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Neurological Institute 2008 Annual Report
Cleveland C
linic Neurological Institute 2
00
8 A
nnual Report
The Cleveland Clinic Foundation9500 Euclid Avenue / AC311 Cleveland, OH 44195
08-NEU-062
Contents
02 C H A I R M A N ’ S W E L C O M E
04 C L E V E L A N D C L I N I C N E U R O L O G I C A L I N S T I T U T E O V E R V I E W
10 O U R C E N T E R S
22 PAT I E N T C A R E
24 C O M M U N I T Y C A R E
26 2 0 0 8 O U T C O M E S
30 T E C H N O L O G Y A N D I N N O VAT I O N
38 R E S E A R C H
50 E D U C AT I O N
54 N E W S TA F F
56 N E U R O L O G I C A L I N S T I T U T E S TA F F
62 S E R V I C E S F O R P H Y S I C I A N S A N D PAT I E N T S
On the cover: Neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, joined the Neurological Institute’s Epilepsy Center in 2008. Subsequently, he performed North America’s first stereoelectroencephalography (SEEG) procedure, which opens the possibility of new treatment options for patients with intractable focal epilepsy.
The Neurological Institute is one of 26 institutes at Cleveland Clinic that group multiple
specialties together to provide collaborative, patient-centered care. The institute is a
leader in treating the most complex neurological disorders, advancing innovations such as
deep brain stimulation, epilepsy surgery, stereotactic spine radiosurgery and blood-brain
barrier disruption. Annually, our staff of more than 250 specialists serves 140,000 patients
and performs 7,500 surgeries. Cleveland Clinic is a nonprofit multispecialty academic
medical center, consistently ranked among the top hospitals in America by U.S.News &
World Report. Founded in 1921, it is dedicated to providing quality specialized care and
includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education
institute and a research institute.
Cleveland Clinic ©2009
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Cleveland Clinic’s Neurological Institute achieved significant growth in patient and
surgical volumes in 2008. This annual report chronicles the progress that underlies the
numbers: geographic expansion, new research insights, innovative treatment modalities,
extended educational opportunities for healthcare professionals and the public, accelerated
collection of clinical data, the addition of talented staff and promising affiliations with
new partners. All these advances are driven by a fundamental goal: to provide exceptional
patient care and improve outcomes.
Michael T. Modic, MD, FACR
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clevelandclinic.org/neuroscience | 866.588.2264
Welcome 3
In Cleveland Clinic’s Neurological Institute, our patient-centered
approach incorporates a strategic design for geographic diversity,
predicated on the notion that the widely dispersed population we
serve is entitled to a uniformly high level of care. Our goal is to
distribute technology and expertise so that, whether an individual
needs emergency or continuing care, location is never an issue.
In fact, patient proximity is an integral component of our tem-
plate for growth throughout Cleveland Clinic. We are resolved
to function as an enterprise-wide entity, rather than as a chain of
discrete facilities. Consequently, the health system is adopting a
coordinated, continuous longitudinal care model, with variable
resources at different regional sites. This configuration benefits
our locally and nationally based patient populations alike. To the
former group, broadened reach promises a consistent level of
expertise close to home, no matter where home happens to be;
for the latter, it augurs improved access and outcomes as well as
unvarying standards of excellence.
This thinking is reflected in the Neurological Institute’s new Lou
Ruvo Center for Brain Health, with addresses in Cleveland and
Las Vegas; our new Center for Behavioral Health, which consoli-
dates psychiatric resources at designated regional sites; our Sleep
Disorders Center, which offers patients a common, high-quality
experience at seven community-based overnight sleep labora-
tories; a new, hospital-based suburban Cleveland neurological
site that addresses even the most complex disorders; and the
Department of Physical Medicine and Rehabilitation, now part of
our institute, with inpatient and outpatient locations throughout
northeast Ohio.
The principal enabler of this shift is technology. In the Neuro-
logical Institute, we are leveraging the technical infrastructure
through our imaging capabilities, which are now distributed
across the community, and the enhanced electronic medical
record. The institute’s Knowledge Program© is focused on stan-
dardizing data collection within each patient’s record to better
track outcomes and analyze information.
A complementary initiative, critical to regional growth, is the
codification of standardized care pathways across the entire hos-
pital system. I alluded to stroke care, possibly the best example in
the Neurological Institute. With the population aging and stroke
incidence rising, these patients are being diagnosed rapidly and
treated appropriately, consistent with Get With The GuidelinesSM
protocols, at every Cleveland Clinic facility.
Ultimately, the key to any successful undertaking is people.
Here, the commingling of Cleveland Clinic and independent
physicians, working together as one team, is an essential piece.
Collaboration is a tenet of the multidisciplinary Neurological
Institute and the foundation for a truly integrated system.
In this annual report, we are pleased to demonstrate how this
system is evolving and expanding to serve patients better and to
prepare for the inevitable healthcare challenges to come. I look
forward to continuing to document our progress.
Sincerely,
Michael T. Modic, MD, FACR
Chairman, Cleveland Clinic Neurological Institute
Dear Colleagues
When we measure clinical outcomes, one variable we do not chart is geography. There are many reasons people do
or do not survive acute events such as stroke, but there is no dispute that superior outcomes often correlate with
immediate access to a medical center equipped with the resources to rapidly provide treatment according to updated,
nationally recommended standards.
Cleveland Clinic Neurological Institute | 2008 Annual Report
4 Overview
U.S.News & World Report’s “America’s Best Hospitals” survey
ranked our neurology and neurosurgery programs sixth in the
nation in 2008 and again in 2009. Our pediatric neurology and
neurosurgery programs were ranked fourth in the nation in both
years. Our neurology, neurosurgery, pediatric neurology/neuro-
surgery and psychiatry programs are also ranked best in Ohio.
The institute model allows our patients to access the care they
need through specialized, multidisciplinary, disease-specific cen-
ters that integrate the expertise of neurologists, neurosurgeons,
orthopaedic surgeons, psychiatrists, psychologists, physiatrists,
neuroradiologists and others into the comprehensive care of a
single disease:
• ClevelandClinicLouRuvoCenterforBrainHealth
• BrainTumorandNeuro-OncologyCenter
• CerebrovascularCenter
• EpilepsyCenter
• MellenCenterforMultipleSclerosisTreatmentandResearch
• CenterforNeuroimaging
• CenterforNeurologicalRestoration
• CenterforPediatricNeurologyandNeurosurgery
• NeurologicalCenterforPain
• NeuromuscularCenter
• DepartmentofPhysicalMedicineandRehabilitation
• DepartmentofPsychiatryandPsychology
• CenterforRegionalNeurology
• SleepDisordersCenter
• CenterforSpineHealth
In2008,theNeurologicalInstituteserved140,000patients
and performed 7,500 surgeries. We provide care across the
spectrum of neurological disorders, including primary and
metastatic tumors of the brain, spine and nerves; pediatric and
adult epilepsy; headache, facial pain syndromes and associated
disorders;movementdisorderssuchasParkinson’sdisease,
essential tremor and dystonia; neurocognitive disorders such as
dementia and Alzheimer’s disease; cerebral palsy and spasticity;
hydrocephalus; metabolic and mitochondrial disease; fetal and
neonatal neurological problems; multiple sclerosis; stroke; cere-
bral aneurysms; brain and spinal vascular malformations; carotid
stenosis; intracranial atherosclerosis; nerve and muscle diseases,
including amyotrophic lateral sclerosis, peripheral neuropathy,
myasthenia gravis and myopathies; sleep disorders; and mental/
behavioral health disorders and chemical dependencies.
ClevelandClinic NeurologicalInstituteOverview
ThemultidisciplinaryClevelandClinicNeurologicalInstituteincludesmorethan250medical,surgicalandresearch
specialists dedicated to the treatment of adult and pediatric patients with neurological and psychiatric disorders. The
institute offers a disease-specific, patient-focused approach to care. Our unique, fully integrated model strengthens
our current standard of care, allows us to measure quality and outcomes on a continual basis, and enhances our ability
to conduct research.
Right: A dedicated 16-bed Neurointensive Care Unit is staffed with neurologists, neurosurgeons, specially trained nurses, respiratory therapists, nutritionists and pharmacists, all under the direction of neurointensivists. The full-service unit, which treats more than 1,300 patients a year, is equipped to manage any neurological condition regardless of severity.
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Overview 7
Expert, Specialized Diagnosis
Neurological Institute physicians draw on advanced diagnostic
capabilities and experience.
Our imaging services include structural and functional magnetic
resonance imaging (MRI), computed tomography (CT),
positron emission tomography (PET), myelography, diagnostic
cerebral/spinal angiography, interventional neuroradiology, and
carotid and transcranial Doppler ultrasound. Our neuroimaging
staff subspecializes in specific disease entities such as epilepsy
and cerebrovascular disease, ensuring accurate, in-depth
interpretations.
Additional diagnostic tools are found in our epilepsy monitoring
units, sleep laboratories, neuropsychological testing facilities,
electromyography laboratory, autonomic laboratory and cutane-
ous nerve laboratory.
The Latest Treatment Modalities
Patients receive leading-edge treatment options at the Neurologi-
cal Institute, where we continue to advance such innovations as
deep brain stimulation (brain pacemakers), epilepsy surgery,
stereotactic spine radiosurgery, endovascular treatment of
cerebral aneurysms and vascular malformations, and neuroen-
doscopy. Distinctive services such as our three-week outpatient
program for sufferers of chronic headaches and our Headache
Infusion Suite provide intensive therapy when needed. The Brain
Tumor and Neuro-Oncology Center’s Translational Therapeutics
Program is accelerating the process of bringing novel therapeu-
tic agents from the laboratory to the patient. Joint Commission
certification as a Primary Stroke Center and accreditation by the
American Academy of Sleep Medicine are just two examples of
our commitment to providing the most advanced and highest
quality of care to our patients.
Relevant Research
We strive to conduct research directly related to conditions expe-
rienced by our patients, with programs in translational research,
clinical trials of drug and device interventions, neuroimaging
research, epidemiology and health outcomes, behavioral and
psychiatric research, and research into better diagnostic meth-
ods. Typically, more than 100 clinical research trials are under
way at any time in the Neurological Institute. In 2008, we were
awarded more than $17.9 million in neurological-based grants
and research contracts.
Convenient Care in the Community
We are committed to making access to world-class care conve-
nient for all our patients, whether they come to us from down the
street or half a world away. Our Neurological Institute regional
centers represent a systemwide expansion of our services to
Cleveland Clinic regional hospitals and family health centers
throughout the community.
In 2008, the Neurological Institute expanded to Lakewood
Hospital, providing comprehensive services to Cleveland’s West
Side and western suburbs. The Cleveland Clinic Neurological
Institute at Lakewood Hospital offers patients access to multiple
specialists in a convenient location where they can receive evalua-
tion, treatment, rehabilitation, preventive care and other services
they require. In addition, Cleveland Clinic neurologists oversee
inpatient care at a number of other Cleveland Clinic hospitals.
The Cerebrovascular Center’s neurovascular intervention and operat-ing suite is designed for traditional microsurgical procedures and for advanced, highly technical endovascular procedures.
Left: The first stereoelectroencephalographic (SEEG) procedure in North America is performed at Cleveland Clinic. SEEG targets specific brain areas to localize the epileptogenic zone more precisely and less invasively.
Cleveland Clinic Neurological Institute | 2008 Annual Report
8 Overview
Our Sleep Disorders Center has also extended its regional pres-
ence with seven community-based overnight sleep laboratories,
including five hotels where sleep studies are performed with
patients’ convenience and comfort in mind.
With the recent formation of our Center for Behavioral Health,
we are building a regional network of mental health and psychi-
atric services to improve patient access to care and ensure quality
and efficiency.
structure lends itself to greater information sharing and process
improvement opportunities. Through continuing education pro-
grams, learning opportunities range from basic nursing instruc-
tion to subspecialization in neurological nursing, enabling nurses,
like their physician colleagues, to provide specialized care.
Pioneering the Collection of Data and Outcomes
The Knowledge Program©, a joint initiative of the Neurological
Institute, the Imaging Institute and the Information Technology
Division, is designed to harness routinely collected electronic
clinical and administrative data to allow us to optimize patient
care and outcomes. Data from multiple electronic sources, in-
cluding imaging results and clinical information collected during
patient encounters, such as disease-specific measures of patients’
health status, are consolidated in a clinical data warehouse that
can be accessed and queried by healthcare personnel. An integral
part of this initiative is the standardization of clinical information
documented within the electronic medical record. Information
gained from the Knowledge Program informs and guides clinical
care, quality improvement and research.
Patients First
We recognize that a patient’s healthcare experience is defined by
both superior clinical outcomes and compassionate, personalized
care: Did we respond when a patient needed us? Were that indi-
vidual and his or her family treated with the dignity and respect
that every person deserves? We have committed to measure this
intensely human variable, patient satisfaction, and we have ap-
pointed a Patient Experience Officer to oversee this initiative.
At Cleveland Clinic’s Neurological Institute, we are dedicated to
maximizing both patient care outcomes and the patient experi-
ence. In addition, advancing medical education and research in
neurology, neurosurgery and psychiatry are institutional priorities.
Right: A nurse in one of the Neurological Institute’s inpatient units assesses a patient’s functionality. Since 2003, Cleveland Clinic has held Magnet hospital status, the highest national designation of nursing excellence. Bestowed by the American Nurses Credentialing Center, Magnet status is the gold standard for patient care.
Integrated Nursing Services
The Neurological Institute integrates inpatient and ambulatory
nursing, enhancing the continuum of patient care. This unique
For Neurological Institute nurses, opportunities abound on the job as well as through continuing education programs that enable subspecial-ization for those who are interested.
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Our Centers 11
Our Centers
With the formation of two new specialized, multidisciplinary centers for brain health and behavioral health, the
Neurological Institute continued to grow in 2008, extending its model of integrated expertise for delivery of disease-
specific, patient-focused care.
Cleveland Clinic Lou Ruvo Center for Brain Health
A collaboration between the Neurological Institute and the Las
Vegas-based Lou Ruvo Brain Institute has resulted in creation
of this highly specialized clinical center for advancement of
research, early detection and treatment of cognitive disorders
such as Alzheimer’s disease.
The Cleveland Clinic Lou Ruvo Center for Brain Health brings
together an interdisciplinary team of neuroscientists, physicians,
therapists, surgeons, imaging specialists and other medical
experts dedicated to preventing the disabling symptoms of
chronic brain disease and prolonging healthy, vital aging in
people at risk for dementia or cognitive disorders.
“New discoveries and emerging science tell us that cognitive
disorders can be identified earlier than previously believed and
potentially altered,” says Michael T. Modic, MD, FACR, Chair-
man of the Neurological Institute. “Our hope is to bring together
world-class clinicians and researchers to advance our understand-
ing of cognitive disorders and provide the best care possible for
people who suffer from them, as well as their caregivers.”
The center will offer services in both Cleveland and Las Vegas,
where a $100 million facility designed by renowned architect
Frank Gehry recently welcomed its first patients. It houses clini-
cal space, a diagnostic center, neuroimaging rooms, physician
offices and laboratories devoted to clinical research.
Randolph B. Schiffer, MD, a nationally known neurologist/
psychiatrist, serves as Director of the Cleveland Clinic Lou Ruvo
Center for Brain Health. Dr. Schiffer spent 10 years as Chairman
of the combined Department of Neuropsychiatry and Behavioral
Science at Texas Tech University Health Sciences Center.
