Movement disorders consult requests from the Johns Hopkins Hospital (main campus) are handled by the inpatient movement disorders consult service comprising one fellow and one staffing attending on a monthly rotation. The consult coverage is provided for weekdays only. This is intended to provide experience with emergencies in movement disorders, acute movement disorders presentations and evaluating patients in an inpatient setting. The consult volume ranges from 0-10 consults per month, with an average of 4 - 6.

Fellows are expected to develop their own research projects or take leadership roles in one or more projects in development. Options include projects under the Udall Center of Excellence, Huntington's Disease Center, Atypical Parkinsonism Clinic, Neuromodulation Center, The Institute of Cell Engineering and Ataxia Center.

Fellows are also encouraged to seek out projects from outside the division in areas such as radiology, neuroimmunology, pediatric neurology and psychiatry. The department of Neurology provides support for writing grants (internal grant review) and critical appraisal of projects. Biostatistical and research project support are provided through the Johns Hopkins Institute for Clinical and Translational Research.

The division facilitates several patient support activities through its community outreach programs, patient-caregiver engagement events and fundraisers. Our fellows can lend their expertise through public lectures and informational articles on research in newsletters and other media. These activities foster fellows' experience in community outreach, public engagement in research and future practice development.

As a referral center for many international patients, Johns Hopkins offers unique opportunities to interact with patients and their local providers from diverse backgrounds. This includes the option to participate in telemedicine initiatives in movement disorders.

Numerous intramural conferences under the umbrella of Johns Hopkins' departments of Neurology and Psychiatry are available to the fellows for expanding their medical education. Movement disorders fellows are expected to prepare and present topics, cases and videos for the following meetings in rotation.

• Johns Hopkins Topic Discussion for Movement Disorders Fellows (JHoT): First and third Wednesdays. Topics cover the breadth of movement disorders, divided among attendings and fellows
• Movement Disorders Video Case Conference: Third Wednesdays (following JHoT). Discussion of teaching cases and those needing consensus
• Ataxia Center Meeting: Second Fridays. Various ataxia topics
• Neuromodulation and Advanced Therapies Committee Meeting: Second Wednesdays. Fellow-run conference, presentation and discussion of candidates for advanced therapies
• Tauopathy Consensus Conference: Fourth Tuesdays. Consensus diagnosis of tauopathy subtypes
• Neurology Grand Rounds: Thursdays

The Maryland-Washington Regional Movement Disorders Video Meeting is a regional quarterly meeting cohosted by the movement disorders divisions at the NIH, University of Maryland, Georgetown University, Walter Reed and Johns Hopkins attended by academic and private community neurologists. The congress typically hosts a guest speaker or a speaker from the respective hosting academic institution, followed by a collegial video conference session.

The incoming fellows are strongly encouraged to attend the "Aspen Conference" organized by the International Parkinson’s and Movement Disorders Society (MDS). Opportunities to attend various conferences organized by the foundations for Parkinson's disease, ataxia, atypical Parkinsonian disorders and HD are also available.

The Parkinson's Disease and Movement Disorders Center at Johns Hopkins University School of Medicine, which is a Parkinson’s Foundation Center of Excellence, provides comprehensive care to a large patient demographic, including local, national and international patients. Fellows rotate with attendings in general movement clinics as well as subspecialty clinics. Fellows also follow patients longitudinally in botulinum toxin and general movement disorders continuity clinics over the course of their two-year fellowship.

The selection of patients for deep brain stimulation (DBS) surgery, intrajejunal levodopa infusion therapy, and other advanced therapies is performed through the neuromodulation and advanced treatments center. Patients are evaluated and video-recorded by fellows in their medication ON and OFF states and discussed at the Multidisciplinary Neuromodulation and Advanced Treatments (NeuModAT) committee meeting. Fellows also work with neuropsychology and psychiatry in patient selection and follow-up of neurocognitive and neuropsychiatric outcomes. Continuity of care is encouraged so that fellows may follow patients from their preoperative evaluation to their OR day and subsequent DBS programming.

A wide range of primary and secondary dystonias of varying complexity are treated with a variety of botulinum toxins under EMG and ultrasound guide at the chemodenervation clinics under the division. Fellows have monthly injection clinics supervised by attendings. Additionally, fellows rotate through attending-run clinics. Physical medicine department also runs chemodenervation clinics where fellows can arrange rotations. Our fellows also may shadow experts at the NIH at the Bethesda campus.

The Johns Hopkins Ataxia Center caters to a large and diverse group of ataxic and spastic patients with inherited and acquired disorders such as spinocerebellar ataxias, Friedrich ataxia, mitochondrial disorders, hereditary spastic paraparesis, episodic ataxias, and idiopathic ataxia. The Ataxia Clinic utilizes a multidisciplinary team-based approach to patient care, and fellows have the opportunity to rotate with the genetic counselor, PT, OT, and SLP as they evaluate and treat patients. Close collaboration with neuro-visual and vestibular specialists also ensures exposure to a variety of eye movement and vestibular pathologies.

Since 2014, Johns Hopkins has served as a primary referral center for all atypical Parkinsonian syndromes, including progressive supranuclear palsy (PSP), corticobasal degeneration (CBD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). The Atypical Parkinsonism Center has been designated as a CurePSP Center of Care and Lewy Body Dementia Association Research Center of Excellence. There is a monthly multidisciplinary clinic for patients with atypical Parkinsonism, during which patients have the opportunity to meet with social work, physical/occupational/speech/swallow therapists, and discuss research opportunities. Additional clinics for frontotemporal dementia (FTD), memory disorders, and adult hydrocephalus are available for interested fellows.

The Johns Hopkins Huntington Disease Center is one of the pioneers in early identification and characterization of the phenotypes of Huntington and related disorders. Founded in 1980, the Center represents a unique partnership between the neurology and psychiatry departments and is a longstanding Huntington Disease Society of America (HDSA) Center of Excellence. In the HD clinic, we provide multidisciplinary clinical services including genetic counseling and social work support to individuals with HD and related disorders. Fellows rotate through the clinic to gain experience in the diagnosis and management of patients with HD and HD-like disorders. The center is involved in many multicenter clinical trials, often via the Huntington Study Group (HSG). It is currently the top site in the US for the CSF biomarker trial (“HDClarity”), and is poised to be a leading site for upcoming disease-modifying therapy trials employing involving strategies like antisense oligonucleotides (ASO).

Pediatric general movement disorders and pediatric ataxia clinic are available for our fellows. This includes a subspecialty Tic Tourette syndrome and stereotypy clinic which fellows can work in. Additional subspecialty rotations are also available through pediatric neurology clinics and the Kennedy Krieger Institute for interested fellows.

The various centers in the Movement Disorders division collaborate with genetics clinics to provide genetic counseling and testing for patients. Fellows work closely with our geneticists to gain insights into patient selection for genetic testing, genetic and reproductive counseling, and appropriate options for testing.

The multidisciplinary Ataxia and Atypical Parkinsonism clinics offer clinicians the opportunity to work closely with experts in physical therapy, occupational therapy and speech-language pathology. Additional experience with special patient populations is available through the PM&R department.