The Movement Disorder Program

The Movement Disorder Program is composed of three movement disorder specialists: Dr. Irene Litvan, Dr. Anne Constantino and Dr. Pratap Chand, as well as multidisciplinary staff. The Movement Disorder Program has three main goals: "patient care", "clinical research" and "education."

Patient care

The Movement disorders program is dedicated to providing the best diagnostic, therapeutic, palliative, and supportive care to patients with movement disorders, cognitive deficits, and neurodegenerative diseases, with a focus on Parkinson’s disease and Parkinsonian disorders, dystonia and complex movement disorders. Patient care begins with an in-depth evaluation by one of the movement disorders specialists, and continues through discussion of diagnoses, needed evaluations, pharmacologic and non-pharmacologic therapies, and ongoing support. The main objective is on improving the quality of life for both patients and caregivers. Our multidisciplinary approach is provided at the 6th floor of the Frazier Neuroscience Rehabilitation Institute.

In addition to diagnosis, evaluation, treatment, and ongoing support, patients may be able to participate in research, which will further our knowledge of these disorders and hopefully one day lead to either progression halting treatments or cures for people suffering from these disorders.

Clinical research

Clinical research is focused on discovering not only the causes and effects of, but also treatments and possible cures for a variety of movement disorders, including Parkinson's disease (PD), Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), Parkinson’s disease and dementia, Dementia with Lewy bodies, and Multiple System Atrophy. Basal ganglia and frontal lobular function as they relate to these disorders are of particular interest.

Patient Care

Our Clinical Program Goals
To further the research and educational goals of the Movement Disorder Program and provide state-of the art care for patients enrolled in the Research Program and their caregivers by providing:

  • Accurate diagnosis
  • State of the art therapeutic care
  • Education, counseling and support

Accurate Diagnosis
Diagnosis can be difficult for non-movement disorder specialists; our experience in both specialized clinical care in movement disorders and research provide us with the skills necessary to aid in appropriate differentiation from among these diseases.

Therapeutic Care
Care for patients is a top priority for the Movement Disorder Program. In order to provide the best care to help alleviate symptoms, we begin with a comprehensive evaluation. In addition to the routine medical evaluation (i.e. physical and histories), we also evaluate mental function, psychiatric health, gait and balance, motility and body function, and overall health satisfaction. Although the time needed to perform these evaluations can be lengthy (~ 2 hours), we feel that this is the only way to get a true understanding of our patient's status and determine their appropriate treatment. Normally, it is the caregiver or a family member that brings the patients in; we also involve them in the evaluation process, as often they provide invaluable information as to our patient's status.

Once we complete our initial evaluations and a course of action has been discussed with the patient and their caregiver/family member, the patient's various therapeutic needs are addressed as needed; this may include physical therapy, occupational therapy, and speech and swallowing therapy or evaluations. We also provide social services assistance as needed. Treatments in the Botox Clinic are provided once a week by Dr. Constantino. Plans to develop a Deep Brain Stimulation Clinic are underway.

After our patients begin their planned course of care, we continually monitor each of the areas of their well-being through meetings with each of the therapeutic areas' specialists, and update the patient's course as needed. Progress is discussed with the patient and their caregiver/family regularly, and input is greatly encouraged at all times. In fact, patients, family members, and caregivers regularly call us just to update us and ask questions as they think of them (that's what we want!).

Education, Counseling, and Support
Patient referrals are done as needed; our overall goal is to alleviate and improve the quality of life of our patients and making them as comfortable with their disorder as possible while waiting for cures. This means not only the physical care of the patient, but also helping to alleviate some of the stressful "non-physical " aspects of dealing with these disorders. We also realize that not only patients are affected by the disorders, but there can be an enormous amount of stress and even depression among the patient's caregivers and family members as well.

