Movement Disorders Institute

Parkinson’s Disease (PD) is a common  neurodegenerative disease characterized clinically by a movement disorder which is related to dopamine defficiency in nigrostriatal pathways, consisting of rest tremor, bradykinesia, rigidity, impairment of postural reflexes  and gait dificulties, leading to severe neurological dysfunction within several years.

Additional non-motor features such as cognitive decline, psychiatric disturbances (e.g. depression and anxiety) and autonomic dysfunction, commonly acompany the motor dysfunction and are related mainly to nondopaminergic deficits and wide spread neuropathological involvement.

 

The mainstay of treatment of PD is pharmacological and when targeting the motor features it consists of
levodopa , dopamine agonists and other modalities that increase dopaminergic transmission.However, several side effects, along with gradually diminishing beneficial effect, are a major limiting factors in the long term pharmacological treatment of PD. Most patients  develop motor complications- response fluctuations and excessive involuntary movements called levodopa-induced dyskinesias. Surgical
therapeutic options have become an acceptable option for advanced PD patients, the most common of which is deep brain stimulation via surgucally implanted cerebral electrodes along with an implantable
pulse generator. This treatment is invasive and may lead to adverse events, and its use is limited by several relative and absolute contra-indications.

Transcranial magnetic stimulation (TMS) is a non-invasive technique of brain stimulation based on electro-magnetic induction that was developed in 1985 . The effect of rTMS in PD  has been tested in several studies. It was concluded that TMS, across applied stimulation sites and parameters, can exert a significant, albeit modest, positive effect on the motor function of patients with PD but unequivocal conclusion could  not be drawn due to differences in  techniques and methodologies.

The primary goal of our research is to advance our understanding of the mechanisms underlying the effects of dual -channel dTMS on various brain networks. The beneficial effect of the dual stimulation may possibly result from both increased excitability of neuronal circuits connecting the PFC to the basal ganglia as well as by normalization of the hyperexcitability of the MC in advanced PD patients. These assumptions must be evaluated and proved in order to maximize the benefit of treatment and to achieve "personalized " treatment , that is tailoring the right stimulation variables for the right patient.

In oreder to achieve these goals we are  using advanced monitoring techniques assessing electropysiological and other changes in the brain of treated patients.We want to develop a monitoring set-up and algorithm using functional MRI (fMRI) and EEG for prediction the response to dTMS treatment.

 

 

Principle Investigators

  • Sharon Hassin-Baer M.D., is a senior neurologist and Movement Disorders specialist working in the
    Department of Neurology at Sheba Medical Center; she is the director of the Movement Disorders Institute in Sheba Medical Center ; she is a senior lecturer at Sackler Faculty of Medicine, Tel-Aviv University.

 

  • Oren Cohen M.D. is a Senior Neurologist in the Department of Neurology at Sheba Medical Centerand a senior lecturer at Sackler Faculty of Medicine, Tel-Aviv University. Dr. Cohen is a graduate of a post-doctoral fellowship in movment disordes at Columbia Presbyterian Medical Center in New-York (2000-2002) and has an experience of more than 20 years in treating patients with neurological disorders and extrapyramidal diseases.

 

 

 Research Coordinator

  • Naama Warman-Alaluf MSc. is a study coordinator in the Movement Disorders Institute in Sheba Medical Center. She has combined BA in Computer Science and Management and Master's degree in medical research at Sackler Faculty of Medicine, Tel-Aviv University.
    Since 2007 Naama is a  lecturer of statistics and probability for BA students in the Open University. Mail: Naama.WarmanAlaluf@sheba.health.gov.il