Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit RC + S.

I see patients with a broad range of movement disorders, including Parkinson's disease, tremors, ataxia, dystonia, tics, and Huntington's disease. I employ deep brain stimulation (DBS) therapy for selected patients with Parkinson's disease, tremor, or dystonia, and use botulinum toxin injections for certain patients with dystonia, tremors, or tics. I work with an interdisciplinary team of physicians, therapists, and other healthcare providers, with the overall goal of helping to improve the lives of patients with complex neurological diseases.

Our research employs engineering approaches to understand and control neural function. We work on fundamental questions and applied development in electrical stimulation of the nervous system to restore function to individuals with neurological impairment or injury.

Current projects include:
• understanding the mechanisms of and developing advanced approaches to deep brain stimulation to treat movement disorders,
• developing novel approaches to peripheral nerve electrical stimulation for restoration of bladder function, 
• understanding the mechanisms of and developing advanced approaches to spinal cord stimulation to treat chronic pain,
• understanding and controlling the cellular effects of transcranial magnetic stimulation, and
• design of novel electrodes and waveforms for selective stimulation of the nervous system.

Design of Clinical Trials
Survival Analysis
Longitudinal Data Analysis
Clustered Data Analysis
ROC Curve Analysis
Design and Analysis of Microarray Studies
Big Data Analysis

I am a movement disorders specialist with a clinical practice focused on the care of people with Parkinson disease (PWP) and other movement disorders. I am interested in ways to improve the quality of care for patients with chronic neurodegenerative conditions, particularly translating clinically effective treatments and lifestyle modifications (e.g. exercise) into the “real world.”  While a growing body of evidence demonstrates that physical activity, including high-intensity exercise, is feasible for PWP and leads to improved motor and non-motor outcomes, translating that knowledge into practice has been challenging. My research in this area focuses on the impact of patient/doctor communication and social determinants of health on promoting or preventing physical activity among PWP.

 In addition to my clinical training, I hold a Master of Science in Narrative Medicine from Columbia University. This unique program, which grew out of the larger field of medical humanities, expands the conceptual framework of clinical medicine to incorporate patient perspective and social experience. I conduct mixed-methods research to design and implement interventions that are actually meaningful to the target population(s). As an example, in my study of Veterans with PD, I was able to conduct qualitative cluster analysis of Veterans’ self-reported barriers and motivators of adherence to exercise recommendations, reporting for the first time the unique barriers faced by this patient population. Additional funded projects using a narrative medicine approach have included (1) exploring the lexicon of burnout among clinical and non-clinical employees; (2) understanding the experience of fatigue and psychosis among PwP and their care-partners; (3) exploring the interactions between border-crossing in literature and border-crossing in medical education/practice.

In particular, narrative medicine offers guideposts toward a revitalized practice of medicine and medical education. In 2020, I was appointed Director of Medical Humanities at Duke, leading a team of clinician scholars in understanding moral injury and structural inequities in medicine. Under this umbrella, I co-direct the interprofessional course Moral Movements in Medicine; teach in the first-year Clinical Skills Immersion, the second-year Cultural Determinants of Health Disparities, and the fourth-year Medical Humanities courses; and mentor third-year students in the Medical Humanities study track.

I am a Movement Disorders Neurologist and see patients at the Morreene Rd Clinic and at the Durham VA Medical Center.
Among the types of movement disorders patients that I see in clinic are individuals who have Parkinson's disease, Essential Tremor, tics, chorea, dystonia, Huntington's disease, tardive movement disorders and Wilson's disease. I use botulinum toxin injections to treat selected patients afflicted with dystonia, tremors, and tics. I manage patients who have undergone deep brain stimulation (DBS) for the treatment of Parkinson's disease, Essential Tremor,and dystonia. In addition to managing patients who have movement disorders, I participate in a variety of clinical trials focussed on improving the management and treatment of Parkinson's disease, Huntington's disease, and dystonia.

Key words: movement disorders, Parkinson's disease, tremors, tics, chorea, dystonia, botulinum toxin injections.

Dr. Nandan Lad is a neurosurgeon, scientist, and entrepreneur and Professor and Vice Chair of Innovation for Duke Neurosurgery. He is Director of the Functional & Restorative Neuromodulation Program and the Duke NeuroInnovations Program, a systematic approach to innovation to large unmet clinical needs.

He completed his MD and PhD in Biochemistry at Chicago Medical School and his neurosurgical residency training at Stanford with fellowships in both Surgical Innovation and Functional Neurosurgery.  

Neuromodulation; Neurorestoration; Bioengineering; Medical Device Design; Clinical Trials; Data Science; Health Outcomes.

Current clinical research interests include clinical trials regarding adaptive or closed-loop deep brain stimulation with novel devices, cellular, and gene therapy in Parkinson disease. Additional trials have included gene therapy for Alzheimer's disease and sensory restoration for development of brain machine interfaces. Clinical treatments include deep brain stimulation, which is now a common procedure for treating Parkinson disease and tremor. Translational approaches include testing new devices and stimulation patterns in the operating room. Pre-clinical research interests focus on evaluation of cerebral perfusion and metabolism changes with stroke, aging and Alzheimer's disease, using both in vivo and in vitro approaches. These basic science interests include new approaches to cerebral blood flow enhancement with brain stimulation, optical imaging of the brain, cellular understanding of metabolism using direct substrate recordings (ie, oxygen, glucose, lactate, respirometry) and developing new methods to understand neurovascular coupling, analyzing complex interactions between neurons, astrocytes and blood vessels.  Further interests include changes in cerebral blood flow with stroke and enhanced recovery after stroke.