GEORGIA REGENTS NEUROSCIENCE CENTER ANNUAL REPORT 2013
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GEORGIA REGENTS NEUROSCIENCE CENTER: WHO WE ARE Our numbers tell our story: With nearly 40 faculty members, 11 centers, $15.9 million in sponsored research and nearly 20,000 patients treated annually in our outpatient clinics alone, Georgia Regents Neuroscience Center continues to improve the care of patients with general and complex neurological conditions throughout Georgia and beyond. 1 First in Georgia and second in the Southeast to receive Advanced Comprehensive Stroke Center designation Only Gamma Knife Center in the region affiliated with a children’s hospital Only one in the region to offer endoscopic endonasal skull base surgery First Level 4 Epilepsy Center in Georgia and South Carolina First Movement and Cognitive Disorders Center in the region for movement disorder and Alzheimer’s patients Only Movement Disorders/Parkinson’s Disease Level 4 Center of Excellence in Georgia or South Carolina Only dedicated Alzheimer’s clinic in Georgia (outside of Atlanta) First angiography suite with VasoCT capability in the region
1:2 Nurse-to-patient ratio goal on the neuroscience intensive care unit 1:4 Nurse-to-patient ratio goal on the neuroscience floor 1 of 16 Hereditary Hemorrhagic Telangiectasia Centers in the U.S. (and one of only about 40 worldwide). This genetic disease can result in nosebleeds and AVMs throughout the body, including the lungs and brain. 1 of 24 Designated Movement Disorders/Parkinson’s Disease Centers of Excellence in the U.S. 1 of 33 Certified, multidisciplinary ALS clinics in the U.S.
3rd Year in a row that the Comprehensive Stroke Center was recognized by the American Heart Association and American Stroke Association for quality care and rapid treatment 17th out of 105 Neurosurgery departments in the U.S. in NIH Blue Ridge rankings. With $935,040 in NIH funding, this ranking represents a rise from 39th in 2004 and a jump from 28th in 2012 14 Years of experience in Gamma Knife surgery 18 Beds in the neuroscience ICU, with an additional 16 beds on the neuroscience floor 28 Hospitals in Georgia affiliated with our REACH telestroke network
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85% Compliance to AHA/ASA stroke quality indicators, ranking us among the highest in the country 1,500 Number of patients (and growing!) treated with Gamma Knife <60 Minutes to stroke treatment under our fast-track protocol 468 Patients monitored annually in our Epilepsy Monitoring Unit 1,255 Resective surgeries for epilepsy performed since our founding 89 Percent of our patients with temporal, class I or class II, epilepsy who become seizure free. Seventy-one percent of our patients with extratemporal, class I or class II, epilepsy become seizure free. 150 High acuity spine cases from around the world treated annually $15.9 million Sponsored research conducted into neurological diseases last year by our neuroscience-related research programs
14,041 Total adult clinic visits 1,830 MS clinic visits 4,541 Pediatric clinic visits 24 Neurology faculty 13 Neurology residents 3 Neurology fellows 8 Neurosurgery faculty 7 Neurosurgery residents
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BENEFITS OF AN ACADEMIC MEDICAL CENTER As part of the state’s second largest academic medical center, Georgia Regents Neuroscience Center offers patients and families numerous benefits, including: • CARE FOR ANY NEUROLOGICAL CONDITION. Our broad range of services and faculty experience means that we have the resources to care for any neurological condition — from simple to complex. We have partnerships with referring physicians throughout Georgia, South Carolina, and beyond who rely on us to consult with them on patient cases and provide care and treatment.
• RESEARCH DISCOVERIES. Patients who come to an academic medical center benefit sooner from the latest discoveries in neurological care and treatment, thanks to the opportunity to participate in clinical trials for new medications, technology, surgical techniques, and more.
• NEUROSCIENCE EXPERTISE. Because we also teach generations of health care professionals, our physicians are well-versed in the newest findings and therapies in their fields. They are boardcertified in all major specialties and subspecialties and deliver their expert care not only here at Georgia Regents Medical Center, but sites around the state and beyond.
Patients with comorbid conditions also benefit from the many other departments and services available within our health system, including: • A 13-county Level I Regional Trauma Center • A 154-bed children’s hospital housing a Level I Pediatric Trauma Center • A dedicated Cancer Center working with us to provide multidisciplinary care and treatment planning for neuro-oncology patients • One of the region’s largest — and most diverse — teams of adult and pediatric neuroradiologists, neuropsychologists, and psychologists/psychiatrists • Inpatient and outpatient rehabilitation • A patient- and family-centered focus to care
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WELCOME
Every day and with every patient, the Georgia Regents Neuroscience Center continues to strive toward innovation. “New” is the name of the game — within this past year, we have formed new partnerships, advanced new techniques and treatments, and brought new research to the bedside to help patients, not just here, but across the nation and even the world. This year’s Georgia Regents Neuroscience Center Annual Report showcases just a few of these cases and stories: New partnerships in stroke We launched a new model of care by partnering with St. Joseph’s/Candler in Savannah to expand comprehensive stroke care throughout the state. Our expanding telestroke hub and spoke system (the first rural telestroke system in the U.S.) now includes 28 hospitals, including Aiken Regional Medical Centers in South Carolina and University Health Care System in Augusta. Collaborations with cancer Our Gamma Knife, neurosurgery, and cancer programs demonstrate the power of collaboration to improve the patient experience.
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Improved monitoring and surgery for epilepsy We applied a new technique for SEEG monitoring and performed our first hippocampal multiple subpial transection. New technique to repair pretzeloid spines Over three years, our spinal team developed an innovative technique to fix this highly complex spinal degenerative problem. First craniosynostosis surgery using a spring device We were the first hospital in the nation to use this device that is designed to improve the care of babies whose sutures fuse too early.
Ongoing management of neurological disorders Our ALS and MS clinics continue to improve quality of life for patients. New Movement and Cognitive Disorders Center This new center will collaborate on the care of Parkinson’s and memory disorders patients. Neurointensivists in critical care We remain the region’s only neuro critical care unit staffed by fellowship-trained neurointensivists. Neuroscience research Ongoing research initiatives include a potential new drug for hemorrhagic stroke, key discoveries on how memories are made and a new Department of Neuroscience and Regenerative Medicine.
In our clinics and operating rooms, we see patients presenting with every possible neurological condition, and we are uniquely positioned to respond. We remain the region’s resource for specialized care in neurological conditions requiring ongoing management, neurosurgery, or other treatments — all in partnership with you. To find out more or to refer a patient, visit gru.edu/neuro or call 706-721-4581. David Hess, MD Chairman of Neurology Cargill Alleyne, MD Chairman of Neurosurgery
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STROKE Annually, it’s estimated that only 2 to 4 percent of stroke patients in the U.S. are treated with the life- and brain-saving drug tPA. In Georgia, the telestroke program, REACH, based at Georgia Regents Comprehensive Stroke Center, has made enormous strides in advancing stroke care and tPA administration at the 28 hospitals currently part of its hub and spoke network. Now a new model of care — a partnership between our stroke center and other participating hospitals — is helping to strengthen that network and further comprehensive stroke and neuroscience care statewide.
“Our partnership with St. Joseph’s/Candler and other hospitals is a relatively new model of care and an extension of our REACH model. To improve stroke care in this state, we’ve found that you can’t do everything remotely — you do need physicians on the ground.” Dr. David Hess, Director of Neurology, Georgia Regents Comprehensive Stroke Center
Since it launched in 2002, Georgia Regents Comprehensive Stroke Center’s REACH program has brought stroke care in Georgia and South Carolina much closer to thousands of patients and established interactive partnerships between GRHealth stroke specialists and referring physicians statewide. It’s also developed new partnerships, one of the newest and most exciting of which is with St. Joseph’s/Candler in Savannah, Ga. By the coming fiscal year, six GRHealth neurologists will practice there full-time, providing neurohospitalist support and outpatient care for stroke and other neurological cases, conducting additional research and clinical trials, and opening up further opportunities for medical student and resident rotations.
STROKE FAST STATS • For the third year in a row, our comprehensive stroke center was recognized with the American Heart Association/ American Stroke Association’s Get With The Guidelines® Stroke Gold Plus Quality Achievement Award and Target Stroke Honor Roll, demonstrating our center’s commitment to quality care and rapid treatment, such as consistently administering tPA within one hour of a patient’s arrival. • The Georgia Coverdell Acute Stroke Registry presented our comprehensive stroke center with an Award of Excellence for demonstrating a 20 percent improvement in tPA administration and an average door-to-needle-time of less than 60 minutes. • We continue to improve our outreach to rural hospitals through a dedicated telestroke coordinator, who conducts onsite training and collects valuable data and feedback on stroke care and our telestroke network.
DISCOVERIES IN STROKE TREATMENT • Leading a Worldwide Stem Cell Trial. Dr. David Hess, Chairman of the Department of Neurology, is the clinical primary investigator for a trial on the first IV-administered stem cell product for stroke treatment, patented by scientists at Athersys Inc. and faculty at Georgia Regents Health System. The trial is at its halfway point and has expanded to the United Kingdom. • Antibiotic’s Role in Reducing Disability Following Hemorrhagic Stroke. Hemorrhagic strokes are far less common — but far deadlier — than ischemic strokes, with no proven therapy available. Led by principal investigator Dr. Jeffery Switzer, a stroke specialist at Georgia Regents Health System, an American Heart Association-funded study is examining the potential role of the common antibiotic minocycline in reducing the high rates of disability following hemorrhagic stroke. • Telestroke Is Cost Effective for Hospitals. A Genentech-funded study examined telestroke data from Georgia Regents Comprehensive Stroke Center and the Mayo Clinic and found that telemedicine not only helps save rural hospitals money, but also improves patient outcomes. Compared to hospitals with no telestroke network, 45 more patients were treated with intravenous thrombolysis, 20 more with endovascular stroke therapies, leading to 6.11 more independent patients discharged home and representing more than $350,000 in cost savings for the network each year, according to the study.
