Neurology: Clinical Programs
The Movement Disorders Clinic at the Toronto Western Hospital was developed by Dr. Anthony Lang in the mid-1980s. Since that time the Morton and Gloria Shulman Movement Disorders Clinic and the Edmond J. Safra Program in Parkinson’s Disease have established an international reputation for patient care, research and education in the field of Parkinson's disease and other movement disorders. This is the largest such clinic in Canada and one of the largest in North America, providing care to patients throughout the province of Ontario as well as patients from other areas of the country, United States and elsewhere (patients are referred for consultation and expert opinion from all over the world and patients from many parts of the world seeking surgical therapy for Parkinson's disease are cared for in our institution.) Part of the clinic's mission is the provision of optimal care and support to patients with all stages of Parkinson's disease, their caregivers and their families. Advancing basic knowledge of the causes of Parkinson's disease and the development of novel therapies through basic and clinical research is another extremely high priority for the clinic. Finally, educating physicians, nurses and other medical personnel about all aspects of Parkinson's disease is a critical component of the mission of the clinic.
Dr. Lang holds the only named chair in Parkinson's disease research in Canada (the Jack Clark Chair for Parkinson’s Disease Research) and also holds the Lily Safra Chair in Movement Disorders. He is the Director of the Division of Neurology at the University of Toronto. Our full-time faculty includes experts in clinical electrophysiology (Dr. Robert Chen), the neurological aspects of surgery for Parkinson's disease (Drs. Alfonso Fasano and Renato Munhoz), basic and clinical neuropharmacology (Dr. Susan Fox), functional neuroimaging (Dr. Antonio Strafella), clinical epidemiology (Dr. Connie Marras), neurobiology (Lorraine Kalia) and education, palliative care and neurogenetics (Elizabeth Slow). We have an extremely active clinical and research fellowship training program with approximately 10 fellows working in our clinics and laboratories over the past year. Other members of our team include three research coordinators, one clinic nurse, two nurses involved in our surgical program, one research assistant, one social worker, and seven other administrative and clerical workers.
The Palliative Care Clinic for Parkinson's disease at the Morton & Gloria Shulman Movement Disorders Centre was developed by Dr. Janis Miyasaki (now in Edmonton) to help patients with movement disorders and their families to plan for the future and to improve quality of life. Our team can help with: symptom control, pain control, depression, confusion or changes in clear thinking and planning for the future (e.g., housing, assistance, etc.)
There is an active research collaboration with our functional neurosurgery team directed by Dr. Andres Lozano (with Drs. Moji Hodai and Suneil Kalia) and physiologists Drs. Jonathan Dostrovsky and William Hutchison. Collaborative research is also conducted with the laboratories of Dr. Jonathan Brotchie in the Toronto Western Research Institute and Dr. Ekaterina Rogaeva at the Centre for Research in Neurodegenerative Diseases and with neuropsychiatrists Dr. Paul Sandor and Mateusz Zurowski.
We are in the process of establishing a University of Toronto Movement Disorders Program in collaboration with neurologists at the other teaching centres. At Sunnybrook Health Sciences Centre, Dr. Mario Masellis directs the clinical and research program interested in behavioural neurology and imaging in movement disorders. At Baycrest Hospital, Dr. Galit Kleiner-Fisman directs an active clinical program with particular interest in interdisciplinary care and patient education. Dr. Tom Steeves directs a general movement disorders program at St. Michael’s Hospital. We are in the process of developing a common database that will be used in all of the movement disorders clinics across the University.
Collectively, the members of the Movement Disorders Program at University of Toronto have a world renowned reputation in all aspects of research for Parkinson's disease and other movement disorders and have made a major impact on knowledge and understanding of the pathophysiology and approaches to treatment designed to improve the quality of care for patients with these disorders.
