Subspecialty Programs

Movement Disorders

Joseph Friedman, MD is a clinical professor and serves as the department's movement disorder specialist. 

Below is a list of common movement disorders treated at the Parkinson's Disease and Movement Disorders Center.

• Parkinson’s Disease
• Atypical Parkinsonism (Progressive Supranuclear Palsy, Multiple System Atrophy)
• Dystonia
• Essential Tremor
• Huntington’s Disease
• Drug induced movement disorders
• Gait disorders
• Tic disorders
The initial evaluation at the Center is a comprehensive assessment that includes:
• A thorough medical history and physical examination by a movement disorders specialist
• Careful assessment of motor function
• Additional tests, including blood tests and other specialized procedures such as brain imaging and genetic testing that may be needed  as well.
• If needed, neuropsychological tests will be arranged.
A thorough follow-up evaluation is done every 3 to 6 months. Patients may be seen more frequently when necessary. 

Botulinum Toxin Clinic

Botulinum toxin injection therapy is available for patients with blepharospams, hemifacial spasms, cervical dystonia/torticollis and other medical indications.

Surgical Treatment

The Parkinson’s Disease and Movement Disorders Center offers a comprehensive functional neurosurgical program for the surgical treatment of movement disorders in collaboration with the Brown University Department of Neurosciences, Rhode Island Hospital and Butler Hospital.  Surgery is considered when medical treatment proves unsatisfactory.  A relatively new neurosurgical procedure, deep brain stimulation (DBS), can relieve symptoms of PD, essential tremor or dystonia by delivering an electrical signal through an electrode that is placed into a specific area of the brain (basal ganglia or thalamus).

Deep brain stimulation surgery is considered for patients with PD if they still achieve some benefit from their medication, but have significant motor fluctuations or wearing-off.  Patients with PD may also be considered candidates for surgery if they have severe tremor that cannot be controlled with medications.  We also offer DBS to patients with essential tremor whose tremors are uncontrolled despite adequate trials of several medications, and patients with dystonia who have significant disability despite adequate trials of antispasmodic medications or botulinum toxin (Botox) injections.

All patients undergo a comprehensive evaluation prior to being recommended for the deep brain stimulation procedure, as follows:

• A thorough history and physical examination by a movement disorders neurologist including a review of records from your current neurologist.
• A detailed assessment by a movement disorders neurosurgeon
• MRI of the brain to make sure there are no other reasons that could explain the patient’s symptoms.
• A detailed neuropsychological and psychiatric evaluation to make sure there is no dementia or untreated depression.

Research

As members of the Parkinson Study Group, we are at the cutting edge of PD research and participate in many multi-center and international clinical trials in an effort to find new treatments to alleviate symptoms and slow the progression of PD. We also conduct our own research on specific problems in PD such as freezing, fatigue, sleep, depression and behavioral complications.

We are an active member of the Huntington Study Group and conduct clinical trials in Huntington’s Disease, putting us at the forefront of Huntington’s research. These clinical trials focus on finding ways of slowing down the progression or preventing the expression of this condition.