Movement Disorders
Hemifacial spasm
Oct. 24, 2024
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- Updated 08.01.2022
- Released 08.01.2022
- Expires For CME 08.01.2025
Perspectives: Life and Work of Dr. Stanley Fahn
Interview questions
• [01:15] What was your childhood like? | |
• [05:50] What got you interested in medicine, neurology, and movement disorders? | |
• [20:00] Who would you consider your most important mentors and why? | |
• [20:25] Dr. Fahn discusses Dr. Houston Merritt | |
• [31:33] What do you consider your major accomplishments? | |
• [31:49] Dr. Fahn discusses his work in dystonia | |
• [43:45] What advice would you give physicians as they embark on their academic career? | |
• [47:35] Dr. Fahn shares his advice | |
• [50:25] How are you adjusting to retirement? | |
Biographical sketch of Dr. Stanley Fahn
Stanley Fahn MD is the H. Houston Merritt Professor Emeritus of Neurology and Director Emeritus of the Center for Parkinson’s Disease and Other Movement Disorders at Columbia University in New York City, where he was an attending neurologist at New York Presbyterian Hospital. He retired from Columbia University on Jan 1, 2021, after 57 years of teaching, research, and patient care. His major research interest has been in experimental therapeutics, and he has participated in many clinical trials, especially in Parkinson disease.
He served as president of the American Academy of Neurology from 2001 to 2003. He served as the scientific director of the Parkinson’s Disease Foundation from 1979 until 2016 when the foundation merged into the new Parkinson’s Foundation. In 1985, he co-founded with Dr. David Marsden The Movement Disorder Society and chaired its steering committee for its first 3 years; Dr. Fahn was elected its first president after the society’s constitution was ratified.
Dr. Fahn was the founding co-editor of the journal Movement Disorders and served in this capacity for the first 10 years of the journal’s existence, until 1996. He has also served as associate editor of the journal Neurology for 10 years. Dr. Fahn has twice served as chairman of the Advisory Committee on Peripheral and Central Nervous System Drugs for the Food and Drug Administration.
In 1986, with Dr. Ira Shoulson, Dr. Fahn co-founded the Parkinson Study Group, a consortium of clinical investigators dedicated to conducting controlled clinical trials on the prevention and treatment of Parkinson disease. Dr. Fahn was elected and re-elected as co-chair of the Parkinson Study Group’s executive committee and served for 20 years in that capacity.
Dr. Fahn was the chief creator and first president of the World Parkinson Coalition, which established and organized the World Parkinson Congresses, the first of which was held in Washington, DC in 2006. He also organized the second and third World Parkinson Congresses, held in Glasgow, Scotland in September 2010 and in Montreal, Canada in October 2013, respectively. He stepped down from the presidency of the World Parkinson Coalition after the October 2013 congress but continued to serve as an invited speaker in the subsequent congresses and has been invited to serve again in 2023. The World Parkinson Congresses, held every 3 years, are international conclaves where health professionals, scientists, and patients and their families meet to review and discuss what is happening in Parkinson disease.
Dr. Fahn organized and executed the development of the Unified Parkinson’s Disease Rating Scale (UPDRS) and modified and popularized the use of the Schwab England ADL scoring for global severity of this disease (13). He participated in developing the MDS-UPDRS that incorporates more nonmotor features of Parkinson disease; he chaired the section to update the motor scores for this new scale. With the Parkinson Study Group, he participated in clinical trials of many pharmacotherapeutic agents for Parkinson disease, including the ELLDOPA trial to study the effect of levodopa therapy on the natural history of Parkinson disease, funded by the National Institutes of Health and published in 2004 in the New England Journal of Medicine. For this work, he was co-winner of the triennial Anne-Marie Opprecht Foundation Parkinson Award in 2005 for the most outstanding scientific work on Parkinson disease published in the years 2002 to 2004. Another notable trial was the first controlled surgical trial for fetal tissue transplantation for patients with advanced Parkinson disease. The NIH selected Dr. Fahn to deliver the 2000 Neurodegeneration Lecture and to serve on the NIH’s Oversight Committee to review and give advice on clinical trials on neuroprotection for Parkinson disease. Dr. Fahn and his scientific colleagues at Columbia University were awarded a Morris K. Udall Parkinson’s Disease Research Center of Excellence by the NIH in 1999; it continued with Dr Robert E. Burke as the next director.
