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Home > Neurosurgery Research > Movement Disorders Research > Starr Laboratory  
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Starr Laboratory
Principal Investigator: Philip A. Starr MD, PhD
  • Associate Professor of Neurological Surgery
  • Co-Director, Functional Neurosurgery Program
  • Surgical Director, Parkinson's Disease Research, Education and Care Center (PADRECC) at San Francisco Veteran's Affairs Medical Center
  • Principal Investigator, Movement Disorders Research
 
Overview of Research Program
 
Surgical treatment of movement disorders is currently enjoying a renaissance, fueled by a better understanding of movement disorder pathophysiology, improved techniques for basal ganglia surgery, and recognition of the shortcomings of long-term medical therapy for Parkinson's disease. Our research program focuses on several areas of movement disorder surgery: Understanding the physiology of the human and non-human primate brain in movement disorders, defining ideal target areas of the brain for maximal therapeutic benefit in movement disorder surgery, improving the technical approach to movement disorder surgery, and developing novel restorative treatments for degenerative disease.
 
Physiology of the human and non-human brain in movement disorders
Funded by an NIH K08 award (co-investigator: Dr. Robert Turner), Dr. Starr's laboratory is performing studies of the role of basal ganglia physiology in dystonia using both human and nonhuman primate models. They have characterized abnormalities in single cell discharge in the globus pallidus in 22 humans with dystonia. This work should lead to an improved theoretical basis for surgical intervention in human dystonia. They have also studied the organization of the human subthalamic nucleus in Parkinson's disease.
 
Defining ideal target areas in the brain for maximal therapeutic benefit in movement disorders surgery
Although deep brain stimulation (DBS) for Parkinson's disease is becoming a widespread procedure, the optimal therapeutic target in the brain for maximal benefit is unknown. It is not clear which of two promising brain targets, the globus pallidus or subthalamic nucleus, offers greater therapeutic benefit. Working with Dr. William Marks and Dr. Jill Ostrem in Neurology, Dr. Starr's group participates in a 6-center trial of DBS of the globus pallidus versus subthalamic nucleus for Parkinson's disease. This trial is funded by grants from both the Veterans Cooperative Studies Program and the National Institutes of Health. They have developed a database of MRI-verified DBS electrode locations for detailed comparison of electrode location with outcome, so as to better define the subregion within each nucleus associated with various therapeutic and adverse effects.
 
Use of interventional MRI in movement disorders surgery
Along with Paul Larson MD (Neurosurgery) and Alastair Martin PhD (Radiology), Dr. Starr's group has developed a novel approach to the placement of deep brain stimulators. In the standard technical approach to this surgery, patients are required to be awake for much of the surgery, for the purpose of performing invasive electrical recordings of the brain. The new approach allows DBS implants to be placed under continuous high resolution MRI imaging of the brain, obviating the need for patients to be awake, to be off their medication, and to undergo invasive physiological recordings. This clincial program was launched in April 2004 and promises to lead to safer, more accurate, and more comfortable surgery for patients with Parkinson's disease and other disorders requiring access to deep brain structures with extremely high accuracy.
 
Gene therapy for Parkinson's disease
Although DBS is now a well-established therapy for Parkinson's disease, it has several shortcomings. It is a relatively complex therapy for the patient, requiring multiple surgeries over time for battery changes and hardware revisions. In addition, it does not protect the patient from progression of the disease. Therefore, newer therapies that restore or protect missing biochemicals or missing circuitry are needed. Dr. Starr, along with colleagues Dr. Paul Larson, Dr. Krys Bankiewicz, Dr. William Marks, and Dr. Jill Ostrem, are conducting investigational trials using gene transfer technology to restore missing elements within the striatum of patients with Parkinson's disease.
 
UCSF UCSF Medical Center UCSF School of Medicine
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