To help alleviate some of these problems, we take specific actions:

  • We provide both written and verbal information about the disease, its progress, and how to handle certain aspects of it; this helps alleviate some of their feelings of loss of control. There are several very good websites dedicated to specific disorders, and we will soon be able to provide access to these sites from within our program office soon, but for now we just let the patients and caregivers know about them and how to contact them.
  • We provide information about local, state, national, and international support groups that are available and are specific to the disease in question, to help alleviate the feeling of being alone in dealing with the disorder.
  • We continually offer our help over the phone; sometimes reassurance is all that a patient or caregiver needs, while other times they may have specific questions that need answering or general information about what to expect.
  • We assess for patient and caregiver support and stress.

Clinical Research

Our Research Program Goals
Our research efforts are dedicated to advancing in the knowledge of the causes, underlying mechanisms that lead to the development of Parkinsonian, Dementia and Dystonia Disorders and search for the best possible treatments. Through our research we strive to identify the most effective interventions and continue the progress toward an eventual cure for these disorders.

  • Increase understanding of causes
  • Refining and developing symptomatic and biologic interventions
  • Improve understanding of non-motor functions

Increase understanding of causes of Parkinsonian Disorders
To help in this search, a clinical, genetic, and environmental study of PSP patients is underway (see below). The longitudinal study of these patients and eventual pathological study is being developed, pending funding. The following studies are being conducted:

  • "Genetic and environmental risk factors for PSP." National Institutes of Aging. Multidisciplinary and multisite project evaluating the genetic and environmental risk factors for the development of PSP. The study involves the recruitment of 500 PSP patients and 1000 controls. Includes investigators from the University of Louisville and other sites (Baylor College of Medicine, Case Western Reserve, Emory School of Medicine, Harvard School of Public Health, Johns Hopkins University, Mayo Clinic Jacksonville, University of Birmingham, Alabama, University of Los Angeles, California, University of Maryland, University of Miami, and University of Washington). http://www.pspstudy.com
  • Studies of the H1/H1 haplotype in Corticobasal Degeneration (CBD) - in conjunction with Mayo Clinic, Jacksonville, Fl
  • GenePD: NIH funded genetic study in Parkinson’s disease led by Dr. Richard Myers, Boston University entitled "Genetic linkage study in Parkinson's disease." 2RO1 NS36711-05A2, http://www.bu.edu/genepd/
  • Validity of the Office of Rare Disorders (ORD) neuropathologic criteria for CBD and related disorders. PI: Litvan, I. Austin Foundation.
  • Search for biomarkers of exposure and disease through the study of Cerebrospinal Fluid, Urine and DNA from cheek swabs. Use of Mass Spectrometry and proteomics.

Refining and development of symptomatic interventions
We are working to refine and develop symptomatic interventions for patients with atypical parkinsonian disorders, as well as interventions to slow or stop the progression of the neurodegenerative processes affecting the basal ganglia and frontal lobes.

  • A six-month, double-blind, randomized, placebo-controlled study of pyruvate, creatine, and niacinamide to evaluate their safety and efficacy. Protocol: UHSC-083-03. Society for Progressive Supranuclear Palsy, Inc. This project also allows the collection of pilot data on gait disturbances in conjunction with Drs. Todd and Bertocci from UofL and Dr. Angeli from the Frazier Rehab Neuroscience Institute.
  • Long-term, multicenter, open-label, safety study with a flexible dose range of KW-6002 as treatment for PD patients who have motor response complications and are receiving Levodopa/Carbidopa therapy
  • "Relative efficacy of brief dynamic therapy vs. hypnotherapy in lessening the severity of unexplained movement disorders." PI: B Schoenbachler B, CoPI: I Litvan.

Improve understanding of non-motor functions
Our research seeks to improve understanding of non-motor functions (i.e., neuropsychiatric and cognitive aspects) of the basal ganglia

  • Role of the subthalamic nucleus in emotion and cognition in patients undergoing subthalamotomies
  • Visuospatial disturbances in Parkinsonian disorders. "Visuospatial cognitive assessment in the diagnosis of atypical parkinsonian disorders."
  • Understanding the underlying mechanism of psychogenic movement disorders: "ERP study of inhibition in conversion disorder." PI: E.M Sokhadze, Co PI I Litvan.
  • Searching for treatment therapiesfor psychogenic movement disorders. PI: B. Schoenbachler, Co PI I. Litvan.

