DEPARTMENTS OF NEUROLOGY AND NEUROLOGICAL...

DEPARTMENTS OF

NEUROLOGY AND

NEUROLOGICAL

SURGERY

UHhospitals.org/Neuro • DEPARTMENTS OF NEUROLOGY AND NEUROLOGICAL SURGERY | 32 | UNIVERSITY HOSPITALS CASE MEDICAL CENTER • 216-844-2724

As national leaders known for innovative, integrated and individualized neurological care, UH Case Medical Center Departments of Neurology and Neurological Surgery bring together the country’s foremost experts in neurology, neurosurgery, neuroradiology, neuro-oncology, neuro-ophthalmology, neurotology, neuropathology, neuropsychology, neuropsychiatry and other related specialties. Within the departments, the University Hospitals Neurological Institute is recognized as one of the nation’s best clinical neuroscience programs and a trusted resource for referring physicians and patients with diseases affecting the nervous system. Through a dedicated team of skilled specialists with access to the latest technologies, facilities and research, the institute delivers superlative care for the full range of neurological disorders, from management of common disorders to the most advanced treatments and surgeries.

DEPARTMENTS OF NEUROLOGY AND

NEUROLOGICAL SURGERY

Among the nation’s leading academic medical centers, UH Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine.

With more than 1,000 registered beds, UH Case Medical Center provides primary, specialty and subspecialty medical and surgical care. Located in the heart of Cleveland’s University Circle on a beautiful 35-acre campus, UH Case Medical Center includes general medical, intensive care and surgical units as well as three major hospitals:

UNIVERSITY HOSPITALS SEIDMAN CANCER CENTER

UNIVERSITY HOSPITALS MACDONALD WOMEN’S HOSPITAL

UNIVERSITY HOSPITALS RAINBOW BABIES & CHILDREN’S HOSPITAL

Our physicians and researchers – who also serve as faculty at Case Western Reserve University School of Medicine – are leaders in their respective fields, and their ongoing clinical research programs push the boundaries of medical progress.

To learn more, visit UHhospitals.org

UH CASE MEDICAL CENTER

ACCELERATING BREAKTHROUGH DISCOVERIES INTO MEDICINESThe Harrington Discovery Institute at University Hospitals is the nonprofit arm of The Harrington Project for Discovery & Development, a national initiative supporting breakthrough research by physician-scientists. The Harrington Project is a new and powerful approach to address the challenges of advancing discoveries into medicines.

To learn more, visit HarringtonDiscovery.org

HARRINGTON DISCOVERY INSTITUTE

Visit UHhospitals.org/CME for the latest in live, webinar and on-demand Continuing Medical Education events.

Warren R. Selman, MDHarvey Huntington Brown, Jr., Professor and ChairDepartment of Neurological SurgeryUH Case Medical Center and Case Western Reserve University School of MedicineNeurosurgeon-in-Chief and Director,UH Neurological Institute

Anthony J. Furlan, MDChair, Department of NeurologyUH Case Medical Center andCase Western Reserve UniversitySchool of MedicineCo-Director, UHNeurological InstituteGilbert W. Humphrey Professor,Case Western Reserve UniversitySchool of Medicine


Physicians at the UH Neurological Institute Brain Tumor & Neuro-Oncology Center are committed to developing the next generation of innovative treatments. They are making crucial advances in the field of immunotherapy, which unleashes the power of patients’ own immune systems to fight one of the deadliest brain cancers: malignant glioma.

Gliomas − which arise from glial or precursor cells and include astrocytoma, glioblastoma, oligodendroglioma and ependymoma − are the most common tumors of the central nervous system and are extremely difficult to treat. Median survival is 11 months from diagnosis.

The conventional approach is surgery to remove as much of the tumor as possible, followed by radiation and chemotherapy with temozolomide, an oral medication that stops or slows the growth of cancer cells. Residual glioma cells, however, are often resistant to treatment, and chemotherapy can have toxic effects. Therefore the Brain Tumor Team at UH Case Medical Center uses additional innovative therapy targeted at these residual cells.