Dr. Fahn founded and directed the first Dystonia Clinical Research Center in the United States. This Center was responsible for determining the autosomal dominant inheritance pattern of torsion dystonia and for mapping several genes for this disorder, including DYT1, DYT5a, and DYT6. The center characterized the natural history and clinical phenotype for idiopathic torsion dystonia, tardive dystonia, and psychogenic dystonia and developed treatments still currently used for these conditions. Dr. Fahn and Dr. David Marsden created the Fahn-Marsden Dystonia Rating Scale. He participated in panels to formally define and classify dystonia and the dystonic disorders, the most recent classification being published in July 2013. He co-organized the first four international dystonia symposia and published the proceedings of those conferences. Dr. Fahn was invited to talk on dystonia in a formal address at the 2001 World Congress of Neurology as the David Marsden Memorial Lecturer. In 2013, Dr. Fahn was the keynote speaker at the Second International Congress on the Treatment of Dystonia in Hannover, Germany.
Dr. Fahn, together with Dr. Joseph Jankovic and Dr. David Marsden, organized and lectured in the annual “Comprehensive Review of Movement Disorders for the Clinical Practitioner” (aka, “Aspen Course”) held in Aspen, Colorado each summer beginning in 1991. The Aspen Course is a formal CME course that was sponsored by Columbia University until 2015 when sponsorship was transferred to the International Parkinson’s and Movement Disorder Society. In 2020, after 30 consecutive years, Dr. Fahn retired from the Aspen Course.
Dr. Fahn continued to be active in patient care, research, and teaching until the day of his retirement, and since then, he participates in divisional teaching rounds remotely via Zoom.
The following tables summarize Dr. Fahn’s achievements, awards, and honors for his work in the field of movement disorders.
Table 1. Noteworthy Achievements
1979 to 2016 | Scientific Director of the Parkinson’s Disease Foundation (now Parkinson's Foundation) |
1985 | Co-founded The Movement Disorder Society with Dr. David Marsden; Chair, Steering Committee, 1985 to 1988 |
1985 | Co-created with Dr. David Marsden the Fahn-Marsden Dystonia Rating Scale (03) |
1986 | Co-founded the Parkinson Study Group with Dr. Ira Shoulson |
1986 | Organized and chaired the first series of movement disorder courses at the AAN's annual meeting beginning in 1986 and lectured in this and other courses every year for more than 10 years. Dr. Fahn also founded the “Unusual Movement Disorders” seminar at the AAN in 1981 and organized this seminar annually until he stepped aside after the 2001 seminar. |
1986 to 1996 | Founding co-editor, Movement Disorders (journal) |
1987 | Organized and executed the development of the Unified Parkinson’s Disease Rating Scale (UPDRS) (13) |
1987 | Modified and popularized the use of the Schwab England ADL scoring for global severity of Parkinson disease (13) |
1988 | Founding president of The Movement Disorders Society |
1990 to 2020 | Co-founded and organized, with Dr. Joseph Jankovic and Dr. David Marsden, and lectured annually at the annual “Comprehensive Review of Movement Disorders for the Clinical Practitioner” (aka, “Aspen Course”) |
1994 | Organized the initial course on movement disorders for the AAN's Continuum |
1997 | Participated in determining the autosomal dominant inheritance pattern and gene mutation of torsion dystonia DYT1 (25) |
2001 | Co-organized and executed the first surgical double-blind transplantation of embryonic fetal cells for advanced Parkinson disease (21) |
2002 | Elected as a member of the Institute of Medicine of the US National Academies (now known as the National Academy of Medicine) |
2003 to 2005 | President of the American Academy of Neurology |
2004 | Creator, organizer, and principal investigator for the ELLDOPA trial to study the effect of levodopa therapy on the natural history of Parkinson disease (18). Co-winner of the Anne-Marie Opprecht Foundation Parkinson Award in 2005 for the most outstanding scientific work on Parkinson disease published in the years 2002-2004 (23). |
