05/09/2024
Dr. Thomas Steeves is a movement disorder neurologist who helps people with Parkinson’s disease, dystonia, tremors and more. He also uses electromyography to help diagnose nerve and muscle diseases.
You have probably heard of Parkinson’s disease, tics and tremors. But what type of doctor can help someone with these conditions? A movement disorder neurologist like Dr. Thomas Steeves specializes in nervous system conditions that cause movement problems. Dr. Steeves joined the Nuvance Health Neuroscience Institute from Toronto, Canada, as the director of movement disorders.
Dr. Steeves shared why he became a movement disorder specialist, how he helps people mentally and physically and what he’s most excited about in the field. Plus, find out how car rides from Canada to New York as a child instilled a love for the Hudson Valley and a desire to care for people in the community.
Why did you choose to be a movement disorders specialist?
Dr. Steeves: The decision to become a movement disorder specialist was not particularly hard for me. Even in medical school, I suspected this was where I was going to end up, and I’d confirmed my path within a matter of months of starting my neurology residency. In retrospect, it was probably because this specialty best fit my conception of what a doctor should be.
Movement disorders neurology relies on what you might call the “art” of its clinical practice. Good movement disorders specialists develop keen powers of observation and a flexible and creative examination technique that responds to the behaviors and movements of the individual in front of them. They combine these skills with an intuitive understanding of clinical presentations. The process is automatic and intuitive. Of course, you can spend a lot of time analyzing everything afterward. But in the moment, as you observe the patient, your mind is doing everything well below the level of language. Usually, you look, and you know.
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You also work in the neurophysiology lab performing electrodiagnostic testing. What is it about this work that appeals to you?
Dr. Steeves: Movement disorders can be a very mentally demanding specialty day in and out because of their complexity, intensity and relative lack of algorithms to guide diagnosis and treatment. I balance movement disorders with my role as an electromyographer in the neurophysiology laboratory. In this role, I perform studies on nerves and muscles and interpret the data to provide relatively concrete answers to other physicians about the source of their patient’s neuromuscular symptoms. This work offers an objective approach to the evaluation of neurologic diseases, and it is probably as far away from movement disorders as you can get.
I completed my electrophysiology training at the Mayo Clinic at a time when I already knew I was going to be a movement disorders specialist; however, over the years, this work in the laboratory has provided a very fulfilling counterpoint to my primary role as a movement disorders specialist.
With time and distance, I’ve also become increasingly grateful to the staff at the Mayo Clinic who provided such a unique learning experience for me. The program they ran was extremely demanding and highly structured. Having now spent many years training junior neurologists myself, I can see how extraordinarily committed they were to ensure their culture of clinical excellence was transmitted to succeeding generations of neurologists.
How do you help people with movement disorders?
Dr. Steeves: There are many types of movement disorders, including Parkinson’s disease, atypical Parkinsonism (or atypical Parkinson’s), dystonia, chorea, tics and tremors to name some of them. Movement disorder specialists can usually help people with these conditions in several ways.
First, we define the problem, might be more complicated than you initially think. Many people will go years thinking they have one type of movement disorder, when in fact, they have another.
Second, we often can provide a specific diagnosis and tell the patient why they have the movement. Based on this information, we may then be able to tell the patient what to expect from their disorder throughout their lifetime, unless the clinical course is unknown. This is no small matter for most patients.
In some instances, we can determine if a movement disorder is arising from a specific underlying medical condition, which may be highly treatable or even curable. If a cure is not possible, we will discuss treatment options to manage symptoms. We also discuss the benefits and risks of treatments, including possible side effects from medications.
In instances where an individual has symptoms that significantly affect their quality of life, we may be able to offer more advanced treatments, like deep brain stimulation and MRI-guided focused ultrasound.
What are you most excited about in treatments to help manage symptoms from movement disorders like Parkinson’s disease, dystonia and tremors?
Dr. Steeves: The spectrum of movement disorders is very broad and the treatments available for each one are also diverse. However, these very different conditions are united because advances in treatments are occurring for most, if not all of them. Every year, our understanding of the basis of these conditions continues to improve, leading us closer to eventual cures.
Treatments for genetic movement disorders
It’s an exciting time for people with genetic conditions, not just in neurology, but the entire field of medicine. In the field of movement disorders, this is particularly true for people with Huntington’s disease, some forms of Parkinson’s disease, dystonia and ataxia, which is a disorder of coordination.
We are on the threshold of being able to offer treatments to correct the underlying genetic abnormalities responsible for these conditions. Hurdles remain, including reliably delivering the technology into the cells of the brain and spinal cord required to make these corrections. But these hurdles are not insurmountable, and I’m confident we will overcome the remaining barriers to success in the years to come.
