GRHealth Neurosciences 2013 Aunnual Report
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Transcript of GRHealth Neurosciences 2013 Aunnual Report
GEORGIA REGENTS NEUROSCIENCE CENTER
ANNUAL REPORT 2013
1First in Georgia and second in the Southeast
to receive Advanced Comprehensive Stroke Center designation
Only Gamma Knife Center in the region affiliated with a children’s hospital
Only one in the region to offer endoscopic endonasal skull base surgery
First Level 4 Epilepsy Center in Georgia and South Carolina
First Movement and Cognitive Disorders Center in the region for movement disorder and Alzheimer’s patients
Only Movement Disorders/Parkinson’s Disease Level 4 Center of Excellence in Georgia or South Carolina
Only dedicated Alzheimer’s clinic in Georgia (outside of Atlanta)
First angiography suite with VasoCT capability in the region
1:2Nurse-to-patient ratio goal on the neuroscience
intensive care unit
1:4Nurse-to-patient ratio goal on the neuroscience floor
1 of 16Hereditary Hemorrhagic Telangiectasia
Centers in the U.S. (and one of only about 40 worldwide). This genetic disease can result in nosebleeds and AVMs throughout the body, including the lungs and brain.
1 of 24Designated Movement Disorders/Parkinson’s
Disease Centers of Excellence in the U.S.
1 of 33Certified, multidisciplinary ALS clinics in the U.S.
3rdYear in a row that the Comprehensive Stroke
Center was recognized by the American Heart Association and American Stroke Association for quality care and rapid treatment
17th out of 105Neurosurgery departments in the U.S. in NIH
Blue Ridge rankings. With $935,040 in NIH funding, this ranking represents a rise from 39th in 2004 and a jump from 28th in 2012
14Years of experience in Gamma Knife surgery
18Beds in the neuroscience ICU, with an additional
16 beds on the neuroscience floor
28Hospitals in Georgia affiliated with our
REACH telestroke network
GEORGIA REGENTS NEUROSCIENCE CENTER: WHO WE ARE
| GRU NEUROSCIENCE ANNUAL REPORT |
Our numbers tell our story: With nearly 40 faculty members, 11 centers, $15.9 million in sponsored research and nearly 20,000 patients treated annually in our outpatient clinics alone, Georgia Regents Neuroscience Center continues to improve the care of patients with general and complex neurological conditions throughout Georgia and beyond.
85%Compliance to AHA/ASA stroke quality indicators, ranking us among the
highest in the country
1,500Number of patients (and growing!) treated with Gamma Knife
<60Minutes to stroke treatment under our fast-track protocol
468Patients monitored annually in our Epilepsy Monitoring Unit
1,255Resective surgeries for epilepsy performed since our founding
89Percent of our patients with temporal, class I or class II, epilepsy who become
seizure free. Seventy-one percent of our patients with extratemporal, class I or class II, epilepsy become seizure free.
150High acuity spine cases from around the world treated annually
$15.9 millionSponsored research conducted into neurological diseases last year by our
neuroscience-related research programs
14,041Total adult clinic visits
1,830MS clinic visits
4,541Pediatric clinic visits
24Neurology faculty
13Neurology residents
3Neurology fellows
8Neurosurgery faculty
7Neurosurgery residents
| GRU NEUROSCIENCE ANNUAL REPORT |
• CARE FOR ANY NEUROLOGICAL
CONDITION.
Our broad range of services and faculty
experience means that we have the
resources to care for any neurological
condition — from simple to complex.
We have partnerships with referring
physicians throughout Georgia, South
Carolina, and beyond who rely on us to
consult with them on patient cases and
provide care and treatment.
• RESEARCH DISCOVERIES.
Patients who come to an academic
medical center benefit sooner from the
latest discoveries in neurological care
and treatment, thanks to the opportunity
to participate in clinical trials for new
medications, technology, surgical
techniques, and more.
• NEUROSCIENCE EXPERTISE.
Because we also teach generations of
health care professionals, our physicians
are well-versed in the newest findings and
therapies in their fields. They are board-
certified in all major specialties and sub-
specialties and deliver their expert care
not only here at Georgia Regents Medical
Center, but sites around the state
and beyond.
BENEFITS OF AN ACADEMIC MEDICAL CENTER
As part of the state’s second largest academic medical center, Georgia Regents Neuroscience Center offers patients and families numerous
benefits, including:
Patients with comorbid conditions also benefit from the many other departments and services available within our health system,
including:
• A 13-county Level I Regional Trauma Center
• A 154-bed children’s hospital housing a Level I Pediatric Trauma Center
• A dedicated Cancer Center working with us to provide multidisciplinary care and treatment planning for neuro-oncology patients
• One of the region’s largest — and most diverse — teams of adult and pediatric neuroradiologists, neuropsychologists, and
psychologists/psychiatrists
• Inpatient and outpatient rehabilitation
• A patient- and family-centered focus to care
| GRU NEUROSCIENCE ANNUAL REPORT |
Every day and with every patient, the Georgia Regents Neuroscience Center continues to strive toward innovation. “New” is the name of the game — within this past year, we have formed new partnerships, advanced new techniques and treatments, and brought new research to the bedside to help patients, not just here, but across the nation and even the world.
This year’s Georgia Regents Neuroscience Center Annual Report showcases just a few of these cases and stories:
New partnerships in stroke We launched a new model of care by partnering with St. Joseph’s/Candler in Savannah to expand comprehensive stroke care throughout the state. Our expanding telestroke hub and spoke system (the first rural telestroke system in the U.S.) now includes 28 hospitals, including Aiken Regional Medical Centers in South Carolina and University Health Care System in Augusta.
Collaborations with cancer Our Gamma Knife, neurosurgery, and cancer programs demonstrate the power of collaboration to improve the patient experience.
WELCOME
| GRU NEUROSCIENCE ANNUAL REPORT |
Improved monitoring and surgery for epilepsy We applied a new technique for SEEG monitoring and performed our first hippocampal multiple subpial transection.
New technique to repair pretzeloid spines Over three years, our spinal team developed an innovative technique to fix this highly complex spinal degenerative problem.
First craniosynostosis surgery using a spring device We were the first hospital in the nation to use this device that is designed to improve the care of babies whose sutures fuse too early.
Ongoing management of neurological disorders Our ALS and MS clinics continue to improve quality of life for patients.
New Movement and Cognitive Disorders Center This new center will collaborate on the care of Parkinson’s and memory disorders patients.
Neurointensivists in critical care We remain the region’s only neuro critical care unit staffed by fellowship-trained neurointensivists.
Neuroscience research Ongoing research initiatives include a potential new drug for hemorrhagic stroke, key discoveries on how memories are made and a new Department of Neuroscience and Regenerative Medicine.
In our clinics and operating rooms, we see patients presenting with every possible neurological condition, and we are uniquely positioned to respond. We remain the region’s resource for specialized care in neurological conditions requiring ongoing management, neurosurgery, or other treatments — all in partnership with you.
To find out more or to refer a patient, visit gru.edu/neuro or call 706-721-4581.
David Hess, MDChairman of Neurology
Cargill Alleyne, MDChairman of Neurosurgery
| GRU NEUROSCIENCE ANNUAL REPORT |
| GRU NEUROSCIENCE ANNUAL REPORT |
Since it launched in 2002, Georgia Regents Comprehensive Stroke Center’s REACH program has brought stroke care in Georgia and South Carolina much closer to thousands of patients and established interactive partnerships between GRHealth stroke specialists and referring physicians statewide.
It’s also developed new partnerships, one of the newest and most exciting of which is with St. Joseph’s/Candler in Savannah, Ga. By the coming fiscal year, six GRHealth neurologists will practice there full-time, providing neurohospitalist support and outpatient care for stroke and other neurological cases, conducting additional research and clinical trials, and opening up further opportunities for medical student and resident rotations.
Annually, it’s estimated that only 2 to 4 percent of stroke patients in the U.S. are treated with the life- and brain-saving drug tPA. In Georgia, the telestroke program, REACH, based at Georgia Regents Comprehensive Stroke Center, has made enormous strides in advancing stroke care and tPA administration at the 28 hospitals currently part of its hub and spoke network. Now a new model of care — a partnership between our stroke center and other participating hospitals — is helping to strengthen that network and further comprehensive stroke and neuroscience care statewide.
“Our partnership with St. Joseph’s/Candler and other hospitals is a relatively new model of care and an extension of our REACH model. To improve stroke care in this state, we’ve found that you can’t do everything remotely — you do need physicians on the ground.”
Dr. David Hess, Director of Neurology, Georgia Regents Comprehensive Stroke Center
STROKE
STROKE FAST STATS
• For the third year in a row, our
comprehensive stroke center
was recognized with the
American Heart Association/
American Stroke Association’s
Get With The Guidelines®
Stroke Gold Plus Quality
Achievement Award and
Target Stroke Honor Roll,
demonstrating our center’s
commitment to quality care
and rapid treatment, such as
consistently administering
tPA within one hour of a
patient’s arrival.
• The Georgia Coverdell Acute
Stroke Registry presented our
comprehensive stroke center
with an Award of Excellence
for demonstrating a 20
percent improvement in tPA
administration and an average
door-to-needle-time of less
than 60 minutes.
• We continue to improve our
outreach to rural hospitals
through a dedicated telestroke
coordinator, who conducts on-
site training and collects valuable
data and feedback on stroke care
and our telestroke network.
DISCOVERIES IN STROKE TREATMENT
• Leading a Worldwide Stem Cell Trial. Dr. David
Hess, Chairman of the Department of Neurology, is
the clinical primary investigator for a trial on the first
IV-administered stem cell product for stroke
treatment, patented by scientists at Athersys Inc.
and faculty at Georgia Regents Health System.
The trial is at its halfway point and has expanded
to the United Kingdom.
• Antibiotic’s Role in Reducing Disability Following
Hemorrhagic Stroke. Hemorrhagic strokes are far
less common — but far deadlier — than ischemic
strokes, with no proven therapy available. Led by
principal investigator Dr. Jeffery Switzer, a stroke
specialist at Georgia Regents Health System,
an American Heart Association-funded study
is examining the potential role of the common
antibiotic minocycline in reducing the high rates
of disability following hemorrhagic stroke.