“The Neurological Institute was thinking about establishing a
creative new medical program for cognition at precisely the same
time the Lou Ruvo Brain Institute was being founded in Las
Vegas to the same purpose,” Dr. Schiffer says. “The Neurological
Institute brings with it almost 100 years of tradition and medical
science in Cleveland. The Lou Ruvo Brain Institute brings with it
a window to the great resources and populations of the South-
west. Together, we will create the pre-eminent program in the
world for care of the cognitive impairment disorders. “
The center provides the most technologically advanced diagnos-
tic services, including 3 Tesla MR and, in the future, PET/CT,
performed by one of the world’s leading neuroimaging academic
medical centers. A multimodal treatment program for people
with mild symptoms of impairment incorporates physical
exercise, cognitive rehabilitation and cognitive-enhancing
medications.
The late Lou Ruvo, from whom the center takes its name, suffered
from Alzheimer’s disease. To his son, Larry Ruvo, Chairman
of the Lou Ruvo Brain Institute, the center is the realization of
a long-held dream: “This is a perfect integration of Cleveland
Clinic’s mission and excellence in patient care, research and
education and what we want to create here in Las Vegas … With
Cleveland Clinic as our operational partner, we will be able to hit
the ground running.”
Left: Early peri-ventricular white matter signal changes in this 55-year-old woman with hypertension and glucose intolerance may be forward-looking warnings that she is at risk for one of the age-related cognitive loss syndromes during the decade ahead.
Cleveland Clinic Neurological Institute | 2008 Annual Report
12 Research
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Our Centers 13
Department of Psychiatry and Psychology
The Department of Psychiatry and Psychology is restructuring
under a new Center for Behavioral Health. The center includes an
abundance of behavioral health resources widely dispersed across
the Cleveland Clinic health system, which includes the main
campus, 10 community hospitals and 17 family health centers
throughout northeast Ohio. Consolidation of key services at
designated regional locations will improve patient access to care
as well as facilitate more effective patient management, ensure
quality of care and drive operational improvements. In addition,
this reorganization will encourage refinement of existing pro-
grams and development of innovative new behavioral healthcare
models.
Under the Center for Behavioral Health concept, selected
Cleveland Clinic facilities will house specialized resources such
as adult psychiatry, child and adolescent psychiatry, chemical
dependency services and geropsychiatric programs. Geographi-
cally dispersed but closely integrated, this regional network will
promote collaboration among behavioral health specialists and
reinforce the team’s ability to deliver comprehensive therapeutic
services that return patients to full functionality.
Patients will be triaged to the particular site where an appropri-
ate concentration of skills and services can best meet their needs.
This centralization of knowledge and expertise will, in turn,
result in better clinical outcomes, more enlightened research and
outcomes data based on a broad regional population, which will
be especially relevant to referring physicians considering where to
send their patients for specialized care.
Brain Tumor and Neuro-Oncology Center
The Brain Tumor and Neuro-Oncology Center (BTNC) is a
national leader in the diagnosis, treatment and research of brain
tumors. A multidisciplinary team of physicians and scientists
focuses almost exclusively on brain tumors, facilitating oppor-
tunities to participate in international research protocols, share
information on new developments and combine therapeutic
approaches. As a result, the center brings the most promising new
treatments to the clinical realm in an environment that empha-
sizes individualized patient care.
The center is a pacesetter in the development, application and
refinement of sophisticated therapies for life-threatening tumors.
Each year, the team records approximately 8,000 outpatient
visits and performs some 950 surgical procedures. The BTNC’s
Cleveland Clinic Gamma Knife® Center, established in 1997,
offers patients a nonsurgical option for treatment of brain and
spinal metastases and other brain disorders.
The Cleveland Clinic Gamma Knife Center is one of only a few
such facilities worldwide certified by Elekta, sole manufacturer
of the Gamma Knife, to train physicians in this precise form of
stereotactic radiosurgery. In 2008, four hands-on courses drew
more than 30 participants, bringing the total number trained to
more than 400.
Left: Intraoperative image guidance allows neurosurgeons to remove brain tumors via minimal-access craniotomies.
Cleveland Clinic psychiatrists, psychologists, clinical nurse specialists, social workers, counselors and therapists provide a full spectrum of mental health and chemical dependence services.
The institute model allows patients to better access care through specialized, multidisciplinary, disease-
specific centers that integrate the expertise of neurologists, neurosurgeons, orthopaedic surgeons, psychiatrists,
psychologists, physiatrists, neuroradiologists and others into the comprehensive care of a single disease.
Cleveland Clinic Neurological Institute | 2008 Annual Report
14 Our Centers
Cerebrovascular Center
The Cerebrovascular Center integrates neurologists, neurosur-
geons, neuroradiologists and neurointensivists who offer expert
diagnosis and medical, endovascular and surgical management
of patients with all cerebrovascular conditions.
With a unique mix of physician subspecialties, the center delivers
endovascular therapy and care of the highest quality. Stroke care
emphasizes aggressive acute intervention. The center is a Joint
Commission-certified Primary Stroke Center and has one of the
highest stroke-related volumes in North America, with more than
3,200 patient visits annually.
Patients receive comprehensive care in the 16-bed Neuroin-
tensive Care Unit. Additionally, the center is home to a Neuro-
endovascular Research Laboratory, which focuses on cerebral
aneurysm treatment, imaging research, blood-brain barrier
function and cerebral hemorrhage management.
Epilepsy Center
Superior diagnostic capabilities, extensive medical and surgical
clinical treatment programs, and an active research focus have
made Cleveland Clinic Epilepsy Center a site of national and
international prominence for the management and investigation
of epilepsy.
The Epilepsy Center has one of the world’s foremost epilepsy
programs, with more than 4,000 adult and 2,000 pediatric
patient visits annually. In 2008, epilepsy neurosurgeons
performed more than 300 surgical procedures, including lobec-
tomies, hemispherectomies, and implantation of vagal nerve and
responsive neurostimulators. Patients have gained an improved
quality of life due to the expertise of the clinical staff and the
availability of leading-edge technologies such as stereoelectro-
encephalography (SEEG): chronic intracranial EEG monitoring
with stereotactically implanted intracerebral electrodes. Cleve-
land Clinic introduced the first SEEG program in North America,
thus offering patients with intractable focal epilepsy a more pre-
cise, less invasive approach to targeting the epileptogenic zone.
Mellen Center for Multiple Sclerosis Treatment and Research
The Mellen Center has the largest, most comprehensive program
for MS care and research worldwide, managing more than
20,000 patient visits annually.
The center offers the most advanced specialized treatments,
supported by an extensive program of research and education.
Patients are evaluated by a multidisciplinary team that makes
individualized treatment recommendations.
Right: The Epilepsy Center’s adult and pediatric monitoring units use digital video EEG technology to locate seizure origin, a prelude to epilepsy surgery in appropriate candidates. Once considered a last resort, surgery in the hands of experts has become a safe, effective treatment for care-fully selected patients who are refractory to medical therapy.
The Mellen Center utilizes standardized tests, such as the 9-Hole Peg Test, to track disease progression and symptom management in multiple sclerosis patients.
The Cerebrovascular Center’s state-of-the-art angiography room allows for endovascular and open craniotomy treatment of patients with cere-brovascular disease.
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Our Centers 17
Basic and clinical research at Cleveland Clinic continues to shed
light on MS. Mellen Center physicians fill leadership roles in
multinational trials of promising new therapies, and they offer
their patients opportunities to enroll in clinical research proto-
cols. These physicians and their patients are true partners in the
pursuit of new insights and treatments that can improve care.
Center for Neuroimaging
The Center for Neuroimaging houses specialists in structural
and functional imaging of the central nervous system for a wide
variety of neurological disorders. Subspecialization in disease
entities (e.g., epilepsy, cerebrovascular disease, oncology) ensures
accurate, in-depth, relevant interpretations.
Across Cleveland Clinic, the Center for Neuroimaging super-
vises and interprets more than 60,000 CT scans and more than
50,000 MR scans each year. In cooperation with the Cerebrovas-
cular Center, Neuroimaging provides cerebrovascular ultrasound,
angiography and interventional neuroradiology services. The
latter category includes more than 3,000 cerebral angiograms
per year as well as management of acute stroke and internal/
external carotid artery embolizations, treatment of vasospasm and
atherosclerotic occlusive disease, and carotid artery stenting.
Neurological Center for Pain
A leader in treatment of patients with pain disorders, this
center integrates two pioneering Cleveland Clinic programs.
The Headache Program brings an interdisciplinary approach to
diagnosis and treatment of migraine, tension headache, daily
headache and cluster headache, including intensive outpatient
therapy known as IMATCH (Interdisciplinary Method for the
Assessment and Treatment of Chronic Headache). The Section
of Pain Medicine tailors comprehensive, innovative behavioral
health and medical services to the needs of people in chronic
pain. The section operates the Chronic Pain Rehabilitation
Program, which combines physical rehabilitation, stress and pain
control regimens, and medication management for patients who
are functionally and psychosocially disabled by intractable pain.
Center for Neurological Restoration
This center is among the first in the world to bring together an
interdisciplinary team of renowned neurologists, neurosurgeons,
psychiatrists, neuropsychiatrists, researchers and other specialists
who offer the latest medical and surgical treatments for patients
with neurological and psychiatric disorders. Center physicians
have earned wide recognition for expertise in medical manage-
ment and innovation in the surgical treatment of movement
disorders such as Parkinson’s disease and dystonia, as well as
behavioral disorders such as obsessive-compulsive disorder and
depression. The surgical team is world renowned for performing
hundreds of deep brain stimulation surgeries.
Left: Neurosurgeon Andre Machado, MD, PhD, performs deep brain stimulation (DBS) on a patient with Parkinson’s disease. The Center for Neuro-logical Restoration, which Dr. Machado directs, is an acknowledged world leader and innovator in DBS surgery, having implanted hundreds of brain pacemakers in patients with intractable neurological and psychiatric disorders.
Combined DTI and fMRI mapping of the motor system. Expressive and receptive language regions are in orange. The multicolored lines connecting them are the fiber tracts that make up the language network.
Patients in the Chronic Pain Rehabilitation Program are taught to reduce negative emotions that result from and worsen their pain.
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Cleveland Clinic Neurological Institute | 2008 Annual Report
18 Our Centers
Neuromuscular Center
The Neuromuscular Center treats patients with and conducts
research on nerve and muscle disease, including amyotrophic
lateral sclerosis and related disorders, peripheral neuropathy,
myasthenia gravis and myopathies. The center’s electromyog-
raphy laboratory is among the largest in Ohio, with locations at
Cleveland Clinic’s main campus and six regional facilities, and
a worldwide reputation for excellence and reliability. Additional
resources include a highly specialized autonomic laboratory
offering cardiovascular autonomic and tilt table tests, the quanti-
tative sudomotor axon reflex test, quantitative sensory test,
sympathetic skin response test, infrared dynamic pupillometry
test and thermoregulatory sweat test. The center’s cutaneous
nerve laboratory provides muscle, nerve and skin biopsies;
histopathological preparation of skin specimens; and pathologi-
cal interpretation of skin biopsies for the diagnosis of small-fiber
peripheral neuropathy.
Center for Pediatric Neurology and Neurosurgery
Cleveland Clinic pediatric neuroscience specialists see more
than 10,000 children each year for an array of neurological
disorders. The team offers state-of-the-art subspecialty care for
children with brain malformations, neurofibromatosis, cerebral
palsy and spasticity, headache, autonomic disorders, cyclic vomit-
ing, hydrocephalus, myelomeningocele, metabolic and mitochon-
drial disorders, multiple sclerosis and other white matter disease,
Tourette syndrome and other movement disorders, neuromuscu-
lar disease and muscular dystrophy, fetal and neonatal neuro-
logical problems, brain and spinal cord tumors, cerebrovascular
disease, neurological complications of cardiac disease and
epilepsy. Comprehensive advanced neurosurgical services, in-
cluding neuroendoscopy, are available.
Pediatric neurological and neurosurgical specialists collaborate
with the Cleveland Clinic Pediatric Institute & Children’s Hos-
pital, providing comprehensive advanced care for all pediatric
neurological disorders.
Department of Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation helps patients with
impairments and disabilities in the areas of mobility, self-care,
communication, swallowing and cognition. These conditions
result from accident, illness or natural causes. A team approach to
Right: U.S.News & World Report ranks Cleveland Clinic’s pediatric neurology and neurosurgery services among the top four such programs in the nation. Specialists collaborate with the Cleveland Clinic Pediatric Institute & Children’s Hospital, providing comprehensive advanced care for all pediatric neurologi-cal disorders.
Vernon Lin, MD, PhD (right), Chairman of Cleveland Clinic’s Department of Physical Medicine and Rehabilitation, and colleagues demonstrate how a noninvasive magnetic stimulator they developed can be applied over clothing to activate respiratory muscles in spinal cord injury patients.
The Neuromuscular Center uses electromyography (EMG) to detect abnormal electrical activity in muscles and nerves. With one of the largest EMG laboratories in Ohio, the center performs more than 3,000 such exams yearly.
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Our Centers 21
rehabilitation helps restore as much independence as possible so
that patients can overcome physical, psychosocial, cognitive and
vocational limitations.
A full range of services spans inpatient rehabilitation, skilled
nursing care and outpatient care, enabling the staff to address
individual needs during each phase of the rehabilitation process.
This approach also allows effective coordination of care so that
patients return to the community with the best chance to main-
tain the gains they have achieved.
Center for Regional Neurology
As part of Cleveland Clinic’s nationally recognized Neurological
Institute, the regional neurology program combines physicians
and other healthcare providers in neurology, neurosurgery,
neuroradiology and behavioral sciences, who treat adult and
pediatric patients with neurological disorders. Regional facilities
extend advanced treatments, technologies and the expertise of
Cleveland Clinic into the surrounding communities and greater
metropolitan areas, making it even easier for patients to access
specialists who treat the most complex neurological conditions,
including aneurysm and stroke, brain tumor, epilepsy, headache,
multiple sclerosis, and sleep and spine disorders.
Sleep Disorders Center
Cleveland Clinic’s Sleep Disorders Center is a multispecialty,
comprehensive program dedicated to the diagnosis and treat-
ment of sleep disorders in children and adults. Accredited by
the American Academy of Sleep Medicine, the center comprises
specialists in neurology, pediatrics, pulmonary medicine, internal
medicine, psychiatry, psychology, otolaryngology and dentistry.
More than 4,000 sleep studies are performed annually in seven
laboratories throughout northeast Ohio.
Neurological Institute physicians draw on advanced diagnostic capabilities and experience. Patients receive
leading-edge treatments and have opportunities to participate in clinical research trials.
The Sleep Disorders Center is committed to advancing under-
standing of sleep disorders, their causes and treatment, and their
relationship with other disorders. To this end, the center offers
patients enrollment in investigational studies conducted in con-
junction with national and international consortia or designed by
Cleveland Clinic physicians.
Center for Spine Health
The Center for Spine Health brings together the expertise of
specialists in neurosurgery, orthopaedic surgery and medical
spine care to provide medical and surgical management of the
full scope of back and spine problems, including scoliosis and
kyphosis, spondylolisthesis, spinal stenosis, primary and
metastatic spinal tumors, mature spine, cervical fractures and
degenerative diseases of the spine. Physicians work closely with
physical therapists and occupational therapists to develop a com-
plete individualized treatment plan for each patient, integrating
the functions of research, clinical practice and education with the
goals of improving patient care, promoting collaboration among
staff, and developing unique technologies and subspecializations.
The Sleep Disorders Center performs more than 4,000 adult and pedi-atric sleep studies annually.
Left: A cervical spine X-ray shows posterior spinal instrumentation. Center for Spine Health surgeons have one of the country’s highest success rates for even the most complex procedures, including lumbar surgeries, cervical and thoracic procedures, spinal deformity and spine tumor.
