University of Florida Movement Disorders Center
The University of Florida Movement Disorders Center (UFMDC) was established at the Evelyn F. and William L. McKnight Brain Institute in July 2002, to bring together UF doctors and researchers with special expertise in Parkinson's disease, tremors, dystonia and other movement disorders. The UFMDC is a National Parkinson Foundation Center of Excellence and Tyler's Hope Center for Comprehensive Dystonia Care.
  • More About the UFMDC
    • MDC Directors
    UFMDC Directors: Clinical Director, Dr Rodriguez, and Center Co-Directors Drs. Fernandez, Okun and Foote

    UFMDC News and Blog

    Two UFs publish case report on L-2-hydroxyglutaric aciduria in a family

    Filed under: research — Tags: , — Chuck Jacobson on November 5, 2009

    A team from the University of Florida and the University of Freiburg in Germany collaborated for this case report:

    Int J Neurosci. 2009;119(11):2118-23.
    Tracing the origin of L-2-hydroxyglutaric aciduria in a family.
    Sass JO, Romrell JS, Vinson SY, Fernandez HH, Fischer J, Rodriguez RL, Okun MS.

    Labor für Klinische Biochemie und Stoffwechsel, Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Mathildenstr. 1, 79106, Freiburg, Germany.

    We describe late diagnosis of an adult with L-2-hydroxyglutaric aciduria (MIM 236792) on the basis of characteristic metabolite data and mutation analysis in the L2HGDH gene. The patient lacked MRI abnormalities which have been purported to be constant or typical findings in this disease. We further report the genetic status of his parents and his one living sibling. Our observations underline the clinical heterogeneity of the syndrome of L-2-hydroxyglutaric aciduria. This report emphasizes the diagnostic benefit of the assessment of urinary organic acids not only in children, but also in adult patients with unexplained neurological symptoms. The patient was determined to be compound heterozygous for two novel missense mutations in exon 4 of the gene (c.418G>C, c.446T>G), resulting in amino acid exchanges from alanine to proline (p.Ala140Pro) and leucine to arginine (p.Leu149Arg), respectively. The mother of our patient was heterozygous for Ala140Pro, and the father heterozygous for Leu149Arg only. Mutation analysis of a healthy 49-year-old third son of the non-consanguineous parents revealed a normal exon 4.

    PubMed Link

    Gainesville’s Fraternal Order of Eagles Raise Money for UF MDC

    Filed under: research — Michael Okun on November 1, 2009

    On Friday Night Oct 30, 2009 Charlie and Michael Sperrazza presented the UF Movement Disorders Center with a $5000 dollar check to support research. The Eagles have been amazingly loyal supporters of the MDC and their contributions over the years have helped keep the creative research spirit alive and prospering. This year the Eagles received $4000 from the central Eagles office to match their $1000 contribution. We can’t thank them enough for all their support (over many years) of the UF MDC! Go Gators!

    UF Publishes Study on ER Encounters and DBS

    Filed under: research — Tags: , , — Michael Okun on October 14, 2009

    UF just published a study in this month’s Journal of Neurology citing that most ER encounters are not DBS related– We must remember to take care of the whole patient. The first author was Andrew Resnick! Abstract follows:

    J Neurol. 2009 Oct 8. [Epub ahead of print]

    The number and nature of emergency department encounters in patients with deep brain stimulators.

    Resnick AS, Foote KD, Rodriguez RL, Malaty IA, Moll JL, Carden DL, Krock NE, Medley MM, Burdick A, Haq IU, Okun MS.
    Department of Neurology, University of Florida, Gainesville, USA

    Deep brain stimulation (DBS) has become an increasingly common modality for control of several neurological disorders such as Parkinson’s disease, dystonia, essential tremor (ET), and others. Our experience has demonstrated the need for emergency physicians to familiarize themselves with the potential complications of the DBS device as well as the device itself. Therefore, our aim in this paper was to elucidate the number and nature of DBS and non-DBS presentations to the emergency department (ED) and to educate and familiarize ED physicians about DBS devices and their potential complications. We also aimed to devise a simple protocol for DBS management so that all ED physicians would have access to the knowledge or referral capabilities when managing a DBS patient. The objective of the present study was to review the number and nature of ED encounters in patients with deep brain stimulation (DBS) devices implanted for movement and neuropsychiatric disorders. Methods: The series of encounters reviewed included 215 unique patients with DBS implantation who were identified using an IRB approved database and a paper chart review. Patients in the study included those implanted at University of Florida (UF), as well as those implanted at outside institutions, so long as they were followed at UF. The cohort included n = 215 DBS patients. 25.6% of all 215 patients presented to the ED at least once, with the most common presentation occurring as a result of a decline in mental status when taking into account all visits (6%). Reasons for presentation to the ED included neurological (54.6%), infections/hardware issues (27.9%), orthopedic/focal problems (10.5%), and medical issues (7%). In total, 29 patients arrived at the ED for DBS related issues (23.2%). Of those who presented to the ED (n = 55), the average age was 53.1 (range 10-80 years). Headache was the most common complaint within the neurological category (22.1%), followed by change in mental status (15.1%), and syncope (9.3%). When examining the data by ED diagnosis, change in mental status occurred most commonly in Parkinson’s disease (19.6%). Falls were most common in essential tremor (27.2%), and headache occurred most commonly in the dystonia group (52.1%). Across all diseases, mental status change was the most common indication for an ED encounter (6%). Parkinson disease patients most commonly presented with altered mental status (8%), essential tremor patients revealed a high preponderance of falls (6.5%), and dystonia patients tended to present with headache (7.1%). It was concluded that a large number of patients with DBS will present to the ED for many reasons, the majority of which will not be direct complications of their DBS device. Neurological issues were the most common chief complaint, with individual differences depending on the underlying disease. It is important for ED physicians to consider non-DBS related complaints in the presentation of these unique patients since these issues comprise the majority of the ED visits. However, when properly evaluating these patients, management of their DBS device, or referrals to neurosurgery and neurology, if necessary, are imperative. In addition to device management, regular ED standards of care should apply to this special cohort of patients.