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A NEW PARTNERSHIP IN SAVANNAH AND OTHER HOSPITALS This new partnership comes on the heels of Medical College of Georgia at Georgia Regents As one of the Georgia Regents physicians on Georgia Regents Comprehensive Stroke Center’s University. In 2009, it also became a REACH hub staff at St. Joseph’s/Candler, Dr. Jill Trumble, accreditation as an Advanced Comprehensive for seven rural hospitals in Southeast Georgia, who directs the movement disorders program Stroke Center by the Joint Commission (the with vascular neurologists at the Georgia Regents and the general neurology outpatient clinic, said first in the state and one of only a handful Comprehensive Stroke Center currently taking patients and the health system both benefit when in the nation) — and is another example of the those calls. neurohospitalists are on staff. innovative solutions GRHealth has “Our partnership with the Georgia Regents Neuroscience advanced to improve stroke care in Center allows us to recruit the highest caliber of physicians “This model is the trend in health care the state and beyond. to our medical staff. Being able to practice in our busy now,” she said. “Having an outpatient community health system and at the same time maintain facility and inpatient neurohospitalists “Our partnership with St. Joseph’s/ an academic appointment at GRU is a winning combination allows me time to concentrate on my for all. Really, it’s all about evidence-based medicine and Candler and other hospitals is a clinic patients without being pulled away providing the best care according to the evidence to the relatively new model of care and an patients that we serve. This just supports that consistency.” to see patients in the hospital, which extension of our REACH model,” allows for better care and less wait times.” Sherry Danello, DOB, MSN, BC-NEA, Vice President said Dr. David Hess, Chairman of Patient Care Services, St. Joseph’s/Candler Although the neurologists’ full-time of Neurology. “To improve stroke care in this state, we’ve found that practice is in Savannah, they remain you can’t do everything remotely — you do need With local neurologists in Savannah moving Georgia Regents faculty members through physicians on the ground.” more toward outpatient care, the partnership also a contractural agreement with St. Joseph’s/ met a need for the two hospitals within the St. Candlers. Their specialties include vascular With its long relationship with GRHealth Joseph’s/Candler health system to have vascular neurology, movement disorders, neuromuscular and Georgia Regents University, St. Joseph’s/ and other neurologists on staff for inpatient care, diseases, neurophysiology, and more. A similar Candler was a good fit. Along with Brunswick’s to maintain its accreditation as a primary stroke model is being launched at Aiken Regional Southeast Georgia Health System, St. Joseph’s/ center, and to offer that same level of care to its Medical Centers and is being explored in other Candler serves as the Southeast Campus of the partner hospitals. locations.
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GAMMA KNIFE & NEUROSURGERY Collaboration is inherent within the neurosurgical team at Georgia Regents Neuroscience Center. Our neurosurgeons have expertise across a vast array of subspecialty areas in neurosurgery, including endoscopic, endovascular, skull base, neuro-oncology, pediatric, spine, peripheral nerve, and Gamma Knife. Because many of our patients present with complex conditions requiring multistage care, we collaborate closely to form the right plan of surgical treatment and management for each patient. With two previous craniotomies for recurrent meningioma, patient Christina Mulvihill presented neurosurgeons at Georgia Regents Neuroscience Center with a complex case. The benign tumor was atypical, continuing to return despite surgical interventions and causing ongoing symptoms of dizziness and nausea. It was also unfortunately located — near the brain stem and also involving her right ear.
COMPLEX NEUROSURGICAL PLANNING “We have benefited very much from the collaboration of the Georgia Regents Neuroscience Center and the GRU Cancer Center. When the tumor board meets, everyone shares their input, and they all have a goal of doing the best for her that can be done. It’s an effort on everyone’s part, and we appreciate that.” Anna Butler, Christina Mulvihill’s mother
Mulvihill’s case went to the neuro-oncology tumor board at Georgia Regents University Cancer Center, where neurooncologists, neurosurgeons, and radiation oncologists examined her scans and determined the best neurosurgical plan. The complex treatment plan would require the involvement of neurosurgery/skull base surgery, specialized radiation therapy, and Gamma Knife — an entire spectrum of care that patients can typically only receive at an academic medical center like Georgia Regents Medical Center.
A very complex skull base surgery to remove the tumor was a success, and Mulvihill also underwent conformal radiation therapy to help spare normal brain tissue — but a followup MRI showed that the tumor was once again growing. During a visit to the multidisciplinary neuro-oncology clinic at the
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“From a regional standpoint, we are one of only a handful of centers that is dedicated to multidisciplinary care, offering multidisciplinary clinics, a tumor board and using novel therapies, including in-house developed protocols. This is very unique, and most patients would have to travel hours away to find something similar.” Dr. Cargill Alleyne, Chair of Neurosurgery at Georgia Regents Neuroscience Center
cancer center, Mulvihill met with her cancer physician as well as her neurosurgeon, Dr. John Vender. As Director of the Gamma Knife Program, Vender recommended that Mulvihill also undergo radiosurgery. “A single mass lesion may not shrink with other therapy,” said Vender. “But Gamma Knife is very effective in treating tumor recurrence.”
REGION’S ONLY GAMMA KNIFE PERFEXION WITH EXTEND TECHNOLOGY Two years ago, the Georgia Regents Neuroscience Center added the Perfexion model with Extend technology to its Gamma Knife Program. The new protocol offers the most advanced radiosurgery technology, with only a handful of sites in the U.S. currently offering this therapy. Perfexion with Extend allows access to larger tumors as well as targets previously unreachable by traditional Gamma Knife units, including the skull base and down to the third or fourth vertebra. It also offers enhanced planning, shorter treatment times, greater tissue sparing, and improved patient comfort.
In Mulvihill’s case, Gamma Knife pinpointed the recurring meningioma as well as other smaller formations within her brain. Mulvihill is continuing to undergo therapy to improve speech lost during her multiple surgeries, along with physical therapy for some paralysis on her right arm as well as balance issues. “Besides my head, I’m fine,” said Mulvihill, her sense of humor still fully intact. According to Dr. Cargill Alleyne, Chairman of Neurosurgery at Georgia Regents Neuroscience Center, “From a regional standpoint, we are one of only a handful of centers that is dedicated to multidisciplinary care, offering multidisciplinary clinics, a tumor board, and using novel therapies, including in-house developed protocols. This is unique, and most patients would have to travel hours away to find something similar.”
NEUROSURGERY FAST STATS • The Georgia Regents Neuroscience Center has one of the area’s largest and most diverse team of neurosurgeons, skilled in caring for any neurological condition requiring surgical intervention. • We are expanding our capabilities in radiosurgery, treating not only the brain, but also areas of the spinal cord. We are one of only a handful of sites in the U.S. offering Gamma Knife Perfexion with Extend technology, designed to target tumors in areas where
other modalities may be too dangerous or not effective. Since our inception, we have cared for more than 1,500 patients at our dedicated Gamma Knife Center. • Recent statistics demonstrate that patients who undergo aneurysm surgery at our Endovascular Center recover with half the complication rate as compared to the national average. Our statistics also show zero mortality during carotid surgery to open strokecausing blockages.
INNOVATIONS IN NEUROSURGERY • Radiosensitization Research. Researchers at our center are exploring how certain drugs may cause pituitary tumors and gliomas to be more sensitive to radiation therapy. Radiosensitization could help optimize the effectiveness of Gamma Knife treatment for brain tumors. • Curcumin Connection. Dr. Cargill Alleyne and Dr. Krishnan Dhandapani, who co-direct the GRU Neurovascular Research Laboratory, hope to initiate clinical trials in the future in patients with intracranial hemorrhages, using a potent drug form of the Indian spice curcumin. In studies, the compound — long used in Indian medicine to reduce inflammation — was found to actively engulf blood clots and clear them away. If successful, this would be the first drug developed to help reduce the risk of significant disability from intracerebral hemorrhage. • Glioblastoma Vaccine Trial. The GRU Cancer Center is conducting Phase III clinical trials in patients with glioblastoma, testing the effectivenss of an anti-EGFRvIII vaccine called CDX-110. Earlier studies have demonstrated a 24-month overall median survival compared to 15 months in historical controls.
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EPILEPSY By combining the best aspects of surface and SEEG (stereotaxic EEG) monitoring, a sophisticated approach at the Georgia Regents Epilepsy Center is improving how we identify site onset of intractable seizures. We are also pioneering challenging neurosurgical procedures such as hippocampal multiple subpial transection. The case described below demonstrates how we are continuing to advance our monitoring and surgical techniques to reduce or even eliminate seizures, while helping to preserve language, memory, and other functions important to quality of life.
Thirteen years ago, when she was 31 years old, Sarah Hutcheson experienced her first seizure. Even after surgery had removed a large tumor that had stretched its fingers deep into her brain, the seizures continued. “The Georgia Regents Epilepsy Center is a wonderful place. They’re really caregiving, and they help you Despite an aggressive as thoroughly as they can. Those regimen of medications, people up here — they are really the the seizures were best anywhere.” becoming more Sarah Hutcheson, frequent, until they were seizure free after 10 years occurring twice a month. “People were really kind,” said Hutcheson, who lives in the small south Georgia town of Soperton. “But you never knew when they would happen, and I wanted to try to get out of the position of having so many seizures.”
EPILEPSY FAST STATS • As the first Level IV Epilepsy Center in Georgia and South Carolina (as determined by the National Association of Epilepsy Centers), the Georgia Regents Epilepsy Center annually monitors more than 450 pediatric and adult patients. We have also performed more than 1,250 resective surgeries since our founding.