92877_NeuroARText_Wt.indd 22 11/3/09 11:50 AM
clevelandclinic.org/neuroscience | 866.588.2264
Patient Care 23
Daily Huddle
Drawing on the Neurological Institute’s multidisciplinary team
structure, the daily huddle is a methodology to facilitate direct
communication among professionals involved in the care of the
neurological patient. Gathering at the same time each morning,
this group of caregivers discusses the plan of care for the day for
each patient. This coordinated effort allows direct input from all
team members on medical, social and disposition issues related
to the patient’s medical condition.
Nursing Leadership Group
This weekly session joins Neurological Institute nurse managers
from the ambulatory and inpatient settings with adult and pediat-
ric operating room nurses, who treat many neurological patients.
Assistant nurse managers, clinical nurse specialists and clinical
instructors also attend. Group diversity is a strength as members
present new initiatives and discuss issues such as stroke treat-
ment and postoperative pain that cross all areas.
Patient Advisory Council
Established in May 2008, this collaborative group of patients,
family members, staff and employees works on projects to
improve patient care. Their input led to the remodeling of the
Neurointensive Care Unit waiting area and the development of a
new patient resource guide.
Health Experience/Outcomes Team
Neurological Institute researchers are working to quantify the
impact of the patient experience on clinical outcomes. The focus
is Cleveland Clinic’s Healing Solutions Program, which offers
meditation, Reiki, massage, spiritual care and individualized
patient services.
Patient Service Navigator
A Patient Service Navigator visits hospitalized patients daily to
address any needs or concerns. The navigator serves as a liaison
for the patient and the care team, providing on-the-spot problem
solving and regular feedback. Issues are tracked and reviewed by
the inpatient arm of the institute’s Patient Experience Team.
Patient Support Groups
Patients coping with serious or chronic illness are encouraged to
share their experiences and socialize with others in similar situa-
tions through support groups such as the following:
• TheBrainTumorSupportGroupmeetsmonthlyatCleveland
Clinic Taussig Cancer Center. Open to patients, their family
members and friends, this helpful forum invites participants
to exchange information on practical concerns such as how
a brain tumor affects job, family and ability to carry out daily
activities. Nurse practitioners assist, providing information and
answering questions about treatments, medications, available
resources and other pertinent issues.
• ThePediatricEpilepsySupportGroupaddressestheneeds
of families caring for a child with refractory epilepsy, who
often find their emotional resources depleted. Weekly group
meetings become a source of strength and comfort for parents
confronting difficult decisions about epilepsy surgery and
guiding their child through difficult procedures such as inva-
sive monitoring of seizures for accurate surgical planning.
Patient Care
At Cleveland Clinic, responsibility to patients extends beyond providing expert diagnosis and advanced treatment modal-
ities. In the belief that patient satisfaction is a critical component of a successful clinical experience, the Neurological
Institute is implementing new strategies to enhance communication and collaboration among staff and with patients.
Left: The daily huddle is a forum for staff physicians, residents, fellows, rehabilitation specialists and other professionals to exchange informa-tion and develop a personalized care plan for each Neurological Institute inpatient.
Cleveland Clinic Neurological Institute | 2008 Annual Report
24 Community Care
Cleveland Clinic Neurological Institute
at Lakewood Hospital
This facility opened in this suburban Cleveland Clinic hospital in
October 2008, offering a full spectrum of services for adult and
pediatric patients with neurological disorders. These services,
which ensure continued growth of the hospital’s well-respected
neuroscience program, include:
• generalneurology
• neurosurgery
• cerebrovasculartestingandtreatment
• TCD/carotidultrasoundtesting
• headacheinfusionclinic
• diagnosticevaluationandtreatmentforepilepsy
• evaluation,follow-upandinfusiontreatmentsformultiple
sclerosis
• electromyogramtesting
• neurorehabilitationandspasticitymanagement
The staff of the Lakewood institute comprises neurologists, neu-
rosurgeons, neuroradiologists, neuroendovascular and cerebro-
vascular surgeons, therapists and specialized nurses. This team
applies the most advanced treatments and technologies to the
most complex conditions in a modern, comfortable setting close
to patients’ homes.
Center for Mood Disorders Treatment and Research
at Lutheran Hospital
In January 2008, an adult inpatient unit for diagnosis and treat-
ment of mood disorders opened at Lutheran Hospital. The center
ranks as the first in northeast Ohio offering both inpatient and
outpatient programs dedicated to the treatment of mood disor-
ders such as major depression and bipolar disorder.
Dependingonindividualneeds,theseprogramsexploreissues
such as:
• assertiveness
• griefandloss
• healthylifestyle
• developmentofnewcopingmethods
• problemsolving
• self-esteem
• comorbidanxietyandsubstanceabuse
• stressandangermanagement
The center’s team includes physicians, nurses, social workers,
therapists and programming staff committed to improving and
maintaining patients’ mental health and well being. With a sup-
portive, caring and structured approach, these professionals help
patients reduce mood disorder symptoms, regain lost confidence
and hope, and improve their functioning and quality of life.
Community Care
The Neurological Institute expanded geographically in 2008, reaching out to a broadly distributed patient popula-
tion through the Center for Regional Neurology. This program combines physicians and other healthcare providers
in neurology, neurosurgery, neuroradiology and behavioral sciences who care for adult and pediatric patients with
neurological disorders. Regional facilities extend advanced treatments, technologies and the expertise of Cleveland
Clinic into the surrounding communities and greater metropolitan areas, making it even easier for patients to access
specialists who treat the most complex neurological disorders.
clevelandclinic.org/neuroscience | 866.588.2264
Community Care 25
Regional Sleep Centers
Cleveland Clinic’s Sleep Disorders Center joined with Cleveland
Clinic health system’s Marymount Hospital sleep program in
2008, resulting in expedited access for referring physicians and
patients. The combined program has seven overnight sleep labs
conveniently located throughout the region.
Five of these labs are based in hotels, where adults and children
12 and older can undergo routine overnight sleep studies, in-
cluding polysomnograms and positive airway pressure titrations.
Geriatric Behavioral Health Services
At selected community hospitals throughout the region, special-
ized multidisciplinary teams work with older adults, helping
them adapt to age-related changes and improve their quality of
life. Under the direction of board-certified psychiatrists, clinical
professionals provide holistic assessment, diagnosis and treat-
ment for conditions such as:
• significantchangesinmentalhealth
• confusion
• memorylapsesand/orforgetfulness
• depression
• anxietyand/ornervousbehaviors
• griefreaction
• difficultyadaptingtochange
• medicationconcerns
• suicidethreatsorattempts
• alcoholand/orsubstanceabuseandmisuse
Cleveland ClinicChagrin FallsCleveland Clinic
Independence
Cleveland ClinicStrongsville
Cleveland ClinicBrunswick
Cleveland ClinicWestlake
Cleveland ClinicElyria
Cleveland ClinicLorain
Cleveland Clinic
Children’sHospital,Shaker
ChestnutCommons,Elyria
Cleveland ClinicAvon Lake
Cleveland ClinicBroadview Heights
Lake Erie
Cleveland ClinicWooster
Cleveland ClinicBeachwood
Cleveland Clinic Solon
Cleveland ClinicWilloughby Hills
LORAIN COUNTY
CUYAHOGA COUNTY
SUMMIT COUNTY
MEDINACOUNTY
LAKE COUNTY
PORTAGECOUNTY
GEAUGACOUNTY
(WAYNE COUNTY)
Cleveland ClinicLakewood
Cleveland Clinic Avon
EuclidHospital
Hillcrest Hospital
Huron Hospital
Lutheran Hospital
Lakewood Hospital
Fairview Hospital
South Pointe Hospital
Medina Hospital
Marymount Hospital
Neurological Institute physicians provide services at Cleveland Clinic’s main campus and at Cleveland Clinic community hospitals and family health centers throughout northeast Ohio, increasing patient access to specialized care.
s Hospitals nFamily Health Centers
clevelandclinic.org/neuroscience | 866.588.2264
Outcomes 27
Brain Tumor
• Spineradiosurgeryisapalliativetreatmentforpain,typically
usedinend-stagecancerpatientswhosediseasehasmetasta-
sizedtothespine.Among103patientswithpainfulspinal
metastaseswhoweretreatedwithsingle-fractionNovalis®spine
radiosurgeryin2007and2008,painscoresshowedastatisti-
callysignificantimprovementjustoneweekaftertreatment,
andtheseresultsremainedstableovertime.
• Clinicalresearchtrialsareimportantdiscoveryandtherapeu-
ticoptionsforbraintumorpatients.Almost300individuals
wereenrolledinthesetrialsthroughClevelandClinic’sBrain
TumorandNeuro-OncologyCenterin2008.
• Patientswhounderwentsupratentorialcraniotomyhad
30-and180-daysurvivalratesof99.1percentand
93.5percent,respectively.
• Amongpatientswhounderwentbrainbiopsies,30-and180-
daysurvivalratesreached94.1percentand80.4percent,
respectively.
• Amongpituitarysurgerypatients,30-and180-daysurvival
ratesexceeded95percent.
• Inpatientmortalityfollowingpituitarysurgerywaszero
percent.
Cerebrovascular
• Intravenoustissueplasminogenactivatorisindicatedfortreat-
mentofacuteischemicstroke,ifadministeredwithin180
minutesofstrokeonsetsymptoms.ClevelandClinic’s2008
performancesurpassedboththenationalaverageandthegoal
forthe“GetWithTheGuidelines”SM StrokeSilverPerformance
Award.GWTGisahospital-basedqualityimprovementpro-
gramfortheAmericanStrokeAssociationandtheAmerican
2008Outcomes
TheNeurologicalInstitutestronglysupportscontinuousmeasurementandtransparentreportingofclinical
outcomes,inthebeliefthatmakingaccurateinformationavailabletopatientsandtheirphysicianswillresultinbetter
healthcaredecisions.ThroughtheKnowledgeProgram©,wearereinforcingourcapabilitytocollectandanalyze
clinicaldata,withtheultimategoalofimprovingthequalityofourcareandouroutcomes.
Left: Before meeting with her clinician, a patient enters self-assessment data directly into the Knowledge Program© electronic tablet. All Neuro-logical Institute patients complete standardized health questionnaires prior to their appointments.
Cleveland Clinic Neurological Institute | 2008 Annual Report
28 Outcomes
Heart Association. Cleveland Clinic was a 2008 recipient of
the Stroke Silver Performance Award.
• WhiletheCerebrovascularCentersawan11percentincrease
inthenumberofproceduresforrupturedcerebralaneurysm
between2007and2008,inpatientmortalityremainedbelow
theexpectedrate(basedonnationalnormativedataandAPR-
DRGsforthelastthreeyears).
• Noinpatientdeathsoccurredin2008fromnonruptured
cerebralaneurysm.Mortalityhasremainedbelowexpected
levelsforthreeyears.
beforesurgeryto2.2timespermonthaftersurgery,with
74percentreportingnoseizurespostoperatively.
• Long-termseizurefreedomwasassessedin550Epilepsy
Centerpatientswhounderwenttemporallobesurgeryfrom
1997through2008.Oneyearaftersurgery,81percentwere
seizurefree;70percentmaintainedseizurefreedomatfive
years.Amongpatientswithpersistentseizuresfollowingthe
surgery,seizurefrequencydeclinedanaverage73percent
postoperatively.
The Epilepsy Center’s adult and pediatric monitoring units feature the latest technology, including all-digital video EEG equipment. Operating around the clock, these units are staffed by dedicated teams.
Cleveland Clinic 2008
GWTG Silver Performance Award Goal
National Average*
0 20 40 60 80 100
Patients Receiving Intravenous Tissue Plasminogen Activator in the Emergency Department within 180 Minutes of Onset of Stroke Symptoms
Percent
Epilepsy
• Inarandomsampleofpatientswhounderwentepilepsy
surgerybetweenJanuary2007andNovember2008,average
seizurefrequencywasreducedfrom12.3timespermonth
Movement Disorders
• Among27Parkinson’sdiseasepatientsimplantedwithdeep
brainstimulatorsin2008,theaverageimprovementinmotor
functionwas57percentaftersurgery(UnifiedParkinson’s
DiseaseRatingScale).
Multiple Sclerosis
• TheMellenCenterforMultipleSclerosisTreatmentand
Researchhastreatedmorethan250patientswithintrathe-
calbaclofentherapy(ITB)since1990.In2008,17patients
underwentimplantationofabaclofenpump.Meanspasticity
scoresshowedastatisticallyrelevantreductionfollowingITB
therapy(ModifiedAshworthScale).
Pain/Headache
• In2008,196patientswithstatusmigrainosis,transformed
migraine,clusterheadacheandchronicdailyheadache
* Hospitals participating in GWTG for five or more years (N = 2,095)
received intravenous infusion therapy lasting one to five days at
the Neurological Center for Pain. Nearly 60 percent reported
a 50 percent or greater reduction in pain immediately after
treatment.
• Sixty-fourindividualscompletedthecenter’sInterdisciplinary
Method for the Assessment and Treatment of Chronic Head-
ache(IMATCH)outpatientprogramin2008.Patients’self-
rated pain and disability scores decreased after the intensive
treatment.
• TheChronicPainRehabilitationProgram(CPRP)treatsindi-
viduals who are emotionally and physically devastated by pain.
Continuingalong-termtrendin2008,patients’meanpain
scores decreased and their functional status improved after
enrollmentintheCPRP(PainDisabilityIndex).
Pediatric Neurology
• Among46pediatricpatientstreatedforheadachein2008,
both headache frequency and number of rescue medications
needed in the previous three months showed improvement.
Groupmeansforheadachefrequencyimproved46percent
inthemeanseven-monthintervalbetweenvisitsoneandtwo
(PediatricMigraineDisabilityAssessment).
• Inchildrenwithsevereheadaches,theaveragenumberof
complete and partial school days missed in the preceding three
monthsdeclinedfrom10.8to2.5.
Pediatric Neurosurgery
• Inpatientmortalityremainedbelowexpectedlevelsafter
surgeryforChiarimalformation,withnodeathsfrom2006
through2008.
Psychiatric Disorders
• AfteroneyearofparticipationintheoutpatientWomen’s
MentalHealthManagementGroup,29womendiagnosed
withmajordepressionregisteredagroupmeandecreaseof2.2
pointsindepressionseverityscore(PHQ-9).Groupmedica-
tion management had a positive effect on remission of depres-
sive symptoms.
• Among202inpatientstreatedin2008attheCenterfor
MoodDisordersTreatmentandResearchatLutheranHospi-
tal,aClevelandClinichospital,astatisticallysignificantreduc-
tion in mean severity of depression occurred from admission
todischarge(HamiltonDepressionScale,Montgomery-Asberg
DepressionRatingScale).
Sleep Disorders
• Sleepinessdecreasedamong217sleepapneapatientswho
receivedpositiveairwaypressure(PAP)treatmentin2008
(EpworthSleepinessScale).
• Functionalstatusimprovedamong216PAP-compliantsleep
apnea patients who assessed their status before and after treat-
ment(FunctionalOutcomesofSleepQuestionnaire).
