Dr Tabish Saifee is a Consultant Neurologist at the National Hospital for Neurology and Neurosurgery in Queen Square and the London North West Healthcare NHS Trust. He runs large neurology clinics for both NHS and private patients with all neurological disorders. However, his specialist interest is in movement disorders, for which he was awarded a PhD from the UCL Institute of Neurology in Queen Square.
Q: Dr Saifee, thank you for finding the time to speak with us today. Firstly, would you please explain your role here in Queen Square and your particular areas of clinical expertise?
Thank you for the invite. I am a Consultant Neurologist in the Movement Disorder group at Queen Square. I see a large number of patients with all neurological disorders due to my interest in acute neurology. I have specialist expertise in the management of patients with all movement disorders, including Parkinson’s disease, one of the commonest diseases within this subspecialty. I run specialist clinics at Queen Square seeing referrals from my GP colleagues in primary care as well as from other Neurologists locally and regionally. I treat patients with all movement disorders such as dystonia and tremor including with the use of botulinum toxin therapy. My particular clinical and research interest is in diagnosing and treating patients with all forms of tremor (a very common symptom) and I am developing a unique service at Queen Square for the management of such patients.
Q: What was it about this particular area of neurology which interested you to focus on it?
During higher specialist neurology training at the National Hospital for Neurology and Neurosurgery, I was awarded an academic clinical fellowship, which I spent with the movement disorders group. It is a very clinical subspecialty that relies heavily on expert clinical assessment of the patient in clinic or at the bedside. Using such ‘phenomenology’, we as clinicians can provide a very timely and accurate diagnosis for our patients at first visit. However, rapid developments in technology have meant that the precision of diagnosis has improved. I remember seeing patients who had been characterized accurately by luminaries such as Professor David Marsden (one of our eminent predecessors at Queen Square), some decades ago, but only now, with the advances in state-of-the-art genetics, imaging and CSF studies etc, have gone on to receive more precise diagnoses.
A number of conditions, in particular Parkinson’s disease can be treated with a wide array of treatments from highly specialist therapy input, an increasing range of targeted therapies and also surgical options such as deep brain stimulation. This provides for very rewarding work. The ability to be able to pick out more unusual specific movement disorders which when treated, could be life-transforming or life-saving, such as in metabolic disorders, Wilson’s disease, focal dystonia, functional movement disorders etc, led me to be fascinated with this area and really struck at the heart of my passion for neurology.
Q: ‘Queen Square’ is widely regarded as the ‘home’ of Neurology and is renowned for the breadth and depth of clinical skill and expertise available in one location. How important to you and your clinical practice is this ability to work alongside colleagues from other clinical specialties in Queen Square?
Working at Queen Square means that I am in an environment where we have cutting edge diagnostics, treatment and knowledge for a wide range of neurological conditions. Complex cases can be discussed in multi-disciplinary meetings with other experts. It allows patients to access, en bloc, a wealth of medical resource. It also means that we can keep up to date with the latest developments in each subspecialty through weekly grand rounds and international speakers and most importantly offer our patients the cutting edge in terms of diagnostic and treatment options. We have state of the art MRI scanners and excellent neuroradiologists and neurophysiologists to facilitate accurate diagnostics. It also means that patients can access great supportive therapy, for example, from highly specialist therapists and team-based approaches to treatments such as deep brain stimulation or highly effective immune therapies in autoimmune diseases. I find that patients often come to my clinic with the satisfaction that they are receiving great care at a leading institution.
Q: Alongside your clinical work, you are also involved in research in the field of movement disorders. Where is the focus for your research currently?
I am particularly interested in clinical research in movement disorders. I have undertaken clinical research in movement disorders funded by the National Institute for Health Research, looking into mechanisms in the brain that generate tremor. I have also published widely in the scientific literature on the pathogenesis of dystonia and Parkinson’s disease. Aside, I am developing phone apps for the diagnosis of tremor and the remote monitoring of Parkinson’s disease. I have also published criteria for consensus diagnosis of certain types of tremor. Using neurophysiological methods, we are interested in probing mechanisms in the brain that generate such abnormal movements. This clearer insight will hopefully provide us with more targeted approaches to drug discovery for the treatment of such disorders in future.
Q: What, in your opinion, might be on the horizon for the diagnosis and treatment of movement disorders?
There are a lot of exciting developments within the field of movement disorders and Parkinson’s disease. We are seeing many new drugs passing through phase 1 to 3 trials, including relevant clinical trials at Queen Square. Whilst we do not yet have a cure for Parkinson’s disease, there are a few approaches looking at detecting the condition very early on by identifying early non-motor features such as REM-sleep behavior disturbance. This is likely in future to enable us to treat the condition at a very early stage to stop or reduce accumulation of abnormal protein complexes such as alpha-synuclein in the brain and hopefully prevent or slow neurodegeneration. We are also seeing very exciting developments in deep brain stimulation and other surgical techniques for treatment of movement disorders. We will see personalized medicine become a part of these treatment approaches, for example with the ability to measure a patient’s movement disorder and in real-time, stimulate the brain accordingly to improve the movement disorder.
Q: You are very kindly speaking at our final GP seminar event of the year, scheduled for November 29th. Could you give us a preview as to what the focus of your presentation will be?
I will be providing a really hands-on clinical and pragmatic approach to diagnosis of different forms of parkinsonism and the management of Parkinson’s disease in the community, both in the early stages and later on with complications of therapy and with the array of motor and non-motor problems that GPs are often asked to deal with. I will also give an overview and structure for how my primary care colleagues can use their clinical skills to diagnose and treat patients with other movement disorders (such as ‘shakes, twitches and jerks’) and when to consider referral to a specialist. I aim to keep this session interactive, answering any questions and providing lots of helpful videos, red flags and top tips.
Private patients seeking an appointment with Dr Saifee at the Queen Square Private Consulting Rooms can contact him through his secretary Joy O’Sullivan at firstname.lastname@example.org or on 020 3865 7226.
If you are a health professional and would be interested in attending the Queen Square GP Seminar with Dr Saifee on November 29th 2017, further details and registration can be accessed through the Queen Square GP Seminars page on this website. Registration for this event will open in September 2017.