• Telestroke Is Cost Effective for Hospitals.
A Genentech-funded study examined telestroke data
from Georgia Regents Comprehensive Stroke Center
and the Mayo Clinic and found that telemedicine
not only helps save rural hospitals money, but also
improves patient outcomes. Compared to hospitals
with no telestroke network, 45 more patients were
treated with intravenous thrombolysis, 20 more
with endovascular stroke therapies, leading to 6.11
more independent patients discharged home and
representing more than $350,000 in cost savings for
the network each year, according to the study.
A NEW PARTNERSHIP IN SAVANNAH AND OTHER HOSPITALS
This new partnership comes on the heels of Georgia Regents Comprehensive Stroke Center’s accreditation as an Advanced Comprehensive Stroke Center by the Joint Commission (the first in the state and one of only a handful in the nation) — and is another example of the innovative solutions GRHealth has advanced to improve stroke care in the state and beyond.
“Our partnership with St. Joseph’s/Candler and other hospitals is a relatively new model of care and an extension of our REACH model,” said Dr. David Hess, Chairman of Neurology. “To improve stroke care in this state, we’ve found that you can’t do everything remotely — you do need physicians on the ground.”
With its long relationship with GRHealth and Georgia Regents University, St. Joseph’s/Candler was a good fit. Along with Brunswick’s Southeast Georgia Health System, St. Joseph’s/Candler serves as the Southeast Campus of the
Medical College of Georgia at Georgia Regents University. In 2009, it also became a REACH hub for seven rural hospitals in Southeast Georgia, with vascular neurologists at the Georgia Regents Comprehensive Stroke Center currently taking those calls.
With local neurologists in Savannah moving more toward outpatient care, the partnership also met a need for the two hospitals within the St. Joseph’s/Candler health system to have vascular and other neurologists on staff for inpatient care, to maintain its accreditation as a primary stroke center, and to offer that same level of care to its partner hospitals.
As one of the Georgia Regents physicians on staff at St. Joseph’s/Candler, Dr. Jill Trumble, who directs the movement disorders program and the general neurology outpatient clinic, said patients and the health system both benefit when neurohospitalists are on staff.
“This model is the trend in health care now,” she said. “Having an outpatient facility and inpatient neurohospitalists allows me time to concentrate on my clinic patients without being pulled away to see patients in the hospital, which allows for better care and less wait times.”
Although the neurologists’ full-time practice is in Savannah, they remain
Georgia Regents faculty members through a contractural agreement with St. Joseph’s/Candlers. Their specialties include vascular neurology, movement disorders, neuromuscular diseases, neurophysiology, and more. A similar model is being launched at Aiken Regional Medical Centers and is being explored in other locations.
| GRU NEUROSCIENCE ANNUAL REPORT |
“Our partnership with the Georgia Regents Neuroscience Center allows us to recruit the highest caliber of physicians to our medical staff. Being able to practice in our busy community health system and at the same time maintain an academic appointment at GRU is a winning combination for all. Really, it’s all about evidence-based medicine and providing the best care according to the evidence to the patients that we serve. This just supports that consistency.”
Sherry Danello, DOB, MSN, BC-NEA, Vice President of Patient Care Services, St. Joseph’s/Candler
Collaboration is inherent within the neurosurgical team at Georgia Regents Neuroscience Center. Our neurosurgeons have expertise across a vast array of subspecialty areas in neurosurgery, including endoscopic, endovascular, skull base, neuro-oncology, pediatric, spine, peripheral nerve, and Gamma Knife. Because many of our patients present with complex conditions requiring multistage care, we collaborate closely to form the right plan of surgical treatment and management for each patient.
With two previous craniotomies for recurrent meningioma, patient Christina Mulvihill presented neurosurgeons at Georgia Regents Neuroscience Center with a complex case. The benign tumor was atypical, continuing to return despite surgical interventions and causing ongoing symptoms of dizziness and nausea. It was also unfortunately located — near the brain stem and also involving her right ear.
COMPLEX NEUROSURGICAL PLANNINGMulvihill’s case went to the neuro-oncology tumor board at Georgia Regents University Cancer Center, where neuro-oncologists, neurosurgeons, and radiation oncologists examined her scans and determined the best neurosurgical plan. The complex treatment plan would require the involvement of neurosurgery/skull base surgery, specialized radiation therapy, and Gamma Knife — an entire spectrum of care that patients can typically only receive at an academic medical center like Georgia Regents Medical Center.
A very complex skull base surgery to remove the tumor was a success, and Mulvihill also underwent conformal radiation therapy to help spare normal brain tissue — but a followup MRI showed that the tumor was once again growing. During a visit to the multidisciplinary neuro-oncology clinic at the
“We have benefited very much from the collaboration of the Georgia Regents Neuroscience Center and the GRU Cancer Center. When the tumor board meets, everyone shares their input, and they all have a goal of doing the best for her that can be done. It’s an effort on everyone’s part, and we appreciate that.”
Anna Butler, Christina Mulvihill’s mother
| GRU NEUROSCIENCE ANNUAL REPORT |
GAMMA KNIFE & NEUROSURGERY
“From a regional standpoint, we are one of only a handful of centers that is dedicated to multidisciplinary care, offering multidisciplinary clinics, a tumor board and using novel therapies, including in-house developed protocols. This is very unique, and most patients would have to travel hours away to find something similar.”
Dr. Cargill Alleyne, Chair of Neurosurgery at Georgia Regents Neuroscience Center
cancer center, Mulvihill met with her cancer physician as well as her neurosurgeon, Dr. John Vender. As Director of the Gamma Knife Program, Vender recommended that Mulvihill also undergo radiosurgery. “A single mass lesion may not shrink with other therapy,” said Vender. “But Gamma Knife is very effective in treating tumor recurrence.”
REGION’S ONLY GAMMA KNIFE PERFEXION WITH EXTEND TECHNOLOGYTwo years ago, the Georgia Regents Neuroscience Center added the Perfexion model with Extend technology to its Gamma Knife Program. The new protocol offers the most advanced radiosurgery technology, with only a handful of sites in the U.S. currently offering this therapy. Perfexion with Extend allows access to larger tumors as well as targets previously unreachable by traditional Gamma Knife units, including the skull base and down to the third or fourth vertebra. It also offers enhanced planning, shorter treatment times, greater tissue sparing, and improved patient comfort.
In Mulvihill’s case, Gamma Knife pinpointed the recurring meningioma as well as other smaller formations within her brain. Mulvihill is continuing to undergo therapy to improve speech lost during her multiple surgeries, along with physical therapy for some paralysis on her right arm as well as balance issues.
“Besides my head, I’m fine,” said Mulvihill, her sense of humor still fully intact.
According to Dr. Cargill Alleyne, Chairman of Neurosurgery at Georgia Regents Neuroscience Center, “From a regional standpoint, we are one of only a handful of centers that is dedicated to multidisciplinary care, offering multidisciplinary clinics, a tumor board, and using novel therapies, including in-house developed protocols. This is unique, and most patients would have to travel hours away to find something similar.”
| GRU NEUROSCIENCE ANNUAL REPORT |
NEUROSURGERY FAST STATS
• The Georgia Regents Neuroscience Center has
one of the area’s largest and most diverse team of
neurosurgeons, skilled in caring for any neurological
condition requiring surgical intervention.
• We are expanding our capabilities in radiosurgery,
treating not only the brain, but also areas of the spinal
cord. We are one of only a handful of sites in the
U.S. offering Gamma Knife Perfexion with Extend
technology, designed to target tumors in areas where
other modalities may be too dangerous or not effective.
Since our inception, we have cared for more than 1,500
patients at our dedicated Gamma Knife Center.
• Recent statistics demonstrate that patients who
undergo aneurysm surgery at our Endovascular Center
recover with half the complication rate as compared
to the national average. Our statistics also show zero
mortality during carotid surgery to open stroke-
causing blockages.
INNOVATIONS IN NEUROSURGERY
• Radiosensitization Research. Researchers at our center are
exploring how certain drugs may cause pituitary tumors
and gliomas to be more sensitive to radiation therapy.
Radiosensitization could help optimize the effectiveness of
Gamma Knife treatment for brain tumors.
• Curcumin Connection. Dr. Cargill Alleyne and Dr. Krishnan
Dhandapani, who co-direct the GRU Neurovascular Research
Laboratory, hope to initiate clinical trials in the future in patients
with intracranial hemorrhages, using a potent drug form of the
Indian spice curcumin. In studies, the compound — long used in
Indian medicine to reduce inflammation — was found to actively
engulf blood clots and clear them away. If successful, this would
be the first drug developed to help reduce the risk of significant
disability from intracerebral hemorrhage.
• Glioblastoma Vaccine Trial. The GRU Cancer Center is
conducting Phase III clinical trials in patients with glioblastoma,
testing the effectivenss of an anti-EGFRvIII vaccine called
CDX-110. Earlier studies have demonstrated a 24-month overall
median survival compared to 15 months in historical controls.
By combining the best aspects of surface and SEEG (stereotaxic EEG) monitoring, a sophisticated approach at the Georgia Regents Epilepsy Center is improving how we identify site onset of intractable seizures. We are also pioneering challenging neurosurgical procedures such as hippocampal multiple subpial transection. The case described below demonstrates how we are continuing to advance our monitoring and surgical techniques to reduce or even eliminate seizures, while helping to preserve language, memory, and other functions important to quality of life.
“The Georgia Regents Epilepsy Center is a wonderful place. They’re really caregiving, and they help you as thoroughly as they can. Those people up here — they are really the best anywhere.”
Sarah Hutcheson, seizure free after 10 years
| GRU NEUROSCIENCE ANNUAL REPORT |
EPILEPSY
Thirteen years ago, when she was 31 years old, Sarah Hutcheson experienced her first seizure. Even after surgery had removed a large tumor that had stretched
its fingers deep into her brain, the seizures continued.
Despite an aggressive regimen of medications, the seizures were becoming more frequent, until they were occurring twicea month.
“People were really kind,” said Hutcheson, who lives in the small south Georgia town of Soperton. “But you never knew when they would happen, and I wanted to try to get out of the position of having so many seizures.”
