Currently on its 34th edition, the now-famous Aspen course is considered a rite of passage for every movement disorder fellow. Over time, it has grown to include an international and diverse group of professionals including general practitioners, advanced practice providers, neurosurgeons, physical therapists, psychologists and many other stakeholders in the field. As described by Dr. Michael Okun, this year’s course director, “The then three up-and-coming superstars in the field realized how impactful it could be to offer a course that struk the balance between education and keeping up to date with the newest trends, while allowing for a third element of close mentoring and coaching.” With a cast that included senior faculty members Dr. Jankovic and Dr. Mark Hallett, as well as newer leaders in the field — Dr. Okun, Dr. Susan Fox, Dr. Jennifer Goldman, and Dr. Alberto Espay — this year's edition of the legendary course once again succeeded in enlightening and rekindling the excitement of new and returning attendees.
The course kicked off with an Amneal industry-sponsored talk by Dr. Stuart Isaacson on the history of levodopa from its discovery in 1913 and FDA approval in 1975, to current therapies in the pipeline to enter the market including novel extended release carbidopa-levodopa formulations, subcutaneous levodopa pumps, and D1-like dopamine receptor agonists.
Foundational talks on phenomenology and physiology followed. Dr. Espay’s talk on phenomenology reminded the audience that not every abnormal movement is rooted in a neurologic etiology, as evidenced by videos of the “Snapping hip syndrome.” Dr. Hallett’s ever-expanding comprehensive review of the basal ganglia included the highly anticipated revelation of GLP-1 as the winner of the neuropeptide of the year award.
The rest of the afternoon was entirely dedicated to parkinsonism. Takeaway messages included Dr. Goldman’s call for trainees to research poorly understood non-motor symptoms in Parkinson’s disease including apathy, temperature dysregulation, urinary symptoms, and sexual dysfunction especially in women. With cautious optimism, Dr. Okun reviewed promises of novel technologies such as wearables and spinal cord stimulators with ability to communicate with implantable brain devices, and discussed their possible ethical repercussions.
The following four days covered the breadth of conditions within the realm of movement disorders, from phenomenology to the latest scientific advancements, including same-week publications, revealing the tremendous expertise and dedication of the presenting faculty. Recurring topics included the importance of rapid identification of treatable etiologies, including a growing number of newly described autoimmune conditions, especially when symptoms develop acute and sub-acutely. Many talks also highlighted unique challenges and opportunities that arise from the exponentially growing identification of pathogenic genetic mutations, reinforcing the relevance of multidisciplinary efforts, including increasingly sought-for genetic counselors.
Other novel challenges posed by technological advances include the spread of functional neurological disorders through social media, as seen in the phenomenon of TikTok tics. The interpretation of poorly understood but increasingly available commercial and clinical tests, including genetic tests and protein and enzymes assays, was also discussed. Cautious curiosity was unanimous among lecturers when analyzing the prolific research output on synuclein-amplification essays, as well as other emerging biomarkers such as the possible role of Tau in Huntington's disease. Promising novel therapeutic and diagnostic options reviewed included longer-lasting botulinum toxins, such as DaxibotulinumtoxinA, in the treatment of dystonia. This was paired with a discussion of the growing evidence of the use of botulinum toxin in the treatment of tremor in other movement disorders such as Parkinson’s disease and essential tremor, as pioneered by Dr. Jankovic. Urgently needed therapies for cerebellar ataxia were also mentioned by Dr. Hallett, including Omaveloxolone for Friedreich's Ataxia and cerebellar non-invasive brain stimulation.
The primacy of the physical exam in light of many new diagnostic technologies was reviewed by Dr. Okun, highlighting that phenomenology still predicts the best targets for deep brain stimulation.
As is traditional at movement disorders gatherings, the late-evening participant video rounds event was a huge success. Presented cases reflected the diversity of phenomenology and etiology discussed during the course, including rare genetic and autoimmune cases, and the international representation at the course, including cases from Canada and India. For Dr. Okun, a highlight of the 34th edition was the fellow luncheon generously sponsored by the Parkinsons Foundation, which honored the mentoring and coaching tradition established since the conception of the course.
“Coaching is us understanding what people can bring to the table,” Dr. Okun said. “We believe fundamentally as Aspen faculty that each of the people at the course has a tremendous opportunity to touch thousands of lives, whether it's in education, clinical care, research, or inventing things in collaborations with industry.”
Mentoring and coaching become even more fundamental in a landscape of limited funding and increasing need for movement disorders-trained specialists in the clinical and scientific forefront.
“If all of the people who are burned out in health care now feel like they're part of something and like they're making an impact, despite the challenges within the health care system, we're going to be able to serve more people for longer,” Okun said.
As a trainee myself, I left the Aspen course admittedly overwhelmed by the mountains of knowledge presented to me, but encouraged and invigorated to follow the trails arduously paved by legends that traveled ahead of me. Inspired by his mountain hikes, Friedrich Nietzsche wrote, “on the mountains of truth, you can never climb in vain: either you will reach a point higher up today, or you will be training your powers so that you will be able to climb higher tomorrow.”
Regardless of where you find yourself in your career path and your previous experience in movement disorders, the Aspen course will certainly elevate you to higher grounds and fuel you with excitement to resume your journey.
Learn more about the foundational Aspen course:
Course details »