Philip A. Starr MD, PhD
Associate Professor in Residence of Neurological Surgery, Dolores Cakebread Endowed Chair
Co-Director, Functional Neurosurgery Program
Surgical Director, Parkinson's Disease Research, Education and Care Center (PADRECC) at San Francisco Veteran's Affairs Medical Center
Dr. Starr's particular specialty interests lie in the area of movement disorders, including Parkinson's disease, tremor, and dystonia. He has fellowship training in microelectrode-guided surgery of movement disorders, which he completed at Emory University in Atlanta, Georgia. Dr. Starr's research interests include physiology of the basal ganglia, clinical trials of novel surgical therapeutics in movement disorders, and the use of interventional magnetic resonance imaging (iMRI) for functional neurosurgery. His primary focus is on research related to the neurophysiology and therapy of movement disorders.
Working together with William Marks MD and Jill Ostrem MD in Neurology in a joint UCSF-San Francisco Veterans Affairs Hospital Medical Center study, Dr. Starr is an investigator for the largest formal clinical trial of deep brain stimulation (DBS) currently taking place in North America: "A Randomized Trial of Best Medical Therapy versus Deep Brain Stimulation of the Globus Pallidus or Subthalamic Nucleus for Parkinson's Disease." This is a 6-center trial jointly funded by the Department of Veterans Affairs and the National Institutes of Health. The technical approach involves magnetic resonance-based stereotaxy and microelectrode recordings to map the borders of the surgical target area. Dr. Starr is also surgical investigator on several Phase I clinical trials of gene transfer approaches for the treatment of Parkinson's disease.
Dr. Starr is one of the most experienced surgeons in North America in the surgical treatment of dystonia using DBS. He conducts NIH-funded research on pallidal physiology in patients with dystonia.
Education, Training, and Previous Positions
- 1983: BS, Princeton University
1989: MD, Harvard Medical School
1989: PhD, Neuroscience, Harvard Medical School
1989-1990: Internship, General Surgery, Brigham and Women's Hospital
1990-1995: Residency in Neurosurgery, Brigham and Women's and Children's Hospital
1995: Chief Resident (Clinical Elective) C.H.U.V., Prof. N. de Tribolet, Lausanne, Switzerland
1996-1997: Clinical Fellowship in Movement Disorders, Emory University
1997-1998: Instructor, Department of Neurological Surgery, Emory University
Selected Professional Memberships and Appointments
- American Association of Neurological Surgeons
Corresponding member, Societe de Neurochirurgie de Langue Francaise
International Society for Movement Disorders
Congress of Neurological Surgeons
AANS/CNS Joint Section for Stereotactic and Functional Neurosurgery
Selected Honors and Awards
- 1999: Veterans' Administration National Program Initiative Award for a Center of Excellence, Veterans' Administration Medical Center, San Francisco, California
2000-2006: NIH K08 award, "Pallidal physiology in human and primate dystonia"
2001-2005: Parkinson's Disease Research, Education and Clinical Center (PADRECC) award from National VA office for Cooperative Study CSP 468, "A randomized Trial of Best Medical Therapy versus Deep Brain Stimulation of the Globus Pallidus or Subthalamic Nucleus for Parkinson's Disease."
2004: Dystonia "Doctor of Excellence" award, Dystonia Medical Research Foundation
2004: Elected Secretary-Treasurer, American Society For Stereotactic and Functional Neurosurgery
2004: Scientific Program Director, Biennial meeting of the American Society for Stereotactic and Functional Neurosurgery, Cleveland Ohio
Selected Recent Publications
Papavassiliou E, Rau G, Heath S, Abosch A, Barbaro NM, Larson PS, Lamborn K, Starr PA. Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome. Neurosurgery 2008;62(Suppl 2):884-94.
Ostrem JL, Starr PA. Treatment of dystonia with deep brain stimulation [Review]. Neurotherapeutics 2008;5(2):320-30.
Marks WJ Jr, Ostrem JL, Verhagen L, Starr PA, Larson PS, Bakay RA, Taylor R, Cahn-Weiner DA, Stoessl AJ, Olanow CW, Bartus RT. Safety and tolerability of intraputaminal delivery of CERE-120 (adeno-associated virus serotype 2-neurturin) to patients with idiopathic Parkinson's disease: an open-label, phase I trial. Lancet Neurol 2008;7(5):400-8.
Martin AJ, Hall WA, Roark C, Starr PA, Larson PS, Truwit CL. Minimally invasive precision brain access using prospective stereotaxy and a trajectory guide. J Magn Reson Imaging 2008;27(4):737-43.
