The Neurologist Is In, Episode 7, Part 2: Frontiers in Treating Movement Disorders With Dr Harini Sarva

In this episode, Rachel Marie E. Salas, MD, MEd, and Harini Sarva, MD, continue their discussion on current practices for the treatment of movement disorders. Dr Sarva discusses her involvement recent and upcoming research in the movement disorders field.

Missed Part 1 of this conversation? Listen to Current Practices for Treating Movement Disorders here.

Can't get enough of The Neurologist Is In? Make sure you're caught up on all the episodes--find the full catalogue here.

About the Speakers:

Rachel Marie E. Salas, MD, Med, FAAN, FANA, is a professor in the Department of Neurology at Johns Hopkins Medicine with a joint appointment in the School of Nursing. She is board certified in Sleep Medicine and Neurology. Dr Salas is the Director of Ambulatory Sleep Services at the Johns Hopkins Center for Sleep and Wellness. Dr Salas has been the Director of the Neurology Clerkship for over a decade. She is the Chair of the Undergraduate Education Subcommittee for the American Academy of Neurology and is an appointed member of the Alliance for Clinical Education. She is the director of the Interprofessional Education and Collaborative Practice for the School of Medicine and a Co-Director for Interprofessional Teaming for the High Value Practice Academic Alliance. Dr Salas is also the founder and Co-Director of the Johns Hopkins Osler Apprenticeship Program (in Neurology), a medical education research program for senior medical students and the Johns Hopkins PreDoc Program, a pipeline premedical college program. Dr Salas is a certified strengths coach and uses a strength-based approach and coaching to connect to, support, and develop those involved with her educational mission and clinical practice. Dr Salas is a 2019-21 Josiah Macy Scholar,  a 2019-20 AMA Health Systems Science Scholar and a 2021 AΩA Leadership Fellow.

Harini Sarva, MD completed a combined undergraduate-medical school eight year program at CUNY Brooklyn College and SUNY Downstate Medical Center.  She completed her undergraduate degree in economics with a magna cum laude from Brooklyn College, during which team she made the Dean’s List every semester and won an award in excellence in economics.  After completing her MD, she was recruited to complete her neurology residency from SUNY Downstate, where she was also a Chief Resident during her final year of training.  She won the SUNY Downstate Alumni Association Outstanding Resident in the Department of Neurology and the Department of Neurology Excellence in Teaching awards.  She subsequently completed her fellowship in Movement Disorders under the mentorship of Dr Susan Bressman and Dr Rachel Saunders-Pullman at Mount Sinai Beth Israel.  During her second year of fellowship, she was awarded the Clinical Teaching Fellowship grant from the Dystonia Medical Research Foundation and a travel grant from the International Society of Parkinson’s disease and Movement Disorders to attend their annual conference in Stockholm. After completing all of her training, she was an attending in neurology at Maimonides Medical Center in Brooklyn, NY, where she was co-director of medical student and resident rotations and developed a movement disorders elective for psychiatry residents.  She also arranged a CME conference entitled “Movement Disorders Review.” Dr Sarva subspecializes in Parkinson’s disease, Essential Tremor, Dystonia, Tics, Chorea, Myoclonus, Ataxia, and Gait Disorders.  She is experienced in botulinum toxin injection therapy for craniofacial and limb dystonia, hemifacial spasm, and spasticity. In addition, she is trained to evaluate patients for deep brain stimulation and is an experienced programmer. Dr Sarva is board certified by the American Board of Psychiatry and Neurology. She is an author of numerous publications and has presented her work at national and international conferences.

Read the Transcript:

Dr Rachel Salas:  Welcome back everyone, the Neurologist Is In podcast. I'm Dr Rachel Salas. I am a sleep neurologist at Johns Hopkins Medicine.

Here with me today is a movement neurologist. We have Dr Harini Sarva, and I'm excited to just pick her brain and learn a little bit more about the work she's doing.

Let's transition over to talking about some of your research and some of your clinical trials. 

Dr Sarva:  I often approach it as trying to treat different facets and phases of PD. 

