Prepared: 4/27/2010

CIRRICULUM VITAE

Philip A. Starr, MD, PhD

DATE OF BIRTH May 30, 1961 CURRENT POSITION Professor, Department of Neurosurgery, UCSF Dolores Cakebread Chair in Neurological Surgery ADDRESS Department of Neurological Surgery 533 Parnassus Ave Box 0445 San Francisco, CA 94143 Tel: 415 353 7500 Email: starrp@neurosurg.ucsf.edu EDUCATION High School Catlin Gabel School, Portland OR 1975-1979 Undergraduate, chemistry Princeton University 1979-1983

Princeton, New Jersey MD Harvard Medical School 1989 Boston, Massachusetts PhD, Neurobiology Harvard Medical School 1989 Boston, Massachusetts Intern Brigham and Women’s Hospital 1989-1990 (General Surgery) Boston, Massachusetts

Residency Brigham and Women’s and 1990-1995 (Neurosurgery) Children’s Hospital Boston, Massachusetts Chief Resident Brigham and Women’s and 1992-1993 (Neurosurgery) Children’s Hospital Boston, Massachusetts

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Chief Resident C.H.U.V. 1995 (Clinical Elective) (mentor: Prof. N. de Tribolet) Lausanne, Switzerland Clinical Fellowship Emory University 1996-1997 (Movement Disorders) Atlanta, Georgia LICENSURE Diplomat of the American Board of Medical Examiners 1990

Massachusetts Medical License Registration 1991

Georgia Medical License Registration 1996 California Medical License Registration (#G84550) 1998 Board Certified in Neurosurgery 2001 California Fluoroscopy supervisors license 2005 ACADEMIC APPOINTMENTS

Instructor Department of Neurological Surgery 1996 Harvard Medical School Boston, Massachusetts Affiliated Scientist Yerkes Regional Primate Research Center 1996-1998 Atlanta, Georgia Instructor Department of Neurological Surgery 1997-1998 Emory University Atlanta, Georgia Assistant Professor Department of Neurological Surgery 1998-2004 In-Residence University of California San Francisco, California Associate Professor Department of Neurological Surgery 2004-2009 In-Residence University of California, San Francisco San Francisco California

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Dolores Cakebread Chair in Department of Neurological Surgery 2005-present Neurological Surgery University of California, San Francisco San Francisco, California Professor Department of Neurological Surgery 2009-present In-Residence University of California, San Francisco San Francisco California OTHER POSITIONS Chief, Divison of Neurosurgery San Francisco Veteran’s Affairs 1998-2001 Medical Center Surgical Director Parkinson’s Disease Research, Education 2001-present And Care Center (PADRECC), San Francisco Veteran’s Affairs Medical Center HONORS AND AWARDS Phi Beta Kappa Society Princeton University 1983 Princeton, New Jersey Veteran’s Administration Veteran’s Administration 1999 National Program Medical Center Initiative Award for a San Francisco, California Center of Excellence Dystonia “Doctor of Dystonia Medical Research Foundation 2004 Excellence” award

KEYWORDS/AREAS OF INTEREST Stereotactic and functional neurosurgery, microelectrode-guided neurosurgery, basal ganglia physiology, deep brain stimulation, Parkinson’s disease, dystonia, tremor, cluster headache, interventional MRI, therapy of degenerative brain disease CLINICAL ACTIVITIES Attending Neurosurgeon, UCSF Medical Center – surgery for movement disorders and pain, 1-2 days/week, outpatient clinic for movement disorders and pain, 1 day/week

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Attending Neurosurgeon, San Francisco Veterans Affairs Medical Center (3/8 FTE) – functional neurosurgery and general neurosurgery including degenerative spine disease, 1/day week Attending Neurosurgeon, San Francisco General Hospital – Attending on call for Neurosurgical emergencies including head and spine trauma, 1 weekend/month Attending Neurosurgeon, Oakland Children’s Hospital – Outpatient clinic for pediatric movement disorders, 2x/year

PROFESSIONAL ORGANIZATIONS

Memberships American Association of Neurological Surgeons 1997-present International Society for Movement Disorders 1998-present Congress of Neurological Surgeons 1999-present American Society for Stereotactic and Functional Neurosurgery (ASSFN) 2000-present American Academy of Neurological Surgery 2005-present International Basal Ganglia Society (IBAGs) 2007-present Service to professional organizations Scientific program director ASSFN Biennial meeting, Cleveland 2004 Ohio Executive Council ASSFN 2000-2004 Secretary-treasurer ASSFN 2004-2006 Vice President ASSFN 2006-2008 President ASSFN 2008-2010 EDITORIAL REVIEWER-Journals

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Editorial review board, Stereotactic and Functional Neurosurgery (30 papers/year) 2006-present Ad hoc reviewer, Neurosurgery (20 papers/year) 2000-present Ad hoc reviewer, Neurology (2 papers) 2002-present Ad hoc reviewer, Pain (1 paper) 2004-present Ad hoc reviewer, Neuromodulation (3 papers) 2004-present Ad hoc reviewer, Brain Research (1 paper) 2005-present Ad hoc reviewer, Brain (4 papers) 2006-present Ad hoc reviewer, Experimental Neurology (3 papers) 2006-present Ad hoc reviewer, Movement Disorders (4 papers) 2007-present Ad hoc reviewer, Journal of Neurology, Neurosurgery and Psychiatry (2 papers) 2007-present Ad hoc reviewer, European Journal of Neuroscience (1 paper) 2007-present Ad hoc reviewer, Journal of Neurophysiology (4 papers) 2007-present Ad hoc reviewer, Cephalalgia (1 paper) 2008-present Ad hoc reviewer, Annals of Neurology (4 papers) 2008-present Ad hoc reviewer, Brain Research Bulletin (1 paper) 2008-present Ad hoc reviewer, Journal of Neuroscience (1 paper) 2008-present Ad hoc reviewer, New England Journal of Medicine (1 paper) 2008-present Ad hoc reviewer, Nature Reviews Neuroscience (1 paper) 2010-present

