Movement Disorders Unit
Movement disorders are common neurological diseases that can affect young and old. Affected individuals have difficulty performing motor activities that require coordination, such as walking, eating, writing or speaking. The problems may be either slowness of movement (called hypokinesia) or the occurrence of involuntary movements or postures that interfere with voluntary movement (called hyperkinetic movements).
Movement disorders include the following diseases:
- Parkinson’s disease
- Parkinsonisms
- Tremor(essential tremor)
- Dystonia
- Korea (Huntington’s Disease)
- Tics (Gilles de la Tourette’s syndrome)
- Myoclonus
- Restless legs syndrome
- Ataxia
- Gait and balance disorders
- Functional movement disorders
The patient is evaluated by a neurologist specialized in movement disorders through a thorough clinical history and neurological examination. We have the most advanced diagnostic resources including high definition anatomical and functional magnetic resonance imaging (MRI), nuclear medicine neuroimaging (DaTSCAN, PET), neurophysiological studies and genetic analysis.
After the diagnosis, a personalized treatment plan is made, which may include:
- Pharmacological treatments
- Botulinum toxin injections guided by electromyography or ultrasound.
- Advanced therapies with continuous infusion pumps
- Possibility of participating in clinical trials with drugs not yet marketed (investigational drugs).
- Functional neurosurgery
Neuro-rehabilitation in Movement Disorders:
There is also the coordinated action of a neuro-rehabilitation team that includes physiotherapy, cognitive therapy, speech therapy and occupational therapy. The therapeutic program is planned and reviewed on an ongoing basis with the aim of improving the symptoms and quality of life of the affected person. The patient and his or her caregiver can count on our availability to ensure care throughout the disease.
Techniques and procedures related to the Movement Disorders Unit.
Indicated for patients suffering from Parkinson’s disease with motor fluctuations.
Multidisciplinary team
o We have a coordinated multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
o High-precision neuroimaging techniques for surgical target planning.
Bilateral implantation surgery of deep electrodes in the subthalamic nucleus or internal pallid nucleus.
o By means of imaging techniques, an exact localization of the deep brain nucleus that has been chosen as a target is achieved.
o Intraoperative micro-recording is performed during the operation to identify the different brain structures in real time.
o Guided by the microregistration, the definitive macroelectrodes are implanted.
o Localization is confirmed by examining the patient awake and in the operating room.
o The patient is put to sleep and the impulse generator connected to the electrodes is implanted.
Duration of treatment
– The patient is admitted to the hospital for 4-7 days.
– Initial and daily neurological evaluation during admission
– Initial and daily neurosurgical evaluation during hospitalization.
In a second phase
- 10-14 days later, the deep brain stimulation parameters are programmed and adjusted.
- During the following 3 months, close follow-up is required in order to make periodic therapeutic adjustments (electrical and oral medication),
- In this way, the maximum benefit of the surgery is obtained.
Coordination of the intervention
- A personalized report is issued and, if required, a communication with the referring physician will be made.
- At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Indicated for patients suffering from dystonia refractory to medical and botulinum toxin treatment.
Multidisciplinary team
o We have a coordinated multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
o High-precision neuroimaging techniques for surgical target planning.
Deep electrode implantation surgery in the bilateral internal pallid nucleus.
o By means of imaging techniques, an exact localization of the deep brain nucleus that has been chosen as a target is achieved.
o During the operation, intraoperative micro-registration is performed to identify the different brain structures in real time.
o Guided by the microregistration, the definitive macroelectrodes are implanted.
o Localization is confirmed by examining the patient awake and in the operating room.
o The patient is put to sleep and the impulse generator connected to the electrodes is implanted.
Duration of treatment
– The patient is admitted to the hospital for 4-7 days.
– Initial and daily neurological evaluation during admission
– Initial and daily neurosurgical evaluation during hospitalization.
In a second phase
- 10-14 days later, the deep brain stimulation parameters are programmed and adjusted.
- During the following 3 months, close follow-up is required in order to make periodic therapeutic adjustments (electrical and oral medication),
- In this way, the maximum benefit of the surgery is obtained.
Coordination of the intervention
- A personalized report is issued and, if required, a communication with the referring physician will be made.
- At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Indicated for patients with tremor refractory to medical and botulinum toxin treatment who choose conventional surgery.
Multidisciplinary team
o We have a coordinated multidisciplinary team: neurosurgeon, neurologist, neuroradiologist and anesthesiologist.
o High-precision neuroimaging techniques for surgical target planning.
Deep electrode implantation surgery in the Ventromedial Nucleus of the Thalamus.
o By means of imaging techniques, an exact localization of the deep brain nucleus that has been chosen as a target is achieved.
o During the operation, intraoperative micro-registration is performed to identify the different brain structures in real time.
o Guided by the microregistration, the definitive macroelectrodes are implanted.
o Localization is confirmed by examining the patient awake and in the operating room.
o The patient is put to sleep and the pulse generator connected to the electrodes is implanted.
Duration of treatment
– The patient is admitted to the hospital for 4-7 days.
– Initial and daily neurological evaluation during admission.
– Initial and daily neurosurgical evaluation during admission.
In a second phase
- 10-14 days later, the deep brain stimulation parameters are programmed and adjusted.
- During the following 3 months, close follow-up is required in order to make periodic therapeutic adjustments (electrical and oral medication).
- In this way, the maximum benefit of the surgery is obtained.
Coordination of the intervention
- A personalized report is issued and, if required, a communication with the referring physician will be made.
