Neurological Institute 2008 Annual Report - Cleveland Clinic · 2013-12-20 · Neurological...

Neurological Institute 2008 Annual Report

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The Cleveland Clinic Foundation9500 Euclid Avenue / AC311 Cleveland, OH 44195

08-NEU-062

Contents

02 C H A I R M A N ’ S W E L C O M E

04 C L E V E L A N D C L I N I C N E U R O L O G I C A L I N S T I T U T E O V E R V I E W

10 O U R C E N T E R S

22 PAT I E N T C A R E

24 C O M M U N I T Y C A R E

26 2 0 0 8 O U T C O M E S

30 T E C H N O L O G Y A N D I N N O VAT I O N

38 R E S E A R C H

50 E D U C AT I O N

54 N E W S TA F F

56 N E U R O L O G I C A L I N S T I T U T E S TA F F

62 S E R V I C E S F O R P H Y S I C I A N S A N D PAT I E N T S

On the cover: Neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, joined the Neurological Institute’s Epilepsy Center in 2008. Subsequently, he performed North America’s first stereoelectroencephalography (SEEG) procedure, which opens the possibility of new treatment options for patients with intractable focal epilepsy.

The Neurological Institute is one of 26 institutes at Cleveland Clinic that group multiple

specialties together to provide collaborative, patient-centered care. The institute is a

leader in treating the most complex neurological disorders, advancing innovations such as

deep brain stimulation, epilepsy surgery, stereotactic spine radiosurgery and blood-brain

barrier disruption. Annually, our staff of more than 250 specialists serves 140,000 patients

and performs 7,500 surgeries. Cleveland Clinic is a nonprofit multispecialty academic

medical center, consistently ranked among the top hospitals in America by U.S.News &

World Report. Founded in 1921, it is dedicated to providing quality specialized care and

includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education

institute and a research institute.

Cleveland Clinic ©2009

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Cleveland Clinic’s Neurological Institute achieved significant growth in patient and

surgical volumes in 2008. This annual report chronicles the progress that underlies the

numbers: geographic expansion, new research insights, innovative treatment modalities,

extended educational opportunities for healthcare professionals and the public, accelerated

collection of clinical data, the addition of talented staff and promising affiliations with

new partners. All these advances are driven by a fundamental goal: to provide exceptional

patient care and improve outcomes.

Michael T. Modic, MD, FACR

92877_NeuroARText_Wt.indd 2 11/3/09 11:49 AM

clevelandclinic.org/neuroscience | 866.588.2264

Welcome 3

In Cleveland Clinic’s Neurological Institute, our patient-centered

approach incorporates a strategic design for geographic diversity,

predicated on the notion that the widely dispersed population we

serve is entitled to a uniformly high level of care. Our goal is to

distribute technology and expertise so that, whether an individual

needs emergency or continuing care, location is never an issue.

In fact, patient proximity is an integral component of our tem-

plate for growth throughout Cleveland Clinic. We are resolved

to function as an enterprise-wide entity, rather than as a chain of

discrete facilities. Consequently, the health system is adopting a

coordinated, continuous longitudinal care model, with variable

resources at different regional sites. This configuration benefits

our locally and nationally based patient populations alike. To the

former group, broadened reach promises a consistent level of

expertise close to home, no matter where home happens to be;

for the latter, it augurs improved access and outcomes as well as

unvarying standards of excellence.

This thinking is reflected in the Neurological Institute’s new Lou

Ruvo Center for Brain Health, with addresses in Cleveland and

Las Vegas; our new Center for Behavioral Health, which consoli-

dates psychiatric resources at designated regional sites; our Sleep

Disorders Center, which offers patients a common, high-quality

experience at seven community-based overnight sleep labora-

tories; a new, hospital-based suburban Cleveland neurological

site that addresses even the most complex disorders; and the

Department of Physical Medicine and Rehabilitation, now part of

our institute, with inpatient and outpatient locations throughout

northeast Ohio.

The principal enabler of this shift is technology. In the Neuro-

logical Institute, we are leveraging the technical infrastructure

through our imaging capabilities, which are now distributed

across the community, and the enhanced electronic medical

record. The institute’s Knowledge Program© is focused on stan-

dardizing data collection within each patient’s record to better

track outcomes and analyze information.

A complementary initiative, critical to regional growth, is the

codification of standardized care pathways across the entire hos-

pital system. I alluded to stroke care, possibly the best example in

the Neurological Institute. With the population aging and stroke

incidence rising, these patients are being diagnosed rapidly and

treated appropriately, consistent with Get With The GuidelinesSM

protocols, at every Cleveland Clinic facility.

Ultimately, the key to any successful undertaking is people.

Here, the commingling of Cleveland Clinic and independent

physicians, working together as one team, is an essential piece.

Collaboration is a tenet of the multidisciplinary Neurological

Institute and the foundation for a truly integrated system.

In this annual report, we are pleased to demonstrate how this

system is evolving and expanding to serve patients better and to

prepare for the inevitable healthcare challenges to come. I look

forward to continuing to document our progress.

Sincerely,


Chairman, Cleveland Clinic Neurological Institute

Dear Colleagues

When we measure clinical outcomes, one variable we do not chart is geography. There are many reasons people do

or do not survive acute events such as stroke, but there is no dispute that superior outcomes often correlate with

immediate access to a medical center equipped with the resources to rapidly provide treatment according to updated,

nationally recommended standards.

Cleveland Clinic Neurological Institute | 2008 Annual Report

4 Overview

U.S.News & World Report’s “America’s Best Hospitals” survey

ranked our neurology and neurosurgery programs sixth in the

nation in 2008 and again in 2009. Our pediatric neurology and

neurosurgery programs were ranked fourth in the nation in both

years. Our neurology, neurosurgery, pediatric neurology/neuro-

surgery and psychiatry programs are also ranked best in Ohio.

The institute model allows our patients to access the care they

need through specialized, multidisciplinary, disease-specific cen-

ters that integrate the expertise of neurologists, neurosurgeons,

orthopaedic surgeons, psychiatrists, psychologists, physiatrists,

neuroradiologists and others into the comprehensive care of a

single disease:

• ClevelandClinicLouRuvoCenterforBrainHealth

• BrainTumorandNeuro-OncologyCenter

• CerebrovascularCenter

• EpilepsyCenter

• MellenCenterforMultipleSclerosisTreatmentandResearch

• CenterforNeuroimaging

• CenterforNeurologicalRestoration

• CenterforPediatricNeurologyandNeurosurgery

• NeurologicalCenterforPain

• NeuromuscularCenter

• DepartmentofPhysicalMedicineandRehabilitation

• DepartmentofPsychiatryandPsychology

• CenterforRegionalNeurology

• SleepDisordersCenter

• CenterforSpineHealth

In2008,theNeurologicalInstituteserved140,000patients

and performed 7,500 surgeries. We provide care across the

spectrum of neurological disorders, including primary and

metastatic tumors of the brain, spine and nerves; pediatric and

adult epilepsy; headache, facial pain syndromes and associated

disorders;movementdisorderssuchasParkinson’sdisease,

essential tremor and dystonia; neurocognitive disorders such as

dementia and Alzheimer’s disease; cerebral palsy and spasticity;

hydrocephalus; metabolic and mitochondrial disease; fetal and

neonatal neurological problems; multiple sclerosis; stroke; cere-

bral aneurysms; brain and spinal vascular malformations; carotid

stenosis; intracranial atherosclerosis; nerve and muscle diseases,

including amyotrophic lateral sclerosis, peripheral neuropathy,

myasthenia gravis and myopathies; sleep disorders; and mental/

behavioral health disorders and chemical dependencies.

ClevelandClinic NeurologicalInstituteOverview

ThemultidisciplinaryClevelandClinicNeurologicalInstituteincludesmorethan250medical,surgicalandresearch

specialists dedicated to the treatment of adult and pediatric patients with neurological and psychiatric disorders. The

institute offers a disease-specific, patient-focused approach to care. Our unique, fully integrated model strengthens

our current standard of care, allows us to measure quality and outcomes on a continual basis, and enhances our ability

to conduct research.

Right: A dedicated 16-bed Neurointensive Care Unit is staffed with neurologists, neurosurgeons, specially trained nurses, respiratory therapists, nutritionists and pharmacists, all under the direction of neurointensivists. The full-service unit, which treats more than 1,300 patients a year, is equipped to manage any neurological condition regardless of severity.


Overview 7

Expert, Specialized Diagnosis

Neurological Institute physicians draw on advanced diagnostic

capabilities and experience.

Our imaging services include structural and functional magnetic

resonance imaging (MRI), computed tomography (CT),

positron emission tomography (PET), myelography, diagnostic

cerebral/spinal angiography, interventional neuroradiology, and

carotid and transcranial Doppler ultrasound. Our neuroimaging

staff subspecializes in specific disease entities such as epilepsy

and cerebrovascular disease, ensuring accurate, in-depth

interpretations.

Additional diagnostic tools are found in our epilepsy monitoring

units, sleep laboratories, neuropsychological testing facilities,

electromyography laboratory, autonomic laboratory and cutane-

ous nerve laboratory.

The Latest Treatment Modalities

Patients receive leading-edge treatment options at the Neurologi-

cal Institute, where we continue to advance such innovations as

deep brain stimulation (brain pacemakers), epilepsy surgery,

stereotactic spine radiosurgery, endovascular treatment of

cerebral aneurysms and vascular malformations, and neuroen-

doscopy. Distinctive services such as our three-week outpatient

program for sufferers of chronic headaches and our Headache

Infusion Suite provide intensive therapy when needed. The Brain

Tumor and Neuro-Oncology Center’s Translational Therapeutics

Program is accelerating the process of bringing novel therapeu-

tic agents from the laboratory to the patient. Joint Commission

certification as a Primary Stroke Center and accreditation by the

American Academy of Sleep Medicine are just two examples of

our commitment to providing the most advanced and highest

quality of care to our patients.

Relevant Research

We strive to conduct research directly related to conditions expe-

rienced by our patients, with programs in translational research,

clinical trials of drug and device interventions, neuroimaging

research, epidemiology and health outcomes, behavioral and

psychiatric research, and research into better diagnostic meth-

ods. Typically, more than 100 clinical research trials are under

way at any time in the Neurological Institute. In 2008, we were

awarded more than $17.9 million in neurological-based grants

and research contracts.

Convenient Care in the Community

We are committed to making access to world-class care conve-

nient for all our patients, whether they come to us from down the

street or half a world away. Our Neurological Institute regional

centers represent a systemwide expansion of our services to

Cleveland Clinic regional hospitals and family health centers

throughout the community.

In 2008, the Neurological Institute expanded to Lakewood

Hospital, providing comprehensive services to Cleveland’s West

Side and western suburbs. The Cleveland Clinic Neurological

Institute at Lakewood Hospital offers patients access to multiple

specialists in a convenient location where they can receive evalua-

tion, treatment, rehabilitation, preventive care and other services

they require. In addition, Cleveland Clinic neurologists oversee

inpatient care at a number of other Cleveland Clinic hospitals.

The Cerebrovascular Center’s neurovascular intervention and operat-ing suite is designed for traditional microsurgical procedures and for advanced, highly technical endovascular procedures.

Left: The first stereoelectroencephalographic (SEEG) procedure in North America is performed at Cleveland Clinic. SEEG targets specific brain areas to localize the epileptogenic zone more precisely and less invasively.


8 Overview

Our Sleep Disorders Center has also extended its regional pres-

ence with seven community-based overnight sleep laboratories,

including five hotels where sleep studies are performed with

patients’ convenience and comfort in mind.

With the recent formation of our Center for Behavioral Health,

we are building a regional network of mental health and psychi-

atric services to improve patient access to care and ensure quality

and efficiency.

structure lends itself to greater information sharing and process

improvement opportunities. Through continuing education pro-

grams, learning opportunities range from basic nursing instruc-

tion to subspecialization in neurological nursing, enabling nurses,

like their physician colleagues, to provide specialized care.

Pioneering the Collection of Data and Outcomes

The Knowledge Program©, a joint initiative of the Neurological

Institute, the Imaging Institute and the Information Technology

Division, is designed to harness routinely collected electronic

clinical and administrative data to allow us to optimize patient

care and outcomes. Data from multiple electronic sources, in-

cluding imaging results and clinical information collected during

patient encounters, such as disease-specific measures of patients’

health status, are consolidated in a clinical data warehouse that

can be accessed and queried by healthcare personnel. An integral

part of this initiative is the standardization of clinical information

documented within the electronic medical record. Information

gained from the Knowledge Program informs and guides clinical

care, quality improvement and research.

Patients First

We recognize that a patient’s healthcare experience is defined by

both superior clinical outcomes and compassionate, personalized

care: Did we respond when a patient needed us? Were that indi-

vidual and his or her family treated with the dignity and respect

that every person deserves? We have committed to measure this

intensely human variable, patient satisfaction, and we have ap-

pointed a Patient Experience Officer to oversee this initiative.

At Cleveland Clinic’s Neurological Institute, we are dedicated to

maximizing both patient care outcomes and the patient experi-

ence. In addition, advancing medical education and research in

neurology, neurosurgery and psychiatry are institutional priorities.

Right: A nurse in one of the Neurological Institute’s inpatient units assesses a patient’s functionality. Since 2003, Cleveland Clinic has held Magnet hospital status, the highest national designation of nursing excellence. Bestowed by the American Nurses Credentialing Center, Magnet status is the gold standard for patient care.

Integrated Nursing Services

The Neurological Institute integrates inpatient and ambulatory

nursing, enhancing the continuum of patient care. This unique

For Neurological Institute nurses, opportunities abound on the job as well as through continuing education programs that enable subspecial-ization for those who are interested.

92877_NeuroARText_Wt.indd 9 11/3/09 2:41 PM


Our Centers 11

Our Centers

With the formation of two new specialized, multidisciplinary centers for brain health and behavioral health, the

Neurological Institute continued to grow in 2008, extending its model of integrated expertise for delivery of disease-

specific, patient-focused care.

Cleveland Clinic Lou Ruvo Center for Brain Health

A collaboration between the Neurological Institute and the Las

Vegas-based Lou Ruvo Brain Institute has resulted in creation

of this highly specialized clinical center for advancement of

research, early detection and treatment of cognitive disorders

such as Alzheimer’s disease.

The Cleveland Clinic Lou Ruvo Center for Brain Health brings

together an interdisciplinary team of neuroscientists, physicians,

therapists, surgeons, imaging specialists and other medical

experts dedicated to preventing the disabling symptoms of

chronic brain disease and prolonging healthy, vital aging in

people at risk for dementia or cognitive disorders.

“New discoveries and emerging science tell us that cognitive

disorders can be identified earlier than previously believed and

potentially altered,” says Michael T. Modic, MD, FACR, Chair-

man of the Neurological Institute. “Our hope is to bring together

world-class clinicians and researchers to advance our understand-

ing of cognitive disorders and provide the best care possible for

people who suffer from them, as well as their caregivers.”

The center will offer services in both Cleveland and Las Vegas,

where a $100 million facility designed by renowned architect

Frank Gehry recently welcomed its first patients. It houses clini-

cal space, a diagnostic center, neuroimaging rooms, physician

offices and laboratories devoted to clinical research.

