Movement Disorders Clinic brings stability with innovative procedures.

Written by John Ferrari | Photographed by Wendy Saade

Treating conditions that affect the brain is always a team effort, and teamwork makes Torrance Memorial’s Movement Disorders Clinic tick. The clinic, a partnership between the Lundquist Neurosciences Institute and Cedars-Sinai, diagnoses and treats movement disorders affecting control of the body’s muscles.

“We review and treat patients as a team: neuropsychologists, neurologists and neurosurgeons,” says neurologist Elliot Hogg, MD, a movement disorder specialist with the clinic and Cedars-Sinai Neurosciences. Three conditions comprise the majority of disorders affecting the clinic’s patients: essential tremor, Parkinson’s disease and dystonia.

Essential tremor usually manifests as shaking of the hands, head, legs or even vocal tremor. Essential tremor may be caused by a miscommunication in brain networks governing timing and movement, says Dr. Hogg.

Parkinson’s disease is caused by brain cells dying prematurely, particularly those that produce dopamine, which controls movement. Patients’ movements become slow and stiff, often accompanied by tremors. The disease can cause nonmotor symptoms as well, ranging from loss of smell to sleep problems, anxiety, depression and declining cognitive function.

Dystonia causes muscle contractions and repetitive or twisting movements. It often affects the neck but can be generalized and affect the entire body, says Dr. Hogg. The spasms may be mild or severe and can be painful. Dystonia can be a primary condition or associated with another disease, such as Parkinson’s.

While symptoms of these conditions can be treated with medications, medication alone may not control the symptoms completely. And potential side effects may be worse than the symptoms.

“When we diagnose a patient, as the neurologist I evaluate medication options first,” Dr. Hogg says. “If symptoms could be better treated with surgical options—deep-brain stimulation or focused ultrasound—I’ll refer to Paula Eboli MD, Torrance Memorial’s medical director of neurosurgery, to evaluate the patient for those programs.

“Both deep-brain stimulation and focused ultrasound can be life-changing procedures,” says Dr. Eboli. Motor-function conditions affect more than the patients’ muscles, she explains. The tremors and inability to control one’s own movements can cause social awkwardness, anxiety and depression.

An established procedure, deep-brain stimulation targets specific neural networks to disrupt aberrant communication, allowing the restoration of normal motor function. It involves implanting a pacemaker-sized microcomputer and battery in the patient’s chest, with a lead extending to the patient’s head. The procedure is guided by MRI scans taken before the surgery to create a 3D road map, augmented by real-time imagery.

A neurosurgeon precisely places electrodes at the point in the brain responsible for the tremor. About a month after the surgery, a neurologist programs the microcomputer to send electrical signals that match the patient’s anatomy, disrupting the aberrant brain signals. “We use multiple electrodes to shape an electrical field, almost like sculpting,” Dr. Hogg says.

A newer procedure—in use at Torrance Memorial since December 2023—focused ultrasound isn’t a surgical procedure in the traditional sense. “We use ultrasound beams focused on a specific piece of brain tissue to very precisely heat the area, creating a small lesion or scar in the tissue that was causing the tremor,” explains Dr. Hogg.

The beams are directed from outside the patient; there is no incision. Because there are no pain receptors in the brain, the procedure is usually painless and doesn’t require general anesthesia. “The patient can actually witness the tremor stop in real time.”

Either or procedure may be recommended for a patient. Focused ultrasound produces immediate results and is nonreversible (and requires shaving the head, says Dr. Eboli). Additionally, focused ultrasound must be used to eliminate tremors on one side of the body at a time, with nine months between procedures.

“We have cases going every week,” says Dr. Hogg. “The procedures are a tremendous leap forward in our ability to treat our patients and the collaboration between Torrance Memorial and Cedars-Sinai provides great opportunities for patients in the South Bay.” •

The Torrance Memorial Movement Disorder Clinic is located at 23560 Crenshaw Blvd. Suite 101, Torrance. To learn more visit: TorranceMemorial.org/medical-services/neurosciences/ or call 310-750-3326.