Focus Areas

Movement disorders are a group of neurological conditions that affect the speed, fluency and ease of movement causing a person to have abnormal voluntary or involuntary movements, or slow movements. More than 30 different diseases, affecting almost 40 million Americans, are characterized as neurological movement disorders. Although many movement disorders are not life threatening, they can significantly impair patients' ability to perform daily activities independently. Depression and other non-motor problems are often associated with movement disorders.

• Ataxia is lack of coordination and often produces jerky movements.
• Dystonia is a neurological movement disorder characterized by involuntary muscle contraction leading to abnormal postures and twisting movements.
• Parkinson's disease is a progressive disorder that is caused by degeneration of the nerve cells that produce the neurotransmitter dopamine in the substania nigra - the part of the brain which controls movement.
• Essential tremor is an uncontrolled shaking or trembling, usually of one or both hands or arms that worsens when basic movements are attempted.
• Dyskinesia is abnormal uncontrolled movement and is a common symptom of many movement disorders.
• Huntington's disease is a hereditary progressive neurological disorder whose symptoms include involuntary movements, gait abnormalities, psychiatric disturbances and cognitive problems.
• Tourette's syndrome is hereditary disorder whose symptoms include motor or vocal tics and attention deficit hyperactivity disorder.

Our researchers are working to develop smart programming using existing DBS devices for treatment of Parkinson’s disease and dystonia. In addition, we are developing non-invasive monitoring and data mining with the goal of building an expert system for programming.

Depression is one of the more common mental disorders and is ranked by the World Health Organization as a leading cause of disability worldwide. Depression is a chronic, debilitating disease and in extreme cases may contribute to people taking their lives. For some, a depression episode will resolve with anti-depressant medications and psychotherapy treatment. However, many patients do not achieve remission despite trying multiple medications, psychotherapy, and/or electroconvulsive therapy. In fact, studies suggest that 50% of depression patients fail to respond after the first being prescribed their first two anti-depressant treatments from different classes over a 2-3 month period. These patients are believed to have a form of depression known as Treatment Resistant Depression (TRD).

TRD is a more severe and chronic form of depression and patients will suffer a great impairment of their daily activities. Some people with TRD may have a family history of depression, suggesting a possible hereditary component of the disease. They are also at a greater risk of hospitalization for their psychiatric illness and are at increased risk of attempting suicide.

Treatments and mechanisms of TRD has been studied at Emory through the Deep Brain Stimulation Clinical Research Program for Treatment Resistant Depression - the first program of its type in the nation. Emory has emerged as a world leader in the development and testing of deep brain stimulation for TRD, a technique pioneered by Helen Mayberg. This research program is unique as it is the only such psychiatry DBS program operating independent of industry sponsored trials. Sponsored research is ongoing with new studies designed to refine and optimize surgery, and to examine mechanisms mediating the antidepressant effects of DBS.

Epilepsy is a neurological disorder in which a person has recurrent seizures. Seizures occur when there is a sudden disruption of normal electrical activity in the brain. They can take many forms, including unusual sensations, changes in awareness, emotions or behavior, involuntary movements or convulsions and loss of consciousness. The causes of epilepsy are diverse and can include genetic factors, brain injury, stroke, infection, developmental abnormalities or other neurologic conditions. In many people, however, no single cause is identified.

Although medication controls seizures for many people, others continue to have seizures despite treatment. ENTICe researchers are developing new forms of neuromodulation, which use carefully targeted electrical stimulation to help regulate abnormal brain activity. By combining brain recording, imaging and surgical innovation, our goal is to make these therapies more precise, more personalized and more effective at reducing seizures and improving quality of life.

Our epilepsy research program studies whether a person’s own brain anatomy can help guide more precise neuromodulation treatment for seizure control. In this image, the brain areas where seizures began are shown in blue. Advanced brain imaging was used to map the pathways linking these seizure areas to different regions of the thalamus, a deep brain structure involved in regulating brain activity. These individualized maps were then used to plan DBS lead placement in areas most closely connected to the patient’s seizure network. Following treatment, this patient went from experiencing more than 60 seizures per day to having seizure-free days during most of each month. This work aims to help make epilepsy neuromodulation more personalized and effective.

Across a broad range of neurologic conditions, movement dysfunction is common resulting in reduced activity participation and quality of life. Traditional rehabilitation approaches to improvement movement function focus on addressing impairments of the body through individualized task-specific training. However, often these approaches still result in persistent inability to move normally. To augment traditional rehabilitation strategies, it is possible to use strategies to (non-)invasively stimulate different parts of the nervous system including the brain and spinal cord to modulate activity that promotes mechanisms of functional neuroplasticity (the capacity to adapt in response to experience) that are necessary for learning and the recovery of function.

Here at Emory, researchers are studying the fundamental mechanisms of neural plasticity using neuroimaging and neurostimulation approaches to identify potential biomarkers of (re)learning that can be targeted with precision. Researchers are also engaged in clinical trials evaluating the effects of innovative neuromodulation strategies aimed at improving movement function across several conditions including, but not limited to, stroke, Parkinson’s disease and multiple sclerosis.

Healthy sleep is a fundamental pillar of brain health. Sleep is a time of active restoration of the brain and body, during which there is energy replenishment, removal of waste products and enhancement of memory functions. Sleep timing, duration and quality can all be improved through a variety of strategies, with great potential for continued improvements through neuromodulation. There are also over 80 sleep disorders, collectively impacting over a billion people worldwide. Emory Sleep Center is focused on diagnosis and treatment using a range of innovative solutions.

• Insomnia is a disorder characterized by difficulty falling asleep, staying asleep or sleeping as long as needed, in the setting of adequate time and space for sleep.
• Obstructive sleep apnea is the most common sleep related breathing disorder, in which there is repeated collapse of the airway during sleep
• Restless legs syndrome is a sensory-motor disorder in which irresistible urges to move the legs at night can prevent sleep onset and quiet rest
• Narcolepsy is a disorder of pathological daytime sleepiness, in which there are repeated attacks of sleep during the day and symptoms of dysregulated REM sleep
• REM sleep behavior disorder results in dream enactment behavior during REM sleep, often causing injury during vivid, violent dreams. It is strongly associated with Parkinson’s disease and related conditions, although other causes also exist.

Innovation forums are disease-oriented, collaborative sessions involving clinicians, scientists, engineers and others from Emory and Georgia Tech. These forums include presentations to discuss barriers, needs, existing treatments and opportunities related to a specific disease or disorder. The goal of the session is to identify how the different disciplines can work together to improve existing treatments or create new ones – advancing neuromodulation therapies.