EPILEPSY FAST STATS
• As the first Level IV Epilepsy
Center in Georgia and South
Carolina (as determined by
the National Association of
Epilepsy Centers), the Georgia
Regents Epilepsy Center
annually monitors more than 450
pediatric and adult patients. We
have also performed more than
1,250 resective surgeries since
our founding.
• According to our most recent
data, our Class I and II outcome
for temporal resections is 89
percent, and our Class I and
II outcome for extratemporal
resections is 71 percent (based on
a one-year follow-up).
• With a dedicated dietitian on
staff, our center is one of only a
few offering the ketogenic diet
as an alternative form of therapy
to reduce seizure frequency and
eventually the use of seizure
medications and their side
effects. The diet may be effective
in certain pediatric patients with
many areas of seizure focus
where surgery is not an option.
“Hippocampal MST combines two threads of epilepsy surgery. Math, with the grids, depth electrodes, computers, and stereotaxis — and hard neurosurgery, with microsurgery into the angles of the brain and hippocampus.”
Dr. Cole Giller, Neurosurgeon,Georgia Regents Epilepsy Center
A NEW TYPE OF SEEG MONITORINGHutcheson presented the team of epileptologists and neurosurgeons at the Georgia Regents Epilepsy Center with an interesting but challenging case. Noninvasive monitoring suggested that the seizures originated in the left temporal lobe, but the risk of a disabling memory decline from resection would be high.
While most centers typically will place either a surface grid or depth electrodes during invasive monitoring, the team at Georgia Regents Epilepsy Center combines both of these techniques in one surgery — by first placing the grids into the subdural space and then stereotaxically inserting the depth electrodes through the grids, using real-time MRI to guide placement. “This technique is now routine at our center,” said neurosurgeon Dr. Cole Giller. “It gives us the best of both worlds.”
Images from both invasive and noninvasive monitoring are then combined to deliver a more accurate 3-D picture of the seizure focus. “With our advanced monitoring, outcomes are better than with the usual techniques because we have more of an idea as to where the seizure focus is located,” said epileptologist Dr. Yong Park. “It’s more precise, in my opinion, and improves the quality of patient care.”
PUSHING THE LIMITS OF SURGERYIn Hutcheson’s case, invasive monitoring confirmed that her seizures originated from both the posterior lateral temporal lobe and the mesial structures, including the hippocampus. To better control her seizures and preserve hippocampal function, the team used a new technique performed at only a few centers around the world: hippocampal multiple subpial
transection, or MST, which uses a series of incisions along the hippocampus to disrupt seizure pathways. “It combines two threads of epilepsy surgery,” said Giller. “Math, with the grids, depth electrodes, computers, and stereotaxis — and hard neurosurgery, with microsurgery into the angles of the brain and hippocampus.”
During the awake procedure, Hutcheson was carefully monitored to ensure memory, language, and other functions remained intact. And following the surgery, for the first time in 10 years, she waited for a seizure to come. And waited.
A year later, she’s still waiting. Hutcheson is back at work and will soon be off all her epilepsy medications. Her memory is intact, her fatigue is gone — and so is the worry. “I never stopped doing anything because I didn’t want the epilepsy to affect me,” she said. “But I feel good now, I really do. I think the Georgia Regents Epilepsy Center is a wonderful place. They’re really caregiving and they help you as thoroughly as they can. Those people up here — they are really the best anywhere.”
| GRU NEUROSCIENCE ANNUAL REPORT |
“With our advanced monitoring, outcomes are better than with the usual techniques because we have more of an idea as to where the seizure focus is located. It’s more precise, in my opinion, and improves the quality of patient care.”
Dr. Yong Park, Epileptologist, Georgia Regents Epilepsy Center
KEY FINDINGS FOR EPILEPSY
• Neuropace RNS System. Our epilepsy center
is one of the original centers involved in the
Neuropace RNS System clinical study for
patients with medically refractory epilepsy.
Neuropace is an implanted therapeutic device
that continually monitors the brain’s electrical
activity and delivers imperceptible levels of
electrical stimulation to normalize brain activity
before an individual experiences seizures. The
device was approved by the FDA this past
November.
• Seizure Monitoring in the Neuro ICU. We
are also one of the only centers in the state
routinely monitoring our neurointensive care
unit patients for nonconvulsive seizures.
Studies have demonstrated that aggressive
treatment of nonconvulsive seizures in patients
who have had some sort of neurological injury
— including stroke, subarachnoid hemorrhage,
or brain trauma — can improve their outcomes.
Our center will soon be gathering and analyzing
data for outcomes research.
| GRU NEUROSCIENCE ANNUAL REPORT |
When Dianne Lemacks presented to the spine specialists at the Georgia Regents Spine Service, the cause of her significant back pain was easy to diagnose, even without a spinal X-ray. Following back surgery 10 years ago for degenerative disc disease, her spine had slowly begun to twist, until it formed a nearly perfect S-curve. The resulting deformity placed her shoulders and her legs out of alignment, affecting her gait and her overall quality of life, even her ability to sleep comfortably in herown bed.
Lemacks had consulted surgeons and other physicians for a number of years for her condition, who had prescribed back braces, special footwear, pain medications, and therapy to help assuage her pain, but told her that nothing could be done for the underlying deformity due to her age, 73, and the complexity of her condition.
The surgical expertise of the spine surgeons at the Georgia Regents Spine Service continues to attract patients from around the world with high acuity cases, including surgical revision, many of which have been considered inoperable. One recent case involved three years of planning to develop an innovative new technique for pretzeloid spines: A complete trunk shift, which straightened the patient’s spine, alleviated her pain and allowed her to return to her former quality of life.
“When Dr. Choudhri went into surgery, he knew my back frontwards and backwards. I don’t know what all he did, but I know he is a genius. Before this surgery, I knew I was destined to be in a wheelchair. Now, I have hope and plans to do things. I feel like I have a new lease on life, and I do.”
Dianne Lemacks, Patient underwent world’s first vertebral column
transection at Georgia Regents Spine Service
SPINE CENTER
SPINE FAST STATS
• An emphasis of our spine service
is on educating neurosurgeons
around the country and the
world on the specialized surgical
techniques developed by our
spine team. We provide free
consults, including a detailed
report with recommendations;
lecture at meetings around
the world; and host visiting
neurosurgeons who travel to
Augusta to view techniques under
the guidance of our specialists.
• Patients from across the U.S. and
around the world who travel to
Augusta for spine surgery benefit
from the assistance of a dedicated
spine concierge. This person
helps patients and families with
travel and accommodations, visas,
a translator service, and many
other aspects of their stay.
ADVANCEMENTS IN SPINE SURGERY
• Google Glass First. Spine surgeons at Georgia
Regents Spine Service recently became one of the
first in the world to use Google Glass during surgery.
The optical head-mounted display allowed surgeons
to visualize CT scans and other images in real time
during surgery.
• 3-D Modeling. Planning complex, multistage
surgeries can be an involved and lengthy process.
The spine team hopes to reduce that time by using
a 3-D printer to create models of a patient’s actual
spine, to help surgeons better plan osteotomies, and
develop new surgical techniques.
• Radiation Reduction. The surgical team at the spine
service has developed techniques to minimize the
amount of radiation used during surgery, reducing
the risk of cataracts, skin burns, and even cancer
down the road. Through minimal radiation surgery,
the team has dramatically cut radiation use down to
10 percent of that used in average spine surgeries.
MAPPING OUT A NEW SURGICAL TECHNIQUE
For patients like Lemacks, Dr. Haroon Choudhri, Director of the Neurosurgery Spine Service, and the multidisciplinary team at the Georgia Regents Spine Service focus on careful, presurgical planning to map out each individual case using drawings and simulations. Many cases of twisted spines involve bone screws, osteotomy slits, and force to bend the spine back into place. Over the course of three years, Choudhri and his team developed a new way to look at the procedure, which would involve less force and could result in an improved outcome.
Choudhri looked at shifting the entire trunk so that the patient’s shoulders and toes would be aligned. Known as vertebral column transection, the massive surgery would involve placing the spine in a “railway track” of screws and rods, a single thin cut across the vertebrae in five stages, then a final shift of the trunk in a very controlled manner to minimize any risk of spine damage. At the cut, the bones would then sit against one other and naturally grow back together. “This was a real innovation — designing a way of cutting the spine so it is completely free to move,” said Choudhri. “This type of thin cut has never been done before, but allowing the bone to stick to itself and grow back together offers the best chance of success. In a way, it’s like the magician’s trick of sawing a woman in half.”
IMPROVED OUTCOMES IN SPINAL SURGERY
Since Lemacks’ spine surgery, she has had no pain. Although Choudhri estimated her recovery would take up to two years, she is now a year out and has returned to an active lifestyle. She has needed only minimal pain medication immediately after surgery, wore a back brace for about 10 months, and is now beginning yoga and other prescribed exercises to strengthenher back.
Choudhri is developing an animation and teaching guide for vertebral column transection and plans to publish and present his findings. “Patients with this type of spinal deformity don’t have to languish,” he said. “This is fixable — and with a very gratifying result.”
| GRU NEUROSCIENCE ANNUAL REPORT |
“This was a real innovation — designing a way of cutting the spine so it is completely free to move. In a way, it’s like the magician’s trick of sawing a woman in half.”
Dr. Haroon Choudhri, Director of the Georgia Regents Spine Service
As the region’s only team of dedicated pediatric neurologists and neurosurgeons, the Georgia Regents Pediatric Neuroscience Center sees referrals for the widest range of congenital and acquired neurological disorders in children, including epilepsy, cerebral palsy, brain tumors, learning disorders, and their comorbidities. Because we are an academic medical center, we strive toward innovation, including being the first in the nation to offer a new neurosurgical technique for craniosynostosis, a condition affecting 1 in 2,000 live births worldwide.
Within a few days of James King’s birth, his mother, Amanda, noticed something wrong with the shape of her son’s head. And her doctors soon confirmed it. Diagnosed with craniosynostosis, James was referred from a community hospital to the Georgia Regents Pediatric Neuroscience Centerfor treatment.
Since he joined the center two years ago, Dr. Ian Heger, a pediatric neurosurgeon, has been working with pediatric plastic surgeon Dr. Jack Yu to bring his minimally invasive approach to the craniofacial program. The referral was timely: James would be the first child in the nation to benefit from a new spring device developed specifically for craniosynostosis.
