Effective treatment for movement disorders, such as Parkinson’s disease and essential tremor, requires a multidisciplinary approach to care. In this Q&A, Brian Dahlben, MD, a movement disorder specialist and neurologist, discusses how the team of experts at Duke Neurology of Raleigh collaborates to offer personalized, cutting-edge treatments for movement disorders, including participation in clinical trials. 

Dahlben: As a neurologist with a specialization in treating movement disorders, I see patients with Parkinson’s disease or other conditions, such as dystonia, ataxia, tremor, tics, dyskinesia, and functional movement disorders. I collaborate with a multidisciplinary team of physicians and specialists to offer comprehensive and personalized care for patients. Depending on the condition being treated, I offer medications and other recommendations centered around the patient’s symptoms and lifestyle. I ask patients how they spend their time, what they like to do, and what feels limiting. Then, we tailor therapies to the right dose and frequency, aiming to reduce their symptoms, which improves quality of life and functioning. We offer some of the most innovative treatment options, including those through clinical trials conducted at Duke.

Dahlben: Our team has multidisciplinary conferences regularly, so we work well together and communicate frequently about our patients’ care. The Raleigh clinic has functional neurosurgeon Stephen Harward, MD, PhD, on site and close access to support services — like physical therapy, occupational therapy, and speech therapy. Our Durham clinic at Morreene Road offers the THRIVE Interdisciplinary Clinic, where medical and therapy appointments can be scheduled on the same day. It’s convenient for patients, and it enables the clinical team to be in close communication about each patient’s progress and care plan. For individuals with Parkinson’s disease, we offer nationally certified programs for voice projection, balance, and mobility.

Dahlben: Some patients with movement disorders benefit from neuromodulation such as deep brain stimulation (DBS) or high-intensity focused ultrasound (HIFU). I work very closely with our neurosurgeons to determine if someone is a candidate for neuromodulation. During our DBS conferences, we share opinions and come to a consensus on treatment plans as a group. Patients benefit from having a neurosurgeon available for DBS and HIFU consultations in our clinic, which is more convenient. We collaborate on cases to develop a coordinated plan for moving forward. I also participate in the DBS surgery by performing intraoperative monitoring, including testing of symptoms during the procedure. This helps limit the side effects after surgery. This level of collaboration between neurologists and neurosurgeons is critical to the success of our Neurosciences Program and to ensure the best outcomes for patients entrusting us with their care.

Dahlben: We’re exploring drug trials for movement disorders. We always have studies open for Parkinson’s disease and some other rare movement disorders. Referring patients to Duke Health ensures that they have access to these trials. One of our clinical trials is exploring the first potential disease-modifying drug to treat progressive supranuclear palsy (PSP). Others are investigating treatments for multiple system atrophy (MSA), dystonia, and Huntington’s disease. A new trial is using gene therapy delivered into the brain for the treatment of Parkinson’s disease.