“Hippocampal MST combines two threads of epilepsy surgery. Math, with the grids, depth electrodes, computers, and stereotaxis — and hard neurosurgery, with microsurgery into the angles of the brain and hippocampus.” Dr. Cole Giller, Neurosurgeon, Georgia Regents Epilepsy Center
• According to our most recent data, our Class I and II outcome for temporal resections is 89 percent, and our Class I and II outcome for extratemporal resections is 71 percent (based on a one-year follow-up). • With a dedicated dietitian on staff, our center is one of only a few offering the ketogenic diet as an alternative form of therapy to reduce seizure frequency and eventually the use of seizure medications and their side effects. The diet may be effective in certain pediatric patients with many areas of seizure focus where surgery is not an option.
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A NEW TYPE OF SEEG MONITORING Hutcheson presented the team of epileptologists and neurosurgeons at the Georgia Regents Epilepsy Center with an interesting but challenging case. Noninvasive monitoring suggested that the seizures originated in the left temporal lobe, but the risk of a disabling memory decline from resection would be high. While most centers typically will place either a surface grid or depth electrodes during invasive monitoring, the team at Georgia Regents Epilepsy Center combines both of these techniques in one surgery — by first placing the grids into the subdural space and then stereotaxically inserting the depth electrodes through the grids, using real-time MRI to guide placement. “This technique is now routine at our center,” said neurosurgeon Dr. Cole Giller. “It gives us the best of both worlds.”
transection, or MST, which uses a series of incisions along the hippocampus to disrupt seizure pathways. “It combines two threads of epilepsy surgery,” said Giller. “Math, with the grids, depth electrodes, computers, and stereotaxis — and hard neurosurgery, with microsurgery into the angles of the brain and hippocampus.” During the awake procedure, Hutcheson was carefully monitored to ensure memory, language, and other functions remained intact. And following the surgery, for the first time in 10 years, she waited for a seizure to come. And waited. A year later, she’s still waiting. Hutcheson is back at work and will soon be off all her epilepsy medications. Her memory is intact, her fatigue is gone — and so is the worry. “I never stopped doing anything because I didn’t want the epilepsy to affect me,” she said. “But I feel good now, I really do. I think the Georgia Regents Epilepsy Center is a wonderful place. They’re really caregiving and they help you as thoroughly as they can. Those people up here — they are really the best anywhere.”
Images from both invasive and noninvasive monitoring are then combined to deliver a more accurate 3-D picture of the seizure focus. “With our advanced monitoring, outcomes are better than with the usual techniques because we have more of an idea as to where the seizure focus is located,” said epileptologist Dr. Yong Park. “It’s more precise, in my opinion, and improves the quality “With our advanced monitoring, outcomes are better than with the of patient care.” usual techniques because we have more of an idea as to where the seizure focus is located. It’s more precise, in my opinion, and improves PUSHING THE LIMITS OF SURGERY the quality of patient care.” In Hutcheson’s case, invasive monitoring confirmed that her Dr. Yong Park, Epileptologist, Georgia Regents Epilepsy Center seizures originated from both the posterior lateral temporal lobe and the mesial structures, including the hippocampus. To better control her seizures and preserve hippocampal function, the team used a new technique performed at only a few centers around the world: hippocampal multiple subpial
KEY FINDINGS FOR EPILEPSY • Neuropace RNS System. Our epilepsy center is one of the original centers involved in the Neuropace RNS System clinical study for patients with medically refractory epilepsy. Neuropace is an implanted therapeutic device that continually monitors the brain’s electrical activity and delivers imperceptible levels of electrical stimulation to normalize brain activity before an individual experiences seizures. The device was approved by the FDA this past November. • Seizure Monitoring in the Neuro ICU. We are also one of the only centers in the state routinely monitoring our neurointensive care unit patients for nonconvulsive seizures. Studies have demonstrated that aggressive treatment of nonconvulsive seizures in patients who have had some sort of neurological injury — including stroke, subarachnoid hemorrhage, or brain trauma — can improve their outcomes. Our center will soon be gathering and analyzing data for outcomes research.
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SPINE CENTER The surgical expertise of the spine surgeons at the Georgia Regents Spine Service continues to attract patients from around the world with high acuity cases, including surgical revision, many of which have been considered inoperable. One recent case involved three years of planning to develop an innovative new technique for pretzeloid spines: A complete trunk shift, which straightened the patient’s spine, alleviated her pain and allowed her to return to her former quality of life.
“When Dr. Choudhri went into surgery, he knew my back frontwards and backwards. I don’t know what all he did, but I know he is a genius. Before this surgery, I knew I was destined to be in a wheelchair. Now, I have hope and plans to do things. I feel like I have a new lease on life, and I do.” Dianne Lemacks, Patient underwent world’s first vertebral column transection at Georgia Regents Spine Service
When Dianne Lemacks presented to the spine specialists at the Georgia Regents Spine Service, the cause of her significant back pain was easy to diagnose, even without a spinal X-ray. Following back surgery 10 years ago for degenerative disc disease, her spine had slowly begun to twist, until it formed a nearly perfect S-curve. The resulting deformity placed her shoulders and her legs out of alignment, affecting her gait and her overall quality of life, even her ability to sleep comfortably in her own bed. Lemacks had consulted surgeons and other physicians for a number of years for her condition, who had prescribed back braces, special footwear, pain medications, and therapy to help assuage her pain, but told her that nothing could be done for the underlying deformity due to her age, 73, and the complexity of her condition.
SPINE FAST STATS â&#x20AC;˘ An emphasis of our spine service is on educating neurosurgeons around the country and the world on the specialized surgical techniques developed by our spine team. We provide free consults, including a detailed report with recommendations; lecture at meetings around the world; and host visiting neurosurgeons who travel to Augusta to view techniques under the guidance of our specialists. â&#x20AC;˘ Patients from across the U.S. and around the world who travel to Augusta for spine surgery benefit from the assistance of a dedicated spine concierge. This person helps patients and families with travel and accommodations, visas, a translator service, and many other aspects of their stay.
ADVANCEMENTS IN SPINE SURGERY • Google Glass First. Spine surgeons at Georgia Regents Spine Service recently became one of the first in the world to use Google Glass during surgery. The optical head-mounted display allowed surgeons to visualize CT scans and other images in real time during surgery. • 3-D Modeling. Planning complex, multistage surgeries can be an involved and lengthy process. The spine team hopes to reduce that time by using a 3-D printer to create models of a patient’s actual spine, to help surgeons better plan osteotomies, and develop new surgical techniques. • Radiation Reduction. The surgical team at the spine service has developed techniques to minimize the amount of radiation used during surgery, reducing the risk of cataracts, skin burns, and even cancer down the road. Through minimal radiation surgery, the team has dramatically cut radiation use down to 10 percent of that used in average spine surgeries.
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MAPPING OUT A NEW SURGICAL TECHNIQUE For patients like Lemacks, Dr. Haroon Choudhri, Director of the Neurosurgery Spine Service, and the multidisciplinary team at the Georgia Regents Spine Service focus on careful, presurgical planning to map out each individual case using drawings and simulations. Many cases of twisted spines involve bone screws, osteotomy slits, and force to bend the spine back into place. Over the course of three years, Choudhri and his team developed a new way to look at the procedure, which would involve less force and could result in an improved outcome. Choudhri looked at shifting the entire trunk so that the patient’s shoulders and toes would be aligned. Known as vertebral column transection, the massive surgery would involve placing the spine in a “railway track” of screws and rods, a single thin cut across the vertebrae in five stages, then a final shift of the trunk in a very controlled manner to minimize any risk of spine damage. At the cut, the bones would then sit against one other and naturally grow back together. “This was a real innovation — designing a way of cutting the spine so it is completely free to move,” said Choudhri. “This type of thin cut has never been done before, but allowing the bone to stick to itself and grow back together offers the best chance of success. In a way, it’s like the magician’s trick of sawing a woman in half.”
“This was a real innovation — designing a way of cutting the spine so it is completely free to move. In a way, it’s like the magician’s trick of sawing a woman in half.” Dr. Haroon Choudhri, Director of the Georgia Regents Spine Service
IMPROVED OUTCOMES IN SPINAL SURGERY Since Lemacks’ spine surgery, she has had no pain. Although Choudhri estimated her recovery would take up to two years, she is now a year out and has returned to an active lifestyle. She has needed only minimal pain medication immediately after surgery, wore a back brace for about 10 months, and is now beginning yoga and other prescribed exercises to strengthen her back. Choudhri is developing an animation and teaching guide for vertebral column transection and plans to publish and present his findings. “Patients with this type of spinal deformity don’t have to languish,” he said. “This is fixable — and with a very gratifying result.”
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PEDIATRIC NEUROSCIENCE As the region’s only team of dedicated pediatric neurologists and neurosurgeons, the Georgia Regents Pediatric Neuroscience Center sees referrals for the widest range of congenital and acquired neurological disorders in children, including epilepsy, cerebral palsy, brain tumors, learning disorders, and their comorbidities. Because we are an academic medical center, we strive toward innovation, including being the first in the nation to offer a new neurosurgical technique for craniosynostosis, a condition affecting 1 in 2,000 live births worldwide. Within a few days of James King’s birth, his mother, Amanda, noticed something wrong with the shape of her son’s head. And her doctors soon confirmed it. Diagnosed with craniosynostosis, James was referred from a community hospital to the Georgia Regents Pediatric Neuroscience Center for treatment. “The care at the Georgia Regents Pediatric Neuroscience Center was excellent. They talked over everything with us and gave us the entire plan written out on how the surgery would be performed, step by step. They were very good at explaining what they were going to do and why.” Amanda King, mother of James, the first child in the nation to benefit from a new technique for craniosynostosis at Georgia Regents Pediatric Neuroscience Center
Since he joined the center two years ago, Dr. Ian Heger, a pediatric neurosurgeon, has been working with pediatric plastic surgeon Dr. Jack Yu to bring his minimally invasive approach to the craniofacial program. The referral was timely: James would be the first child in the nation to benefit from a new spring device developed specifically for craniosynostosis.