Education

Focusing on providing exceptional education to students, fellows, and other researchers will enrich every long and short-range goal for the care and research of all Movement Disorders. Comprehensive education and support provided to patients, families, and caregivers will immediately enrich the quality of life for all involved. Our education efforts are therefore, two fold: 1) we are dedicated to enhancing the education of medical professionals in the areas of movement disorders and dementias, and 2) we strive to provide as much education and support as possible within our constrained budget to patients, caregivers, and the general public about the diagnosis, treatments, research, and avenues of support available.

University of Louisville Movement Disorder & Dementia Fellowship Program
The Fellowship experience is very rewarding. The Fellow has plenty of opportunities to participate in the care and investigation of all aspects of movement disorders and dementia. The Fellowship Program includes: a clinical program and a research program in movement disorders. Its length is one or two years, but we anticipate that most fellows would spend two years in training. Appointments are for a single year, with the decision to renew dependent upon performance during the past year.

The clinical program involves participating in the diagnosis and multidisciplinary care of patients with movement disorders and dementia in both the outpatient and an inpatient settings. Direct teaching is carried out during outpatient evaluations, inpatient consultations, hospital rounds, and movement disorder seminars. The Fellow participates in a full-day outpatient clinic weekly under the direct supervision of Dr. Litvan or Dr. Constantino where on average the Fellow evaluates two new patients and four follow-up patients a week. For inpatient care, the Fellow is responsible for the daily management of his/her assigned movement disorder/dementia patient under the supervision of the faculty staff and/or Dr. Litvan or Constantino. Outpatient care is provided in a new, modern rehabilitation facility, at the Frazier Rehabilitation Neuroscience Institute where multidisciplinary care is available as a “one stop shop.” After learning the procedures of the evaluation by being an observer, the Fellow is the first to evaluate a patient and then discusses the patient with Drs. Litvan or Constantino. Patients with common as well as unusual diagnostic and therapeutic problems from all over the U.S. and from other countries are evaluated in our outpatient clinic. When evaluating patients, the Fellow follows a clinical form developed by Dr. Litvan that scores symptoms and signs with specific rating scales. The information collected is reviewed by Drs. Litvan and Constantino prior to be entered into a computerized database by the Fellow. The patients are also videotaped during the examination and the Fellow is in charge of including the videos into an existing video library. The video library is for research and educational purposes. It is expected that Fellows will attend academic conferences and present their work including case-presentations and video-conferences. There are other conferences run by the Department of Neurology, including Grand Rounds and special lectures that fellows may attend. Plans to develop a Deep Brain Stimulation Clinic are underway that Fellows will soon participate.

The research program is a clinical one and current projects include a case-control study in PSP, natural history study of parkinsonism, genetic, behavioral studies and pharmacologic drug trials in parkinsonism and dystonia, as well as participation in the dystonia clinic under the direct supervision of Dr. Constantino. After participating in ongoing clinical research projects, the Fellow is expected to initiate his/her own project. Fellows are encouraged to develop, conduct and publish valuable research, with help from Drs. Litvan or Constantino. There is a possibility of doing courses in the School of Public Health on epidemiology and research in rehabilitation aspects.

Goals of the Fellowship
1. Develop expertise in the diagnosis and multidisciplinary treatment of movement disorders and dementia.
2. Develop skills in research design, data analysis and basic epidemiological principles.
4. Gain experience in the coordination and execution of clinical trials.
5. Develop a core of clinical and basic science knowledge relevant to the field of movement disorders and dementia.
6. Learning how to administer botulinum toxin.
7. Learning how to adjust deep brain stimulators.

Application Processing
1. Your letter of application
2. Your curriculum vitae and bibliography,
3. Three letters of recommendation from your neurology or other training programs, one of these letters must be from your Chief of Service
4. A letter describing yourself as a person, stating what your ultimate goals are, what duration of Fellowship training you anticipate, and what research projects you have been thinking about.