Since 1998, a team of researchers led by Andrew Sloan, MD, Director, UH Neurological Institute Brain Tumor & Neuro-Oncology Center and Vice Chair for Research Affairs of Neurological Surgery, Peter D. Cristal Chair in Neurosurgery, UH Case Medical Center; and Professor of Neurological Surgery, Case Western Reserve University School of Medicine, has been exploring immunotherapy, which harnesses lymphocytes, including naturally occurring T cells, to destroy cancer cells.

One way to do this is by modifying the signals that keep T cells in check. Immune checkpoint proteins, including cytotoxic T-lymphocyte-associated antigen 4 (CTLA4) and programmed cell death 1 (PD-1), are found on the surface of T cells and inhibit the overactivation of the immune system. Cancer cells exploit this response by secreting molecules that bind to these checkpoint proteins and prevent T cell attacks. There is abundant evidence that malignant gliomas are among the most immunosuppressive of all tumors, according to Dr. Sloan.

Researchers Investigate Leading-Edge Immunotherapy Treatments for Malignant Brain Tumors

All National Institutes of Health (NIH) funding for basic and clinical research is awarded to the School of Medicine at Case Western Reserve University.

The discovery of checkpoint proteins led to the development of checkpoint inhibitors, which are monoclonal antibodies that bind to the proteins and block their inhibitory action, in effect “cutting the brakes” on T cell response and freeing them to attack cancer cells.

Starting in January 2015, Dr. Sloan will be involved in two trials examining two checkpoint inhibitors: ipilimumab, which binds to CTLA4, and nivolumab, which binds to PD-1.

He will be the lead investigator in a trial that will determine the optimal dose of ipilimumab, nivolumab and the combination of both drugs when given with temozolomide during maintenance treatment for patients with newly diagnosed glioblastoma. This trial is supported by the National Cancer Institute-funded Adult Brain Tumor Consortium, a group of 11 elite brain tumor centers that work together to develop innovative treatments.

Dr. Sloan also will be participating in a pharmaceutical company-funded trial that will determine the optimal dose of ipilimumab, nivolumab and the

combination of both drugs for patients with recurrent glioma, for which there is no standard chemotherapy or radiation treatment.

Checkpoint inhibitors have shown promise in treating a range of common cancers, including renal cell carcinoma, lymphoma, breast cancer, non-small cell lung cancer and, most notably, metastatic melanoma. In 2011, the U.S. Food and Drug Administration approved ipilimumab (marketed by Bristol-Myers Squibb under the brand name Yervoy) for the treatment of metastatic melanoma; it was the first medication to improve overall survival in patients with advanced forms of the disease.

There are two key potential benefits of immunotherapy for glioma, Dr. Sloan says. Theoretically, T cells should retain a memory of the cancer cell antigen and be able to reactivate if the cancer should recur. The approach also offers minimal toxicity, which is critical because studies show that intensifying temozolomide therapy or administering additional chemotherapies generally do not improve outcomes.

POWERING UP THE IMMUNE SYSTEM

Dr. Andrew Sloan


TBI

CLINICAL ADVANCES

Nicholas Bambakidis, MD, Director, Cerebrovascular and Skull Base Surgery, UH Neurological Institute, UH Case Medical Center; and Professor, Neurological Surgery, Case Western Reserve University School of Medicine, was part of a surgical team that performed the first successful auditory brainstem implant (ABI) in Northeast Ohio. Dr. Bambakidis implanted the device in the brainstem, and was assisted by Cliff Megerian, MD, holder of the Richard W. and Patricia R. Pogue Chair in Auditory Surgery and Hearing Sciences; Chairman, Otolaryngology – Head & Neck Surgery; Director, Otology and Neurotology, UH Case Medical Center; and Professor, Otolaryngology – Head & Neck Surgery and Neurological Surgery, School of Medicine; and Maroun Semaan, MD, Associate Director, Otology, Neurotology and Balance Disorders, UH Case Medical Center, and Assistant Professor, Otolaryngology, School of Medicine.

The Sixth Annual Northeast Ohio Parkinson’s Boot Camp™ held September 6, 2014, drew nearly 1,000 attendees.

The free, grant-funded event offered hands-on instruction on exercise techniques, mind and body wellness practices, and skills to help those with Parkinson’s and their caregivers to help them better manage the disease. This annual event is spearheaded by Benjamin Walter, MD, Director of the Parkinson’s

& Movement Disorders Center and Medical Director of the Deep Brain Stimulation Program at University

Hospitals, and Assistant Professor of Neurology, School of Medicine.