NEW INTERVENTIONS, BETTER OUTCOMES Standard treatments for craniosynostosis involve a series of cuts and sutures in the bones of the skull that allow the brain to reexpand and require babies to wear a hard, molded helmet during their first year.
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“We’ve broken new ground. Not only are we setting things up to do a new surgery that’s cutting edge, but we’re trying to understand how this surgery works on these children in a way that no one ever has before.” Dr. Ian Heger, Chief of Pediatric Neurosurgery
The new device pioneered at our center requires only two very small incisions and uses an endoscope to guide the insertion of a specially developed spring device. Similar to an enlarged open paper clip, the device is designed with a certain tension to release over a given amount of time and gently expand the skull as the child’s brain continues to rapidly develop and grow.
BETTER CARE, BIGGER BENEFITS Despite a few complications, James has had a rapid recovery and will return to the children’s hospital in a few months for a second surgery to remove the spring devices. “Even when we first got to go back and see him, we already noticed a difference in him,” said Amanda. Through the new procedure, Heger anticipates patients and their families will benefit from a decreased surgery time, less blood loss, a shorter hospital stay, and a quicker recovery. Heger and his team are also examining the advantages of performing this type of surgery in babies only 3 to 4 months old instead of 6 months and older, as has been the standard.
“Children grow tremendously in that period of time,” said Heger. “There is a renewed interest in thinking that cosmetically, children do better when surgery is performed earlier, but are we also doing anything developmentally, physiologically, or neurologically that’s beneficial?” It’s estimated that 15 percent of children with craniosynostosis will go on to have some type of developmental issue. Data collected at the center on other children who have had early craniosynostosis surgery has already seen improvements in blood flow in the brain. The pediatric neuroscience team is planning to conduct other neurodevelopment assessments to see if they can correlate early surgery with better developmental outcomes.
PEDIATRIC NEUROSCIENCE FAST STATS • Critically ill children in our pediatric intensive care unit and neonatal intensive care can often suffer from underlying seizures that can cause further neurological damage. Our center is focused on supporting 24/7 EEG monitoring to identify these underlying seizures and treat them early. • A fully staffed and dedicated pediatric neurosurgery operating room is available 24/7, with minimally invasive and other technologically advanced equipment that is the same as that in the adult OR but specially sized for pediatric patients. • We continue to be the region’s referral center for pediatric epilepsy, thanks to our Level 4 Epilepsy Center, the highest level attainable as determined by the National Association of Epilepsy Centers. Our pediatric patients benefit from less invasive monitoring techniques as well as leading-edge surgical and medical management of seizures. • A dedicated spasticity clinic uses medications such as Botox injections to help relieve muscle spasms related to cerebral palsy and other congenital disorders. • Children with learning disorders and comorbid conditions benefit from a multidisciplinary model of care in which neurologists, psychologists, and developmental pediatricians at our center work together to manage overlapping problems in a single visit. • Our pediatric neuroscience center also offers the state’s only tuberous sclerosis clinic outside of Atlanta. This rare genetic disorder causes nonmalignant tumors to form in many different organs, including the brain, eyes, heart, kidney, skin, and lungs, and can lead to seizures, developmental delays, intellectual disability, and autism. • Dr. James Carroll is the principal investigator on a multiyear study evaluating the safety and efficacy of a cord blood infusion in children with motor disabilities due to cerebral palsy.
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NEUROLOGICAL DISORDERS For patients struggling with symptoms related to a vast array of general neurological disorders, the Georgia Regents Neuroscience Center offers specialized services that focus on accurate diagnosis and management of these diseases in partnership with the referring physician. Along with care for general conditions such as migraine, neurological pain, vertigo, and neuropathy, our certified ALS clinic and patient-centered MS clinic provide long-term management of these chronic conditions. REGION’S ONLY CERTIFIED ALS CLINIC According to Dr. Michael Rivner, Director of the ALS Clinic at the Georgia Regents Neuroscience Center, patients with ALS typically die within five years of the initial symptoms of the disease. Diagnosing these patients as soon as possible and involving them in our multidisciplinary ALS Clinic for care and support is his highest priority. Currently, about 150 patients from Georgia, South Carolina, and beyond receive care at two ALS clinic locations — one in Augusta and one in Macon. Patients with symptoms of ALS receive extensive electrodiagnostic testing to make the diagnosis — then Rivner and his team spend an equally lengthy amount of time to discuss the diagnosis and what it means to the patient and his or her family. As the region’s only ALS clinic certified by the national ALS Association (and the only center certified in Georgia), our multidisciplinary program is designed so that patients see all their specialists in a single visit, including neurologists; physical, occupational, and speech therapists; dietitians; and equipment vendors, including augmentative communication specialists, respiratory equipment dealers, wheelchair vendors, and more. In addition, we have a close partnership with the ALS Association of Georgia, the ALS Association of South Carolina, and the Muscular Dystrophy Association, who help provide counseling services and social work support for the clinic as well as help patients with the high costs of living with ALS. Patients also benefit from state-of-theart treatment and active clinical trials. “While unfortunately, we can’t cure this disease, this doesn’t mean there’s nothing we can do,” said Rivner. “There are many things that can make life for patients with ALS better. The outlook for ALS is far better than it was 30 years ago.”
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COMPREHENSIVE CARE FOR MULTIPLE SCLEROSIS For patients diagnosed with multiple sclerosis, the news can be overwhelming. The Augusta MS Center, part of the Georgia Regents Neuroscience Center, is a comprehensive, family-centered care facility dedicated to the diagnosis and treatment of multiple sclerosis and related diseases. The center has a strong, well-trained clinical team, able to address the complex needs of people with MS in an integrated manner. The MS center focuses on an individualized approach to treatment, and the staff encourages patients to be actively involved in all aspects of their care. The center has extensive experience with immune-modulating therapies to include injectable, oral, and on-site infusion therapies. Management of the symptoms related to multiple sclerosis improves patient function and quality of life.
Patient and family health education is an important part of our approach to patient care. Specialized services include intrathecal baclofen for spasticity, driving assessments in the on-campus Driving Simulation Lab, psychological services, cognitive assessments, rehabilitation services, and consultation by neuro-ophthalmology and urology. Patients also receive routine depression screenings, since many MS patients report an impact to their emotional wellbeing related to their diagnosis. Free patient and family counseling and a support group are available. As the only MS clinic in Georgia outside of Atlanta — and with no MS center located in the state of South Carolina — the Augusta MS Center sees a wide catchment of patients from across the two states.
“When I come to the Augusta MS Center, they give you support, and if you have questions you want to ask, there’s a lot of one-on-one time. I love my care. It’s very personal, and you feel very important to the care team. They will strive to do what’s best for you and offer you the best care that’s out there. They treat you like family, they really do. I had more questions answered and more attention in my first clinic visit than I had in any other appointment with any kind of doctor.” Ben Huff, has lived successfully with MS for 15 years
INNOVATIONS IN NEUROLOGICAL DISEASES • ALS Drug Trials.The ALS Clinic is actively involved in Phase II multicenter trials for the drugs fingolimod and tirasemtiv. It’s believed that fingolimod may block certain immune cells from entering the brain and spinal cord where they can cause activities that result in damage to motor neurons. Tirasemtiv may facilitate muscle contraction in those with ALS by sensitizing muscle fibers to calcium. • Potential ALS Biomarkers. The ALS Clinic has also gathered clinical data on an ongoing basis to help identify antibodies and potential biomarkers for ALS. A paper is pending publication. • Myasthenia Gravis Multicenter Study. Dr. Rivner and Dr. Lin Mei, a GRU neuroscientist, recently identified a novel biomarker for the autoimmune neuromuscular disease myasthenia gravis. They found that an antibody to the protein LRP4 is a cause of this disease in up to 10 percent of patients, and the department hopes to soon launch a multicenter study. • MS Drug Trials. The Augusta Multiple Sclerosis Center is actively recruiting for multiple pharmaceutical studies evaluating benefits and adverse effects of disease-modifying medications to slow the progression of multiple sclerosis. One study evaluates the effects of transitioning from natalizumab to fingolimod. Others monitor the adverse effects that patients may experience from oral DMTs, including dimethyl fumerate and fingolimod. • Fitness to Drive. In association with the driving simulator lab at the GRU physical therapy department, the MS center is conducting a fitness to drive study in which participants with MS symptoms that limit their driving ability can receive driving rehabilitation to safely get back on the road.
PSYCHOLOGICAL STUDIES The MS center continues to conduct a variety of research studies in collaboration with The Department of Psychology, most recently evaluating: • Health promotion model for treatment and adherence and quality of life with MS • Cognitive fusion mediating the impact of stigma on well-being in adults living with MS • Impact of routine depression screenings on provider behavior • Stress management in caregivers of persons with MS • Impact of MS on sexual function and communication • Variables associated with patient activation in persons with MS
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NEUROLOGICAL DISEASES FAST STATS • The Augusta MS Center is a member of the Consortium of MS Centers. It is also affiliated with the Georgia Chapter and the South Carolina Regional Office of the Mid-Atlantic Chapter of the National Multiple Sclerosis Society and was recently recognized by the society as a Comprehensive Care Center for MS.
• Pyschological services at the Augusta MS Center have gained national and international attention as a model for care at various MS conferences, such as the 22nd European Committee on the Treatment and Research of Multiple Sclerosis in Madrid, Spain.
• The ALS Clinic at Georgia Regents Neuroscience Center is only one of 34 centers certified by the national ALS Association, and the only such center in Georgia. It also has locations in both Augusta and Macon.
• An annual walk and an inaugural golf tournament are just a few of the fundraisers hosted by the ALS Clinic to help provide support for patients living with the disorder. Last year’s walk raised nearly $70,000.