We have one neuroprotective trial that we're running right now and that's a tyrosine kinase inhibitor. It's a newer version of some of the CML drugs that are on the market, hopefully, better bloodbrain barrier potential. That's looking at slowing down disease progression in patients who've been diagnosed in the last three years. 

Then, we have our Focused Ultrasound study looking at the power pallidothalamic tract for more advanced patients. We have the GBA gene therapy trial for patients who have either single or have homogeneous mutations in the GBA gene that can potentially be diseasemodifying. 

We also have our dopamine replacement, stem cell trial that we're running as well for patients who don't want DBS but are at the point where they need something more than just oral medications. 

We're also part of the levodopa pump trial as well. We're one of the sites for that. That's a sub q delivery of carbidopa/levodopa, again, for patients who are having the fluctuations but aren't ready for neurosurgical intervention. 

Then we have been recruiting for enlite PD, which is looking at using light therapy for patients with Parkinson's and sleep disorders. That's been exciting as well. 

Dr Salas:  Wow. You have a lot going on there. It's a lot of cuttingedge stuff. That's cool. If I was wanting to send or find more information if I had a patient that might be interested in this, where could I tell my patients to go check you out or check out the work that you're doing? 

Dr Sarva:  All the studies are on clinicaltrials.gov. They can also email me directly. Our research coordinators are also readily available, or they want to call up the office. The staff will put them right through to the research coordinators. There are multiple facets to get in touch with us about clinical trials. 

Dr Salas:  That's awesome. I didn't know how active you are with clinical trials. The reason I know you is because of our work with education. I know that you're very focused and passionate about teaching all types of learners, whether they're medical students, health professions, learners, residents and fellows, and whatnot. 

You're also involved nationally in leadership on the education front. That's where I met you through the American Academy of Neurology. Tell me what got you into education. 

Dr Sarva:  My dad to start off with. He was a great educator. He was a clinician. Then, in med school, I had wonderful mentors, at SUNY Downstate, the program director at that time. 

I remember as I was a thirdyear medical student and sitting in round one day, and I went up there and said, "I'm interested in neurology." She called me over to her office and mentored me from there. 

Then, throughout, we had such wonderful teachers for residency and fellowship. A lot of role models throughout. It keeps you engaged for sure. It's very easy with so much information coming at you, from every different angle to get lost. To have motivated students that keeps you engaged keeps you interested in acting. That's what made it for me. 

Dr Salas:  That's great. I know you have some leadership roles at your institution, you want to share what those roles are? Those formal education roles. 

Dr Sarva:  I am the faculty advisor for a student interest group in neurology, which is sponsored by the American Academy of Neurology. It's been a fun experience and I've had a chance to work with some great students and do some fun sessions. 

Whether it's having movie panels or residency panels or exposing them to the different facets, and meeting different subspecialists, meeting a lot of the junior faculty, and incorporating PEDs, neuro as well. It's been great to open their eyes into the world of neurology. 

We still have this stigma of diagnose and adios thing. Students will associate the neurologist with having a bow tie and long reflex hammer. Seeing more people, more diverse people, younger people interested in doing exciting things. 

There's a lot of fun, exciting stuff happening, a lot of stroke, epilepsy movement, but neurogenetics and what they've pioneered for us recently as well, has been a great experience. That's something that I've enjoyed over the years. 

Having patients work with them on setting up their outpatient electives has been great as well. A lot oftentimes, clerkships and even residences are so impatient, focused. It's often common for students to think, "Well, it's as epilepticus stroke and MS exacerbations." 

That's all we're seeing in as far as neurology is concerned or gammaray when it comes in. To see the daytoday practice of sleep neurologists, we send them to our Sleep Center, MS Center, with us and with our dementia experts, with their epileptologist and our headache specialist. They get a good wide view. 

They come back saying, "This has been informative for us. We didn't know there was so much we could do as neurologist." It's not just history and exam, we do a ton of procedures, too. For those students who want to get their hands dirty and do stuff, there's a lot out there for them. 

