Divisions: Department of Neurology

M. Maral Mouradian, MD
Distinguished Professor of Neurology
William Dow Lovett Professor of Neurology
Founding Director of the RWJMS Institute for Neurological Therapeutics
Vice Chancellor for Faculty Development at Rutgers Biomedical and Health Sciences
Director, American Parkinson Disease Association Center for Advanced Research at RWJMS

Dr. Mouradian is an internationally recognized physician scientist in the understanding and treatment of Parkinson’s disease.  She trained in neurology at the University of Cincinnati Medical Center followed by further study in movement disorders, neuropharmacology and molecular neurobiology at the US National Institutes of Health (NIH) where she worked with the Nobel Laureate Marshall Nirenberg. Prior to joining Rutgers, Dr. Mouradian led the Genetic Pharmacology research program of the National Institute for Neurological Disorders and Stroke at the NIH.

Her career focus has been to elucidate the molecular pathogenesis of Parkinson’s disease (PD) and its treatment complications, and to develop improved and novel therapies both for disease modification and better symptom control. Her seminal contributions have provided the rationale for the development of continuous therapeutic modalities for PD such as pump, skin patch, and controlled release formulations of oral drugs. To date, she has authored over 200 scholarly publications, edited two books on Parkinson disease, and holds several patents. Her research is funded by the NIH, the Michael J. Fox Foundation for Parkinson’s Research, the American Parkinson Disease Association, and other foundations. She is a member of the Board of Directors of the American Neurological Association, the American Society for Experimental Neurotherapeutics, and the Scientific Advisory Board of the American Parkinson Disease Association. In addition, she is the Editor-in-Chief of the journal Neurotherapeutics.  She the recipient of several awards including the NIH award of Merit, the Board of Trustees Award for Excellence in Research from Rutgers University, and the Honorary Alumni Award from Rutgers - Robert Wood Johnson Medical School. She is a member of the Association of American Physicians.

Jennifer Chen, MD
Assistant Professor of Neurology
Associate Residency Program Director

Dr. Jennifer Chen is a board-certified neurologist with subspecialty training in movement disorders.  She received her medical degree at New York University School of Medicine and completed her Neurology Residency at Mount Sinai in New York City.  Following her residency, she pursued a two-year fellowship in movement disorders at the University of California San Francisco (UCSF), one the largest deep brain stimulation (DBS) referral centers in the West Coast.  Her training there has provided her with expertise and experience in the evaluation/selection of DBS candidates and DBS programming for Parkinson’s disease and other movement disorders.  Additionally she gained extensive skills in the administration of botulinum toxin for neurologic indications, which is one of her main interests outside of DBS.   Currently, she is also involved in several industry-sponsored trials for the treatment of Parkinson’s disease.

Clinical and Research Interests

• Dystonia
• Deep brain stimulation
• Botulinum toxin treatments
• Essential tremor
• Parkinson’s disease

Gian Pal, MD, MS
Assistant Professor of Neurology

Dr. Pal is a board-certified neurologist and movement disorders specialist. He received his MD from Robert Wood Johnson Medical School, completed his residency in neurology at Georgetown University Medical Center, and received his MS in clinical research from Rush University Medical College where he also completed his fellowship training in movement disorders.  After 6 years at Rush focusing on deep brain stimulation, Dr. Pal joined the faculty at Rutgers.  Dr. Pal's research interests include deep brain stimulation, Parkinson's disease genetics, and studying the role of the gut microbiome in Parkinson's disease. He has served as principal investigator for multicenter studies funded by the Michael J. Fox Foundation and the Parkinson Study Group (PSG) and has conducted investigator initiated research regarding GBA mutations in Parkinson disease.  He has received multiple philanthropic awards for his research and most recently received funding from the NIH in the form of a K-award.

Clinical and Research interests:

• Deep brain stimulation
• Parkinson’s disease genetics
• Microbiome in Parkinson’s disease

Marco Russo, MD, PhD
Assistant Professor of Neurology

Dr. Russo is a board-certified neurologist and movement disorders specialist in New Brunswick.  He received his MD and PhD degrees from Columbia University College of Physicians & Surgeons, completed neurology residency at New York University, and then a clinical research fellowship in the Fresco Institute for Parkinson's and Movement Disorders at NYU, with focus on biomarkers Parkinson's disease and other alpha-synuclein disorders.  His research interests include ongoing improvement of diagnostic precision for synucleinopathies, and understanding the complex etiologies underlying parkinsonism and neurodegenerative disease.