NEW INTERVENTIONS, BETTER OUTCOMESStandard treatments for craniosynostosis involve a series of cuts and sutures in the bones of the skull that allow the brain to re-expand and require babies to wear a hard, molded helmet during their first year.
“The care at the Georgia Regents Pediatric Neuroscience Center was excellent. They talked over everything with us and gave us the entire plan written out on how the surgery would be performed, step by step. They were very good at explaining what they were going to do and why.”
Amanda King, mother of James, the first child in the nation to benefit from a new technique for craniosynostosis at Georgia Regents Pediatric Neuroscience Center
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PEDIATRIC NEUROSCIENCE
“We’ve broken new ground. Not only are we setting things up to do a new surgery that’s cutting edge, but we’re trying to understand how this surgery works on these children in a way that no one ever has before.” Dr. Ian Heger, Chief of Pediatric Neurosurgery
The new device pioneered at our center requires only two very small incisions and uses an endoscope to guide the insertion of a specially developed spring device. Similar to an enlarged open paper clip, the device is designed with a certain tension to release over a given amount of time and gently expand the skull as the child’s brain continues to rapidly develop and grow. BETTER CARE, BIGGER BENEFITSDespite a few complications, James has had a rapid recovery and will return to the children’s hospital in a few months for a second surgery to remove the spring devices. “Even when we first got to go back and see him, we already noticed a difference in him,” said Amanda.
Through the new procedure, Heger anticipates patients and their families will benefit from a decreased surgery time, less blood loss, a shorter hospital stay, and a quicker recovery.
Heger and his team are also examining the advantages of performing this type of surgery in babies only 3 to 4 months old instead of 6 months and older, as has been the standard.
“Children grow tremendously in that period of time,” said Heger. “There is a renewed interest in thinking that cosmetically, children do better when surgery is performed earlier, but are we also doing anything developmentally, physiologically, or neurologically that’s beneficial?”
It’s estimated that 15 percent of children with craniosynostosis will go on to have some type of developmental issue. Data collected at the center on other children who have had early craniosynostosis surgery has already seen improvements in blood flow in the brain. The pediatric neuroscience team is planning to conduct other neurodevelopment assessments to see if they can correlate early surgery with better developmental outcomes.
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PEDIATRIC NEUROSCIENCE FAST STATS
• Critically ill children in our pediatric intensive care unit and neonatal
intensive care can often suffer from underlying seizures that can cause
further neurological damage. Our center is focused on supporting 24/7
EEG monitoring to identify these underlying seizures and treat them
early.
• A fully staffed and dedicated pediatric neurosurgery operating room
is available 24/7, with minimally invasive and other technologically
advanced equipment that is the same as that in the adult OR but
specially sized for pediatric patients.
• We continue to be the region’s referral center for pediatric epilepsy,
thanks to our Level 4 Epilepsy Center, the highest level attainable
as determined by the National Association of Epilepsy Centers. Our
pediatric patients benefit from less invasive monitoring techniques as
well as leading-edge surgical and medical management of seizures.
• A dedicated spasticity clinic uses medications such as Botox injections
to help relieve muscle spasms related to cerebral palsy and other
congenital disorders.
• Children with learning disorders and comorbid conditions benefit from
a multidisciplinary model of care in which neurologists, psychologists,
and developmental pediatricians at our center work together to manage
overlapping problems in a single visit.
• Our pediatric neuroscience center also offers the state’s only tuberous
sclerosis clinic outside of Atlanta. This rare genetic disorder causes
nonmalignant tumors to form in many different organs, including the
brain, eyes, heart, kidney, skin, and lungs, and can lead to seizures,
developmental delays, intellectual disability, and autism.
• Dr. James Carroll is the principal investigator on a multiyear study
evaluating the safety and efficacy of a cord blood infusion in children
with motor disabilities due to cerebral palsy.
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REGION’S ONLY CERTIFIED ALS CLINICAccording to Dr. Michael Rivner, Director of the ALS Clinic at the Georgia Regents Neuroscience Center, patients with ALS typically die within five years of the initial symptoms of the disease. Diagnosing these patients as soon as possible and involving them in our multidisciplinary ALS Clinic for care and support is his highest priority.
Currently, about 150 patients from Georgia, South Carolina, and beyond receive care at two ALS clinic locations — one in Augusta and one in Macon. Patients with symptoms of ALS receive extensive electrodiagnostic testing to make the diagnosis — then Rivner and his team spend an equally lengthy amount of time to discuss the diagnosis and what it means to the patient and his or her family.
As the region’s only ALS clinic certified by the national ALS Association (and the only center certified in Georgia), our multidisciplinary program is designed so that patients see all their specialists in a single visit, including neurologists; physical, occupational, and speech therapists; dietitians; and equipment vendors, including augmentative communication specialists, respiratory equipment dealers, wheelchair vendors, and more.
In addition, we have a close partnership with the ALS Association of Georgia, the ALS Association of South Carolina, and the Muscular Dystrophy Association, who help provide counseling services and social work support for the clinic as well as help patients with the high costs of living with ALS. Patients also benefit from state-of-the-art treatment and active clinical trials. “While unfortunately, we can’t cure this disease, this doesn’t mean there’s nothing we can do,” said Rivner. “There are many things that can make life for patients with ALS better. The outlook for ALS is far better than it was 30 years ago.”
For patients struggling with symptoms related to a vast array of general neurological disorders, the Georgia Regents Neuroscience Center offers specialized services that focus on accurate diagnosis and management of these diseases in partnership with the referring physician. Along with care for general conditions such as migraine, neurological pain, vertigo, and neuropathy, our certified ALS clinic and patient-centered MS clinic provide long-term management of these chronic conditions.
NEUROLOGICAL DISORDERS
COMPREHENSIVE CARE FOR MULTIPLE SCLEROSIS
For patients diagnosed with multiple sclerosis, the news can be overwhelming. The Augusta MS Center, part of the Georgia Regents Neuroscience Center, is a comprehensive, family-centered care facility dedicated to the diagnosis and treatment of multiple sclerosis and related diseases. The center has a strong, well-trained clinical team, able to address the complex needs of people with MS in an integrated manner.
The MS center focuses on an individualized approach to treatment, and the staff encourages patients to be actively involved in all aspects of their care. The center has extensive experience with immune-modulating therapies to include injectable, oral, and on-site infusion therapies. Management of the symptoms related to multiple sclerosis improves patient function and quality of life.
Patient and family health education is an important part of our approach to patient care. Specialized services include intrathecal baclofen for spasticity, driving assessments in the on-campus Driving Simulation Lab, psychological services, cognitive assessments, rehabilitation services, and consultation by neuro-ophthalmology and urology. Patients also receive routine depression screenings, since many MS patients report an impact to their emotional well-being related to their diagnosis. Free patient and family counseling and a support group are available.
As the only MS clinic in Georgia outside of Atlanta — and with no MS center located in the state of South Carolina — the Augusta MS Center sees a wide catchment of patients from across the two states.
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“When I come to the Augusta MS Center, they give you support, and if you have questions you want to ask, there’s a lot of one-on-one time. I love my care. It’s very personal, and you feel very important to the care team. They will strive to do what’s best for you and offer you the best care that’s out there. They treat you like family, they really do. I had more questions answered and more attention in my first clinic visit than I had in any other appointment with any kind of doctor.” Ben Huff, has lived successfully with MS for 15 years
INNOVATIONS IN NEUROLOGICAL DISEASES
• ALS Drug Trials.The ALS Clinic is actively involved in Phase II multicenter
trials for the drugs fingolimod and tirasemtiv. It’s believed that fingolimod
may block certain immune cells from entering the brain and spinal cord
where they can cause activities that result in damage to motor neurons.
Tirasemtiv may facilitate muscle contraction in those with ALS by sensitizing
muscle fibers to calcium.
• Potential ALS Biomarkers. The ALS Clinic has also gathered clinical data on
an ongoing basis to help identify antibodies and potential biomarkers for
ALS. A paper is pending publication.
• Myasthenia Gravis Multicenter Study. Dr. Rivner and Dr. Lin Mei, a GRU
neuroscientist, recently identified a novel biomarker for the autoimmune
neuromuscular disease myasthenia gravis. They found that an antibody to
the protein LRP4 is a cause of this disease in up to 10 percent of patients, and
the department hopes to soon launch a multicenter study.
• MS Drug Trials. The Augusta Multiple Sclerosis Center is actively recruiting
for multiple pharmaceutical studies evaluating benefits and adverse effects
of disease-modifying medications to slow the progression of multiple
sclerosis. One study evaluates the effects of transitioning from natalizumab
to fingolimod. Others monitor the adverse effects that patients may
experience from oral DMTs, including dimethyl fumerate and fingolimod.
• Fitness to Drive. In association with the driving simulator lab at the GRU
physical therapy department, the MS center is conducting a fitness to drive
study in which participants with MS symptoms that limit their driving ability
can receive driving rehabilitation to safely get back on the road.
PSYCHOLOGICAL STUDIES
The MS center continues to conduct a variety of research studies in collaboration with The Department of Psychology, most recently evaluating:
• Health promotion model for treatment and
adherence and quality of life with MS
• Cognitive fusion mediating the impact of stigma
on well-being in adults living with MS
• Impact of routine depression screenings on
provider behavior
• Stress management in caregivers of persons
with MS
• Impact of MS on sexual function and
communication
• Variables associated with patient activation in
persons with MS
NEUROLOGICAL DISEASES FAST STATS
• The Augusta MS Center is a member of the Consortium of MS
Centers. It is also affiliated with the Georgia Chapter and the
South Carolina Regional Office of the Mid-Atlantic Chapter of the
National Multiple Sclerosis Society and was recently recognized
by the society as a Comprehensive Care Center for MS.
• The ALS Clinic at Georgia Regents Neuroscience Center is only
one of 34 centers certified by the national ALS Association,
and the only such center in Georgia. It also has locations in both
Augusta and Macon.
• Pyschological services at the Augusta MS Center have gained
national and international attention as a model for care at
various MS conferences, such as the 22nd European Committee
on the Treatment and Research of Multiple Sclerosis in
Madrid, Spain.