Dr Salas:  I totally agree. I resonate with the point that you said. I remember when I chose to do neuro, just like all the neurologists that I was seeing as role models and who are fabulous, but they didn't look like me. A lot has changed. I know we're doing some work because we need more neurologists out there. People are living longer, one in six Americans have a neurological disorder. 

I'll put a shout out, I'm sure the same is for movement but even for sleep medicine. We don't have enough sleep specialist. Now with the pandemic, there's just all types of more sleep disorders. Everyone has insomnia and everything. 

Then the circadian rhythm is a big issue with people working from home and on their electronic devices and not really having a fixed schedule. I want to put a plug out there in case we have some learners or medical students or people thinking about, "Maybe I should do neurology." You should. You should consider it. 

It's a fascinating field. There's a lot that you can do. There's a space for everybody. If you want to be an intensivist or you could be a neurointensivist. If you only want to see patients in hospitals, you could be a neurohospitalist. If you want to be in part of cuttingedge surgery, epilepsy, they work hand in hand with neurosurgeons. 

They've been doing amazing stuff for a long period of time or if you want to be interventionalist with all of the aneurysm coiling and things. There's so much that the patients do, the students, residents can do when they get into neurology for sure. 

Dr Salas:  There's even newer areas of neurology emerging. You mentioned the neurohospitalist, but there's also like neuropalliative care, neurogeriatrics. Any other ones that come to mind? 

Dr Sarva:  Neurooncology, for sure. I think there's a cause some people are looking at. Neuroimmunology and not just MS but neuroimmunology and autoimmune disorders and in neuroendocrinology. If people have issues with the pituitary gland and there's definitely a role for neurologist there. 

Dr Salas:  Sports neurology. Even global health, we did a recording with Dr Deanna Sailor who's doing a lot of global health and neurology. She's in Africa right now. A lot of things to consider. I'm curious, you mind sharing with the audience why movement? What drew you to movement? 

Dr Sarva:  Full disclosure, I went to med school wanting to be a cardiologist like Bernadette. I love the preclinical neuroscience stuff and I did my neuroclerkship early in there to see if I really liked it and I did. 

I was debating between neuromuscular sleep and movement during residency. I had two really wonderful movement mentors during residency, Patricia Cavanaugh and Martin Luciano, who are at different facets of their movement careers but we're basically put together a great perspective on a career movement. 

You can be completely clinical and see a ton of diverse patients. It's like very oldschool neurology with a lot of cuttingedge stuff that's coming to the forefront now. It's a lot of history, a lot of exam. There's no perfect MRI scan for these patients, but really involves a lot of cuttingedge research, genetics, surgical interventions. 

Seeing the way that they described it and it is one field, we don't see a lot of as medical students or residents. There was that "I want to learn more about something that I'm just not seeing a lot of" kind of thing. I had such a fabulous experience in fellowship so that's where my movement journey has led me to. 

Dr Salas:  That's really cool and awesome. I know that there's a lot of talk about burnout. There's a lot of emphasis on wellbeing and wellness. I wish we could all do some yoga and be cool. In neurology too, we're not at the top, we are like with burnout being an issue. I know that we've nationally been really working towards finding ways to improve wellbeing for neurologists. 

I always want to ask the speakers, what do you do for fun when you're not working? What are you doing? 

Dr Sarva:  Prior to the pandemic, a lot of traveling with my family, enjoy photography. Those were my big things. I would say since then I've been doing a lot more gardening, both indoor and outdoor, and recently my husband and I started playing ping pong together. We're nerdy, but that's OK. I guess that's our mojo. 

A lot of hiking, a lot of spending time with family, especially catching up over the past year has really made a big difference. We had been reading quite a bit as well, but I think that's some time we'll probably get back into. Those are biggest hobbies. 

Dr Salas:  We all get stressed out sometimes, and even overwhelms. I know for sure at least for me is definitely burned out especially when earlier in my career, being a new mom, and trying to find my place at a very big institution. Looking back, I'm probably busier than I ever was. I'm so much busier, but I really enjoy the work I do. 