- Anthony E. Lang, MD - Professor
- Robert Chen, MD - Professor
- Antonio P. Strafella, MD, PhD - Associate Professor
- Connie Marras, MD - Assistant Professor
- Susan Fox, MD - Assistant Professor
- Lorraine Kalia, MD - Assistant Professor
- Renato Munhoz, MD
- Alfonso Fasano, MD
Don Borrett, MD - consultant
Alex Birnbaum, MD - consultant
Toronto Western Institute
Jonathan Brotchie, PhD - Senior Investigator
Sarah Duff-Canning, PhD - Senior Investigator
University of Toronto - CRND
Movement Disorders Centre
Toronto Western Hospital
399 Bathurst Street, McLaughlin 7-421
Toronto, ON M5T 2S8
Fax: 416 603 5004
Malton, Shelley (email@example.com)
Yong, Tammy (firstname.lastname@example.org)
Hatton, Lisa (email@example.com)
Chiu, Tiffany (firstname.lastname@example.org)
Ortiz, Rhoda (Rhoda.Ortiz@uhn.ca)
Williams, Patricia (email@example.com)
Victor, Ann Marie (firstname.lastname@example.org)
Geobey, Brent (Brent.Geobey@uhn.ca)
Clinical and Research
Long, Janine (email@example.com)
Hoque, Tasnuva (firstname.lastname@example.org)
So, Julie (email@example.com)
Poon, Yu-Yan (firstname.lastname@example.org)
Racioppa, Julie (email@example.com)
Rothberg, Brandon (firstname.lastname@example.org)
Mancini, Deborah (email@example.com)
Fallis, Melanie (Melanie.Fallis@uhn.ca)
Visanji, Naomi (Naomi.Visanji@uhnresearch.ca)
Ghate, Taneera (Taneera.Ghate@uhn.ca)
Diagnosis of PD < 5 yrs, MMSE ³27, subjects may take Amantadine and/or anticholinergics, NOT on L-dopa, or DA, MAO-inhibitors, COMT (prior exposure to L-dopa or DA OK; washout =30 days prior to screening)
Dr. Fox, Dr. Walsh, Deborah
Male/female between 35-75 yrs old, female NOT of child bearing potential, H&Y 1-2.5, subject not requiring PD treatment for six months, prior PD medicinal treatment not exceeding four wks, 10 visits over 32 wks
Dr. Fox, Dr. Mestre, Dr. Connolly, Julie S
Other Movement Disorders
Cervical Dystonia – off Botox x three - four months, not driving
Dr. Marras, Brandon
Male/female age 40 or older, meets NINDS –SPSP criteria, not diagnosed with Alzheimer’s, no presence of atypical features, no other neurological disease, and non-demented
Dr. Marras, Brandon
Dystonia Coalition Study
Over 18 yrs old, established/new cervical dystonia subjects, three months since last injection, videotaping, neurological & psychiatric evaluations, questionnaires, TWSTRS, blood draw
*currently recruiting from Botox clinics
Dr. Fox, Brandon
Focal hand dystonia Botox/rTMS
Looking for a total of 10 Writer’s cramp pts
Dr. Chen, Dr. Phielipp, Tasnuva
The Epilepsy Program is devoted to the diagnosis and treatment of epilepsy and to the advancement of understanding in all aspects of the condition. Adult outpatients are seen throughout the city, by epileptologists at Sunnybrook Health Sciences Centre, St Michael's Hospital, and the Epilepsy Clinic at the Toronto Western Hospital (TWH). Paediatric patients are evaluated and treated through the Paediatric Epilepsy Program at the Hospital for Sick Children.
For the evaluation of adult patients with intractable epilepsy, the inpatient Epilepsy Monitoring Unit (EMU) at Toronto Western Hospital was expanded in 2014 from five beds to 10 beds, allowing for continuous video-EEG recording of patients with seizures, enabling accurate diagnosis of epilepsy (differentiating it from other conditions that may mimic epilepsy) and specific classification of the type of epilepsy. Such accurate diagnosis and classification is of prime importance in guiding appropriate treatment and counselling.
For patients with medically-refractory epilepsy who may be candidates for epilepsy surgery, the continuous video-EEG recording performed in the EMU allows for accurate localization of the brain region responsible for a patient's seizures. The inpatient video-EEG recording is a part of the services provided by the Clinical Neurophysiology Laboratory at TWH, which also offers extensive outpatient EEG and video-EEG as well as continuous ambulatory EEG services for the evaluation of epilepsy.