• An annual walk and an inaugural golf tournament are just a few of
the fundraisers hosted by the ALS Clinic to help provide support
for patients living with the disorder. Last year’s walk raised
nearly $70,000.
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“Dr. Rivner and the ALS Clinic have been great. They’ve been there for us, and when we had questions, they had the answers. It’s also great to have it this close. The support of it — that’s the thing. I don’t know what people did years ago when there was nothing. The clinic here has people who care and who are working to bring an end to this thing.”
Leslie Holmes, husband to Debbie, diagnosed with ALS two years ago
On the one hand, Parkinson’s disease and Alzheimer’s disease are very different. But on the other, they are the same. Both brain disorders have similar disease processes, and both are challenging for physicians to manage and treat. The new Movement and Cognitive Disorders Center — part of the Georgia Regents Neuroscience Center — was designed to bring together the expertise of our interdisciplinary team and our clinical researchers to help improve patients’ and caregivers’ quality of life and uncovernew treatments.
If you examined the brain of a Parkinson’s disease patient and one of an Alzheimer’s disease patient, you would see many of the same neurodegenerative processes at work, causing movement disorders and perhaps later dementia in the one and memory disorders in the other.
But while science has grasped an understanding of how these two diseases develop, the challenge continues to be identifying optimum treatment, if not a cure. This was the impetus for the new
Movement and Cognitive Disorders Center, part of the Georgia Regents Neuroscience Center. The center brings together our National Parkinson Foundation Center of Excellence in Movement Disorders/Parkinson’s Disease as well as Georgia’s only dedicated Alzheimer’s clinic outside of Emory Universityin Atlanta.
Led by Drs. Kapil D. Sethi and John C. Morgan, board-certified neurologists, a focus of the center will be on exploring drug and other therapies to help treat and slow down progression of these diseases. In addition, the center will continue to work on improving overall quality of life for these patients and their families. “We have a regional impact, not just a Georgia impact,”
“I don’t know anything different from [the Movement and Cognitive Disorders Center]. GRU is the only place that has a movement disorders program here, and they’ve been such a help. Let me put it this way: It’s just being able to talk with Dr. John Morgan and the clinic, getting updates, and telling him what’s going on. I’m being kept ahead of things [treatment-wise].”
Frank Tobakos, Parkinson’s patient for the past six years
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MOVEMENT AND COGNITIVE DISORDERS CENTER
said Morgan. “Our focus is on delivering the best patient care we can for all forms of movement and cognitive disorders.” PARKINSON’S DISEASE CARE: A TRADITION OF EXCELLENCEOur movement disorders/Parkinson’s disease program recently earned its redesignation as a Center of Excellence by the National Parkinson Foundation. Since we first earned our designation more than a decade ago, we have continued to be the only Movement Disorders/Parkinson’s Disease Center of Excellence in Georgia and South Carolina, and we join only 24 such centers in the U.S. The “Center of Excellence” designation means that we meet rigorous criteria for research, comprehensive care delivery, professional education, and patient outreach services.
For medication-resistant Parkinson’s disease, our center has a nearly 30-year history of surgical interventions, and our deep brain stimulation program has been active for almost two decades. We carefully select our patients, who benefit from individualized programming of the DBS device, either by our physicians or the referring physician. Over the past four years, we have performed more than 220 procedures for movement disorders with excellent results and low morbidity.
As part of our emphasis on delivering the best care and treatment for patients with Parkinson’s disease or related disorders, Morgan travels around the country, lecturing to physicians; physical, occupational, and speech therapists; social workers; and others about Parkinson’s disease and how to better care for these patients. Sethi also lectures physicians,
caregivers, and therapists about Parkinson’s disease, both in the U.S. and internationally, serving as an international leader in the field ofmovement disorders.
In total, more than 700 patients with Parkinson’s disease — and an additional 300 with parkinsonism — receive care at our center. PARTNERSHIPS IN ALZHEIMER’S DISEASEThe Alzheimer’s program transitioned from Dr. Suzanne Smith to Morgan this past year but continues to provide the same interdisciplinary care for patients and families affected by Alzheimer’s disease and other memory disorders. Patients also continue to benefit from the center’s strong partnership with the Alzheimer’s Association Augusta regional office, which supports the clinic with helpful resources, including access to local support groups.
At the clinic, patients start with a full evaluation by Morgan, with the assistance of his physician assistant, Elizabeth Prince-Coleman. Many patients are also referred for neuropsychological assessment by Dr. Greg Lee, a board-certified neuropsychologist. A neuropsychological assessment provides the basis for a treatment plan and any updates. Few centers in this area have a full-time neuropsychologist on staff providing this kind of assessment for patients with neurological disorders.
Patients with other memory disorders, including mild cognitive impairment and stroke-related memory impairment, are also seen at the center.
“My family and I feel blessed to be under the care of Dr. John Morgan and his team at Georgia Regents Movement and Cognitive Disorders Center. My mother has had compassionate care during a recent new difficult diagnosis. Our family was impressed with the overall experience and are thankful to have such a wonderful team to help with our mother’s care.”
Kathy Chavis, family member
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MOVEMENT AND COGNITIVE DISORDERS FAST STATS
• Our center facilitates access to local support groups
for Parkinson’s disease and Alzheimer’s disease, with
physicians and staff often attending these meetings
and speaking on disease-related topics.
• Parkison’s disease patients can also benefit from
our partnership with the Family Y, which offers a
swimming and exercise program designed specifically
for patients with movement disorders.
• Our Alzheimer’s program’s interdisciplinary
team includes a dementia specialist, physician
assistant, psychiatrists, clinical psychologists, and an
experienced neuropsychologist to assess patients with
Alzheimer’s disease or other memory disorders.
• Future plans for the Movement and Cognitive Disorders
Center include launching a philanthropic campaign to
construct a dedicated center focusing on clinical care
and research in a single location.
IMPROVING CARE FOR MOVEMENT AND COGNITIVE DISORDERS
• “Wii-hab” for Parkinson’s. The Nintendo Wii gaming
system has been found to have significant benefits for
patients with Parkinson’s disease, according to a recent
study by Dr. Nathan “Ben” Herz from our center, now
heading the occupational therapy program at Mary
Baldwin College. The study, which was published in the
journal Parkinsonism & Related Disorders, demonstrated
that Wii therapy provides improvements in short-term
motor and nonmotor skills, mood, and overall quality
of life.
• Ongoing Drug Trials. Our movement disorders program
has many ongoing studies of drugs that attack Parkinson’s
disease in its many different stages, including slowing
disease progression, improving dyskinesias related to
levodopa therapy, treating the disease’s neuropsychiatric
and cognitive effects, treating autonomic symptoms, and
improving motor function. In addition, our Alzheimer’s
program is working with pharmaceutical companies and
other sources to become involved in clinical trials for
Alzheimer’s disease.
• Memory Mechanism. Dr. Joe Tsien of the GRU Brain &
Behavior Discovery Institute has identified an NMDA
receptor in animal models that controls the development
of memory patterns, which has promise in helping
researchers understand the mechanisms behind
Alzheimer’s disease and could lead to better treatments.
Critically ill patients with neurological conditions benefit from the area’s only dedicated Neuro Critical Care Center staffed by fellowship-trained neurointensivists. Opened in 2003, the center includes an 18-bed neuroscience intensive care unit as well as a 16-bed neuroscience floor, with specially trained staff providing continuous monitoring for patients recovering from a host of neurological disorders that impact critical bodily functions.
For neurointensivists Dr. Subhashini Ramesh and Dr. Alfredo Garcia, the benefit of a dedicated Neuro Critical Care Center for patients with devastating neurological injuries or conditions is clear: its special expertise in caring for complex patients recovering from stroke, aneurysm or brain hemorrhage, brain swelling or infection, brain tumors, seizures, spine and other neurosurgeries, and many other disorders.
ON THE HOUR, EVERY HOURWhile all critical care units are staffed by critical care intensivists, the role of neurointensivists is a fairly new one. At Georgia Regents Neuroscience Center, our neuro ICU is staffed by the region’s only neurointensivists, who are fellowship trained in neuro critical care.
An important part of their role is the continual monitoring and assessment of each of the critically ill patients on the unit. Every hour, neurointensivists perform a neurological exam on the neuro ICU patients to assess brain activity and monitor sometimes rapidly occurring neurological changes. “If the brain is affected
[by a complication], the exam is often the only thing that gives an indication of change in the patient,” said Ramesh. “The neurological exam is the mirror of the brain for us.”
“People trained in neurocritical care typically understand not just the critical care aspect of medicine, but also have special expertise in the brain itself. You have an edge when you’re being treated by a neurointensivist in that situation.”
Dr. Subhashini Ramesh, Neurointensivist, Georgia Regents Neuroscience Intensive Care Unit
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NEURO CRITICAL CARE CENTER
REGION’S ONLY ROUTINE EEG MONITORING FOR SEIZURES Based on that exam, the neurointensivists can then order specific interventions. One of these is EEG monitoring to help identify nonconvulsive seizures.
This type of monitoring is unique in the ICU setting but has garnered national attention for its role in identifying these subclinical seizures, which show no outward sign but can lead to poorer outcomes in patients. The Georgia Regents Neuro Critical Care Center is the only one in the state, outside of Atlanta, that routinely performs EEG monitoring in the ICU.
Dr. Deborah Moore-Hill, an epileptologist who is fellowship trained in both neurophysiology and epilepsy, performs EEG monitoring on certain patients who may be at risk for these types of seizures. These include patients who demonstrate more impairment than the neurointensivists expect based on their known neurological injuries.
The continual monitoring allows the physicians to review data in real time and deliver aggressive treatment for seizures, with no delay. “Studies have shown that in patients with intracerebral hemorrhage, if they were allowed to have uncontrolled subclinical seizures, it worsens their overall clinical outlook,” said Moore-Hill.
A MODEL FOR CARESince the unit opened in 2003 as a model unit for patient- and family-centered care, the Neuro Critical Care Center has continued to model improved care for other ICUs throughout the nation as well as our own health system. For example, the ICU is staffed by dedicated neuroscience nurses at a 1:2 nurse to patient ratio goal. These nurses are specially equipped to handle changes on a patient’s neurological exam.
