Movement Disorders Video Rounds

Contact: Cindy Starr
(513) 558-3505
[email protected]

CINCINNATI-How does a physician approach a complex medical condition that may or may not be what it appears? That is the challenge offered by the bi-monthly Movement Disorders Video Rounds, a collegial, academic exercise at the James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati Neuroscience Institute. The video rounds, which feature video of patients with ambiguous or complex diagnoses, are the brainchild of Alberto Espay, MD, Assistant Professor in the Department of Neurology.

“During video rounds we get together and discuss challenging cases,” Dr. Espay says. “These are patients who have come to us with atypical presentations, and we have had a difficult time diagnosing them. They are not the bread-and-butter presentations for any of the conditions.

“During the sessions we think about these cases from the ground up,” Dr. Espay continues. “We consider the patient, the videotape of the examination, pertinent data and the patient’s medical history. Then we all brainstorm. Of course, the person who is presenting the case has more information, because presumably a number of investigations have already been undertaken to try to determine the diagnosis. And of course, therapy has been delivered to the patient.”

The goal of video rounds, Dr. Espay says, “is to learn one or two things about movement disorders that you didn’t know coming into this session.”

Dr. Espay, who came to UC in 2005, started the video rounds in 2006 as an enjoyable way for physicians and residents to better educate themselves about the spectrum of movement disorders, which is vast and dotted with rarities and exceptions. The field of movement disorders is by its nature highly visual, with patients experiencing a range of symptoms or side-effects related to movement, including balance problems, freezing of gait, stiffness, loss of coordination, tremor, and involuntary movements. Gardner Center neurologists routinely acquire video of patients to preserve a benchmark prior to treatment or disease progression.

Because video rounds are held at the end of the day, and because attendance is voluntary, Dr. Espay offers a little wine and cheese to help the medicine go down. “It’s very informal,” Dr. Espay says. “No one has high brows about this.”

Last year Dr. Espay took the video rounds concept a step further, by inviting the University of Louisville and the Medical College of Georgia and turning it into the Tri-State Movement Disorders Competition, a CME-accredited educational session sponsored by an unrestricted educational grant from TEVA Pharmaceuticals.

During the competition, each team presents two or three cases, which the opposing schools then strive to think through and diagnose. “The test is to show that your thinking process is logical,” Dr. Espay says. “The answer is the diagnosis. It is a nurturing experience for all of us.”

The Gardner Center team triumphed in 2008 and 2009, and Dr. Espay proudly displays the official trophy in his office.

This year’s most difficult case is likely to be submitted for publication as a case study. It involved the diagnosis of a patient who developed a parkinsonian syndrome in her mid-teens. Dr. Espay, who first saw her in her late teens, disagreed with the initial diagnosis of dopa-responsive dystonia because of inconsistent features of her disease, including disease progression and prominent dyskinesias of the face. Although he had seen only one case like hers before, he correctly postulated that she was suffering from a rare condition known as neuronal intra-nuclear inclusion disease (NIID). A brain biopsy eventually affirmed Dr. Espay’s diagnosis. The patient, he says, “became only the sixth reported case of juvenile parkinsonism and only the second presenting in a way that, early on, was indistinguishable from dopa-responsive dystonia, but that eventually revealed other features that were not consistent with that condition.”

Physicians are not the only ones who benefit from seeing video of patients with movement disorders. “All of our patients are videotaped, and we review these videos with them,” Dr. Espay says. “If patients come back three years after their first assessment and wonder what they were like before, we can show them. It’s a great tool for us, and our patients really appreciate this resource.”