State-of-the-art multimodal brain imaging is available for the evaluation of patients in the Epilepsy Program, including high resolution 3T MRI, fMRI and MEG. All patients who may be candidates for epilepsy surgery undergo formal neuropsychological testing and neuropsychiatric evaluation.
All forms of classical epilepsy surgery are performed at TWH, including implantation of depth and subdural electrodes for recording intracranial EEG in difficult cases where the site of seizure onset cannot be determined from non-invasive recordings. There is a special interest in novel neurostimulation techniques at TWH for patients with medically-refractory epilepsy who are not candidates for classical epilepsy surgery, in particular electrical deep brain stimulation.
Research into all aspects of epilepsy is a major mission of the program and many members of the clinical team are active in research ranging from cellular electrophysiology to seizure prediction and EEG source localization to studies of quality-of-life in people with epilepsy. Some of these researchers have achieved national and international acclaim and many work together with a large number of interdisciplinary collaborators both within the University of Toronto system and beyond to further the basic understanding of epilepsy.
Another goal of the Epilepsy Program is to constantly strive to raise awareness of epilepsy in society. Relatedly, we hope to increasingly bring knowledge of epilepsy and epilepsy care to the community, and at the same time improve access to specialized centres such as ours to facilitate accurate diagnosis and optimal treatment for all patients.
Epilepsy Program members, Division of Neurology:
Dr. Danielle Andrade (TWH, Co-Director Epilepsy Program)
Dr. Joseph Bruni (SMH)
Dr. Esther Bui (TWH)
Dr. Peter Carlen (TWH)
Dr. Martin del Campo (TWH)
Dr. Jack Schneiderman (SMH)
Dr. Peter Tai (TWH)
Dr. Richard Wennberg (TWH)
Dr. Catherine Zahn (TWH)
Epilepsy Program members, other Divisions:
Dr Taufik Valiante, (Neurosurgery, TWH, Co-Director Epilepsy Program)
Dr. Karl Farcnik (Neuropsychiatry, TWH)
Dr. Andres Lozano (Neurosurgery, TWH)
Dr. Mary-Pat McAndrews (Neuropsychology, TWH)
Dr. Melanie Cohn (Neuropsychology, TWH)
Chari Anor (Epilepsy Clinic Nurse, TWH)
The field of neuromuscular disorders has been prominent at the University of Toronto since the 1960’s. John Humphrey established a nation-wide reputation for expertise in the treatment of neuromuscular disorders. He was the first in Canada to use plasma exchange in patients with Guillain-Barre syndrome, and was widely recognized and respected for his expertise. Dr. Peter Ashby established a reputation for expertise in spinal disorders and studies of mechanisms of spasticity.
Today, the Neuromuscular Section at the University of Toronto is active at each of the major hospital units at the University of Toronto. Clinical care is provided to patients with focal and diffuse neuropathies, myopathies and muscular dystrophy, neuromuscular junction disorders, motor neuron disease, and spinal disorders/radiculopathy.
The director, Dr. Vera Bril, is located at University Health Network/Mount Sinai Hospital. Dr. Bril is involved in research and clinical care for patients with myasthenia gravis, chronic inflammatory demyelinating polyneuropathy, and diabetic neuropathy. Dr. Lorne Zinman, at Sunnybrook Health Sciences Centre, directs one of the largest ALS clinics and research centres in Canada. He is also interested in clinical epidemiology. Dr. Gyl Midroni at St. Michael’s Hospital has a particular interest in medical education and has established a unique and comprehensive electrodiagnostic training course for residents.
