Dr. Veronica Santini joined the Stanford Neurology faculty in 2014, where she has a busy movement disorders and clinical research practice. Dr. Santini co-directs the Multidisciplinary Huntington Disease and Ataxia Clinic, where she oversees a large and dedicated team of specialists providing holistic, patient-centered care. In 2015, it received the prestigious designation as a Huntington Disease Society of America, Center of Excellence and has maintained this designation under her leadership. Given her expertise in the evaluation of autonomic dysfunction and in ataxia, she has a particular interest in the management of multiple system atrophy. Dr. Santini is impassioned to provide equitable healthcare, identifying disparities in neurologic care worldwide and launching global multidisciplinary neurologic programs to provide care to low income nations. Her most recent work, in collaboration with the American Academy of Neurology (AAN) and the St. Luke Foundation, delivers neurologic care to impoverished nation of Haiti. Due to this work, she was named a Global Ambassador of the St. Luke Foundation. Dr. Santini was also selected as a 2015 AAN Palatucci Advocate and a 2016 AAN Emerging Leader. She is also active in other leadership roles of the AAN and of the International Parkinson and Movement Disorders Society.

Dr. Santini is enthusiastic about medical education and has a responsibility in teaching Stanford medical students from their first to their graduating years at Stanford. She is an Educator 4 C.A.R.E., where she directs a learning community of over 30 students throughout their training and previously held leadership roles in the Practice of Medicine and Science of Medicine courses. She resumes her instruction to the clinical medical students as director of the Required Neurology Clerkship and is a mentor for the neurology residents and movement disorders fellows. She is also a member of multiple School of Medicine education committees and has played a prominent role nationally to increase student interest and engagement in the neurosciences. Dr. Santini has won numerous teaching awards, including the Neurology Clerkship Educator award, the Lysa Forno Excellence in Teaching award, The Henry J. Kaiser Family Foundation Award for Excellence in Pre-Clinical Teaching, the Award for Excellence in Promotion of Humanism, and the Lawrence H. Mathers Award for Exceptional Commitment to Teaching and Active Involvement in Medical Education.

Clinical Focus

  • Neurology
  • Movement Disorders

Academic Appointments

Administrative Appointments

  • Educator 4 C.A.R.E. (Compassion, Advocacy, Responsibility, Empathy), Stanford University, School of Medicine (2017 - Present)
  • Co-Lead Quarter 3, Practice of Medicine I, Stanford University, School of Medicine (2015 - Present)
  • Director, Parkinsons Disease Duopa Program, Stanford Movement Disorders Clinic (2015 - Present)
  • Associate Clerkship Director of the Neurology clerkship, Stanford University, School of Medicine (2014 - Present)
  • Co-Director, Multidisciplinary Huntingtons Disease and Ataxia Clinic, A Huntington's Disease Society of America, Center of Excellence (2014 - Present)

Honors & Awards

  • The Henry J. Kaiser Family Foundation Award for Excellence in Pre-Clinical Teaching, Stanford University, School of Medicine (2018)
  • Emerging Leaders Forum, American Academy of Neurology (2016)
  • Lysia Forno Excellence in Teaching Award, Stanford University, Department of Neurology (2016)
  • Medical Student Neurology Clerkship Faculty Teaching Award, Stanford University, Department of Neurology (2016)
  • Fellow, Stanford University's Center for Innovation in Global Health (2015)
  • Palatucci Advocacy Leadership Forum, American Academy of Neurology (2015)
  • Global Ambassador, St. Luke Foundation Nonprofit Organization in Port-au-Prince, Haiti (2014)
  • Humanism and Excellence in Teaching Award, Outstanding Resident Role Model, The Arnold P. Gold Foundation (2012)
  • Resident Award for Excellence in Teaching, Tufts Medical Center (2010)

Boards, Advisory Committees, Professional Organizations

  • Member, Parkinson Study Group (2018 - Present)
  • Member, Huntington Study Group (2016 - Present)
  • Executive Committee Member, Massachusetts Neurological Association (2012 - 2014)
  • Member, Huntington's Disease Society of America (2014 - Present)
  • Executive Board Member, Boston University Global Health Committee (2013 - Present)
  • DIrector, Boston Medical Center Neurology Global Health Committee (2012 - Present)
  • Member, Movement Disorders Society (2013 - Present)
  • Member, American Academy of Neurology (2008 - Present)
  • Member, American Medical Association (2005 - Present)

