Bio

Bio


Dr. Veronica Santini is a neurologist who specializes in the diagnosis and management of movement disorders, including the treatment of Parkinsons disease and atypical parkinsonism, tremor, tic disorder (including Tourette’s syndrome), dystonia, chorea, and ataxia. Dr. Santini co-directs the Multidisciplinary Huntingtons Disease and Ataxia Clinic at Stanford University Movement Disorders Clinic. In this role, she oversees a large and dedicated team of doctors and specialists, who collectively provide the emotional, cognitive, psychosocial, and physical supports required for truly holistic, patient-centered care. Already providing gold standard care for these patients, Dr. Santini further expanded the services of the clinic and its patient referral basis, leading to its prestigious designation as a Huntingtons Disease Society of America (HDSA) Center of Excellence. In addition to her work in Huntingtons disease and ataxia syndromes, Dr. Santini has specialized training in disorders of the autonomic nervous system and has a particular interest in the management of Multiple System Atrophy.

Dr. Santini is enthusiastic about medical education and has a responsibility in teaching Stanford medical students from their first to their graduating years at Stanford. In their first year, Dr. Santini leads Quarter 3 of the Practice of Medicine course, followed by neurology specific workshops in Quarters 5 and 6 of the students’ second year. She is also a lead lecturer in the neurosciences portion of the Human Health and Disease course in the second year. She resumes her instruction to the senior medical students as the Associate Clerkship Director of the Neurology Clerkship. She is also an influential educator and mentor for the neurology residents and the movement disorders fellows, implementing several curricula for these trainees. Dr. Santini is a valued educator in the Department of Neurology and the School of Medicine and she has won numerous teaching awards within these roles.

Dr. Santini is also impassioned to provide exceptional and equitable healthcare to all. Identifying the great disparities in neurologic care worldwide, Dr. Santini launched global neurologic programs to provide care to developing nations. Her most recent work, in collaboration with the American Academy of Neurology (AAN) and the St. Luke Foundation, delivers neurologic care to Haiti, the poorest nation in the Western Hemisphere, which has been struck by devastating natural disasters. She leads a team of neurologists, trainees, nurses, physical therapists, and pharmacists to Port-au-Prince personally at least once annually, while other teams of neurologists provide continuity of care at least once monthly. In addition to providing neurologic care and education in Haiti, Dr. Santini has worked with medical centers in Nepal and Kenya.

Dr. Santini performs research within these realms to advance the science, improve patient care outcomes, and to increase education and understanding of neurologic disease. In addition to numerous speaking engagements, Dr. Santini has authored several articles in well-respected, peer-reviewed journals and a book chapter within the celebrated text: Parkinsons Disease and Movement Disorders.

Dr. Santini received her medical degree from Boston University, where she went on to complete her Neurology residency, becoming Chief Resident in her final year of training. She continued on at Boston University to complete a fellowship in Movement Disorders and joined the Stanford faculty in 2014. She was 1 of only 12 international candidates selected as an AAN Emerging Leader and also became an AAN Palatucci Advocate. Furthermore, she received distinctions as the recipient of the Neurology Clerkship Educator award, the Lysa Forno Excellence in Teaching award, and as a Faculty Fellow of the Stanford University Center for Innovation in Global Health.

Clinical Focus


  • Neurology
  • Movement Disorders

Academic Appointments


Administrative Appointments


  • Educator 4 C.A.R.E. (Compassion, Advocacy, Responsibility, Empathy), Stanford University, School of Medicine (2017 - Present)
  • Co-Lead Quarter 3, Practice of Medicine I, Stanford University, School of Medicine (2015 - Present)
  • Director, Parkinsons Disease Duopa Program, Stanford Movement Disorders Clinic (2015 - Present)
  • Associate Clerkship Director of the Neurology clerkship, Stanford University, School of Medicine (2014 - Present)
  • Co-Director, Multidisciplinary Huntingtons Disease and Ataxia Clinic, A Huntington's Disease Society of America, Center of Excellence (2014 - Present)

