The Movement Disorders Fellowship Program at Beth Israel Deaconess Medical Center (BIDMC) was established in 1999 and has a distinguished record of training fellows who have gone on to academic leadership positions and includes several who are directors of movement disorders centers. Our movement disorders division continues to grow and includes a highly productive group of clinician-researchers with multidisciplinary clinical, research expertise with leadership roles at several National and International organizations. We offer a two-year comprehensive Movement Disorders Clinician-Scientist Fellowship training program personalized and designed to prepare top candidates for academic careers in clinical and translational research in PD and other movement disorders. Our fellows have extensive training in brain stimulation therapies for PD and other movement disorders. Ours is the oldest DBS surgery program in Boston. We have a dedicated DBS Center with a multidisciplinary team with several unique patient programs offered through our PD center of excellence. Our fellowship training is catered to the needs and structured to best suit the goals of our trainees, thus greatly enhancing our ability to prepare future clinician-scientist leaders in PD for academic careers. Our training is focused on innovative movement disorder research, brain stimulation and clinical care. The multidisciplinary and highly collaborative clinical and research environment here at the Harvard Medical School provides our fellows the wherewithal for a successful career in academic neurology.
Prerequisite Training
Candidates must complete a three-year ACGME accredited Residency Training Program in Neurology prior to starting the Movement Disorders fellowship. Clinical fellows are required to be licensed to practice medicine in Massachusetts prior to beginning the fellowship.
Goals and Objectives for Training
The educational purpose of the Movement Disorders Fellowship is for the fellow to progressively gain the clinical knowledge and skills necessary to diagnose and manage a wide range of movement disorders.
- Develop expertise in the diagnosis and treatment of movement disorders in different settings (emergency, inpatient and outpatient), including diagnostic evaluation, treatment, management, counseling and prevention of:
- Parkinson’s disease
- Huntington’s disease
- Dystonia
- Tremor
- Myoclonus
- Tics
- Gait disturbances
- Chorea
- Tardive dyskinesia
- Functional Movement Disorders
- Other disorders of the basal ganglia
- Demonstrate physical examination skills to elicit physical findings to aid in the diagnosis of a movement disorder.
- Understand the pharmacology of commonly used medications for treatment of various movement disorders.
- Understand the basic anatomy and pathophysiology of the basal ganglia as it pertains to movement disorders.
- Develop competence in the therapeutic use of botulinum toxin injections for dystonia, hemifacial spasm, and related disorders.
- Develop competence in screening, pre-operative evaluation and post-operative care for patients receiving deep brain stimulation.
- Work effectively with multidisciplinary teams oriented to the care of these patients.
- Order and interpret of laboratory and imaging tests in patients with movement disorders.
- Understand basic principles of objective evaluation of Movement disorders using clinical neurophysiologic techniques such as tremor analysis, jerk-like movement (myoclonus) recordings, etc.
- Develop a core of clinical and basic science knowledge relevant to the field of movement disorders.
- Understand the latest advances in human genetics and translational aspects of multi-omics data applied to clinical and translational research in Movement disorders.
- Evaluate biomedical and clinical literature relevant to movement disorders.
- Develop the capacity to pursue an academic career in the field of movement disorders.
Curriculum
There are more than 2,000 outpatient visits by movement disorders patients to our center each year. Our patient population provides an excellent clinical and research base. BIDMC is a Center of Excellence for the Parkinson Foundation and Huntington Disease Society of America.
We have a computer-based electronic medical record system for access to our clinical records and research database. The Parkinson’s Disease and Movement Disorders Center is involved in many research projects, including clinical trials for treatment of Parkinson’s disease and other movement disorders.
Fellowship training includes clinical experiences at Beth Israel Deaconess Medical Center. Pediatric patients with movement disorders are seen with a collaboration with Boston Children’s Hospital once monthly. All other clinical activities take place at BIDMC.
Our neurology fellowship program also has strong collaborative services in neurosurgery, sleep neurology, behavioral/cognitive neurology, autonomic testing lab, palliative care, and psychiatry with opportunities for multidisciplinary clinical training and research.
Clinical and Research Components
Fellows spend about 70% of the first year mainly in direct patient care in the outpatient setting comprehensive training in the evaluation and treatment of a rich and wide variety of movement disorder patients and rarely inpatient consultations.. Clinical care is about two half day sessions per week in the second year of fellowship and adapted based on the clinical interest and research to be pursued. The structure of the fellowship training is adapted to best suit the clinical and research needs of the trainee.
Patient Care Responsibilities
Fellows see approximately 8 to 10 new patients and 15 to 20 follow-up patients weekly. They are responsible for conducting the clinical history and examination, concisely summarizing the case, and making diagnostic and treatment plans with attending guidance and supervision with each visit.
Additionally, fellows are responsible for the occasional inpatient consultations as well. Fellows are also responsible for ongoing care and correspondence with patients that may occur in between clinical visits.
Didactic Components
There is a weekly session that rotates through video conference, journal club, DBS team meetings, Parkinson Foundation Center of Excellence meetings and guest lecturers are scheduled once a month, so that there is a didactic session once a week. Fellows will also help with the teaching of residents and medical students. There is a weekly session with the fellowship director.