EDITOR-BOOKS Editor, AANS publication “Atlas of Operative Neurosurgery”, 2008 Functional Neurosurgery volume, Thieme, Inc. Editor, “Deep Brain Stimulation in Neurological Disorders” 2007 Humana Publishers, Inc. INVITED LECTURES AND SYMPOSIA

INTERNATIONAL

Japanese Society of Functional Neurosurgery 1997 Osaka, Japan The Asian Society for Stereotactic and Functional Neurosurgery 2000 “Deep Brain Stimulation: Experience with 150 cases” Beijing, China The Movement Disorders Society 8th International Congress, Seminar on 2004 “Targeting the basal ganglia for functional neurosurgery” Rome, Italy

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Medtronic European DBS forum 2005 “Use of interventional MRI for placement of DBS electrodes” Montreux, Switzerland Symposium in honor of retirement of Professor N. de Tribolet 2007 “Movement disorders surgery: the view from San Francisco” Geneva, Switzerland American Society for Stereotactic and Functional Neurosurgery 2008 “Use of interventional MRI for placement of DBS electrodes” Vancouver BC Canada 2008 NATIONAL Congress of Neurological Surgeons 1997 “Pallidotomy and deep brain stimulation” New Orleans, Louisiana Congress of Neurological Surgeons 1997 “Movement Disorders” New Orleans, Louisiana Congress of Neurological Surgeons 1997 Lunch Seminar “Pallidotomy: Techniques and Results” New Orleans, Louisiana Congress of Neurological Surgeons 1999 Lunch Seminar “Thalamic Surgery for Movement Disorders” Boston, Massachusetts

Medtronic DBS Programming Course 2000 San Francisco, California

American Association of Neurological Surgeons 2000 Movement Disorders Course San Francisco, California Sofamor-Danek/Medtronic 2000 Image Guided Surgery Course

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Congress of Neurological Surgeons 2000 Annual Meeting “Movement Disorders: Pathophysiology, Diagnosis, Treatment” San Antonio, Texas Congress of Neurological Surgeons 2000 “Surgical Management of Tremor: role of Thalamotomy, Chronic Thalamic Stimulation, And Stereotactic Radiosurgical Thalamotomy San Antonio, Texas

American Academy of Neurological Surgery 2000 “Deep Brain Stimulation for Parkinson’s Disease: Which target?” Colorado Springs, Colorado

American Association of Neurological Surgeons Annual Meeting 2001 “Contemporary Management of Movement Disorders” Toronto, Ontario, Canada Congress of Neurological Surgeons Annual Meeting 2001 “Surgical Management of Tremor: Role of Thalamotomy, Chronic Thalamic Stimulation, and Stereotactic Radiosurgical Thalamotomy” San Diego, California Congress of Neurological Surgeons Annual Meeting 2001 “Management of the “Other” Movement Disorders: Dystonia, Chorea, and Rubral Tremor” San Diego, California American Association of Neurological Surgeons Annual Meeting 2002 “Contemporary Management of Movement Disorders” Chicago, Illinois Continuing Medical Education Course 2002 “Surgery for Movement Disorders” Charleston, South Carolina Visiting Professor, University of Colorado 2002 Department of Neurosurgery, “Surgery for movement disorders” Denver, Colorado American Association of Neurological Surgeons Annual Meeting 2003 “Contemporary Management of Movement Disorders” San Diego, CA

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American Society for Stereotactic and Functional Neurosurgery, 2003 “Electrophysiologic Targeting for Movement Disorders Surgery” New York, New York American Association of Neurological Surgeons Annual Meeting 2004 “Contemporary Management of Movement Disorders” Orlando, FL The Movement Disorders Society 9th International Congress, Seminar on 2005 “Targeting the basal ganglia for functional neurosurgery” New Orleans, LA American Association of Neurological Surgeons Annual Meeting 2005 “Surgery for Parkinson’s disease” New Orleans, LA Congress of Neurological Surgeons Annual meeting 2005 “Pallidal physiology in dystonia” Boston, MA Dystonia Medical Research Foundation symposium on surgery for dystonia, 2005 “Targeting the globus pallidus in dystonia: surgical technique” Atlanta, GA American Association of Neurological Surgeons Annual Meeting 2006 “Surgery for Parkinson’s disease” San Francisco CA American Association of Neurological Surgeons Annual Meeting 2006 “Contemporary Management of Movement Disorders” San Francisco CA Bachman-Strauss Foundation symposium: Latest Developments in the 2006 Pathophysiology and Imaging of Dystonia “Microelectrode-guided surgery for dystonia: Physiological observations” New York, New York Dystonia Medical Research Foundation symposium: The Role of Animals in 2007 Dystonia Research “Pallidal physiology in dystonia in humans and nonhuman primates” Washington DC

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American Association of Neurological Surgeons Annual Meeting 2006 “Surgery for Parkinson’s disease” San Francisco CA American Association of Neurological Surgeons Annual Meeting 2007 “Surgery for Parkinson’s disease” Washington DC Visiting Professor, Thomas Jefferson University Hospital 2007 “Surgery for movement disorders: new techniques, new targets” Philadelphia, PA NINDS workshop, “Gene Delivery to the Central Nervous System” 2007 “Intrastriatal delivery of AAV-vectors for movement disorders” Washington, DC Dystonia Medical Research Foundation symposium: Surgery for dystonia 2008 “Target choice in dystonia” Chicago, Ill

