Training & Curriculum

The first year of training establishes the educational basis of expertise in movement disorders and allows the fellow to progressively gain the clinical knowledge necessary to diagnose and manage a wide range of movement disorders, including the following:

• Parkinson's disease
• Dystonia
• Tremor
• Huntington's disease and other types of chorea
• Myoclonus
• Tics
• Tardive dyskinesia and other disorders of the basal ganglia

Clinical expertise is acquired in different settings (outpatient, inpatient and emergency department) and includes diagnostic evaluation, treatment, management, counseling and prevention. The fellow is an integral part of the movement disorders clinic, conducting evaluations of new and established patients and learning the intricacies of diagnosing various subtypes of movement disorders. The fellow also takes an active role in structuring patient management and learning interventional therapies, including pharmacotherapy, botulinum toxin injections and deep brain stimulation (DBS). Additionally, our innovative psychiatry clinic for patients with movement disorders is available to fellows up to two half-days per week.

Training in botulinum toxin injections provides the fellow with knowledge of the necessary steps for successful chemodenervation therapy, including clinical indications and expected outcomes, target muscle(s) selection, toxin reconstitution and injection techniques, use of electromyogram guidance, effective doses and troubleshooting of possible side effects. Weekly hands-on injection sessions reinforce theoretical and practical knowledge throughout the training period.

Cedars-Sinai offers one of the most rigorous programs of training in the neurosurgical and neurological management of DBS for medication-refractory movement disorders. Fellows are trained in all multidisciplinary aspects of implantation and long-term management of patients receiving this therapy. In addition to evaluating new candidates for DBS surgery and patients receiving long-term therapy from implanted devices, fellows become well versed in the criteria for DBS implantation in patients with movement disorders. Specific training is focused on finding optimal parameters of stimulation to treat motor symptoms while minimizing stimulation adverse effects.

Finally, the program provides education in the intraoperative monitoring and testing of patients with movement disorders who are undergoing stereotactic functional neurosurgery. Training includes obtaining and interpreting single neuron microelectrode recordings and macroelectrode stimulation testing.

Because teaching is considered such an important mission at Cedars-Sinai, fellows are responsible for a series of journal clubs and lectures in Cedars-Sinai's newly ACGME-accredited Neurology Residency Program. Fellows' academic education is enhanced through review of updated material and acquisition of teaching skills. Topics include, among others, clinical phenomenology; neurogenetics and physiopathology; and pharmacological and surgical treatment of movement disorders.

The fellow is exposed to the basics of clinical research, participating as co-investigator under a number of investigator-initiated and industry-sponsored clinical research trials. The fellow will undergo training and certification by the Cedars-Sinai Institutional Review Board in the protection of human subjects and good clinical practice, in addition to being trained and certified in standard clinical rating scales in movement disorders.

Fellows interested in more rigorous research training have the opportunity to study biostatistics and are encouraged to develop independent research projects, particularly during the optional second year. These projects may focus on one of the core areas of expertise at Cedars-Sinai — regenerative medicine, neuroimaging, clinical outcomes research and neurophysiology.

The fellow will have the option of attending bimonthly human neurophysiology research seminars led by Ueli Rutishauser, PhD and sponsored by Cedars-Sinai and California Institute of Technology, or monthly regenerative medicine research seminars led by Clive Svendsen, PhD. Those interested in transcranial magnetic stimulation can take advantage of our collaboration with Marco Iacoboni, MD, PhD, and Allan Wu, MD, at the Ahmanson-Lovelace Brain Mapping Center at UCLA. The fellow with interests or expertise outside these areas may choose to pursue an independent course drawing on the abundant resources in the Cedars-Sinai umbrella, including the Cedars-Sinai Graduate Program in Biomedical Science and Translational Medicine and the Clinical and Translational Science Institute.

In addition, fellows have the option of enrolling in the Cedars-Sinai Clinical Scholars Program, a course of study offered at our institution that is designed to train promising young physicians for a career in clinical research. This program offers a dedicated curriculum of biostatistics, bioethics, data management, clinical trial design, manuscript writing and grant writing.

The fellowship is structured as a period of two years, with intensive clinical training concentrated in the first year and continuation in the second year dependent on the fellow's academic interests. During the first year, the fellow will spend a minimum of five half-days per week at clinics, rotating clinical preceptors among movement disorder specialists and attending physicians in neurosurgery and psychiatry. A quarterly review to identify strengths, weaknesses and academic areas of focus will be conducted. The second-year schedule is expected to be more flexible, to leave time for research activities (see Program Overview).

In addition to clinical care, the fellow will have access to regular educational conferences, including the following:

• Weekly video rounds, during which videos of patients are reviewed and discussed
• Biweekly research meetings
• Monthly neurosurgery conference
• Monthly journal clubs
• Other meetings of interest (monthly neurogenetics conference and weekly neurology grand rounds)