The multiple sites of neuromuscular practice throughout Toronto each have individual strengths, however unite for various activities throughout the year, including the annual “Neuromuscular Day,” which highlights the ongoing research in the city. This activity was started in 2002 by Dr. Vera Bril and invites high-profile international neuromuscular speakers to participate. Recent invited guests have included Dr .Robert Griggs (University of Rochester, 2014), Dr. Gyl Wolfe (University of Buffalo, 2013), Dr. Richard Barohn (University of Kanasas, 2012), Dr. Michael Sinnreich (Montreal Neurological Institute, 2011), and Dr. Ingemar Merkies (Erasmus University, Netherlands, 2010), among others.
- PCORI - Patient Assisted Intervention for Neuropathy: Comparison of Treatment in Real Life Situations
- Evaluation of Corneal Confocal Microscopy as a Surrogate Endpoint for the Identification and Prediction of Diabetic Neuropathy
- Immune Globulin as a Corticosteroid Sparing Agent in Corticosteroid Dependent Patients with Myasthenia Gravis
- Immune Globulin in Symptomatic Subjects with Myasthenia Gravis
- Open Label study of subcutaneous immunoglobulin in myasthenia gravis
- CSF protein levels in diabetic patients with distal symmetric polyneuropathy
- Treatment with Gamunex 10%for Patients with Demyelination and Diabetes Mellitus (IDIDM)
- open-label trial to assess the efficacy and safety of Immune Globulin 10% in patients with Myasthenia Gravis exacerbations
- The utility of corneal confocal microscopy in small fiber neuropathy
- Repetitive nerve stimulation in Myasthenia Gravis
- The percentage and predictors of treatable polyneuropathies in the neuromuscular clinic
- Immune Globulin with Recombinant Human Hyaluronidase and Immune Globulin Infusion for the Treatment of CIDP
- The validation of the CAP-PRI (chronic acquired polyneuropathy-patient reported index) in patients with acquired and idiopathic polyneuropathy
- study to evaluate CFZ533 in patients with moderate to severe myasthenia gravis
- Evaluation of Criteria for Diagnosis of Inflammatory Neuropathy in Patients with Diabetic Sensorimotor Polyneuropathy
- Development of a new scale of functional impairment for use in clinical trials and practice in Myasthenia Gravis
- Qualityof lifein patients with Neurofibromatosis type 1 and 2
- open-label extension study to investigate the long-term safety and efficacy of IgPro20 in maintenance treatment of CIDP
- Rare Disease Diagnostic Awareness Project (Pompe’s disease)
For further information on any of these trials: call Research Manager, Eduardo Ng, at 416-340-4184
Hospital for Sick Children
Dr. James Dowling
Dr. Jiri Vajsar
St. Michael’s Hospital
Dr. David Chan
Dr. Gyl Midroni
Dr. Michael Sawa
Dr. Thomas Steeves
Sunnybrook Health Sciences Centre
Dr. Devra Baryshnik
Dr. Aaron Izenberg
Dr. Lorne Zinman
University Health Network (Toronto General/Toronto Western Hosptials)
Dr. Peter Ashby
Dr. Ari Breiner
Dr. Vera Bril (Neuromuscular Section Director)
Dr. Dubravka Dodig
Dr. Robert Chen
Dr. Hans Katzberg
Basic Scientists: Drs. Janice Robertson and Ekaterina Rogaeva (Centre for Research in Neurodegenerative Disease)
Neurosurgeons: Dr. Farhad Pirouzmand (Sunnybrook, peripheral nerve surgery)
Pathologists: Drs. Rasmus Kiehl and Lily Hazrati (UHN), Dr. Patrick Shannon (Mount Sinai Hospital), Dr. Julia Keith (Sunnybrook Health Sciences Centre)
Radiologists: Dr. Ali Naraghi (Musculoskeletal and peripheral nervous system imaging)
For qualified neurology trainees, there are fellowship opportunities available at the University Health Network (Toronto General and Western sites). The primary fellowship supervisor is Dr. Vera Bril, and fellows may be accepted for one or two-year programs. Fellows who wish to undertake a significant research project or concurrently complete a master’s degree are expected to apply for a two-year fellowship program. The fellows will receive broad training in neuromuscular disease including disorders of nerve, muscle, and neuromuscular junction. Fellows may receive advanced training in advanced EMG techniques, percutaneous muscle biopsy, or peripheral nerve imaging, depending on their skill level. A variety of research opportunities are available. There are monthly case rounds, as well as monthly journal clubs, and combined rounds with neuropathology to review muscle biopsy specimens. Please contact Dr. Vera Bril at 416.340.3315 or firstname.lastname@example.org for further information.