American Association of Neurological Surgeons Annual Meeting 2008 “Surgery for Parkinson’s disease” Chicago, Ill American Association of Neurological Surgeons Annual Meeting 2008 “DBS of the pedunculopontine nucleus” Chicago, Ill American Association of Neurological Surgeons Annual Meeting 2008 “Gene transfer for Parkinson’s disease” Chicago, Ill American Association of Neurological Surgeons Annual Meeting 2009 “Surgery for Parkinson’s disease” San Diego Congress of Neurological Surgeons 2009 “Surgery for Movement Disorders” – course director New Orleans, LA

REGIONAL

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UCLA Symposium 2000 “Advanced Neuromodulation of the Brain” University of California, Los Angeles UCSF CME Course 2000 “Functional Neurosurgery: Epilepsy and Movement Disorders” University of California San Francisco, California

Visiting Professor, Mayo Clinic Scottsdale department of Neurology 2004 “Surgical treatment of Dystonia” Scottsdale, AZ Invited keynote speaker, Southwest Regional Dystonia Patient 2004 Symposium, “DBS for dystonia: information for patients” Scottsdale, AZ Medical grand rounds, St. Vincent’s Hospital, Portland OR “Deep brain 2004 stimulation: what’s new”

Physiatry Grand Rounds, Oakland Children’s Hospital 2005 “Surgery for pediatric dystonia” Oakland, CA Pediatric Neurology Grand Rounds, University of California, Davis 2006 “Surgery for pediatric dystonia” Sacramento CA

San Francisco Neurological Society Annual Meeting 2006 “What’s new in movement disorders surgery” Sonoma, CA Neurology Grand Rounds, St. Alphonsus Hospital 2006 “Deep brain stimulation in movement disorders” Boise, Idaho Boise area Parkinson’s Disease Support Group 2006 Boise, Idaho Children’s Hospital of Madera Grand Rounds 2007 “Surgery for pediatric dystonia” Madera, CA

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Kinetics Foundation symposium 2007 “Parkinson’s disease and DBS” Palo Alto, CA 15th Napa Pain conference DBS for pain, movement disorders, psychiatric disorders 2008 Napa, California Activa Therapy Update 2009 “Emerging indications for DBS” Boulder, CO California Children’s Services, Oakland 2009 “DBS for pediatric movement disorders” Treatment of dystonia: Medtronic forum for East Bay practitioners 2009 Lafayette Park Hotel, Lafayette CA Grand rounds at Santa Rosa Memorial Hospital 2010 “Treatment of cluster headache” Keynote speaker, UCLA neural interfaces for therapeutic interventions 2010 “Image guided and frameless approaches for DBS” “Exploring new targets for surgical treatment of movement disorders”

UNIVERSITY AND PUBLIC SERVICE University: Subcommittee of the Institutional animal care and use committee (IACUC) 2008-present on retirement of nonhuman primates used in research Public Service: Presentations to regional support groups for patients with Parkinson’ 1999-present Disease or dystonia, and and families (~ twice per year) On-site teaching program for non-UCSF neurologists and neurosurgeons 1999-present to learn techniques in deep brain stimulation surgery (~20 cases/year) Visits to non-USF operating rooms to assist in establishing programs in 1999-present Movement disorders surgery, at the following centers: California Pacifac

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Medical Center, San Francisco; Kaiser Permanente of Northern California, Sacramento; Sutter Hospital System, Sacramento, University of Colorado Health Sciences Center, Denver; Mayo Clinic Scottsdale, Scottsdale Arizona, and to hospitals in Shanghai, China and Taipei, Taiwan.

TEACHING and MENTORING

Section Leader 1985-1986 Sections in Neurophysiology, and 1994-1995 Neuroanatomy, and Pharmacology Harvard Medical School Boston, Massachusetts Case presentations to neurosurgery residents 1X/month 1998-present Neurology 110 clerkship, didactic session with medical students,1X/month 1998-present Annual didactic lecture to first year medical student neuroscience course 2001-present

Primary mentor and supervisor, fellowship in stereotactic and functional neurosurgery, UCSF Fellows mentored: Dates Fellow Current position 2002-2003 Dr. Steven Papavasiliou Beth Israel/Deaconess Medical Center,

Boston MA 2004-2005 Dr. Paul House University of Utah Medical Center, Salt

Lake City, Utah 2006-2007 Dr. Karl Sillay University of Wisconsin, Madison 2007-2008 Dr. Sepehr Sani Rush University Medical Center 2009 Dr. Kia Shahlaie University of California, Davis

Predoctoral students mentored: Dates Name Program Role 2008-2009

Andrea Crowell Doris Duke Medical Student Fellowship Program

Primary mentor for one year research fellowship

TEACHING AWARDS Rosegay Award for excellence in teaching neurosurgical residents 2002 (given by residents)

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SUMMARY OF TEACHING HOURS 2006-2007: 240 total hours of teaching (including preparation).

Formal class or course teaching hours: 20 hours Informal teaching hours: 100 hours Mentoring hours 120

2007-2008: 240 total hours of teaching (including preparation). Formal class or course teaching hours: 20 hours Informal teaching hours: 100 hours Mentoring hours 120

2008-2009: 240 total hours of teaching (including preparation) (anticipated) Formal class or course teaching hours: 20 hours Informal teaching hours: 100 hours Mentoring hours 120

TEACHING NARRATIVE

My major teaching commitment has been to our residents and fellows. Since 2004, I have been the primary mentor for 4 more fellows in functional neurosurgery (listed above), who come to UCSF for one year following their neurosurgical residency. In addition to intensive operative teaching, I am the fellows’ primary mentor for at least one publication per year and at least one meeting presentation. Since 2005 I have also been primary mentor for publications written by several UCSF residents, including Dr. Edward Chang (paper in Journal of Neurophysiology) , Dr. Devin Binder (paper in Neurosurgery), Dr. Dan Lim (paper in Stereotactic and Functional Neurosurgery), and Dr. Mark Richardson (paper in Stereotactic and Functional Neurosurgery).

