CLEVELAND — Aasef Shaikh, MD, PhD, grew up in India as the son of two ENT surgeons, which he credits for his early interest in understanding the system that helps humans keep their balance. After finishing medical school, he immigrated to the United States to pursue a PhD in neuroscience, where his fascination with human balance only grew.
Aasef Shaikh, MD, PhD, (center) and his colleagues utilizing mixed reality – a combination of virtual reality and the real world — HoloLens technology to visualize neuron pathways in the human brain. Photo from the Cleveland FES center
During his postdoctoral work, he began researching the mechanics of the cerebellum and how humans perceive motion. Moving to Johns Hopkins Medicine to work with David Zee, MD, one of the world’s foremost experts on balance disorders, Shaikh’s interest expanded to include biomedical engineering and how it could be combined with neuroscience to impact the balance system.
“I got introduced to an expert in basal ganglia, and I got interested in Parkinson’s and movement disorders and how the balance system is interfered with in these patients,” Shaikh explained. “The next step was to go into clinical training and become a neurologist and to apply all the science that I learned to patient-focused medicine.”
Zee’s research partner, John Leigh, MD, was at the Louis Stokes VAMC in Cleveland at the time and offered Shaikh a chance to continue of his research into balance disorders while pursuing a clinical path helping Cleveland’s veterans.
“As a resident, I was closely working with veterans,” Shaikh said. “A lot of them were suffering from some sort of movement disorders, and a lot had Parkinson’s. A lot had balance problems. A lot had eye movement problems.”
Eventually, Shaikh took over for Leigh and now splits his time between research, teaching and acting as the staff neurologist specializing in movement disorders at the Cleveland VAMC.
“When I joined VA [in 2015], one of the big attractions was that there was nobody at that time in the entire state of Ohio who was trained in doing movement disorders. And there were so many veterans suffering,” Sheikh said. “The moment I started my clinic, it was filled with patients with movement disorders. We started offering the most cutting edge treatments available to the veterans right away.”
That included deep brain stimulation, where electrodes are implanted in target areas of the brain and used to moderate movement disorder symptoms. Eventually, DBS treatment would grow to make up over 70% of Shaikh’s practice at VA.
With so many veterans seeking care, Shaikh saw an opportunity to create a robust research program partnered with the clinical practice. Within six months of arriving at Cleveland, Sheikh began a research program into Parkinson’s and movement disorders and applied to VA’s Parkinson’s Disease Research, Education and Clinical Center in Philadelphia to make the Cleveland VAMC its consortium center—a regional specialty clinic for patients unable to travel to a PADRECC. Shaikh’s proposal was accepted, and now the Louis Stokes VA is the only Consortium Center for Parkinson’s and movement disorders in VISN 10.
Veterans from all over Ohio and surrounding states travel to Shaikh’s clinic for treatment, helping fuel some of the most cutting-edge research being conducted on movement disorders.
Much of that research is with DBS and how the technology can be used to modulate the human brain and improve veterans’ balance. Shaikh and his team -also are looking at the phenomenon of gait=freezing, where patients with Parkinson’s and other disorders cease walking mid-stride.
“We’re using virtual reality and augmented reality and integrating that into the neuromodulation while using the DBS [to discover] which particular part of the brain we can stimulate or modulate or prevent gait-freezing,” Shaikh explained. “Then we take all this clinical information and research info and imaging data, and we collaborate with biomedical engineers [to] computer model [a patient’s brain]. Then we study which area of the brain is modulated when we see this outcome and vice versa. That gives us a very tedious and very carefully looked at map of the balance system and the gait system, and it tells us how we can do better in the future.”
If Shaikh and his team can help improve veterans’ balance, then they can help prevent them from falling. And falls are one of the main causes of injury and death in patients with movement disorders. “Parkinson’s patients fall very, very frequently,” Shaikh explained. “They cannot perceive their balance in an adequate way. And they do not have very good coordination of their upper and lower body. Then there’s the freezing of gait where they get stuck to the floor, and we don’t know why. We don’t know the mechanism for that. Likewise for balance. We don’t know the mechanism for that. If we can understand these better, we can have substantial improvement in the quality of life in patients with Parkinson’s.”
Shaikh also spends much of his time working with patients suffering from dystonia—an abnormal twisting and turning of a body part in a range of movement disorders and a common symptom of many psychiatric medications. It’s also seen in patients who have had certain types of strokes and in patients following a traumatic brain injury.
“There’s twisting and turning, constant muscle pull and constant shaking—it’s quite debilitating,” Shaikh said. “It’s considered rare, but in my experience it’s not so rare in veterans. At the Cleveland VA, 40% of our research is also focused on dystonia. We’re using biomedical engineering and a signal processing approach to studying movements, and we also offer DBS for dystonia.”
Because movement disorders cut across so many specialties, Shaikh’s work is attracting the attention of physicians from across the medical center.
“We have a dedicated social worker, and have ended up hiring another movement disorder specialist. But we also have so many people interested in movement disorders who are experts in other areas,” he declared. “We have neurologists and sleep neurologists. We have a traumatic brain injury and polytrauma site, and we [work with] the neurologist who runs that. We have a multidisciplinary team of scientists and biomedical engineers. We are all working together as a huge team to essentially conquer Parkinson’s.”
