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The common denominator of these disorders constitutes the affection of so called subcortical brain nuclei (basal ganglia) on the one hand, but also the public character of the disorders on the other hand. Patients can be readily recognized by their apparent affection, they, indeed, are stigmatized. The treatment of movement disorders reflects the change of neurology from a predominantly diagnostic to a therapeutic discipline. Thus, highly effective therapeutic strategies have been developed during the last 50 years such as the introduction of levo-dopa for Parkinson's disease more than 40 years ago. In addition, in the last 20 years functional neurosurgery has been revived as a very effective and reversible treatment using deep brain stimulation (DBS) for movement disorders like Parkinson's disease and dystonia. Despite these remarkable improvements the distinct need for further research is underlined by the fact that there is still no cure for most, if not all movement disorders.
More than 1000 patients with movement disorders are treated annually in the outpatient clinic both at the Charité Campus Virchow-Klinikum (CVK) and Charité Campus Benjamin Franklin (CBF). Routine treatments comprise injections with botulinum toxin for dystonia and various drug therapies for Parkinson's diesease. Diverse (partially multicenter) studies, both at the national and international level, aim at improving the therapeutic potentials in the treatment of movement disorders and allow a careful management of individual patients. At the Campus Virchow-Klinikum deep brain stimulation has emerged as powerful tool for the treatment of Parkinson's disease, essential tremor, and various types of dystonias (appointments for the deep brain stimulation outpatient clinic can be scheduled via Frau Zielinski, Secretariat of Professor Kühn, T: +49 30 450 560 123). Furthermore, there is research in progress dealing with new therapeutic strategies for atypical Parkinsonian syndromes. Special consultation for patients with tic disorders on an out-patient basis and for patients with spasticity following ischemic brain injury for treatment with botulinum toxin (call +49 30 450 560 038) have been installed.
The members of the department of movement disorders at the Charité are both clinically and scientifically involved in further refining and improving therapy and diagnostics for movement disorders. In 2010 a clinical research unit focusing on deep brain stimulation (funded by the German Research Foundation) was established under the direction of Prof. Andrea Kühn at the department of neurology at the Charité (www.kfo247.de/en).
Clinical neuroscience and neurophysiology (Professor Kühn)
Research in the "Motor Neuroscience Group" focuses on basic and clinical research related to the physiology of cortico-basal ganglia-thalamic loops. Several research methodologies are used in the lab to record neuronal activity from the basal ganglia and the cortex. The principal methodology covers invasive recordings of deep brain activity from different basal ganglia nuclei in humans, which are the targets for deep brain stimulation (DBS) electrodes in various pathologies like Parkinson's disease, dystonia, tremor, Tourette's syndrome, obsessive-compulsive disorder or severe depression. This approach permits intraoperative recordings of single-unit activity via microelectrodes and postoperative recordings of local field potential (LFP) activity via the implanted DBS-macroelectrodes. In addition, cortical activity is investigated by means of electroencephalography (EEG) and magnetoencephalography (MEG). Finally, the modulation of cortical excitability is studied with transcranial magnetic stimulation (TMS).
Our current research programme extends from the work on understanding the mechanisms of action of DBS to the investigation of different motor, cognitive and emotional aspects of the cortico-basal ganglia physiology:
One of our main interests is the investigation of cortical and basal ganglia motor functions in patients suffering from different movement disorders. Interactions within the cortico-basal ganglia network during motor tasks as well as its modulation leading to abnormal movements can be explored using simultaneous deep brain (LFP) and cortical (EEG/MEG) recordings. Moreover, analysing single and multi-unit activity in combination with LFP activity from the basal ganglia offers the opportunity to investigate basic neuronal encoding mechanisms for movement parameters. Finally, we further explore the mechanism of action of deep brain stimulation. (Christof Brücke, Julian Neumann, Daniel Kroneberg)
Further projects investigate the role of the basal ganglia in conflict processing and error detection during action-monitoring. A special focus is the study of error detection and motor prediction via forward models. To this end, we investigate direct recordings from the STN and GPi in patients undergoing DBS during performance of reaction-time conflict tasks and overlearned motor programmes. (María Herrojo Ruiz, Julian Neumann)
Studying DBS-related changes in emotional processing are of special clinical relevance in PD patients with chronic DBS. Here, we record LFP activity from basal ganglia structures during emotional paradigms and correlate our findings with neuropsychiatric parameters. Furthermore, neurophysiological parameters of affective processing are also studied in patients suffering from severe depression undergoing DBS of the subgenulate cingulum. (Julius Huebl, Wolf-Julian Neumann, in collaboration with the Department of Psychiatry, Malek Bajbouj, Angela Merkl)
Prof. Peter Brown, Department of Clinical Neurology, Radcliff Infirmary, University of Oxford, UK
Prof. Joachim K. Krauss, Dept. of Neurosurgery, Medical School Hannover
Dr. Vladimir Litvak, The Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, UK
Prof. Bart Nuttin, Dept. of Neurosurgery, Katholieke Universiteit Leuven, Belgien
Dr. Tilman Sander-Thömmes, National Metrology Institute, Berlin