Spinal Cord Disease
• TheCenterforSpineHealthusesateamapproachtodiagnosis,
treatment,patientsatisfactionandqualityforindividualswith
spine tumors. This strategy is credited for annual increases in
spinepatientsandcasesstudiedattheweeklySpineTumor
ReviewBoard,whichengagessurgeons,radiologists,patholo-
gistsandotherspecialistsinalogic-baseddecision-makingpro-
cess.From2006through2008,boththenumbersofpatients
and cases studied more than doubled.
clevelandclinic.org/neuroscience | 866.588.2264
Outcomes29
Weekly Spine Tumor Review Board meetings involve multidisciplinary clinical teams that evaluate complex cases through a logic-based decision-making process.
clevelandclinic.org/neuroscience | 866.588.2264
Technology and Innovation 31
Brain Tumor and Neuro-Oncology Center
Prospective First-in-Man Safety Trial of Laser Treatment
Cleveland Clinic’s Brain Tumor and Neuro-Oncology Center
(BTNC) was the first in the world to use a new, laser-based system
in a human for minimally invasive treatment of a brain tumor.
The AutoLITT™ (laser interstitial thermal therapy) system
coagulates tumors through a special laser probe, precisely
directed into the tumor, with the heating process monitored by
specialized software and thermal MRI techniques. Gene Barnett,
MD, FACS, leads this trial of a technology that could offer the
benefits of conventional surgery for some inoperable tumors and
spare patients more invasive interventions.
Stereotactic Radiosurgery for Spinal Tumors
Led by neurosurgeon Lilyana Angelov, MD, Cleveland Clinic’s
Spine Radiosurgery (SRS) program provides patients with
specialized, integrated care for complex problems related to
spine tumors. This program, the first of its kind in Ohio, is the
state’s largest and most established. To date, Dr. Angelov and her
multidisciplinary spine care team have reviewed and approved
management of more than 600 spine tumor cases and per-
formed more than 250 spine radiosurgeries.
Metastasis to the spinal column in cancer patients is often associ-
ated with disabling pain, and may result in neurological dysfunc-
tion and paralysis related to direct compression of the spinal cord
or nerve roots by tumor or instability of the spinal column.
Cleveland Clinic’s SRS program uses a novel modality, the
Novalis® Shaped Beam Surgery system, to deliver a high dose of
radiation to spinal metastases in a precise, conformal fashion,
enveloping the tumor in three dimensions without significant
scatter or spread beyond the target to sensitive adjacent organs
such as the spinal cord.
SRS can be used as a stand-alone treatment or as an adjunct to
other modalities. It can even be used as salvage therapy after con-
ventional radiation for spine metastases has failed. A noninvasive
outpatient procedure with minimal recovery time, this highly
selective, precise radiation therapy results in effective, rapid relief
of pain and exceptional tumor control.
Among patients treated at Cleveland Clinic, pain scores improved
by nearly 80 percent as early as one week post-treatment com-
pared with immediately before SRS. Moreover, this post-treatment
pain relief was durable, with almost 90 percent of evaluable
patients experiencing continued pain improvement at 12 months
following SRS. Radiographic tumor control was obtained in
approximately 90 percent of evaluated cases, including tumors
traditionally perceived to be radioresistant, such as renal cell
carcinoma and melanoma.
Tailoring Treatment of Oligodendroglioma
The discovery of a genetic alteration in oligodendrogliomas that
was prognostic of improved response to treatment and survival
was a landmark event in neuro-oncology. However, it was not
entirely clear how best to use this information to tailor therapy for
Technology and Innovation
Patients benefit from the latest treatment modalities at the Neurological Institute, where scientists and clinicians
working together continue to advance innovations and accelerate the process of bringing novel therapeutic agents
from the laboratory to the bedside.
Left: Brain Tumor and Neuro-Oncology Center neurosurgeons perform more than 950 brain tumor surgeries each year, aided by the latest tech-nological innovations. More than 25 percent of new brain tumor patients travel to Cleveland Clinic from outside Ohio.
Cleveland Clinic Neurological Institute | 2008 Annual Report
32 Technology and Innovation
maximal benefit, without the harmful side effects associated with
radiation and chemotherapies.
Michael Vogelbaum, MD, PhD, has been a coleader of an inter-
national effort to define how best to use the information provided
by analysis of this alteration, also referred to as 1p/19q codele-
tion. In 2008, he was the lead author of a paper published in
the journal Neuro-Oncology, reporting the results of a study he
led with the Radiation Therapy Oncology Group that examined a
chemotherapy-only treatment for patients with malignant oligo-
dendroglial tumors. He is now the U.S. Principal Investigator for
a European-led Phase III trial of radiation and/or chemotherapy
for 1p/19q non-codeleted anaplastic gliomas and the U.S. co-PI
for another Phase III trial of radiation and/or chemotherapy for
1p/19q codeleted anaplastic gliomas. These studies will define
the optimal treatment for patients with grade III gliomas.
Epilepsy Center
Enhanced Localization Ability with Magnetoencephalography (MEG)
The MEG laboratory at Cleveland Clinic’s Epilepsy Center
has enhanced the center’s diagnostic capabilities. Cleveland
Clinic is among a select number of institutions in the world with
this technology, which measures magnetic fields produced by
electrical activity in the brain to localize the epileptic focus.
MEG is used routinely to better identify epileptic sources in
patients in whom the area of the brain causing the seizures would
otherwise be difficult to identify. Since its inception, the MEG
laboratory has tested more than 50 clinical patients. Results,
taken with the rest of the clinical evaluations, have been used to
refine the location of the epileptic focus, help guide the place-
ment of intracranial recording electrodes or ascertain that the
patient is not a surgical candidate.
The neurocomputing and clinical neurophysiology teams have
added capabilities to the basic MEG system, making it uniquely
advanced. These new developments include:
• specializedsoftwaretopost-processtherecordedMEG
waveforms
• continuous,synchronized digitalvideorecordingtoenable
direct correlation of the patient’s physical actions with MEG
waveforms
• onlineannotationsthatprovidesecond-by-secondtestingand
clinical information during a MEG recording
• anonlinedatabasethatkeepsrawresultsaswellasinterpreta-
tions to facilitate ongoing quality assessment
Mellen Center for Multiple Sclerosis Treatment and Research
Optical Coherence Tomography to Monitor Axonal Injury
Optical coherence tomography (OCT) is a rapid, noninvasive,
painless test that generates high-resolution images of the retina.
Cleveland Clinic researchers are exploring utilization of OCT to
measure the thickness of the retinal nerve fiber layer and the vol-
ume of the macula. The optic nerve is an important site of injury
in MS, and the ability to monitor the degree of injury would be
an important advance in both clinical practice and experimental
treatment trials.
Center for Neuroimaging
Correcting Motion-Corrupted Imaging Data
High-Angular Resolution Diffusion-Weighted Imaging (HARDI)
presents a challenge with regard to intrascan subject motion.
Image volumes are acquired serially on subjects, varying the
direction of diffusion sensitivity gradually throughout the scan.
Robust calculation of the final diffusion tensor assumes no
intrascan motion of the subject. HARDI acquisitions can take
10 minutes or more to acquire; thus, the assumption of no intra-
scan motion is problematic. Cleveland Clinic neuroradiologists
demonstrated that a previously published tensor-fit method is
sufficient in most cases when iterated up to 20 times on a single
data set. Motion effects can be removed to the 0.2 mm level, thus
reducing the error on the diffusion direction below 0.2 degree.
Defining Anatomic-Based Seeds for Functional Connectivity Analysis
Assessment of functional connectivity in the human brain,
using low-frequency blood oxygen level-dependent (BOLD)
Right: Magnetoencephalography (MEG) can evaluate the brain’s spontaneous activity or its response to specific stimuli. With a very large number of sensors, as well as the absence of any effect from skull or scalp, MEG has an inherently high resolution and provides superior accuracy, espe-cially when combined with MRI.
Cleveland Clinic Neurological Institute | 2008 Annual Report
34 Technology and Innovation
fluctuation present in dynamically sampled MRI data, has
become a common technique. The most common method of
assessing connectivity is to measure the temporal correlation
between two functional brain regions.
Due to individual variation in functional localization in the
human brain, a standard technique for identifying regions of
interest is to perform task-based functional MRI. This imposes a
serious limitation on the ability to analyze functional connectiv-
ity in studies in which activation data also have been obtained.
Cleveland Clinic researchers introduced a method for defining
connectivity reference regions, based on combining anatomic
landmarks with a regional measure of temporal coherence. This
measure, derived from Kendall’s coefficient of concordance,
results in robust measures of functional connectivity.
Monitoring System for Deep Brain Stimulators during MRI
Performing functional MRI (fMRI) studies of implanted deep
brain stimulators (DBS) is important in understanding the
mechanisms of this therapy. To date, all fMRI has been done with
externalized DBS leads connected directly to a pulse generator in
the MRI console room immediately after surgical placement of
the lead. In this configuration, it is straightforward to program
the pulse generator such that the timing between acquired MRI
data and the stimulation is known.
When using implantable pulse generators (IPGs), it becomes
problematic to determine the state of the IPG during the acquisi-
tion of MRI data. Cleveland Clinic developed a passive radiofre-
quency (RF) monitoring system, which, when placed over the
implant on the patient’s chest, determines the state of the pulse
generator from characteristic low-frequency RF energy emissions.
This enables researchers to correlate stimulation with regional
changes in BOLD-weighted MRI signal.
Working with Patients to Improve Functional MRI Quality
Functional MRI studies are performed daily with standardized
paradigms to provide consistent preoperative localization of
motor, speech generation and receptive speech areas, with an
Right: Postoperative X-ray shows placement of bilateral deep brain stimulation (DBS) leads and electrodes in a patient with obsessive-compulsive disorder (OCD). Cleveland Clinic is among four centers worldwide where psychiatric neurosurgery teams have collaborated to investigate the safety and efficacy of DBS for refractory OCD.
85 percent success rate. A program was developed in which a
neuroradiologist interviews every patient to individualize the
study when indicated, provide instructions for the paradigms,
and emphasize the consequences of inattention and movement.
A study that examined the effect of the prescan patient interview
in improving scan quality showed that an intensive intervention
can reduce unacceptable sequences from 15 percent to
5 percent.
Previously, language fMRI examinations were conducted only
in English. The paradigms have been extended to include other
languages, such as Spanish and French. Also, for language-chal-
lenged patients such as children and those with injuries such as
strokes, simpler paradigms are available, incorporating pictures
and simpler language. This change has resulted in a significant
improvement in reliability of all clinical studies.
Lateralization Score for fMRI Studies to Judge Hemispheric
Speech Dominance
The major clinical utility for performing fMRI studies is presurgi-
cal planning, particularly for epilepsy and brain tumor patients.
The important issue is to identify the essential eloquent cortical
areas governing language and motor activity so the surgeon can
provide adequate margins to minimize post-surgical morbidity.
Often, this issue is resolved by determining language lateraliza-
tion, a process hitherto determined by the neuroradiologist based
on a qualitative impression of the fMRI images.
Recent work has extended the qualitative impression of language
lateralization with a quantitative lateralization index or score,
which is computer-generated and based on an analysis of 42
patients who had both fMRI and Wada lateralization. Wada is the
gold standard; however, because it involves catheter angiography,
it carries significant risk. Work at Cleveland Clinic shows how
this computer-generated lateralization index more accurately
identifies and quantifies the degree of qualitative language
lateralization. For studies in which quality is not significantly
degraded by motion or inattention, a qualitative lateralization
clevelandclinic.org/neuroscience | 866.588.2264
Technology and Innovation 37
correlation of R2=0.34 is increased to R2=0.60 when the neuro-
radiologist is assisted by the computer-generated index.
Integration of Diffusion Tensor Imaging
With diffusion tensor imaging (DTI), also known as tractography,
neuroscientists are noninvasively probing the long-neglected
white matter pathways in the brain. The significance of this
technological leap forward was illustrated at the 2008 Cleveland
Clinic Medical Innovations Summit, where DTI was among 10
breakthroughs that Cleveland Clinic physicians cited as most
likely to impact medicine in the coming year.
In clinical practice, Cleveland Clinic neuroscientists are utilizing
DTI to create a detailed spatial wiring map of the brain, which
can enhance surgical planning and prognosis accuracy. In the
research laboratory, they are applying DTI to advance understand-
ing of a wide range of brain disorders, including Parkinson’s
disease, epilepsy, multiple sclerosis and traumatic brain injury.
Neurological Center for Pain/Center for Neurological Restoration
Neurostimulation for Treatment of Cluster Headaches
The Center for Neurological Restoration conducted an IRB-
approved study in collaboration with the Neurological Center for
Pain to assess the safety and efficacy of acute neurostimulation of
the sphenopalatine ganglia (SPG) for treatment of severe cluster
headaches. Five patients underwent SPG stimulation and three
returned for a second trial, for eight total treatment sessions. Four
treatment sessions (in three patients) produced complete resolu-
tion of at least one cluster attack within two minutes, suggesting
that this technique may hold promise for treatment of these and
other types of headache.
Sleep Disorders Center
Multidisciplinary CPAP Compliance Group Therapy
Continuous Positive Airway Pressure (CPAP) therapy is the
standard treatment for sleep apnea, but an estimated 30 percent
to 50 percent of patients are noncompliant, for both mechanical
and psychological reasons.
Cleveland Clinic’s Sleep Disorders Center started a group therapy
initiative to target these patients. Led by a sleep specialist, a
psychologist and a sleep technician, the groups of six to eight
patients meet in sessions that last about 90 minutes. Patients
discuss their problems with CPAP and receive tips from profes-
sionals, while learning from other patients. They have opportuni-
ties to try other CPAP masks and devices and, depending on the
nature of the problem, they receive detailed individual treatment
plans. Patient feedback has been highly positive.
Biofeedback for Chronic Insomnia
Chronic insomnia affects 10 percent to 15 percent of adults.
Although hypnotic medicines are effective in some patients, they
are not always safe for long-term use.
Cleveland Clinic’s Sleep Disorders Center is one of a very few
centers in the country with a dedicated biofeedback program for
chronic insomnia. The most commonly used forms of treatment
are EMG biofeedback, respiratory biofeedback, thermal biofeed-
back and neurofeedback.
Psychologists and sleep specialists offer the treatment in weekly
sessions for five to six weeks. More than two-thirds of patients
report significant improvement in chronic insomnia symptoms.
Center for Spine Health
Delaying Recurrences of Myxopapillary Ependymomas
The Center for Spine Health is the largest center in the United
States conducting adjuvant radiation therapy (ART) studies. A
center study found the use of therapeutic radiation beneficial in
delaying a second occurrence of myxopapillary ependymomas.
Patients who did not receive ART had a median time to recur-
rence of 1.1 years, while those who received ART had a median
time to recurrence of 9.6 years.
Left: An MRI of a lumbar spine shows some involvement of Level 5 with an infectious or tumorous process. The Center for Spine Health utilizes advanced imaging technologies to diagnose a variety of spine-related conditions.
clevelandclinic.org/neuroscience | 866.588.2264
Research 39
In 2008, grant and contract research dollars funding neurologi-
cal investigations in the Neurological Institute, Lerner Research
Institute and Department of Neuroradiology totaled more than
$17.9 million. Additional metrics from 2008 help quantify an
expanding program:
Number of new clinical research trials: 42
Number of active clinical research trials: 139
Staff leading clinical research trials: 50
New patients enrolled in clinical research trials: 772
Number of patients enrolled in clinical research trials: 1,690
Number of National Institutes of Health grants and contracts
(includes Lerner Research Institute and Neuroradiology): 91
Number of non-NIH neurological grants
(includes Lerner Research Institute and Neuroradiology): 167
This support was instrumental to a number of noteworthy
advances within the Neurological Institute.
Cranial Radiosurgery for the Older Old
Although the incidence of cancer increases with age, research
studies have traditionally excluded older patients, especially those
75 and older. In cancer that spreads to the brain from another
site, data from patients younger than 65 suggested that increas-
ing age was associated with a poorer prognosis, irrespective of
whether the patient received surgery, whole brain radiation or
stereotactic radiosurgery (SRS).