Professional Education

  • Fellowship: Boston University School of Medicine (2014) MA
  • Residency: Boston University School of Medicine (2013) MA
  • Medical Education: Boston University School of Medicine (2009) MA
  • Board Certification: American Board of Psychiatry and Neurology, Neurology (2013)
  • Internship: Caritas St Elizabeth?s Medical Center (2010) MA
  • Fellowship in Movement Disorders, Boston University Medical Center (2014)
  • Board Certification, American Board of Psychiatry and Neurology (2013)
  • Residency, Boston University Medical Center (2013)
  • Internship, St. Elizabeth’s Medical Center (2010)
  • Medical Doctorate, Boston University School of Medicine (2009)
  • Bachelor's of Science, University of Miami, Chemistry (2003)

Community and International Work

  • St. Luke Foundation, Port-Au-Prince, Haiti



    Ongoing Project


    Opportunities for Student Involvement


  • Masinde Muliro University of Science & Technology, Kakamega, Kenya


    Global Neurologic Education and Programs

    Populations Served

    Underserved, middle-low income countries



    Ongoing Project


    Opportunities for Student Involvement


  • Tribhuvan University Teaching Hospital, Kathmandu, Nepal


    Gobal Health Delivery



    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

Please see our website @

Clinical Trials

  • AZD3241 PET MSA Trial, Phase 2, Randomized,12 Week Safety and Tolerability Trial With PET in MSA Patients Recruiting

    AZD3241 myeloperoxidase (MPO) inhibitor trial is assessing safety and tolerability, randomized trial, in patients with Multiple System Atrophy.

    View full details

  • Continued Access Protocol: ExAblate Transcranial MR Guided Focused Ultrasound for the Treatment of Essential Tremors Not Recruiting

    The objective of this prospective, multi site, single-arm study is to capture the efficacy of treatment using the ExAblate Transcranial System and to further demonstrate safety in medication-refractory tremor in patients with essential tremor (ET).

    Stanford is currently not accepting patients for this trial. For more information, please contact Evalina Salas, 650-724-4131.

    View full details

  • ExAblate Transcranial MR Guided Focused Ultrasound in the Treatment of Essential Tremor Not Recruiting

    A feasibility Study to Evaluate Safety and Initial Effectiveness of ExAblate Transcranial MRI-guided focused ultrasound (MRgFUS) treatment of patients with medication-refractory movement disorders, namely Essential Tremor (ET). This study is designed as a prospective, single site, single arm, nonrandomized study. Assessments will be made before and three months after MRgFUS for clinical symptom relief, quality of life (QoL) improvements, and safety of MRgFUS in the treatment of ET. Similarly, QoL measures will be obtained using Quality of Life in Essential Tremor (QUEST) questionnaire. Relative Safety will be evaluated using a common description of Significant Clinical Complications for patients treated in this study. This study will be performed on the 3T MR scanners. The ExAblate system is a medical device that involves a focused ultrasound system and an MRI scanner. ExAblate delivers a pulse of focused ultrasound energy, or sonication, to the targeted tissue. In this particular study the targeted tissue is a unilateral thermal lesion created in the ventralis intermedius nucleus of the thalamus. The treatment begins with a series of standard diagnostic MR images to identify the location and shape of tumor to be treated. The ExAblate computer uses the physician's designation of the target volume to plan the best way to cover the target volume with small spots called "sonications". These treatment spots are cylinder shaped. Their size depends on sonication power and duration. During the treatment, a specific MR scan, which can be processed to identify changes in tissue temperature, provides a thermal map of the treatment volume to confirm the therapeutic effect. The thermal map is used to monitor the treatment in progress, and confirm that the ablation is proceeding according to plan, thus closing the therapy loop. The ExAblate transcranial operates a helmet-shaped transducer (currently utilizing 1000-element phased array transducer) positioned above the subject head. The ExAblate transcranial system also includes means to immobilize the subject head, cool the interface water, and software for CT analysis and phase correction computation. The ExAblate transcranial system is an experimental device and is being investigated in this study.

    Stanford is currently not accepting patients for this trial.