Honors & Awards


  • The Henry J. Kaiser Family Foundation Award for Excellence in Pre-Clinical Teaching, Stanford University, School of Medicine (2018)
  • Emerging Leaders Forum, American Academy of Neurology (2016)
  • Lysia Forno Excellence in Teaching Award, Stanford University, Department of Neurology (2016)
  • Medical Student Neurology Clerkship Faculty Teaching Award, Stanford University, Department of Neurology (2016)
  • Fellow, Stanford University's Center for Innovation in Global Health (2015)
  • Palatucci Advocacy Leadership Forum, American Academy of Neurology (2015)
  • Global Ambassador, St. Luke Foundation Nonprofit Organization in Port-au-Prince, Haiti (2014)
  • Humanism and Excellence in Teaching Award, Outstanding Resident Role Model, The Arnold P. Gold Foundation (2012)
  • Resident Award for Excellence in Teaching, Tufts Medical Center (2010)

Boards, Advisory Committees, Professional Organizations


  • Member, Parkinson Study Group (2018 - Present)
  • Member, Huntington Study Group (2016 - Present)
  • Executive Committee Member, Massachusetts Neurological Association (2012 - 2014)
  • Member, Huntington's Disease Society of America (2014 - Present)
  • Executive Board Member, Boston University Global Health Committee (2013 - Present)
  • DIrector, Boston Medical Center Neurology Global Health Committee (2012 - Present)
  • Member, Movement Disorders Society (2013 - Present)
  • Member, American Academy of Neurology (2008 - Present)
  • Member, American Medical Association (2005 - Present)

Professional Education


  • Fellowship:Boston University School of Medicine Office of the Registrar (2014) MA
  • Residency:Boston University School of Medicine Office of the Registrar (2013) MA
  • Medical Education:Boston University School of Medicine Office of the Registrar (2009) MA
  • Board Certification: Neurology, American Board of Psychiatry and Neurology (2013)
  • Internship:Caritas St Elizabeth?s Medical Center (2010) MA
  • Fellowship in Movement Disorders, Boston University Medical Center (2014)
  • Board Certification, American Board of Psychiatry and Neurology (2013)
  • Residency, Boston University Medical Center (2013)
  • Internship, St. Elizabeth’s Medical Center (2010)
  • Medical Doctorate, Boston University School of Medicine (2009)
  • Bachelor's of Science, University of Miami, Chemistry (2003)

Community and International Work


  • St. Luke Foundation, Port-Au-Prince, Haiti

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • Masinde Muliro University of Science & Technology, Kakamega, Kenya

    Topic

    Global Neurologic Education and Programs

    Populations Served

    Underserved, middle-low income countries

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • Tribhuvan University Teaching Hospital, Kathmandu, Nepal

    Topic

    Gobal Health Delivery

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

Research & Scholarship

Current Research and Scholarly Interests


Please see our website @ http://med.stanford.edu/neurology/divisions/md.html

Clinical Trials


  • AZD3241 PET MSA Trial, Phase 2, Randomized,12 Week Safety and Tolerability Trial With PET in MSA Patients Recruiting

    AZD3241 myeloperoxidase (MPO) inhibitor trial is assessing safety and tolerability, randomized trial, in patients with Multiple System Atrophy.

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  • Continued Access Protocol: ExAblate Transcranial MR Guided Focused Ultrasound for the Treatment of Essential Tremors Not Recruiting

    The objective of this prospective, multi site, single-arm study is to capture the efficacy of treatment using the ExAblate Transcranial System and to further demonstrate safety in medication-refractory tremor in patients with essential tremor (ET).

    Stanford is currently not accepting patients for this trial. For more information, please contact Evalina Salas, 650-724-4131.

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  • ExAblate Transcranial MR Guided Focused Ultrasound in the Treatment of Essential Tremor Not Recruiting

