plan. Phinney is just one example of the proven results Stanford is seeing with its patients who incorporate exercise into their treatment for Parkinson’s and other movement disorders. “There are a number of athletes who get Parkinson’s,” says Bronte-Stewart. “When patients engage in high-level exercise training, they can improve their condition. We try to get patients involved in exercise therapy right away.”
Balance is key
Patients who are seen at Stanford’s Movement Disorders Clinic may also undergo testing and retraining at the Stanford Human Motor Control and Balance Laboratory. This laboratory uses computerized measurements of movement to help physicians accurately diagnose movement disorders and customize therapy for patients.
Our clinicians can show a Parkinson’s patient what is upset within their system, and how they can regain some of their balance through exercise, says Bronte-Stewart. “It’s one of the things that sets us apart.”
Through testing and feedback, patients can see how any intervention - exercise, medications, DBS – is changing their disease. “We can give patients data so they can see the effects of what they’re doing,” says Bronte-Stewart. “It’s helping motivate them to continue to improve and engage in the prescribed therapies.” By combining exercise and balance retraining, patients learn how to use their brain and body in concert to improve. It’s a perfect adjunct therapy to medications, and some patients are able to gradually reduce or eliminate their medications when engaged in regular exercise.
Improved imaging
With the addition of Dr. Poston, the Movement Disorders Clinic is bringing in new neuro-imaging capabilities to pinpoint the precise circuits that are not working properly in patients with movement disorders. The Movement Disorders team uses PET scans, nuclear scans and MRI to diagnose a patient’s condition, look at motor control and balance and test patients on and off their medications to determine if they are responding to medications positively. This advanced imaging capability is especially valuable for difficult to diagnose patients or for patients who are not responding as expected to current therapies. Many disorders share similar symptoms, but may affect different circuits in the brain. Stanford is able to make a precise diagnosis for referring physicians, and help guide them in caring for their patients.
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