    View full details

All Publications

  • Latent brain state dynamics and cognitive flexibility in older adults. Progress in neurobiology Lee, B., Cai, W., Young, C. B., Yuan, R., Ryman, S., Kim, J., Santini, V., Henderson, V. W., Poston, K. L., Menon, V. 2021: 102180


    Cognitive impairment in older adults is a rapidly growing public health concern as the elderly population dramatically grows worldwide. While it is generally assumed that cognitive deficits in older adults are associated with reduced brain flexibility, quantitative evidence has been lacking. Here, we investigate brain flexibility in healthy older adults (ages 60-85) using a novel Bayesian switching dynamical system algorithm and ultrafast temporal resolution (490msec) whole-brain fMRI data during performance of a Sternberg working memory task. We identify latent brain states and characterize their dynamic temporal properties, including state transitions, associated with encoding, maintenance, and retrieval. Crucially, we demonstrate that brain inflexibility is associated with slower and more fragmented transitions between latent brain states, and that brain inflexibility mediates the relation between age and cognitive inflexibility. Our study provides a novel neurocomputational framework for investigating latent dynamic circuit processes underlying brain flexibility and cognition in the context of aging.

    View details for DOI 10.1016/j.pneurobio.2021.102180

    View details for PubMedID 34627994

  • Education Research: NeuroBytes: A New Rapid, High-Yield e-Learning Platform for Continuing Professional Development in Neurology. Neurology Lavette, L. E., Miller, A., Rook, B., London, Z., Cook, C., Merkler, A. E., Santini, V., Ruff, I. M., Kraakevik, J., Smith, D., Anderson, W. E., Johnson, S. L., Yan, P. Z., Sweeney, J., Chamberlain, A., Rogers-Baggett, B., Isaacson, R., Strowd, R. E. 2021


    ObjectiveTo determine whether NeuroBytes is a helpful e-Learning tool in neurology through usage, viewer type, estimated time and cost of development, and post-course survey responses.BackgroundA sustainable continuing professional development (CPD) system is vital in neurology due to the field's expanding therapeutic options and vulnerable patient populations. In an effort to offer concise, evidence based updates to a wide range of neurology professionals, the AAN launched NeuroBytes in 2018. NeuroBytes are brief (<5 min) videos that provide high-yield updates to AAN members.MethodsNeuroBytes was beta tested from August-December 2018 and launched for pilot circulation from January-April 2019. Usage was assessed by quantifying course enrollment and completion rates; feasibility by cost and time required to design and release a module; appeal by user satisfaction; and impact by self-reported change in practice.ResultsA total of 5,130 NeuroBytes enrollments (1,026±551/month) occurred from January 11-May 28, 2019 with a median of 588 enrollments per module (interquartile range, 194-922) and 37% course completion. The majority of viewers were neurologists (54%), neurologists in training (26%), and students (8%). NeuroBytes took 59 hours to develop at an estimated $77.94/hour. Of the 1,895 users who completed the survey, 82% were "extremely" or "very likely" to recommend NeuroBytes to a colleague and 60% agreed that the depth of educational content was "just right."ConclusionsNeuroBytes is a user-friendly, easily accessible CPD product that delivers concise updates to a broad range of neurology practitioners and trainees. Future efforts will explore models where NeuroBytes combines with other CPD programs to impact quality of training and clinical practice.

    View details for DOI 10.1212/WNL.0000000000012133

    View details for PubMedID 33931531

  • Neurology trial registrations on between 2007 and 2018: A cross-sectional analysis of characteristics, early discontinuation, and results reporting. Journal of the neurological sciences Turner, B. E., Magnani, C. J., Frolov, A., Weeks, B. T., Steinberg, J. R., Huda, N., Shah, L. M., Zuroff, L., Gu, B. J., Rasmussen, H., Edwards, J. G., Save, A. V., Shen, M., Ren, M., Bryant, B. R., Ma, Q., Feng, A. Y., Liang, A. C., Santini, V. E. 2021; 428: 117579


    Increasing neurological disease burden and advancing treatment options require clinical trials to expand the evidence base of clinical care. We aimed to characterize neurology clinical trials registered between October 2007 and April 2018 and identify features associated with early discontinuation and results reporting.We compared 16,994 neurology (9.4%) and 163,714 non-neurology comparison trials registered to Trials therapeutic focus within neurology was assigned via combination programmatic and manual review. We performed descriptive analyses of trial characteristics, cox regression of early discontinuation, and multivariable logistic regression for results reporting within 3 years of completion.Most neurology trials were academic-funded (58.5%) followed by industry (31.9%) and US-government (9.6%). Neurology trials focused more on treatment than prevention compared to non-neurology studies. Of neurology trials, 11.3% discontinued early, and 32.2% of completed trials reported results by April 30, 2018. In multivariable analysis accounting for time-to-event, neurology trials were at lower risk of discontinuation than non-neurology trials (adjusted hazard 0.83, p < 0.0001). Both academic and government-funded trials had greater risk of discontinuation than industry (adjusted hazard 0.57 and 0.46, respectively). Among completed trials, government-funded studies (adjusted odds ratio 2.12, p < 0.0001) had highest odds of results reporting while academic trials reported less (adjusted odds ratio 0.51, p < 0.0001).Funding source is associated with trial characteristics and outcomes in neurology. Improvements in trial completion and timely dissemination of results remain urgent goals for the field.