Arcival Salazar, MSN, APN, CEN
Nurse Practitioner

Arcival Salazar is a nurse practitioner working in the movement disorder division. He obtained his Bachelors of Science in Nursing at Ramapo College of New Jersey and Masters of Science in Nursing at Chamberlain College of Nursing.  Prior to becoming a nurse practitioner he was an emergency department nurse at Monmouth Medical Center Southern Campus and Robert Wood Jonhson University Hospital in New Brunswick. Interests include Parkinson's disease and deep brain stimulation (DBS) management.

Michelle Chen, PhD
Instructor of Neurology
Core Member of the Center for Healthy Aging in the Institute for Health, Health Care Policy and Aging Research

Dr. Michelle Chen is a neuropsychologist, with a PhD in Clinical Psychology from Yeshiva University. She obtained clinical training through Montefiore Medical Center, NYU Langone Medical Center, and VA Maryland Health Care System, where she worked with a variety of patient populations including movement and other neurodegenerative disorders. She also completed a postdoctoral fellowship focusing on neuropsychology and neuroscience research at Kessler Foundation. She currently leads the Rutgers Neuropsychology Laboratory where she studies the applications of digital health technology (e.g., smartphones, wearable devices) in remote assessment and treatment of neurological symptoms. Dr. Chen has been funded through several non-profit foundations. Most recently, she is the recipient of a K23 Patient-Oriented Research Career Development Award from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (one of the agencies in the National Institutes of Health). She also received a Research Council Collaborative Multidisciplinary Award from Rutgers University.

Ling Pan, MD
Assistant Professor of Neurology

Dr. Ling Pan is a board-certified neurologist with subspecialty training in movement disorders at Rutgers Health. She completed her MD at SUNY Downstate Medical Center, general neurology residency at Mount Sinai Hospital, and fellowship in movement disorders at New York University. Prior to joining Rutgers, Dr. Pan spent three years as an attending movement disorders specialist at NYU’s Center for Neuromodulation, where she developed clinical expertise in deep brain stimulation (DBS) and MR-guided focused ultrasound (MRgFUS) for a variety of indications, including Parkinson’s disease, essential tremor, dystonia, other tremor disorders, and Tourette syndrome. Her interests include the application of neuromodulation for atypical movement disorders, and improving the efficiency and accessibility of DBS and MRgFUS for patients.

Tremor is an involuntary rhythmic shaking that can affect one or more parts of the body. It can occur on its own or as a symptom of another neurologic disorder (Parkinson’s disease, multiple sclerosis e.g.) 

Essential Tremor (ET) is a neurological condition characterized by involuntary rhythmic shaking that typically worsens with action. It predominantly affects the hands and arms but can also spread to the head, voice, trunk and legs. ET is the most common movement disorder in the world, eight times more common than Parkinson’s disease, with which it can be confused. Typically it worsens with age and has a 50% chance of being inherited. The exact cause is unknown, though one theory implicates the cerebellum (area involved in movement coordination) and its communication with other parts of the brain.

Parkinson’s disease (PD) is a progressive neurodegenerative disease (condition where cells relating to the brain or nerves degenerate) that primarily affects the neurons (nerve cells) that produce a chemical called dopamine. Dopamine is a neurotransmitter that acts as a messenger between nerve cells. This communication allows for coordination of movement which is then transmitted to the body. The loss of dopamine causes many of the symptoms we see in PD, including rest tremor, stiffness (rigidity), slow movement (bradykinesia), as well as gait and balance changes. Though this is a simplified view (dopamine affects other systems – e.g mood – and PD affects other neurotransmitters), it gives us a basis for understanding the disease and how we treat it. 

Parkinsonism refers to any combination of movement abnormalities that are found in Parkinson’s disease (those listed above).  As such, Parkinson’s disease is itself a cause of parkinsonism but there are other conditions that can cause it, such as the so-called atypical parkinsonisms aka Parkinson Plus syndromes. These include progressive supranuclear palsy (PSP), multiple system atrophy (MSA), corticobasal degeneration (CBD) and dementia with Lewy bodies. There are also secondary causes of parkinsonism such as strokes or certain drugs. Sometimes it is difficult to differentiate between PD and other causes of parkinsonism, especially early on, which is why an by a movement disorders specialist can be important for both diagnosis and management. 