Randolph B. Schiffer, MD, a nationally known neurologist/

psychiatrist, serves as Director of the Cleveland Clinic Lou Ruvo

Center for Brain Health. Dr. Schiffer spent 10 years as Chairman

of the combined Department of Neuropsychiatry and Behavioral

Science at Texas Tech University Health Sciences Center.

“The Neurological Institute was thinking about establishing a

creative new medical program for cognition at precisely the same

time the Lou Ruvo Brain Institute was being founded in Las

Vegas to the same purpose,” Dr. Schiffer says. “The Neurological

Institute brings with it almost 100 years of tradition and medical

science in Cleveland. The Lou Ruvo Brain Institute brings with it

a window to the great resources and populations of the South-

west. Together, we will create the pre-eminent program in the

world for care of the cognitive impairment disorders. “

The center provides the most technologically advanced diagnos-

tic services, including 3 Tesla MR and, in the future, PET/CT,

performed by one of the world’s leading neuroimaging academic

medical centers. A multimodal treatment program for people

with mild symptoms of impairment incorporates physical

exercise, cognitive rehabilitation and cognitive-enhancing

medications.

The late Lou Ruvo, from whom the center takes its name, suffered

from Alzheimer’s disease. To his son, Larry Ruvo, Chairman

of the Lou Ruvo Brain Institute, the center is the realization of

a long-held dream: “This is a perfect integration of Cleveland

Clinic’s mission and excellence in patient care, research and

education and what we want to create here in Las Vegas … With

Cleveland Clinic as our operational partner, we will be able to hit

the ground running.”

Left: Early peri-ventricular white matter signal changes in this 55-year-old woman with hypertension and glucose intolerance may be forward-looking warnings that she is at risk for one of the age-related cognitive loss syndromes during the decade ahead.


12 Research


Our Centers 13

Department of Psychiatry and Psychology

The Department of Psychiatry and Psychology is restructuring

under a new Center for Behavioral Health. The center includes an

abundance of behavioral health resources widely dispersed across

the Cleveland Clinic health system, which includes the main

campus, 10 community hospitals and 17 family health centers

throughout northeast Ohio. Consolidation of key services at

designated regional locations will improve patient access to care

as well as facilitate more effective patient management, ensure

quality of care and drive operational improvements. In addition,

this reorganization will encourage refinement of existing pro-

grams and development of innovative new behavioral healthcare

models.

Under the Center for Behavioral Health concept, selected

Cleveland Clinic facilities will house specialized resources such

as adult psychiatry, child and adolescent psychiatry, chemical

dependency services and geropsychiatric programs. Geographi-

cally dispersed but closely integrated, this regional network will

promote collaboration among behavioral health specialists and

reinforce the team’s ability to deliver comprehensive therapeutic

services that return patients to full functionality.

Patients will be triaged to the particular site where an appropri-

ate concentration of skills and services can best meet their needs.

This centralization of knowledge and expertise will, in turn,

result in better clinical outcomes, more enlightened research and

outcomes data based on a broad regional population, which will

be especially relevant to referring physicians considering where to

send their patients for specialized care.

Brain Tumor and Neuro-Oncology Center

The Brain Tumor and Neuro-Oncology Center (BTNC) is a

national leader in the diagnosis, treatment and research of brain

tumors. A multidisciplinary team of physicians and scientists

focuses almost exclusively on brain tumors, facilitating oppor-

tunities to participate in international research protocols, share

information on new developments and combine therapeutic

approaches. As a result, the center brings the most promising new

treatments to the clinical realm in an environment that empha-

sizes individualized patient care.

The center is a pacesetter in the development, application and

refinement of sophisticated therapies for life-threatening tumors.

Each year, the team records approximately 8,000 outpatient

visits and performs some 950 surgical procedures. The BTNC’s

Cleveland Clinic Gamma Knife® Center, established in 1997,

offers patients a nonsurgical option for treatment of brain and

spinal metastases and other brain disorders.

The Cleveland Clinic Gamma Knife Center is one of only a few

such facilities worldwide certified by Elekta, sole manufacturer

of the Gamma Knife, to train physicians in this precise form of

stereotactic radiosurgery. In 2008, four hands-on courses drew

more than 30 participants, bringing the total number trained to

more than 400.

Left: Intraoperative image guidance allows neurosurgeons to remove brain tumors via minimal-access craniotomies.

Cleveland Clinic psychiatrists, psychologists, clinical nurse specialists, social workers, counselors and therapists provide a full spectrum of mental health and chemical dependence services.

The institute model allows patients to better access care through specialized, multidisciplinary, disease-

specific centers that integrate the expertise of neurologists, neurosurgeons, orthopaedic surgeons, psychiatrists,

psychologists, physiatrists, neuroradiologists and others into the comprehensive care of a single disease.


14 Our Centers

Cerebrovascular Center

The Cerebrovascular Center integrates neurologists, neurosur-

geons, neuroradiologists and neurointensivists who offer expert

diagnosis and medical, endovascular and surgical management

of patients with all cerebrovascular conditions.

With a unique mix of physician subspecialties, the center delivers

endovascular therapy and care of the highest quality. Stroke care

emphasizes aggressive acute intervention. The center is a Joint

Commission-certified Primary Stroke Center and has one of the

highest stroke-related volumes in North America, with more than

3,200 patient visits annually.

Patients receive comprehensive care in the 16-bed Neuroin-

tensive Care Unit. Additionally, the center is home to a Neuro-

endovascular Research Laboratory, which focuses on cerebral

aneurysm treatment, imaging research, blood-brain barrier

function and cerebral hemorrhage management.

Epilepsy Center

Superior diagnostic capabilities, extensive medical and surgical

clinical treatment programs, and an active research focus have

made Cleveland Clinic Epilepsy Center a site of national and

international prominence for the management and investigation

of epilepsy.

The Epilepsy Center has one of the world’s foremost epilepsy

programs, with more than 4,000 adult and 2,000 pediatric

patient visits annually. In 2008, epilepsy neurosurgeons

performed more than 300 surgical procedures, including lobec-

tomies, hemispherectomies, and implantation of vagal nerve and

responsive neurostimulators. Patients have gained an improved

quality of life due to the expertise of the clinical staff and the

availability of leading-edge technologies such as stereoelectro-

encephalography (SEEG): chronic intracranial EEG monitoring

with stereotactically implanted intracerebral electrodes. Cleve-

land Clinic introduced the first SEEG program in North America,

thus offering patients with intractable focal epilepsy a more pre-

cise, less invasive approach to targeting the epileptogenic zone.

Mellen Center for Multiple Sclerosis Treatment and Research

The Mellen Center has the largest, most comprehensive program

for MS care and research worldwide, managing more than

20,000 patient visits annually.

The center offers the most advanced specialized treatments,

supported by an extensive program of research and education.

Patients are evaluated by a multidisciplinary team that makes

individualized treatment recommendations.

Right: The Epilepsy Center’s adult and pediatric monitoring units use digital video EEG technology to locate seizure origin, a prelude to epilepsy surgery in appropriate candidates. Once considered a last resort, surgery in the hands of experts has become a safe, effective treatment for care-fully selected patients who are refractory to medical therapy.

The Mellen Center utilizes standardized tests, such as the 9-Hole Peg Test, to track disease progression and symptom management in multiple sclerosis patients.

The Cerebrovascular Center’s state-of-the-art angiography room allows for endovascular and open craniotomy treatment of patients with cere-brovascular disease.


Our Centers 17

Basic and clinical research at Cleveland Clinic continues to shed

light on MS. Mellen Center physicians fill leadership roles in

multinational trials of promising new therapies, and they offer

their patients opportunities to enroll in clinical research proto-

cols. These physicians and their patients are true partners in the

pursuit of new insights and treatments that can improve care.

Center for Neuroimaging

The Center for Neuroimaging houses specialists in structural

and functional imaging of the central nervous system for a wide

variety of neurological disorders. Subspecialization in disease

entities (e.g., epilepsy, cerebrovascular disease, oncology) ensures

accurate, in-depth, relevant interpretations.

Across Cleveland Clinic, the Center for Neuroimaging super-

vises and interprets more than 60,000 CT scans and more than

50,000 MR scans each year. In cooperation with the Cerebrovas-

cular Center, Neuroimaging provides cerebrovascular ultrasound,

angiography and interventional neuroradiology services. The

latter category includes more than 3,000 cerebral angiograms

per year as well as management of acute stroke and internal/

external carotid artery embolizations, treatment of vasospasm and

atherosclerotic occlusive disease, and carotid artery stenting.

Neurological Center for Pain

A leader in treatment of patients with pain disorders, this

center integrates two pioneering Cleveland Clinic programs.

The Headache Program brings an interdisciplinary approach to

diagnosis and treatment of migraine, tension headache, daily

headache and cluster headache, including intensive outpatient

therapy known as IMATCH (Interdisciplinary Method for the

Assessment and Treatment of Chronic Headache). The Section

of Pain Medicine tailors comprehensive, innovative behavioral

health and medical services to the needs of people in chronic

pain. The section operates the Chronic Pain Rehabilitation

Program, which combines physical rehabilitation, stress and pain

control regimens, and medication management for patients who

are functionally and psychosocially disabled by intractable pain.

Center for Neurological Restoration

This center is among the first in the world to bring together an

interdisciplinary team of renowned neurologists, neurosurgeons,

psychiatrists, neuropsychiatrists, researchers and other specialists

who offer the latest medical and surgical treatments for patients

with neurological and psychiatric disorders. Center physicians

have earned wide recognition for expertise in medical manage-

ment and innovation in the surgical treatment of movement

disorders such as Parkinson’s disease and dystonia, as well as

behavioral disorders such as obsessive-compulsive disorder and

depression. The surgical team is world renowned for performing

hundreds of deep brain stimulation surgeries.

Left: Neurosurgeon Andre Machado, MD, PhD, performs deep brain stimulation (DBS) on a patient with Parkinson’s disease. The Center for Neuro-logical Restoration, which Dr. Machado directs, is an acknowledged world leader and innovator in DBS surgery, having implanted hundreds of brain pacemakers in patients with intractable neurological and psychiatric disorders.

Combined DTI and fMRI mapping of the motor system. Expressive and receptive language regions are in orange. The multicolored lines connecting them are the fiber tracts that make up the language network.

Patients in the Chronic Pain Rehabilitation Program are taught to reduce negative emotions that result from and worsen their pain.



18 Our Centers

Neuromuscular Center

The Neuromuscular Center treats patients with and conducts

research on nerve and muscle disease, including amyotrophic

lateral sclerosis and related disorders, peripheral neuropathy,

myasthenia gravis and myopathies. The center’s electromyog-

raphy laboratory is among the largest in Ohio, with locations at

Cleveland Clinic’s main campus and six regional facilities, and

a worldwide reputation for excellence and reliability. Additional

resources include a highly specialized autonomic laboratory

offering cardiovascular autonomic and tilt table tests, the quanti-

tative sudomotor axon reflex test, quantitative sensory test,

sympathetic skin response test, infrared dynamic pupillometry

test and thermoregulatory sweat test. The center’s cutaneous

nerve laboratory provides muscle, nerve and skin biopsies;

histopathological preparation of skin specimens; and pathologi-

cal interpretation of skin biopsies for the diagnosis of small-fiber

peripheral neuropathy.

Center for Pediatric Neurology and Neurosurgery

Cleveland Clinic pediatric neuroscience specialists see more

than 10,000 children each year for an array of neurological

disorders. The team offers state-of-the-art subspecialty care for

children with brain malformations, neurofibromatosis, cerebral

palsy and spasticity, headache, autonomic disorders, cyclic vomit-

ing, hydrocephalus, myelomeningocele, metabolic and mitochon-

drial disorders, multiple sclerosis and other white matter disease,

Tourette syndrome and other movement disorders, neuromuscu-

lar disease and muscular dystrophy, fetal and neonatal neuro-

logical problems, brain and spinal cord tumors, cerebrovascular

disease, neurological complications of cardiac disease and

epilepsy. Comprehensive advanced neurosurgical services, in-

cluding neuroendoscopy, are available.

Pediatric neurological and neurosurgical specialists collaborate

with the Cleveland Clinic Pediatric Institute & Children’s Hos-

pital, providing comprehensive advanced care for all pediatric

neurological disorders.

Department of Physical Medicine and Rehabilitation

Physical Medicine and Rehabilitation helps patients with

impairments and disabilities in the areas of mobility, self-care,

communication, swallowing and cognition. These conditions

result from accident, illness or natural causes. A team approach to

Right: U.S.News & World Report ranks Cleveland Clinic’s pediatric neurology and neurosurgery services among the top four such programs in the nation. Specialists collaborate with the Cleveland Clinic Pediatric Institute & Children’s Hospital, providing comprehensive advanced care for all pediatric neurologi-cal disorders.

Vernon Lin, MD, PhD (right), Chairman of Cleveland Clinic’s Department of Physical Medicine and Rehabilitation, and colleagues demonstrate how a noninvasive magnetic stimulator they developed can be applied over clothing to activate respiratory muscles in spinal cord injury patients.

The Neuromuscular Center uses electromyography (EMG) to detect abnormal electrical activity in muscles and nerves. With one of the largest EMG laboratories in Ohio, the center performs more than 3,000 such exams yearly.


Our Centers 21

rehabilitation helps restore as much independence as possible so

that patients can overcome physical, psychosocial, cognitive and

vocational limitations.

A full range of services spans inpatient rehabilitation, skilled

nursing care and outpatient care, enabling the staff to address

individual needs during each phase of the rehabilitation process.

This approach also allows effective coordination of care so that

patients return to the community with the best chance to main-

tain the gains they have achieved.

Center for Regional Neurology

As part of Cleveland Clinic’s nationally recognized Neurological

Institute, the regional neurology program combines physicians

and other healthcare providers in neurology, neurosurgery,

neuroradiology and behavioral sciences, who treat adult and

pediatric patients with neurological disorders. Regional facilities

extend advanced treatments, technologies and the expertise of

Cleveland Clinic into the surrounding communities and greater

metropolitan areas, making it even easier for patients to access

specialists who treat the most complex neurological conditions,

including aneurysm and stroke, brain tumor, epilepsy, headache,

multiple sclerosis, and sleep and spine disorders.

Sleep Disorders Center

Cleveland Clinic’s Sleep Disorders Center is a multispecialty,

comprehensive program dedicated to the diagnosis and treat-

ment of sleep disorders in children and adults. Accredited by

the American Academy of Sleep Medicine, the center comprises

specialists in neurology, pediatrics, pulmonary medicine, internal

medicine, psychiatry, psychology, otolaryngology and dentistry.

More than 4,000 sleep studies are performed annually in seven

laboratories throughout northeast Ohio.

Neurological Institute physicians draw on advanced diagnostic capabilities and experience. Patients receive

leading-edge treatments and have opportunities to participate in clinical research trials.

The Sleep Disorders Center is committed to advancing under-

standing of sleep disorders, their causes and treatment, and their

relationship with other disorders. To this end, the center offers

patients enrollment in investigational studies conducted in con-

junction with national and international consortia or designed by

Cleveland Clinic physicians.