Our team includes the following specialty areas: Neurology, Neurosurgery, Rehabilitation medicine (including occupational, physical, speech, voice, swallowing, and cognitive therapy), Neuropsychiatry, Neuropsychology, Sleep disorders, Autonomic disorders, Neurogenetics, Social work and community resource specialists, Urology, and Palliative Care.
Clinical Experiences and Faculty Preceptors
Parkinson’s Disease Multidisciplinary Care: Ours is one of the PD Centers of Excellence and our program offers several unique patient and caregiver support groups. We have won several awards for the unique PD and caregiver programs offered through our center. We have a monthly interdisciplinary care meetings offered to all our PD and atypical PD patients, attended by our Movement disorders faculty, psychiatrists, palliative care specialist, PT, OT, social work and speech pathology. All movement disorders faculty are involved in the clinical care of PD patients at our center.
Movement disorders surgery program: Ours is the oldest Deep Brian Stimulation surgery programs in Boston, co-directed by Dr. Lan Luo and Dr. Ron Alterman. Fellows are trained in all aspects of DBS surgery beginning with patient selection, surgical planning, intraoperative neurophysiologic mapping, post-operative programming, and care of patients under direct supervision of Drs. Luo, Merchant and Simon. Our program has 2 functional neurosurgeons Drs. Alterman and Aronson. Fellows also gain extensive experience in troubleshooting complex cases referred to our highly experienced center. Our monthly multidisciplinary DBS meetings for discussing surgical candidates is attended by movement disorder neurology faculty, neurosurgery, neuropsychiatry, speech pathology, students, and research/administrative staff. We also have a monthly journal club for discussing invasive and non-invasive brain stimulation treatments for movement disorders. Our DBS surgery program also has a clinical and neuroimaging database for all our DBS patients.
Dystonia Center for Comprehensive Care and Botulinum Toxin Clinic: Our center is an active member of the Dystonia Coalition, and our faculty members are active members and serve leadership/advisory roles at Dystonia Medical Research Foundation. Our center offers multidisciplinary and comprehensive care for dystonia. Fellows are trained in the performance of EMG and ultrasound guided botulinum toxin injections under supervision of Drs. Samuel Frank, Shabbir Merchant and Lan Luo. Surgical treatments such as DBS are offered to medication and botulinum toxin injection refractory patients. Fellows gain expertise in the treatment of all types of dystonia and spasticity from different etiologies such as post-stroke, cerebral palsy, post-trauma, etc.
Huntington’s Disease Center of Excellence: We are a HD center of excellence and provide multidisciplinary care for patients and families affected by HD. Dr. Samuel Frank co-chairs the HD society of America and also directs our HD Center. Our center participates in several cutting edge clinical and basic science research for treatment of HD and has philanthropy research support for fellows interested in pursuing research on clinical and pathophysiologic aspects of HD.
Motor Control Physiology and Clinical Neurophysiology in Movement Disorders: We offer a truly unique training experience in the objective recording of movement disorders using clinical neurophysiologic techniques such as tremor analysis, myoclonus and other jerk movement recording, etc. for objective characterization and phenotyping of movement disorders. Dr. Merchant who co-chairs the MDS Task Force on Clinical Neurophysiology in Movement Disorders is directly involved in training of fellows in learning these techniques. Fellows can learn other clinical neurophysiologic techniques such as transcranial magnetic stimulation, peripheral and central measures of nervous system excitability and plasticity.
Cognitive Neuroscience and Behavioral Neurology: Dr. Dan Press is the chief of Cognitive Neurology Unit and is dual trained in cognitive neurology and movement disorders. Fellows can gain experience in evaluation and treatment of dementia and other behavioral disorders in Parkinson’s disease, Lewy body dementia and other neurodegenerative disorders. Fellows can collaborate with faculty and trainees in Cognitive Neurology Unit.
Atypical Parkinsonism Clinic: Fellows can work with Dr. Veronique Vanderhorst whose laboratory does novel work in understanding circuitry and neuropathology of atypical Parkinsonism.
Autonomic Testing Laboratory: Fellows can work with Dr. Roy Freeman and Dr. Chris Gibbons to learn autonomic testing and performing skin biopsy for diagnoses of typical and atypical Parkinsonism.
Research Environment
BIDMC is a 649-bed tertiary care hospital and one of the three flagship teaching hospitals of HMS. BIDMC consistently ranks among the top three recipients of biomedical research funding from the NIH. The 50 full-time faculty members in the Neurology Dept have total annual NIH funding of over $14M direct. The Movement Disorders Center includes a diverse group of faculty members:
Dr. David K. Simon is the Movement Disorders Division Chief and has had leadership roles in the Parkinson’s Study Group (PSG). He performs basic and translational research on mitochondrial dysfunction and neuroprotection in PD as well as clinical disease modification research in PD. Dr. Simon is a member of the NINDS “PD-BRAC” biospecimen review access committee. He also is Chair of the Cure Parkinson’s Trust’s “international Linked Clinical Trials” Committee, and Chair of the Scientific Advisory Board of the Weston Brain Institute.