    View details for DOI 10.1016/j.jns.2021.117579

    View details for PubMedID 34332371

  • Sacral Nerve Stimulation in Parkinson's Disease Patients with Overactive Bladder Symptoms. Urology Greenberg, D. R., Sohlberg, E. M., Zhang, C. A., Santini, V. E., Comiter, C. V., Enemchukwu, E. A. 2020


    OBJECTIVES: To assess the efficacy, safety, and outcomes of sacral nerve stimulation (SNS) for Parkinson's Disease (PD) patients with overactive bladder (OAB) symptoms.METHODS: We retrospectively reviewed PD patients who underwent Stage I SNS. Demographics, urodynamic data, and baseline voiding function were analyzed. Efficacy and safety of treatment were determined by rate of progression to Stage II, explantation, and surgical revision. Long-term outcomes were assessed using voiding diaries and/or clinic notes.RESULTS: 60% (9/15) experienced ≥50% improvement in urinary parameters and proceeded to Stage II. There was no significant difference in age, BMI, comorbidities, PD disease duration, or levodopa equivalent daily dose between successful and non-successful Stage I patients. However, 100% of female patients experienced Stage I success compared to 44% of male PD patients (p=0.04). Individuals with >12-month follow-up experienced an average reduction of 6 voids/day. No patients required revision or explantation of their device at latest clinic follow-up (22.2 ± 7.8 months). Higher maximal urethral closure pressures (MUCP), detrusor pressure at maximum flow rate (PdetQmax), post-void residual (PVR) volume, and mean BOOI were observed in the Stage I trial failures.CONCLUSION: At our institution, PD patients have a similar rate of progression to Stage II compared to the general population. SNS is an effective therapy that should be considered among the treatment options for PD patients with OAB symptoms. Urodynamic parameters associated with obstruction may be predictive of SNS failure in PD patients and may help guide patient selection, however further studies are needed.

    View details for DOI 10.1016/j.urology.2020.06.063

    View details for PubMedID 32681915

  • Attracting neurology's next generation: A qualitative study of specialty choice and perceptions. Neurology Jordan, J. T., Cahill, C., Ostendorf, T., Gutmann, L., Navarro, A., Gamaldo, C. E., Santini, V. E., Ali, I., Soni, M., Wilson, R. B., Said, R. R., Czeisler, B. M., Rock, M., Smith, A. G. 2020


    OBJECTIVES: To better understand the reasons medical students select or avoid a career in neurology by using a qualitative methodology to explore these factors, with the long-term objective of attracting more graduates to the field.METHODS: In 2017, 27 medical students and 15 residents participated in 5 focus groups, and 33 fourth-year medical students participated in semistructured individual interviews. Participants were asked predefined open-ended questions about specialty choice, experiences in their basic neuroscience course and neurology clerkship, and perceptions about the field. Interviews were audio recorded and transcribed. We used a flexible coding methodology to generate themes across groups and interviews.RESULTS: Four main analytical themes emerged: (1) early and broad clinical exposure allows students to "try on" neurology and experience the variety of career options; (2) preclerkship experiences and a strong neuroscience curriculum lay the foundation for interest in the field; (3) personal interactions with neurology providers may attract or deter students from considering the specialty; and (4) persistent stereotypes about neurologists, neurology patients, and treatment options harm student perceptions of neurology.CONCLUSION: Efforts to draw more students to neurology may benefit from focusing on clinical correlations during preclerkship neuroscience courses and offering earlier and more diverse clinical experiences, including hands-on responsibilities whenever possible. Finally, optimizing student interactions with faculty and residents and reinforcing the many positive aspects of neurology are likely to favorably affect student perceptions.