Center for Spine Health

The Center for Spine Health brings together the expertise of

specialists in neurosurgery, orthopaedic surgery and medical

spine care to provide medical and surgical management of the

full scope of back and spine problems, including scoliosis and

kyphosis, spondylolisthesis, spinal stenosis, primary and

metastatic spinal tumors, mature spine, cervical fractures and

degenerative diseases of the spine. Physicians work closely with

physical therapists and occupational therapists to develop a com-

plete individualized treatment plan for each patient, integrating

the functions of research, clinical practice and education with the

goals of improving patient care, promoting collaboration among

staff, and developing unique technologies and subspecializations.

The Sleep Disorders Center performs more than 4,000 adult and pedi-atric sleep studies annually.

Left: A cervical spine X-ray shows posterior spinal instrumentation. Center for Spine Health surgeons have one of the country’s highest success rates for even the most complex procedures, including lumbar surgeries, cervical and thoracic procedures, spinal deformity and spine tumor.


Patient Care 23

Daily Huddle

Drawing on the Neurological Institute’s multidisciplinary team

structure, the daily huddle is a methodology to facilitate direct

communication among professionals involved in the care of the

neurological patient. Gathering at the same time each morning,

this group of caregivers discusses the plan of care for the day for

each patient. This coordinated effort allows direct input from all

team members on medical, social and disposition issues related

to the patient’s medical condition.

Nursing Leadership Group

This weekly session joins Neurological Institute nurse managers

from the ambulatory and inpatient settings with adult and pediat-

ric operating room nurses, who treat many neurological patients.

Assistant nurse managers, clinical nurse specialists and clinical

instructors also attend. Group diversity is a strength as members

present new initiatives and discuss issues such as stroke treat-

ment and postoperative pain that cross all areas.

Patient Advisory Council

Established in May 2008, this collaborative group of patients,

family members, staff and employees works on projects to

improve patient care. Their input led to the remodeling of the

Neurointensive Care Unit waiting area and the development of a

new patient resource guide.

Health Experience/Outcomes Team

Neurological Institute researchers are working to quantify the

impact of the patient experience on clinical outcomes. The focus

is Cleveland Clinic’s Healing Solutions Program, which offers

meditation, Reiki, massage, spiritual care and individualized

patient services.

Patient Service Navigator

A Patient Service Navigator visits hospitalized patients daily to

address any needs or concerns. The navigator serves as a liaison

for the patient and the care team, providing on-the-spot problem

solving and regular feedback. Issues are tracked and reviewed by

the inpatient arm of the institute’s Patient Experience Team.

Patient Support Groups

Patients coping with serious or chronic illness are encouraged to

share their experiences and socialize with others in similar situa-

tions through support groups such as the following:

• TheBrainTumorSupportGroupmeetsmonthlyatCleveland

Clinic Taussig Cancer Center. Open to patients, their family

members and friends, this helpful forum invites participants

to exchange information on practical concerns such as how

a brain tumor affects job, family and ability to carry out daily

activities. Nurse practitioners assist, providing information and

answering questions about treatments, medications, available

resources and other pertinent issues.

• ThePediatricEpilepsySupportGroupaddressestheneeds

of families caring for a child with refractory epilepsy, who

often find their emotional resources depleted. Weekly group

meetings become a source of strength and comfort for parents

confronting difficult decisions about epilepsy surgery and

guiding their child through difficult procedures such as inva-

sive monitoring of seizures for accurate surgical planning.

Patient Care

At Cleveland Clinic, responsibility to patients extends beyond providing expert diagnosis and advanced treatment modal-

ities. In the belief that patient satisfaction is a critical component of a successful clinical experience, the Neurological

Institute is implementing new strategies to enhance communication and collaboration among staff and with patients.

Left: The daily huddle is a forum for staff physicians, residents, fellows, rehabilitation specialists and other professionals to exchange informa-tion and develop a personalized care plan for each Neurological Institute inpatient.


24 Community Care

Cleveland Clinic Neurological Institute

at Lakewood Hospital

This facility opened in this suburban Cleveland Clinic hospital in

October 2008, offering a full spectrum of services for adult and

pediatric patients with neurological disorders. These services,

which ensure continued growth of the hospital’s well-respected

neuroscience program, include:

• generalneurology

• neurosurgery

• cerebrovasculartestingandtreatment

• TCD/carotidultrasoundtesting

• headacheinfusionclinic

• diagnosticevaluationandtreatmentforepilepsy

• evaluation,follow-upandinfusiontreatmentsformultiple

sclerosis

• electromyogramtesting

• neurorehabilitationandspasticitymanagement

The staff of the Lakewood institute comprises neurologists, neu-

rosurgeons, neuroradiologists, neuroendovascular and cerebro-

vascular surgeons, therapists and specialized nurses. This team

applies the most advanced treatments and technologies to the

most complex conditions in a modern, comfortable setting close

to patients’ homes.

Center for Mood Disorders Treatment and Research

at Lutheran Hospital

In January 2008, an adult inpatient unit for diagnosis and treat-

ment of mood disorders opened at Lutheran Hospital. The center

ranks as the first in northeast Ohio offering both inpatient and

outpatient programs dedicated to the treatment of mood disor-

ders such as major depression and bipolar disorder.

Dependingonindividualneeds,theseprogramsexploreissues

such as:

• assertiveness

• griefandloss

• healthylifestyle

• developmentofnewcopingmethods

• problemsolving

• self-esteem

• comorbidanxietyandsubstanceabuse

• stressandangermanagement

The center’s team includes physicians, nurses, social workers,

therapists and programming staff committed to improving and

maintaining patients’ mental health and well being. With a sup-

portive, caring and structured approach, these professionals help

patients reduce mood disorder symptoms, regain lost confidence

and hope, and improve their functioning and quality of life.

Community Care

The Neurological Institute expanded geographically in 2008, reaching out to a broadly distributed patient popula-

tion through the Center for Regional Neurology. This program combines physicians and other healthcare providers

in neurology, neurosurgery, neuroradiology and behavioral sciences who care for adult and pediatric patients with

neurological disorders. Regional facilities extend advanced treatments, technologies and the expertise of Cleveland

Clinic into the surrounding communities and greater metropolitan areas, making it even easier for patients to access

specialists who treat the most complex neurological disorders.


Community Care 25

Regional Sleep Centers

Cleveland Clinic’s Sleep Disorders Center joined with Cleveland

Clinic health system’s Marymount Hospital sleep program in

2008, resulting in expedited access for referring physicians and

patients. The combined program has seven overnight sleep labs

conveniently located throughout the region.

Five of these labs are based in hotels, where adults and children

12 and older can undergo routine overnight sleep studies, in-

cluding polysomnograms and positive airway pressure titrations.

Geriatric Behavioral Health Services

At selected community hospitals throughout the region, special-

ized multidisciplinary teams work with older adults, helping

them adapt to age-related changes and improve their quality of

life. Under the direction of board-certified psychiatrists, clinical

professionals provide holistic assessment, diagnosis and treat-

ment for conditions such as:

• significantchangesinmentalhealth

• confusion

• memorylapsesand/orforgetfulness

• depression

• anxietyand/ornervousbehaviors

• griefreaction

• difficultyadaptingtochange

• medicationconcerns

• suicidethreatsorattempts

• alcoholand/orsubstanceabuseandmisuse

Cleveland ClinicChagrin FallsCleveland Clinic

Independence

Cleveland ClinicStrongsville

Cleveland ClinicBrunswick

Cleveland ClinicWestlake

Cleveland ClinicElyria

Cleveland ClinicLorain

Cleveland Clinic

Children’sHospital,Shaker

ChestnutCommons,Elyria

Cleveland ClinicAvon Lake

Cleveland ClinicBroadview Heights

Lake Erie

Cleveland ClinicWooster

Cleveland ClinicBeachwood

Cleveland Clinic Solon

Cleveland ClinicWilloughby Hills

LORAIN COUNTY

CUYAHOGA COUNTY

SUMMIT COUNTY

MEDINACOUNTY

LAKE COUNTY

PORTAGECOUNTY

GEAUGACOUNTY

(WAYNE COUNTY)

Cleveland ClinicLakewood

Cleveland Clinic Avon

EuclidHospital

Hillcrest Hospital

Huron Hospital

Lutheran Hospital

Lakewood Hospital

Fairview Hospital

South Pointe Hospital

Medina Hospital

Marymount Hospital

Neurological Institute physicians provide services at Cleveland Clinic’s main campus and at Cleveland Clinic community hospitals and family health centers throughout northeast Ohio, increasing patient access to specialized care.

s Hospitals nFamily Health Centers


Outcomes 27

Brain Tumor

• Spineradiosurgeryisapalliativetreatmentforpain,typically

usedinend-stagecancerpatientswhosediseasehasmetasta-

sizedtothespine.Among103patientswithpainfulspinal

metastaseswhoweretreatedwithsingle-fractionNovalis®spine

radiosurgeryin2007and2008,painscoresshowedastatisti-

callysignificantimprovementjustoneweekaftertreatment,

andtheseresultsremainedstableovertime.

• Clinicalresearchtrialsareimportantdiscoveryandtherapeu-

ticoptionsforbraintumorpatients.Almost300individuals

wereenrolledinthesetrialsthroughClevelandClinic’sBrain

TumorandNeuro-OncologyCenterin2008.

• Patientswhounderwentsupratentorialcraniotomyhad

30-and180-daysurvivalratesof99.1percentand

93.5percent,respectively.

• Amongpatientswhounderwentbrainbiopsies,30-and180-

daysurvivalratesreached94.1percentand80.4percent,

respectively.

• Amongpituitarysurgerypatients,30-and180-daysurvival

ratesexceeded95percent.

• Inpatientmortalityfollowingpituitarysurgerywaszero

percent.

Cerebrovascular

• Intravenoustissueplasminogenactivatorisindicatedfortreat-

mentofacuteischemicstroke,ifadministeredwithin180

minutesofstrokeonsetsymptoms.ClevelandClinic’s2008

performancesurpassedboththenationalaverageandthegoal

forthe“GetWithTheGuidelines”SM StrokeSilverPerformance

Award.GWTGisahospital-basedqualityimprovementpro-

gramfortheAmericanStrokeAssociationandtheAmerican

2008Outcomes

TheNeurologicalInstitutestronglysupportscontinuousmeasurementandtransparentreportingofclinical

outcomes,inthebeliefthatmakingaccurateinformationavailabletopatientsandtheirphysicianswillresultinbetter

healthcaredecisions.ThroughtheKnowledgeProgram©,wearereinforcingourcapabilitytocollectandanalyze

clinicaldata,withtheultimategoalofimprovingthequalityofourcareandouroutcomes.

Left: Before meeting with her clinician, a patient enters self-assessment data directly into the Knowledge Program© electronic tablet. All Neuro-logical Institute patients complete standardized health questionnaires prior to their appointments.


28 Outcomes

Heart Association. Cleveland Clinic was a 2008 recipient of

the Stroke Silver Performance Award.

• WhiletheCerebrovascularCentersawan11percentincrease

inthenumberofproceduresforrupturedcerebralaneurysm

between2007and2008,inpatientmortalityremainedbelow

theexpectedrate(basedonnationalnormativedataandAPR-

DRGsforthelastthreeyears).

• Noinpatientdeathsoccurredin2008fromnonruptured

cerebralaneurysm.Mortalityhasremainedbelowexpected

levelsforthreeyears.

beforesurgeryto2.2timespermonthaftersurgery,with

74percentreportingnoseizurespostoperatively.

• Long-termseizurefreedomwasassessedin550Epilepsy

Centerpatientswhounderwenttemporallobesurgeryfrom

1997through2008.Oneyearaftersurgery,81percentwere

seizurefree;70percentmaintainedseizurefreedomatfive

years.Amongpatientswithpersistentseizuresfollowingthe

surgery,seizurefrequencydeclinedanaverage73percent

postoperatively.

The Epilepsy Center’s adult and pediatric monitoring units feature the latest technology, including all-digital video EEG equipment. Operating around the clock, these units are staffed by dedicated teams.

Cleveland Clinic 2008

GWTG Silver Performance Award Goal

National Average*

0 20 40 60 80 100

Patients Receiving Intravenous Tissue Plasminogen Activator in the Emergency Department within 180 Minutes of Onset of Stroke Symptoms

Percent

Epilepsy

• Inarandomsampleofpatientswhounderwentepilepsy

surgerybetweenJanuary2007andNovember2008,average

seizurefrequencywasreducedfrom12.3timespermonth

Movement Disorders

• Among27Parkinson’sdiseasepatientsimplantedwithdeep

brainstimulatorsin2008,theaverageimprovementinmotor

functionwas57percentaftersurgery(UnifiedParkinson’s

DiseaseRatingScale).

Multiple Sclerosis

• TheMellenCenterforMultipleSclerosisTreatmentand

Researchhastreatedmorethan250patientswithintrathe-

calbaclofentherapy(ITB)since1990.In2008,17patients

underwentimplantationofabaclofenpump.Meanspasticity

scoresshowedastatisticallyrelevantreductionfollowingITB

therapy(ModifiedAshworthScale).

Pain/Headache

• In2008,196patientswithstatusmigrainosis,transformed

migraine,clusterheadacheandchronicdailyheadache

* Hospitals participating in GWTG for five or more years (N = 2,095)

received intravenous infusion therapy lasting one to five days at

the Neurological Center for Pain. Nearly 60 percent reported

a 50 percent or greater reduction in pain immediately after

treatment.

• Sixty-fourindividualscompletedthecenter’sInterdisciplinary

Method for the Assessment and Treatment of Chronic Head-

ache(IMATCH)outpatientprogramin2008.Patients’self-

rated pain and disability scores decreased after the intensive

treatment.

• TheChronicPainRehabilitationProgram(CPRP)treatsindi-

viduals who are emotionally and physically devastated by pain.

Continuingalong-termtrendin2008,patients’meanpain

scores decreased and their functional status improved after

enrollmentintheCPRP(PainDisabilityIndex).

Pediatric Neurology

• Among46pediatricpatientstreatedforheadachein2008,

both headache frequency and number of rescue medications

needed in the previous three months showed improvement.

Groupmeansforheadachefrequencyimproved46percent

inthemeanseven-monthintervalbetweenvisitsoneandtwo

(PediatricMigraineDisabilityAssessment).

• Inchildrenwithsevereheadaches,theaveragenumberof

complete and partial school days missed in the preceding three

monthsdeclinedfrom10.8to2.5.

Pediatric Neurosurgery

• Inpatientmortalityremainedbelowexpectedlevelsafter

surgeryforChiarimalformation,withnodeathsfrom2006

through2008.

Psychiatric Disorders

• AfteroneyearofparticipationintheoutpatientWomen’s

MentalHealthManagementGroup,29womendiagnosed

withmajordepressionregisteredagroupmeandecreaseof2.2

pointsindepressionseverityscore(PHQ-9).Groupmedica-

tion management had a positive effect on remission of depres-

sive symptoms.

• Among202inpatientstreatedin2008attheCenterfor

MoodDisordersTreatmentandResearchatLutheranHospi-

tal,aClevelandClinichospital,astatisticallysignificantreduc-

tion in mean severity of depression occurred from admission

todischarge(HamiltonDepressionScale,Montgomery-Asberg

DepressionRatingScale).