2006 | Principal creator and founding president of the World Parkinson Coalition, which established and organizes triennial World Parkinson Congresses |
2008 | Participated in developing the MDS-UPDRS that incorporates more nonmotor features of Parkinson disease; he chaired the section to update the motor scores for this new scale (23). |
Founded and directed the first dystonia clinical research center in the United States | |
Served 10 years as Associate Editor, Neurology (journal) | |
Twice served as Chairman of the Advisory Committee on Peripheral and Central Nervous System Drugs for the Food and Drug Administration | |
Over the course of his career, Dr. Fahn trained over 130 movement disorders fellows, many of whom became professors of neurology worldwide. |
Table 2. Selected Publications
Book | |
Principles and Practice of Movement Disorders (14; 10; 24) | |
Co-authored with Dr. Joseph Jankovic, the textbook was first published in 2007. The second edition, with added co-author Dr. Mark Hallett, was published in 2011. The third edition was published in 2021. | |
Parkinson disease etiology | |
“Monoamines in the human neostriatum: Topographic distribution in normals and in Parkinson's disease and their role in akinesia, rigidity, chorea, and tremor” (16) | |
This was the first paper to confirm Hornykiewicz’s findings of striatal dopamine deficiency in people with Parkinson disease. This was one of Dr. Fahn’s earliest publications from his independent research lab (at the University of Pennsylvania). The paper also was the first to describe the topographical distribution of dopamine content within the normal human neostriatum and correlated that distribution with symptoms of tremor and akinesia. | |
“The Unified Parkinson's Disease Rating Scale” (13) | |
Although the heavily cited publication doesn’t get to the etiology of Parkinson disease, it indirectly relates to the natural history of the disease. The scale has been highly utilized in therapeutic clinical trials in Parkinson disease. | |
“The oxidant stress hypothesis in Parkinson's disease: evidence supporting it” (12) | |
Article argues for the role of oxidant stress as a major factor in the pathogenesis of Parkinson disease. The subsequent MDS-UPDRS was based on this original UPDRS. | |
Parkinson disease treatment | |
“Transplantation of embryonic dopamine neurons for severe Parkinson's disease” (21) | |
The first double-blind surgical trial in Parkinson disease was designed by Dr. Fahn, who was also responsible for organizing the clinical evaluations. | |
“Levodopa and the progression of Parkinson's disease” (18) | |
The ELLDOPA trial was the first double-blind trial on the dose-response efficacy and safety of levodopa for Parkinson disease. | |
“Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease” (26) | |
The DATATOP trial was the first double-blind trial to test medications for slowing the clinical worsening of Parkinson disease. It showed that DEPRENYL (selegiline) was highly effective in slowing the clinical worsening of Parkinson disease. | |
“Impact of sustained DEPRENYL (selegiline) in levodopa-treated Parkinson's disease: a randomized placebo-controlled extension of the DEPRENYL and tocopherol antioxidative therapy of parkinsonism trial” (27) | |
The BLIND-DATE trial was a controlled clinical trial evaluating selegiline in the presence of levodopa. Even in the presence of this highly symptomatically effective levodopa therapy, selegiline slowed the clinical worsening of Parkinson disease and delayed the development of freezing of gait. | |
Dystonia etiology | |
“Validity and reliability of a rating scale for the primary torsion dystonias” (03) | |
The Fahn-Marsden rating scale for dystonia doesn’t get to the etiology of dystonia, but indirectly relates to the natural history of generalized dystonia. This rating scale is the most widely used scale in dystonia clinical trials. | |