RESEARCH AWARDS AND GRANTS

CURRENT 1.) NIH 1 R01 NSO69779 (Starr) 2010-2013 Cortical and basal ganglia local field potentials in human movement disorders $250,000/year direct In this project, we record local field potentials from primary motor cortex in patients with primary dystonia, Parkinson’s disease, and essential tremor who are undergoing surgery for placement of deep brain stimulators. These are compared with cortical recordings in patients with epilepsy who have had placement of subdural monitoring grids. The goal is to test the hypothesis that dystonia and Parkinson’s disease are characterized by distinct oscillation frequencies in primary motor cortex, compared to patients without a basal ganglia disorder. Role: PI

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2.) NIH R21 EB008888 (Martin) 2009-2011 MRI - guided DBS implantation for PD (PI: Alastair Martin) $125,000/year direct This project aims to improve STN visualization and target selection for stimulation therapy in PD. It investigates the role of diffusion tensor imaging, higher magnetic field strengths and internal MR coils for improving target selection and correlates clinical outcome with the position achieved with image guidance. Role: Co-Investigator

3.) Surgivision, Inc. and UC Discovery grant (Martin/Starr) 2009-2011 Use of interventional MRI for placement of deep brain stimulators $250,000/year Surgivision Inc., paired with a UC Discovery grant, is providing support to develop new skull mounted aiming devices and software for interventional MRI, optimized for the placement of DBS electrodes and infusion therapies. Interventional MRI allows placement of DBS electrodes using real time MR guidance. Role: Co-PI

PAST 1.) NIH Medical Scientist Training Program 1985-1989 2.)American Parkinson’s Disease Association (Starr) 1997-1998 Intranigral fetal allograft in a nonhuman primate model of Parkinson’s Disease $30,000/year Role: PI 3.) NIH/NINDS K08 (Starr; mentor: Rob Turner) 2001-2006 Basal Ganglia Physiology in Dystonia $150,000/year direct Role: PI $750,000 direct yrs 1-5 4.) Benign Essential Blepharospasm Foundation (Ostrem) 2008-2009 Clinical trial of STN-DBS for cervical dystonia $50,000/year Role: co-PI 5.) Dystonia Medical Research Foundation (Starr) 2009-2010 STN and M1 local field potentials in patients with dystonia $65,000/year In this project, we record local field potentials simultaneously from the cortex and basal ganglia in patients undergoing surgery for placement of deep brain stimulators. The goal is to test the hypothesis that dystonia and Parkinson’s disease are characterized by distinct oscillation frequencies in both basal ganglia and primary motor cortex. Role: PI

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PUBLICATIONS Peer reviewed journal articles 1. Fodor SP, Starr PA, Spiro TG. Raman spectroscopic elucidation of DNA backbone conformations for poly (dG-dT), poly (dA-dC), and poly (dA-dT) in CsFsolution Biopolymers 24: 1493-500, 1985 2. Starr PA, Sewell WF. Neurotransmitter release from hair cells and its blockade by glutamate-receptor antagonists. Hearing Research 52:23-42-, 1991

3. Sewell WF, Starr PA. Effects of calcitonin gene-related peptide and efferent nerve stimulation on afferent transmission in the lateral line organ. Journal of Neurophysiology 65:1158-1169, 1991 4. Savage EB, Gugino L, Starr P, Black PM, Cohn LH, Aranki SF. Pituitary apoplexy following cardiopulmonary bypass: consideration for a staged cardiac and neurosurgical procedure. European Journal of Cardio-thoracic Surgery 8:333-336, 1994. 5. Lim F, Hartley D, Starr P, Lang P, Song S, Yu L, Wang Y, Geller A. Packaging defective HSV-1 vectors using an IE 2 deletion mutant supports efficient expression in cultured cortical cells. Biotechniques 20:460-469, 1996 6. Starr PA, Lim F, Grant F, Trask L, Lang P, Yu L, Geller A. Long-term persistence of defective HSV-1 vectors in vivo demonstrated by re-activation of vector gene expression. Gene Therapy 3:615-623, 1996 7. Cohn MC, Hudgins PA, Sheppard SK, Starr PA, Bakay RAE. Pre- and Post-operative MR evaluation of stereotactic pallidotomy. AJNR 19:1075-1080, 1998. 8. Starr PA, Vitek JL, Bakay RAE. Ablative Surgery and Deep Brain Stimulation for Parkinson’s Disease. Neurosurgery 43:pp-, 1998. 9. Starr PA, Vitek JL, Bakay RAE. Deep brain stimulation for Movement Disorders. Neurosurgery Clinics of North America 9:381-402, 1998 10. Starr PA. The Axon Guideline System 3000. Neurosurgery 44:1354-1357, 1999. 11. Starr PA, Vitek JL, DeLong M, Bakay RAE. MRI-based stereotactic localization of the Globus Pallidus and subthalamic nucleus. Neurosurgery 44:303-314, 1999.