Sleep Disorders

• Sleepinessdecreasedamong217sleepapneapatientswho

receivedpositiveairwaypressure(PAP)treatmentin2008

(EpworthSleepinessScale).

• Functionalstatusimprovedamong216PAP-compliantsleep

apnea patients who assessed their status before and after treat-

ment(FunctionalOutcomesofSleepQuestionnaire).

Spinal Cord Disease

• TheCenterforSpineHealthusesateamapproachtodiagnosis,

treatment,patientsatisfactionandqualityforindividualswith

spine tumors. This strategy is credited for annual increases in

spinepatientsandcasesstudiedattheweeklySpineTumor

ReviewBoard,whichengagessurgeons,radiologists,patholo-

gistsandotherspecialistsinalogic-baseddecision-makingpro-

cess.From2006through2008,boththenumbersofpatients

and cases studied more than doubled.


Outcomes29

Weekly Spine Tumor Review Board meetings involve multidisciplinary clinical teams that evaluate complex cases through a logic-based decision-making process.


Technology and Innovation 31


Prospective First-in-Man Safety Trial of Laser Treatment

Cleveland Clinic’s Brain Tumor and Neuro-Oncology Center

(BTNC) was the first in the world to use a new, laser-based system

in a human for minimally invasive treatment of a brain tumor.

The AutoLITT™ (laser interstitial thermal therapy) system

coagulates tumors through a special laser probe, precisely

directed into the tumor, with the heating process monitored by

specialized software and thermal MRI techniques. Gene Barnett,

MD, FACS, leads this trial of a technology that could offer the

benefits of conventional surgery for some inoperable tumors and

spare patients more invasive interventions.

Stereotactic Radiosurgery for Spinal Tumors

Led by neurosurgeon Lilyana Angelov, MD, Cleveland Clinic’s

Spine Radiosurgery (SRS) program provides patients with

specialized, integrated care for complex problems related to

spine tumors. This program, the first of its kind in Ohio, is the

state’s largest and most established. To date, Dr. Angelov and her

multidisciplinary spine care team have reviewed and approved

management of more than 600 spine tumor cases and per-

formed more than 250 spine radiosurgeries.

Metastasis to the spinal column in cancer patients is often associ-

ated with disabling pain, and may result in neurological dysfunc-

tion and paralysis related to direct compression of the spinal cord

or nerve roots by tumor or instability of the spinal column.

Cleveland Clinic’s SRS program uses a novel modality, the

Novalis® Shaped Beam Surgery system, to deliver a high dose of

radiation to spinal metastases in a precise, conformal fashion,

enveloping the tumor in three dimensions without significant

scatter or spread beyond the target to sensitive adjacent organs

such as the spinal cord.

SRS can be used as a stand-alone treatment or as an adjunct to

other modalities. It can even be used as salvage therapy after con-

ventional radiation for spine metastases has failed. A noninvasive

outpatient procedure with minimal recovery time, this highly

selective, precise radiation therapy results in effective, rapid relief

of pain and exceptional tumor control.

Among patients treated at Cleveland Clinic, pain scores improved

by nearly 80 percent as early as one week post-treatment com-

pared with immediately before SRS. Moreover, this post-treatment

pain relief was durable, with almost 90 percent of evaluable

patients experiencing continued pain improvement at 12 months

following SRS. Radiographic tumor control was obtained in

approximately 90 percent of evaluated cases, including tumors

traditionally perceived to be radioresistant, such as renal cell

carcinoma and melanoma.

Tailoring Treatment of Oligodendroglioma

The discovery of a genetic alteration in oligodendrogliomas that

was prognostic of improved response to treatment and survival

was a landmark event in neuro-oncology. However, it was not

entirely clear how best to use this information to tailor therapy for

Technology and Innovation

Patients benefit from the latest treatment modalities at the Neurological Institute, where scientists and clinicians

working together continue to advance innovations and accelerate the process of bringing novel therapeutic agents

from the laboratory to the bedside.

Left: Brain Tumor and Neuro-Oncology Center neurosurgeons perform more than 950 brain tumor surgeries each year, aided by the latest tech-nological innovations. More than 25 percent of new brain tumor patients travel to Cleveland Clinic from outside Ohio.


32 Technology and Innovation

maximal benefit, without the harmful side effects associated with

radiation and chemotherapies.

Michael Vogelbaum, MD, PhD, has been a coleader of an inter-

national effort to define how best to use the information provided

by analysis of this alteration, also referred to as 1p/19q codele-

tion. In 2008, he was the lead author of a paper published in

the journal Neuro-Oncology, reporting the results of a study he

led with the Radiation Therapy Oncology Group that examined a

chemotherapy-only treatment for patients with malignant oligo-

dendroglial tumors. He is now the U.S. Principal Investigator for

a European-led Phase III trial of radiation and/or chemotherapy

for 1p/19q non-codeleted anaplastic gliomas and the U.S. co-PI

for another Phase III trial of radiation and/or chemotherapy for

1p/19q codeleted anaplastic gliomas. These studies will define

the optimal treatment for patients with grade III gliomas.

Epilepsy Center

Enhanced Localization Ability with Magnetoencephalography (MEG)

The MEG laboratory at Cleveland Clinic’s Epilepsy Center

has enhanced the center’s diagnostic capabilities. Cleveland

Clinic is among a select number of institutions in the world with

this technology, which measures magnetic fields produced by

electrical activity in the brain to localize the epileptic focus.

MEG is used routinely to better identify epileptic sources in

patients in whom the area of the brain causing the seizures would

otherwise be difficult to identify. Since its inception, the MEG

laboratory has tested more than 50 clinical patients. Results,

taken with the rest of the clinical evaluations, have been used to

refine the location of the epileptic focus, help guide the place-

ment of intracranial recording electrodes or ascertain that the

patient is not a surgical candidate.

The neurocomputing and clinical neurophysiology teams have

added capabilities to the basic MEG system, making it uniquely

advanced. These new developments include:

• specializedsoftwaretopost-processtherecordedMEG

waveforms

• continuous,synchronized digitalvideorecordingtoenable

direct correlation of the patient’s physical actions with MEG

waveforms

• onlineannotationsthatprovidesecond-by-secondtestingand

clinical information during a MEG recording

• anonlinedatabasethatkeepsrawresultsaswellasinterpreta-

tions to facilitate ongoing quality assessment


Optical Coherence Tomography to Monitor Axonal Injury

Optical coherence tomography (OCT) is a rapid, noninvasive,

painless test that generates high-resolution images of the retina.

Cleveland Clinic researchers are exploring utilization of OCT to

measure the thickness of the retinal nerve fiber layer and the vol-

ume of the macula. The optic nerve is an important site of injury

in MS, and the ability to monitor the degree of injury would be

an important advance in both clinical practice and experimental

treatment trials.


Correcting Motion-Corrupted Imaging Data

High-Angular Resolution Diffusion-Weighted Imaging (HARDI)

presents a challenge with regard to intrascan subject motion.

Image volumes are acquired serially on subjects, varying the

direction of diffusion sensitivity gradually throughout the scan.

Robust calculation of the final diffusion tensor assumes no

intrascan motion of the subject. HARDI acquisitions can take

10 minutes or more to acquire; thus, the assumption of no intra-

scan motion is problematic. Cleveland Clinic neuroradiologists

demonstrated that a previously published tensor-fit method is

sufficient in most cases when iterated up to 20 times on a single

data set. Motion effects can be removed to the 0.2 mm level, thus

reducing the error on the diffusion direction below 0.2 degree.

Defining Anatomic-Based Seeds for Functional Connectivity Analysis

Assessment of functional connectivity in the human brain,

using low-frequency blood oxygen level-dependent (BOLD)

Right: Magnetoencephalography (MEG) can evaluate the brain’s spontaneous activity or its response to specific stimuli. With a very large number of sensors, as well as the absence of any effect from skull or scalp, MEG has an inherently high resolution and provides superior accuracy, espe-cially when combined with MRI.


34 Technology and Innovation

fluctuation present in dynamically sampled MRI data, has

become a common technique. The most common method of

assessing connectivity is to measure the temporal correlation

between two functional brain regions.

Due to individual variation in functional localization in the

human brain, a standard technique for identifying regions of

interest is to perform task-based functional MRI. This imposes a

serious limitation on the ability to analyze functional connectiv-

ity in studies in which activation data also have been obtained.

Cleveland Clinic researchers introduced a method for defining

connectivity reference regions, based on combining anatomic

landmarks with a regional measure of temporal coherence. This

measure, derived from Kendall’s coefficient of concordance,

results in robust measures of functional connectivity.

Monitoring System for Deep Brain Stimulators during MRI

Performing functional MRI (fMRI) studies of implanted deep

brain stimulators (DBS) is important in understanding the

mechanisms of this therapy. To date, all fMRI has been done with

externalized DBS leads connected directly to a pulse generator in

the MRI console room immediately after surgical placement of

the lead. In this configuration, it is straightforward to program

the pulse generator such that the timing between acquired MRI

data and the stimulation is known.

When using implantable pulse generators (IPGs), it becomes

problematic to determine the state of the IPG during the acquisi-

tion of MRI data. Cleveland Clinic developed a passive radiofre-

quency (RF) monitoring system, which, when placed over the

implant on the patient’s chest, determines the state of the pulse

generator from characteristic low-frequency RF energy emissions.

This enables researchers to correlate stimulation with regional

changes in BOLD-weighted MRI signal.

Working with Patients to Improve Functional MRI Quality

Functional MRI studies are performed daily with standardized

paradigms to provide consistent preoperative localization of

motor, speech generation and receptive speech areas, with an

Right: Postoperative X-ray shows placement of bilateral deep brain stimulation (DBS) leads and electrodes in a patient with obsessive-compulsive disorder (OCD). Cleveland Clinic is among four centers worldwide where psychiatric neurosurgery teams have collaborated to investigate the safety and efficacy of DBS for refractory OCD.

85 percent success rate. A program was developed in which a

neuroradiologist interviews every patient to individualize the

study when indicated, provide instructions for the paradigms,

and emphasize the consequences of inattention and movement.

A study that examined the effect of the prescan patient interview

in improving scan quality showed that an intensive intervention

can reduce unacceptable sequences from 15 percent to

5 percent.

Previously, language fMRI examinations were conducted only

in English. The paradigms have been extended to include other

languages, such as Spanish and French. Also, for language-chal-

lenged patients such as children and those with injuries such as

strokes, simpler paradigms are available, incorporating pictures

and simpler language. This change has resulted in a significant

improvement in reliability of all clinical studies.

Lateralization Score for fMRI Studies to Judge Hemispheric

Speech Dominance

The major clinical utility for performing fMRI studies is presurgi-

cal planning, particularly for epilepsy and brain tumor patients.

The important issue is to identify the essential eloquent cortical

areas governing language and motor activity so the surgeon can

provide adequate margins to minimize post-surgical morbidity.

Often, this issue is resolved by determining language lateraliza-

tion, a process hitherto determined by the neuroradiologist based

on a qualitative impression of the fMRI images.

Recent work has extended the qualitative impression of language

lateralization with a quantitative lateralization index or score,

which is computer-generated and based on an analysis of 42

patients who had both fMRI and Wada lateralization. Wada is the

gold standard; however, because it involves catheter angiography,

it carries significant risk. Work at Cleveland Clinic shows how

this computer-generated lateralization index more accurately

identifies and quantifies the degree of qualitative language

lateralization. For studies in which quality is not significantly

degraded by motion or inattention, a qualitative lateralization


Technology and Innovation 37

correlation of R2=0.34 is increased to R2=0.60 when the neuro-

radiologist is assisted by the computer-generated index.

Integration of Diffusion Tensor Imaging

With diffusion tensor imaging (DTI), also known as tractography,

neuroscientists are noninvasively probing the long-neglected

white matter pathways in the brain. The significance of this

technological leap forward was illustrated at the 2008 Cleveland

Clinic Medical Innovations Summit, where DTI was among 10

breakthroughs that Cleveland Clinic physicians cited as most

likely to impact medicine in the coming year.

In clinical practice, Cleveland Clinic neuroscientists are utilizing

DTI to create a detailed spatial wiring map of the brain, which

can enhance surgical planning and prognosis accuracy. In the

research laboratory, they are applying DTI to advance understand-

ing of a wide range of brain disorders, including Parkinson’s

disease, epilepsy, multiple sclerosis and traumatic brain injury.

Neurological Center for Pain/Center for Neurological Restoration

Neurostimulation for Treatment of Cluster Headaches

The Center for Neurological Restoration conducted an IRB-

approved study in collaboration with the Neurological Center for

Pain to assess the safety and efficacy of acute neurostimulation of

the sphenopalatine ganglia (SPG) for treatment of severe cluster

headaches. Five patients underwent SPG stimulation and three

returned for a second trial, for eight total treatment sessions. Four

treatment sessions (in three patients) produced complete resolu-

tion of at least one cluster attack within two minutes, suggesting

that this technique may hold promise for treatment of these and

other types of headache.


Multidisciplinary CPAP Compliance Group Therapy

Continuous Positive Airway Pressure (CPAP) therapy is the

standard treatment for sleep apnea, but an estimated 30 percent

to 50 percent of patients are noncompliant, for both mechanical

and psychological reasons.

Cleveland Clinic’s Sleep Disorders Center started a group therapy

initiative to target these patients. Led by a sleep specialist, a

psychologist and a sleep technician, the groups of six to eight

patients meet in sessions that last about 90 minutes. Patients

discuss their problems with CPAP and receive tips from profes-

sionals, while learning from other patients. They have opportuni-

ties to try other CPAP masks and devices and, depending on the

nature of the problem, they receive detailed individual treatment

plans. Patient feedback has been highly positive.

Biofeedback for Chronic Insomnia

Chronic insomnia affects 10 percent to 15 percent of adults.

Although hypnotic medicines are effective in some patients, they

are not always safe for long-term use.

Cleveland Clinic’s Sleep Disorders Center is one of a very few

centers in the country with a dedicated biofeedback program for

chronic insomnia. The most commonly used forms of treatment

are EMG biofeedback, respiratory biofeedback, thermal biofeed-

back and neurofeedback.

Psychologists and sleep specialists offer the treatment in weekly

sessions for five to six weeks. More than two-thirds of patients

report significant improvement in chronic insomnia symptoms.


Delaying Recurrences of Myxopapillary Ependymomas

The Center for Spine Health is the largest center in the United

States conducting adjuvant radiation therapy (ART) studies. A

center study found the use of therapeutic radiation beneficial in

delaying a second occurrence of myxopapillary ependymomas.

Patients who did not receive ART had a median time to recur-

rence of 1.1 years, while those who received ART had a median

time to recurrence of 9.6 years.

Left: An MRI of a lumbar spine shows some involvement of Level 5 with an infectious or tumorous process. The Center for Spine Health utilizes advanced imaging technologies to diagnose a variety of spine-related conditions.