    View details for DOI 10.1212/WNL.0000000000009461

    View details for PubMedID 32332127

  • Case Report on Deep Brain Stimulation Rescue After Suboptimal MR-Guided Focused Ultrasound Thalamotomy for Essential Tremor: A Tractography-Based Investigation. Frontiers in human neuroscience Saluja, S. n., Barbosa, D. A., Parker, J. J., Huang, Y. n., Jensen, M. R., Ngo, V. n., Santini, V. E., Pauly, K. B., Ghanouni, P. n., McNab, J. A., Halpern, C. H. 2020; 14: 191


    Essential tremor (ET) is the most prevalent movement disorder in adults, and can often be medically refractory, requiring surgical intervention. MRI-guided focused ultrasound (MRgFUS) is a less invasive procedure that uses ultrasonic waves to induce lesions in the ventralis intermedius nucleus (VIM) to treat refractory ET. As with all procedures for treating ET, optimal targeting during MRgFUS is essential for efficacy and durability. Various studies have reported cases of tremor recurrence following MRgFUS and long-term outcome data is limited to 3-4 years. We present a tractography-based investigation on a case of DBS rescue for medically refractory ET that was treated with MRgFUS that was interrupted due to the development of dysarthria during the procedure. After initial improvement, her hand tremor started to recur within 6 months after treatment, and bilateral DBS was performed targeting the VIM 24 months after MRgFUS. DBS induced long-term tremor control with monopolar stimulation. Diffusion MRI tractography was used to reconstruct the dentatorubrothalamic (DRTT) and corticothalmic (CTT) tracts being modulated by the procedures to understand the variability in efficacy between MRgFUS and DBS in treating ET in our patient. By comparing the MRgFUS lesion and DBS volume of activated tissue (VAT), we found that the MRgFUS lesion was located ventromedially to the VAT, and was less than 10% of the size of the VAT. While the lesion encompassed the same proportion of DRTT streamlines, it encompassed fewer CTT streamlines than the VAT. Our findings indicate the need for further investigation of targeting the CTT when using neuromodulatory procedures to treat refractory ET for more permanent tremor relief.

    View details for DOI 10.3389/fnhum.2020.00191

    View details for PubMedID 32676015

    View details for PubMedCentralID PMC7333679

  • Three-year follow-up of prospective trial of focused ultrasound thalamotomy for essential tremor. Neurology Halpern, C. H., Santini, V., Lipsman, N., Lozano, A. M., Schwartz, M. L., Shah, B. B., Elias, W. J., Cosgrove, G. R., Hayes, M. T., McDannold, N., Aldrich, C., Eisenberg, H. M., Gandhi, D., Taira, T., Gwinn, R., Ro, S., Witt, J., Jung, N. Y., Chang, J. W., Rosenberg, J., Ghanouni, P. 2019


    OBJECTIVE: To test the hypothesis that transcranial magnetic resonance-guided focused ultrasound (tcMRgFUS) thalamotomy is effective, durable, and safe for patients with medication-refractory essential tremor (ET), we assessed clinical outcomes at 3-year follow-up of a controlled multicenter prospective trial.METHODS: Outcomes were based on the Clinical Rating Scale for Tremor, including hand combined tremor-motor (scale of 0-32), functional disability (scale of 0-32), and postural tremor (scale of 0-4) scores, and total scores from the Quality of Life in Essential Tremor Questionnaire (scale of 0-100). Scores at 36 months were compared with baseline and at 6 months after treatment to assess for efficacy and durability. Adverse events were also reported.RESULTS: Measured scores remained improved from baseline to 36 months (all p < 0.0001). Range of improvement from baseline was 38%-50% in hand tremor, 43%-56% in disability, 50%-75% in postural tremor, and 27%-42% in quality of life. When compared to scores at 6 months, median scores increased for hand tremor (95% confidence interval [CI] 0-2, p = 0.0098) and disability (95% CI 1-4, p = 0.0001). During the third follow-up year, all previously noted adverse events remained mild or moderate, none worsened, 2 resolved, and no new adverse events occurred.CONCLUSIONS: Results at 3 years after unilateral tcMRgFUS thalamotomy for ET show continued benefit, and no progressive or delayed complications. Patients may experience mild degradation in some treatment metrics by 3 years, though improvement from baseline remains significant.CLINICALTRIALSGOV IDENTIFIER: NCT01827904.CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that for patients with severe ET, unilateral tcMRgFUS thalamotomy provides durable benefit after 3 years.