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12. Starr PA, Vitek JL, Bakay RAE. Pallidotomy: Theory and Techniques. Techniques in Neurosurgery 5:31-45, 1999. 13. Wichmann T, Bergman H, Starr PA, Subramanian T, Watts RL, DeLong MR Comparison of MPTP-induced changes in spontaneous neuronal discharge in the internal pallidal segment and in the substantia nigra pars reticulata in primates. Exp Brain Res 125:397-409, 1999 14. Starr PA, Wichmann T, van Horne C, Bakay RA. Intranigral transplantation of fetal substantia nigra allograft in the hemiparkinsonian rhesus monkey. Cell Transplant. 8:37-45, 1999. 15. Starr PA, Subramanian T, Bakay RAE, Wichmann T. Electrophysiologic localization of the substantia nigra in the Parkinsonian subhuman primate. Journal of Neurosurgery 93:704-710, 2000 16. Reich CA, Hudgins PA, Sheppard S, Starr PA, Bakay RAE. A high-resolution fast spin echo-inversion recover sequence for preoperative localization of the internal globus pallidus. AJNR 21:928-931, 2000 17. Byrd D, Marks WJ, Starr PA. Deep brain stimulation for advanced Parkinson’s Disease. AORN 72:387-408, 2000 18. Starr PA, Christine CW, Theodosopoulos PV, Lindsey N, Byrd D, Marks WJ. Implantation of deep brain stimulators into the subthalamic nucleus: Technical approach and magnetic resonance imaging-verified electrode locations. Journal of Neurosurgery 97: 370-387, 2002 19. Theodosopoulos PV, Marks WJ, Christine C, Starr PA. Locations of movement-related cells in the human parkinsonian subthalamic nucleus. Movement Disorders 18: 791-798, 2003 20. Starr PA, Placement of deep brain stimulators into the subthalamic nucleus and globus pallidus: Technical approach, Stereotactic and Functional Neurosurgery 79:118-145, 2003 21. Starr PA, Theosopoulos PV, Turner RS: Surgery of the Subthalamic Nucleus: Use of Movement-Related Neuronal Activity for Surgical Navigation, Neurosurgery 53: 1146-1149, 2003

22. Papavassiliou E, Rau G, Heath S, Abosch A, Barbaro N, Larson P, Lamborn K, Starr PA Thalamic stimulation for essential tremor: Relation of lead location to outcome. Neurosurgery, 54:1120-1129, 2004

23. Binder D, Rau G, Starr PA. Risk factors for hemorrhage during microelectrode-guided DBS for movement disorders. Neurosurgery, 56: 722-732, 2005

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24. Starr PA, Marks W, Rau G, Davis V, Simmons D, Lindsey N, Turner RS. Spontaneous pallidal discharge in dystonia: comparison with Parkinson’s disease and normal macaque. J Neurophys, 93: 3165-3176,2005 25. Martin AJ, Larson PS, Ostrem JL, Sootsman WK Talke P, Weber OM, Levesque N, Myers J , Starr PA. Placement of deep brain stimulator electrodes using real-time high field interventional MRI. Magnetic Resonance in Medicine, 54:1107-1114, 2005 26. Holloway KL, Gaede SE, Starr PA, Rosenow JM, Ramakrishnan V, Henderson JM. Frameless stereotaxy using bone fiducial markers for deep brain stimulation. J Neurosurg. 103: 404-13, 2005 27. Starr PA. Surgery for Parkinson's disease: integration of neurology and neurosurgery. Clin Neurosurg. 52:202-4, 2005 28. Starr PA, Turner RS, Rau G, Lindsey N, Heath S, Volz M, Marks WJ, Microelectrode-guided implantation of deep brain stimulators into the globus pallidus internus for dystonia: techniques, electrode locations, and outcomes. J Neurosurg 104:488-501, 2006 29. Lim DA, Kandhar SM, Heath S, Ostrem JL, Ringel N, Starr PA. Multiple target deep brain stimulation for multiple sclerosis related and post-stroke Holmes’ tremor. Stereotact Funct Neurosurg, in press. 30. Starr PA, Barbaro N, Raskin N, Ostrem JL. Chronic stimulation of the posterior hypothalamic region for cluster headache: technique and one-year results in four patients. J. Neurosurg 106:999-1005,2007 31. Ostrem JL, Marks WJ, Volz M, Heath S, Starr PA. Pallidal Deep Brain Stimulation in a Series of Patients with Cranial-Cervical Dystonia (Meige Syndrome). Movement Disord 22:1885-1891, 2007. 32. 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. Movement Disord, 15:1790-1793, 2007. 33. Chang EF, R.S. Turner RS, Ostrem JL, Davis VR, Starr PA. Neuronal Responses to Passive Movement in the Globus Pallidus Internus in Primary Dystonia. J Neurophysiol, 98:3696-3707, 2007. 34. 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. Experimental Neurology 211:227-233, 2008.

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35. Sillay K, Larson P, Starr PA. Deep brain stimulator hardware infections: incidence and management in a large series. Neurosurgery, 62:360-366,2008.

36. Marks WJ, 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, 7:400-408, 2008 37. Larson PS, Richardson RM, Starr PA, Martin AJ. Magnetic resonance imaging of implanted deep brain stimulators: experience in a large series. Stereotact Funct Neurosurg, 86(2):92-100, 2008 38. Eberling JL, Jagust WJ, Christine CW, Starr P, Larson P, Bankiewicz KS, Aminoff MJ. Results from a phase I safety trial of hAADC gene therapy for Parkinson disease. Neurology 70:1980-1983, 2008 39. Sani S, Shimamoto S, Turner RS, Levesque N, Starr PA. Spontaneous Neuronal Activity in the Posterior Hypothalamic Region in Humans. Neurosurgery 64 Suppl: 161-167, 2009 40. Sani S, Ostrem JL, Shimamoto S, Levesque N, Starr PA. Single Unit "Pauser" Characteristics of the Globus Pallidus Pars Externa Distinguish Primary Dystonia from Secondary Dystonia and Parkinson's Disease. Experimental Neurology, 216:295-299, 2009 41. Berman, B.D., P.A. Starr, W.J. Marks, Jr. and J.L. Ostrem, Induction of bradykinesia with pallidal deep brain stimulation in patients with cranial-cervical dystonia. Stereotact Funct Neurosurg, 2009. 87(1): p. 37-44. 42. Martin, A.J., P.S. Larson, J.L. Ostrem and P.A. Starr, Interventional magnetic resonance guidance of deep brain stimulator implantation for Parkinson disease. Top Magn Reson Imaging, 2009. 19(4): p. 213-21. 43. Christine, C.W., J.W. Langston, R.S. Turner and P.A. Starr, The neurophysiology and effect of deep brain stimulation in a patient with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced parkinsonism. J Neurosurg, 2009. 110(2): p. 234-8. 44. Richardson, M., J.L. Ostrem and P.A. Starr, Surgical repositioning of misplaced subthalamic electrodes in Parkinson's disease: Location of effective and ineffective leads. Stereotact Funct Neurosurg., 2009 (87) 297-303. 45. Schrock LE, Ostrem JL, Turner RS, Shimamoto SA, Starr PA. The subthalamic nucleus in primary dystonia: single unit discharge characteristics. J Neurophysiolol 2009 (102) p 3740-52