Treatments for Parkinson’s disease
Treatment options for Parkinson’s disease symptoms continue to expand every year. Deep-brain stimulation has been widely available for at least 30 years. MRI-guided focused ultrasound has only been available for the last eight years, and mainly for managing tremors. However, it is increasingly applied to treat Parkinson’s disease.
For those who want a less-invasive approach, we now can deliver L-dopa in a continuous infusion by a small, subcutaneous (under the skin) pump. This treatment can keep symptoms under continuous control. It is like the way insulin is administered to people to treat diabetes.
These therapies offer hope to people with Parkinson’s disease, allowing them to maintain their independence, active lifestyles and important social connections.
Treatments for dystonia and tremors
For people with dystonia and for some with tremors, botulinum toxin injections guided by electromyography and ultrasound are very good treatment options. The use of ultrasound to guide injections has greatly improved the outcomes for more complex dystonias affecting the limbs.
For the rare individual with more extensive or generalized dystonia, as well as those with more severe tremors, deep brain stimulation can be a very effective intervention. MRI-guided focused ultrasound is also a therapy for severe tremors and is currently being evaluated for the management of some forms of dystonia. The early results seem promising.
Movement disorders can be emotionally difficult to deal with. How do you help people deal with their situation?
Dr. Steeves: Knowing the treatment can help them achieve personal and professional goals, minimize discomfort and maintain a good quality of life offers them a great deal of hope and encouragement. Many people are very adaptable and able to see the good in their lives, despite difficulties encountered along the way.
The broad spectrum of movement disorders means the impact on patients can be quite variable. This means my own contributions to any patient’s emotional well-being varies depending on the condition and the individual.
Many disorders, including tremors, are benign conditions that produce no significant disability over the course of someone’s life. Significant psychological benefit can be derived from the reassurance that their condition is not likely to have a major impact long-term. After a patient has been relieved of the anxiety from the uncertainty over their diagnosis, their desire for a specific treatment and need to take medication also significantly subsides.
For those with a movement disorder that produces more significant disability, but still does not reflect a neurodegenerative process, it can be helpful for the people to know their long-term course in life will not be significantly altered; although, they will be aware of their symptoms. People with more severe tremors or more common forms of dystonia fall into this category. However, for quite a large proportion of these cases, we can provide excellent treatments that minimize the impact of symptoms.
Progressive neurodegenerative conditions will have a significant impact on the individual and their families. I know this group of disorders and their impact very well, both personally and professionally. Even within this group, a broad spectrum of severity exists, ranging from disorders that may reduce the lifespan of an individual to one that allows someone to remain active and engaged for many years. In most instances, we can provide treatments to improve symptoms. This is particularly true for Parkinson’s disease, where we can have a dramatic impact on symptom severity.
Regardless of the condition, we provide education to patients and their families, which can alleviate some of their fears. We also provide education about potential complications with the hopes to ultimately avoid them. For example, swallowing complications is associated with many neurodegenerative conditions. Monitoring the patient with appropriate studies, diet modifications and speech therapy can help. Proactive interventions like these can offer reassurance to individiduals and their families.
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Importantly, in the more severe neurodegenerative cases, we can provide some information on the prognosis so everyone can prepare, physically, mentally or emotionally. In my experience, among the worst things that can happen is a lack of understanding of anticipated needs and time course, resulting in a vulnerable person who has been left alone and unsupported.
Why did you choose to join the Nuvance Health Neuroscience Institute?
Dr. Steeves: I joined Nuvance Health from Toronto, Canada for personal and professional reasons. I didn’t end up in the Hudson Valley by accident.
Both sides of my family are originally from the East Coast of the United States. My mother’s side of the family is from New York, dating back to a time when it was New Amsterdam. Despite my roots running deep in America, I grew up on the Canadian prairies in a place that bears no physical or cultural resemblance to the Hudson Valley.
Possibly because of this, during the summers when I was a child, my mother and father made sure our family of five got into our old Falcon station wagon to make a long, hot and dusty drive across the continent to spend time with my grandparents at their home in the hills above Cold Spring, N.Y. I remember Cold Spring occupied a place within the family mythology as an ideal place or at least a better place.
I worked at the University of Toronto for the last 15 years. After completing three years of fellowship training, I stayed to establish a movement disorders clinic at one of the major academic medical centers in downtown Toronto. During my time in academic medicine, I diagnosed and cared for many people with very complex conditions and trained many neurologists.
Coming to Vassar Brothers Medical Center and the Nuvance Institute Neuroscience Institute gives me both the resources and the opportunity to provide the highest standards of care to patients while serving in a community that has personal significance.
If someone thinks they or a loved one has a movement disorder, what should they do?
Dr. Steeves: If you think you or a loved one has a movement disorder, an evaluation by a primary care physician or general neurologist is a very good place to start. If even minimal concerns or uncertainties persist, a movement disorders will be able to help.