Despite the known efficacy of SRS in treating brain metastasis,
little was known of its efficacy in older patients. Robert Weil, MD,
and colleagues from the Brain Tumor and Neuro-Oncology Center
performed the first large analysis of a consecutive series of patients
75 and older treated with SRS, which was generally the sole
treatment for their brain metastases. In 44 patients treated over
13 years, SRS of one or more brain metastases produced results
comparable to those found in younger patients: Average survival
exceeded seven months, with more than one-third of patients
surviving one year and longer. Patients tolerated the treatment
well, with no loss of physical function.
This study supports the idea that aggressive, multimodal treat-
ment of cancer that spreads to the brain can be effective and safe
in older patients, with results similar to those experienced by
younger patients.
Understanding Combat-Related Traumatic Brain Injury
Traumatic brain injury (TBI) caused by improvised explosive
devices is fast becoming the signature wound of the Iraq and
Afghanistan wars. With a $1.4 million grant from the U.S.
Research
The Neurological Institute conducts a robust research program that fosters a culture of innovation and collaboration.
Physicians and scientists within the institute work closely with colleagues in the Lerner Research Institute, the basic
science research arm of Cleveland Clinic, pursuing laboratory-based and clinical research as well as translational
research that applies laboratory findings to improve patient care.
Left: Neural stem cells generate various types of cells. They can generate astrocytes, oligodendrocytes and neurons, according to the stimuli they are under. These cells are prime candidates for stem cell transplantation therapies.
Cleveland Clinic Neurological Institute | 2008 Annual Report
40 Research
Department of Defense, Cleveland Clinic cognitive neuroscientist
Stephen Rao, PhD, and collaborators are using advanced brain
imaging techniques to better understand blast-related TBI.
Dr. Rao, the Principal Investigator, is working with colleagues
at Baylor College of Medicine. Their research will determine
if blast-related TBI, thought to be produced by wave-induced
changes in atmospheric pressure, can be differentiated from the
better-studied civilian TBI, which is caused primarily by mechani-
cal forces such as the sudden jolt from an auto accident or fall.
Functional magnetic resonance imaging and diffusion tensor
imaging will be used to identify differences and parallels between
military and civilian TBI.
As many as 20 percent of soldiers returning from Iraq and
Afghanistan have TBI. Approximately 40 percent of these are
mild cases that are often overlooked because they do not show
up on traditional screening tests. Yet, if a solider returns to
combat without treatment for a mild TBI, a second or third blast
injury can be much more crippling, according to Dr. Rao. Each
successive injury further depletes the neural reserve, hampering
recovery.
Furthermore, the effects of even one mild TBI can linger, mani-
fested months or years later in memory problems, mood swings
and constant frustration. Thus, research to identify damage
caused by the first blast injury assumes even greater relevance.
New Neuron Growth in Adult Brains
Lerner Research Institute researchers discovered evidence of the
generation of new neurons in adult brains. The findings, pub-
lished in Brain, challenge views that the adult human brain lacks
the ability to grow new neurons.
This research, led by Bruce Trapp, PhD, Chairman of the Depart-
ment of Neurosciences at Lerner Research Institute, involved
examination of neurons in the brains of nine patients with
multiple sclerosis (MS) and four healthy control group subjects.
The study used advance staining techniques to detect and charac-
terize neurons in normal subcortical white matter and acute and
chronic demyelinated brain lesions. In MS, the immune system
destroys the myelin sheaths that surround and protect nerves. The
nerves then “misfire,” slowing or disrupting impulses.
Dr. Trapp’s team found that neurons occupying the white matter
also are destroyed during demyelination. In a small percentage
of old MS lesions, however, white matter neurons increased
72 percent compared with normal brain regions.
The study suggests that demyelinated tissues produce signals that
can enhance the generation of new neurons in damaged areas of
the brain. Thus, there is evidence to support the thesis that new
neurons can regrow in MS lesions.
It is unclear how much function the new tissues have, but this
basic science discovery may provide a basis for development of
new therapies for MS and other neurodegenerative diseases.
Collaborating with Dr. Trapp on the research were Susan
Staugaitis, MD, PhD, and neurologists at the Mellen Center for
Multiple Sclerosis Treatment and Research.
Stem cell biology and the resulting regenerative medicine hold the promise of moving medicine beyond simply
dealing with symptoms.
Grahame Kidd, PhD, left, and Bruce Trapp, PhD, analyze images of “new neurons” in multiple sclerosis brain sections.
clevelandclinic.org/neuroscience | 866.588.2264
Research 41
Unlocking Stem Cell Potential
Jeremy Rich, MD, nationally known for his research on cancer
stem cells and brain tumors, was recruited from Duke University
Medical Center in 2008 to serve as Chairman of Lerner Research
Institute’s newly created Department of Stem Cell Biology and
Regenerative Medicine.
she would have pedaled alone. Dr. Alberts set out to investigate
whether “forced exercise,” in which people are pushed beyond
their normal limits, is therapeutic for Parkinson’s patients.
To test the theory, he designed a tandem bicycle that forces
patients to pedal at accelerated rates. Among the early findings:
Motor function improved significantly in patients’ arms, even
though they were working only their legs, which suggests to Dr.
Alberts that forced exercise impacts higher brain function and
improves central motor function.
Patients averaged a 30 percent improvement in their symptoms,
and these gains were sustained for four weeks after they stopped
forced exercising.
Dr. Alberts posits that driving the central nervous system beyond
its normal capacity can lead to biochemical changes necessary for
these improvements.
Further research is needed to understand the underlying mecha-
nisms. Mark Lowe, PhD, of Cleveland Clinic’s Imaging Institute,
and Micheal Phillips, MD, Section Head of Imaging Sciences in
the Department of Diagnostic Radiology, are collaborating on
the project.
Novel Oral Therapies for Multiple Sclerosis
MS researchers are poised for a breakthrough in the form of the
first-ever oral agents for treatment of the disease, which are now in
Phase III testing. Neurologists at Cleveland Clinic’s Mellen Center
for Multiple Sclerosis Treatment and Research are closely involved
in these promising investigations, as are the study participants
among their patients.
Mellen Center Medical Director Robert Fox, MD, is Principal
Investigator on a Phase III study of the oral immunomodulator
fumarate. Jeffrey Cohen, MD, Director of Experimental Thera-
peutics at the Mellen Center, was PI on a Phase III trial of the oral
drug fingolimod. Dr. Cohen also serves on the adjudication board
for an ongoing study of oral cladribine and the steering committee
for trials of the immunomodulator laquinimod.
Brain precursor cells that give rise to myelin-forming cells are impor-tant for repairing damage from demyelinating diseases like multiple sclerosis. In this population, all precursor cells expressed a common marker molecule (red), but only a subset also expressed a marker associated with cell maturation (green).
Stem cell biology and the resulting regenerative medicine hold
the promise of moving medicine beyond simply dealing with
symptoms. Dr. Rich’s goal is to develop a comprehensive research
group to study stem cells, from the basic science to implementa-
tion of new therapies to treat a variety of diseases. He plans to
recruit about 10 faculty members in the next five years to build a
department with approximately 100 employees.
Forced Exercise Reduces Parkinson’s Symptoms
Sometimes, insight comes in an unlikely setting. Jay Alberts, PhD,
Department of Biomedical Engineering, had just completed a
450-mile bicycle trip across Iowa to raise awareness of Parkinson’s
disease when a patient mentioned that she had no symptoms dur-
ing the ride, and the tremor in her hand was gone afterward. The
patient had been paired with a rider who set a faster pace than
Cleveland Clinic Neurological Institute | 2008 Annual Report
42 Research
Plasma Exchange as Treatment for Rare Complication
The drug natalizumab helps treat multiple sclerosis by inhibiting
white blood cells from entering the brain and attacking nerves,
but this drug also lowers the patient’s immunity. Some patients
taking natalizumab have suffered an uncommon, but usually
fatal, infection called progressive multifocal leukoencephalopathy
(PML).
In a study published in the journal Neurology, Robert Fox, MD,
and colleagues examined the effect of plasma exchange in 12 MS
patients taking natalizumab. This study showed that monoclonal
antibodies can be removed from the body with plasma exchange,
and this removal leads to improved immune function. Using
population modeling, Dr. Fox and colleagues suggested that
five plasma exchanges are needed to effectively remove natali-
zumab from the bodies of patients receiving this therapy. Plasma
exchange may help convert PML into a manageable complication
of treatment with natalizumab, which would improve the overall
safety of this therapy.
Tissue Collection Supports Multiple Sclerosis Research
Many MS basic research studies require brain and spinal cord
tissue from diseased patients. Because brain biopsies are rare,
autopsy collection of tissues is vital in providing the required
resources for these studies. Cleveland Clinic has developed an
effective MS Tissue Donation Program.
An advanced directive program includes educational materials,
written informed consent, donor identification card, and a secure
database with patient demographics and disease characteristics. A
rapid autopsy protocol ensures 24/7 transportation, postmortem
imaging and tissue procurement.
At the time of death, calls from family and care providers are
routed to the on-call MS tissue donation nurse coordinator,
who activates the ambulance transport and notifies the imag-
ing, autopsy and tissue-processing teams. The body undergoes
The Spine Research Laboratory includes a state-of-the-art biomechanics laboratory. Biomechanical testing involves eccentric axial loading of a spinal motion segment to determine stress distribution within the intervertebral disc.
clevelandclinic.org/neuroscience | 866.588.2264
Research 43
postmortem MRI, followed by brain and spinal cord removal and
processing by a neuropathologist and the tissue-processing team.
Local pathologists are utilized for distant patients.
A total of 224 patients have enrolled in the advanced directive
program. Since 1997, 64 patients have donated their tissues.
Median postmortem interval (time from death to fixation) was
6.1 hours.
This program has been successful in effectively procuring and
rapidly processing MS tissues, and has supported high-impact
publication in The New England Journal of Medicine, Annals of
Neurology and Archives of Neurology.
Spine Research Laboratory at Lutheran Hospital
Eighty percent of American adults experience back problems at
some point in their lives. Cleveland Clinic’s Spine Research
Lab (SRL), which relocated in 2008 to Lutheran Hospital, a
Cleveland Clinic hospital, is dedicated to improving quality of life
for people with spinal disorders through research, innovation and
education.
The SRL strengthens the comprehensive spine program developed
in recent years at Lutheran. The program is noted for medical and
surgical spine care and inpatient rehabilitation. The addition of
the SRL, under the direction of Lars Gilbertson, PhD, intensifies a
complementary focus on research and education.
The SRL hosts medical students, bioengineering students,
residents and fellows from the departments of Neurosurgery and
Orthopaedic Surgery, along with research fellows from around
the world.
With the SRL, the spine program at Lutheran is fast becoming an
integrated continuum with Cleveland Clinic’s main campus and
the Neurological Institute, as Dr. Gilbertson and staff work closely
with Center for Spine Health Director Gordon Bell, MD, and his
clinical staff.
In recognition of its commitment to spinal care and research,
the SRL received a five-year grant from Ohio’s Third Frontier
Commission. In its new home, the SRL seeks to establish itself
as a national leader in spinal innovation and to educate the next
generation of spine researchers and clinicians.
Neurological Institute Chairs
Holders of the following endowed chairs are entrusted with the
stewardship of funds generated by the gifts of Cleveland Clinic’s
generous supporters.
Gene Barnett, MD, FACSDirector, Brain Tumor and Neuro-Oncology Center The Rose Ella Burkhardt Chair in Neurosurgery
William Bingaman, MD Vice Chairman, Clinical Areas, Neurological InstituteThe Shusterman Endowed Chair
Irene Katzan, MD, MSThe Wamberg Family Endowed Chair in Stroke Research
Michael T. Modic, MD, FACRChairman, Neurological InstituteThe William P. and Amanda C. Madar Endowed Chair and Professorship
Imad Najm, MDDirector, Epilepsy CenterThe Joseph and Ellen Thomas Endowed Chair
Stephen Rao, PhDDirector, The Ralph and Luci Schey Foundation Center for Advanced Cognitive FunctionThe Ralph and Luci Schey Endowed Chair in Cognitive Function
Ali Rezai, MD *The Jane and Lee Seidman Chair in Functional Neurosurgery
Richard A. Rudick, MD Vice Chairman, Research and Development, Neurological InstituteDirector, Mellen Center for Multiple Sclerosis Treatment and ResearchThe Hazel Prior Hostetler Endowed Chair
Tanya Tekautz, MDBrain Tumor and Neuro-Oncology CenterThe Karen Colina Wilson Endowed Chair in Pediatric Brain Tumor Research
Jerrold Vitek, MD, PhDCenter for Neurological RestorationThe Edward F. and Barbara A. Bell Family Endowed Chair
Michael Vogelbaum, MD, PhDAssociate Director, Brain Tumor and Neuro-Oncology CenterThe Robert W. and Kathryn B. Lamborn Chair for Neuro-Oncology
Robert J. Weil, MDDirector of Laboratory Research, Brain Tumor and Neuro-Oncology CenterThe Melvin H. Burkhardt Chair in Neuro-Oncology Clinical Research
Currently Unassigned Endowed Chairs The Andrea L. and Joseph F. Hahn, MD, Endowed ChairThe Jane and Lee Seidman Chair in Functional Neurosurgery
* Until July 2009
Cleveland Clinic Neurological Institute | 2008 Annual Report
44 Research
Brain Tumor and Neuro-Oncology Center
Balmaceda C, Peereboom D, Pannullo S, Cheung YKK, Fisher PG, Alavi J, Sisti M, Chen J, Fine RL. Multi-institutional phase II study of temozolomide administered twice daily in the treatment of recurrent high-grade gliomas. Cancer. 2008 Mar 1; 112(5):1139-1146.
Chao ST, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Neyman G, Reuther AM, Suh JH. Salvage stereotactic radiosurgery effectively treats recurrences from whole-brain radiation therapy. Cancer. 2008 Oct 15;113(8):2198-2204.
Georgitsi M, De Menis E, Cannavo S, Makinen MJ, Tuppurainen K, Pauletto P, Curto L, Weil RJ, Paschke R, Zielinski G, Wasik A, Lubinski J, Vahteristo P, Karhu A, Aaltonen LA. Aryl hydrocarbon receptor interacting protein (AIP) gene mutation analysis in children and adolescents with sporadic pituitary adenomas. Clin Endocrinol (Oxf ). 2008 Oct;69(4):621-627.
Gibson SE, Zeng WF, Weil RJ, Prayson RA. Aurora B kinase expression in ependymal neoplasms. Appl Immunohistochem Mol Morphol. 2008 May;16(3):274-278.
Guo S, Chao ST, Reuther AM, Barnett GH, Suh JH. Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery. Stereotact Funct Neurosurg. 2008;86(3):135-146.
Kang TY, Jin T, Elinzano H, Peereboom D. Irinotecan and bevacizumab in progressive primary brain tumors, an evaluation of efficacy and safety. J Neurooncol. 2008 Aug;89(1):113-118.
Kim SH, Weil RJ, Chao ST, Toms SA, Angelov L, Vogelbaum MA, Suh JH, Barnett GH. Stereotactic radiosurgical treatment of brain metastases in older patients. Cancer. 2008 Aug 15; 113(4):834-840.
Marko NF, Toms SA, Barnett GH, Weil R. Genomic expression patterns distinguish long-term from short-term glioblastoma survivors: a preliminary feasibility study. Genomics. 2008 May;91(5):395-406.
Selected Publications
Neurological Institute staff authored more than 470 publications in 2008, including the following. For a complete
list, go to clevelandclinic.org/nipublications.