“Dr. Rivner and the ALS Clinic have been great. They’ve been there for us, and when we had questions, they had the answers. It’s also great to have it this close. The support of it — that’s the thing. I don’t know what people did years ago when there was nothing. The clinic here has people who care and who are working to bring an end to this thing.” Leslie Holmes, husband to Debbie, diagnosed with ALS two years ago
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MOVEMENT AND COGNITIVE DISORDERS CENTER On the one hand, Parkinson’s disease and Alzheimer’s disease are very different. But on the other, they are the same. Both brain disorders have similar disease processes, and both are challenging for physicians to manage and treat. The new Movement and Cognitive Disorders Center — part of the Georgia Regents Neuroscience Center — was designed to bring together the expertise of our interdisciplinary team and our clinical researchers to help improve patients’ and caregivers’ quality of life and uncover new treatments. If you examined the brain of a Parkinson’s disease patient and one of an Alzheimer’s disease patient, you would see many of the same neurodegenerative processes at work, causing movement disorders and perhaps later dementia in the one and memory disorders in the other. But while science has grasped an understanding of how these two diseases develop, the challenge continues to be identifying optimum treatment, if not a cure. This was the impetus for the new Movement and Cognitive Disorders Center, part of the Georgia Regents Neuroscience Center. The center brings together “I don’t know anything different from our National Parkinson Foundation Center of Excellence in [the Movement and Cognitive Disorders Center]. GRU is the only place that has Movement Disorders/Parkinson’s Disease as well as Georgia’s a movement disorders program here, only dedicated Alzheimer’s clinic outside of Emory University and they’ve been such a help. Let me in Atlanta. put it this way: It’s just being able to talk with Dr. John Morgan and the clinic, Led by Drs. Kapil D. Sethi and John C. Morgan, board-certified getting updates, and telling him what’s neurologists, a focus of the center will be on exploring drug going on. I’m being kept ahead of things [treatment-wise].” and other therapies to help treat and slow down progression of these diseases. In addition, the center will continue to work Frank Tobakos, on improving overall quality of life for these patients and their Parkinson’s patient for the past six years families. “We have a regional impact, not just a Georgia impact,”
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“My family and I feel blessed to be under the care of Dr. John Morgan and his team at Georgia Regents Movement and Cognitive Disorders Center. My mother has had compassionate care during a recent new difficult diagnosis. Our family was impressed with the overall experience and are thankful to have such a wonderful team to help with our mother’s care.” Kathy Chavis, family member
said Morgan. “Our focus is on delivering the best patient care we can for all forms of movement and cognitive disorders.”
PARKINSON’S DISEASE CARE: A TRADITION OF EXCELLENCE Our movement disorders/Parkinson’s disease program recently earned its redesignation as a Center of Excellence by the National Parkinson Foundation. Since we first earned our designation more than a decade ago, we have continued to be the only Movement Disorders/Parkinson’s Disease Center of Excellence in Georgia and South Carolina, and we join only 24 such centers in the U.S. The “Center of Excellence” designation means that we meet rigorous criteria for research, comprehensive care delivery, professional education, and patient outreach services. For medication-resistant Parkinson’s disease, our center has a nearly 30-year history of surgical interventions, and our deep brain stimulation program has been active for almost two decades. We carefully select our patients, who benefit from individualized programming of the DBS device, either by our physicians or the referring physician. Over the past four years, we have performed more than 220 procedures for movement disorders with excellent results and low morbidity. As part of our emphasis on delivering the best care and treatment for patients with Parkinson’s disease or related disorders, Morgan travels around the country, lecturing to physicians; physical, occupational, and speech therapists; social workers; and others about Parkinson’s disease and how to better care for these patients. Sethi also lectures physicians,
caregivers, and therapists about Parkinson’s disease, both in the U.S. and internationally, serving as an international leader in the field of movement disorders. In total, more than 700 patients with Parkinson’s disease — and an additional 300 with parkinsonism — receive care at our center.
PARTNERSHIPS IN ALZHEIMER’S DISEASE The Alzheimer’s program transitioned from Dr. Suzanne Smith to Morgan this past year but continues to provide the same interdisciplinary care for patients and families affected by Alzheimer’s disease and other memory disorders. Patients also continue to benefit from the center’s strong partnership with the Alzheimer’s Association Augusta regional office, which supports the clinic with helpful resources, including access to local support groups. At the clinic, patients start with a full evaluation by Morgan, with the assistance of his physician assistant, Elizabeth Prince-Coleman. Many patients are also referred for neuropsychological assessment by Dr. Greg Lee, a board-certified neuropsychologist. A neuropsychological assessment provides the basis for a treatment plan and any updates. Few centers in this area have a full-time neuropsychologist on staff providing this kind of assessment for patients with neurological disorders. Patients with other memory disorders, including mild cognitive impairment and stroke-related memory impairment, are also seen at the center.
MOVEMENT AND COGNITIVE DISORDERS FAST STATS • Our center facilitates access to local support groups for Parkinson’s disease and Alzheimer’s disease, with physicians and staff often attending these meetings and speaking on disease-related topics. • Parkison’s disease patients can also benefit from our partnership with the Family Y, which offers a swimming and exercise program designed specifically for patients with movement disorders.
• Our Alzheimer’s program’s interdisciplinary team includes a dementia specialist, physician assistant, psychiatrists, clinical psychologists, and an experienced neuropsychologist to assess patients with Alzheimer’s disease or other memory disorders. • Future plans for the Movement and Cognitive Disorders Center include launching a philanthropic campaign to construct a dedicated center focusing on clinical care and research in a single location.
IMPROVING CARE FOR MOVEMENT AND COGNITIVE DISORDERS • “Wii-hab” for Parkinson’s. The Nintendo Wii gaming system has been found to have significant benefits for patients with Parkinson’s disease, according to a recent study by Dr. Nathan “Ben” Herz from our center, now heading the occupational therapy program at Mary Baldwin College. The study, which was published in the journal Parkinsonism & Related Disorders, demonstrated that Wii therapy provides improvements in short-term motor and nonmotor skills, mood, and overall quality of life. • Ongoing Drug Trials. Our movement disorders program has many ongoing studies of drugs that attack Parkinson’s disease in its many different stages, including slowing disease progression, improving dyskinesias related to levodopa therapy, treating the disease’s neuropsychiatric and cognitive effects, treating autonomic symptoms, and improving motor function. In addition, our Alzheimer’s program is working with pharmaceutical companies and other sources to become involved in clinical trials for Alzheimer’s disease. • Memory Mechanism. Dr. Joe Tsien of the GRU Brain & Behavior Discovery Institute has identified an NMDA receptor in animal models that controls the development of memory patterns, which has promise in helping researchers understand the mechanisms behind Alzheimer’s disease and could lead to better treatments.
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NEURO CRITICAL CARE CENTER Critically ill patients with neurological conditions benefit from the area’s only dedicated Neuro Critical Care Center staffed by fellowship-trained neurointensivists. Opened in 2003, the center includes an 18-bed neuroscience intensive care unit as well as a 16-bed neuroscience floor, with specially trained staff providing continuous monitoring for patients recovering from a host of neurological disorders that impact critical bodily functions. For neurointensivists Dr. Subhashini Ramesh and Dr. Alfredo Garcia, the benefit of a dedicated Neuro Critical Care Center for patients with devastating neurological injuries or conditions is clear: its special expertise in caring for complex patients recovering from stroke, aneurysm or brain hemorrhage, brain swelling or infection, brain tumors, seizures, spine and other neurosurgeries, and many other disorders.
ON THE HOUR, EVERY HOUR “People trained in neurocritical care typically understand not just the critical care aspect of medicine, but also have special expertise in the brain itself. You have an edge when you’re being treated by a neurointensivist in that situation.”
While all critical care units are staffed by critical care intensivists, the role of neurointensivists is a fairly new one. At Georgia Regents Neuroscience Center, our neuro ICU is staffed by the region’s only neurointensivists, who are fellowship trained in neuro critical care.
An important part of their role is the continual monitoring and assessment of each of the critically ill patients on the unit. Every hour, neurointensivists perform a neurological exam on the neuro ICU patients to assess brain activity and monitor sometimes rapidly occurring neurological changes. “If the brain is affected [by a complication], the exam is often the only thing that gives an indication of change in the patient,” said Ramesh. “The neurological exam is the mirror of the brain for us.”
Dr. Subhashini Ramesh, Neurointensivist, Georgia Regents Neuroscience Intensive Care Unit
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REGION’S ONLY ROUTINE EEG MONITORING FOR SEIZURES Based on that exam, the neurointensivists can then order specific interventions. One of these is EEG monitoring to help identify nonconvulsive seizures. This type of monitoring is unique in the ICU setting but has garnered national attention for its role in identifying these subclinical seizures, which show no outward sign but can lead to poorer outcomes in patients. The Georgia Regents Neuro Critical Care Center is the only one in the state, outside of Atlanta, that routinely performs EEG monitoring in the ICU. Dr. Deborah Moore-Hill, an epileptologist who is fellowship trained in both neurophysiology and epilepsy, performs EEG monitoring on certain patients who may be at risk for these types of seizures. These include patients who demonstrate more impairment than the neurointensivists expect based on their known neurological injuries. The continual monitoring allows the physicians to review data in real time and deliver aggressive treatment for seizures, with no delay. “Studies have shown that in patients with intracerebral hemorrhage, if they were allowed to have uncontrolled subclinical seizures, it worsens their overall clinical outlook,” said Moore-Hill.
A MODEL FOR CARE Since the unit opened in 2003 as a model unit for patient- and familycentered care, the Neuro Critical Care Center has continued to model improved care for other ICUs throughout the nation as well as our own health system. For example, the ICU is staffed by dedicated neuroscience nurses at a 1:2 nurse to patient ratio goal. These nurses are specially equipped to handle changes on a patient’s neurological exam. Recent quality initiatives have included tracking data on external ventricular drains for hemorrhages and ventriculitis rates after EVD placement. As part of Georgia Regents Health System’s philosophy of Patient- and Family-Centered Care, the Neuro Critical Care Unit continues to invite families to remain with patients 24/7 in the neuroscience ICU, which is atypical in most ICU settings.