Recent quality initiatives have included tracking data on external ventricular drains for hemorrhages and ventriculitis rates after EVD placement.
As part of Georgia Regents Health System’s philosophy of Patient- and Family-Centered Care, the Neuro Critical Care Unit continues to invite families to remain with patients 24/7 in the neuroscience ICU, which is atypical in most ICU settings.
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“We have the capability to handle any nervous system problem. And that’s really important to support the mission of treating anything that comes through the door, no matter how complex … Often the patient’s health is the biggest part of the problem. So having the ability to provide extremely high level critical care with very dedicated professionals supporting the patients and taking care of the patients is a huge asset.” Dr. John Vender, Neurosurgeon, Georgia Regents Neuroscience Center
NEURO CRITICAL CARE FAST STATS
• The Georgia Regents Neuro
Critical Care Unit is staffed by the
region’s only neurointensivists
trained in critical care specific to
neurological disorders.
• Patients also benefit from a 1:2
nurse to patient ratio, routine EEG
monitoring for nonconvulsive
seizures (a major factor for poor
outcomes), as well as other quality
improvement measures.
• Unlike most ICUs, families are
welcome to remain with patients
24/7. As part of our patient- and
family-centered philosophy,
we always empower patients
and families so they can be
knowledgeable and involved in
their own care.
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Imagine it: A patient comes in complaining of fatigue, excessive thirst or hunger, blurry vision, and tingling. If doctors didn’t have a clinical understanding that these symptoms in conjunction with low glucose levels meant diabetes, it would be difficult, if not impossible, to treat this disease.
This is why neuroscientists at Georgia Regents University continue to move forward on decoding how the brain works — to devise new mechanisms to treat common disorders and conditions such as Alzheimer’s disease, Parkinson’s disease, schizophrenia, traumatic brain injury, and more.
As part of an academic health center, the Georgia Regents Neuroscience Center is uniquely positioned to benefit from on-campus research in real time. The partnership of our clinicians with our longstanding neuroscience research program continues to produce translational discoveries that benefit our patients and families.
A MEMORY SWITCH?Even before President Obama announced the BRAIN Initiative last year, neuroscientists at GRU already had nearly seven years of work into brain activity mapping through support from the Georgia
Many describe the human brain as the last frontier in science. Neuroscience research received a catalyst last year when President Barack Obama invited the scientific community to join him in the BRAIN Initiative (Brain Research through Advancing Innovative Neurotechnologies). The initiative focuses on inspiring scientists to a better understanding of the brain and translating that understanding into new ways to treat, prevent, and even cure brain disorders. The top-tier basic and clinical research at the Georgia Regents Neuroscience Center is taking on that challenge.
“Hemorrhagic stroke is a dire disease, with no treatment options and limited surgical options. Our curcumin project illustrates the point of our lab — to get a basic science finding and get it across that magical wall that separates MDs from PhDs.”
Dr. Krishnan Dhandapani, GRU Neurovascular Lab
RESEARCH
“The idea is to try to develop new tools that allow you to listen in to brain conversation, to understand what it says and how it generates memories, thoughts, and actions. Understanding the brain code is essential to understanding all sorts of mental problems, including brain aging.”
Dr. Joe Tsien, Co-Director, GRU Brain and Behavior Discovery Institute
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Research Alliance. “We’re producing initial success in decoding the brain activities underlying memory,” said Dr. Joe Tsien, Co-Director of the GRU Brain and Behavior Discovery Institute. “Now for the first time, we are able to crack the neural code.”
Tsien and his research team have identified an NMDA receptor in the hippocampus that helps control learning and memory. When this “switch” is turned off or disabled in animal models, not only is their memory code faulty, but they also have difficulty retrievingthese memories.
This finding is a breakthrough in aiding scientists to understand all types of mental disorders, including brain aging, and could assist in the development of better treatments for schizophrenia, bipolar disorder, andParkinson’s disease.
A BREAKTHROUGH IN BRAIN BLEEDINGPatients with intracerebral hemorrhages have few options. Surgery has been found to be of little to no benefit, and more often than not, these
patients languish for weeks in a neurointensive care unit, waiting for the body to heal itself — and live the rest of their lives withsignificant disability.
But for these patients, there is now hope. Nearly five years ago, Dr. Cargill Alleyne, Dr. Krishnan Dhandapani, and the research team in the Neurovascular Research Laboratory made an astounding finding: The Indian spice, curcumin — long used in Indian medicine to reduce inflammation — actively engulfs the blood clots in intracerebral hemorrhage, clearing them away. Further research demonstrated that curcumin works by increasing the rate of phagocytosisin macrophages.
Dhandapani and Alleyne are currently working with East China Normal University to develop a more potent drug form of the Indian spice. “Because curcumin is a proven safe compound, even if only 10 percent of patients benefit, there is no risk and high reward. And what if a majority of people respond?” said Dhandapani. “The potential is that this could be one of the next big drugs for patients with thisdevastating condition.”
“How do you know if it’s myasthenia gravis if you don’t have a diagnosis? Without
it, a patient is just left hanging — they’re wondering, they’re anxious. We believe that
we can better characterize myasthenia gravis patients. If this biomarker correlates with their
symptoms, their entire treatment would be very different.”
Dr. Lin Mei, GRU Department of Neuroscience and Regenerative Medicine
STRENGTHENING RESEARCH INTO NEUROLOGICAL AND PSYCHIATRIC DISEASE
Bringing together the strength of GRU’s vast resources in neuroscience and stem cell research is the focus of the new Department of Neuroscience and Regenerative Medicine. Led by Dr. Lin Mei, a neuroscientist and expert in brain cell communication who has directed MCG’s Institute of Molecular Medicine and Genetics for six years, the department is poised to expand innovative translational neuroscience research, as well as medical and graduate school education and postdoctoral mentoring — to engage the next generation of neuroscientists.
This research includes recent innovations such as the development of a schizophrenia mouse model, in which scientists can manipulate levels of the protein neuregulin-1, which is found at higher levels in some schizophrenia patients. Mei and neurologist Dr. Michael Rivner also recently identified a novel biomarker for myasthenia gravis: An antibody to the protein LRP4 has been identified as a cause of this disease in up to 10 percent of patients, and the department hopes to soon launch a multicenter study.
With the addition of regenerative medicine to the program, Mei also anticipates exploring the potential of this therapy in many fields.
“These terrific leaders will work closely and collaboratively with Drs. David Hess and Cargill Alleyne in our Departments of Neurology and Neurosurgery as well as Dr. Joe Tsien in the Brain and Behavior Discovery Institute and many others across our campus and the world to advance our understanding and treatment of the brain,” said Dr. Peter Buckley, Dean of the Medical College of Georgia at Georgia Regents University. “Collectively, these strategic realignments enhance our focus on neuroscience across clinical, basic science, and translational realms.”
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As the Southeast’s regional referral center for patients with chronic or acute neurological conditions, we would be glad to provide specialty or subspecialty care, a second opinion, or work with you to manage your patient’s condition.
HOW TO REFER PATIENTS
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Call 706-721-4581
Contact the Georgia Regents Neuroscience Scheduling Centerdirectly with:• Patient’s name, contact information, and insurance information• Diagnosis• Specialty requested• Referring physician’s name and contact information
If the patient is still at your office, we can arrange for a specific appointment that works with your patient’s schedule. Or we will contact the patient directly by telephone to set up an appointment. We will also ask you to send over a copy of the patient’s medical record (including insurance card), lab results, or imaging studies.
Fax 706-721-1459
The referring physician’s office may fax over a request, including: • Patient’s name, contact information, and a copy of the patient’s insurance card• Diagnosis• Specialty requested• Referring physician’s name and contact information
The Georgia Regents Neuroscience Scheduling Center will contact your office for copies of medical records, lab results, or imaging studies and will contact the patient directly by telephone to set up an appointment.
WORKING WITH THE GEORGIA REGENTS NEUROSCIENCE CENTER
With busy specialty and subspecialty clinics, our goal is to ensure that your patients are seen as soon as possible. Our dedicated schedulers have direct access to all our providers’ calendars and will work to accommodate your patients with an appointment at the earliest time available.
Urgent patient referrals are reviewed immediately by a physician medical director so that we can schedule appointments within one to two days. For emergent situations, please use our Level I Trauma Center and Emergency Department.
We also strive to consistently provide feedback and physicians’ notes so that you can remain updated on your patient’s status.