Our clinic provides evaluation, care and research opportunities for PSP and other atypical parkinsonisms, while our behavioral and memory clinic focuses on Lewy Body dementia, Parkinson’s disease dementia and other causes of cognitive impairment.

Dystonia is a disorder that causes excessive involuntary muscle contractions resulting in abnormal postures, twisting, and characteristically patterned movements. This causes difficulty for individuals to control their movements. It is typically worsened by voluntary movements and can even be task-specific (e.g. writing). Dystonia can affect any part of the body including the eyelids, face, jaw, tongue, vocal cords, neck, arms/hands, legs/feet, and torso.  It may also affect a single body party (focal) or two or more continuous parts (segmental) that may include the torso (generalized).

In some cases, the cause of dystonia is due to drugs, brain injury, or other neurological or metabolic disorders, so-called secondary or acquired dystonia.  In many other cases, dystonia is the only symptom and there is no clear etiology, so-called primary or isolated dystonia, the processes of which we do not completely understand though genetics can be a part.

The treatment for dystonia can depend on the cause, however, in general, botulinum toxin injections can offer improvement in function, pain, and overall quality of life.  Please see our botulinum toxin program for more information.  In some cases, deep brain stimulation or other surgery may be considered.

Hemifacial spasms are a neurological disorder characterized by involuntary twitching or pulling (spasms) of one side of the face. Typically it starts under the eye with intermittent twitching and spreads all around the eye causing involuntary eye closure.

It may later affect the lower face with pulling of the lip and flaring of the neck. Sometimes it is due to a blood vessel touching the facial nerve, but injury to the nerve itself can cause it or there may be no reason at all. The standard treatment is botulinum toxin injections to the affected area(s), though in some cases surgery can be an option.

Huntington’s disease is a rare genetic disorder that causes the progressive degeneration of neurons in the brain.  It is classically characterized by involuntary “dance-like” movements called chorea as well as psychiatric and cognitive problems. Personality changes are not uncommon including irritability and mood swings; patients also develop difficulty with problem-solving and poor judgment. Additional motor manifestations include gait impairment and speech and swallowing difficulty.

The disease is typically inherited with those afflicted having a 50/50 chance of passing it down to their children, though about 1-3% of patients have no family history.  Management involves a multidisciplinary team that usually includes neurology, psychiatry, genetic counseling, and social work.  Please refer to the Samuel L. Baily Huntington's Disease Family Service Center at Rutgers Health for more information. 

Tardive syndromes refer to a category of movement disorders that are secondary to long-term use (months to years) of certain drugs called neuroleptics (typically those used to treat psychiatric disorders).

These include the classic tardive dyskinesia, which describes writhing/darting movements of the tongue, as well as:

• Chewing movements
• Lip puckering or smacking
• Writhing of the limbs
• Dystonia (see above)
• Parkinsonism
• Stereotypy (repeated voluntary purposeless movements),
• Tremors, jerks, tics, or akathisia (sense of uncomfortable restlessness).  

Treatment typically involves discontinuing/reducing the causative medication but if unable, additional medications may be used and in some cases botulinum toxin.

Tourette’s syndrome is a neurologic and psychiatric condition characterized by repetitive, stereotyped movements and vocalizations (tics), which are usually preceded by an urge.  While the movements/sounds may be suppressed somewhat, this may cause a large build-up of tension leading to an involuntary need to express them. Most tic symptoms are not impairing so no treatment is required.

However, if they do interfere, Cognitive Behavioral Intervention for Tics (CBIT), which includes awareness training and competing response training, is recommended. The treatment is effective in large, multi-center, trials with significant reduction in tics and ability to function.

Medications may also be used to treat tics, the most effective of which are neuroleptics, though these may incur significant side effects (e.g. tardive syndromes, see above) and may not eliminate all the symptoms. 

• Ataxia
• Myoclonus
• Other forms of Chorea
• Restless Legs Syndrome

Essential tremor (ET) is a neurological condition characterized by involuntary rhythmic shaking that typically worsens with action.  It predominantly affects the hands and arms but can also spread to the head, voice, trunk, and legs. In cases where medications have minimal efficacy (or are intolerable) and the tremor is disabling, DBS can offer substantial symptom relief. ET was one of the first disorders for which DBS treatment received FDA approval in 1997. Though it is not a cure for ET or any other disorder, it can greatly improve quality of life.

Typically evaluation will consist of consultation with one of our neurologists, our neurosurgeon, and an MRI brain. Additional testing may be done after consultation if deemed necessary.