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46. Starr, P.A., J.L. Ostrem, A. Martin, P. Talke, N. Levesque and P. Larson, Subthalamic nucleus deep brain stimulator placement using high field interventional MRI and a skull-mounted aiming device: technique and application accuracy. J Neurosurg. 2010 (112): p479-90 47. Shimamoto SA, Larson PS, Ostrem JL, Glass GA, Turner RS, Starr PA. Physiological identification of the human pedunculopontine nucleus. J Neurol Neurosurg Psychiatry. 2010 (81) p. 80-6

Review Articles

Starr PA. Surgical treatment of dystonia. Contemporary Neurosurgery 27:1-6, 2005 Ostrem JL, Starr PA. Treatment of dystonia with deep brain stimulation. Neurotherapeutics 5:320-330, 2008. Book Chapters Bakay RAE, Starr PA Optimal target for pallidotomy-A controversy. In Krauss J, Grossman R, Jankovic J, (eds.): Pallidal Surgery for the treatment of Parkinson’s Disease and Movement Disorders. Lippincott-Raven, Hagerstown, Maryland, 1998. Starr PA, Vitek JL, Bakay RAE Pallidotomy: Clinical results. In Germano I, ed: Surgical Treatment of Movement Disorders. American Association of Neurological Surgeons, 1998, pp 143-158. Starr PA, VanHorne C Neural transplantation for the movement disorder of Parkinson’s disease. In Joseph AB, Young RR, eds: Movement Disorders in Neurology and Psychiatry. Blackwell Science, Oxford, 1999.

Starr PA, Vitek JL, Bakay RAE Surgery for movement disorders. In Kay AH, Black PM, eds: Operative Neurosurgery. Churchill Livingston, London, 1999. Bakay RAE, Kordower JH, Starr PA Restorative surgical therapies for Parkinson’s disease

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In Tuszynki MH, Kordower JR, eds: CNS Regeneration: Basic Science and Clinical Advances. Academic Press, San Diego, 1999. Starr PA Neurosurgery In Norton J, ed: Surgery: Scientific Basis and Current Practice. Springer-Verlag, New York, 2001 Starr PA Movement disorders responsive to surgery In Doherty, ed: Current Surgical Diagnosis and Treatment. 11th Edition, McGraw-Hill, New York, 2002 Starr PA Technical considerations in movement disorders surgery. In Schulder M, ed: The Handbook of Stereotactic and Functional Neurosurgery. Marcel Dekker, New York, 2003 Theodosopoulos P, Turner R, Starr P Electrophysiological Findings in STN and SNr IN: Microelectrode Recordings in Human Movement Disorder Surgery K. Burchiel and Z. Israel, editors Thieme: New York, 2004 Starr PA, Avoiding Complications and Correcting Errors. IN: Movement Disorders Surgery: The Essentials. R. Bakay, Editors. Thieme: New York, in press Starr PA, Ahn A. Deep brain stimulation for medically intractable cluster headache. IN: Deep Brain Stimulation in Neurological and Psychiatric Disorders. Humana Press: Totawa, New Jersey, in press Starr PA, Sillay K. Complication avoidance and management in DBS surgery. IN: Deep Brain Stimulation in Neurological and Psychiatric Disorders. Humana Press: Totawa, New Jersey, in press Sillay K, Starr PA, DBS for Parkinson’s Disease. IN: Textbook of Neuromodulation. Blackwell Publishing, Oxford England, in press Starr PA, Bankiewicz KS. Gene transfer for Parkinson’s Disease. In: Textbook of Stereotactic and Functional Neurosurgery, Springer, in press Starr PA, Martin AJ, Larson PS. Implantation of deep brain stimulator electrodes using interventional MRI. In: Intra-operative MRI guided Neurosurgery, Thieme, in press.

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ABSTRACTS Starr PA, Sewell WF Effects of amino acid antagonists on auditory nerve synaptic potentials. Society of Neuroscience, 1988. Starr PA, Goumnerova LC Pseudotumoral cerebellar infarction complicating cervical spine fusion in rheumatoid arthritis. American Association of Neurological Surgeons, 1992. Starr PA, Lim F, Geller, AI Use of a defective HSV-1 vector system for gene transfer in the rat brain. Congress of Neurological Surgeons, 1994. Starr PA, Scott RM Une serie chirurgicale de cavernomes intracraniens chex l’enfant (A series of surgically treated intracranial cavernomas in children). Societe de Neurochirurgie de Langue Francaise, 1994. Starr PA, Lim F, Geller AI Long-term persistence of HSV-1 amplicon vectors in the rat central nervous system. American Society for Stereotactic and Functional Neurosurgery, 1995. Starr PA, Vitek JL, DeLong MR, Bakay RAE Optimal stereotactic targeting for microelectrode-guided Gpi pallidotomy. World Society for Stereotactic and Functional Neurosurgery, 1997. Starr PA, Wichmann T, Subramanian T, DeLong MR, Bakay RAE Electrophysiological characteristics of the substantia nigra in the normal and parkinsonian primate. Vth World Meeting on Microelectrode Techniques during Functional and Stereotactic Neurosurgery, 1997.