UH Neurological Institute has been designated as a Gold Center of Excellence and featured as a top-performing center by the consulting firm that is the industry standard for evaluating program infrastructure in neurosciences. The Chicago consulting firm NeuStrategy Inc. conducted the survey, which is the only one of its kind in the neurosciences field. A hospital’s overall performance is determined by measuring program progress in four key areas: clinical and research programs, staff, facilities and technology, and business. The survey findings underscore the importance of UH’s multispecialty approach to care. UH Neurological Institute was noted for its innovative, integrated and individualized care model, which puts patient care at the forefront of everything it does. The Neurological Institute Leadership Council was credited for changing the way the institute interacts with the community, including development of outreach programs such as the Parkinson’s Boot Camp.

UH Neurological Institute launched the Traumatic Brain Injury Center in 2014. This multidisciplinary, integrated center provides coordinated care for any form of TBI and is led by S. Alan Hoffer, MD, Director of the Traumatic Brain Injury Center, Co-Director of the Reinberger Neuroscience Intensive Care Unit, UH Case Medical Center; and Assistant Professor of Neurological Surgery, School of Medicine. In the past, there have been several areas of expertise within UH for treating TBI including neurosurgery, neuro-intensive care, sports medicine and neuropsychology. Rehabilitation services for TBI, similar to those needed for other types of brain injury, such as stroke, are already in place. Although these services have been offered, they were never integrated into a single coordinated effort until now. Another key aspect is the creation of a single path of entry, so that patients are able to bypass the emergency department in order to get evaluated and treated more quickly.

UH Neurological Institute expanded its geographic

footprint further in 2014 to include services at

UH Parma Medical Center.

Dr. Benjamin Walter


Case Western Reserve University School of Medicine and the Baylor College of Medicine will manage a $27.3 million grant dedicated to understanding and one day preventing sudden unexpected death in epilepsy (SUDEP). The National Institutes of Health’s National Institute of Neurological Disorders and Stroke grant will help 13 centers in the United States and one in the United Kingdom team up to form a SUDEP Center Without Walls for Collaborative Research called The Center for SUDEP Research. The basic scientists and clinicians of the Center Without Walls will direct their research and epilepsy care efforts toward uncovering the biological mechanisms and risk factors for SUDEP with the goal of developing potential interventions to prevent it. Samden Lhatoo, MD, FRCP, will serve as Principal Investigator and Co-Director of the Center for SUDEP Research. Dr. Lhatoo serves as Director of the Epilepsy Center, UH Case Medical Center, and Professor, Department of Neurology, School of Medicine.

UH Case Medical Center is participating in a new national Alzheimer’s disease (AD) clinical research study evaluating the potential benefits of an investigational medicine when taken by people with mild-to-moderate AD who are already being treated with donepezil (Aricept). Titled NOBLE, the trial is evaluating T817MA, which may

have the potential to modify the pace of the disease in those who are currently suffering with mild-to-moderate AD. Alan Lerner, MD, Director of the Brain Health & Memory Center at UH Case Medical Center and Professor of Neurology, School of Medicine, is leading UH Case Medical Center’s participation in this study. No new drug has been approved by the U.S. Food and Drug Administration (FDA) for the treatment of AD since 2003. The NOBLE study was launched to potentially help address this gap in treatment.

UH Case Medical Center also opened a new landmark study to learn if an antibody can slow memory loss in people over 65 who have memory complaints. Also led by Dr. Alan Lerner, the A4 study – Anti-Amyloid Treatment in Asymptomatic Alzheimer’s study – will test whether the amyloid antibody called solanezumab can prevent or slow the progression of Alzheimer’s disease.

Cathy Sila, MD, Director, Comprehensive Stroke Center, UH Neurological Institute, and Case Western Reserve University School of Medicine George M. Humphrey II Professor of Neurology, is leading a unique trial that examines the efficacy of opening blocked brain arteries immediately after stroke symptoms present. The DAWN (DWI or CTP Assessment with Clinical All National Institutes of Health (NIH) funding for basic and clinical research

is awarded to the School of Medicine at Case Western Reserve University.