Research 39

In 2008, grant and contract research dollars funding neurologi-

cal investigations in the Neurological Institute, Lerner Research

Institute and Department of Neuroradiology totaled more than

$17.9 million. Additional metrics from 2008 help quantify an

expanding program:

Number of new clinical research trials: 42

Number of active clinical research trials: 139

Staff leading clinical research trials: 50

New patients enrolled in clinical research trials: 772

Number of patients enrolled in clinical research trials: 1,690

Number of National Institutes of Health grants and contracts

(includes Lerner Research Institute and Neuroradiology): 91

Number of non-NIH neurological grants

(includes Lerner Research Institute and Neuroradiology): 167

This support was instrumental to a number of noteworthy

advances within the Neurological Institute.

Cranial Radiosurgery for the Older Old

Although the incidence of cancer increases with age, research

studies have traditionally excluded older patients, especially those

75 and older. In cancer that spreads to the brain from another

site, data from patients younger than 65 suggested that increas-

ing age was associated with a poorer prognosis, irrespective of

whether the patient received surgery, whole brain radiation or

stereotactic radiosurgery (SRS).

Despite the known efficacy of SRS in treating brain metastasis,

little was known of its efficacy in older patients. Robert Weil, MD,

and colleagues from the Brain Tumor and Neuro-Oncology Center

performed the first large analysis of a consecutive series of patients

75 and older treated with SRS, which was generally the sole

treatment for their brain metastases. In 44 patients treated over

13 years, SRS of one or more brain metastases produced results

comparable to those found in younger patients: Average survival

exceeded seven months, with more than one-third of patients

surviving one year and longer. Patients tolerated the treatment

well, with no loss of physical function.

This study supports the idea that aggressive, multimodal treat-

ment of cancer that spreads to the brain can be effective and safe

in older patients, with results similar to those experienced by

younger patients.

Understanding Combat-Related Traumatic Brain Injury

Traumatic brain injury (TBI) caused by improvised explosive

devices is fast becoming the signature wound of the Iraq and

Afghanistan wars. With a $1.4 million grant from the U.S.

Research

The Neurological Institute conducts a robust research program that fosters a culture of innovation and collaboration.

Physicians and scientists within the institute work closely with colleagues in the Lerner Research Institute, the basic

science research arm of Cleveland Clinic, pursuing laboratory-based and clinical research as well as translational

research that applies laboratory findings to improve patient care.

Left: Neural stem cells generate various types of cells. They can generate astrocytes, oligodendrocytes and neurons, according to the stimuli they are under. These cells are prime candidates for stem cell transplantation therapies.


40 Research

Department of Defense, Cleveland Clinic cognitive neuroscientist

Stephen Rao, PhD, and collaborators are using advanced brain

imaging techniques to better understand blast-related TBI.

Dr. Rao, the Principal Investigator, is working with colleagues

at Baylor College of Medicine. Their research will determine

if blast-related TBI, thought to be produced by wave-induced

changes in atmospheric pressure, can be differentiated from the

better-studied civilian TBI, which is caused primarily by mechani-

cal forces such as the sudden jolt from an auto accident or fall.

Functional magnetic resonance imaging and diffusion tensor

imaging will be used to identify differences and parallels between

military and civilian TBI.

As many as 20 percent of soldiers returning from Iraq and

Afghanistan have TBI. Approximately 40 percent of these are

mild cases that are often overlooked because they do not show

up on traditional screening tests. Yet, if a solider returns to

combat without treatment for a mild TBI, a second or third blast

injury can be much more crippling, according to Dr. Rao. Each

successive injury further depletes the neural reserve, hampering

recovery.

Furthermore, the effects of even one mild TBI can linger, mani-

fested months or years later in memory problems, mood swings

and constant frustration. Thus, research to identify damage

caused by the first blast injury assumes even greater relevance.

New Neuron Growth in Adult Brains

Lerner Research Institute researchers discovered evidence of the

generation of new neurons in adult brains. The findings, pub-

lished in Brain, challenge views that the adult human brain lacks

the ability to grow new neurons.

This research, led by Bruce Trapp, PhD, Chairman of the Depart-

ment of Neurosciences at Lerner Research Institute, involved

examination of neurons in the brains of nine patients with

multiple sclerosis (MS) and four healthy control group subjects.

The study used advance staining techniques to detect and charac-

terize neurons in normal subcortical white matter and acute and

chronic demyelinated brain lesions. In MS, the immune system

destroys the myelin sheaths that surround and protect nerves. The

nerves then “misfire,” slowing or disrupting impulses.

Dr. Trapp’s team found that neurons occupying the white matter

also are destroyed during demyelination. In a small percentage

of old MS lesions, however, white matter neurons increased

72 percent compared with normal brain regions.

The study suggests that demyelinated tissues produce signals that

can enhance the generation of new neurons in damaged areas of

the brain. Thus, there is evidence to support the thesis that new

neurons can regrow in MS lesions.

It is unclear how much function the new tissues have, but this

basic science discovery may provide a basis for development of

new therapies for MS and other neurodegenerative diseases.

Collaborating with Dr. Trapp on the research were Susan

Staugaitis, MD, PhD, and neurologists at the Mellen Center for

Multiple Sclerosis Treatment and Research.

Stem cell biology and the resulting regenerative medicine hold the promise of moving medicine beyond simply

dealing with symptoms.

Grahame Kidd, PhD, left, and Bruce Trapp, PhD, analyze images of “new neurons” in multiple sclerosis brain sections.


Research 41

Unlocking Stem Cell Potential

Jeremy Rich, MD, nationally known for his research on cancer

stem cells and brain tumors, was recruited from Duke University

Medical Center in 2008 to serve as Chairman of Lerner Research

Institute’s newly created Department of Stem Cell Biology and

Regenerative Medicine.

she would have pedaled alone. Dr. Alberts set out to investigate

whether “forced exercise,” in which people are pushed beyond

their normal limits, is therapeutic for Parkinson’s patients.

To test the theory, he designed a tandem bicycle that forces

patients to pedal at accelerated rates. Among the early findings:

Motor function improved significantly in patients’ arms, even

though they were working only their legs, which suggests to Dr.

Alberts that forced exercise impacts higher brain function and

improves central motor function.

Patients averaged a 30 percent improvement in their symptoms,

and these gains were sustained for four weeks after they stopped

forced exercising.

Dr. Alberts posits that driving the central nervous system beyond

its normal capacity can lead to biochemical changes necessary for

these improvements.

Further research is needed to understand the underlying mecha-

nisms. Mark Lowe, PhD, of Cleveland Clinic’s Imaging Institute,

and Micheal Phillips, MD, Section Head of Imaging Sciences in

the Department of Diagnostic Radiology, are collaborating on

the project.

Novel Oral Therapies for Multiple Sclerosis

MS researchers are poised for a breakthrough in the form of the

first-ever oral agents for treatment of the disease, which are now in

Phase III testing. Neurologists at Cleveland Clinic’s Mellen Center

for Multiple Sclerosis Treatment and Research are closely involved

in these promising investigations, as are the study participants

among their patients.

Mellen Center Medical Director Robert Fox, MD, is Principal

Investigator on a Phase III study of the oral immunomodulator

fumarate. Jeffrey Cohen, MD, Director of Experimental Thera-

peutics at the Mellen Center, was PI on a Phase III trial of the oral

drug fingolimod. Dr. Cohen also serves on the adjudication board

for an ongoing study of oral cladribine and the steering committee

for trials of the immunomodulator laquinimod.

Brain precursor cells that give rise to myelin-forming cells are impor-tant for repairing damage from demyelinating diseases like multiple sclerosis. In this population, all precursor cells expressed a common marker molecule (red), but only a subset also expressed a marker associated with cell maturation (green).

Stem cell biology and the resulting regenerative medicine hold

the promise of moving medicine beyond simply dealing with

symptoms. Dr. Rich’s goal is to develop a comprehensive research

group to study stem cells, from the basic science to implementa-

tion of new therapies to treat a variety of diseases. He plans to

recruit about 10 faculty members in the next five years to build a

department with approximately 100 employees.

Forced Exercise Reduces Parkinson’s Symptoms

Sometimes, insight comes in an unlikely setting. Jay Alberts, PhD,

Department of Biomedical Engineering, had just completed a

450-mile bicycle trip across Iowa to raise awareness of Parkinson’s

disease when a patient mentioned that she had no symptoms dur-

ing the ride, and the tremor in her hand was gone afterward. The

patient had been paired with a rider who set a faster pace than


42 Research

Plasma Exchange as Treatment for Rare Complication

The drug natalizumab helps treat multiple sclerosis by inhibiting

white blood cells from entering the brain and attacking nerves,

but this drug also lowers the patient’s immunity. Some patients

taking natalizumab have suffered an uncommon, but usually

fatal, infection called progressive multifocal leukoencephalopathy

(PML).

In a study published in the journal Neurology, Robert Fox, MD,

and colleagues examined the effect of plasma exchange in 12 MS

patients taking natalizumab. This study showed that monoclonal

antibodies can be removed from the body with plasma exchange,

and this removal leads to improved immune function. Using

population modeling, Dr. Fox and colleagues suggested that

five plasma exchanges are needed to effectively remove natali-

zumab from the bodies of patients receiving this therapy. Plasma

exchange may help convert PML into a manageable complication

of treatment with natalizumab, which would improve the overall

safety of this therapy.

Tissue Collection Supports Multiple Sclerosis Research

Many MS basic research studies require brain and spinal cord

tissue from diseased patients. Because brain biopsies are rare,

autopsy collection of tissues is vital in providing the required

resources for these studies. Cleveland Clinic has developed an

effective MS Tissue Donation Program.

An advanced directive program includes educational materials,

written informed consent, donor identification card, and a secure

database with patient demographics and disease characteristics. A

rapid autopsy protocol ensures 24/7 transportation, postmortem

imaging and tissue procurement.

At the time of death, calls from family and care providers are

routed to the on-call MS tissue donation nurse coordinator,

who activates the ambulance transport and notifies the imag-

ing, autopsy and tissue-processing teams. The body undergoes

The Spine Research Laboratory includes a state-of-the-art biomechanics laboratory. Biomechanical testing involves eccentric axial loading of a spinal motion segment to determine stress distribution within the intervertebral disc.


Research 43

postmortem MRI, followed by brain and spinal cord removal and

processing by a neuropathologist and the tissue-processing team.

Local pathologists are utilized for distant patients.

A total of 224 patients have enrolled in the advanced directive

program. Since 1997, 64 patients have donated their tissues.

Median postmortem interval (time from death to fixation) was

6.1 hours.

This program has been successful in effectively procuring and

rapidly processing MS tissues, and has supported high-impact

publication in The New England Journal of Medicine, Annals of

Neurology and Archives of Neurology.

Spine Research Laboratory at Lutheran Hospital

Eighty percent of American adults experience back problems at

some point in their lives. Cleveland Clinic’s Spine Research

Lab (SRL), which relocated in 2008 to Lutheran Hospital, a

Cleveland Clinic hospital, is dedicated to improving quality of life

for people with spinal disorders through research, innovation and

education.

The SRL strengthens the comprehensive spine program developed

in recent years at Lutheran. The program is noted for medical and

surgical spine care and inpatient rehabilitation. The addition of

the SRL, under the direction of Lars Gilbertson, PhD, intensifies a

complementary focus on research and education.

The SRL hosts medical students, bioengineering students,

residents and fellows from the departments of Neurosurgery and

Orthopaedic Surgery, along with research fellows from around

the world.

With the SRL, the spine program at Lutheran is fast becoming an

integrated continuum with Cleveland Clinic’s main campus and

the Neurological Institute, as Dr. Gilbertson and staff work closely

with Center for Spine Health Director Gordon Bell, MD, and his

clinical staff.

In recognition of its commitment to spinal care and research,

the SRL received a five-year grant from Ohio’s Third Frontier

Commission. In its new home, the SRL seeks to establish itself

as a national leader in spinal innovation and to educate the next

generation of spine researchers and clinicians.

Neurological Institute Chairs

Holders of the following endowed chairs are entrusted with the

stewardship of funds generated by the gifts of Cleveland Clinic’s

generous supporters.

Gene Barnett, MD, FACSDirector, Brain Tumor and Neuro-Oncology Center The Rose Ella Burkhardt Chair in Neurosurgery

William Bingaman, MD Vice Chairman, Clinical Areas, Neurological InstituteThe Shusterman Endowed Chair

Irene Katzan, MD, MSThe Wamberg Family Endowed Chair in Stroke Research

Michael T. Modic, MD, FACRChairman, Neurological InstituteThe William P. and Amanda C. Madar Endowed Chair and Professorship

Imad Najm, MDDirector, Epilepsy CenterThe Joseph and Ellen Thomas Endowed Chair

Stephen Rao, PhDDirector, The Ralph and Luci Schey Foundation Center for Advanced Cognitive FunctionThe Ralph and Luci Schey Endowed Chair in Cognitive Function

Ali Rezai, MD *The Jane and Lee Seidman Chair in Functional Neurosurgery

Richard A. Rudick, MD Vice Chairman, Research and Development, Neurological InstituteDirector, Mellen Center for Multiple Sclerosis Treatment and ResearchThe Hazel Prior Hostetler Endowed Chair

Tanya Tekautz, MDBrain Tumor and Neuro-Oncology CenterThe Karen Colina Wilson Endowed Chair in Pediatric Brain Tumor Research

Jerrold Vitek, MD, PhDCenter for Neurological RestorationThe Edward F. and Barbara A. Bell Family Endowed Chair

Michael Vogelbaum, MD, PhDAssociate Director, Brain Tumor and Neuro-Oncology CenterThe Robert W. and Kathryn B. Lamborn Chair for Neuro-Oncology

Robert J. Weil, MDDirector of Laboratory Research, Brain Tumor and Neuro-Oncology CenterThe Melvin H. Burkhardt Chair in Neuro-Oncology Clinical Research

Currently Unassigned Endowed Chairs The Andrea L. and Joseph F. Hahn, MD, Endowed ChairThe Jane and Lee Seidman Chair in Functional Neurosurgery

* Until July 2009


44 Research


Balmaceda C, Peereboom D, Pannullo S, Cheung YKK, Fisher PG, Alavi J, Sisti M, Chen J, Fine RL. Multi-institutional phase II study of temozolomide administered twice daily in the treatment of recurrent high-grade gliomas. Cancer. 2008 Mar 1; 112(5):1139-1146.

Chao ST, Barnett GH, Vogelbaum MA, Angelov L, Weil RJ, Neyman G, Reuther AM, Suh JH. Salvage stereotactic radiosurgery effectively treats recurrences from whole-brain radiation therapy. Cancer. 2008 Oct 15;113(8):2198-2204.

Georgitsi M, De Menis E, Cannavo S, Makinen MJ, Tuppurainen K, Pauletto P, Curto L, Weil RJ, Paschke R, Zielinski G, Wasik A, Lubinski J, Vahteristo P, Karhu A, Aaltonen LA. Aryl hydrocarbon receptor interacting protein (AIP) gene mutation analysis in children and adolescents with sporadic pituitary adenomas. Clin Endocrinol (Oxf ). 2008 Oct;69(4):621-627.

Gibson SE, Zeng WF, Weil RJ, Prayson RA. Aurora B kinase expression in ependymal neoplasms. Appl Immunohistochem Mol Morphol. 2008 May;16(3):274-278.

Guo S, Chao ST, Reuther AM, Barnett GH, Suh JH. Review of the treatment of trigeminal neuralgia with gamma knife radiosurgery. Stereotact Funct Neurosurg. 2008;86(3):135-146.