“We have the capability to handle any nervous system problem. And that’s really important to support the mission of treating anything that comes through the door, no matter how complex … Often the patient’s health is the biggest part of the problem. So having the ability to provide extremely high level critical care with very dedicated professionals supporting the patients and taking care of the patients is a huge asset.” Dr. John Vender, Neurosurgeon, Georgia Regents Neuroscience Center
NEURO CRITICAL CARE FAST STATS • The Georgia Regents Neuro Critical Care Unit is staffed by the region’s only neurointensivists trained in critical care specific to neurological disorders. • Patients also benefit from a 1:2 nurse to patient ratio, routine EEG monitoring for nonconvulsive seizures (a major factor for poor outcomes), as well as other quality improvement measures. • Unlike most ICUs, families are welcome to remain with patients 24/7. As part of our patient- and family-centered philosophy, we always empower patients and families so they can be knowledgeable and involved in their own care.
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RESEARCH Many describe the human brain as the last frontier in science. Neuroscience research received a catalyst last year when President Barack Obama invited the scientific community to join him in the BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies). The initiative focuses on inspiring scientists to a better understanding of the brain and translating that understanding into new ways to treat, prevent, and even cure brain disorders. The top-tier basic and clinical research at the Georgia Regents Neuroscience Center is taking on that challenge.
“Hemorrhagic stroke is a dire disease, with no treatment options and limited surgical options. Our curcumin project illustrates the point of our lab — to get a basic science finding and get it across that magical wall that separates MDs from PhDs.” Dr. Krishnan Dhandapani, GRU Neurovascular Lab
Imagine it: A patient comes in complaining of fatigue, excessive thirst or hunger, blurry vision, and tingling. If doctors didn’t have a clinical understanding that these symptoms in conjunction with low glucose levels meant diabetes, it would be difficult, if not impossible, to treat this disease. This is why neuroscientists at Georgia Regents University continue to move forward on decoding how the brain works — to devise new mechanisms to treat common disorders and conditions such as Alzheimer’s disease, Parkinson’s disease, schizophrenia, traumatic brain injury, and more.
As part of an academic health center, the Georgia Regents Neuroscience Center is uniquely positioned to benefit from on-campus research in real time. The partnership of our clinicians with our longstanding neuroscience research program continues to produce translational discoveries that benefit our patients and families.
A MEMORY SWITCH? Even before President Obama announced the BRAIN Initiative last year, neuroscientists at GRU already had nearly seven years of work into brain activity mapping through support from the Georgia
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“The idea is to try to develop new tools that allow you to listen in to brain conversation, to understand what it says and how it generates memories, thoughts, and actions. Understanding the brain code is essential to understanding all sorts of mental problems, including brain aging.” Dr. Joe Tsien, Co-Director, GRU Brain and Behavior Discovery Institute
Research Alliance. “We’re producing initial success in decoding the brain activities underlying memory,” said Dr. Joe Tsien, CoDirector of the GRU Brain and Behavior Discovery Institute. “Now for the first time, we are able to crack the neural code.” Tsien and his research team have identified an NMDA receptor in the hippocampus that helps control learning and memory. When this “switch” is turned off or disabled in animal models, not only is their memory code faulty, but they also have difficulty retrieving these memories. This finding is a breakthrough in aiding scientists to understand all types of mental disorders, including brain aging, and could assist in the development of better treatments for schizophrenia, bipolar disorder, and Parkinson’s disease.
A BREAKTHROUGH IN BRAIN BLEEDING Patients with intracerebral hemorrhages have few options. Surgery has been found to be of little to no benefit, and more often than not, these
patients languish for weeks in a neurointensive care unit, waiting for the body to heal itself — and live the rest of their lives with significant disability. But for these patients, there is now hope. Nearly five years ago, Dr. Cargill Alleyne, Dr. Krishnan Dhandapani, and the research team in the Neurovascular Research Laboratory made an astounding finding: The Indian spice, curcumin — long used in Indian medicine to reduce inflammation — actively engulfs the blood clots in intracerebral hemorrhage, clearing them away. Further research demonstrated that curcumin works by increasing the rate of phagocytosis in macrophages. Dhandapani and Alleyne are currently working with East China Normal University to develop a more potent drug form of the Indian spice. “Because curcumin is a proven safe compound, even if only 10 percent of patients benefit, there is no risk and high reward. And what if a majority of people respond?” said Dhandapani. “The potential is that this could be one of the next big drugs for patients with this devastating condition.”
“How do you know if it’s myasthenia gravis if you don’t have a diagnosis? Without it, a patient is just left hanging — they’re wondering, they’re anxious. We believe that we can better characterize myasthenia gravis patients. If this biomarker correlates with their symptoms, their entire treatment would be very different.” Dr. Lin Mei, GRU Department of Neuroscience and Regenerative Medicine
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STRENGTHENING RESEARCH INTO NEUROLOGICAL AND PSYCHIATRIC DISEASE Bringing together the strength of GRU’s vast resources in neuroscience and stem cell research is the focus of the new Department of Neuroscience and Regenerative Medicine. Led by Dr. Lin Mei, a neuroscientist and expert in brain cell communication who has directed MCG’s Institute of Molecular Medicine and Genetics for six years, the department is poised to expand innovative translational neuroscience research, as well as medical and graduate school education and postdoctoral mentoring — to engage the next generation of neuroscientists. This research includes recent innovations such as the development of a schizophrenia mouse model, in which scientists can manipulate levels of the protein neuregulin-1, which is found at higher levels in some schizophrenia patients. Mei and neurologist Dr. Michael Rivner also recently identified a novel biomarker for myasthenia gravis: An antibody to the protein LRP4 has been identified as a cause of this disease in up to 10 percent of patients, and the department hopes to soon launch a multicenter study.
With the addition of regenerative medicine to the program, Mei also anticipates exploring the potential of this therapy in many fields. “These terrific leaders will work closely and collaboratively with Drs. David Hess and Cargill Alleyne in our Departments of Neurology and Neurosurgery as well as Dr. Joe Tsien in the Brain and Behavior Discovery Institute and many others across our campus and the world to advance our understanding and treatment of the brain,” said Dr. Peter Buckley, Dean of the Medical College of Georgia at Georgia Regents University. “Collectively, these strategic realignments enhance our focus on neuroscience across clinical, basic science, and translational realms.”
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HOW TO REFER PATIENTS
As the Southeast’s regional referral center for patients with chronic or acute neurological conditions, we would be glad to provide specialty or subspecialty care, a second opinion, or work with you to manage your patient’s condition. Call 706-721-4581
Fax 706-721-1459
Contact the Georgia Regents Neuroscience Scheduling Center directly with: • Patient’s name, contact information, and insurance information • Diagnosis • Specialty requested • Referring physician’s name and contact information
The referring physician’s office may fax over a request, including: • Patient’s name, contact information, and a copy of the patient’s insurance card • Diagnosis • Specialty requested • Referring physician’s name and contact information
If the patient is still at your office, we can arrange for a specific appointment that works with your patient’s schedule. Or we will contact the patient directly by telephone to set up an appointment. We will also ask you to send over a copy of the patient’s medical record (including insurance card), lab results, or imaging studies.
The Georgia Regents Neuroscience Scheduling Center will contact your office for copies of medical records, lab results, or imaging studies and will contact the patient directly by telephone to set up an appointment.
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WORKING WITH THE GEORGIA REGENTS NEUROSCIENCE CENTER With busy specialty and subspecialty clinics, our goal is to ensure that your patients are seen as soon as possible. Our dedicated schedulers have direct access to all our providers’ calendars and will work to accommodate your patients with an appointment at the earliest time available. Urgent patient referrals are reviewed immediately by a physician medical director so that we can schedule appointments within one to two days. For emergent situations, please use our Level I Trauma Center and Emergency Department. We also strive to consistently provide feedback and physicians’ notes so that you can remain updated on your patient’s status.
