Dr. Mandar Jog, Assistant Director, Lawson and Director of the National Parkinson Foundation Centre of Excellence at London Health Sciences Centre (LHSC), is the recipient of this year’s Innovation Award. Presented at the 2018 Lawson Impact Awards event, the award recognized Dr. Jog’s development of a personalized therapy that has successfully treated over a hundred research patients with tremors in their arms and hands.
The Innovation Award is given to a scientist whose research has resulted in translation into advances in health care either through commercialization or adoption of new clinical practice. Dr. Jog’s received the award for his publication, “Functional Ability Improved in Essential Tremor by IncobotulinumtoxinA Injections Using Kinematically Determined Biomechanical Patterns—A New Future,” published in PLOS ONE.
Tremors, typically caused by Parkinson’s disease or essential tremor, are a common movement disorder symptom, yet there is no effective treatment. The only option for patients whose tremors cannot be managed pharmacologically is deep brain stimulation, an invasive surgical procedure with operative risks.
Neurotoxin therapy has been identified as a possible treatment for tremors. Some neurotoxins, such as botulinum toxin, reduce muscle activity and are already on the market for a variety of uses. However, if the injection of botulinum toxin is given in the wrong muscles or the patient is not given the correct dose, it can cause negative side effects. Another challenge is that everyone experiences tremors in different ways. The location and strength of the movements, and how often they occur varies widely.
“For the longest time, people couldn’t figure out whether a horse has one foot on the ground when it’s galloping or if all the feet come off the ground. When they developed high-speed photography they were able to show that yes, at certain points, all four of a horse’s feet are off the ground at the same time. The analogy kind of applies to tremor, which can be very complex. Dr. Jog has developed a tool that allows an analysis of the complexity of tremors,” says Dr. Paul Cooper, Chair of the Department of Neurological Sciences at Schulich Medicine & Dentistry and Chief of the Department of Neurological Sciences at LHSC.
Using a combination of wearable sensors and complex algorithms, Dr. Jog and his team are able to determine which muscles and what biomechanics are at play for each patient’s unique tremor symptoms. Using this information, clinicians can precisely place injections to reduce tremor at the exact source.
“You just put on the sensors in multiple joints, the technology records the muscle movements passively, and the algorithm solves the problem for you. We can teach physicians the anatomy but the assessment intelligence is impossible to teach. With this technology, all physicians need to know is how to do an injection,” says Dr. Jog, who is also a professor at Western University’s Schulich School of Medicine & Dentistry.
Through clinical trials, participants have experienced striking improvements to the severity of their tremors after receiving the assessment and tailored injections.
Dr. Jog’s innovative approach could also be more widely applicable to a number of different movement disorders, including cervical dystonia, a condition where the neck muscles contract involuntarily causing abnormal movements in the head and neck.