    View details for DOI 10.1212/WNL.0000000000008561

    View details for PubMedID 31748250

  • Characteristics of graduating US allopathic medical students pursuing a career in neurology NEUROLOGY Gutmann, L., Cahill, C., Jordan, J. T., Gamaldo, C. E., Santini, V., Ali, I., Soni, M., Wilson, R. B., Said, R., Czeisler, B. M., Smith, A. 2019; 92 (17): E2051–E2063
  • Characteristics of graduating US allopathic medical students pursuing a career in neurology. Neurology Gutmann, L., Cahill, C., Jordan, J. T., Gamaldo, C. E., Santini, V., Ali, I., Soni, M., Wilson, R. B., Said, R., Czeisler, B. M., Smith, A. G. 2019


    OBJECTIVES: To identify factors associated with medical students becoming neurologists because, despite the increasing burden of neurologic disorders, there is a growing neurologist shortage.METHODS: Deidentified data from the Association of American Medical Colleges Matriculating Student Questionnaire (MSQ) and Graduation Questionnaire (GQ) were obtained for the graduation years 2013 to 2014 through 2016 to 2017. Logistic regression was used to assess demographic characteristics and responses to training and career-related questions in association with specialty choice (intent to enter neurology).RESULTS: Of the 51,816 students with complete data, 1,456 (2.8%) indicated an intent to enter a neurology residency. Factors associated with an increased likelihood of entering neurology were a student's rating of excellent for their basic neuroscience course and neurology clerkship, participation in an MD/PhD program, majoring in neuroscience or psychology as an undergraduate, a selection response of "content of the specialty was a strong influence on career choice," and indicating interest in neurology on the MSQ. Factors associated with a decreased likelihood of entering neurology were a higher-priority response on the GQ for salary, work/life balance, and personal fit of the specialty.CONCLUSION: Data from surveys at the entry into and graduation from medical school suggest several approaches to increase the number of medical students entering neurology, including a focus on the student-reported quality of the basic neuroscience course and neurology clerkships, targeted engagement with MD/PhD students, and mentoring programs for students interested in neurology. Efforts to improve salaries for neurologists, to reduce medical school debt, and to improve work/life balance may also help to attract more students.

    View details for PubMedID 30926683

  • "But doctor, I googled it!": The "three Rs" of managing patients in the age of information overload. Clinics in dermatology Mundluru, S. N., Werbaneth, K., Therkelsen, K. E., Larson, A. R., Santini, V. E. 2019; 37 (1): 74–77


    Managing patient interactions in the age of the Internet can be particularly difficult due to the vast amount of information available. Dermatologists should be able to identify relevant patient concerns to adequately address them. We discuss the ethical issues involved in interacting with patients who use the Internet for medical knowledge, and we suggest a method, using the "three Rs" (reassure, redirect, refer), to conduct these interactions. Appropriate evaluation and categorization of patients with regard to their concerns and needs can help guide physicians on how to use the three Rs in managing patient care and expectations.

    View details for PubMedID 30554626

  • Late diagnosis of a rare urea cycle disorder mimicking Kleine-Levin syndrome. Neurology. Clinical practice Bozinov, N., Han, M., Lau, W., Santini, V. 2018; 8 (6): e43–e45

    View details for DOI 10.1212/CPJ.0000000000000547

    View details for PubMedID 30588389

  • Neurology Residents as Comprehensive Educators (Neuro RACE). The neurologist Santini, V. E., Wu, C. K., Hohler, A. D. 2018; 23 (5): 149–51


    Residents are expected to be educators often without any formal schooling, and many continue a career in academic medicine where they play a pivotal role in education. However, few resident curricula have been published to include instruction in teaching, particularly in the field of Neurology. To guide Neurology residents as they take on their role as a clinician-educator, we developed a 1-year curriculum (Neurology Residents as Comprehensive Educators "Neuro RACE") with monthly sessions divided into didactics, small group discussions, and interactive kinetic learning. A postcurriculum survey was used to evaluate the residents' response to this curriculum. Residents reported an overall improvement in their comfort and confidence in their teaching abilities. As an integral part of academic training, residents-as-teachers curricula should take a prominent role in Neurology training programs.