The commitment to exceptional patient care begins with revolutionary discovery. University Hospitals Case Medical Center is the primary affiliate of Case Western Reserve University School of Medicine, a national leader in medical research and education and consistently ranked among the top research medical schools in the country by U.S. News & World Report. Through their faculty appointments at Case Western Reserve University School of Medicine, physicians at UH Case Medical Center are advancing medical care through innovative research and discovery that bring the latest treatment options to patients.

TOMORROW’S CURES TODAY.

UH Case Medical Center’s physicians, surgeons and scientists –

all members of the faculty of Case Western Reserve University

School of Medicine – are leaders in their respective fields,

and their ongoing research programs are at the leading edge

of medical progress. A strong emphasis on translational, or

“bench-to-bedside,” research means that new and innovative

treatments and technologies transfer more rapidly from the

research laboratory to actual patient care.

Mismatch in the Triage of Wake Up and Late Presenting Strokes Undergoing Neurointervention) trial will investigate the safety and benefit of opening a blocked brain artery in select patients with acute stroke up to 24 hours after symptom onset. All patients in the trial will undergo special imaging studies with either an MR DWI or, if not a candidate for MRI, a CT scan sequence with perfusion (CTP) to determine if brain tissue is still viable. If there is no evidence of significant tissue damage, the patient will be randomized to one of two treatment strategies – an endovascular procedure with thrombectomy to open the clogged artery with maximal medical management or maximal medical management alone.

At the 2014 American Association of Neurological Surgeons Annual Meeting, Jonathan Miller, MD, Director of Functional and Restorative Medicine at UH Case Medical Center, and Associate Professor of Neurological Surgery, School of Medicine, and colleagues presented results from a small study looking at deep brain electrode implantation as a possible alternative to the traditional WADA test used prior to epilepsy surgery. With four patients implanted with deep brain electrodes to identify the areas of the brain where their epileptic seizures originated, Dr. Miller was able to

stimulate each side of the brain while the patient read words. He found that their speech was halted upon stimulation on the speech-dominant side of the brain, but unaffected by stimulation on the nondominate side. And there were no adverse events of implantation or stimulation.

Dr. Andrew Sloan is participating in a trial of the experimental vaccine rindopepimut, which targets the tumor-specific oncogene EGFRvIII in patients with relapsed glioblastoma (about 30 percent of patients have tumors that test positive for this mutation). He is also studying custom-made vaccines that incorporate protein-peptide complexes from a patient’s own tumor to help build an effective immune response. A vaccine that incorporates the heat shock protein-peptide complex-96 (HSPPC-96) already has yielded positive results for newly diagnosed and recurrent glioblastoma patients, and is in Phase II clinical trials.

UH Neurological Institute took the lead on developing the Cleveland Regional Coordinating Stroke Center. Cleveland’s four major academic medical centers, which includes UH Case Medical Center, began collaborating with Case Western Reserve University School of Medicine to drive new clinical research for the prevention and treatment of stroke and the rehabilitation of stroke patients. The principal investigator on this project is Anthony Furlan, MD, Chairman, Department of Neurology, UH Case Medical Center and Case Western Reserve University School of Medicine; Co-Director, UH Neurological Institute; Gilbert W. Humphrey Professor, School of Medicine. A $1 million grant from the National Institute of Neurological Disorders and Stroke will go to the School of Medicine through its Clinical Translational Science Collaborative, another NIH-funded program designed to speed the movement of medical research from the laboratory to clinical care.

Dr. Cathy Sila

10 | UNIVERSITY HOSPITALS CASE MEDICAL CENTER • 216-844-2724 UHhospitals.org/Neuro • DEPARTMENTS OF NEUROLOGY AND NEUROLOGICAL SURGERY | 11

DEPARTMENTS OF NEUROLOGY & NEUROLOGICAL SURGERY CHAIRMEN

Warren R. Selman, MDHarvey Huntington Brown, Jr.,Professor and Chair, Departmentof Neurological Surgery,UH Case Medical Center andCase Western ReserveUniversity School of Medicine,Neurosurgeon-in-Chief andDirector, UH Neurological Institute

Anthony J. Furlan, MDChairman, Department ofNeurology, UH Case MedicalCenter and Case Western ReserveUniversity School of MedicineCo-Director, UH Neurological InstituteGilbert W. Humphrey Professor,Case Western ReserveUniversity School of Medicine

