MDS Affiliate Member Society
An Interview with Dr. Miguel Gago, Portuguese Movement Disorder Society
Contributed by Francesca Morgante, MD, PhD, Messina, Italy and Gertrud Tamás, MD, PhD, Budapest, Hungary
Miguel Gago is a 39-year-old neurologist in the Department of Neurology and Director of the Academic Center of the Hospital of Guimaraes, in Portugal. He is a Professor of Clinical Neurosciences in the School of Medicine, University of Minho, Portugal, where he conducts his main area of research in gait and postural control. Dr. Gago is a member of national and international scientific societies of Movement Disorders, and was elected Treasurer (2012) and President (2015) of the Portuguese National Movement Disorder Society.
1. How did you become interested in Movement Disorders?
My interest in Movement Disorders started at the beginning of my neurology fellowship in 2005, as it was one of the areas of specialty of my mentor, who was a part of the DBS team in the Hospital of Sao Joao. Also, by that time, we were living exciting times in Portugal, as Parkinson’s disease surgery was booming, new drugs were released on the market, such as dopamine agonists and triple combinations of levodopa/carbidopa/entacapone, and Duodopa was starting its clinical trial. It is extremely gratifying and rewarding to be able to control and deliver a meaningful clinical benefit to a patient so quickly, either pharmacologically or by DBS. This is probably one of the universal reasons that has driven so many neurologists to the field of neuroscience. In 2011, after a few years dedicated to DBS, I started a new outpatient consultation in movement disorders and dementia in my current hospital, connected to the University of Minho. It was there that I started to consolidate a scientific interest on the interplay between gait and cognition in different neurological diseases with extra-pyramidal manifestations.
2. Are there referral centers for deep brain stimulation in your country? Is there a DBS network and if yes, how is it organized? Are there tertiary movement disorders centers in your country?
In Portugal, according to the differentiation of ward and outpatient consultations, we can divide the different hospitals into three main categories: tertiary movement disorders centers performing DBS; secondary hospitals; and primary hospitals with general neurological consultations. Covering the ten million inhabitants, we have four DBS Centers; two in the North (Porto), and one in both in the Center (Coimbra) and South (Lisbon), that are currently performing DBS for Parkinson’s disease, Dystonia, Essential Tremor and Obsessive Compulsive Disorders, etc. Secondary hospitals, providing healthcare for a population of about 300,000 inhabitants, have a multidisciplinary movement disorders disease consultation, involving psychiatry and physiotherapy, botulinum toxin, and develop basic research or clinical trials. These secondary hospitals, scattered throughout the geography of the country, refer the patients needing DBS to the tertiary centers, so as that all citizens are currently about 250km away from a surgical center.
3. Is there an official training or fellowship program for Movement Disorders in your country?
During the internship of neurology, which has a minimum of five years of duration, the residents can opt for a general training, lasting from one to three months, or a more dedicated training in movement disorders. Those that decide to specialize in movement disorders, although there are no national published strict guidelines, do a minimum of one to two years of supervised training, assuming thereafter responsibility for an outpatient consultation in the last year of fellowship. Also, during this training, it is mandatory to be integrated into one of the tertiary movement disorders centers, in order to have contact with DBS, Duodopa, botulinum toxin or apomorphine techniques. Also, during the fellowship, although not mandatory, most of the residents have the opportunity to attend an abroad internship, three to 12 months (maximum), in one of the international centers (Barcelona, London, Kiel, Toronto, etc.) with whom we have previous partnerships.
4. When was the Portuguese Movement Disorders Society founded? When did it join MDS?
The Portuguese Movement Disorders Society was founded in 2009, after the involvement of several neurologists, including one of the founding members, Prof. Cristina Sampaio. Currently, our society has almost 200 members and joined MDS as an Affiliate Member Society in 2016. One of the main goals of our society, besides providing education to the neurology fellows, is to engage and interlink all health professionals such as physiotherapists and psychologists, and basic sciences researchers.
5. Do you meet annually for a national congress of the Portuguese Movement Disorders Society? How does the Portuguese Movement Disorders Society support young people interested in getting more experience in the field?
Each year, The Portuguese Movement Disorders Society holds a national congress, with a scientific program covering general education and phenomenological discussion of clinical movement disorder videos, in addition to pharmaceutical industry symposia. In recent years, we have opened our society to basic science researchers, devoting a period to oral communications and awarding a monetary prize for best basic science research. More than ever, in order to deliver a translational approach, it is critical to interlink professionals from different science fields.
The Portuguese Movement Disorders Society financially supports the registration of all fellows of neurology, as well as first authors of nonmedical oral presentations. Curiously, despite being in the beginning a large financial burden, it has indirectly been the biggest reason of success of recent year meetings, having warranted the involvement of a growing number of physicians and scientists. The paradigms of scientific and monetary support coming from pharmaceutical industry are changing, clearly not favorable for a young neurologist, and as so, more than ever, scientific societies are a growing channel in order to ensure training and education and even fund clinical research in neuroscience.
6. Can you tell us about any MDS activities in Portugal in the past year?
Since becoming an Affiliate Member Society in 2016, MDS sponsored two courses; one covering motor and speech rehabilitation taking place at the CNS-Torres Vedras, and a DBS meeting in Porto. In September of 2017, we held a meeting dedicated to the celebration of the 200 years of Parkinson’s disease, where we highlighted the natural history of the disease, therapeutic advances, the growing field of genetics and new biological biomarkers and neuroimaging.
7. How does the Portuguese Movement Disorders Society interact with patient associations? How are patient associations contributing to fund research in Portugal?
In Portugal, we have the National Association of Parkinson’s Disease Patients and Huntington’s Disease Patients Association. All physicians provide their scientific contribution, by writing scientific articles in the magazine of the patients and caregivers associates, or by providing knowledge and awareness of the civic society, particularly in small and more isolated communities.