    View details for PubMedID 30169365

  • Slower saccadic reading in Parkinson's disease PLOS ONE Jehangir, N., Yu, C., Song, J., Shariati, M., Binder, S., Beyer, J., Santini, V., Poston, K., Liao, Y. 2018; 13 (1): e0191005


    Idiopathic Parkinson's Disease (PD) is characterized by degeneration of dopaminergic and other neurons, leading to motor and non-motor deficits. Abnormal eye movements in PD, including fixations, saccades, and convergence, are well described. However, saccadic reading, which requires serial and alternating saccades and fixations, is not well studied, despite its obvious impact on the quality of life. In this study, we assessed saccadic reading using variations of the King-Devick (KD) test, a rapid single digit number naming test, as a way to assess the ability to make serial left-to-right ocular motor movements necessary for reading. We recruited 42 treated PD patients and 80 age-matched controls and compared their reading times with a variety of measures, including age, duration of disease, Unified Parkinson's Disease Rating Scale (UPDRS), the National Eye Institute 25-Item Visual Functioning Questionnaire 25 (VFQ-25), and Montreal Cognitive assessment (MoCA) test. The subjects performed 4 trials of reading 120 single digit numbers aloud as fast as possible without making errors. In each trial, they read 3 pages (KD1, KD2, and KD3), and each page contained 40 numbers per page in 8 lines with 5 numbers/line. We found that PD patients read about 20% slower than controls on all tests (KD1, 2, and 3 tests) (p < 0.02), and both groups read irregularly spaced numbers slower than regularly spaced numbers. Having lines between numbers to guide reading (KD1 tests) did not impact reading time in both PD and controls, but increased visual crowding as a result of decreased spacing between numbers (KD3 tests) was associated with significantly slower reading times in both PD and control groups. Our study revealed that saccadic reading is slower in PD, but controls and PD patients are both impacted by visuospatial planning challenges posed by increased visual crowding and irregularity of number spacing. Reading time did not correlate with UPDRS or MoCA scores in PD patients but significantly correlated with age, duration of disease, and VFQ-25 scores. The presence of convergence insufficiency did not significantly correlate with reading time in PD patients, although on average there was slower reading time in those with convergence insufficiency by 8 s (p = 0.2613). We propose that a simple reading task using 120 single-digit numbers can be used as a screening tool in the clinical setting to assess functional ocular motor difficulties in Parkinson's disease that can have a profound impact on quality of life.

    View details for PubMedID 29364897

  • Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Movement disorders Ravikumar, V. K., Parker, J. J., Hornbeck, T. S., Santini, V. E., Pauly, K. B., Wintermark, M., Ghanouni, P., Stein, S. C., Halpern, C. H. 2017


    Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options.Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques.Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery.Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society.

    View details for DOI 10.1002/mds.26997

    View details for PubMedID 28370272

  • Neuroacanthocytosis: A case with unusual clinical features & novel response to treatment JOURNAL OF THE NEUROLOGICAL SCIENCES Wu, C. K., Santini, V. E., Dittus, C., Saint Hilaire, M. H. 2017; 373: 346

    View details for PubMedID 27988032

  • Transcranial MRI-guided high-intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome. Journal of magnetic resonance imaging : JMRI Federau, C. n., Goubran, M. n., Rosenberg, J. n., Henderson, J. n., Halpern, C. H., Santini, V. n., Wintermark, M. n., Butts Pauly, K. n., Ghanouni, P. n. 2017


    Transcranial MR-guided high-intensity focused ultrasound (tcMRgFUS) is a promising noninvasive method to treat medication-refractory essential tremor.To define the correlation between lesion size after ablation, thermal dose, and clinical outcome in tcMRgFUS treatment of essential tremor.Retrospective.Eight patients with medication-refractory essential tremor were treated using a tcMRgFUS system at 3T.T2 -weighted images were acquired immediately and at 1 year posttreatment at 3T.An atlas of the thalamic nuclei and dose maps were warped to the posttreatment images. The thermal dose, the immediate posttreatment lesion volume and 1-year final lesion volume, and the volumes confined inside the ventral division of the ventral lateral posterior thalamic nucleus (VLpv) were correlated to clinical outcome at 1 month and 1 year using Pearson's coefficient. The spatial region of treatment correlating with maximal clinical outcome was derived in a normalized space from average maps of clinical tremor score improvement at 1 year.Statistical significance was assessed using the Wilcoxon two-tailed rank test.The correlations between thermal dose, lesion volume posttreatment and at 1 year, and outcome at 1 year were good (r = 0.73, 0.65, 0.73, respectively), and were slightly better than at 1 month (r = 0.57, 0.49, 0.65). Reducing the measurement to include only the portion within the VLpv did not significantly modify the correlations (P = 0.09). The center of the spatial region of treatment was found in the anterior commissure - posterior commissure plane, 14.3 mm lateral from the midline, and 8.3 mm rostral to the posterior commissure.In this pilot study a good correlation was found between the size of the lesion, the thermal dose, and the clinical outcome in patients treated for essential tremor with ablation of the VLpv with tcMRgFUS.1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.