    Canada’s Globe & Mail interviews Michael J. Fox on his Foundation

    Filed under: research — Chuck Jacobson on October 2, 2009

    Michael J. Fox sits down with the Globe and Mail to talk about Parkinson Disease and his research foundation.

    The foundation demands that scientists share results and tools, and it closely monitors their work. But it also encourages them to take risks, devoting roughly $2-million a year to a rapid-response fund that gets money quickly into the hands of scientists who come up with new ideas.

    In less than six weeks, a scientist can have the seed money to test out a hypothesis and see if it is worth pursuing. Most of the time, it doesn’t pan out, which is why government funding agencies prefer to support research that will lead to steady but incremental advances.

    Read the whole interview here…

    UF scientists construct ‘off switch’ for Parkinson therapy

    Filed under: research — Tags: , , , , — Chuck Jacobson on August 31, 2009

    Please read the complete article here. Excerpts follow:

    Together, the findings suggest that gene therapy to enable the brain to retain its ability to produce dopamine, a neurotransmitter that falls in critically short supply in Parkinson’s patients, could be safely attempted during earlier stages of the disease with an added likelihood of success.

    …

    “We have worked every day for 10 years to design a construct to the gene delivery vector that enhances the safety profile of gene transfer for Parkinson’s disease,” said Ronald Mandel, a professor of neuroscience at UF’s McKnight Brain Institute and the Powell Gene Therapy Center. “With that added measure of safety, we believe we can intervene with gene transfer in patients at earlier stages of the disease. We strongly believe that trials to save dopamine-producing connections in patients with Parkinson’s disease have failed because the therapy went into patients who were in the late stages of the disease and who had too few remaining dopamine-producing connections.”

    …

    “With this technique, you could adjust the therapy in the patient,” said Fredric P. Manfredsson, a postdoctoral associate in UF’s department of neuroscience. “That would be extremely helpful because no one is really certain yet what dosage is required for a protective effect in humans. The process is also much more sensitive than we had imagined it would be. GDNF production can be shut down completely with a dose of doxycycline that is much smaller than what is commonly prescribed.”

    FGATIR – New imaging method for visualizing DBS targets developed at UF

    Filed under: research — Tags: , , , — Chuck Jacobson on June 24, 2009

    We have recently developed and employed a Fast Gray Matter Acquisition T1 Inversion Recovery (FGATIR – pronounced F-gator) 3T MRI sequence to more reliably visualize the structures targeted in deep brain stimulation. You can see comparative screenshots of the FGATIR vs T1 and T2 FLAIR on the FGATIR page.

    FGATIR

    Coronal images of subcortical structures in the A) T1-w 3D MP-RAGE, B) T2-w 3D FLAIR, C) T1-w FGATIR, and a Sagittal image D) T1-w FGATIR with deformable atlas contours overlaid. The contour colors for the deformable atlas are (from most anterior to most posterior): striatum (blue), GPe (green), anterior commissure (black), GPi (red), optic tract (yellow), thalamus (green), various VL thalamic nuclei (green), STN (red), and SNr (black).

    Learn more about Deep Brain Stimulation surgery.

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    Medicine - Our physicians see dozens of patients each week in the UF Movement Disorders Clinic.

    Surgery - University of Florida neurosurgeons use deep brain stimulation and other techniques to treat patients with Parkinson's Disease and other movement disorders

    Education - Fellows, medical students, graduate students and pre-meds learn about movement disorders while working at the UFMDC and shadowing our physicians.

    Research - Researchers from multiple disciplines work together to find new and better treatments for movement disorders while looking for causes and cures.

    Why go to the University of Florida for your Parkinson's or Movement Disorders surgery?

    Answer: Because the UFMDC has one of the largest interdisciplinary teams in the world dedicated to making sure your deep brain stimulation device is placed correctly.

    You will see a fellowship trained movement disorders neurologist, a fellowship trained movement disorders neurosurgeon, and you will receive the best possible medical optimization. Additionally, you will have access to a complete interdisciplinary team of experts in every area (speech, voice, walking, balance, memory, depression/anxiety disorders, rehabilitation, driving, occupational therapy, etc.) who specialize in the care of Parkinson's and Movement Disorder Patients.

    We will ensure you are the right candidate, and discuss with you in detail what symptoms we think you can expect to improve with a deep brain stimulation surgical therapy. Your case will be discussed in detail with the interdisciplinary team prior to any surgical intervention. In addition we will provide a top-notch operating room experience with a neurologist, microelectrode multiple pass mapping, and careful imaging and guidance for the proper placement of your device. After it is implanted you will have full access to a dedicated staff for programming and followup of your medication and DBS needs. Should you have any problems we are always available to help you.

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