DEPARTMENT OF NEUROLOGYDavid C. Preston, MDProfessor and Vice ChairmanProgram Director, NeurologyResidency

BRAIN HEALTH & MEMORY

Alan J. Lerner, MDDirector, Brain Health& Memory CenterChair for Memory and CognitionProfessor

Brian Appleby, MDAssociate Professor

Peter J. Whitehouse, MD, PhDProfessor

Yan Yang, MD, PhDInstructor

EPILEPSY & CLINICAL NEUROPHYSIOLOGY

Samden D. Lhatoo, MD, FRCPDirector, Epilepsy Center, Professor

Hans Lüders, MD, PhDProfessor

Shahram Amina, MDAssistant Professor

Fareeha Ashraf, MDClinical Instructor

Michael W. Devereaux, MDProfessor

Matthew Eccher, MD, MSPHAssistant Professor

Tanvir U. Syed, MD, MPHAssistant Professor

NEUROMUSCULAR & AUTONOMIC

Bashar Katirji, MDDirector, Neuromuscular CenterProfessor

Gerald E. Grossman, MDAssistant Professor

Aamir Hussain, MDAssistant Clinical Professor

David C. Preston, MD

Jenice Robinson, MDAssistant Professor

Barbara E. Shapiro, MD, PhDDirector, Neuromuscular ResearchAssociate Professor

STROKE & CEREBROVASCULAR

Cathy Sila, MDDirector, Comprehensive StrokeCenter, George M. Humphrey IIChair in Neurology, Professor

Anthony J. Furlan, MD

Joseph C. LaManna, PhDProfessor

Svetlana Pundik, MDAssistant Professor

Sophia Sundararajan, MD, PhDAssistant Professor

COMMUNITY NEUROLOGY

Tina F. Blitz, MDInstructor

Marek A. Buczek, MD, PhDAssistant Professor

Aamir Hussain, MDClinical Assistant Professor

Annette Janus, MDAssistant Professor

Mustafa Kahriman, MDAssistant Professor

Daniel W. Miller, MDAssistant Professor

Amani Ramahi, MDAssistant Professor

Ronald G. Riechers, MDAssistant Professor

Mark Rorick, MDDirector, Primary Stroke Center at UH Geauga Medical CenterClinical Associate Professor

Alessandro Serra, MD, PhDAssistant Professor

Colleen B. Tomcik, MDInstructor

Norton Winer, MDClinical Assistant Professor

Leonard Weinberger, MDClinical Assistant Professor

NEUROCRITICAL CARE

Michael DeGeorgia, MDDirector, Neurocritical Care Center Maxeen Stone and John A. FlowerChair in NeurologyProfessor

Ciro Ramos Estebanez, MDAssistant Professor

Alan S. Hoffer, MDDirector, NeurotraumaAssistant Professor

Wei Xiong, MDAssistant Professor

NEUROPSYCHOLOGY PROGRAM

Philip Fastenau, PhDDirector, Clinical NeuropsychologyProfessor

Christopher M. Bailey, PhDAssistant Professor

Cynthia Griggins, PhDAssistant Professor

Paula K. Ogrocki, PhDAssistant Professor

CLINICIANS AND SCIENTISTSat UH Case Medical Center and Case Western Reserve University School of Medicine

PARKINSON’S & MOVEMENT DISORDERS AND DEEP BRAIN STIMULATION

Benjamin L. Walter, MDDirector, Parkinson’s & Movement Disorders CenterMedical Director, Deep BrainStimulation (DBS) ProgramAssistant Professor

Steven A. Gunzler, MDAssistant Professor

MULTIPLE SCLEROSIS

Stephen M. Selkirk, MD, PhDInstructor

Marie Tani, MDClinical Assistant Professor

Edward L. Westbrook, MDAssociate Professor

NEURO-OPHTHALMOLOGY & BALANCE

Robert B. Daroff, MDProfessor and Chair Emeritus

John S. Stahl, MD, PhDProfessor

Mark F. Walker, MDAssociate Professor

NEURO-ONCOLOGY

Lisa R. Rogers, DODirector, Medical Neuro-OncologyProfessor

NEURO-REHABILITATION

Robert L. Ruff, MD, PhDProfessorChief of the VA Neurology Service

NEUROLOGICAL OUTCOMES

Martha Sajatovic, MDDirector, Neurological & Behavioral OutcomesCenter, Willard W. Brown Chair in Neurological OutcomesProfessor