Kang TY, Jin T, Elinzano H, Peereboom D. Irinotecan and bevacizumab in progressive primary brain tumors, an evaluation of efficacy and safety. J Neurooncol. 2008 Aug;89(1):113-118.

Kim SH, Weil RJ, Chao ST, Toms SA, Angelov L, Vogelbaum MA, Suh JH, Barnett GH. Stereotactic radiosurgical treatment of brain metastases in older patients. Cancer. 2008 Aug 15; 113(4):834-840.

Marko NF, Toms SA, Barnett GH, Weil R. Genomic expression patterns distinguish long-term from short-term glioblastoma survivors: a preliminary feasibility study. Genomics. 2008 May;91(5):395-406.

Selected Publications

Neurological Institute staff authored more than 470 publications in 2008, including the following. For a complete

list, go to clevelandclinic.org/nipublications.

Pineyro MM, Makdissi A, Faiman C, Prayson RA, Reddy SK, Mayberg MC, Weil RJ, Hamrahian AH. Poor correlation of serum alpha-subunit concentration and magnetic resonance imaging following pituitary surgery in patients with nonfunctional pituitary macroadenomas. Endocr Pract. 2008 May;14(4):452-457.

Sade B, Lee JH. High incidence of optic canal involvement in clinoidal meningiomas: rationale for aggressive skull base approach. Acta Neurochir (Wien). 2008 Nov;150(11):1127-1132.


Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard-Kienitz B, Pride GL Jr, Purdy PD, Welch BG, Woo HH, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella DJ. Angiographic patterns of wingspan in-stent restenosis. Neurosurgery. 2008 Jul;63(1):23-27;discussion 27-28.

Bhatt A, Vora NA, Thomas AJ, Majid A, Kassab M, Hammer MD, Uchino K, Wechsler L, Jovin TG, Gupta R. Lower pretreatment cerebral blood volume affects hemorrhagic risks after intra-arterial revascularization in acute stroke. Neurosurgery. 2008 Nov;63(5):874-878.

Cucullo L, Couraud PO, Weksler B, Romero IA, Hossain M, Rapp E, Janigro D. Immortalized human brain endothelial cells and flow-based vascular modeling: a marriage of convenience for rational neurovascular studies. J Cereb Blood Flow Metab. 2008 Feb;28(2):312-328.

Fan QY, Ramakrishna S, Marchi N, Fazio V, Hallene K, Janigro D. Combined effects of prenatal inhibition of vasculogenesis and neurogenesis on rat brain development. Neurobiol Dis. 2008 Dec;32(3):499-509.

Kelly ME, Turner RD IV, Moskowitz SI, Gonugunta V, Hussain MS, Fiorella D. Delayed migration of a self-expanding intracranial microstent. AJNR Am J Neuroradiol. 2008 Nov;29(10):1959-1960.


Research 45

Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic and clinical benefits of portable head/neck CT imaging in the intensive care unit. Radiol Manage. 2008 Mar-Apr;30(2):50-54.

Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, Brown WD, Terborg C, Gilden DH. The varicella zoster virus vasculopathies: clinical, CSF, imaging, and virologic features. Neurology. 2008 Mar 11;70(11):853-860.

Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, Jarouse J, Brillman J, Murali S, Gupta R. Atrial fibrillation detected by mobile cardiac outpatient telemetry in cryptogenic TIA or stroke. Neurology. 2008 Nov 18;71(21):1696-1701.

Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch BG, Niemann DB, Purdy PD, Aagaard-Kienitz B, Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, Fiorella D. Influence of patient age and stenosis location on wingspan in-stent restenosis. AJNR Am J Neuroradiol. 2008 Jan;29(1):23-27.

Turner RD, Byrne JV, Kelly ME, Mitsos AP, Gonugunta V, Lalloo S, Rasmussen PA, Fiorella D. Delayed visual deficits and monocular blindness after endovascular treatment of large and giant paraophthalmic aneurysms. Neurosurgery. 2008 Sep;63(3):469-474.

Epilepsy Center

Bautista JF, Kelly JA, Harley JB, Gray-McGuire C. Addressing genetic heterogeneity in complex disease: finding seizure genes in systemic lupus erythematosus. Epilepsia. 2008 Mar;49(3):527-530.

Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, Naugle RI, Nair D, Najm IM. Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following left temporal lobectomy for intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199-205.

Chapin JS, Busch RM, Janigro D, Dougherty M, Tilelli CQ, Lineweaver TT, Naugle RI, Diaz-Arrastia R, Najm IM. APOE epsilon4 is associated with postictal confusion in patients with medically refractory temporal lobe epilepsy. Epilepsy Res. 2008 Oct;81(2-3):220-224.

Dutton C, Foldvary-Schaefer N. Contraception in women with epilepsy: pharmacokinetic interactions, contraceptive options, and management. Int Rev Neurobiol. 2008;83:113-134.

Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution of obstructive sleep apnea with epilepsy surgery? Expanding the relationship between sleep and epilepsy. Epilepsia. 2008 Aug;49(8):1457-1459.

Jehi L, Najm IM. Sudden unexpected death in epilepsy: impact, mechanisms, and prevention. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S66-S70.

Kim H, Piao Z, Liu P, Bingaman W, Diehl B. Secondary white matter degeneration of the corpus callosum in patients with intractable temporal lobe epilepsy: a diffusion tensor imaging study. Epilepsy Res. 2008 Oct;81(2-3):136-142.

Lachhwani DK, Loddenkemper T, Holland KD, Kotagal P, Mascha E, Bingaman W, Wyllie E. Discontinuation of medications after successful epilepsy surgery in children. Pediatr Neurol. 2008 May;38(5):340-344.

Mani J, Diehl B, Piao Z, Schuele SS, Lapresto E, Liu P, Nair DR, Dinner DS, Luders HO. Evidence for a basal temporal visual language center: cortical stimulation producing pure alexia. Neurology. 2008 Nov 11;71(20):1621-1627.

Zotev VS, Matlashov AN, Volegov PL, Savukov IM, Espy MA, Mosher JC, Gomez JJ, Kraus RH Jr. Microtesla MRI of the human brain combined with MEG. J Magn Reson. 2008 Sep;194(1):115-120.


Cardona AE, Sasse ME, Liu L, Cardona SM, Mizutani M, Savarin C, Hu T, Ransohoff RM. Scavenging roles of chemokine receptors: chemokine receptor deficiency is associated with increased levels of ligand in circulation and tissues. Blood. 2008 Jul 15;112(2):256-263.

Chang A, Smith MC, Yin X, Fox RJ, Staugaitis SM, Trapp BD. Neurogenesis in the chronic lesions of multiple sclerosis. Brain. 2008 Sep;131(Pt 9):2366-2375.

Cohen JA, Calabresi PA, Chakraborty S, Edwards KR, Eickenhorst T, Felton WL III, Fisher E, Fox RJ, Goodman AD, Hara-Cleaver C, Hutton GJ, Imrey PB, Ivancic DM, Mandell BF, Perryman JE, Scott TF, Skaramagas TT, Zhang H. Avonex combination trial in relapsing-remitting MS: rationale, design and baseline data. Mult Scler. 2008 Apr;14(3):370-382.

Fisher E, Lee JC, Nakamura K, Rudick RA. Gray matter atrophy in multiple sclerosis: a longitudinal study. Ann Neurol. 2008 Sep;64(3):255-265.


46 Research

Fox RJ, McColl RW, Lee JC, Frohman T, Sakaie K, Frohman E. A preliminary validation study of diffusion tensor imaging as a measure of functional brain injury. Arch Neurol. 2008 Sep;65(9):1179-1184.

Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, Phillips MD. Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity. Hum Brain Mapp. 2008 Jul;29(7):818-827.

Moll NM, Rietsch AM, Ransohoff AJ, Cossoy MB, Huang D, Eichler FS, Trapp BD, Ransohoff RM. Cortical demyelination in PML and MS: similarities and differences. Neurology. 2008 Jan 29;70(5):336-343.

Sutliff MH, Naft JM, Stough DK, Lee JC, Arrigain SS, Bethoux FA. Efficacy and safety of a hip flexion assist orthosis in ambulatory multiple sclerosis patients. Arch Phys Med Rehabil. 2008 Aug;89(8):1611-1617.

Trapp BD, Nave KA. Multiple sclerosis: an immune or neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247-269.

Young EA, Fowler CD, Kidd GJ, Chang A, Rudick R, Fisher E, Trapp BD. Imaging correlates of decreased axonal Na+/K+ ATPase in chronic multiple sclerosis lesions. Ann Neurol. 2008 Apr;63(4):428-435.


Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki MN, Grooff PN. Effects of diagnostic information, per se, on patient outcomes in acute radiculopathy and low back pain. AJNR Am J Neuroradiol. 2008 Jun;29(6):1098-1103.

Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears J, Traboulsi EI. Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly — broadening the clinical spectrum of midline defects. J Neurol. 2008 Jun;255(6):885-890.

Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, Phillips MD. Resting state sensorimotor functional connectivity in multiple sclerosis inversely correlates with transcallosal motor pathway transverse diffusivity. Hum Brain Mapp. 2008 Jul;29(7):818-827.

Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic and clinical benefits of portable head/neck CT imaging in the intensive care unit. Radiol Manage. 2008 Mar-Apr;30(2):50-54.

Phillips MD. Functional faults: fMRI in MS. Neurology. 2008 Jan 22;70(4):248-249.


Alberts JL, Voelcker-Rehage C, Hallahan K, Vitek M, Bamzai R, Vitek JL. Bilateral subthalamic stimulation impairs cognitive-motor performance in Parkinson’s disease patients. Brain. 2008 Dec;131(Pt 12):3348-3360.

Cooper SE, Kuncel AM, Wolgamuth BR, Rezai AR, Grill WM. A model predicting optimal parameters for deep brain stimulation in essential tremor. J Clin Neurophysiol. 2008 Oct;25(5):265-273.

Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia. 2008;46(1):213-223.

Guo Y, Rubin JE, McIntyre CC, Vitek JL, Terman D. Thalamocortical relay fidelity varies across subthalamic nucleus deep brain stimulation protocols in a data-driven computational model. J Neurophysiol. 2008 Mar;99(3):1477-1492.

Johnson MD, Miocinovic S, McIntyre CC, Vitek JL. Mechanisms and targets of deep brain stimulation in movement disorders. Neurotherapeutics. 2008 Apr;5(2):294-308.

Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden D, Feinstein A. Epigenetics of personality traits: an illustrative study of identical twins discordant for risk-taking behavior. Twin Res Hum Genet. 2008 Feb;11(1):1-11.

Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, Schurigyn T, Farag E. Perioperative events during deep brain stimulation: the experience at Cleveland Clinic. J Neurosurg Anesthesiol. 2008 Jan;20(1):36-40.

Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis NM. Surgery for movement disorders. Neurosurgery. 2008 Feb;62(Suppl 2):809-838.

Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Schupbach M, D’Ambrosia J, Thobois S, Tamma F, Herzog J, Speelman JD, Samanta J, Kubu C, Rossignol H, Poon YY, Saint-Cyr JA, Ardouin C, Moro E. A multicentre study on suicide outcomes following subthalamic stimulation for Parkinson’s disease. Brain. 2008 Oct;131(Pt 10):2720-2728.

Xu W, Russo GS, Hashimoto T, Zhang J, Vitek JL. Subthalamic nucleus stimulation modulates thalamic neuronal activity. J Neurosci. 2008 Nov 12;28(46):11916-11924.


Research 47


Chahine LM, Patrick R, Tavee J. Complex regional pain syndrome after infliximab infusion. J Pain Symptom Manage. 2008 Sep;36(3):e2-e4.

Cheng G, Kaminski HJ, Gong B, Zhou L, Hatala D, Howell SJ, Zhou X, Mustari MJ. Monocular visual deprivation in macaque monkeys: a profile in the gene expression of lateral geniculate nucleus by laser capture microdissection. Mol Vis. 2008;14:1401-1413.

Holmes RO Jr, Tavee J. Vasospasm and stroke attributable to ephedra-free xenadrine: case report. Mil Med. 2008 Jul;173(7):708-710.

McClelland S III, Bethoux FA, Boulis NM, Sutliff MH, Stough DK, Schwetz KM, Gogol DM, Harrison M, Pioro EP. Intrathecal baclofen for spasticity-related pain in amyotrophic lateral sclerosis: efficacy and factors associated with pain relief. Muscle Nerve. 2008 Mar;37(3):396-398.

Rini BI, Shook S. Is Guillain Barre syndrome likely in this patient? Oncology (Williston Park). 2008 Jan;22(1):70-71.

Shook SJ, Mamsa H, Jen JC, Baloh RW, Zhou L. Novel mutation in KCNA1 causes episodic ataxia with paroxysmal dyspnea. Muscle Nerve. 2008 Mar;37(3):399-402.

Sorenson EJ, Windbank AJ, Mandrekar JN, Bamlet WR, Appel SH, Armon C, Barkhaus PE, Bosch P, Boylan K, David WS, Feldman E, Glass J, Gutmann L, Katz J, King W, Luciano CA, McCluskey LF, Nash S, Newman DS, Pascuzzi RM, Pioro E, Sams LJ, Scelsa S, Simpson EP, Subramony SH, Tiryaki E, Thornton CA. Subcutaneous IGF-1 is not beneficial in 2-year ALS trial. Neurology. 2008 Nov 25;71(22):1770-1775.

Tavee J, Morris H III. Severe postictal laryngospasm as a potential mechanism for sudden unexpected death in epilepsy: a near-miss in an EMU. Epilepsia.2008 Dec;49(12):2113-2117.

Zhou L, Rafael-Fortney JA, Huang P, Zhao XS, Cheng G, Zhou X, Kaminski HJ, Liu L, Ransohoff RM. Haploinsufficiency of utrophin gene worsens skeletal muscle inflammation and fibrosis in mdx mice. J Neurol Sci. 2008 Jan 15;264(1-2):106-111.


Bigal M, Sheftell F, Tepper S, Tepper D, Ho TW, Rapoport A. A randomized double-blind study comparing rizatriptan, dexamethasone, and the combination of both in the acute treatment of menstrually related migraine. Headache. 2008 Oct;48(9):1286-1293.

Cleves C, Tepper SJ. Sumatriptan/naproxen sodium combination for the treatment of migraine. Expert Rev Neurother. 2008 Sep;8(9):1289-1297.

Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced serotonin syndrome: a review. Expert Opin Drug Saf. 2008 Sep;7(5):587-596.

Syrjala KL, Abrams JR, Polissar NL, Hansberry J, Robison J, DuPen S, Stillman M, Fredrickson M, Rivkin S, Feldman E, Gralow J, Rieke JW, Raish RJ, Lee DJ, Cleeland CS, DuPen A. Patient training in cancer pain management using integrated print and video materials: a multisite randomized controlled trial. Pain. 2008 Mar;135(1-2):175-186.

Tepper SJ, Stillman MJ. Clinical and preclinical rationale for CGRP-receptor antagonists in the treatment of migraine. Headache. 2008 Sep;48(8):1259-1268.