Pineyro MM, Makdissi A, Faiman C, Prayson RA, Reddy SK, Mayberg MC, Weil RJ, Hamrahian AH. Poor correlation of serum alpha-subunit concentration and magnetic resonance imaging following pituitary surgery in patients with nonfunctional pituitary macroadenomas. Endocr Pract. 2008 May;14(4):452-457.
Sade B, Lee JH. High incidence of optic canal involvement in clinoidal meningiomas: rationale for aggressive skull base approach. Acta Neurochir (Wien). 2008 Nov;150(11):1127-1132.
Cerebrovascular Center
Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, Purdy PD, Welch BG, Woo HH, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ. Angiographic patterns of wingspan in-stent restenosis. Neurosurgery. 2008 Jul;63(1):23-27;discussion 27-28.
Bhatt A, Vora NA, Thomas AJ, Majid A, Kassab M, Hammer MD, Uchino K, Wechsler L, Jovin TG, Gupta R. Lower pretreatment cerebral blood volume affects hemorrhagic risks after intra-arterial revascularization in acute stroke. Neurosurgery. 2008 Nov;63(5):874-878.
Cucullo L, Couraud PO, Weksler B, Romero IA, Hossain M, Rapp E, Janigro D. Immortalized human brain endothelial cells and flow-based vascular modeling: a marriage of convenience for rational neurovascular studies. J Cereb Blood Flow Metab. 2008 Feb;28(2):312-328.
Fan QY, Ramakrishna S, Marchi N, Fazio V, Hallene K, Janigro D. Combined effects of prenatal inhibition of vasculogenesis and neurogenesis on rat brain development. Neurobiol Dis. 2008 Dec;32(3):499-509.
Kelly ME, Turner RD IV, Moskowitz SI, Gonugunta V, Hussain MS, Fiorella D. Delayed migration of a self-expanding intracranial microstent. AJNR Am J Neuroradiol. 2008 Nov;29(10):1959-1960.
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Research 45
Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic and clinical benefits of portable head/neck CT imaging in the intensive care unit. Radiol Manage. 2008 Mar-Apr;30(2):50-54.
Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008 Mar 11;70(11):853-860.
Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, Jarouse J, Brillman J, Murali S, Gupta R. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology. 2008 Nov 18;71(21):1696-1701.
Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch BG, Niemann DB, Purdy PD, Aagaard-Kienitz B, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella D. Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol. 2008 Jan;29(1):23-27.
Turner RD, Byrne JV, Kelly ME, Mitsos AP, Gonugunta V, Lalloo S, Rasmussen PA, Fiorella D. Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms. Neurosurgery. 2008 Sep;63(3):469-474.
Epilepsy Center
Bautista JF, Kelly JA, Harley JB, Gray-McGuire C. Addressing genetic heterogeneity in complex disease: finding seizure genes in systemic lupus erythematosus. Epilepsia. 2008 Mar;49(3):527-530.
Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, Naugle RI, Nair D, Najm IM. Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following left temporal lobectomy for intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199-205.
Chapin JS, Busch RM, Janigro D, Dougherty M, Tilelli CQ, Lineweaver TT, Naugle RI, Diaz-Arrastia R, Najm IM. APOE epsilon4 is associated with postictal confusion in patients with medically refractory temporal lobe epilepsy. Epilepsy Res. 2008 Oct;81(2-3):220-224.
Dutton C, Foldvary-Schaefer N. Contraception in women with epilepsy: pharmacokinetic interactions, contraceptive options, and management. Int Rev Neurobiol. 2008;83:113-134.
Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution of obstructive sleep apnea with epilepsy surgery? Expanding the relationship between sleep and epilepsy. Epilepsia. 2008 Aug;49(8):1457-1459.
Jehi L, Najm IM. Sudden unexpected death in epilepsy: impact, mechanisms, and prevention. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S66-S70.
Kim H, Piao Z, Liu P, Bingaman W, Diehl B. Secondary white matter degeneration of the corpus callosum in patients with intractable temporal lobe epilepsy: a diffusion tensor imaging study. Epilepsy Res. 2008 Oct;81(2-3):136-142.
Lachhwani DK, Loddenkemper T, Holland KD, Kotagal P, Mascha E, Bingaman W, Wyllie E. Discontinuation of medications after successful epilepsy surgery in children. Pediatr Neurol. 2008 May;38(5):340-344.
Mani J, Diehl B, Piao Z, Schuele SS, Lapresto E, Liu P, Nair DR, Dinner DS, Luders HO. Evidence for a basal temporal visual language center: cortical stimulation producing pure alexia. Neurology. 2008 Nov 11;71(20):1621-1627.
Zotev VS, Matlashov AN, Volegov PL, Savukov IM, Espy MA, Mosher JC, Gomez JJ, Kraus RH Jr. Microtesla MRI of the human brain combined with MEG. J Magn Reson. 2008 Sep;194(1):115-120.
Mellen Center for Multiple Sclerosis Treatment and Research
Cardona AE, Sasse ME, Liu L, Cardona SM, Mizutani M, Savarin C, Hu T, Ransohoff RM. Scavenging roles of chemokine receptors: chemokine receptor deficiency is associated with increased levels of ligand in circulation and tissues. Blood. 2008 Jul 15;112(2):256-263.
Chang A, Smith MC, Yin X, Fox RJ, Staugaitis SM, Trapp BD. Neurogenesis in the chronic lesions of multiple sclerosis. Brain. 2008 Sep;131(Pt 9):2366-2375.
Cohen JA, Calabresi PA, Chakraborty S, Edwards KR, Eickenhorst T, Felton WL III, Fisher E, Fox RJ, Goodman AD, Hara-Cleaver C, Hutton GJ, Imrey PB, Ivancic DM, Mandell BF, Perryman JE, Scott TF, Skaramagas TT, Zhang H. Avonex combination trial in relapsing-remitting MS: rationale, design and baseline data. Mult Scler. 2008 Apr;14(3):370-382.
Fisher E, Lee JC, Nakamura K, Rudick RA. Gray matter atrophy in multiple sclerosis: a longitudinal study. Ann Neurol. 2008 Sep;64(3):255-265.
Cleveland Clinic Neurological Institute | 2008 Annual Report
46 Research
Fox RJ, McColl RW, Lee JC, Frohman T, Sakaie K, Frohman E. A preliminary validation study of diffusion tensor imaging as a measure of functional brain injury. Arch Neurol. 2008 Sep;65(9):1179-1184.
Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, Phillips MD. Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity. Hum Brain Mapp. 2008 Jul;29(7):818-827.
Moll NM, Rietsch AM, Ransohoff AJ, Cossoy MB, Huang D, Eichler FS, Trapp BD, Ransohoff RM. Cortical demyelination in PML and MS: similarities and differences. Neurology. 2008 Jan 29;70(5):336-343.
Sutliff MH, Naft JM, Stough DK, Lee JC, Arrigain SS, Bethoux FA. Efficacy and safety of a hip flexion assist orthosis in ambulatory multiple sclerosis patients. Arch Phys Med Rehabil. 2008 Aug;89(8):1611-1617.
Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247-269.
Young EA, Fowler CD, Kidd GJ, Chang A, Rudick R, Fisher E, Trapp BD. Imaging correlates of decreased axonal Na+/K+ ATPase in chronic multiple sclerosis lesions. Ann Neurol. 2008 Apr;63(4):428-435.
Center for Neuroimaging
Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008 Jun;29(6):1098-1103.
Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears J, Traboulsi EI. Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly — broadening the clinical spectrum of midline defects. J Neurol. 2008 Jun;255(6):885-890.
Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, Phillips MD. Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity. Hum Brain Mapp. 2008 Jul;29(7):818-827.
Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic and clinical benefits of portable head/neck CT imaging in the intensive care unit. Radiol Manage. 2008 Mar-Apr;30(2):50-54.
Phillips MD. Functional faults: fMRI in MS. Neurology. 2008 Jan 22;70(4):248-249.
Center for Neurological Restoration
Alberts JL, Voelcker-Rehage C, Hallahan K, Vitek M, Bamzai R, Vitek JL. Bilateral subthalamic stimulation impairs cognitive-motor performance in Parkinson’s disease patients. Brain. 2008 Dec;131(Pt 12):3348-3360.
Cooper SE, Kuncel AM, Wolgamuth BR, Rezai AR, Grill WM. A model predicting optimal parameters for deep brain stimulation in essential tremor. J Clin Neurophysiol. 2008 Oct;25(5):265-273.
Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia. 2008;46(1):213-223.
Guo Y, Rubin JE, McIntyre CC, Vitek JL, Terman D. Thalamocortical relay fidelity varies across subthalamic nucleus deep brain stimulation protocols in a data-driven computational model. J Neurophysiol. 2008 Mar;99(3):1477-1492.
Johnson MD, Miocinovic S, McIntyre CC, Vitek JL. Mechanisms and targets of deep brain stimulation in movement disorders. Neurotherapeutics. 2008 Apr;5(2):294-308.
Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden D, Feinstein A. Epigenetics of personality traits: an illustrative study of identical twins discordant for risk-taking behavior. Twin Res Hum Genet. 2008 Feb;11(1):1-11.
Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, Schurigyn T, Farag E. Perioperative events during deep brain stimulation: the experience at Cleveland Clinic. J Neurosurg Anesthesiol. 2008 Jan;20(1):36-40.
Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis NM. Surgery for movement disorders. Neurosurgery. 2008 Feb;62(Suppl 2):809-838.
Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Schupbach M, D’Ambrosia J, Thobois S, Tamma F, Herzog J, Speelman JD, Samanta J, Kubu C, Rossignol H, Poon YY, Saint-Cyr JA, Ardouin C, Moro E. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain. 2008 Oct;131(Pt 10):2720-2728.
Xu W, Russo GS, Hashimoto T, Zhang J, Vitek JL. Subthalamic nucleus stimulation modulates thalamic neuronal activity. J Neurosci. 2008 Nov 12;28(46):11916-11924.
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Neuromuscular Center
Chahine LM, Patrick R, Tavee J. Complex regional pain syndrome after infliximab infusion. J Pain Symptom Manage. 2008 Sep;36(3):e2-e4.
Cheng G, Kaminski HJ, Gong B, Zhou L, Hatala D, Howell SJ, Zhou X, Mustari MJ. Monocular visual deprivation in macaque monkeys: a profile in the gene expression of lateral geniculate nucleus by laser capture microdissection. Mol Vis. 2008;14:1401-1413.
Holmes RO Jr, Tavee J. Vasospasm and stroke attributable to ephedra-free xenadrine: case report. Mil Med. 2008 Jul;173(7):708-710.
McClelland S III, Bethoux FA, Boulis NM, Sutliff MH, Stough DK, Schwetz KM, Gogol DM, Harrison M, Pioro EP. Intrathecal baclofen for spasticity-related pain in amyotrophic lateral sclerosis: efficacy and factors associated with pain relief. Muscle Nerve. 2008 Mar;37(3):396-398.
Rini BI, Shook S. Is Guillain Barre syndrome likely in this patient? Oncology (Williston Park). 2008 Jan;22(1):70-71.
Shook SJ, Mamsa H, Jen JC, Baloh RW, Zhou L. Novel mutation in KCNA1 causes episodic ataxia with paroxysmal dyspnea. Muscle Nerve. 2008 Mar;37(3):399-402.
Sorenson EJ, Windbank AJ, Mandrekar JN, Bamlet WR, Appel SH, Armon C, Barkhaus PE, Bosch P, Boylan K, David WS, Feldman E, Glass J, Gutmann L, Katz J, King W, Luciano CA, McCluskey LF, Nash S, Newman DS, Pascuzzi RM, Pioro E, Sams LJ, Scelsa S, Simpson EP, Subramony SH, Tiryaki E, Thornton CA. Subcutaneous IGF-1 is not beneficial in 2-year ALS trial. Neurology. 2008 Nov 25;71(22):1770-1775.
Tavee J, Morris H III. Severe postictal laryngospasm as a potential mechanism for sudden unexpected death in epilepsy: a near-miss in an EMU. Epilepsia.2008 Dec;49(12):2113-2117.
Zhou L, Rafael-Fortney JA, Huang P, Zhao XS, Cheng G, Zhou X, Kaminski HJ, Liu L, Ransohoff RM. Haploinsufficiency of utrophin gene worsens skeletal muscle inflammation and fibrosis in mdx mice. J Neurol Sci. 2008 Jan 15;264(1-2):106-111.
Neurological Center for Pain
Bigal M, Sheftell F, Tepper S, Tepper D, Ho TW, Rapoport A. A randomized double-blind study comparing rizatriptan, dexamethasone, and the combination of both in the acute treatment of menstrually related migraine. Headache. 2008 Oct;48(9):1286-1293.
Cleves C, Tepper SJ. Sumatriptan/naproxen sodium combination for the treatment of migraine. Expert Rev Neurother. 2008 Sep;8(9):1289-1297.
Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008 Sep;7(5):587-596.
Syrjala KL, Abrams JR, Polissar NL, Hansberry J, Robison J, DuPen S, Stillman M, Fredrickson M, Rivkin S, Feldman E, Gralow J, Rieke JW, Raish RJ, Lee DJ, Cleeland CS, DuPen A. Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial. Pain. 2008 Mar;135(1-2):175-186.
Tepper SJ, Stillman MJ. Clinical and preclinical rationale for CGRP-receptor antagonists in the treatment of migraine. Headache. 2008 Sep;48(8):1259-1268.
Tepper SJ, Zatochill M, Szeto M, Sheftell F, Tepper DE, Bigal M. Development of a simple menstrual migraine screening tool for obstetric and gynecology clinics: the menstrual migraine assessment tool. Headache. 2008 Nov;48(10):1419-1425.
Center for Pediatric Neurology and Neurosurgery
Bedaiwy MA, Fathalla MM, Shaaban OM, Ragab MH, Elbaba S, Luciano M, El-Nashar SA, Falcone T. Reproductive implications of endoscopic third ventriculostomy for the treatment of hydrocephalus. Eur J Obstet Gynecol Reprod Biol. 2008 Sep;140(1):55-60.
Chappelow AV, Reid J, Parikh S, Traboulsi EI. Aicardi syndrome in a genotypic male. Ophthalmic Genet. 2008 Dec;29(4):181-183.
Factora R, Luciano M. When to consider normal pressure hydrocephalus in the patient with gait disturbance. Geriatrics. 2008 Feb;63(2):32-37.
Fong J, Wu G, Wyllie E, Gupta A. Interictal hypermetabolic subcortical band on brain FDG-PET in doublecortin mutation. Neurology. 2008 Aug 12;71(7):535.
Haas RH, Parikh S, Falk MJ, Saneto RP, Wolf NI, Darin N, Wong LJ, Cohen BH, Naviaux RK. The in-depth evaluation of suspected mitochondrial disease. Mol Genet Metab. 2008 May;94(1):16-37.
Loddenkemper T, Alexopoulos AV, Kotagal P, Moosa A, Lachhwani DK, Gupta A, Bingaman W, Wyllie E. Epilepsy
Cleveland Clinic Neurological Institute | 2008 Annual Report
48 Research
surgery in epidermal nevus syndrome variant with hemimegalencephaly and intractable seizures. J Neurol. 2008 Nov;255(11):1829-1831.
Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears J, Traboulsi EI. Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly — broadening the clinical spectrum of midline defects. J Neurol. 2008 Jun;255(6):885-890.
Parikh S, Cohen BH, Gupta A, Lachhwani DK, Wyllie E, Kotagal P. Metabolic testing in the pediatric epilepsy unit. Pediatr Neurol. 2008 Mar;38(3):191-195.
Weissman JR, Kelley RI, Bauman ML, Cohen BH, Murray KF, Mitchell RL, Kern RL, Natowicz MR. Mitochondrial disease in autism spectrum disorder patients: a cohort analysis. PLoS ONE. 2008;3(11):e3815.
