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Faculty Spotlight: Patrick Hickey, DO

Wednesday, May 11, 2016

This week’s faculty spotlight shines on Patrick Hickey, DO, medical director of the Morreene Road Neurology Clinic and the Duke Fellowship program in Parkinson’s disease and movement disorders. Hickey talks to us about how he became interested in movement disorders, how his perspective has changed since completing the fellowship program, and a brighter future for people with Parkinson’s disease.

What does a typical day for you look like? What are your responsibilities within the Department?
I see general movement disorder patients on Mondays and Wednesdays at the Morreene Road clinic. On Tuesdays I join two of our neurosurgery colleagues (Drs. Turner and Lad) in the operating room for deep brain stimulation surgery, where I perform microelectrode recording and testing of patients undergoing implantation. On Thursdays I run a joint DBS evaluation clinic with Dr. Lad, examining patients referred for neurosurgical management of PD, tremor, and dystonia. In addition, we run a fantastic interdisciplinary clinic with physical therapy, occupational therapy, speech therapy and clinical social work on Wednesdays and Thursdays – allowing comprehensive evaluation and care of patients who often do not have access to these specialty services.

How did you first get interested in movement disorders? What do you enjoy most about working in this area?
As a resident, I had a fantastic mentor that specialized in this area and sparked my interest. I found myself gravitating toward his clinic growing more and more interested in the field during electives. During that time I started to realize the profound impact that specialized neurological care can have on patients with Parkinson’s disease and other movement disorders, something that has been demonstrated in research studies as well.

Patient care remains the most satisfying aspect of my career, though working at Duke has opened up a tremendous number of opportunities to explore collaborative and clinical research.

You completed our fellowship program in movement disorders in 2012. What’s your current involvement in this program? How has your perspective changed since you were a fellow?
Fellowship at Duke was a tremendous experience and I have been extremely fortunate to continue to be involved in the program. I am currently the fellowship director, which allows me to remain active in trainee recruitment, curriculum development, and clinical instruction.

I think my primary perspective change has been in the ability to step back and see things from a larger point of view. When I first entered training the vast expanse of, and possibilities within, the field were overwhelming. As I have gained more experience, it has become much easier to contextualize new information and see how things fit into my clinical and research focus.

What are the strongest elements of this program?
The strongest element of the Duke Parkinson Disease and Movement Disorders Center and fellowship are the faculty, who are all exceptional clinician/scientists with diverse backgrounds and academic interests. Trainees have the chance to work with all core faculty, which produces a well-rounded provider and allows the development of a unique clinical or scientific focus. The program is extremely dynamic, which allows adaptation to a specific trainee’s interests and strengths.

You recently received a second year of funding from the PDC’s ENhanced Academics in a Basic Laboratory Environment (ENABLE) career development program. What sort of work are you doing in this program?
The ENABLE program is a fantastic opportunity, protecting clinic time in order to focus on collaborative work within a basic science laboratory here at Duke. My project is in conjunction with the Center for In Vivo Microscopy, led by G. Allen Johnson, PhD. Dr. Johnson’s lab has developed a high-resolution postmortem diffusion MRI reference atlas of the human brainstem, allowing detailed 3D maps of white matter connections in the brain. An earlier collaboration demonstrated the clinical utility of this atlas, correlating DBS electrode position within the registered template with treatment efficacy.

Currently we are expanding the use of the dataset, attempting to incorporate it into the planning of DBS surgery. This may allow more individualized stimulation approaches, the expansion of neurosurgical indications to address refractory symptoms, an improved understanding of brain circuitries and their involvement in various neurological and psychiatric illnesses, and improved safety outcomes.

How does the future look for patients with movement disorders? What is the most exciting development in this area that you see coming in the next five years?
The majority of the patients we see have Parkinson’s disease, or a form thereof, and there is great optimism that a significant breakthrough is near. Improved understanding of disease mechanisms may result in treatments that slow or reverse disease progression, and some of these are already being evaluated in human trials. In addition, advances in imaging, bioinformatics, and biotechnology are aimed at improving targeted therapies – including more precise and individualized DBS as well as novel approaches such as gene therapy. Within the next five years we should have significantly more treatment options for those with PD and other movement disorders and be closer to offering a therapy that can meaningfully impact disease progression.

What’s one thing you wished more patients knew about movement disorders?
A large number of patients, caregivers, and even providers are unaware of how many treatment options currently exist for those with movement disorders. In many instances this can lead to a delay in referral, initiation of therapy, and improvement in a patient’s symptoms and quality of life.

What passions or hobbies do you have outside of the Department?
Most of my free time is spent exploring North Carolina and the surrounding area with my family. I used to be fairly good at golf and still enjoy playing when I get the chance. I have gotten into photography and am learning how to manage a manual camera better. I like to read and am currently finishing Sapiens by Yuval Noah Harari – highly recommended.

Hickey and son
Hickey and his son Liam stand in front of a rather large construction vehicle.

In the absence of a recent photo of their father, Hickey's children Liam and Madeline take center stage.