By: Grace Huff
In the latest issue of Continuum: Lifelong Learning in Neurology, several faculty and alumni from the Norman Fixel Institute for Neurological Diseases made impactful contributions to the Movement Disorders edition, reinforcing Fixel’s national leadership in neurological education, clinical care, and translational research.
“Continuum is the leading source for neurology clinical reviews and is an indispensable education resource for our specialty. I’m deeply grateful for Dr. Okun serving as guest editor for this latest issue on movement disorders, and Dr. Rawls for authoring the leadoff article on Parkinson’s disease,” said Lyell Jones, MD, FAAN, editor of the issue.
Michael Okun, MD, and Ashley Rawls, MD, Lead Parkinson’s Focus
Michael S. Okun, MD, Executive Director of the Fixel Institute, served as guest editor for the issue, while Fixel neurologist Ashley Rawls, MD, MS, authored the lead article, Parkinson Disease. Their contributions laid the foundation for the issue and centered around a patient-first, evidence-based approach to care. “Continuum plays a vital role in shaping how neurologists approach complex disorders like Parkinson’s disease. It was an honor to contribute to this issue and to highlight the latest advancements changing how we diagnose and treat Parkinson’s and movement disorders,” said Okun.
Dr. Rawls’ article offers a comprehensive and up-to-date review of Parkinson’s disease, highlighting early and late symptoms, diagnostic strategies, and the evolving treatment landscape. Notably, she discusses advances in subcutaneous dopaminergic therapies and the potential use of α-synuclein skin biopsies as a diagnostic aid. Her article serves as a clinical guide for tailoring therapies across disease stages and emphasizes individualized treatment plans that balance motor and non-motor symptom management.
“As a movement disorders specialist, I’m passionate about bridging the gap between research and real-world care. Being part of this issue of Continuum allowed me to highlight the advances and nuances that can make a real difference in patients’ lives,” said Rawls.
Expanding Fixel’s Reach: Contributions from Additional Faculty
Fixel neurologist Bhavana Patel, DO, authored Dementia With Lewy Bodies, a timely and clinically relevant article that explores the nuances of diagnosing and managing one of the most complex Parkinsonian syndromes. She provides a detailed overview of the 2017 revised diagnostic criteria, prodromal syndromes like mild cognitive impairment due to Lewy bodies, and red flags such as REM sleep behavior disorder and fluctuating cognition. Patel also discusses the diagnostic value of biomarkers, including the α-synuclein seed amplification assay and the cingulate island sign seen on FDG-PET imaging, which aid in distinguishing DLB from Alzheimer’s disease.
Nikolaus McFarland, MD, PhD, contributed Progressive Supranuclear Palsy and Corticobasal Syndrome, addressing two often underrecognized Parkinsonian mimics. He outlines key clinical differences, such as vertical gaze palsy in PSP and asymmetric limb rigidity in CBS, and highlights the importance of early diagnosis, especially in the context of emerging treatments targeting tau pathology. The article underscores the importance of managing neuropsychiatric and motor symptoms through a multidisciplinary lens and encourages clinicians to recognize early warning signs and overlapping features for timely intervention.
Spotlight on Former Fellows: Jessica Frey, MD, and Kathryn Moore, MD
Former Fixel fellows continue to shape the field through education, clinical care, and scholarship.
Jessica Frey, MD, authored Tourette Syndrome and Tic Disorders, a detailed review of tics, including the recent rise in functional tic-like behaviors, particularly during the COVID-19 pandemic. Frey provides a nuanced look at distinguishing functional tics from Tourette syndrome and advocates for greater access to behavioral therapies like Comprehensive Behavioral Intervention for Tics (CBIT). She discusses the promising results of the first-in-class medication ecopipam, which met its primary endpoint for tic reduction, and outlines the potential role of deep brain stimulation in treatment-resistant cases.
Kathryn Moore, MD, authored Huntington Disease and Chorea, offering a structured diagnostic approach to choreiform disorders across age groups. She provides a rich overview of HD pathology, including insights into the role of vesicular monoamine transporter 2 inhibitors and the emergence of disease-modifying strategies like antisense oligonucleotides and micro-RNA. Moore also emphasizes the importance of early identification, counseling, and care partner support, sharing clinical cases and imaging findings—such as forehead chorea and motor impersistence, that can help distinguish HD from other causes.
A National Platform for Fixel’s Mission
The presence of multiple Fixel faculty and former trainees in this flagship Continuum issue, published by the American Academy of Neurology, reflects the institute’s growing influence as a hub for clinical excellence and educational leadership in movement disorders.
“Serving as guest editor gave me the opportunity to work alongside some of the brightest minds in movement disorders. Our goal was to provide clinicians with clear, practical insights to support better outcomes for patients with Parkinson’s disease and beyond,” said Okun. “It was a particular honor to edit this issue, which included several brilliant Fixel Institute faculty and former trainees now leading the field.”
From Parkinson’s disease to its mimics, and from Tourette syndrome to chorea, this Continuum issue showcases Fixel’s mission in action, bringing expert knowledge, innovative therapies, and compassionate care to the forefront of neurology.