Dystonia is a disorder that causes excessive involuntary muscle contractions resulting in abnormal postures and movements that are characteristically patterned and twisting. This causes difficulty for individuals to control their movements.

It is typically worsened by voluntary movement and can even be task-specific (e.g. writing). The exact mechanism is unclear but we know it can respond to DBS when medication fails to provide adequate relief. Response to DBS varies but on average studies indicate about a 50-60% reduction in symptoms overall and some may have more (up to 90%) depending on the cause of dystonia. 

Typically evaluation will consist of consultation with one of our neurologists, our neurosurgeon, and an MRI brain.  Additional testing may be done after consultation, which may include genetic and/or neuropsychological testing.

DBS may be considered for other disorders (e.g. Tourette’s, obsessive-compulsive disorder, other types of tremors) and is done on a case-by-case basis. Please contact our office for a consultation.

Botulinum toxin is a potent neurotoxin produced by the bacteria Clostridium botulinum.  The toxin blocks the release of acetylcholine, a neurotransmitter, into the space between the nerve and the muscle. This in effect causes muscle paralysis.

If the toxin becomes systemic, such as in the case of Clostridium bacterial infection or consuming large amounts of contaminated food, botulism can occur, causing difficulty moving and breathing. However, the botulinum toxin used in medical injections has been carefully sterilized and diluted to prevent this from occurring.

In nature, 8 types of botulinum toxin exist, named A-H, but only types A and B are available for medical use. Though Botox is the most widely known, it is one of four brands approved in the United States for medical treatment, three being type A and one type B. They are:

• Botox (Onabotulinumtoxin A)
• Xeomin (Incobotulinumtoxin A)
• Dysport (Abobotulinumtoxin A)
• Myobloc (Rimabotulinumtoxin B)

No generics are available.  All types have shown to be equally effective, though the choice of brand may depend on pricing and current FDA approvals. This should be discussed with your physician.

Within movement disorders, botulinum toxin is used to treat dystonia (e.g. cervical dystonia, blepharospasm), hemifacial spasm, and in certain cases tremors and tics.  Additionally, botulinum toxin injections can treat spasticity of muscles that can occur after a brain or spinal cord injury such as a stroke.

It temporarily reduces overactive muscle contractions allowing for more normal mobility and can even relieve pain. Botulinum toxin is also approved for the treatment of chronic migraine, overactive bladder, excessive drooling (sialorrhea), and excessive sweating (hyperhidrosis).

Botulinum toxin is injected intramuscularly using a fine needle. Depending on the reason and area being treated multiple injections may be required. Practitioners may use anatomical landmarks, electromyography (EMG), or ultrasound for guidance depending on what is being treated as well as where he/she was trained. The injections are an outpatient procedure and take place in the office. 

Though it is a toxin, with proper administration and correct dosage, the injections can provide the desired benefit with minimal risk. Sometimes patients may experience mild flu-like symptoms for the first few days to a week, but otherwise, systemic complications are exceedingly rare.

Other side effects may stem from local spread depending on the area being injected, such as drooping eyelids from injections around the eye. Your physician will discuss with you the possible complications based on your condition. The side effects around the injection site may include pain, redness, bleeding, and hematoma. 

Therapeutics effects start in about a week to 10 days and peak around 6 weeks post injections. On average injections will last about 3-4 months and then need to be repeated.

For medical purposes, most commercial insurances and Medicare do cover botulinum toxin injections, although your co-pay may vary depending on your plan. If your insurance does not cover or if you do not have insurance, most of the companies offer an assistance program.

At Robert Wood Johnson neurology clinics, you will first need a consultation with the appropriate specialist. Afterwards, your provider will send the prescription for pre-authorization which can take 6-8 weeks.

Once approved, you will be scheduled for your injection, and your pharmacy will ship the medication to the clinic. Authorization typically will need to be repeated about once a year.

• Movement Disorders specialists
  • Jennifer Y. Chen: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, focal tics, tremor, sialorrhea, spasticity
  • Marco Russo: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, focal tics, tremor, sialorrhea
  • Gian Pal: dystonia, including but not limited to cervical dystonia and blepharospasm, hemifacial spasm, sialorrhea
• Neuro-ophthalmology:
  • Fred Lepore: Blepharospasm and hemifacial spasm
• Headache:
  • Pengfei Zhang: Migraine
  • Shelly Rishty (General Neurology and Epilepsy): Migraine
• Neuromuscular:
  • Shan Chen: Spasticity and sialorrhea