    A feasibility Study to Evaluate Safety and Initial Effectiveness of ExAblate Transcranial MRI-guided focused ultrasound (MRgFUS) treatment of patients with medication-refractory movement disorders, namely Essential Tremor (ET). This study is designed as a prospective, single site, single arm, nonrandomized study. Assessments will be made before and three months after MRgFUS for clinical symptom relief, quality of life (QoL) improvements, and safety of MRgFUS in the treatment of ET. Similarly, QoL measures will be obtained using Quality of Life in Essential Tremor (QUEST) questionnaire. Relative Safety will be evaluated using a common description of Significant Clinical Complications for patients treated in this study. This study will be performed on the 3T MR scanners. The ExAblate system is a medical device that involves a focused ultrasound system and an MRI scanner. ExAblate delivers a pulse of focused ultrasound energy, or sonication, to the targeted tissue. In this particular study the targeted tissue is a unilateral thermal lesion created in the ventralis intermedius nucleus of the thalamus. The treatment begins with a series of standard diagnostic MR images to identify the location and shape of tumor to be treated. The ExAblate computer uses the physician's designation of the target volume to plan the best way to cover the target volume with small spots called "sonications". These treatment spots are cylinder shaped. Their size depends on sonication power and duration. During the treatment, a specific MR scan, which can be processed to identify changes in tissue temperature, provides a thermal map of the treatment volume to confirm the therapeutic effect. The thermal map is used to monitor the treatment in progress, and confirm that the ablation is proceeding according to plan, thus closing the therapy loop. The ExAblate transcranial operates a helmet-shaped transducer (currently utilizing 1000-element phased array transducer) positioned above the subject head. The ExAblate transcranial system also includes means to immobilize the subject head, cool the interface water, and software for CT analysis and phase correction computation. The ExAblate transcranial system is an experimental device and is being investigated in this study.

    Stanford is currently not accepting patients for this trial.

    View full details

Publications

All Publications


  • Slower saccadic reading in Parkinson's disease PLOS ONE Jehangir, N., Yu, C., Song, J., Shariati, M., Binder, S., Beyer, J., Santini, V., Poston, K., Liao, Y. 2018; 13 (1): e0191005

    Abstract

    Idiopathic Parkinson's Disease (PD) is characterized by degeneration of dopaminergic and other neurons, leading to motor and non-motor deficits. Abnormal eye movements in PD, including fixations, saccades, and convergence, are well described. However, saccadic reading, which requires serial and alternating saccades and fixations, is not well studied, despite its obvious impact on the quality of life. In this study, we assessed saccadic reading using variations of the King-Devick (KD) test, a rapid single digit number naming test, as a way to assess the ability to make serial left-to-right ocular motor movements necessary for reading. We recruited 42 treated PD patients and 80 age-matched controls and compared their reading times with a variety of measures, including age, duration of disease, Unified Parkinson's Disease Rating Scale (UPDRS), the National Eye Institute 25-Item Visual Functioning Questionnaire 25 (VFQ-25), and Montreal Cognitive assessment (MoCA) test. The subjects performed 4 trials of reading 120 single digit numbers aloud as fast as possible without making errors. In each trial, they read 3 pages (KD1, KD2, and KD3), and each page contained 40 numbers per page in 8 lines with 5 numbers/line. We found that PD patients read about 20% slower than controls on all tests (KD1, 2, and 3 tests) (p < 0.02), and both groups read irregularly spaced numbers slower than regularly spaced numbers. Having lines between numbers to guide reading (KD1 tests) did not impact reading time in both PD and controls, but increased visual crowding as a result of decreased spacing between numbers (KD3 tests) was associated with significantly slower reading times in both PD and control groups. Our study revealed that saccadic reading is slower in PD, but controls and PD patients are both impacted by visuospatial planning challenges posed by increased visual crowding and irregularity of number spacing. Reading time did not correlate with UPDRS or MoCA scores in PD patients but significantly correlated with age, duration of disease, and VFQ-25 scores. The presence of convergence insufficiency did not significantly correlate with reading time in PD patients, although on average there was slower reading time in those with convergence insufficiency by 8 s (p = 0.2613). We propose that a simple reading task using 120 single-digit numbers can be used as a screening tool in the clinical setting to assess functional ocular motor difficulties in Parkinson's disease that can have a profound impact on quality of life.