“The early onset torsion dystonia gene (DYT1) encodes an ATP binding protein” (25) | |
Article presented the identification of the DYT1 gene. | |
Dystonia therapy | |
“High dosage anticholinergic therapy in dystonia” (06) | |
Article was the first report on a series of cases showing the efficacy of high-dosage antimuscarinics on dystonia. | |
“Torsion dystonia: A double blind, prospective trial of high dosage trihexyphenidyl” (04) | |
This double-blind trial showed the efficacy of high dosage trihexyphenidyl on dystonia. | |
“Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm” (01) | |
The article described the usefulness of botulinum toxin injections for focal dystonia. | |
Tardive dyskinesia | |
“Tardive dystonia. Late onset and persistent dystonia caused by antipsychotic drugs” (02) | |
The first report of tardive dystonia. | |
“Treatment of tardive dyskinesia: Use of dopamine depleting agents” (07) | |
Article summarized Dr. Fahn’s treatment approach to tardive dyskinesia syndromes with DA-depleting agents. The actual research data were presented in subsequent papers (08; 09). | |
Tics | |
“The clinical spectrum of motor tics” (05) | |
Tics had been described for about 100 years, but prior to this paper, their description had not been characterized in the terminology of movement disorder phenomenology, setting tics apart from other movement disorders. | |
Myoclonus | |
“The Unified Myoclonus Rating Scale (UMRS): a statistically valid clinical rating instrument for evaluating patients with myoclonus” (22) | |
This paper presented the only quantitative rating scale for myoclonus. | |
Psychogenic | |
“Psychogenic dystonia” (20) | |
This article defined the criteria for classifying psychogenic movement disorders into “documented,” “clinically established,” probable,” and “possible” psychogenic movement disorders. | |
Tremor | |
“Clinical rating scale for tremor” (19) | |
This chapter in Parkinson's Disease and Movement Disorders presented a now widely used rating scale to measure severity of tremor. | |
Classification and history of movement disorders | |
“Classification and investigation of dystonia” (17) | |
This chapter in Movement Disorders 2 provided an early definition of dystonia and a classification scheme of the disorder. Over the years, this classification has been updated by consensus groups. | |
“Classification of movement disorders” (10) | |
This article reviews the development of the field of movement disorders, with the presentation of classification schemes for various movement disorders. | |
“The medical treatment of Parkinson disease from James Parkinson to George Cotzias” (11) | |
This article reviews the development of medical therapy for Parkinson disease from the time of James Parkinson’s seminal paper to the development of high-dosage levodopa therapy. | |
Table 3. Awards from American Neurologic Organizations
1986 | Robert Wartenberg Award for outstanding clinical research, American Academy of Neurology (AAN) |
1988 | First Soriano Lectureship for excellence in research, American Neurological Association |
1993 | Stanley Fahn Lectureship (series); Movement Disorder Society named one of its two principal lectureships for its international congresses in his honor. |
1996 | A. B. Baker Award for outstanding educator in neurology. |
1997 | First AAN Movement Disorder Prize for outstanding contributions to movement disorders. |
1999 | Morris K. Udall Parkinson’s Disease Research Center of Excellence (Center of Excellence designation awarded to Columbia University by the National Institutes of Health, NIH) |
2005 | President's Distinguished Service Award, The Movement Disorder Society |
2016 | Jay Van Andel Award for Outstanding Achievement in Parkinson's Disease Research, Van Andel Research Institute |
2017 | Alfred Markowitz Clinical Service Award (Practitioner of the Year), Columbia University Medical Center’s Society of Practitioners |
2017 | Recognition Award, American Society for Experimental NeuroTherapeutics |
Table 4. International Recognition
2004 | George C. Cotzias Biomedical Research Award, Academy of Athens, Greece |