Please mail or fax your application to:

Mail:
Irene Litvan, M.D.
Raymond Lee Lebby Professor of Parkinson Disease Research
University of Louisville School of Medicine
Department of Neurology
Building A, Room 113
500 South Preston St
Louisville, KY 40202

FAX: 502-852-1990

If there are openings in our fellowship program, we will schedule interviews for the applicants following receipt of the appropriate documentation.
If you have any questions regarding the program, please contact Dr. Litvan by email: i.litvan@louisville.edu or phone: 502-852-3655.

Movement disorders program team members

Program director

Irene Litvan, M.D.

Raymond Lee Lebby Professor of
Parkinson Disease Research

Director, Movement Disorders Program

University of Louisville
Louisville, KY 40292

Phone: 502-852-3655

Fax: 502-852-1990
i.litvan@louisville.edu

Dr. Litvan is an endowed professor of Parkinsons Disease research and the director of the Movement Disorder Program at the University of Louisville. She received her Medical Degree from the University of Uruguay and later completed her Neurology Residency and fellowship in Neuropsychology and Dementia, at the Hospital Santa Creu i Sant Pau, in Barcelona, Spain.

In 1986, Dr. Litvan joined the Experimental Therapeutics Branch, National Institutes of Health (NIH), as a Post-doctoral fellow. After completing a required 2nd Residency in Neurology at Georgetown University, Dr. Litvan was appointed as a Senior Staff Fellow in the Neuroepidemiology Branch of the National Institute of Neurologic Disorders and Stroke. She left there in 1997 to join the Henry M. Jackson Foundation, where she remained as a guest scientist until 2002. In 2000, Dr. Litvan opened her own clinical practice in Bethesda, MD.

In 2002, Dr. Litvan became the Raymond Lee Lebby endowed Professor of Parkinsons Disease Research at the University of Louisville and the Director of its Movement Disorder Program. In 2006, she became the Director of the Movement Disorder Program at the Frazier Rehabilitation Institute, as well.

Dr. Litvan is an American Board-Certified Neurologist. She has published numerous peer-reviewed articles on the diagnosis of neurodegenerative, parkinsonian, and dementia disorders, as well as on the neuropsychiatry of cortical and subcortical dementias. She was senior editor of the first book on progressive supranuclear palsy (PSP) (Oxford University Press, 1992),the senior editor of the first book on corticobasal degeneration (CBD) (Lippincott-Press, 2000) and the editor of the book on atypical parkinsonian disorders (Humana Press, 2005).

Dr. Litvan is a member of the American Neurologic Association and a fellow of the American Academy of Neurology. She serves on many boards and committees. Currently, she is member of the Movement Disorders Society International Executive Committee, Oversight Committee and CME Committee and is also the secretary of the World Federation of Neurology Research Group on Dementia. She is a member of the medical scientific boards of the Society for PSP, PSP Association for England and Europe and the Association for Frontotemporal Dementias.

Dr. Litvan is Co-Editor of Moving Along, the newsletter of the Movement Disorder Society since 2000 and she is an ad-hoc reviewer for several medical, neurologic and neuropsychologic journals. She received the NIH merit award for leading international multicenter studies to evaluate and improve the clinical diagnostic criteria of several dementia and parkinsonian neurodegenerative disorders. She is currently directing studies to identify biologic markers, and symptomatic and biologic therapies to slow the course of neurodegenerative disorders and has received a 3.5 million NIH award to study the genetic and environmental factors of PSP, the most frequent atypical parkinsonian disorder.

 

Anne E. Constantio, M.D
Assistant Professor

Ph: (502) 852-0292
Fax: (502) 852-3644

Anne E. Constantino, M.D. finished her medical school at the University of the East, Ramon Magsaysay Medical Center in the Philippines and completed her residency training in Internal Medicine in her home country. She did her Internship at the joint program of New York University and Veterans Affairs Medical Center in New York City and subsequently a neurology residency in SUNY Upstate Medical Center (PGY 2) and Cornell University Medical Center (PGY 3 and 4). She was trained as a fellow in Movement Disorders at the Center for Parkinson’s Disease and Other Movement Disorders at Columbia University, College of Physicians and Surgeons where she participated in research and clinical trials in Parkinson’s disease, tremors and botulinum toxin injections. After fellowship training, she was appointed as a faculty in the Neurology Department of New York University Medical Center for two years, after which she joined a private practice in Southeastern Kentucky while being a part time faculty (Assistant Professor) at the University of Kentucky Neurology Department. Since December of 2006 she became an Assistant Professor at the Movement Disorders Program, Department of Neurology, University of Louisville.