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PHYSICIANS: NEUROSURGERY
CARGILL H. ALLEYNE JR., MD
HAROON F. CHOUDHRI, MD
Professor and Chairman, Neurosurgery Director, Neurosurgery Vascular Service Director, Residency Program Co-Director, Neurosurgical Intensive Care Unit Co-Director, Cardiovascular Research Laboratory
Professor and Chief Section of Adult Neurosurgery Director, Neurosurgery Spine Service Director, Neurosurgery Spine Fellowship
Specialty: Neurosurgery, cerebrovascular, brain tumors, spine
Clinical Interests: Bloodless medicine program, complex (revision/reoperative) spine surgery, cervical spine surgery, thoracic spine surgery, lumbar spine surgery, spine tumors, neck-armlow back pain, minimally invasive spine surgery, endoscopic spine surgery, scoliosis/deformity surgery, craniocervical junction surgery, occipital cervical fusion, spinal fusion, thoracic discectomy, spinal stenosis, spondylolysis/spondylolisthesis, cervical spondylotic myelopathy, ossification of the posterior longitudinal ligament, spinal vascular lesions, surgery for spine trauma/ fractures, image guided spine surgery
Clinical Interests: Vascular diseases of the brain and spinal cord, stroke and TIAâ&#x20AC;&#x2122;s, brain aneurysms (surgery and coiling), brain vascular malformations, carotid stenosis, endovascular surgery, Gamma Knife radiosurgery, skull base brain tumors, spine surgery, general neurosurgery
Specialty: Neurosurgery, complex spine surgery
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COLE A. GILLER, MD, PHD, MBA, FACS
IAN HEGER, MD, FAAP, FACS
Professor, Neurosurgery Director, Functional and Stereotactic Neurosurgery
Assistant Professor, Neurosurgery Pediatric Neurosurgery Section Chief
Specialty: Neurosurgery, functional neurosurgery
Specialty: Pediatric neurosurgery, neuro-oncology
Clinical Interests: Epilepsy surgery, surgery for Parkinsonâ&#x20AC;&#x2122;s disease, tremor and other movement disorders, Gamma Knife radiosurgery, brain tumors
Clinical Interests: Craniosynostosis and craniofacial disorders, brain and spinal cord tumors, spasticity, spina bifida, tethered cord, vascular malformations, and chiari malformations
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S. DION MACOMSON, MD
SCOTT RAHIMI, MD
Assistant Professor, Neurology Assistant Director, Residency Program
Assistant Professor, Neurosurgery Specialty: Neurosurgery, cerebrovascular, spine
Specialty: Pediatric neurosurgery, spine surgery, general neurosurgery Clinical Interests: Hydrocephalus, ventricular endoscopy, brain tumors, peripheral nerve entrapment, cervical and lumbar spine disease
Clinical Interests: Aneurysms, arteriovenous malformations, tumors, dural arteriovenous fistulas
JONATHAN TUTTLE, MD
JOHN R. VENDER, MD
Assistant Professor, Neurosurgery and Orthopaedics
Professor and Vice Chairman, Neurosurgery Medical Director, Gamma Knife Center Co-Director, Georgia Center for Skull and Base Surgery
Specialty: Neurosurgery, with focus on complex spine surgery Clinical Interests: Complex spine surgery, cervical, thoracic, and lumbar degenerative diseases, minimally invasive spine surgery, kyphoplasty, spine trauma and revision spine surgery
Specialty: Neurosurgery, skull base tumors, spine surgery, spinal stimulator implant Clinical Interests: Adult brain tumors, pituitary tumors, craniocervical junction, stereotactic surgery, head injury, spasticity, Gamma Knife radiosurgery, normal pressure hydrocephalus, implantable pain management and therapy
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PHYSICIANS: NEUROLOGY
DAVID C. HESS, MD
DEBORAH BOLAND, DO
Chairman and Professor of Neurology Presidential Distinguished Chair Joint Appointment, Institute of Molecular Medicine and Genetics and School of Graduate Studies
Assistant Professor
Specialty: Vascular neurology, internal medicine, neurology Clinical Interests: Treatment of acute ischemic stroke and research on stroke prevention and cell therapy for stroke
Specialty: Movement disorders Clinical Interests: Parkinsonâ&#x20AC;&#x2122;s disease, spasticity, deep brain stimulator programming, botulinum toxin injections for dystonia, hemifacial spasm, blepharospasm, and sailorrhea
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ASKIEL BRUNO, MD
JAMES CARROLL, MD
Professor, Neurology
Professor, Neurology and Pediatrics Chief, Child Neurology Section
Specialty: Neurology, vascular neurology Specialty: Pediatric neurology, pediatrics Clinical Interests: Cerebrovascular disease Clinical Interests: General child neurology, neuromuscular disorders, metabolic diseases, cerebral palsy
MORRIS J. COHEN, EDD
J. EDWARD HARTMANN, MD
Professor, Neurology, Pediatrics, and Psychiatry Director, Pediatric Neuropsychology Service
Associate Professor, Neurology
Specialty: Pediatric neuropsychology Clinical Interests: Children with learning disabilities, attention deficit disorder, epilepsy, brain tumors, traumatic brain injury, stroke and other neurological disorders which affect learning and behavior
Specialty: Neurology, clinical neurophysiology, electrodiagnostic medicine Clinical Interests: Myasthenia gravis, ALS, myopathies, peripheral neuropathies, carpal tunnel syndrome
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GREGORY P. LEE, PHD, ABPP
DEBRA MOORE-HILL, MD
Professor, Neurology Director, Adult Neuropsychology Service
Assistant Professor, Neurology Director of Continuous Prolonged EEG Monitoring
Specialty: Neuropsychology Specialty: Epilepsy Clinical Interests: Neuropsychological assessment, evaluation of cognitive and personality functions in patients with known or suspected brain disease or trauma, intracarotid sodium amobarbital (Wada) procedures on epilepsy surgery candidates, cortical mapping of sensorimotor and language areas and evaluation of memory during neurosurgery
Clinical Interests: Epilepsy, continuous ICU EEG, clinical neurophysiology
JOHN C. MORGAN, MD, PHD
ANTHONY M. MURRO, MD
Associate Professor, Neurology
Professor, Neurology Director, Neurodiagnostic Lab
Specialty: Movement disorders Specialty: Epilepsy, clinical neurophysiology Clinical Interests: Parkinsonâ&#x20AC;&#x2122;s disease, movement disorders
Clinical Interests: Epilepsy, clinical neurophysiology
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FENWICK T. NICHOLS III, MD, FACP
YONG D. PARK, MD
Professor, Neurology and Radiology Director, Neurosonology Labs Director, Vascular Neurology Fellowship
Professor, Neurology and Pediatrics Director, Epilepsy Monitoring Unit
Specialty: Neurology, vascular neurology, internal medicine Clinical Interests: Cerebrovascular disease (stroke), ultrasound examination of cerebral vascular system circulation
Specialty: Epilepsy (child), pediatric neurology, sleep medicine, clinical neurophysiology Clinical Interests: Evaluation of pediatric epilepsy surgery, childhood seizure disorders, sleep disorders in children, and narcolepsy
J. NED PRUITT II, MD
SUBHASHINI RAMESH, MBBS
Professor, Neurology Director, MCG Neurology Residency Program
Assistant Professor, Neurology Specialty: Neuro Critical Care
Specialty: General neurology, neuromuscular diseases, headaches Clinical Interests: Neuromuscular diseases, headaches
Clinical Interests: Neuro critical care, cerebrovascular disease
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MICHAEL H. RIVNER, MD
ELIZABETH SEKUL, MD
Charbonnier Professor, Neurology Director, Electrodiagnostic Medicine Laboratory Director, Clinical Neurophysiology Training Program Director, ALS Clinic
Associate Professor, Neurology, Pediatrics and Child Neurology
Specialty: Neurology, clinical neurophysiology, pain management
Clinical Interests: Muscular dystrophies, cerebral palsy, migraines and pediatric movement disorders, spasticity, clinical neurophysiology
Specialty: Pediatric neurology, electrodiagnostic medicine
Clinical Interests: Neurology and neurophysiology, neuromuscular diseases, electromyography, botulinum injections, computer applications in neurology
KAPIL D. SETHI, MD, FRCP
SUZANNE H. SMITH, MD
Professor, Neurology Director, Movement Disorders Program
Associate Professor, Neurology Director, MS Clinic
Specialty: Movement disorders
Specialty: Multiple Sclerosis, general neurology, memory disorders
Clinical Interests: Research on Parkinsonâ&#x20AC;&#x2122;s disease and other movement disorders
Clinical Interests: Multiple sclerosis, dementia
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SHANNON STEWART, MD
SUZANNE STRICKLAND, MD
Assistant Professor, Neurology Savannah, GA Campus
Assistant Professor, Neurology and Pediatrics
Specialty: Vascular neurology, neurology Clinical Interests: Stroke, teleneurology, neuro hospitalist
Specialty: Epilepsy, neurology, pediatric neurology Clinical Interests: Epilepsy, pediatric neurology
THOMAS R. SWIFT, MD
JEFFREY A. SWITZER, DO, MCTS
Professor Emeritus and former Chairman, Neurology Former President, American Academy of Neurology
Associate Professor, Neurology Director, Telestroke and Teleneurology Director, Comprehensive Stroke Center
Specialty: Neurology Clinical Interests: General adult neurology
Specialty: Vascular neurology, acute stroke treatment Clinical Interests: Teleneurology, acute stroke treatment, telestroke, uncommon causes of stroke
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JILL TRUMBLE, MD Assistant Professor, Neurology Savannah, GA Campus Specialty: Movement disorders Clinical Interests: Treatment of a multitude of movement disorders through programming of deep brain stimulators and chemodenervation with botulinum toxin
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RESEARCH FACULTY: NEUROLOGY
Lin Mei, MD, PhD Professor, Department of Neurology Institute of Molecular Medicine and Genetics, School of Graduate Studies Director, Institute of Molecular Medicine and Genetics Georgia Research Alliance Eminent Scholar Joe Z.Tsien, PhD Professor, Department of Neurology, Medical College of Georgia Co-Director Brain and Behavior Discovery Institute Georgia Research Alliance Eminent Scholar in Cognitive and Systems Neurobiology
Darrell Brann, PhD Regentsâ&#x20AC;&#x2122; Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies Director, Graduate Program in Neuroscience Associate Director, Clinical Affairs, IMMAG David T. Blake, PhD Associate Professor, Department of Neurology, Institute of Molecular Medicine and Genetics Bo-Shiun Chen, PhD Assistant Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies Sean P. Didion, PhD Adjunct Assistant Professor, Department of Neurology
Quansheng Du, PhD, DSc Associate Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies Julietta Frey, PhD Charbonnier Professor MCG Full Professor Department of Neurology BBDI-Memory and Cognition Program Jimok Kim, PhD Assistant Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies Lynnette McCluskey, PhD Associate Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies
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Albert Pan, PhD Assistant Professor, Department of Neurology Institute of Molecular Medicine and Genetics
Phillip Wang, PhD Assistant Professor, Department of Psychiatry and Health Behavior Brain and Behavior Discovery Institute Memory and Cognition Program
Nilkantha Sen, PhD Assistant Professor, Department of Neurology Institute of Molecular Medicine and Genetics
Wei-Hua Wu, PhD Assistant Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies
Almira Vazdarjanova, PhD Assistant Professor, Department of Pharmacology and Toxicology, Brain and Behavior Discovery Institute Memory and Cognition Program, School of Medicine
Wen-Cheng Xiong, PhD Weiss Research Professor, Department of Neurology, Institute of Molecular Medicine and Genetics, School of Graduate Studies Jianhua Xu PhD Assistant Professor, Department of Neurology, Institute of Molecular Medicine and Genetics
Robert K. Yu, PhD, MedScD Professor and GRA Eminent Scholar, Institute of Molecular Medicine and Genetics Director, Institute of Neuroscience Quanguang Zhang, PhD Assistant Professor, Department of Neurology Institute of Molecular Medicine and Genetics
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RESEARCH FACULTY: NEUROSURGERY
Krishnan Dhandapani, PhD Associate Professor, Department of Neurosurgery Co-Director, Cerebrovascular Research Laboratory Kirov A. Sergei, PhD Associate Professor, Department of Neurosurgery, School of Graduate Studies, Brain and Behavior Discovery Institute - Memory and Cognition Program, Institute of Molecular Medicine and Genetics Director, Human Brain Lab Ioulia Fomitcheva, PhD Assistant Research Scientist, Department of Neurosurgery - Human Brain Laboratory Sangeetha Sukumari-Ramesh Assistant Research Scientist Department of Neurosurgery
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PUBLICATIONS
American Journal of Managed Care. 2012 Aug;18
British Medical Journal Case Reports. 2012
Clinical Rehabilitation. 2013 [e-pub: February
(5 Suppl):S83-8. Sethi KD, Mehta SH. “A clinical
Jun 28. Hughes DG, Alleyne CH. “Rare giant
14, 2013, doi: 10.1177/0269215512470674.]
primer on restless legs syndrome: what we
traumatic cervical arterio¬venous fistula in
Bruno A, Close B, Gomadam A, Switzer
know, and what we don’t know.”
neurofibromatosis type 1 patient.”