2008 | The Gilberto Gamez Award, Philippines Neurological Association |
2009 | The First Wayne Hening Award, World Association of Sleep Medicine |
2010 | The Luis Barraquer Ferré Award, Spanish Neurological Society |
2011 | Donald Calne Award, Parkinson Society Canada |
2017 | Melvin Yahr Lecture, International Association of Parkinson’s and Related Disorders |
Other | Honorary Foreign Member of the Columbian, Spanish, French, Argentinian, Mexican, Polish, and Japanese neurologic academies |
Table 5. Additional Awards and Honors
Anne-Marie Opprecht Foundation Parkinson Award | Co-winner of this triennial prize in 2005 for the most outstanding scientific work on Parkinson disease published in the years 2002 to 2004 (23) |
James Parkinson Medal | Awarded to Dr. Fahn in 2007, this medal is awarded once every 10 years by the Parkinson’s Disease Foundation. |
Springer Prize | American Parkinson Disease Association |
Guthrie Family Humanitarian Award | Huntington Disease Society of America |
Srinivasan Award | Chennai, India |
Page and William Black Lifetime Achievement Award | Parkinson’s Disease Foundation |
Distinguished Service Award | Dystonia Medical Research Foundation |
Donald Calne Award | Parkinson Society Canada |
Bruce Ochsman Lifetime Achievement Award | Tourette Association of America |
Hall Of Fame | Benign Blepharospasm Research Foundation |
Honorary Lifetime Member | Board of Directors, Dystonia Medical Research Foundation |
Stanley Fahn Fellowship for trainees in dystonia research | Fellowship named in his honor by the Dystonia Medical Research Foundation in 1998 |
Stanley Fahn Travel Grants | Grants created and named in his honor by the World Parkinson Coalition in 2012 |
Stanley Fahn Awards For Junior Investigators | Awards created and named in his honor by the World Parkinson Coalition in 2016 |
Stanley Fahn Junior Investigator Awards | Awards established by the Parkinson’s Disease Foundation in 2015 (continued in 2017 by its successor foundation, the Parkinson’s Foundation, as the Stanley Fahn Transition Faculty Awards). |
Media
References
- 01
- Brin MF, Fahn S, Moskowitz C, et al. Localized injections of botulinum toxin for the treatment of focal dystonia and hemifacial spasm. Mov Disord 1987;2(4):237-54. PMID 3504553
- 02
- Burke RE, Fahn S, Jankovic J, et al. Tardive dystonia: late-onset and persistent dystonia caused by antipsychotic drugs. Neurology 1982;32(12):1335-46. PMID 6128697
- 03
- Burke RE, Fahn S, Marsden CD, Bressman SB, Moskowitz C, Friedman J. Validity and reliability of a rating scale for the primary torsion dystonias. Neurology 1985;35(1):73-7. PMID 3966004
- 04
- Burke RE, Fahn S, Marsden CD. Torsion dystonia: a double-blind, prospective trial of high-dosage trihexyphenidyl. Neurology 1986;36(2):160-4. PMID 3511401
- 05
- Fahn S. The clinical spectrum of motor tics. Adv Neurol 1982;35:341-4. PMID 7148580
- 06
- Fahn S. High dosage anticholinergic therapy in dystonia. Neurology 1983a;33(10):1255-61. PMID 6136938
- 07
- Fahn S. Treatment of tardive dyskinesia: use of dopamine-depleting agents. Clin Neuropharmacol 1983b;6(2):151-8. PMID 6133619
- 08
- Fahn S. Long-term treatment of tardive dyskinesia with presynaptically acting dopamine-depleting agents. Adv Neurol 1983c;37:267-76. PMID 6858776
- 09
- Fahn S. A therapeutic approach to tardive dyskinesia. J Clin Psychiatry 1985;46(4 Pt 2):19-24. PMID 2858474
- 10
- Fahn S. Classification of movement disorders. Mov Disord 2011;26(6):947-57. PMID 21626541
- 11
- Fahn S. The medical treatment of Parkinson disease from James Parkinson to George Cotzias. Mov Disord 2015;30(1):4-18. PMID 25491387
- 12
- Fahn S, Cohen G. The oxidant stress hypothesis in Parkinson's disease: evidence supporting it. Ann Neurol 1992;32(6):804-12. PMID 1471873
- 13
- Fahn S, Elton R, Members of the UPDRS Development Committee. The Unified Parkinson’s Disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M, editors. Recent Developments in Parkinson’s Disease. Vol. 2. McMellam Health Care Information: Florham Park, 1987a:153-63.