Sunnybrook Health Sciences Centre offers a one-two year clinical and research fellowship in Neuromuscular Diseases and Clinical Neurophysiology. Fellows will gain expertise in the diagnosis and management of a broad range of neuromuscular disorders and have the opportunity to participate in clinical research studies with a primary focus on motor neuron diseases/ALS. Fellows will also receive extensive training in neurophysiology and will qualify to take the Canadian EMG certification exam. For further information contact Dr. Lorne Zinman at email@example.com.
The University of Toronto Division of Neurology has a comprehensive sleep disorders program. The neurology division has a focus on neurological aspects of sleep medicine, but also treats common sleep disorders such as obstructive sleep apnea that have major implications for neurological conditions such as epilepsy, and cognitive impairment. Particular areas of interest to the program include narcolepsy, parasomnias such as REM sleep behaviour disorder (seen in Parkinson's disease and Lewy Body Dementia), restless legs syndrome/periodic limb movements, circadian rhythm abnormalities and sleep disorders in stroke including sleep apnea. We have state-of-the-art sleep laboratory facilities with full video polysomnography with multiple sleep latency testing/maintenance of wakefulness testing as well as ancillary tests including actigraphy, psychomotor vigilance assessment etc. Our data is collected for advanced signal analysis and correlation with clinical characteristics.
We teach a broad range of interdisciplinary students and have had students from around the world. We have an active research agenda with >$500,000 in peer-reviewed funding, and over 50 publications in the last five years.
Dr. Brian Murray (Director) - Sunnybrook Health Sciences Centre
Dr. Andrew Lim - Sunnybrook Health Sciences Centre
Dr. Mark Boulos - Sunnybrook Health Sciences Centre
Collaborative work with colleagues in family practice and respirology support insomnia management and mechanical ventilation in neuromuscular disorders.
Information on how to refer patients
Patients can be referred for clinical assessment with a brief referral faxed to 416-480-6092. We arrange clinical consultation first, and determine if sleep studies are necessary and arrange the appropriate investigations. We prefer that patients not have sleep studies elsewhere as this limits our ability to arrange investigations.
Major research interests include:
- polysomnographic signal analysis for characterization of neurological and psychiatric disorders
- investigation of the epidemiological, genetic and pathophysiological links between sleep and circadian disruption, and the development of neurological outcomes such as cognitive impairment, dementia and stroke
- investigation of circadian rhythms of gene expression and epigenomic modification in the human cerebral cortex
- investigation of the genetic determinants of human sleep and circadian traits
- ambulatory and actigraphic tools for assessment of sleep/wake behaviours in large cohort studies
- sleep disorders and stroke prevention/rehabilitation
Sound sleep can reduce Alzheimer's risk: Genetic risk factor for Alzheimer's disease may be offset by better sleep (Oct. 21, 2013) http://sunnybrook.ca/research/media/item.asp?c=2&i=1051&f=sleep-alzheimers-risk
Are you an early riser or a night owl? Check your DNA, Radio Canada International (Dec. 20, 2012) http://www.rcinet.ca/english/daily/interviews-2012/10-50_2012-12-20-are-you-an-early-riser-or-a-night-owlr-check-your-dna/
You are most likely to die at 11 a.m. The Atlantic. (Nov 19, 2012) http://www.theatlantic.com/health/archive/2012/11/you-are-most-likely-to-die-at-11-am/265427/
Scientists stimulate dreaming sleep for the first time PDF, Sunnybrook News (Sep. 30, 2009) http://sunnybrook.ca/uploads/SBNews090930.pdf
Brain waves of dreaming sleep found for first time PDF, Sunnybrook News (July 13, 2007) http://sunnybrook.ca/uploads/SB070713.pdf