    View details for DOI 10.1371/journal.pone.0191005

    View details for Web of Science ID 000423412500032

    View details for PubMedID 29364897

    View details for PubMedCentralID PMC5783375

  • Cost-effectiveness of focused ultrasound, radiosurgery, and DBS for essential tremor. Movement disorders Ravikumar, V. K., Parker, J. J., Hornbeck, T. S., Santini, V. E., Pauly, K. B., Wintermark, M., Ghanouni, P., Stein, S. C., Halpern, C. H. 2017

    Abstract

    Essential tremor remains a very common yet medically refractory condition. A recent phase 3 study demonstrated that magnetic resonance-guided focused ultrasound thalamotomy significantly improved upper limb tremor. The objectives of this study were to assess this novel therapy's cost-effectiveness compared with existing procedural options.Literature searches of magnetic resonance-guided focused ultrasound thalamotomy, DBS, and stereotactic radiosurgery for essential tremor were performed. Pre- and postoperative tremor-related disability scores were collected from 32 studies involving 83 magnetic resonance-guided focused ultrasound thalamotomies, 615 DBSs, and 260 stereotactic radiosurgery cases. Utility, defined as quality of life and derived from percent change in functional disability, was calculated; Medicare reimbursement was employed as a proxy for societal cost. Medicare reimbursement rates are not established for magnetic resonance-guided focused ultrasound thalamotomy for essential tremor; therefore, reimbursements were estimated to be approximately equivalent to stereotactic radiosurgery to assess a cost threshold. A decision analysis model was constructed to examine the most cost-effective option for essential tremor, implementing meta-analytic techniques.Magnetic resonance-guided focused ultrasound thalamotomy resulted in significantly higher utility scores compared with DBS (P < 0.001) or stereotactic radiosurgery (P < 0.001). Projected costs of magnetic resonance-guided focused ultrasound thalamotomy were significantly less than DBS (P < 0.001), but not significantly different from radiosurgery.Magnetic resonance-guided focused ultrasound thalamotomy is cost-effective for tremor compared with DBS and stereotactic radiosurgery and more effective than both. Even if longer follow-up finds changes in effectiveness or costs, focused ultrasound thalamotomy will likely remain competitive with both alternatives. © 2017 International Parkinson and Movement Disorder Society.

    View details for DOI 10.1002/mds.26997

    View details for PubMedID 28370272

  • Neuroacanthocytosis: A case with unusual clinical features & novel response to treatment JOURNAL OF THE NEUROLOGICAL SCIENCES Wu, C. K., Santini, V. E., Dittus, C., Saint Hilaire, M. H. 2017; 373: 346

    View details for DOI 10.1016/j.jns.2016.12.002

    View details for Web of Science ID 000394200700078

    View details for PubMedID 27988032

  • Transcranial MRI-guided high-intensity focused ultrasound for treatment of essential tremor: A pilot study on the correlation between lesion size, lesion location, thermal dose, and clinical outcome. Journal of magnetic resonance imaging : JMRI Federau, C., Goubran, M., Rosenberg, J., Henderson, J., Halpern, C. H., Santini, V., Wintermark, M., Butts Pauly, K., Ghanouni, P. 2017

    Abstract

    Transcranial MR-guided high-intensity focused ultrasound (tcMRgFUS) is a promising noninvasive method to treat medication-refractory essential tremor.To define the correlation between lesion size after ablation, thermal dose, and clinical outcome in tcMRgFUS treatment of essential tremor.Retrospective.Eight patients with medication-refractory essential tremor were treated using a tcMRgFUS system at 3T.T2 -weighted images were acquired immediately and at 1 year posttreatment at 3T.An atlas of the thalamic nuclei and dose maps were warped to the posttreatment images. The thermal dose, the immediate posttreatment lesion volume and 1-year final lesion volume, and the volumes confined inside the ventral division of the ventral lateral posterior thalamic nucleus (VLpv) were correlated to clinical outcome at 1 month and 1 year using Pearson's coefficient. The spatial region of treatment correlating with maximal clinical outcome was derived in a normalized space from average maps of clinical tremor score improvement at 1 year.Statistical significance was assessed using the Wilcoxon two-tailed rank test.The correlations between thermal dose, lesion volume posttreatment and at 1 year, and outcome at 1 year were good (r = 0.73, 0.65, 0.73, respectively), and were slightly better than at 1 month (r = 0.57, 0.49, 0.65). Reducing the measurement to include only the portion within the VLpv did not significantly modify the correlations (P = 0.09). The center of the spatial region of treatment was found in the anterior commissure - posterior commissure plane, 14.3 mm lateral from the midline, and 8.3 mm rostral to the posterior commissure.In this pilot study a good correlation was found between the size of the lesion, the thermal dose, and the clinical outcome in patients treated for essential tremor with ablation of the VLpv with tcMRgFUS.1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2017.