Being involved nationally, working with people like you and other...That lights me up, even though I work more now. I still make time. I go to my boy's lacrosse games. I do love a lot of travel. 

It sounds like you're doing some cool stuff, but what do you do when you had a bad day or feeling overwhelmed? Do you do those things? Is there something else that...I always find that we can share with each other ways to handle because we're all going to experience stress and stressful events. How do you handle that? 

Dr Sarva:  First and foremost, I just put my work phone and stuff away for me, try to unwind as much as possible whether it's watching an old movie or having dinner with my husband. It really helps just that family time or anything else. 

Trying to disconnect from work because we are so connected techwise, it's almost like we never can get away, but making that extra effort to say, "From this time to this time, I'm not going to look at my work mail. I'm not going to open up my laptop. I'm just going to unwind completely." 

It's really helped especially over the last year or so. Just prior to the pandemic, I would still be working on some stuff or side projects on the weekends, and then we would go out after I was done. Now, I'm just focusing more on family, trying to unwind more. 

If I have a moment where I'm by myself and I can work on something, I will, but generally speaking, I am trying to take it one day at a time. 

Dr Salas:  I really like that. When I'm talking to people and asking them these questions, what I'm finding is there is more metacog. It's like being aware like, "Whoa." Let me take a step back, let me, like you said, disconnect which is also good for sleep by the way. 

Dr Sarva:  Totally. 

Dr Salas:  I love that. Thank you for sharing some of your hobbies and what you do for fun. Sometimes, it's easy for us to get ingrained in work. 

Like you're saying, we're so much more connected. Probably having more meetings more than ever because of zoom. It's easier. You can go like lots of media. 

Taking the time, taking that breath, taking that pause, and putting family first. I couldn't agree more. 

Tell me what's next. What's next for Dr Sarva? What are you getting into? Anything new coming in, or that you're looking to get into? You've done a clinical practice in neuro, you're doing research, some awesome research in neuro, you're doing neuroeducation. What's next? 

Dr Sarva:  I definitely want to expand the clinical trials. I know it sounds like I'm doing quite a bit already but there's so much very exciting stuff that's happening. I'd like to make this as multidisciplinary as possible because we have a lot of resources here from a professional standpoint and to integrate the center better. 

I would say, professionally, those are probably my biggest goals at the moment. Personally, getting back out there and traveling again. I'm looking forward to being an AAN this year, and using that as a stepping stone to reboot the travel experience. 

Dr Salas:  I couldn't agree with it. I can't wait to start traveling. I hope it's coming sooner than later. 

Even crazy. It's almost like three years. You probably do this so well. I'm hoping I'm seeing you soon at one of our conferences coming up. Should be nice to connect with everybody. I always want to leave the last a few minutes to...Is there anything else that you want to share, or something important could be about movement, it could be just neurology in general, any last thoughts? 

Dr Sarva:  Neurology is not really a scary field. It's not. I was just thinking back at being a medical student, and learning about all the tracks the first time, and then putting things into use as a resident. It's not hard, it really isn't. It's actually a lot of fun. 

You develop a really nice tightknit community with your red coresidents and faculty mentors. It is a field for anyone who wants whether they want a high pressure, neurointensivist lifestyle, and do a tonne of procedures, or if they want I guess more of less emergent, emergency depend of lifestyle with sores. 

It gives you a lot of opportunities. It is very fun. 

Dr Salas:  Well, thank you so much, Dr Sarva. You are a superstar doing amazing things that truly academic. The old term like the triple threat, do a research, education, clinical. Then not only serving as a role model and educator at your institution at Cornell but also nationally, which I think is very important, because you're making a difference. 

We're making change. We're working together as neurologists to get the word out and have better care for patients, and hopefully trying to recruit the next generation of clinicians, because we need everybody not just neurologists. We need nursing. We need social work pharmacy, like all of those... 

Dr Sarva:  Absolutely. 

Dr Salas:  ...professions. Thank you so much. I know you're very busy. It was great having you. We'll talk soon. 

Dr Sarva:  Thank you for having me, thank you. Bye.