Starr PA, Vitek JL, DeLong MR, Bakay RAE Failed pallidotomy: Indications for reoperation. Congress of Neurological Surgeons, 1997. Starr PA, Wichmann T, VanHorne C, Bakay RAE Intranigral transplantation of fetal substantia nigra allografts in the hemiparkinsonian Rhesus monkey. American Society for Neural Transplantation, 1998.

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Starr PA, Vitek JL, DeLong MR, Bakay RAE MRI-based stereotactic targeting of the subthalamic nucleus. Congress of Neurological Surgeons, 1998. Abosch A, Marks W, Starr PA Thalamic Stimulation for tremor: Relationship of Lead location postoperative MRI to outcome and side effects. Congress of Neurological Surgeons, 1999. Starr PA, Feiwell R, Marks W Placement of deep brain stimulators into the subthalamic nucleus: Technical approaches. American Society for Stereotactic and Functional Neurosurgery, 1999. Starr PA, Christine C, Byrd D, Lindsey N, Marks Jr M Deep brain stimulation of the subthalamic Nucleus for Parkinson’s disease: Technical approach and MRI-Verified lead location in 44 implants. Congress of Neurological Surgeons, 2000. Starr PA, Lindsey N, Byrd D, Marks WJ Spontaneous neuronal discharge in the globus pallidus in 3 patients with dystonia. Movement Disorders 13, supplement 3. Marks WJ, Christine C, Clay H, Heath S, Aminoff M, Starr PA Unilateral and bilateral deep brain stimulation of the globus pallidus or subthalamic nucleus in patients with medically refractory Parkinson’s disease: Short term results of randomized trial. Movement Disorders 15, supplement 3:53. Theodosopoulos PV, Christine C, Byrd D, Lindsey N, Starr PA Physiology and functional organization of the human subthalamic nucleus. Movement Disorders, 15, supplement 3:43. Starr PA, Christine C, Clay H, Heath S, Barbaro N, Aminoff M, Marks WJ A prospective, randomized trial of chronic deep brain stimulation of the globus pallidus or subthalamic nucleus for medically refractory Parkinson’s disease J Neurosurgery 92:543.

Ojemann SG, Saloner D, Edmister W, Marks W, Starr P Magnetic Resonance Imaging of Deep Brain Stimulators: Experience with 190 Cases Proceedings of the 70th Anniversary of the American Association of Neurological Surgeons Annual Meeting Toronto, Ontario, Canada, April 2001.

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Ojemann S, Marks, Jr. W, Mori M, Starr P Pallidal stimulation for Parkinson’s disease: Electrode locations verified by postoperative MRI Proceedings of the 51st Annual Meeting of the Congress of Neurological Surgeons San Diego, California, October 2001. Theodosopoulos P, Christine C, Turner R, Marks W, Starr P Higher oscillations in the human subthalamic nucleus Proceedings of the 51st Annual Meeting of the Congress of Neurological Surgeons San Diego, California, October 2001. Binder DK, Starr PA Hemorrhagic complications of microelectrode-guided DBS American Society for Stereotactic and Functional Neurosurgery New York City, May 2003 Papavassiliou E, Barbaro N, Larson P, Abosch A, Marks WJ, Lamborn K, Starr PA Thalamic stimulation for essential tremor: Relation of lead location to outcome American Society for Stereotactic and Functional Neurosurgery New York City, May 2003 Larson P, Rau G, Starr PA: Stimulation-induced mood changes in the subthalamic nucleus: Location of the cathodal contact. American Society for Stereotactic and Functional Neurosurgery New York City, May 2003 Starr PA, Rau G, Turner R Deep brain stimulation for dystonia: technical approach and MRI-verified electrode locations Congress of Neurological Surgeons Denver, October 2003. Starr PA, Marks W, Rau G, Mori M, Simmons D, Lindsey N, Turner RS. Spontaneous pallidal discharge in 15 patients with dystonia. Movement Disorders Society 8th International Congress Rome Italy June 2004 Larson P, Martin A, Sootsman K, Lindsey N, Myers J, Talke P, Starr PA. Use of interventional MRI for placement of deep brain stimulator electrodes. American Society for Stereotactic and Functional Neurosurgery Cleveland, Ohio 2004 Starr PA, House P, Heath S, Volz M, Ostrem J. Deep brain stimulation of the posterior hypothalamic area for treatment of medically refractory cluster headache: report of four cases World Society for Sterotactic and Functional Neurosurgery

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Rome, Italy 2005 Starr PA, Turner RS, Davis V, Marks WJ, Ostrem JL. Pallidal deep brain stimulation for dystonia: experience with 42 cases. American Academy of Neurological Surgeons Half Moon Bay, CA 2005 Starr PA, Barbaro N, Raskin N, Ostrem J. Deep brain stimulation for cluster headache: One-year results in four cases. American Association of Neurological Surgeons San Francisco CA 2006 Starr PA, Verhagen M, Larson PS, Bakay RA, Taylor R, Cahn-Wiener D, Bartus R, Ostrem JL, Marks WJ, Intrastriatal gene transfer with AAV-neurturin for Parkinson’s disease: results of a phase I trial . American Association of Neurological Surgeons Washington DC 2007 Larson PS, Martin AJ, Ostrem JL, Talke P, Sootsman WK, Levesque NL, Meyers J, Starr PA, Placement of Subthalamic DBS Electrodes Using 1.5T Interventional MRI: Preliminary Clinical Outcomes and Targeting Accuracy. American Association of Neurological Surgeons Washington DC 2007 Sillay K, Larson PS, Starr PA, Perioperative infection of implanted DBS systems: incidence and management in a large series. American Association of Neurological Surgeons Washington DC 2007 Starr PA, Ostrem JL, Shimamoto S, Turner RS, Pallidal neuronal oscillations during movement distinguish dystonia from Parkinson’s disease International Basal Ganglia Society (IBAGS) Egmond An Zee, The Netherlands 2007 Starr PA, Kang G, Heath S, Shimamoto S, Turner RS, Pallidal neuronal discharge in Huntington’s disease International Basal Ganglia Society (IBAGS) Egmond An Zee, The Netherlands 2007 Ostrem JL, Volz MM, Starr PA, Deep Brain Stimulation (DBS) of the Subthalamic Nucleus (STN) in Patients with Segmental and Focal Cervical Dystonia Society for Movement Disorders Chicago IL 2008