    View details for DOI 10.1002/jmri.25878

    View details for PubMedID 29076274

  • Mon Chéri Haiti: Neurology lessons learned. Neurology Sharma, M., Santini, V., Auguste, M., Hohler, A. D., Etienne, M., Jones, E., Alessi, A. 2015; 85 (2): 169-171

    View details for DOI 10.1212/WNL.0000000000001735

    View details for PubMedID 26170399

  • Increasing student recruitment into neurology: Joining the family. Neurology Larsen, D. P., Santini, V. E. 2015; 84 (23): 2302-2303

    View details for DOI 10.1212/WNL.0000000000001668

    View details for PubMedID 25957335

  • Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy After Repetitive Head Injury JOURNAL OF NEUROPATHOLOGY AND EXPERIMENTAL NEUROLOGY McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H., Kubilus, C. A., Stern, R. A. 2009; 68 (7): 709-735

    Abstract

    Since the 1920s, it has been known that the repetitive brain trauma associated with boxing may produce a progressive neurological deterioration, originally termed dementia pugilistica, and more recently, chronic traumatic encephalopathy (CTE). We review 48 cases of neuropathologically verified CTE recorded in the literature and document the detailed findings of CTE in 3 profession althletes, 1 football player and 2 boxers. Clinically, CTE is associated with memory disturbances, behavioral and personality changes, parkinsonism, and speech and gait abnormalities. Neuropathologically, CTE is characterized by atrophy of the cerebral hemispheres, medial temporal lobe, thalamus, mammillary bodies, and brainstem, with ventricular dilatation and a fenestrated cavum septum pellucidum. Microscopically, there are extensive tau-immunoreactive neurofibrillary tangles, astrocytic tangles, and spindle-shaped and threadlike neurites throughout the brain. The neurofibrillary degeneration of CTE is distinguished from other tauopathies by preferential involvement of the superficial cortical layers, irregular patchy distribution in the frontal and temporal cortices, propensity for sulcal depths, prominent perivascular, periventricular, and subpial distribution, and marked accumulation of tau-immunoreactive astrocytes. Deposition of beta-amyloid, most commonly as diffuse plaques, occurs in fewer than half the cases. Chronic traumatic encephalopathy is a neuropathologically distinct slowly progressive tauopathy with a clear environmental etiology.

    View details for Web of Science ID 000267557400001

    View details for PubMedID 19535999

  • Clock drawing performance in cognitively normal elderly ARCHIVES OF CLINICAL NEUROPSYCHOLOGY Hubbard, E. J., Santini, V., Blankevoort, C. G., Volkers, K. M., Barrup, M. S., Byerly, L., Chaisson, C., Jefferson, A. L., Kaplan, E., Green, R. C., Stern, R. A. 2008; 23 (3): 295-327

    Abstract

    The Clock Drawing Test (CDT) is a common neuropsychological measure sensitive to cognitive changes and functional skills (e.g., driving test performance) among older adults. However, normative data have not been adequately developed. We report the distribution of CDT scores using three common scoring systems [Mendez, M. F., Ala, T., & Underwood, K. L. (1992). Development of scoring criteria for the Clock Drawing Task in Alzheimer's Disease. Journal of the American Geriatrics Society, 40, 1095-1099; Cahn, D. A., Salmon, D. P., Monsch, A. U., Butters, N., Wiederholt, W. C., & Corey-Bloom, J. (1996). Screening for dementia of the Alzheimer type in the community: The utility of the Clock Drawing Test. Archives of Clinical Neuropsychology, 11(6), 529-539], among 207 cognitively normal elderly. The systems were well correlated, took little time to use, and had high inter-rater reliability. We found statistically significant differences in CDT scores based on age and WRAT-3 Reading score, a marker of education quality. We present means, standard deviations, and t- and z-scores based on these subgroups. We found that "normal" CDT performance includes a wider distribution of scores than previously reported. Our results may serve as useful comparisons for clinicians wishing to know whether their patients perform in the general range of cognitively normal elderly.

    View details for DOI 10.1016/j.acn.2007.12.003

    View details for Web of Science ID 000256559500007

    View details for PubMedID 18243644