Brian Dahlben, MD, MSc, first became interested in neuroscience in high school after he read about phantom limb pain. He decided to pursue neurology and then movement disorders with the goal of developing close relationships with his patients and helping them live their best lives, and came to Duke as the first member of our newly expanded Movement Disorder Fellowship program.
For this week’s Spotlight interview, the second-year fellow talks to us about the research he’s conducting to help improve care for people living with dystonia. He also shares how the relationships he developed with two patients during his training shaped his perspective. Finally, Dahlben talks about his plans for a future in academic medicine (or professional ice-cream tasting) and an early research project he conducted on the effects of concussion among Canadian hockey players.
What are your current responsibilities as a Schilsky Movement Disorders Fellow? What does a typical day look like for you?
It’s exciting as a second-year fellow at Duke to have a high degree of autonomy. I see clinic patients once weekly, including common conditions like Parkinson’s disease and essential tremor, as well as much rarer conditions like Huntington’s, various forms of dystonia, and ataxia. A key element of treatment for many of our patients includes deep brain stimulation, and I have been lucky to receive excellent training in the intra-operative and outpatient management of DBS. The remainder of my time is dedicated to research initiatives in dystonia, specifically working to understand the neural underpinnings of cervical dystonia and writer’s cramp.
How and when did you get interested in neurology? How did you decide to focus on movement disorders in particular?
I remember reading in high school about phantom limb pain and being utterly fascinated by human perception and neuroscience. I spent time volunteering with the Alzheimer’s Association and developed a deeper appreciation of how neurologic diseases can threaten one’s sense of self. In medical school, I discovered that movement disorders is a really innovative space within neurology. I love that the physical exam remains the key to diagnosis, and that we can offer therapies to help patients live their best lives. Being a movement specialist enables a close relationship with my patients, who need regular follow-up and whose needs change over time.
In addition to your medical degree you also have a master’s in neuroscience. How do those two degrees complement each other and inform your work?
That’s a good question. Completing my master’s thesis (which focused on the human stress response), and then immersing myself full-time in research at Brigham and Women’s Hospital (using MRI to investigate the effects of traumatic brain injury in veterans and professional athletes) taught me about problem-solving, professionalism, and communication. As a physician, these are skills that I continue to build on daily, to make my patients feel heard and confident in their individualized treatment plan.
You’re currently in your second, research-focused year of your fellowship. What’s the focus of this research, and how will it help us better understand or treat movement disorders?
I am working closely this year with Dr. Noreen Bukhari-Parlakturk, a dystonia expert. We have an ongoing prospective study of cervical dystonia, using a system with wearable sensors and 3D video capture to develop a quantitative tool to measure CD severity. In a retrospective analysis of focal hand dystonia (aka writer’s cramp), I am using diffusion tensor imaging to gain insight into white matter changes unique to this disorder. A better understanding of dystonia, for which the underlying brain mechanisms are admittedly not well defined, is an important step toward developing better and more targeted therapies.
What’s one experience from your time as a fellow that’s stood out as especially helpful or memorable to you?
Two patients jump to mind. One is a gentleman with Parkinson’s, who leads a very active lifestyle and works as a lawyer, but was not receiving adequate symptom relief with just medications. Over the course of a year, we decided to pursue DBS, I accompanied him in the OR for the surgery, and completed his initial and subsequent DBS programming sessions. It has been so rewarding to see his quality of life improve, and to have been there each step of the way.
The second patient is a young man who presented with sudden onset of a bothersome hand tremor. In the physical exam his tremor was distractible and could be entrained by tapping his fingers in a sequence, leading to the tremor disappearing. We discussed the nature of his diagnosis, a functional (psychogenic) tremor, and how it can respond to such maneuvers. Despite the reality that most neurologic conditions we see are progressive, it was gratifying to see that functional movement disorders like his can and often do improve, sometimes in a single visit.
What plans do you have for after you complete your fellowship? If you could have any job in the world, what would it be?
Fellowship at Duke has shown me the value of a large academic practice in connecting patients with resources, providing adequate physician support, and fostering the cycle of lifelong learning and teaching by staying engaged with residents and students. I plan to put my fellowship training to good use as a movement specialist within the academic sphere. And if that doesn’t work out, then I’d pursue a career in professional ice cream tasting.
You contributed to a Journal of Neurosurgery article discussing the white matter microstructure in ice hockey players with a history of concussion. What were the most interesting takeaways from that project?
As part of the Hockey Concussion Education Project in 2015, we had access to MRI scans of Canadian hockey players during a collegiate season. Using DTI measures, we found that those with concussion (either a history of concussion, or one was sustained during that season) had detectable differences in several white matter connections. More and more research over the past decade has revealed that traumatic brain injury, including repetitive subconcussive head blows, are associated with white matter changes in athletes if not florid clinical symptoms. These findings have already had meaningful implications for public policy and the true impact of head trauma.
What other passions or hobbies do you have outside of the Department?
My main passions are playing ultimate or enjoying the outside on a hike or trail run! North Carolina is such a beautiful place to explore, from the mountains in Asheville to the beaches in Wilmington.
