Innovations in the Treatment and Care of Movement Disorders

Neurology is at the forefront of innovations which are transforming the treatment landscape for movement disorders. Breakthrough discoveries in neurogenetics, neuroimmunology, and neuromodulation have produced better therapeutic options for neurodegenerative diseases and neurologic conditions. Neurologists are hard at work cultivating relationships and networking with academic institutions and pharmaceutical companies to develop therapeutic options for dreadful conditions that, up until now, were untreatable. This issue reviews the latest updates in the treatment and care for several neurologic conditions: Parkinson disease, essential tremor, Friedreich ataxia, and tardive syndromes, and the role of neuromodulation and rehabilitative medicine in the treatment of movement disorders.

Our issue starts with an article about the pharmacotherapy of Parkinson disease by Dr. Anh-Thu Ngo Vu. Dr. Vu discusses the medical management of early and advanced Parkinson disease and considerations for motor and non-motor symptoms. The article is an excellent review for healthcare providers who care for patients afflicted with the world’s second-most common neurodegenerative disorder.

Next, Shaila Ghanekar and I discuss treatments for essential tremor, one of the most common movement disorders in the world. Although essential tremor continues to be treated with traditional medications, including beta-blockers and anti-epileptic medications, neuromodulation procedures such as deep brain stimulation (DBS) and MRI-guided focused ultrasound surgery (MRgFUS) are now available to treat medically refractory essential tremor. Additional clinical trials are underway to find innovative methods to treat this condition.

Members of the University of South Florida Neuromodulation Center, including Drs. Yarema B. Bezchlibnyk, Oliver Flouty, Jay I. Kumar, Keaton Piper, and Donald A. Smith review surgical options for Parkinson disease, essential tremor, and dystonia, including DBS, lesioning with radiofrequency ablation, stereotactic radiosurgery, and MRgFUS. Dr. Smith is a pioneer in DBS for treating essential tremor, having performed one of the first DBS procedures in North America in 1993. The article is a fantastic review of the state of the art neuromodulation options for movement disorders.

Nowhere is the exciting, innovative world of therapeutics more evident than with Friedreich ataxia, a rare and devastating genetic disease that affects children and adults. Shaila Ghanekar and I discuss the pathophysiology and treatment of Friedrich ataxia. This year, 2023, saw the first Food and Drug Administration (FDA) approval of a drug, omaveloxolone (Skyclarys; Reata Pharmaceuticals, Plano, TX), to treat Friedreich ataxia. Although the medicine is not curative, its acceptance by the FDA and its ability to improve symptoms mark a breakthrough in therapeutics for this disease.

Next, Drs. Sasivimol Virameteekul and Roongroj Bhidayasiri discuss emerging treatments for tardive syndromes. With the significant rise in antipsychotic prescribing in the United States, it is estimated that at least 5 million people are exposed to antipsychotics annually, potentially leading to tardive syndromes. These syndromes typically lead to lower quality-of-life outcomes for affected patients. The authors provide an excellent overview of the current treatment landscape for tardive syndromes.

Finally, Kimberly Miczak, Dr. Carrellyn Grant-Case , and Dr. Miriam Segal provide an excellent review of rehabilitation for movement disorders. Rehabilitation is no longer a “postscript” or afterthought in treating movement disorders but is now often considered a secondary treatment. For example, recent literature suggests that exercise may reduce symptoms and improve the rate of progression of Parkinson disease.

I want to thank my colleagues who contributed their time and talent to this issue. We hope you enjoy it.