JA, Hess DC, Gross H, Akinwuntan A, and
BMJ Case Reports. 2013 Jan 11[doi:10.1136/
Circulation: Cardiovascular Quality and
bcr-2012-0006857]. Smitherman AD, Woodall
Outcomes. 2013 Jan 1;6(1):18-26. Switzer JA,
MN, Alleyne CH, Rahimi SY. “Open surgical
Demaerschalk BM, Xie J, Liangyi F, Villa KF,
Current Pharmaceutical Design.
management of a ruptured intracranial
Wu EQ. “Cost-effectiveness of hub-and-spoke
2012;18(25):3670-6. Borlongan CV, Glover LE,
aneurysm in Klippel-Trenaunay-Weber
telestroke networks for the management
Sanberg PR, Hess DC. “Permeating the blood
syndrome.”
of acute ischemic stroke from the hospitals’
brain barrier and abrogating the inflammation
perspectives.”
in stroke: implications for stroke therapy.”
Brain. 2013 136: 1446-1461, [Epub ahead of print; (2013) Mar 6],. Sword J, Masuda T, Croom D, Kirov SA. “Evolution of neuronal and astroglial disruption in the peri-contusional cortex of mice revealed by in vivo two-photon imaging.” British Medical Journal Case Reports. 2012 Jul 3. Cormican MT, Paschalis T, Viers A, Alleyne CH. “Unusual case of subarachnoid haemorrhage in patient with Fabry’s disease: case report and literature review.”
Clinical Nuclear Medicine. 2012 Dec;37(12):11798. Pillai JJ, Williams HT, Forseen SE, Park YD. “Presurgical Lateralization of Seizure Focus in Temporal Lobe Epilepsy with Noninvasive Imaging.”
Nichols FT. “Simplified modified Rankin Scale Questionnaire Correlates with Stroke Severity.”
Decision Making in Spinal Care. 2nd Edition. Thieme Anderson and Vaccaro, eds/ New York, 2012, 55-58. Chutkan N, Tuttle J, “Cervicothoracic fractures and dislocations.”
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MedLink Neurology. Jan 29, 2013. Strelzik
J Neurol Surg A Cent Eur Neurosurg 1–6.
Circ Cardiovasc Qual Outcomes 6:18-26. 2013.
J, Carroll JE. “Neonatal intraventricular
2013. Samuel TA, Parikh, J, Sharma S, Giller
Switzer JA, Demaerschalk BM, Xie J, Liangyi
hemorrhage.”
CA, Sterling K, Kapoor S, Pirkle C, Jillella A.
F, Villa KF, Wu EQ. “Cost-effectiveness of
“Recurrent adult choroid plexus carcinoma
hub-and-spoke telestroke networks for the
PMID: 2333996, Stroke 44:1191-7. 2013.
treated with high-dose chemotherapy and
management of acute ischemic stroke from the
Hess DC, Hoda MN, Bhatia K. “Remote limb
syngeneic stem cell (bone marrow) transplant.”
hospitals’ perspectives.”
translate into a promising treatment for acute
Brain 136: 1446-1461, [Epub ahead of print;
Stroke 44:1282-1287. 2013. Howard G, Cushman
stroke?”
(2013) Mar 6]. 2013. Sword J, Masuda T,
M, Howard VJ, Kissela BM, Kleindorfer DO,
Croom D, Kirov SA. “Evolution of neuronal and
Moy CS, Switzer J, Woo D. “Risk factors for
BMJ Case Reports. Jan 2013 [doi:10.1136/bcr-
astroglial disruption in the pericontusional
intracerebral hemorrhage: The Reasons for
2012-0006857]. Smitherman AD, Woodall
cortex of mice revealed by in vivo two-photon
Geographic and Racial Differences in Stroke
MN, Alleyne CH, Rahimi SY. “Open surgical
imaging.”
(REGARDS) Study.”
aneurysm in Klippel-Trenaunay-Weber
Lancet Neurology 12:244-252. 2013. Meador
Encyclopedia of Otolaryngology, Head and
syndrome.”
KJ, Baker GA, Browning N, Cohen MJ, Bromley
Neck, Springer. 2013:167–172. Alleyne CH.
RL, Clayton-Smith J, Kalayjian LA, Kanner A,
“Angiography.” ed: Kountakis SE.
preconditioning and postconditioning: Will it
management of a ruptured intracranial
Liporace JD, Pennell PB, Privitera M, Loring DW. “Fetal antiepileptic drug exposure and
Encyclopedia of Otolaryngology, Head and
cognitive outcomes at age 6 years (NEAD
Neck, Springer. 2013:186–191. Alleyne CH.
Study): A Prospective Observational Study.”
“Arteriovenous alformations.” ed: Kountakis SE.
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Encyclopedia of Otolaryngology, Head and
Encyclopedia of Otolaryngology, Head and
Curr Top Med Chem 13:2283-90. 2013. Liao TV,
Neck, Springer. 2013:337–341. Hartmann JE.
Neck, Springer. 2013:2845–2847. Rivner MH.
Forehand CC, Hess DC, Fagan SC. “Minocycline
“The blink reflex.” ed: Kountakis SE.
“Transcranial magnetic stimulation of facial
repurposing in critical illness: focus on stroke.”
nerve.” ed: Kountakis SE. Encyclopedia of Otolaryngology, Head and
Transl Stroke Res 2014 [doi: 10.1007/s12975-013-
Neck, Springer. 2013:738–743. Hartmann JE.
Encyclopedia of Otolaryngology, Head and
0318-6]. Hoda MN, Bhatia K, Hafez SS, Johnson
“Electromyography.” ed: Kountakis SE.
Neck, Springer. 2013:1590–1592. Rivner MH.
MH, Siddiqui S, Ergul A, Zaidi KR, Fagan SC,
“Maximum stimulation test.” ed: Kountakis SE.
Hess DC. “Remote ischemic perconditioning is
Encyclopedia of Otolaryngology, Head and
effective after embolic stroke in ovariectomized
Neck, Springer. 2013:1448–1454. Vender JR,
Lancet Neurology 3:244-252. 2013. Meador KJ,
Youssef PP. “Lateral skull base epidermoids.”
Baker GA, Browning N, Cohen MJ, et al.
ed: Kountakis SE.
“Fetal antiepileptic drug exposure and cognitive
Physiol Behav 2013 Nov 25;125C:8-16 [doi:
outcomes at age 6 years (NEAD Study): A
10.1016/j.physbeh.2013.11.004, Epub ahead of
prospective observational study.”
print]. Duberstein KJ, Platt SR, Holmes SP, Dove
Encyclopedia of Otolaryngology, Head and Neck, Springer. 2013:1840–1842. Rivner MH. “Nerve excitability test.” ed: Kountakis SE.
female mice.”
CR, Howerth EW, Kent M, Stice SL, Hill WD, Hess Epilepsy & Behavior 29:308-315. 2013. Cohen
DC, West FD. “Gait analysis in a pre- and post-
MJ, Meador KJ, Browning N, May R, Baker GA,
ischemic stroke biomedical pig model.”
Encyclopedia of Otolaryngology, Head and
Clayton-Smith J, et al. “Fetal antiepileptic drug
Neck, Springer. 2013:841–846. Rivner MH.
exposure: Adaptive and emotional/behavioral
“Evoked EMG.” ed: Kountakis SE.
functioning at age 6 years.”
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Operative Techniques in Otolaryngology —
Neurographics 3:155-158, 2013. Youssef PY,
Head and Neck Surgery 24:213-217, 2013.
Alleyne CH. “Aneurysm associated with an
Prosser JD, Solares CA, Vender J, Alleyne C.
accessory MCA.”
“Transfacial approaches to the clivus.” Pain 154: 2469-2476, 2013. Yowtak J, Wang J, Operative Techniques in Otolaryngology – Head
Kim HY, Lu Y, Chung K, Chung JM. “Effect of
and Neck Surgery 24:172-178, 2013. Vender JR.
antioxidant treatment on spinal GABA neurons
“Retrosigmoid approach.”
in a neuropathic pain model in the mouse.”
Neurology 81:e137, 2013 [doi: 10.1212/ WNL.0b013e3182a9f40f]. Woodall MN, Alleyne CH. “Microvascular decompression of the optic nerve.” Journal of Neurosurgery. 2013 November [doi:10.3171/2013.10.JNS122402, Epub ahead of print]. Woodall MN, McGettigan M, Figueroa R, Gossage P, Alleyne CH. “Cerebral vascular malformations in hereditary hemorrhagic telangiectasia.”