Her research interests include dystonia, tremors, ataxias and unusual movement disorders. Dr. Constantino directs the dystonia and Botox Clinic.

Clinical research coordinator

Whitney Rogers, R.A.
Clinical Research Cordinator

500 South Preston St.
A Bldg, Room 113
Louisville, KY 40202

Ph: (502) 852-3655,
Fax: (502) 852-1990

Whitney Rogers is the clinical research coordinator for the Movement Disorder program headed by Dr. Irene Litvan. Whitney holds a B.A. in Biology and a minor in Chemistry from the University of Louisville and has over seven years of administrative experience in medicine and patient care. Her main responsibility is the coordination of all components of clinical trials. This includes contract, budget, regulatory requirements, administrative aspects, patient management and recruitment. Acting as liaison for research sponsors including the National Institutes of Health, Human Studies Committee, and the investigator, she collects, organizes, compiles and maintains research clinical data and prepares protocols for submission to the Institutional Review Board (IRB). Mrs. Rogers is also responsible for administering neuropsychological testing to patients and works as a medical assistant to Dr. Litvan in the Movement Disorder Clinic.

 

Clinical Data Manager

Chris Cunningham, Ph.D.

Chris Cunningham, Ph.D.
Clinical Data Manager

500 South Preston St.
A Bldg, Room 113
Louisville, KY 40202

Phone: (502) 852-7717
Fax: (502) 852-1990
E-mail: chris.cunningham@louisville.edu

Chris holds a B.S. in Biology and an M.S. in Toxicology from the University of Kentucky and a Ph.D. in Pharmacology and Toxicology from the University of Louisville. He has four years experience in environmental and regulatory toxicology His main responsibility is the management of clinical data collection, processing and auditing. He is also responsible for finding and securing additional sources of research funding.

 

 

Kathleen Sheeley, RRT, CCRC
Research Administrative Manager

Ph: (502) 852-1665
Fax: (502) 852-1990

Kathleen Sheeley graduated from the University of Louisville Respiratory Care Program. She is also a Registered Respiratory Therapist as well as a Certified Research Coordinator. Kathleen is responsible for regulatory, financial, grant preparation, contract negotiations, assisting in sponsor updates, as well as helping in any aspect of the research projects as needed.

 

Lisa Potts, BS
Graduate Fellow

Ph: (502) 852-7717
Fax: (502) 852-1990

Lisa Potts graduated from Centre College with a BS in Psychobiology.  She is currently pursuing a doctorate degree in Anatomy and Neurobiology at the University of Louisville.  Lisa will be assisting the Clinical Research Team while gathering data for her dissertation.

Other team members (specific information coming to our site soon)

  • Occupational Therapist
  • Physical Therapist
  • Speech/ swallowing Specialist
  • Biometrics and Gait Analyst
  • Social Worker

Our affiliations

 

For routine consultation or referral

Please contact us at:

University of Louisville Movement Disorder Program
Frazier Rehab and Neuroscience Center
220 Abraham Flexner Way
Louisville, KY 40202

Phone: (502) 582-7654
Fax: (502) 582-0521

For more information on the Movement Disorders Program, call (502) 852-3655
or (866) 777-0448

See also

Dr. Litvan also has a research foundation dedicated to finding cures for neurode-
generative disorders http://www.LNRF.info

Copyright © 2004 Neurology Department
University of Louisville—All rights reserved

This page was last modified on: 02/06/2007

 

Patient and public information on movement disorders

For routine consultation or referral

Please contact us at:

University of Louisville
Movement Disorder Program
Frazier Rehab and Neuroscience Center
220 Abraham Flexner Way
Louisville, KY 40202

Phone: (502) 582-7654
Fax: (502) 582-0521

For more information on the Movement Disorders Program, call (502) 852-3655
or (866) 777-0448