Department of Psychiatry and Psychology
Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, Naugle RI, Nair D, Najm IM. Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following left temporal lobectomy for intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199-205.
Coffman KL. The debate about marijuana usage in transplant candidates: recent medical evidence on marijuana health effects. Curr Opin Organ Transplant. 2008 Apr;13(2):189-195.
Falcone T, Carlton E, Janigro D, Simon B, Franco K. Self-harm during first-episode psychosis. Br J Psychiatry. 2008 Aug;193(2):167.
Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia. 2008;46(1):213-223.
Heinberg LJ, Coughlin JW, Pinto AM, Haug N, Brode C, Guarda AS. Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain. Body Image. 2008 Sep;5(3):279-290.
Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden D, Feinstein A. Epigenetics of personality traits: an illustrative study of identical twins discordant for risk-taking behavior. Twin Res Hum Genet. 2008 Feb;11(1):1-11.
McKee MG. Biofeedback: an overview in the context of heart-brain medicine. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S31-S34.
Muzina DJ. Depression and anxiety: distinguishing unipolar and bipolar disorders. Ann Clin Psychiatry. 2008 Dec;20 Suppl 1:S19-S23.
Pandya M, Kubu CS, Giroux ML. Parkinson disease: not just a movement disorder. Cleve Clin J Med. 2008 Dec;75(12):856-864.
Tesar GE. Whither hospital and academic psychiatry? Psychiatr Clin North Am. 2008 Mar;31(1):27-42.
Tetzlaff JE, Collins GB. Reentry of anesthesiology residents after treatment of chemical dependency — is it rational? J Clin Anesth. 2008 Aug;20(5):325-327.
Sleep Disorders Center
Aboussouan LS, Lattin CD, Kline JL. Determinants of long-term mortality after prolonged mechanical ventilation. Lung. 2008 Sep;186(5):299-306.
Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution of obstructive sleep apnea with epilepsy surgery? Expanding the relationship between sleep and epilepsy. Epilepsia. 2008 Aug;49(8):1457-1459.
Gugliotti D, Grant P, Jaber W, Aboussouan L, Bae C, Sessler D, Scahuer P, Kaw R. Challenges in cardiac risk assessment in bariatric surgery patients. Obes Surg. 2008 Jan;18(1):129-133.
Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D. Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients. Obes Surg. 2008 Jan;18(1):134-138.
Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. 2008 Aug;12(3):259-264.
Malow BA, Foldvary-Schaefer N, Vaughn BV, Selwa LM, Chervin RD, Weatherwax KJ, Wang L, Song Y. Treating obstructive sleep apnea in adults with epilepsy: a randomized pilot trial. Neurology. 2008 Aug 19;71(8):572-577.
Minai OA, Malik N, Foldvary N, Bair N, Golish JA. Prevalence and characteristics of restless legs syndrome in patients with pulmonary hypertension. J Heart Lung Transplant. 2008 Mar;27(3):335-340.
clevelandclinic.org/neuroscience | 866.588.2264
Research 49
Selwa LM, Marzec ML, Chervin RD, Weatherwax KJ, Vaughn BV, Foldvary-Schaefer N, Wang L, Song Y, Malow BA. Sleep staging and respiratory events in refractory epilepsy patients: is there a first night effect? Epilepsia. 2008 Dec;49(12):2063-2068.
Center for Spine Health
Foley KT, Mroz TE, Arnold PM, Chandler HC Jr, Dixon RA, Girasole GJ, Renkens KL Jr, Riew KD, Sasso RC, Smith RC, Tung H, Wecht DA, Whiting DM. Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion. Spine J. 2008 May-Jun;8(3):436-442.
Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC. Musculoskeletal allograft risks and recalls in the United States. J Am Acad Orthop Surg. 2008 Oct;16(10):559-565.
Mroz TE, Yamashita T, Davros WJ, Lieberman IH. Radiation exposure to the surgeon and the patient during kyphoplasty. J Spinal Disord Tech. 2008 Apr;21(2):96-100.
Schofferman J, Mazanec D. Evidence-informed management of chronic low back pain with opioid analgesics. Spine J. 2008 Jan-Feb;8(1):185-194.
Steinmetz MP, Patel R, Traynelis V, Resnick DK, Anderson PA. Cervical disc arthroplasty compared with fusion in a workers’ compensation population. Neurosurgery. 2008 Oct;63(4):741-747.
Steinmetz MP, Rajpal S, Trost G. Segmental spinal instrumentation in the management of scoliosis. Neurosurgery. 2008 Sep;63(3 Suppl):131-138.
Studer RK, Gilbertson LG, Georgescu H, Sowa G, Vo N, Kang JD. p38 MAPK inhibition modulates rabbit nucleus pulposus cell response to IL-1. J Orthop Res. 2008 Jul;26(7):991-998.
Vadala G, Studer RK, Sowa G, Spiezia F, Iucu C, Denaro V, Gilbertson LG, Kang JD. Coculture of bone marrow mesenchymal stem cells and nucleus pulposus cells modulate gene expression profile without cell fusion. Spine. 2008 Apr 15;33(8):870-876.
Vadala G, Sobajima S, Lee JY, Huard J, Denaro V, Kang JD, Gilbertson LG. In vitro interaction between muscle-derived stem cells and nucleus pulposus cells. Spine J. 2008 Sep;8(5):804-809.
Watters WC III, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008 Mar-Apr;8(2):305-310.
Neurosurgical Anesthesiology
Bala E, Sessler DI, Nair DR, McLain R, Dalton JE, Farag E. Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery. Anesthesiology. 2008 Sep;109(3):417-425.
Cata JP, Noguera EM, Parke E, Ebrahim Z, Kurz A, Kalfas I, Mascha E, Farag E. Patient-controlled epidural analgesia (PCEA) for postoperative pain control after lumbar spine surgery. J Neurosurg Anesthesiol. 2008 Oct;20(4):256-260.
Elkassabany NM, Bhatia J, Deogaonkar A, Barnett GH, Lotto M, Maurtua M, Ebrahim Z, Schubert A, Ference S, Farag E. Perioperative complications of blood brain barrier disruption under general anesthesia: a retrospective review. J Neurosurg Anesthesiol. 2008 Jan;20(1):45-48.
Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, Schurigyn T, Farag E. Perioperative events during deep brain stimulation: the experience at Cleveland Clinic. J Neurosurg Anesthesiol. 2008 Jan;20(1):36-40.
Maurtua MA, Deogaonkar A, Bakri MH, Mascha E, Na J, Foss J, Sessler DI, Lotto M, Ebrahim Z, Schubert A. Dosing of remifentanil to prevent movement during craniotomy in the absence of neuromuscular blockade. J Neurosurg Anesthesiol. 2008 Oct;20(4):221-225.
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Education 51
Neurological Institute physicians direct the core neuroscience
curriculum for approximately 120 medical students annually at
Cleveland Clinic Lerner College of Medicine. They also share
valuable information with the public on the latest neurological
advances.
This commitment to education was expressed in new forms in
2008, including presentation of the first Neurological Institute
Research Day.
Medical Professionals
Continuing Medical Education
The Center for Continuing Education is responsible for one
of the world’s largest, most diverse CME programs. In 2008,
more than 15,000 professionals participated in more than
250 Neurological Institute-sponsored CME programs, rang-
ing from weekly grand rounds in six departments to multi-day
international symposia, regional programs, association meetings,
guest lectures and training courses.
The center’s efforts to expand CME opportunities through non-
traditional learning were highly successful in 2008, when
2,087 certificates were issued for completion of online neuro-
logical courses. The number represents a 60 percent increase
over 2007.
Graduate Medical Education
The Neurological Institute offers approximately 30 accredited
and non-accredited training programs providing physician
education and research opportunities in neurology, neurosur-
gery, psychiatry and psychology. Residents and fellows work side
by side with some of the world’s most renowned experts in the
neurosciences.
Core residency programs accredited by the Accreditation Council
for Graduate Medical Education (ACGME) encompass adult
neurology, child neurology, neurosurgery, adult psychiatry, and
child and adolescent psychiatry. ACGME-accredited subspecialty
fellowships and non-accredited fellowships are also available.
Research fellowships are offered for MDs and PhDs interested in
clinician/scientist careers.
Neurological Institute Research Day
In 2008, the Neurological Institute inaugurated Research Day,
a forum showcasing the projects of medical students, residents,
and clinical, research and post-doctoral fellows. Participants
made 74 poster and platform presentations and competed for
recognition awards at the event, which was judged by an interdis-
ciplinary team of Neurological Institute staff members.
Education
The Neurological Institute collaborates with Cleveland Clinic’s Center for Continuing Education to offer a highly
regarded series of continuing medical education (CME) programs to physicians and other healthcare professionals. In
addition, the institute provides extensive graduate medical education opportunities, training some 170 clinical and
research fellows and residents annually and hosting approximately 70 international and national physician-observers
each year.
Left: Residents review anatomy in the Spine Research Laboratory. The Neurological Institute offers almost 30 training programs in neurology, neuro-surgery, psychiatry and psychology, enabling residents and fellows to learn from some of the world’s most renowned experts in the neurosciences.
Cleveland Clinic Neurological Institute | 2008 Annual Report
52 Education
For the presenters, Research Day was an opportunity to share
their work and obtain helpful feedback, hone their writing and
presentation skills, find new resources and collaborators, and
earn recognition from mentors and peers. Participant Adrian
Zachary, DO, MPH, alluded to a “feeling of honor presenting
research.”
For the physician-judges, Research Day reinforced “an under-
standing of our excellence,” in the words of Edward Benzel,
MD. The event also inspired appreciation of and respect for the
presenters and their work. Chief Resident Joyce Lee, MD, spoke
for many when she remarked on “the amount of research gener-
ated by the residents in the NI — as busy as they are, they still
manage to find the time to generate amazing research studies
and papers.”
Twelve presenters received awards for their work. Leopoldo
Pozuelo, MD, was honored as the Neurological Institute
Cleveland Clinic Lerner College of Medicine Teacher of the Year.
Ultimately, the experience fostered a sense of community within
the institute and exposed participants to methodologies that
specialty areas outside their own apply to answer research ques-
tions. Attendees commented on the general enthusiasm and the
opportunity to communicate across departments. The strongest
testimonials came from presenters who said they looked forward
to taking part in Research Day 2009.
Patients and the Public
Through a range of communication channels, Neurological Insti-
tute physicians and allied health professionals connect with the
community, sharing information on specific neurological condi-
tions, answering common questions, and helping patients and
family members cope with challenging diagnoses and diseases.
Among the most popular forums are:
• Health Talks, which are free educational seminars at Cleveland
Clinic’s main campus and Cleveland Clinic family health cen-
ters throughout northeast Ohio. Recent sessions have focused
on management of pituitary disorders, Parkinson’s disease and
wellness, and treatment options for chronic back pain.
• Live web chats with physicians who discuss a variety of neuro-
logical disorders, diagnoses and therapeutic options. Topics
have included medical management of back pain, pediatric
brain tumor, neurofibromatosis, multiple sclerosis, sleep disor-
ders, adult scoliosis and memory loss.
• Gatherings that forge lasting bonds, such as the Pediatric Epi-
lepsy Support Group’s second biennial reunion for children
who underwent epilepsy surgery at Cleveland Clinic and their
families. The two-day event in August 2008 drew 280 attend-
ees from as far away as Ireland and South Africa. Educational
as well as social, the reunion featured physician-led sessions for
patients’ caregivers that focused on life after epilepsy surgery.
The first Neurological Institute Research Day, showcasing the work of medical students, residents and clinical fellows.
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Education 53
Music and the Brain
Can music speed the healing process? Should musicians and
neuroscientists collaborate on healing techniques? Questions
like these were addressed during “Music and the Brain,” three
public programs presented jointly by the Neurological Institute
and the Arts and Medicine Institute, in partnership with the U.S.
Department of Health and Human Services and The Cleveland
Orchestra. The innovative series began at Cleveland Clinic and
unfolded on an international stage, drawing a total of more than
500 participants:
• ClevelandClinic’s“Doctor-PatientMusicConnection,”
which aims to improve medical care by raising the level of the
physician-patientrelationshipthroughtheperformingarts,
presented a piano and chamber music recital performed by
physicians and patients. A reception followed the event, which
was designed primarily for patients and their families.
• Twodayslater,aconcert-symposiumon“neuromusic”
explored the relationship between music and the physiological
andpathologicalprocessesinthenervoussystem.Co-directed
byKamalChémali,MD,andNeilCherian,MD,theday-
long event featured lectures by nationally recognized experts,
including Neurological Institute physicians. The session,
offered for CME credit, attracted medical professionals as well
as musicians. The day concluded with a panel discussion and
piano recital at the Cleveland Institute of Music.
• ClevelandClinicandTheClevelandOrchestrajoinedforces
for a symposium at the Salzburg Festival in Austria, where a
panel of international experts examined new understanding
about the intersection of music and neuroscience, the effect of
musiconhealthandthebrain’simpactonmusicalability.The
program launched a collaboration between two world leaders
in medicine and music.
The Pediatric Epilepsy Support Group offers families of children with epilepsy a forum for education, discussion and camaraderie.
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New Staff 55
Due to its clinical expertise, academic achievement and
research capabilities, the Neurological Institute has earned an
international reputation, and continues to attract elite clinicians
and scientists who aspire to be affiliated with one of the world’s
premier medical centers.
In 2008, the following professionals joined the Neurological
Institute staff:
Lou Ruvo Center for Brain Health
Randolph B. Schiffer, MD, neurologist/psychiatrist, Director
Cerebrovascular Center
Rishi Gupta, MD, vascular and interventional neurologist
Ferdinand Hui, MD, interventional neuroradiologist
Shaye Moskowitz, MD, PhD, endovascular neurosurgeon
Epilepsy Center
Juan Bulacio, MD, clinical neurophysiologist
Jorge Gonzalez-Martinez, MD, PhD, neurosurgeon
Stephen Hantus, MD, epileptologist
John Mosher, PhD, neuroscientist, Section Head
of the magnetoencephalography program
Diosely Silveira, MD, PhD, epileptologist
Lerner Research Institute
James Kaltenbach, PhD, neuroscientist, Department of
Neurosciences and Cleveland Clinic Head and Neck Institute
Jeremy Rich, MD, neurologist, Chairman of the Department
of Stem Cell Biology and Regenerative Medicine
Neurological Center for Pain
Deborah Tepper, MD, internist
Stewart Tepper, MD, neurologist
Center for Neurological Restoration
Anwar Ahmed, MD, neurologist
Center for Regional Neurology
Sheila Rubin, MD, neurologist
Jennifer Ui, MD, neurologist
Joseph Zayat, MD, neurologist
Sleep Disorders Center
Sally Ibrahim, MD, sleep specialist
Center for Spine Health
Tagreed Khalaf, MD, medical spine specialist
Department of Psychiatry and Psychology
Joseph Austerman, DO, psychiatrist
New Staff
The lifeblood of any organization is its people. Cleveland Clinic Neurological Institute includes more than 250
medical, surgical and research specialists dedicated to the diagnosis, treatment and understanding of all neurological
conditions affecting adult and pediatric patients.
Left: Sally Ibrahim, MD, sees both adult and pediatric patients with sleep disorders. Reflecting the scope of the Sleep Disorders Center’s capabilities, she treats a wide range of conditions, including sleep apnea, disorders of excessive daytime sleepiness, circadian rhythm disorders, restless legs syndrome and parasomnias.