Tepper SJ, Zatochill M, Szeto M, Sheftell F, Tepper DE, Bigal M. Development of a simple menstrual migraine screening tool for obstetric and gynecology clinics: the menstrual migraine assessment tool. Headache. 2008 Nov;48(10):1419-1425.

Center for Pediatric Neurology and Neurosurgery

Bedaiwy MA, Fathalla MM, Shaaban OM, Ragab MH, Elbaba S, Luciano M, El-Nashar SA, Falcone T. Reproductive implications of endoscopic third ventriculostomy for the treatment of hydrocephalus. Eur J Obstet Gynecol Reprod Biol. 2008 Sep;140(1):55-60.

Chappelow AV, Reid J, Parikh S, Traboulsi EI. Aicardi syndrome in a genotypic male. Ophthalmic Genet. 2008 Dec;29(4):181-183.

Factora R, Luciano M. When to consider normal pressure hydrocephalus in the patient with gait disturbance. Geriatrics. 2008 Feb;63(2):32-37.

Fong J, Wu G, Wyllie E, Gupta A. Interictal hypermetabolic subcortical band on brain FDG-PET in doublecortin mutation. Neurology. 2008 Aug 12;71(7):535.

Haas RH, Parikh S, Falk MJ, Saneto RP, Wolf NI, Darin N, Wong LJ, Cohen BH, Naviaux RK. The in-depth evaluation of suspected mitochondrial disease. Mol Genet Metab. 2008 May;94(1):16-37.

Loddenkemper T, Alexopoulos AV, Kotagal P, Moosa A, Lachhwani DK, Gupta A, Bingaman W, Wyllie E. Epilepsy


48 Research

surgery in epidermal nevus syndrome variant with hemimegalencephaly and intractable seizures. J Neurol. 2008 Nov;255(11):1829-1831.

Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears J, Traboulsi EI. Pituitary stalk duplication in association with moya moya disease and bilateral morning glory disc anomaly — broadening the clinical spectrum of midline defects. J Neurol. 2008 Jun;255(6):885-890.

Parikh S, Cohen BH, Gupta A, Lachhwani DK, Wyllie E, Kotagal P. Metabolic testing in the pediatric epilepsy unit. Pediatr Neurol. 2008 Mar;38(3):191-195.

Weissman JR, Kelley RI, Bauman ML, Cohen BH, Murray KF, Mitchell RL, Kern RL, Natowicz MR. Mitochondrial disease in autism spectrum disorder patients: a cohort analysis. PLoS ONE. 2008;3(11):e3815.


Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, Naugle RI, Nair D, Najm IM. Poor presurgical performance on both verbal and visual memory measures is associated with low risk for memory decline following left temporal lobectomy for intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199-205.

Coffman KL. The debate about marijuana usage in transplant candidates: recent medical evidence on marijuana health effects. Curr Opin Organ Transplant. 2008 Apr;13(2):189-195.

Falcone T, Carlton E, Janigro D, Simon B, Franco K. Self-harm during first-episode psychosis. Br J Psychiatry. 2008 Aug;193(2):167.

Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. Impulsivity and risk-taking behavior in focal frontal lobe lesions. Neuropsychologia. 2008;46(1):213-223.

Heinberg LJ, Coughlin JW, Pinto AM, Haug N, Brode C, Guarda AS. Validation and predictive utility of the Sociocultural Attitudes Toward Appearance Questionnaire for Eating Disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain. Body Image. 2008 Sep;5(3):279-290.

Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden D, Feinstein A. Epigenetics of personality traits: an illustrative study of identical twins discordant for risk-taking behavior. Twin Res Hum Genet. 2008 Feb;11(1):1-11.

McKee MG. Biofeedback: an overview in the context of heart-brain medicine. Cleve Clin J Med. 2008 Mar;75 Suppl 2:S31-S34.

Muzina DJ. Depression and anxiety: distinguishing unipolar and bipolar disorders. Ann Clin Psychiatry. 2008 Dec;20 Suppl 1:S19-S23.

Pandya M, Kubu CS, Giroux ML. Parkinson disease: not just a movement disorder. Cleve Clin J Med. 2008 Dec;75(12):856-864.

Tesar GE. Whither hospital and academic psychiatry? Psychiatr Clin North Am. 2008 Mar;31(1):27-42.

Tetzlaff JE, Collins GB. Reentry of anesthesiology residents after treatment of chemical dependency — is it rational? J Clin Anesth. 2008 Aug;20(5):325-327.


Aboussouan LS, Lattin CD, Kline JL. Determinants of long-term mortality after prolonged mechanical ventilation. Lung. 2008 Sep;186(5):299-306.

Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution of obstructive sleep apnea with epilepsy surgery? Expanding the relationship between sleep and epilepsy. Epilepsia. 2008 Aug;49(8):1457-1459.

Gugliotti D, Grant P, Jaber W, Aboussouan L, Bae C, Sessler D, Scahuer P, Kaw R. Challenges in cardiac risk assessment in bariatric surgery patients. Obes Surg. 2008 Jan;18(1):129-133.

Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, Jaber W, Schauer P, Sessler D. Challenges in pulmonary risk assessment and perioperative management in bariatric surgery patients. Obes Surg. 2008 Jan;18(1):134-138.

Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath. 2008 Aug;12(3):259-264.

Malow BA, Foldvary-Schaefer N, Vaughn BV, Selwa LM, Chervin RD, Weatherwax KJ, Wang L, Song Y. Treating obstructive sleep apnea in adults with epilepsy: a randomized pilot trial. Neurology. 2008 Aug 19;71(8):572-577.

Minai OA, Malik N, Foldvary N, Bair N, Golish JA. Prevalence and characteristics of restless legs syndrome in patients with pulmonary hypertension. J Heart Lung Transplant. 2008 Mar;27(3):335-340.


Research 49

Selwa LM, Marzec ML, Chervin RD, Weatherwax KJ, Vaughn BV, Foldvary-Schaefer N, Wang L, Song Y, Malow BA. Sleep staging and respiratory events in refractory epilepsy patients: is there a first night effect? Epilepsia. 2008 Dec;49(12):2063-2068.


Foley KT, Mroz TE, Arnold PM, Chandler HC Jr, Dixon RA, Girasole GJ, Renkens KL Jr, Riew KD, Sasso RC, Smith RC, Tung H, Wecht DA, Whiting DM. Randomized, prospective, and controlled clinical trial of pulsed electromagnetic field stimulation for cervical fusion. Spine J. 2008 May-Jun;8(3):436-442.

Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC. Musculoskeletal allograft risks and recalls in the United States. J Am Acad Orthop Surg. 2008 Oct;16(10):559-565.

Mroz TE, Yamashita T, Davros WJ, Lieberman IH. Radiation exposure to the surgeon and the patient during kyphoplasty. J Spinal Disord Tech. 2008 Apr;21(2):96-100.

Schofferman J, Mazanec D. Evidence-informed management of chronic low back pain with opioid analgesics. Spine J. 2008 Jan-Feb;8(1):185-194.

Steinmetz MP, Patel R, Traynelis V, Resnick DK, Anderson PA. Cervical disc arthroplasty compared with fusion in a workers’ compensation population. Neurosurgery. 2008 Oct;63(4):741-747.

Steinmetz MP, Rajpal S, Trost G. Segmental spinal instrumentation in the management of scoliosis. Neurosurgery. 2008 Sep;63(3 Suppl):131-138.

Studer RK, Gilbertson LG, Georgescu H, Sowa G, Vo N, Kang JD. p38 MAPK inhibition modulates rabbit nucleus pulposus cell response to IL-1. J Orthop Res. 2008 Jul;26(7):991-998.

Vadala G, Studer RK, Sowa G, Spiezia F, Iucu C, Denaro V, Gilbertson LG, Kang JD. Coculture of bone marrow mesenchymal stem cells and nucleus pulposus cells modulate gene expression profile without cell fusion. Spine. 2008 Apr 15;33(8):870-876.

Vadala G, Sobajima S, Lee JY, Huard J, Denaro V, Kang JD, Gilbertson LG. In vitro interaction between muscle-derived stem cells and nucleus pulposus cells. Spine J. 2008 Sep;8(5):804-809.

Watters WC III, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, Reitman CA, Shaffer WO, Summers JT, Toton JF. Degenerative lumbar spinal stenosis: an evidence-based clinical guideline for the diagnosis and treatment of degenerative lumbar spinal stenosis. Spine J. 2008 Mar-Apr;8(2):305-310.

Neurosurgical Anesthesiology

Bala E, Sessler DI, Nair DR, McLain R, Dalton JE, Farag E. Motor and somatosensory evoked potentials are well maintained in patients given dexmedetomidine during spine surgery. Anesthesiology. 2008 Sep;109(3):417-425.

Cata JP, Noguera EM, Parke E, Ebrahim Z, Kurz A, Kalfas I, Mascha E, Farag E. Patient-controlled epidural analgesia (PCEA) for postoperative pain control after lumbar spine surgery. J Neurosurg Anesthesiol. 2008 Oct;20(4):256-260.

Elkassabany NM, Bhatia J, Deogaonkar A, Barnett GH, Lotto M, Maurtua M, Ebrahim Z, Schubert A, Ference S, Farag E. Perioperative complications of blood brain barrier disruption under general anesthesia: a retrospective review. J Neurosurg Anesthesiol. 2008 Jan;20(1):45-48.

Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, Schurigyn T, Farag E. Perioperative events during deep brain stimulation: the experience at Cleveland Clinic. J Neurosurg Anesthesiol. 2008 Jan;20(1):36-40.

Maurtua MA, Deogaonkar A, Bakri MH, Mascha E, Na J, Foss J, Sessler DI, Lotto M, Ebrahim Z, Schubert A. Dosing of remifentanil to prevent movement during craniotomy in the absence of neuromuscular blockade. J Neurosurg Anesthesiol. 2008 Oct;20(4):221-225.


Education 51

Neurological Institute physicians direct the core neuroscience

curriculum for approximately 120 medical students annually at

Cleveland Clinic Lerner College of Medicine. They also share

valuable information with the public on the latest neurological

advances.

This commitment to education was expressed in new forms in

2008, including presentation of the first Neurological Institute

Research Day.

Medical Professionals

Continuing Medical Education

The Center for Continuing Education is responsible for one

of the world’s largest, most diverse CME programs. In 2008,

more than 15,000 professionals participated in more than

250 Neurological Institute-sponsored CME programs, rang-

ing from weekly grand rounds in six departments to multi-day

international symposia, regional programs, association meetings,

guest lectures and training courses.

The center’s efforts to expand CME opportunities through non-

traditional learning were highly successful in 2008, when

2,087 certificates were issued for completion of online neuro-

logical courses. The number represents a 60 percent increase

over 2007.

Graduate Medical Education

The Neurological Institute offers approximately 30 accredited

and non-accredited training programs providing physician

education and research opportunities in neurology, neurosur-

gery, psychiatry and psychology. Residents and fellows work side

by side with some of the world’s most renowned experts in the

neurosciences.

Core residency programs accredited by the Accreditation Council

for Graduate Medical Education (ACGME) encompass adult

neurology, child neurology, neurosurgery, adult psychiatry, and

child and adolescent psychiatry. ACGME-accredited subspecialty

fellowships and non-accredited fellowships are also available.

Research fellowships are offered for MDs and PhDs interested in

clinician/scientist careers.

Neurological Institute Research Day

In 2008, the Neurological Institute inaugurated Research Day,

a forum showcasing the projects of medical students, residents,

and clinical, research and post-doctoral fellows. Participants

made 74 poster and platform presentations and competed for

recognition awards at the event, which was judged by an interdis-

ciplinary team of Neurological Institute staff members.

Education

The Neurological Institute collaborates with Cleveland Clinic’s Center for Continuing Education to offer a highly

regarded series of continuing medical education (CME) programs to physicians and other healthcare professionals. In

addition, the institute provides extensive graduate medical education opportunities, training some 170 clinical and

research fellows and residents annually and hosting approximately 70 international and national physician-observers

each year.

Left: Residents review anatomy in the Spine Research Laboratory. The Neurological Institute offers almost 30 training programs in neurology, neuro-surgery, psychiatry and psychology, enabling residents and fellows to learn from some of the world’s most renowned experts in the neurosciences.


52 Education

For the presenters, Research Day was an opportunity to share

their work and obtain helpful feedback, hone their writing and

presentation skills, find new resources and collaborators, and

earn recognition from mentors and peers. Participant Adrian

Zachary, DO, MPH, alluded to a “feeling of honor presenting

research.”

For the physician-judges, Research Day reinforced “an under-

standing of our excellence,” in the words of Edward Benzel,

MD. The event also inspired appreciation of and respect for the

presenters and their work. Chief Resident Joyce Lee, MD, spoke

for many when she remarked on “the amount of research gener-

ated by the residents in the NI — as busy as they are, they still

manage to find the time to generate amazing research studies

and papers.”

Twelve presenters received awards for their work. Leopoldo

Pozuelo, MD, was honored as the Neurological Institute

Cleveland Clinic Lerner College of Medicine Teacher of the Year.

Ultimately, the experience fostered a sense of community within

the institute and exposed participants to methodologies that

specialty areas outside their own apply to answer research ques-

tions. Attendees commented on the general enthusiasm and the

opportunity to communicate across departments. The strongest

testimonials came from presenters who said they looked forward

to taking part in Research Day 2009.

Patients and the Public

Through a range of communication channels, Neurological Insti-

tute physicians and allied health professionals connect with the

community, sharing information on specific neurological condi-

tions, answering common questions, and helping patients and

family members cope with challenging diagnoses and diseases.

Among the most popular forums are:

• Health Talks, which are free educational seminars at Cleveland

Clinic’s main campus and Cleveland Clinic family health cen-

ters throughout northeast Ohio. Recent sessions have focused

on management of pituitary disorders, Parkinson’s disease and

wellness, and treatment options for chronic back pain.

• Live web chats with physicians who discuss a variety of neuro-

logical disorders, diagnoses and therapeutic options. Topics

have included medical management of back pain, pediatric

brain tumor, neurofibromatosis, multiple sclerosis, sleep disor-

ders, adult scoliosis and memory loss.

• Gatherings that forge lasting bonds, such as the Pediatric Epi-

lepsy Support Group’s second biennial reunion for children

who underwent epilepsy surgery at Cleveland Clinic and their

families. The two-day event in August 2008 drew 280 attend-

ees from as far away as Ireland and South Africa. Educational

as well as social, the reunion featured physician-led sessions for

patients’ caregivers that focused on life after epilepsy surgery.

The first Neurological Institute Research Day, showcasing the work of medical students, residents and clinical fellows.


Education 53

Music and the Brain

Can music speed the healing process? Should musicians and

neuroscientists collaborate on healing techniques? Questions

like these were addressed during “Music and the Brain,” three

public programs presented jointly by the Neurological Institute

and the Arts and Medicine Institute, in partnership with the U.S.

Department of Health and Human Services and The Cleveland

Orchestra. The innovative series began at Cleveland Clinic and

unfolded on an international stage, drawing a total of more than

500 participants:

• ClevelandClinic’s“Doctor-PatientMusicConnection,”

which aims to improve medical care by raising the level of the

physician-patientrelationshipthroughtheperformingarts,

presented a piano and chamber music recital performed by

physicians and patients. A reception followed the event, which

was designed primarily for patients and their families.