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Schrock L, Shimamoto S, Ostrem J, Turner RS, Starr PA, Physiology of the subthalamic nucleus in patients with primary dystonia. Society for Movement Disorders Chicago IL 2008 Sani S, Shimamoto S, Levesque N, Starr PA, Single Unit “Pauser” characteristics of the Globus Pallidus Pars Externa in Dystonia: comparison with Parkinson’s disease and Normal Non-Human Primate Society for Movement Disorders Chicago IL 2008 Shimamoto S, Larson PS, Sani SB, Ostrem JL, Glass GA, Turner RS, Starr PA Single Unit Discharge in the Human Pedunculopontine Nucleus American Society for Stereotactic and Functional Neurosurgery Vancouver BC Canada 2008 Richardson MR, Ostrem JL, Starr PA Repositioning of failed subthalamic nucleus DBS electrodes American Association of Neurological Surgeons San Diego CA 2009 Crowell A, Ostrem JL, Shimamoto S, Starr PA Cortical and subthalamic local field potentials in primary dystonia World Society for Stereotactic and Functional Neurosurgery Toronto Canada 2009 Crowell A, Ostrem JL, Shimamoto S, Lim D, Starr PA M1 local field potentials distinguish Parkinson’s disease, primary dystonia, and essential tremor Society for Neuroscience Chicago, IL 2009

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REASEARCH PROGRAM SUMMARY

My research program focuses on several areas of movement disorders surgery: 1.) Physiology of the human and non-human brain in movement disorders. I have a number

of publications in basal ganglia physiology in awake humans, the most recent listed below. My laboratory has shown that single unit discharge in the globus pallidus in dystonia is characterized by abnormally low discharge rates, and abnormal oscillatory activity in the 2-10 Hz range. We defined pallidal abnormalities in Huntington’s disease. We have demonstrated abnormal movement related pallidal activity in dystonia. Recently, we have utilized electrocorticography in movement disorders, simultaneously with basal ganglia recordings, to show that cortical and basal ganglia oscillation frequencies distinguish the three most common movement disorders. The findings have implications for current model of basal ganglia dysfunction in movement disorders, and extend the “oscillation hypothesis” of Parkinson’s disease to include other basal ganglia disorders, including primary dystonia.

2.) Clinical trials I am the surgical principal investigator in the funded clinical trials listed in the table below. Through these clinical trials, we are defining the optimal brain target for deep brain stimulation (DBS) in Parkinson’s disease, and we are exploring new technical approaches (gene transfer) in Parkinson’s disease. We are investigating the use of new brain stimulation devices, and new techniques for DBS insertion.

3.) Table 1. Funded Clinical Trials

Trial Dates Sponsor #subjects enrolled UCSF/SFVA

CSP-468, Randomized trial of deep brain stimulation of the globus pallidus or subthalamic nucleus for Parkinson’s Disease

2002-present VA cooperative trials program and NIH

70 (enrollment completed)

A Phase I trial of Gene transfer using AAV-neurturin for the treatment of Parkinson’s disease – three year extension study

2006-present Ceregene, Inc. 8 (enrollment completed)

A Phase II randomized, double blinded trial of Gene transfer using AAV-neurturin for the treatment of Parkinson’s disease

2006-present Ceregene, Inc. 11 (enrollment complete)

Gene transfer using AAV-AADC for the treatment of Parkinson’s Disease

2004-present Genzyme, Inc. 10 (enrollment complete)

DBS for essential tremor using the ANS Libra device

2005-present Advanced Neuromodulation

16

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Systems, Inc.

4.) Defining novel surgical techniques in brain stimulator implantation. Our group has defined the technical approach to microelectrode guided DBS implantation for dystonia, resulting in the first American publication on this technique (reference below). We have also pioneered the use of high field interventional MRI in DBS implantation, resulting in the first publication on this technique (reference below).

Most significant recent publications: (1-5)

1. Starr PA, Rau GM, Davis V, Marks WJ, Jr., 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. Role: collected and performed analysis of all data in this study, over a five year period. Wrote the manuscript. 2. 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. Role: collected and performed analysis of all data in this study, wrote the manuscript. 3.) Chang EF, R.S. Turner RS, Ostrem JL, Davis VR, Starr PA. Neuronal Responses to Passive Movement in the Globus Pallidus Internus in Primary Dystonia. J Neurophysiol, 98:3696-3707, 2007. Role: collected all data in the study. Mentored the first author, Dr. Chang, in all analysis steps, and co-wrote the manuscript. 4.) 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. Experimental Neurology 211:227-233, 2008 Role: collected and performed analysis of all data in this study, wrote the manuscript. 5.) Starr, P.A., J.L. Ostrem, A. Martin, P. Talke, N. Levesque and P. Larson, Subthalamic nucleus deep brain stimulator placement using high field interventional MRI and a skull-mounted aiming device: technique and application accuracy. J Neurosurg., in press

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Role: along with Dr. Paul Larson and Dr. Alastair Martin, we co-developed the surgical methods for a novel approach to DBS insertion. I wrote the manuscript.