- 14
- Fahn S, Jankovic J. Principles and Practice of Movement Disorders. Philadelphia: Churchill Livingstone Elsevier, 2007.
- 15
- Fahn S, Jankovic J, Hallett M. Principles and practice of movement disorders. Edinburgh: Elsevier Saunders, 2011.
- 16
- Fahn S, Libsch LR, Cutler RW. Monoamines in the human neostriatum: topographic distribution in normals and in Parkinson's disease and their role in akinesia, rigidity, chorea, and tremor. J Neurol Sci 1971;14(4):427-55. PMID 5125758
- 17
- Fahn S, Marsden CD, Calne DB. Classification and investigation of dystonia. In: Marsden CD, Fahn S, editors. Movement Disorders 2. London:Butterworths, 1987b:332-58.
- 18
- Fahn S, Oakes D, Shoulson I, et al. Levodopa and the progression of Parkinson's disease. N Engl J Med 2004;351(24):2498-508. PMID 15590952
- 19
- Fahn S, Tolosa E, Martin C. Clinical rating scale for tremor. In: Jankovic J, Tolosa E, editors. Parkinson's Disease and Movement Disorders. Urban and Schwarzenberg: Baltimore, 1988:225 34.
- 20
- Fahn S, Williams DT. Psychogenic dystonia. Adv Neurol 1988;50:431-55. PMID 3400501
- 21
- Freed CR, Greene PE, Breeze RE, et al. Transplantation of embryonic dopamine neurons for severe Parkinson's disease. N Engl J Med 2001;344(10):710-9. PMID 11236774
- 22
- Frucht S, Leurgans S, Hallett M, Fahn S. The Unified Myoclonus Rating Scale (UMRS): a statistically valid clinical rating instrument for evaluating patients with myoclonus. Mov Disord 2000;15 (Suppl 3):107.
- 23
- Goetz CG, Tilley BC, Shaftman SR, et al. Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 2008;23(15):2129-70. PMID 19025984
- 24
- Jankovic J, Hallett M, Okun MS, Comella CL, Fahn S. Principles and Practice of Movement Disorders. Elsevier Health Sciences, 2021.
- 25
- Ozelius LJ, Hewett JW, Page CE, et al. The early-onset torsion dystonia gene (DYT1) encodes an ATP-binding protein. Nat Genet 1997;17(1):40-8. PMID 9288096
- 26
- Parkinson Study Group. Effects of tocopherol and deprenyl on the progression of disability in early Parkinson's disease. N Engl J Med 1993;328(3):176-83. PMID 8417384
- 27
- Shoulson I, Oakes D, Fahn S, et al. Impact of sustained deprenyl (selegiline) in levodopa-treated Parkinson's disease: a randomized placebo-controlled extension of the deprenyl and tocopherol antioxidative therapy of parkinsonism trial. Ann Neurol 2002;51(5):604-12. PMID 12112107
- 28
- References especially recommended by the author or editor for general reading.
Contributors
All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.
Author
-
Stanley Fahn MD
Dr. Fahn of Columbia University received contracted research from Stoparkinson Healthcare Systems LLC as a principal investigator.
See Profile
Editor
-
Joseph Jankovic MD
Dr. Jankovic, Director of the Parkinson's Disease Center and Movement Disorders Clinic at Baylor College of Medicine has no relevant financial relationships to disclose.
See Profile
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