Cleveland Clinic Neurological Institute | 2008 Annual Report
56 Neurological Institute
Neurological Institute Chairmen
Michael T. Modic, MD, FACR
Chairman, Neurological Institute
William Bingaman, MD
Vice Chairman, Clinical Areas,
Neurological Institute
Richard Rudick, MD
Vice Chairman, Research and
Development, Neurological Institute
Edward Benzel, MD
Chairman, Department of
Neurological Surgery
Kerry Levin, MD
Chairman, Department of Neurology
Vernon Lin, MD, PhD
Chairman, Department of
Physical Medicine and Rehabilitation
Thomas Masaryk, MD
Chairman, Department of
Diagnostic Radiology
George E. Tesar, MD
Chairman, Department of
Psychiatry and Psychology
Bruce Trapp, PhD
Chairman, Department of
Neurosciences, Lerner Research Institute
Staff
Lou Ruvo Center for Brain Health
Randolph B. Schiffer, MD
Director, Lou Ruvo Center for
Brain Health
Charles Bernick, MD
Cynthia S. Kubu, PhD, ABPP-CN
Richard Naugle, PhD
Michael Parsons, PhD
Alexander Rae-Grant, MD, FRCP (C)
Stephen Rao, PhD
Director, Schey Foundation Center for
Advanced Cognitive Function
Patrick Sweeney, MD
Janice Zimbelman, PT, PhD
Brain Tumor and Neuro-Oncology Center
Gene Barnett, MD, FACS
Director, Brain Tumor and
Neuro-Oncology Center
Manmeet Ahluwalia, MD
Lilyana Angelov, MD, FRCS(C)
Samuel Chao, MD
Bruce H. Cohen, MD
Joung Lee, MD
David Peereboom, MD
Jeremy Rich, MD
Burak Sade, MD
Glen Stevens, DO, PhD
John Suh, MD
Tanya Tekautz, MD
Michael Vogelbaum, MD, PhD
Robert Weil, MD
Cerebrovascular Center
Peter Rasmussen, MD
Director, Cerebrovascular Center
Neil Friedman, MBChB
James Gebel, MD
Rishi Gupta, MD
Ferdinand Hui, MD
Irene Katzan, MD, MS
Gwendolyn Lynch, MD
Edward Manno, MD
Thomas Masaryk, MD
Shaye Moskowitz, MD, PhD
J. Javier Provencio, MD, FCCM
Vivek Sabharwal, MD
Ken Uchino, MD
Epilepsy Center
Imad Najm, MD
Director, Epilepsy Center
Andreas Alexopoulos, MD, MPH
Jocelyn Bautista, MD
William Bingaman, MD
Juan Bulacio, MD
Richard Burgess, MD, PhD
Robyn Busch, PhD
Jessica Chapin, PhD
Tatiana Falcone, MD
Nancy Foldvary-Schaefer, DO
Paul Ford, PhD
Jorge Gonzalez-Martinez, MD, PhD
Ajay Gupta, MD
Stephen Hantus, MD
Jennifer Haut, PhD, ABPP-CN
Lara Jehi, MD
clevelandclinic.org/neuroscience | 866.588.2264
Neurological Institute 57
Patricia Klaas, PhD
Prakash Kotagal, MD
Deepak Lachhwani, MBBS, MD
John Mosher, PhD
Dileep Nair, MD
Richard Naugle, PhD
Paul Ruggieri, MD
Diosely Silveira, MD, PhD
Norman So, MD
Andrey Stojic, MD, PhD
George E. Tesar, MD
Ingrid Tuxhorn, MD
Elaine Wyllie, MD
Mellen Center for Multiple Sclerosis
Treatment and Research
Richard Rudick, MD
Director, Mellen Center for Multiple
Sclerosis Treatment and Research
Robert Bermel, MD
Francois Bethoux, MD
Adrienne Boissy, MD
Jeffrey Cohen, MD
Robert Fox, MD
Keith McKee, MD
Deborah Miller, PhD
Alexander Rae-Grant, MD, FRCP (C)
Richard M. Ransohoff, MD
Mary Rensel, MD
Lael Stone, MD
Center for Neuroimaging
Thomas Masaryk, MD
Director, Center for Neuroimaging
Manzoor Ahmed, MD
Todd M. Emch, MD
Stephen E. Jones, MD, PhD
Mark Lowe, PhD
Parvez Masood, MD
Michael T. Modic, MD, FACR
Doksu Moon, MD
Micheal Phillips, MD
Paul Ruggieri, MD
Alison Smith, MD
Todd Stultz, DDS, MD
Andrew Tievsky, MD
Center for Neurological Restoration
Andre Machado, MD, PhD
Director, Center for Neurological
Restoration
Anwar Ahmed, MD
Jay Alberts, PhD
Scott Cooper, MD, PhD
Milind Deogaonkar, MD
Darlene Floden, PhD
Ilia Itin, MD
Cynthia S. Kubu, PhD, ABPP-CN
Richard Lederman, MD, PhD
Donald A. Malone Jr., MD
Cameron McIntyre, PhD
Mayur Pandya, DO
Patrick Sweeney, MD
Jerrold Vitek, MD, PhD
Center for Pediatric Neurology and
Neurosurgery
Elaine Wyllie, MD
Director, Center for Pediatric Neurology
Mark Luciano, MD, PhD
Director, Center for Pediatric
Neurosurgery
Bruce H. Cohen, MD
Xiao Di, MD, PhD
Stephen Dombrowski, PhD
Gerald Erenberg, MD
Neil Friedman, MBChB
Debabrata Ghosh, MD, DM
Gary Hsich, MD
Irwin Jacobs, MD
Sudeshna Mitra, MD
Manikum Moodley, MD
Sumit Parikh, MD
A. David Rothner, MD
Tanya Tekautz, MD
Neurological Center for Pain
Edward Covington, MD
Director, Neurological Center for Pain
Cynthia Bamford, MD
Neil Cherian, MD
Steven Krause, PhD, MBA
Jennifer Kriegler, MD
Robert Kunkel, MD
Jahangir Maleki, MD, PhD
MaryAnn Mays, MD
Judith Scheman, PhD
Mark Stillman, MD
Deborah Tepper, MD
Stewart Tepper, MD
Neuromuscular Center
Kerry Levin, MD
Director, Neuromuscular Center
Mohammad Alsharabati, MD
Kamal Chémali, MD
Neil Friedman, MBChB
Rebecca Kuenzler, MD
Richard Lederman, MD, PhD
Erik Pioro, MD, PhD
David Polston, MD
Robert Shields Jr., MD
Steven Shook, MD
Jinny Tavee, MD
Lan Zhou, MD, PhD
Cleveland Clinic Neurological Institute | 2008 Annual Report
58 Neurological Institute
Right: Epilepsy Center Director Imad Najm, MD, right, confers with William Bingaman, MD, Vice Chairman, Clinical Areas, Neurological Institute, at a patient management conference. These sessions bring center staff together to discuss patients suitable for epilepsy surgery.
General Adult Neurology
Kerry Levin, MD
Chairman, Department of Neurology
Thomas E. Gretter, MD
Richard Lederman, MD, PhD
Patrick Sweeney, MD
Department of Physical Medicine
and Rehabilitation
Vernon Lin, MD, PhD
Chairman, Department of Physical
Medicine and Rehabilitation
Michael Felver, MD
Medical Director, Center for Rehabilitation and Subacute Services
Steven Landers, MD, MPH
Medical Director, Home Care Services
Raghavendra Allareddy, MD
Frederick Frost, MD
Sepideh Haghpanah, MD
Juliet Hou, MD
Lynn Jedlicka, MD
Anantha Reddy, MD
Kalyani Shah, MD
Deborah Venesy, MD
Department of Psychiatry and Psychology
George E. Tesar, MD
Chairman, Department of Psychiatry
and Psychology
Donald A. Malone Jr., MD
Director, Center for Behavioral Health
Susan Albers-Bowling, PsyD
Kathleen Ashton, PhD
Joseph M. Austerman, DO
Scott Bea, PsyD
Dana Brendza, PsyD
Karen Broer, PhD
Robyn Busch, PhD
Jessica Chapin, PhD
Kathy Coffman, MD
Gregory Collins, MD
Edward Covington, MD
Roman Dale, MD
Beth Dixon, PsyD
Judy Dodds, PhD
Tatiana Falcone, MD
Darlene Floden, PhD
Kathleen Franco, MD
John P. Glazer, MD
Lilian Gonsalves, MD
J. Robert Gribble, PhD
Jennifer Haut, PhD, ABPP-CN
Leslie Heinberg, PhD
Karen Jacobs, DO
Joseph W. Janesz, PhD, LICDC
Regina Josell, PsyD
Elias Khawan, MD
Patricia Klaas, PhD
Steven Krause, PhD, MBA
Cynthia S. Kubu, PhD, ABPP-CN
Michael McKee, PhD
Gene Morris, PhD
David J. Muzina, MD
Richard Naugle, PhD
Mayur Pandya, DO
Michael Parsons, PhD
Leo Pozuelo, MD
Kathleen Quinn, MD
Ted Raddell, PhD
Judith Scheman, PhD
Isabel Schuermeyer, MD
Jean Simmons, PhD
Barry Simon, DO
Catherine Stenroos, PhD
David Streem, MD
Adele Viguera, MD
John Vitkus, PhD
Cynthia White, PsyD
Amy Windover, PhD
Center for Regional Neurology
Stephen Samples, MD
Director, Center for Regional Neurology
Mohammad Alsharabati, MD
A. Romeo Craciun, MD
Director, Stroke Center,
Marymount Hospital
James Gebel, MD
Sheila Rubin, MD
Roderick Spears, MD
Andrey Stojic, MD, PhD
Diana Tanase, MD
Jennifer Ui, MD
Joseph Zayat, MD
Center for Regional Neurological Surgery
Michael Mervart, MD
Director, Center for Regional
Neurological Surgery
Samuel Borsellino, MD
Roseanna Lechner, MD
Samuel Tobias, MD
92877_NeuroARText_Wt.indd 59 11/3/09 2:41 PM
clevelandclinic.org/neuroscience | 866.588.2264
Left: Neurologists work side by side with neurosurgeons, behavioral health specialists and researchers in the Neurological Institute, providing the highest-quality care for patients and an enhanced educational experience for physicians in training.
Sleep Disorders Center
Nancy Foldvary-Schaefer, DO
Director, Sleep Disorders Center
Loutfi Aboussouan, MD
Kathleen Ashton, PhD
Charles Bae, MD
A. Romeo Craciun, MD
Michelle Drerup, PsyD
Sally Ibrahim, MD
Alan Kominsky, MD
Jyoti Krishna, MD
William Novak, MD
Carlos Rodriguez, MD
Center for Spine Health
Gordon Bell, MD
Director, Center for Spine Health
Edward Benzel, MD
Edwin Capulong, MD
Russell DeMicco, DO
Lars Gilbertson, PhD
Augusto Hsia Jr., MD
Serkan Inceoglu, PhD
Iain Kalfas, MD
Tagreed Khalaf, MD
Ajit Krishnaney, MD
Daniel Mazanec, MD
Robert McLain, MD
Thomas Mroz, MD
R. Douglas Orr, MD
Judith Scheman, PhD
Richard Schlenk, MD
Michael Steinmetz, MD
Santhosh Thomas, DO, MBA
Fredrick Wilson, DO
Adrian Zachary, DO, MPH
Neuroanesthesiology
Rafi Avitsian, MD
Section Head, Neurosurgical and Spine
Surgery Anesthesiology
Section Head, Neuro-endovascular
Anesthesiology
Zeyd Ebrahim, MD
O.R. Clinical Director
Armin Schubert, MD
Chairman, Department of
General Anesthesiology
Ehab Farag, MD, FRCA
Paul Kempen, MD, PhD
Jia Lin, MD, PhD
Mariel Manlapaz, MD
Marco Maurtua, MD
Stacy Ritzman, MD
Vivek Sabharwal, MD
Gloria Walters, MD
Lerner Research Institute
Department of Neurosciences
Bruce Trapp, PhD
Chairman, Department of
Neurosciences, Lerner Research Institute
Cornelia Bergmann, PhD
Jianguo Cheng, MD, PhD
James Kaltenbach, PhD
Hitoshi Komuro, PhD
Bruce Lamb, PhD
Yu-Shang Lee, PhD
Ching-Yi Lin, PhD
Yoav Littner, MD
Sanjay W. Pimplikar, PhD
Erik Pioro, MD, PhD
J. Javier Provencio, MD, FCCM
Richard M. Ransohoff, MD
Director, Neuroinflammation Research
Center, Lerner Research Institute
Susan Staugaitis, MD, PhD
Michael Steinmetz, MD
Stephen Stohlman, PhD
Jerrold Vitek, MD, PhD
Riqiang Yan, PhD
Lan Zhou, MD, PhD
Lerner Research Institute
Biomedical Engineering
Jay Alberts, PhD
Elizabeth Fisher, PhD
Aaron Fleischman, PhD
Cameron McIntyre, PhD
Lerner Research Institute
Cell Biology
Damir Janigro, PhD
Pathology and Laboratory Medicine
Institute Anatomic Pathology
Richard Prayson, MD
Neurological Institute 61
Cleveland Clinic Neurological Institute | 2008 Annual Report
62 Cleveland Clinic Information
Neurological Institute
24/7 hospital transfers or physician consults 800.553.5056
Neurological Institute Contact Center
Centralized scheduling that allows patients to make appointments with any Neurological Institute physician at any location
216.636.5860 or toll-free 866.588.2264
Web
clevelandclinic.org/neuroscience
Services for Physicians
Physician Directory View all Cleveland Clinic staff online at clevelandclinic.org/staff.
Physician Liaison Referring physicians have a direct and personal link to Cleveland Clinic with our Physician Liaison. For help with any interaction involving Cleveland Clinic, contact Physician Liaison Kate Kenny at clevelandclinic.org/ContactKate.
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To arrange a transfer for acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage), STEMI (ST elevated myocardial infarction) or aortic syndromes, call 877.379.CODE (2633).
For all other critical care transfers, call 216.444.8302 or 800.553.5056.
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Stay Connected to Cleveland Clinic
Contents
02 C H A I R M A N ’ S W E L C O M E
04 C L E V E L A N D C L I N I C N E U R O L O G I C A L I N S T I T U T E O V E R V I E W
10 O U R C E N T E R S
22 PAT I E N T C A R E
24 C O M M U N I T Y C A R E
26 2 0 0 8 O U T C O M E S
30 T E C H N O L O G Y A N D I N N O VAT I O N
38 R E S E A R C H
50 E D U C AT I O N
54 N E W S TA F F
56 N E U R O L O G I C A L I N S T I T U T E S TA F F
62 S E R V I C E S F O R P H Y S I C I A N S A N D PAT I E N T S
On the cover: Neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, joined the Neurological Institute’s Epilepsy Center in 2008. Subsequently, he performed North America’s first stereoelectroencephalography (SEEG) procedure, which opens the possibility of new treatment options for patients with intractable focal epilepsy.
The Neurological Institute is one of 26 institutes at Cleveland Clinic that group multiple
specialties together to provide collaborative, patient-centered care. The institute is a
leader in treating the most complex neurological disorders, advancing innovations such as
deep brain stimulation, epilepsy surgery, stereotactic spine radiosurgery and blood-brain
barrier disruption. Annually, our staff of more than 250 specialists serves 140,000 patients
and performs 7,500 surgeries. Cleveland Clinic is a nonprofit multispecialty academic
medical center, consistently ranked among the top hospitals in America by U.S.News &
World Report. Founded in 1921, it is dedicated to providing quality specialized care and
includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education
institute and a research institute.
Cleveland Clinic ©2009
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Neurological Institute 2008 Annual Report
Cleveland C
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