- At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Indicated for patients with tremor refractory to medical and botulinum toxin treatment who prefer non-invasive surgery.
Surgical equipment
o Latest model of Leksell Gamma Knife from Elekta.
o High-precision neuroimaging techniques for surgical target planning.
o We have a coordinated multidisciplinary team: neurosurgeon, neurologist and neuroradiologist.
Stereotactic surgery, using Elekta Leksell Gamma Knife gamma rays.
o By means of imaging techniques, an exact localization of the Ventromedial nucleus of the Thalamus is achieved.
o The procedure is performed in a non-invasive way, without incisions, without shaving the head.
o Gamma rays are used to produce a lesion of the neurons that produce the tremor.
Duration of treatment
– The patient is admitted to the hospital the day before or the same morning.
– The surgery is performed in 4-5 hours.
– The patient goes home the same evening.
Follow-up
- The effect of the surgery will be seen over the next 3-6 months.
- Tremor medication will be adjusted as the surgical treatment takes effect.
Coordination of the intervention
- A personalized report is issued and, if required, a communication with the referring physician will be made.
- At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Procedure indicated for patients with complicated Parkinson’s disease with motor fluctuations refractory to other therapeutic measures.
The purpose of this test is to identify the dose of apomorphine (a potent dopamine agonist that acts on D1 and D2 receptors and is administered subcutaneously) needed to produce a significant clinical improvement in a patient with complicated Parkinson’s disease with profound offs and refractory to oral therapy.
Treatment description
- The patient will be admitted to the day hospital, and depending on the severity of the disease, the stay will be 2-5 hours.
- For the procedure to be successful:
- A pre-treatment is performed, prior to admission, with Domperodone (60 mg), for 3 days.
- Aniparkinsonian medication is suppressed for 12 hours.
- A subcutaneous injection of 2mg of Apomorphine is administered.
- The motor response is observed and quantified, using scales. The clinical response to the different doses is evaluated by the movement disorders specialist.
- If the response received is insufficient, the dose is increased at 1-hour intervals until the adequate dose is found.
- During the test, the patient and/or family members and/or caregivers are taught how to handle the apomorphine dosing pen for subcutaneous application.
- Issuance of a personalized report and, if required, communication with the referring physician.
- Follow-up after discharge by telephone consultation.
At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Treatment indicated for patients with disabling tremor refractory to pharmacological treatment, it is an alternative to surgical treatment.
Treatment with stereotactic radiosurgery, using an Elekta Leksell Gamma Knife gamma ray system.
Treatment description
- Initial and daily neurological evaluation during admission by the Movement Disorders Program.
- Prior to admission, medical treatment is optimized.
- Continuous neurological care, in presence and localized, for the management of tremor after surgery.
Issuance of a personalized report and, if required, communication with the referring physician.
Follow-up after discharge by telephone consultation.
At all times, the Neurology Service secretary, by telephone or in person, will schedule and coordinate anynecessary complementary testsor other appointments.
Procedure indicated for patients with primary or secondary, generalized, segmental or focal dystonia such as occupational dystonia (scrivener’s cramp, musician’s dystonia), blepharospasm or cervical dystonia.
The purpose of this technique is to administer botulinum toxin (type A or type B) in order to improve dystonia, characterized by involuntary muscle spasms that produce abnormal movements and postures, as well as tremor and pain.
Treatment description
- An initial assessment of the affected muscles and their functionality is performed.
- In the same consultation, botulinum toxin is injected through a needle/electrode with electromyographic guidance to ensure precise localization of the infiltration in the target muscles of the extremities. Precision is very important to avoid side effects due to involvement of nearby muscles that are not involved in the dystonia.
- If the affected region is the face, it is infiltrated with a fine needle and electromyographic guidance is not required.
- Botulinum toxin treatment relaxes dystonic muscles, improving involuntary contractures.
- Issuance of a personalized report and, if required, communication with the referring physician.
- Follow-up after discharge by telephone consultation.
At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Procedure indicated for patients with primary muscular spasticity or secondary to spastic paralysis, cerebral ictus, demyelinating lesions, spinal cord injuries, etc.
The purpose of this technique is to administer botulinum toxin (type A or type B) in order to improve muscle spasticity, correcting forced postures and their long-term consequences (painful contractures, bone deformities, etc.).
Treatment description
- An initial assessment of the affected muscles and their functionality is performed.
- In the same consultation, botulinum toxin is injected through a needle/electrode with electromyographic guidance to ensure precise localization of the infiltration in the target muscles of the extremities. Precision is very important to avoid side effects due to the involvement of nearby muscles that are not involved.
- Botulinum toxin treatment relaxes spastic muscles and therefore corrects forced and non-functional postures (e.g. adduction of lower limbs, claw hand, equinus foot, etc.). It is safe, self-limiting and with few side effects.
- The duration of each treatment is 3-6 months.
- Issuance of a personalized report and, if required, communication with the referring physician.
- Follow-up after discharge by telephone consultation.
At all times, the Neurology Department secretary, by telephone or in person, will schedule and coordinate any necessary complementary tests or other appointments.
Our
Specialties
Movement Disorders Unit Team
Dr. Monica Kurtis Urra
Neurologist
Movement Disorders Unit Director
Dr. Marisa Almarcha Menargues
Neurologist
Associate of the Movement Disorders Unit
Dr. Isabel Pareés Moreno
Neurologist
Associate of the Movement Disorders Unit
