Movement Disorders (MD, UMCG) performs scientific research, and provides tertiary clinical care and education on neurological movement disorders in children and adults. We are a unique group of clinicians and researchers that focusses on excellent clinical care that is closely tied to advanced scientific research.
MD has two major themes of research consisting of:
1. hyperkinetic movement disorders (dystonia, myoclonus, tremor, chorea and ataxia), incl. functional movement disorders (headed by prof. Marina de Koning-Tijssen, Dept. of Neurology).
2. hypokinetic movement disorders (headed by prof. Teus van Laar, Dept. of Neurology). MD has a long history of functional imaging and neurophysiological examinations. Many of the scientific questions arise from the daily clinical practice.
This way, our group is continuously working on improving patient care through advanced clinical research.
MD’s scientific work ranges from clinical to fundamental research. MD’s translational studies combine clinical activities with functional and fundamental scientific research. In collaboration with the Dept. of Neurosurgery, MD investigates how deep brain stimulation (DBS) can be used to improve the treatment of both hyper- and hypokinetic movement disorders.
Within the MD research programme, several postdocs and a large number of PhD students are working on a variety of movement disorder projects. In most of these MD research projects also Bachelor and Master students are participating (short internship and/or graduation project). Within MD, there is room for personal contribution, creativity and a critical attitude. We are interested in new solutions and stimulate our colleagues and students to acquire knowledge elsewhere.
MD’s hyperkinetic theme focusses on:
1. Phenotyping of patients with different kind of movement disorders in both children and adults. To perform this research, we set up a database (approx. 1500 patients). At this moment, a large NEMO/ZonMW-TOP project is running with the aim to use machine learning algorithms to classify different types of movement disorders using 3D-video, sensors and EMG activity. In addition, good phenotyping is used to describe patients with different (rare) movement disorders, such as myoclonus dystonia, progressive myoclonus ataxia, task-specific dystonia (‘zwabberbeen’), ‘Noordzeeziekte’, and different metabolic disorders with movement disorders, such as Niemann Pieck disease. Phenotyping is focused on both motor and non-motor symptoms, such as psychiatry and cognition, and quality of life.
2. Our translational research aims to discover new genes that underlie movement disorders and unravel the pathophysiology of and mechanisms behind several diseases. Our clinical deparment has close collaborations with the Dept. of Genetics, the Dept. of Biomedical Sciences of Cells and Systems (BSCS) and the Dept. of Nuclear Medicine & Medical Imaging (NMMI). BSCS is doing a lot of research into iron storage diseases such as neuro-degeneration with brain iron accumulation (NBIA). In our genetic studies, we focus on network analyses of genes involved in movement disorders to determine new candidate genes. Electrophysiological studies give insight into the pathophysiology of tremor myoclonus and dystonia. In collaboration with NMMI (fMRI and PET), we study the brains networks involved in different movement disorders (also part of the NEMO/ZonMW-TOP project).
3. For treatment studies, we focus on the improvement of deep brain nucleus stimulation (DBS) for dystonia using electrophysiological measurements pre-, per and post-operatively. In the near future, a NBIA treatment trial will start in close collaboration with BSCS.
MD’s hypokinetic theme is organized around three main topics:
1. Pathophysiology of Parkinson’s disease (PD) and personalized medicine, with a main focus on the gut-brain axis, the role of inflammation and the development of PD-related dementia and visual hallucinations. For this reason, the DUPARC cohort was started, which is a dopa-naïve de novo PD cohort with >150 participants, who are deeply phenotyped with MRI, dopaminergic- (F-DOPA PET) and cholinergic imaging (FEOBV-PET), gut microbiome analysis (16S and metagenomics), optical coherence tomography and neuropsychological examination, in combination with genotyping (GSA-MD and single cell RNA sequencing). Lifelines-DEEP participants serve as valuable controls in this study design. Another line of research is related to the treatment of visual hallucinations by means of rTMS, using advanced techniques to image brain network connectivity, as a basis for rTMS treatment.
2. Innovative treatments, with a main focus on advanced treatments in PD, disease modification and the role of pharmacogenetics. Our TULIP cohort consists of 160 GBA1 patients, part of a national GBA1 cohort of over 500 patients, in which the clinical course of the different mutations is established. The TULIP cohort is also the basis for new therapeutics, focussing on lysosomal hypo/dysfunction, in order to modify the course of PD. At this moment, the use of medication in PD is based on trial and error, which has to become more personalized, using a medication passport for PD patients. This passport is now being created and tested, including all genetic variants of receptors and enzymes, involved in the dopaminergic and cholinergic treatment of PD patients.
3. Value-based healthcare in PD, with a focus on analyzing the outcomes of a new organisational model on regional PD-care. Since 2017, PD care in Groningen is organised in ‘Punt voor Parkinson’ (PVP), which is a regional PD expertise center. This center offers all advanced therapies, and coordinates professional education and clinical research for the northern regions of the Netherlands. The concept of PVP is now extended to other regions as well. Analysis of the costs and benefits of this model, focussing on value instead of volume is now ongoing, and will serve to definitely establish this new way of organising PD care.