    View details for PubMedID 29076274

  • Neuroacanthocytosis: A case with unusual clinical features & novel response to treatment JOURNAL OF THE NEUROLOGICAL SCIENCES Wu, C. K., Santini, V. E., Do, C. 2016; 370: 55–56

    View details for PubMedID 27772787

  • Abnormal eye movement behavior during reading in Parkinson's disease PARKINSONISM & RELATED DISORDERS Yu, C. Y., Lee, T., Shariati, A., Santini, V., Poston, K., Liao, Y. 2016; 32: 130–32


    Reading difficulties are common in Parkinson's disease (PD) but not well studied. We report a case of reading difficulties in a 40-year-old man with 6-year history of PD on dopamine replacement therapy.We performed detailed neuro-ophthalmic examination and assessment of reading with and without infrared oculography.Clinical examination revealed visual acuity of 20/20, no evidence of vision loss, and normal eye movement and ocular alignment with normal saccades, pursuit, and normal convergence. During King-Devick test, a rapid number reading task performed on a book, patient had normal number reading speed. More detailed study of number and word reading using infrared oculography revealed that while this patient had normal speed and eye movement behavior during number reading, he had dramatic slowing and eye movement abnormality during word reading. The slower reading speed during word reading was due to increased number of progressive saccades, smaller saccade amplitudes, increased number of regressive saccades, and longer fixation durations.This case nicely illustrated the importance of comprehensive neuro-ophthalmic evaluations in Parkinson's disease and shows that reading difficulties can arise even when there is good visual acuity, ocular motor abilities necessary to read, and accommodation. In this case, reading difficulty was due to higher order ocular motor planning or cognitive abilities involved in word reading since the patient had no difficulty with ocular motor planning while reading numbers. These findings may have important implications towards our understanding of PD and can serve to spark further research in this important area.

    View details for PubMedID 27592009

  • Mon Chéri Haiti: Neurology lessons learned. Neurology Sharma, M., Santini, V., Auguste, M., Hohler, A. D., Etienne, M., Jones, E., Alessi, A. 2015; 85 (2): 169-171

    View details for DOI 10.1212/WNL.0000000000001735

    View details for PubMedID 26170399

  • Increasing student recruitment into neurology: Joining the family. Neurology Larsen, D. P., Santini, V. E. 2015; 84 (23): 2302-2303

    View details for DOI 10.1212/WNL.0000000000001668

    View details for PubMedID 25957335

  • Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H., Kubilus, C. A., Stern, R. A. 2009; 68 (7): 709-735


    Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology.

    View details for Web of Science ID 000267557400001

    View details for PubMedID 19535999

  • Clock drawing performance in cognitively normal elderly ARCHIVES OF CLINICAL NEUROPSYCHOLOGY Hubbard, E. J., Santini, V., Blankevoort, C. G., Volkers, K. M., Barrup, M. S., Byerly, L., Chaisson, C., Jefferson, A. L., Kaplan, E., Green, R. C., Stern, R. A. 2008; 23 (3): 295-327


    The Clock Drawing Test (CDT) is a common neuropsychological measure sensitive to cognitive changes and functional skills (e.g., driving test performance) among older adults. However, normative data have not been adequately developed. We report the distribution of CDT scores using three common scoring systems [Mendez, M. F., Ala, T., & Underwood, K. L. (1992). Development of scoring criteria for the Clock Drawing Task in Alzheimer's Disease. Journal of the American Geriatrics Society, 40, 1095-1099; Cahn, D. A., Salmon, D. P., Monsch, A. U., Butters, N., Wiederholt, W. C., & Corey-Bloom, J. (1996). Screening for dementia of the Alzheimer type in the community: The utility of the Clock Drawing Test. Archives of Clinical Neuropsychology, 11(6), 529-539], among 207 cognitively normal elderly. The systems were well correlated, took little time to use, and had high inter-rater reliability. We found statistically significant differences in CDT scores based on age and WRAT-3 Reading score, a marker of education quality. We present means, standard deviations, and t- and z-scores based on these subgroups. We found that "normal" CDT performance includes a wider distribution of scores than previously reported. Our results may serve as useful comparisons for clinicians wishing to know whether their patients perform in the general range of cognitively normal elderly.

    View details for DOI 10.1016/j.acn.2007.12.003

    View details for Web of Science ID 000256559500007

    View details for PubMedID 18243644