Movement Disorders

General Information

The Movement Disorders Clinic specializes in the evaluation and treatment of disorders of gait, coordination and other aspects of movement. Patients are seen with diseases such as Parkinson's disease, Parkinson-plus syndromes, torticollis and other dystonias, Huntington's disease, tremors, spinocerebellar syndromes, myoclonus, and all other neurodegenerative illnesses involving the cerebellum and basal ganglia. 

Patients also are evaluated for blepharospasm, hemifacial spasm, and cerebellar ataxias. Specialized care, including Botulinum Toxin is provided for all types of dystonia including torticollis, writer's cramp, musician's cramp, sialorrhea and focal dystonia in the limbs. Surgical options, including Deep Brain Stimulation (DBS), pallidotomy, and carbidopa-levodopa enteral suspension (CLES) delivered by PEF/J, are available for appropriate patients with Parkinson's disease. Multiple experimental trials to evaluate the safety and efficacy of new drugs and procedures for Parkinson's disease and Parkinson Plus syndromes are also available for appropriate patients.

Patients may be referred for a single consultation visit or for continued care and management of particularly difficult movement disorders. Other patients may be enrolled in clinical studies while continuing to receive routine medical care from their primary physicians. In all cases, the staff strives to arrange a treatment program among the patient, referring doctor, and clinic that maximizes patient care, communication and efficiency.

Our multidisciplinary team is comprised of neurologists with special expertise in movement disorders, pharmacists, nurses, social workers and a patient services coordinator. Each of these health care professionals plays a key role in making your visit as efficient and comfortable as possible.

Learn About Parkinson's Disease


Listen below to hear Dr. John Slevin and Janet Greene talk about Parkinson's Disease!


Treatment

Deep Brain Stimulation (DBS) is an FDA-approved surgical procedure that does not destroy any parts of the brain. A small electrode is surgically implanted in the brain; it emits an electrical pulse that controls erratic movements. Following the initial surgery, doctors monitor the patient's progress and adjust the electrical pulse accordingly. The multidisciplinary team at Kentucky Neuroscience Institute works with each patient to find the best course of treatment. Medication is usually the first step, but some patients don't respond to medication. In those cases, KNI offers the most advanced surgical alternatives – including Deep Brain Stimulation. For more information on DBS, Click Here

Providers

MICHAEL R. DOBBS, MD, MHCM

ZAIN GUDURU, MD

JULIE GURWELL, PA-C, PHD

LINDSEY KROMPAK NOLL, PA-C

JOHN T. SLEVIN, MD, MBA

CRAIG VAN HORNE, MD, PHD

TRITIA R. YAMASAKI, MD, PHD

Support

There are many support groups and resources available to you if you have questions about Movement Disorders. Among these are both local and national organizations along with informational courses about Parkinson's Disease. To learn more about these resources, Click Here

Clinical Trials

Below is a list of current movement disorder clinical trials. If you are interested in learning more, please contact Renee Wagner at Renee.Wagner@uky.edu.

An Open-Label, Phase 3 Study Examining the Long-Term Safety, Tolerability and Efficacy of APL-130277 in Levodopa Responsive Patients with Parkinson’s Disease Complicated by Motor Fluctuations (“OFF” Episodes) (CTH-301)

Open label study medication is used as needed and applied under the tongue to treat motor fluctuations (“OFF” episodes) between regular scheduled doses of PD medication for new patients or those who completed CTH-300 study.

INCLUSION:

1. Meaningful response to Levodopa (L-Dopa)

2. Receiving stable doses of L-Dopa/carbidopa (immediate or chronic release [CR]) administered at least 4 times per day OR Rytary administered at least 3 times per day. Other PD meds must be stable for 4 weeks prior to screening except MAO-B is 8 weeks

3. No planned medication change(s) or surgical intervention anticipated during the course of study.

4. Patients must experience at least one well defined "OFF" episode per day with a total daily "OFF" time duration of ≥ 2 hours during the waking day, based on patient self-assessment.

5. H&Y ON of Stage III or less

6.MMSE >25.

EXCLUSION:

1. Previous treatment with any of the following: a neurosurgical procedure for PD; continuous subcutaneous (s.c.) apomorphine infusion; Duodopa/Duopa; or APL-130277.

2. Treatment with any form of s.c. apomorphine within 7 days prior to the second Screening Visit (SV2). Patients that stopped s.c. apomorphine for any reason other than systemic safety concerns or lack of efficacy may be considered.

3. Currently taking selective 5HT3 antagonists (ie, ondansetron, granisetron, dolasetron, palonosetron, alosetron), dopamine antagonists (excluding quetiapine and clozapine) or dopamine depleting agents.

4. Suicidal ideations

An Open-Label Study in Subjects with Parkinson's Disease to Evaluate the Safety and Tolerability of Titration and Continuous Subcutaneous Infusion of ABBV-951 for up to 4 Weeks in an Outpatient Environment (M15-579)

Open label study medication is delivered by continuous subcutaneous infusion via external pump in patients who experience motor complications inadequately controlled by oral medications.