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HAROON F. CHOUDHRI, MDProfessor and Chief
Section of Adult Neurosurgery
Director, Neurosurgery Spine Service
Director, Neurosurgery Spine Fellowship
Specialty: Neurosurgery, complex spine surgery
Clinical Interests: Bloodless medicine program,
complex (revision/reoperative) spine surgery,
cervical spine surgery, thoracic spine surgery,
lumbar spine surgery, spine tumors, neck-arm-
low back pain, minimally invasive spine surgery,
endoscopic spine surgery, scoliosis/deformity
surgery, craniocervical junction surgery, occipital
cervical fusion, spinal fusion, thoracic discectomy,
spinal stenosis, spondylolysis/spondylolisthesis,
cervical spondylotic myelopathy, ossification
of the posterior longitudinal ligament, spinal
vascular lesions, surgery for spine trauma/
fractures, image guided spine surgery
CARGILL H. ALLEYNE JR., MDProfessor and Chairman, Neurosurgery
Director, Neurosurgery Vascular Service
Director, Residency Program
Co-Director, Neurosurgical Intensive Care Unit
Co-Director, Cardiovascular Research
Laboratory
Specialty: Neurosurgery, cerebrovascular, brain
tumors, spine
Clinical Interests: Vascular diseases of the
brain and spinal cord, stroke and TIA’s, brain
aneurysms (surgery and coiling), brain vascular
malformations, carotid stenosis, endovascular
surgery, Gamma Knife radiosurgery, skull base
brain tumors, spine surgery, general neurosurgery
PHYSICIANS: NEUROSURGERY
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IAN HEGER, MD, FAAP, FACSAssistant Professor, Neurosurgery
Pediatric Neurosurgery Section Chief
Specialty: Pediatric neurosurgery,
neuro-oncology
Clinical Interests: Craniosynostosis and
craniofacial disorders, brain and spinal cord
tumors, spasticity, spina bifida, tethered cord,
vascular malformations, and chiari malformations
COLE A. GILLER, MD, PHD, MBA, FACSProfessor, Neurosurgery
Director, Functional and Stereotactic
Neurosurgery
Specialty: Neurosurgery, functional neurosurgery
Clinical Interests: Epilepsy surgery, surgery for
Parkinson’s disease, tremor and other movement
disorders, Gamma Knife radiosurgery,
brain tumors
| GRU NEUROSCIENCE ANNUAL REPORT |
| GRU NEUROSCIENCE ANNUAL REPORT |
SCOTT RAHIMI, MDAssistant Professor, Neurosurgery
Specialty: Neurosurgery, cerebrovascular, spine
Clinical Interests: Aneurysms, arteriovenous
malformations, tumors, dural
arteriovenous fistulas
JOHN R. VENDER, MDProfessor and Vice Chairman, Neurosurgery
Medical Director, Gamma Knife Center
Co-Director, Georgia Center for Skull and
Base Surgery
Specialty: Neurosurgery, skull base tumors, spine
surgery, spinal stimulator implant
Clinical Interests: Adult brain tumors, pituitary
tumors, craniocervical junction, stereotactic
surgery, head injury, spasticity, Gamma Knife
radiosurgery, normal pressure hydrocephalus,
implantable pain management and therapy
S. DION MACOMSON, MDAssistant Professor, Neurology
Assistant Director, Residency Program
Specialty: Pediatric neurosurgery, spine surgery,
general neurosurgery
Clinical Interests: Hydrocephalus, ventricular
endoscopy, brain tumors, peripheral nerve
entrapment, cervical and lumbar spine disease
JONATHAN TUTTLE, MDAssistant Professor, Neurosurgery and
Orthopaedics
Specialty: Neurosurgery, with focus on complex
spine surgery
Clinical Interests: Complex spine surgery,
cervical, thoracic, and lumbar degenerative
diseases, minimally invasive spine surgery,
kyphoplasty, spine trauma and revision
spine surgery
| GRU NEUROSCIENCE ANNUAL REPORT |
PHYSICIANS: NEUROLOGY
DEBORAH BOLAND, DOAssistant Professor
Specialty: Movement disorders
Clinical Interests: Parkinson’s disease, spasticity,
deep brain stimulator programming, botulinum
toxin injections for dystonia, hemifacial spasm,
blepharospasm, and sailorrhea
DAVID C. HESS, MDChairman and Professor of Neurology
Presidential Distinguished Chair
Joint Appointment, Institute of Molecular
Medicine and Genetics and School of Graduate
Studies
Specialty: Vascular neurology, internal medicine,
neurology
Clinical Interests: Treatment of acute ischemic
stroke and research on stroke prevention and cell
therapy for stroke
JAMES CARROLL, MDProfessor, Neurology and Pediatrics
Chief, Child Neurology Section
Specialty: Pediatric neurology, pediatrics
Clinical Interests: General child neurology,
neuromuscular disorders, metabolic diseases,
cerebral palsy
J. EDWARD HARTMANN, MDAssociate Professor, Neurology
Specialty: Neurology, clinical neurophysiology,
electrodiagnostic medicine
Clinical Interests: Myasthenia gravis, ALS,
myopathies, peripheral neuropathies, carpal
tunnel syndrome
ASKIEL BRUNO, MDProfessor, Neurology
Specialty: Neurology, vascular neurology
Clinical Interests: Cerebrovascular disease
MORRIS J. COHEN, EDDProfessor, Neurology, Pediatrics, and Psychiatry
Director, Pediatric Neuropsychology Service
Specialty: Pediatric neuropsychology
Clinical Interests: Children with learning
disabilities, attention deficit disorder, epilepsy,
brain tumors, traumatic brain injury, stroke and
other neurological disorders which affect learning
and behavior
| GRU NEUROSCIENCE ANNUAL REPORT |
DEBRA MOORE-HILL, MDAssistant Professor, Neurology
Director of Continuous Prolonged EEG
Monitoring
Specialty: Epilepsy
Clinical Interests: Epilepsy, continuous ICU EEG,
clinical neurophysiology
ANTHONY M. MURRO, MDProfessor, Neurology
Director, Neurodiagnostic Lab
Specialty: Epilepsy, clinical neurophysiology
Clinical Interests: Epilepsy, clinical
neurophysiology
GREGORY P. LEE, PHD, ABPPProfessor, Neurology
Director, Adult Neuropsychology Service
Specialty: Neuropsychology
Clinical Interests: Neuropsychological
assessment, evaluation of cognitive and
personality functions in patients with known or
suspected brain disease or trauma, intracarotid
sodium amobarbital (Wada) procedures on
epilepsy surgery candidates, cortical mapping of
sensorimotor and language areas and evaluation
of memory during neurosurgery
JOHN C. MORGAN, MD, PHD Associate Professor, Neurology
Specialty: Movement disorders
Clinical Interests: Parkinson’s disease,
movement disorders
| GRU NEUROSCIENCE ANNUAL REPORT |
YONG D. PARK, MDProfessor, Neurology and Pediatrics
Director, Epilepsy Monitoring Unit
Specialty: Epilepsy (child), pediatric neurology,
sleep medicine, clinical neurophysiology
Clinical Interests: Evaluation of pediatric epilepsy
surgery, childhood seizure disorders, sleep
disorders in children, and narcolepsy
SUBHASHINI RAMESH, MBBS Assistant Professor, Neurology
Specialty: Neuro Critical Care
Clinical Interests: Neuro critical care,
cerebrovascular disease
FENWICK T. NICHOLS III, MD, FACPProfessor, Neurology and Radiology
Director, Neurosonology Labs
Director, Vascular Neurology Fellowship
Specialty: Neurology, vascular neurology,
internal medicine
Clinical Interests: Cerebrovascular disease
(stroke), ultrasound examination of cerebral
vascular system circulation
J. NED PRUITT II, MDProfessor, Neurology
Director, MCG Neurology Residency Program
Specialty: General neurology, neuromuscular
diseases, headaches
Clinical Interests: Neuromuscular diseases,
headaches
| GRU NEUROSCIENCE ANNUAL REPORT |
ELIZABETH SEKUL, MDAssociate Professor, Neurology, Pediatrics and
Child Neurology
Specialty: Pediatric neurology,
electrodiagnostic medicine
Clinical Interests: Muscular dystrophies, cerebral
palsy, migraines and pediatric movement
disorders, spasticity, clinical neurophysiology
SUZANNE H. SMITH, MDAssociate Professor, Neurology
Director, MS Clinic
Specialty: Multiple Sclerosis, general neurology,
memory disorders
Clinical Interests: Multiple sclerosis, dementia
MICHAEL H. RIVNER, MDCharbonnier Professor, Neurology
Director, Electrodiagnostic Medicine Laboratory
Director, Clinical Neurophysiology Training
Program
Director, ALS Clinic
Specialty: Neurology, clinical neurophysiology,
pain management
Clinical Interests: Neurology and
neurophysiology, neuromuscular diseases,
electromyography, botulinum injections,
computer applications in neurology
KAPIL D. SETHI, MD, FRCPProfessor, Neurology
Director, Movement Disorders Program
Specialty: Movement disorders
Clinical Interests: Research on Parkinson’s
disease and other movement disorders
| GRU NEUROSCIENCE ANNUAL REPORT |
SUZANNE STRICKLAND, MDAssistant Professor, Neurology and Pediatrics
Specialty: Epilepsy, neurology,
pediatric neurology
Clinical Interests: Epilepsy, pediatric neurology
JEFFREY A. SWITZER, DO, MCTSAssociate Professor, Neurology
Director, Telestroke and Teleneurology
Director, Comprehensive Stroke Center
Specialty: Vascular neurology,
acute stroke treatment
Clinical Interests: Teleneurology, acute stroke
treatment, telestroke, uncommon causes of stroke
SHANNON STEWART, MDAssistant Professor, Neurology
Savannah, GA Campus
Specialty: Vascular neurology, neurology
Clinical Interests: Stroke, teleneurology,
neuro hospitalist
THOMAS R. SWIFT, MDProfessor Emeritus and former Chairman,
Neurology
Former President, American Academy of
Neurology
Specialty: Neurology
Clinical Interests: General adult neurology
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JILL TRUMBLE, MDAssistant Professor, Neurology
Savannah, GA Campus
Specialty: Movement disorders
Clinical Interests: Treatment of a multitude of
movement disorders through programming of
deep brain stimulators and chemodenervation
with botulinum toxin
| GRU NEUROSCIENCE ANNUAL REPORT |
RESEARCH FACULTY: NEUROLOGY
| GRU NEUROSCIENCE ANNUAL REPORT |
Lin Mei, MD, PhD
Professor, Department of Neurology
Institute of Molecular Medicine and
Genetics,
School of Graduate Studies
Director, Institute of Molecular Medicine
and Genetics
Georgia Research Alliance Eminent Scholar
Joe Z.Tsien, PhD
Professor, Department of Neurology,
Medical College of Georgia
Co-Director Brain and Behavior Discovery
Institute
Georgia Research Alliance Eminent Scholar
in Cognitive and Systems Neurobiology
Darrell Brann, PhD
Regents’ Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Director, Graduate Program in
Neuroscience
Associate Director, Clinical Affairs, IMMAG
David T. Blake, PhD
Associate Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics
Bo-Shiun Chen, PhD
Assistant Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Sean P. Didion, PhD
Adjunct Assistant Professor, Department of
Neurology
Quansheng Du, PhD, DSc
Associate Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Julietta Frey, PhD
Charbonnier Professor MCG
Full Professor Department of Neurology
BBDI-Memory and Cognition Program
Jimok Kim, PhD
Assistant Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Lynnette McCluskey, PhD
Associate Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
| GRU NEUROSCIENCE ANNUAL REPORT |
Albert Pan, PhD
Assistant Professor, Department of
Neurology
Institute of Molecular Medicine and
Genetics
Nilkantha Sen, PhD
Assistant Professor, Department of
Neurology
Institute of Molecular Medicine and
Genetics
Almira Vazdarjanova, PhD
Assistant Professor, Department of
Pharmacology and Toxicology, Brain and
Behavior Discovery Institute -
Memory and Cognition Program, School of
Medicine
Phillip Wang, PhD
Assistant Professor, Department of
Psychiatry and Health Behavior
Brain and Behavior Discovery Institute -
Memory and Cognition Program
Wei-Hua Wu, PhD
Assistant Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Wen-Cheng Xiong, PhD
Weiss Research Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics, School of Graduate Studies
Jianhua Xu PhD
Assistant Professor, Department of
Neurology, Institute of Molecular Medicine
and Genetics
Robert K. Yu, PhD, MedScD
Professor and GRA Eminent Scholar,
Institute of Molecular Medicine and
Genetics Director, Institute of Neuroscience
Quanguang Zhang, PhD
Assistant Professor, Department of
Neurology
Institute of Molecular Medicine and
Genetics
RESEARCH FACULTY: NEUROSURGERY
| GRU NEUROSCIENCE ANNUAL REPORT |
Krishnan Dhandapani, PhD
Associate Professor, Department of Neurosurgery
Co-Director, Cerebrovascular Research Laboratory
Kirov A. Sergei, PhD
Associate Professor, Department of Neurosurgery,
School of Graduate Studies, Brain and Behavior Discovery Institute - Memory and Cognition Program,
Institute of Molecular Medicine and Genetics
Director, Human Brain Lab
Ioulia Fomitcheva, PhD
Assistant Research Scientist, Department of Neurosurgery - Human Brain Laboratory
Sangeetha Sukumari-Ramesh
Assistant Research Scientist Department of Neurosurgery
PUBLICATIONS
| GRU NEUROSCIENCE ANNUAL REPORT |
American Journal of Managed Care. 2012 Aug;18
(5 Suppl):S83-8. Sethi KD, Mehta SH. “A clinical
primer on restless legs syndrome: what we
know, and what we don’t know.”