Sillay KA, Larson PS, Starr PA. Deep brain stimulator hardware-related infections: incidence and management in a large series. Neurosurgery 2008;62(2):360-7.
Starr PA, Kang GA, Heath S, Shimamoto S, Turner RS. Pallidal neuronal discharge in Huntington's disease: support for selective loss of striatal cells originating the indirect pathway. Exp Neurol 2008;211(1):227-33.
Larson PS, Richardson RM, Starr PA, Martin AJ. Magnetic Resonance Imaging of Implanted Deep Brain Stimulators: Experience in a Large Series. Stereotact Funct Neurosurg 2007;86(2):92-100.
Chang EF, Turner RS, Ostrem JL, Davis VR, Starr PA. Neuronal Responses to Passive Movement in the Globus Pallidus Internus in Primary Dystonia. J Neurophysiol 2007;98(6):3696-707.
Ostrem JL, Marks WJ Jr, Volz MM, Heath SL, Starr PA. Pallidal deep brain stimulation in patients with cranial-cervical dystonia (Meige syndrome). Mov Disord 2007;22(13):1885-1891.
Evidente VG, Lyons MK, Wheeler M, Hillman R, Helepolelei L, Beynen F, Nolte D, Muller U, Starr PA. First case of X-linked dystonia-parkinsonism ("Lubag") to demonstrate a response to bilateral pallidal stimulation. Mov Disord 2007;22(12):1790-3.
Starr PA, Barbaro NM, Raskin NH, Ostrem JL. Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and 1-year results in four patients. J Neurosurg 2007;106(6):999-1005.
Nakamura K, Christine CW, Starr PA, Marks WJ Jr. Effects of unilateral subthalamic and pallidal deep brain stimulation on fine motor functions in Parkinson's disease. Mov Disord 2007;22(5):619-26.
Rothlind JC, Cockshott RW, Starr PA, Marks WJ Jr. Neuropsychological performance following staged bilateral pallidal or subthalamic nucleus deep brain stimulation for Parkinson's disease. J Int Neuropsychol Soc 2007;13(1):68-79.
Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Ostrem JL, Marks WJ Jr. Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 2006;104(4):488-501.
Starr PA. Surgery for Parkinson's disease: integration of neurology and neurosurgery. Clin Neurosurg 2005;52:202-4.
Binder DK, Rau GM, Starr PA. Risk factors for hemorrhage during microelectrode-guided deep brain stimulator implantation for movement disorders. Neurosurgery 2005;56(4):722-32.
Holloway KL, Gaede SE, Starr PA, Rosenow JM, Ramakrishnan V, Henderson JM. Frameless stereotaxy using bone fiducial markers for deep brain stimulation. J Neurosurg 2005;103(3):404-13.
Martin AJ, Larson PS, Ostrem JL, Keith Sootsman W, Talke P, Weber OM, Levesque N, Myers J, Starr PA. Placement of deep brain stimulator electrodes using real-time high-field interventional magnetic resonance imaging. Magn Reson Med 2005;54(5):1107-14.
Starr PA, Rau GM, Davis V, Marks WJ, Ostrem JL, Simmons D, Lindsey N, Turner RS. Spontaneous pallidal neuronal activity in human dystonia: Comparison with Parkinson's disease and normal macaque. J Neurophysiol 2005;93(6):3165-76.
Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Ostrem JL, Marks WJ Jr. Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes [Review]. Neurosurg Focus 2004;17(1):[11 p.]. Available from: http://www.aans.org/education/journal/neurosurgical/july04/17-1-4.pdf
Papavassiliou E, Rau G, Heath S, Abosch A, Barbaro NM, Larson PS, Lamborn K, Starr PA. Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome. Neurosurgery 2004;54(5):1120-29; discussion 1129-30.
Theodosopoulos PV, Marks WJ Jr, Christine C, Starr PA: Locations of movement-related cells in the human subthalamic nucleus in Parkinson's disease. Mov Disord 2003;18(7):791-8.
Starr PA. Placement of deep brain stimulators into the subthalamic nucleus or Globus pallidus internus: technical approach [Review]. Stereotact Funct Neurosurg 2002;79(3-4):118-45.
Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Mosely A, Marks WJ Jr. Implantation of deep brain stimulators into the subthalamic nucleus: technical approach and magnetic resonance imaging-verified lead locations. J Neurosurg 2002;97(2):370-87.