BIOSTATISTICS

Curtis Tatsuoka, PhDDirector of BiostatisticsClinical Trials Unit

Sophia Sundararajan, MD, PhDMedical Director, Clinical Trials UnitAssistant Professor

DEPARTMENT OF NEUROLOGICAL SURGERYCLINICAL FACULTY

Nicholas C. Bambakidis, MDDirector, Cerebrovascular& Skull Base SurgeryProfessor and Vice Chair for Clinical Affairs

Steven Fulop, MD, MSClinical Assistant Professor

Rishi Goel, MDAssistant Clinical Professor

David J. Hart, MDDirector, Spinal Neurosurgery CenterAssociate Professor

Alan Hoffer, MDDirector, Traumatic Brain Injury CenterCo-Director, Neurocritical Care Center Director, NeurotraumaAssistant Professor

Roseanna Lechner, MDClinical Assistant Professor ofNeurological Surgery

Jonathan Miller, MDDirector, Functional & RestorativeNeurosurgery CenterAssociate Professor

Richard B. Rhiew, MD, PhDClinical Assistant Professor ofNeurological Surgery

Andrew E. Sloan, MDDirector, Brain Tumor & Neuro-Oncology CenterPeter D. Cristal Chair inNeurosurgeryVice Chair for Research Affairsand Professor

Jennifer Sweet, MDAssistant Professor

Krystal Tomei, MD, MPHAssistant Professor

ADJUNCT FACULTY

Barbara Bangert, MDPediatric NeuroradiologyAssistant Professor

Kristine Blackham, MDNeuroradiologyAssistant Professor

Michael Coffey, MDNeuroradiologyAssistant Professor

Mark Cohen, MDNeuropathologyAssistant Professor

Charles Lanzieri, MDNeuroradiologyAssistant Professor

Cliff Megerian, MDDirector of Otology &NeurotologyProfessor

Peter N. Poolos Jr., MDCommunity NeurosurgeryProfessor

Jeffrey Sunshine, MD, PhDNeuroradiologyAssistant Professor

Mark Rodgers, MDNeuropathologyAssistant Professor

Robert Tarr, MDNeuroradiologyProfessor

RESEARCH FACULTY

Eli E. Bar, PhD

Yu “Agnes” Luo, PhDAssistant Professor ofNeurological Surgery

EMERITUS FACULTY

Benedict Colombi, MDProfessor

Russell H. Hardy Jr., MDProfessor

Barry J. Hoffer, MD, PhDResearch Scientist, Adjunct Professor of Neurosurgery

R. John Leigh, MDDirector, Neuro-Ophthalmology & Balance Center, Professor Emeritus

W. David Lust, PhDProfessor

Louis F. Dell’Osso, PhDDirector, Ocular MotorNeurophysiology LaboratoryProfessor Emeritus

Robert Ratcheson, MDProfessor

Mel Shaffron, MDProfessor

Yoshiru Takaoka, MDProfessor

INDEPENDENT SPECIALIST ON STAFFMarian Patterson, MD

UH NEUROLOGICAL INSTITUTE

Through 15 Centers of Excellence, the UH Neurological Institute at UH Case Medical Center provides comprehensive care for pediatric, adult and elderly patients. Teams of experts – including specialists from UH Seidman Cancer Center and UH Rainbow Babies & Children’s Hospital – collaborate to devise personalized care plans using the latest clinical advances and leading-edge technologies.

CENTERS OF EXCELLENCEBrain Health & Memory CenterBrain Tumor & Neuro-Oncology CenterCommunity Neurology CenterComprehensive Stroke CenterEpilepsy CenterFunctional & Restorative Neurosurgery CenterMusic & Medicine CenterNeurocritical Care CenterNeurological & Behavioral Outcomes CenterNeuromuscular CenterNeuropsychiatry CenterNeuroscience Nursing Practice CenterParkinson’s & Movement Disorders CenterSpinal Neurosurgery CenterTraumatic Brain Injury Center

To refer a patient or learn more about UH Case

Medical Center Departments of Neurology and

Neurological Surgery, call 216-844-2724 or

visit UHhospitals.org/Neuro.

© 2014 University Hospitals BRA 00295

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