Dr. Shabbir Merchant, is the fellowship director and his research interests include motor control physiology, invasive/non-invasive brain simulation, motor learning and developing novel treatments for movement disorders. He co-chairs MDS Task Force on Clinical Neurophysiology and directs the motor control physiology laboratory involved in objective evaluation of movement disorders using clinical neurophysiologic techniques such as tremor analysis, myoclonus and other jerk-like movement recordings, etc. which is a unique offering for trainees in USA interested in clinical neurophysiology of movement disorders.
Dr. Samuel Frank has conducted well over 50 clinical and industry sponsored clinical trials. He is the Director of Clinical Research Network Development at BIDMC, and currently has several ongoing clinical trials for treatment of PD, HD, dystonia, ET. He co-chairs of the Huntington Study Group Executive Membership Committee.
Dr. Veronique Vanderhorst performs basic research on neural circuitries in the brainstem mediating gait, sleep disordered breathing and dystonia. In parallel translational clinicopathological studies she correlates key metrics of walking and tone, and of breathing and arousal from sleep in the elderly with AD, PD and other neuropathologies.
Dr. Bruno A. Benitez is a human geneticist and does novel work in understanding pathophysiology of neurodegenerative disorders using patient-derived multi-omics (genomics, transcriptomics, proteomics and metabolomics) along with disease modeling in iPSC and mouse models. He is also leading biorepository development efforts for neurodegenerative disorders such as PD .
Dr. Lan Luo, along with neurosurgeon Dr. Ron Alterman, directs the deep brain stimulation (DBS) program, carries out clinical outcomes research, and studies DBS treatment for various movement disorders. Dr. Luo’s research is focused on using functional and structural connectivity to understand the neural circuitry for gait disorders including freezing of gait in PD; her work has been funded by the Parkinson’s Study Group.
Dr. Daniel Press is the chief of Cognitive Neurology Unit and cognitive neurology core at the Berenson-Allen center for non-invasive brain stimulation. His research interest include developing treatments and understanding motor learning for neurodegenerative disorders such as Parkinson’s disease, Alzheimer’s disease and other neurodegenerative disorders.
Dr. Roy Freeman and Dr. Chris Gibbons carry out investigations of skin, small nerve fiber and autonomic biomarkers of Parkinson’s disease and MSA.
Dr. Clifford Saper is the past Chair of Department of Neurology here at BIDMC and his laboratory has made significant contributions to our understanding the impact of loss of dopamine and norepinephrine neurons on sleep wake cycles. His laboratory is currently investigating the impact of alpha synuclein deposition on wake-sleep and circadian regulatory systems.
Fellows are expected to develop their research interests. They are strongly encouraged to develop collaborative research projects with our extensive faculty within and outside our division. This can involve original clinical, translational, or basic research under the supervision and mentorship of the movement disorders faculty. If successful, fellows are guided to apply for funding for further support.
Fellows are encouraged to present research findings at annual national and international conferences such as the Movement Disorders Society or the American Academy of Neurology. Fellows can also participate in the ongoing and planned industry and investigator initiated clinical trials with an option to serve as co-investigators. They get to experience all aspects of participation in clinical trials beginning with the approval process with the Institutional Review Board, patient recruitment and conduction of clinical trials.
The research environment is highly collaborative with numerous opportunities for research projects within and between each areas outlined above, with highly experienced mentors available for basic, translational, and clinical research. Our center’s close ties to the National Parkinson’s Foundation, Huntington’s Disease Society, Dystonia Coalition, Dystonia Medical Research Foundation, Huntington’s Study Group, Parkinson’s Study Group provide additional opportunities for establishing collaborative research projects that extend beyond our center.
How to Apply
We participate in the San Francisco Match program (sfmatch.org).
Applicants should register with SF Match and send their application materials directly to SF Match, including a CV, short personal statement, and three letters of reference. Registration opens April 1 and interviews will take place from May to July.
For questions about our program, please email: wkanello@bidmc.harvard.edu
Diversity Equity and Inclusion
Our Program regards values and issues related to DEI highly and has taken several steps and has been highly innovative in implementing several programs. Our PD center of excellence was awarded the patient advocacy award for the LGBTQ community. Our current team of faculty have diverse clinical, cultural, demographic and racial backgrounds and we uphold DEI principles in our search of fellows. Our center also has several programs such as “For and About Women” focused on issues and struggles of women patient and caregivers dealing with PD. We also have “Calling All Artists” program which brings PD patients and caregivers together and is a “beyond the pill box” way to maintain wellness in PD patients with artistic pursuits.
Faculty
Shabbir Merchant, MD (Fellowship Director)
David Simon, MD, PhD, Chief, Movement Disorders
Samuel Frank, MD
Veronique VanderHorst, MD, PhD
Lan Luo, MD (co-director DBS program)
Bruno A. Benitez, MD
Daniel Press, MD
Clifford Saper, MD, PhD
Ron L. Alterman, MD (Chief of Neurosurgery, co-director DBS program)
Joshua P. Aronson, MD (Functional Neurosurgeon)