BMJ Case Reports. 2013 Jan 11[doi:10.1136/
bcr-2012-0006857]. Smitherman AD, Woodall
MN, Alleyne CH, Rahimi SY. “Open surgical
management of a ruptured intracranial
aneurysm in Klippel-Trenaunay-Weber
syndrome.”
Brain. 2013 136: 1446-1461, [Epub ahead of print;
(2013) Mar 6],. Sword J, Masuda T, Croom D,
Kirov SA. “Evolution of neuronal and astroglial
disruption in the peri-contusional cortex of mice
revealed by in vivo two-photon imaging.”
British Medical Journal Case Reports. 2012 Jul 3.
Cormican MT, Paschalis T, Viers A, Alleyne CH.
“Unusual case of subarachnoid haemorrhage
in patient with Fabry’s disease: case report and
literature review.”
British Medical Journal Case Reports. 2012
Jun 28. Hughes DG, Alleyne CH. “Rare giant
traumatic cervical arterio¬venous fistula in
neurofibromatosis type 1 patient.”
Circulation: Cardiovascular Quality and
Outcomes. 2013 Jan 1;6(1):18-26. Switzer JA,
Demaerschalk BM, Xie J, Liangyi F, Villa KF,
Wu EQ. “Cost-effectiveness of hub-and-spoke
telestroke networks for the management
of acute ischemic stroke from the hospitals’
perspectives.”
Clinical Nuclear Medicine. 2012 Dec;37(12):1179-
8. Pillai JJ, Williams HT, Forseen SE, Park YD.
“Presurgical Lateralization of Seizure Focus
in Temporal Lobe Epilepsy with Noninvasive
Imaging.”
Clinical Rehabilitation. 2013 [e-pub: February
14, 2013, doi: 10.1177/0269215512470674.]
Bruno A, Close B, Gomadam A, Switzer
JA, Hess DC, Gross H, Akinwuntan A, and
Nichols FT. “Simplified modified Rankin Scale
Questionnaire Correlates with Stroke Severity.”
Current Pharmaceutical Design.
2012;18(25):3670-6. Borlongan CV, Glover LE,
Sanberg PR, Hess DC. “Permeating the blood
brain barrier and abrogating the inflammation
in stroke: implications for stroke therapy.”
Decision Making in Spinal Care. 2nd Edition.
Thieme Anderson and Vaccaro, eds/ New
York, 2012, 55-58. Chutkan N, Tuttle J,
“Cervicothoracic fractures and dislocations.”
| GRU NEUROSCIENCE ANNUAL REPORT |
MedLink Neurology. Jan 29, 2013. Strelzik
J, Carroll JE. “Neonatal intraventricular
hemorrhage.”
PMID: 2333996, Stroke 44:1191-7. 2013.
Hess DC, Hoda MN, Bhatia K. “Remote limb
preconditioning and postconditioning: Will it
translate into a promising treatment for acute
stroke?”
BMJ Case Reports. Jan 2013 [doi:10.1136/bcr-
2012-0006857]. Smitherman AD, Woodall
MN, Alleyne CH, Rahimi SY. “Open surgical
management of a ruptured intracranial
aneurysm in Klippel-Trenaunay-Weber
syndrome.”
J Neurol Surg A Cent Eur Neurosurg 1–6.
2013. Samuel TA, Parikh, J, Sharma S, Giller
CA, Sterling K, Kapoor S, Pirkle C, Jillella A.
“Recurrent adult choroid plexus carcinoma
treated with high-dose chemotherapy and
syngeneic stem cell (bone marrow) transplant.”
Brain 136: 1446-1461, [Epub ahead of print;
(2013) Mar 6]. 2013. Sword J, Masuda T,
Croom D, Kirov SA. “Evolution of neuronal and
astroglial disruption in the pericontusional
cortex of mice revealed by in vivo two-photon
imaging.”
Lancet Neurology 12:244-252. 2013. Meador
KJ, Baker GA, Browning N, Cohen MJ, Bromley
RL, Clayton-Smith J, Kalayjian LA, Kanner A,
Liporace JD, Pennell PB, Privitera M, Loring
DW. “Fetal antiepileptic drug exposure and
cognitive outcomes at age 6 years (NEAD
Study): A Prospective Observational Study.”
Circ Cardiovasc Qual Outcomes 6:18-26. 2013.
Switzer JA, Demaerschalk BM, Xie J, Liangyi
F, Villa KF, Wu EQ. “Cost-effectiveness of
hub-and-spoke telestroke networks for the
management of acute ischemic stroke from the
hospitals’ perspectives.”
Stroke 44:1282-1287. 2013. Howard G, Cushman
M, Howard VJ, Kissela BM, Kleindorfer DO,
Moy CS, Switzer J, Woo D. “Risk factors for
intracerebral hemorrhage: The Reasons for
Geographic and Racial Differences in Stroke
(REGARDS) Study.”
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:167–172. Alleyne CH.
“Angiography.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:186–191. Alleyne CH.
“Arteriovenous alformations.” ed: Kountakis SE.
| GRU NEUROSCIENCE ANNUAL REPORT |
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:337–341. Hartmann JE.
“The blink reflex.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:738–743. Hartmann JE.
“Electromyography.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:1448–1454. Vender JR,
Youssef PP. “Lateral skull base epidermoids.”
ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:1840–1842. Rivner MH.
“Nerve excitability test.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:841–846. Rivner MH.
“Evoked EMG.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:2845–2847. Rivner MH.
“Transcranial magnetic stimulation of facial
nerve.” ed: Kountakis SE.
Encyclopedia of Otolaryngology, Head and
Neck, Springer. 2013:1590–1592. Rivner MH.
“Maximum stimulation test.” ed: Kountakis SE.
Lancet Neurology 3:244-252. 2013. Meador KJ,
Baker GA, Browning N, Cohen MJ, et al.
“Fetal antiepileptic drug exposure and cognitive
outcomes at age 6 years (NEAD Study): A
prospective observational study.”
Epilepsy & Behavior 29:308-315. 2013. Cohen
MJ, Meador KJ, Browning N, May R, Baker GA,
Clayton-Smith J, et al. “Fetal antiepileptic drug
exposure: Adaptive and emotional/behavioral
functioning at age 6 years.”
Curr Top Med Chem 13:2283-90. 2013. Liao TV,
Forehand CC, Hess DC, Fagan SC. “Minocycline
repurposing in critical illness: focus on stroke.”
Transl Stroke Res 2014 [doi: 10.1007/s12975-013-
0318-6]. Hoda MN, Bhatia K, Hafez SS, Johnson
MH, Siddiqui S, Ergul A, Zaidi KR, Fagan SC,
Hess DC. “Remote ischemic perconditioning is
effective after embolic stroke in ovariectomized
female mice.”
Physiol Behav 2013 Nov 25;125C:8-16 [doi:
10.1016/j.physbeh.2013.11.004, Epub ahead of
print]. Duberstein KJ, Platt SR, Holmes SP, Dove
CR, Howerth EW, Kent M, Stice SL, Hill WD, Hess
DC, West FD. “Gait analysis in a pre- and post-
ischemic stroke biomedical pig model.”
| GRU NEUROSCIENCE ANNUAL REPORT |
Operative Techniques in Otolaryngology —
Head and Neck Surgery 24:213-217, 2013.
Prosser JD, Solares CA, Vender J, Alleyne C.
“Transfacial approaches to the clivus.”
Operative Techniques in Otolaryngology – Head
and Neck Surgery 24:172-178, 2013. Vender JR.
“Retrosigmoid approach.”
Neurology 81:e137, 2013 [doi: 10.1212/
WNL.0b013e3182a9f40f]. Woodall MN, Alleyne
CH. “Microvascular decompression of the optic
nerve.”
Journal of Neurosurgery. 2013 November
[doi:10.3171/2013.10.JNS122402, Epub ahead
of print]. Woodall MN, McGettigan M, Figueroa
R, Gossage P, Alleyne CH. “Cerebral vascular
malformations in hereditary hemorrhagic
telangiectasia.”
Neurographics 3:155-158, 2013. Youssef PY,
Alleyne CH. “Aneurysm associated with an
accessory MCA.”
Pain 154: 2469-2476, 2013. Yowtak J, Wang J,
Kim HY, Lu Y, Chung K, Chung JM. “Effect of
antioxidant treatment on spinal GABA neurons
in a neuropathic pain model in the mouse.”