MAIN INCLUSION:

1. Must be between 30 to 85 years of age.

2. MMSE >24

3. Must be taking a regimen of oral medications for PD that has remained unchanged for at least 30 days before enrollment. This regimen must include levodopa-containing formulations.

4. Must be judged inadequately controlled on current therapy in the opinion of the investigator and experience a minimum of 2.5 hours of "Off" time per day as assessed by PD Diary prior to Enrollment/Day 1 (Visit 3).

5. Must have a recognizable/identifiable "Off" and "On" state (motor fluctuations) as established through observation at Screening Visit 1 (Visit 1) by the investigator and confirmed by the PD diary entries recorded during the concordance test performed in Screening Visit 1 (Visit 1).

6. 16. Subject must have no clinically relevant or significant electrocardiogram (ECG) abnormalities, including ECG with QT interval corrected for heart rate (QTc) using Fridericia's formula (QTcF) > 450 msec (males) or > 470 msec (females).

A Single Ascending Dose Study to Evaluate the Safety, Tolerability, and Pharmacokinetics of 24-Hour and 72-Hour Subcutaneous Infusions of ABBV-951 in Subjects with Parkinson's Disease (M15-738).

This is an in-patient study where patients receive a dose of study medication delivered by continuous subcutaneous infusion via external pump over either 24 or 72 hours and is for patients who experience motor complications inadequately controlled by oral medications.

INCLUSION:

1. Optimized and stable regimen or oral PD medications for at least 30 days.  Must include oral CD/LD tablets (Sinemet)

2. Between 45 and 85 years of age.

3. BMI >18.0 to < 38

A Randomized, Double-Blind, Placebo-Controlled, Phase IIa, Parallel Group, Two-Cohort Study to Define the Safety, Tolerability, Clinical and Exploratory Biological Activity of the Chronic Administration of Nilotinib in Participants with Parkinson’s Disease (PD) (NILO-PD)

The first cohort of the study is for moderate to advanced PD patients taking levodopa and the second cohort is for early untreated PD patients. 

INCLUSION:

1. Age between 40-79.

2. PD dx duration >5 years.

3. H&Y stage >2 and <4 in the ON state.

4. Stable PD medications, for at least 30 days prior to screening visit. 

EXCLUSION:

1. History of suicide attempt or suicidal ideations.

2. Participants with history of cardiac arrhythmia, long QT syndrome, or a corrected QT interval (QTc) ≥450ms at baseline.

3. Participants with a diagnosis of dementia based on the clinicians assessment, or a Montreal Cognitive Assessment (MoCA) score < 21 at baseline.

A Phase 3, Twelve-week, Multi-Center, Multinational, Randomized, Double-Blind, Double Dummy, Parallel Group Study to Determine the Efficacy, Safety and Tolerability of P2B001 Once Daily Compared to its Individual Components in Subjects With Early Parkinson’s Disease and to a Calibration Arm of Pramipexole ER.  (P2B001)

Study combining low dose combination of pramipexole and rasagiline into an extended release product (single pill) and comparing the combination product to the individual medications.

MAIN INCLUSION:

1. Age ≥35 years of age to <76 year.

2. Disease duration less than 3 years.

3. H&Y stage score of < 3.

4. MMSE score ≥ 26.

MAIN EXCLUSION:

1. History of psychosis or hallucinations within the previous 12 months.

2. Previous exposure to levodopa or a dopamine agonist for longer than 4 weeks; if previous exposure was less than 4 weeks then it must not be within 2 months prior.

3. Previous exposure to a MAO-B inhibitor for longer than 4 weeks; if previous exposure was less than 4 weeks then it must not be within 3 months prior to the baseline visit.

4. Has taken anticholinergic drugs for PD or amantadine for longer than 4 weeks; if previous exposure was less than 4 weeks then it must not be within 1 month prior to the baseline visit.

Continuation of a Pilot Study to Evaluate the Safety and Feasibility of Implanting Autologous Peripheral Nerve Grafts into the Substantia Nigra of Subjects with Parkinson’s Disease Undergoing Deep Brain Stimulation Surgery and Treatment (APGN).

Study implanting sural nerve graft into substantia nigra of PD patients who are undergoing DBS surgery.

A Randomized, Double-Blind, Placebo-Controlled Multiple Dose Study to Assess Efficacy, Safety, Tolerability, and Pharmacokinetics of ABBV-8E12 in Progressive Supranuclear Palsy (M15-562).

This is a 52 week multi-center phase 2 study using an anti-human tau antibody administered via IV infusion for PSP patients who have had PSP symptoms for less than 5 years.

INCLUSION:

1. Age>40.

2. Presence of PSP symptoms for less than 5 years.

3. Subject is able to walk 5 steps with minimal assistance.

EXCLUSION:

1. Weighing less than 44 kg (97 lbs).

2. MMSE score < 15.

3. Any contraindication or inability to tolerate brain MRIs.

4. Subject resides at a skilled nursing or dementia care facility, or admission to such a facility is planned during the study period. 

No