• Twodayslater,aconcert-symposiumon“neuromusic”

explored the relationship between music and the physiological

andpathologicalprocessesinthenervoussystem.Co-directed

byKamalChémali,MD,andNeilCherian,MD,theday-

long event featured lectures by nationally recognized experts,

including Neurological Institute physicians. The session,

offered for CME credit, attracted medical professionals as well

as musicians. The day concluded with a panel discussion and

piano recital at the Cleveland Institute of Music.

• ClevelandClinicandTheClevelandOrchestrajoinedforces

for a symposium at the Salzburg Festival in Austria, where a

panel of international experts examined new understanding

about the intersection of music and neuroscience, the effect of

musiconhealthandthebrain’simpactonmusicalability.The

program launched a collaboration between two world leaders

in medicine and music.

The Pediatric Epilepsy Support Group offers families of children with epilepsy a forum for education, discussion and camaraderie.


New Staff 55

Due to its clinical expertise, academic achievement and

research capabilities, the Neurological Institute has earned an

international reputation, and continues to attract elite clinicians

and scientists who aspire to be affiliated with one of the world’s

premier medical centers.

In 2008, the following professionals joined the Neurological

Institute staff:

Lou Ruvo Center for Brain Health

Randolph B. Schiffer, MD, neurologist/psychiatrist, Director


Rishi Gupta, MD, vascular and interventional neurologist

Ferdinand Hui, MD, interventional neuroradiologist

Shaye Moskowitz, MD, PhD, endovascular neurosurgeon

Epilepsy Center

Juan Bulacio, MD, clinical neurophysiologist

Jorge Gonzalez-Martinez, MD, PhD, neurosurgeon

Stephen Hantus, MD, epileptologist

John Mosher, PhD, neuroscientist, Section Head

of the magnetoencephalography program

Diosely Silveira, MD, PhD, epileptologist

Lerner Research Institute

James Kaltenbach, PhD, neuroscientist, Department of

Neurosciences and Cleveland Clinic Head and Neck Institute

Jeremy Rich, MD, neurologist, Chairman of the Department

of Stem Cell Biology and Regenerative Medicine


Deborah Tepper, MD, internist

Stewart Tepper, MD, neurologist


Anwar Ahmed, MD, neurologist


Sheila Rubin, MD, neurologist

Jennifer Ui, MD, neurologist

Joseph Zayat, MD, neurologist


Sally Ibrahim, MD, sleep specialist


Tagreed Khalaf, MD, medical spine specialist


Joseph Austerman, DO, psychiatrist

New Staff

The lifeblood of any organization is its people. Cleveland Clinic Neurological Institute includes more than 250

medical, surgical and research specialists dedicated to the diagnosis, treatment and understanding of all neurological

conditions affecting adult and pediatric patients.

Left: Sally Ibrahim, MD, sees both adult and pediatric patients with sleep disorders. Reflecting the scope of the Sleep Disorders Center’s capabilities, she treats a wide range of conditions, including sleep apnea, disorders of excessive daytime sleepiness, circadian rhythm disorders, restless legs syndrome and parasomnias.


56 Neurological Institute

Neurological Institute Chairmen


Chairman, Neurological Institute

William Bingaman, MD

Vice Chairman, Clinical Areas,

Neurological Institute

Richard Rudick, MD

Vice Chairman, Research and

Development, Neurological Institute

Edward Benzel, MD

Chairman, Department of

Neurological Surgery

Kerry Levin, MD

Chairman, Department of Neurology

Vernon Lin, MD, PhD


Physical Medicine and Rehabilitation

Thomas Masaryk, MD


Diagnostic Radiology

George E. Tesar, MD


Psychiatry and Psychology

Bruce Trapp, PhD


Neurosciences, Lerner Research Institute

Staff

Lou Ruvo Center for Brain Health

Randolph B. Schiffer, MD

Director, Lou Ruvo Center for

Brain Health

Charles Bernick, MD

Cynthia S. Kubu, PhD, ABPP-CN

Richard Naugle, PhD

Michael Parsons, PhD

Alexander Rae-Grant, MD, FRCP (C)

Stephen Rao, PhD

Director, Schey Foundation Center for

Advanced Cognitive Function

Patrick Sweeney, MD

Janice Zimbelman, PT, PhD


Gene Barnett, MD, FACS

Director, Brain Tumor and

Neuro-Oncology Center

Manmeet Ahluwalia, MD

Lilyana Angelov, MD, FRCS(C)

Samuel Chao, MD

Bruce H. Cohen, MD

Joung Lee, MD

David Peereboom, MD

Jeremy Rich, MD

Burak Sade, MD

Glen Stevens, DO, PhD

John Suh, MD

Tanya Tekautz, MD

Michael Vogelbaum, MD, PhD

Robert Weil, MD


Peter Rasmussen, MD

Director, Cerebrovascular Center

Neil Friedman, MBChB

James Gebel, MD

Rishi Gupta, MD

Ferdinand Hui, MD

Irene Katzan, MD, MS

Gwendolyn Lynch, MD

Edward Manno, MD

Thomas Masaryk, MD

Shaye Moskowitz, MD, PhD

J. Javier Provencio, MD, FCCM

Vivek Sabharwal, MD

Ken Uchino, MD

Epilepsy Center

Imad Najm, MD

Director, Epilepsy Center

Andreas Alexopoulos, MD, MPH

Jocelyn Bautista, MD

William Bingaman, MD

Juan Bulacio, MD

Richard Burgess, MD, PhD

Robyn Busch, PhD

Jessica Chapin, PhD

Tatiana Falcone, MD

Nancy Foldvary-Schaefer, DO

Paul Ford, PhD

Jorge Gonzalez-Martinez, MD, PhD

Ajay Gupta, MD

Stephen Hantus, MD

Jennifer Haut, PhD, ABPP-CN

Lara Jehi, MD


Neurological Institute 57

Patricia Klaas, PhD

Prakash Kotagal, MD

Deepak Lachhwani, MBBS, MD

John Mosher, PhD

Dileep Nair, MD

Richard Naugle, PhD

Paul Ruggieri, MD

Diosely Silveira, MD, PhD

Norman So, MD

Andrey Stojic, MD, PhD

George E. Tesar, MD

Ingrid Tuxhorn, MD

Elaine Wyllie, MD

Mellen Center for Multiple Sclerosis

Treatment and Research

Richard Rudick, MD

Director, Mellen Center for Multiple

Sclerosis Treatment and Research

Robert Bermel, MD

Francois Bethoux, MD

Adrienne Boissy, MD

Jeffrey Cohen, MD

Robert Fox, MD

Keith McKee, MD

Deborah Miller, PhD

Alexander Rae-Grant, MD, FRCP (C)

Richard M. Ransohoff, MD

Mary Rensel, MD

Lael Stone, MD


Thomas Masaryk, MD

Director, Center for Neuroimaging

Manzoor Ahmed, MD

Todd M. Emch, MD

Stephen E. Jones, MD, PhD

Mark Lowe, PhD

Parvez Masood, MD


Doksu Moon, MD

Micheal Phillips, MD

Paul Ruggieri, MD

Alison Smith, MD

Todd Stultz, DDS, MD

Andrew Tievsky, MD


Andre Machado, MD, PhD

Director, Center for Neurological

Restoration

Anwar Ahmed, MD

Jay Alberts, PhD

Scott Cooper, MD, PhD

Milind Deogaonkar, MD

Darlene Floden, PhD

Ilia Itin, MD


Richard Lederman, MD, PhD

Donald A. Malone Jr., MD

Cameron McIntyre, PhD

Mayur Pandya, DO

Patrick Sweeney, MD

Jerrold Vitek, MD, PhD

Center for Pediatric Neurology and

Neurosurgery

Elaine Wyllie, MD

Director, Center for Pediatric Neurology

Mark Luciano, MD, PhD

Director, Center for Pediatric

Neurosurgery

Bruce H. Cohen, MD

Xiao Di, MD, PhD

Stephen Dombrowski, PhD

Gerald Erenberg, MD


Debabrata Ghosh, MD, DM

Gary Hsich, MD

Irwin Jacobs, MD

Sudeshna Mitra, MD

Manikum Moodley, MD

Sumit Parikh, MD

A. David Rothner, MD

Tanya Tekautz, MD


Edward Covington, MD

Director, Neurological Center for Pain

Cynthia Bamford, MD

Neil Cherian, MD

Steven Krause, PhD, MBA

Jennifer Kriegler, MD

Robert Kunkel, MD

Jahangir Maleki, MD, PhD

MaryAnn Mays, MD

Judith Scheman, PhD

Mark Stillman, MD

Deborah Tepper, MD

Stewart Tepper, MD


Kerry Levin, MD

Director, Neuromuscular Center

Mohammad Alsharabati, MD

Kamal Chémali, MD


Rebecca Kuenzler, MD


Erik Pioro, MD, PhD

David Polston, MD

Robert Shields Jr., MD

Steven Shook, MD

Jinny Tavee, MD

Lan Zhou, MD, PhD


58 Neurological Institute

Right: Epilepsy Center Director Imad Najm, MD, right, confers with William Bingaman, MD, Vice Chairman, Clinical Areas, Neurological Institute, at a patient management conference. These sessions bring center staff together to discuss patients suitable for epilepsy surgery.

General Adult Neurology

Kerry Levin, MD

Chairman, Department of Neurology

Thomas E. Gretter, MD


Patrick Sweeney, MD

Department of Physical Medicine

and Rehabilitation

Vernon Lin, MD, PhD

Chairman, Department of Physical

Medicine and Rehabilitation

Michael Felver, MD

Medical Director, Center for Rehabilitation and Subacute Services

Steven Landers, MD, MPH

Medical Director, Home Care Services

Raghavendra Allareddy, MD

Frederick Frost, MD

Sepideh Haghpanah, MD

Juliet Hou, MD

Lynn Jedlicka, MD

Anantha Reddy, MD

Kalyani Shah, MD

Deborah Venesy, MD


George E. Tesar, MD

Chairman, Department of Psychiatry

and Psychology

Donald A. Malone Jr., MD

Director, Center for Behavioral Health

Susan Albers-Bowling, PsyD

Kathleen Ashton, PhD

Joseph M. Austerman, DO

Scott Bea, PsyD

Dana Brendza, PsyD

Karen Broer, PhD

Robyn Busch, PhD

Jessica Chapin, PhD

Kathy Coffman, MD

Gregory Collins, MD

Edward Covington, MD

Roman Dale, MD

Beth Dixon, PsyD

Judy Dodds, PhD

Tatiana Falcone, MD

Darlene Floden, PhD

Kathleen Franco, MD

John P. Glazer, MD

Lilian Gonsalves, MD

J. Robert Gribble, PhD

Jennifer Haut, PhD, ABPP-CN

Leslie Heinberg, PhD

Karen Jacobs, DO

Joseph W. Janesz, PhD, LICDC

Regina Josell, PsyD

Elias Khawan, MD

Patricia Klaas, PhD

Steven Krause, PhD, MBA


Michael McKee, PhD

Gene Morris, PhD

David J. Muzina, MD

Richard Naugle, PhD

Mayur Pandya, DO

Michael Parsons, PhD

Leo Pozuelo, MD

Kathleen Quinn, MD

Ted Raddell, PhD

Judith Scheman, PhD

Isabel Schuermeyer, MD

Jean Simmons, PhD

Barry Simon, DO

Catherine Stenroos, PhD

David Streem, MD

Adele Viguera, MD

John Vitkus, PhD

Cynthia White, PsyD

Amy Windover, PhD


Stephen Samples, MD

Director, Center for Regional Neurology

Mohammad Alsharabati, MD

A. Romeo Craciun, MD

Director, Stroke Center,

Marymount Hospital

James Gebel, MD

Sheila Rubin, MD

Roderick Spears, MD

Andrey Stojic, MD, PhD

Diana Tanase, MD

Jennifer Ui, MD

Joseph Zayat, MD

Center for Regional Neurological Surgery

Michael Mervart, MD

Director, Center for Regional

Neurological Surgery

Samuel Borsellino, MD

Roseanna Lechner, MD

Samuel Tobias, MD

92877_NeuroARText_Wt.indd 59 11/3/09 2:41 PM


Left: Neurologists work side by side with neurosurgeons, behavioral health specialists and researchers in the Neurological Institute, providing the highest-quality care for patients and an enhanced educational experience for physicians in training.


Nancy Foldvary-Schaefer, DO

Director, Sleep Disorders Center

Loutfi Aboussouan, MD

Kathleen Ashton, PhD

Charles Bae, MD

A. Romeo Craciun, MD

Michelle Drerup, PsyD

Sally Ibrahim, MD

Alan Kominsky, MD

Jyoti Krishna, MD

William Novak, MD

Carlos Rodriguez, MD


Gordon Bell, MD

Director, Center for Spine Health

Edward Benzel, MD

Edwin Capulong, MD

Russell DeMicco, DO

Lars Gilbertson, PhD

Augusto Hsia Jr., MD

Serkan Inceoglu, PhD

Iain Kalfas, MD

Tagreed Khalaf, MD

Ajit Krishnaney, MD

Daniel Mazanec, MD

Robert McLain, MD

Thomas Mroz, MD

R. Douglas Orr, MD

Judith Scheman, PhD

Richard Schlenk, MD

Michael Steinmetz, MD

Santhosh Thomas, DO, MBA

Fredrick Wilson, DO

Adrian Zachary, DO, MPH

Neuroanesthesiology

Rafi Avitsian, MD

Section Head, Neurosurgical and Spine

Surgery Anesthesiology

Section Head, Neuro-endovascular

Anesthesiology

Zeyd Ebrahim, MD

O.R. Clinical Director

Armin Schubert, MD


General Anesthesiology

Ehab Farag, MD, FRCA

Paul Kempen, MD, PhD

Jia Lin, MD, PhD

Mariel Manlapaz, MD

Marco Maurtua, MD

Stacy Ritzman, MD

Vivek Sabharwal, MD

Gloria Walters, MD


Department of Neurosciences

Bruce Trapp, PhD


Neurosciences, Lerner Research Institute

Cornelia Bergmann, PhD

Jianguo Cheng, MD, PhD

James Kaltenbach, PhD

Hitoshi Komuro, PhD

Bruce Lamb, PhD

Yu-Shang Lee, PhD

Ching-Yi Lin, PhD

Yoav Littner, MD

Sanjay W. Pimplikar, PhD

Erik Pioro, MD, PhD

J. Javier Provencio, MD, FCCM

Richard M. Ransohoff, MD

Director, Neuroinflammation Research

Center, Lerner Research Institute

Susan Staugaitis, MD, PhD

Michael Steinmetz, MD

Stephen Stohlman, PhD

Jerrold Vitek, MD, PhD

Riqiang Yan, PhD

Lan Zhou, MD, PhD


Biomedical Engineering

Jay Alberts, PhD

Elizabeth Fisher, PhD

Aaron Fleischman, PhD

Cameron McIntyre, PhD


Cell Biology

Damir Janigro, PhD

Pathology and Laboratory Medicine

Institute Anatomic Pathology

Richard Prayson, MD

Neurological Institute 61


62 Cleveland Clinic Information

Neurological Institute

24/7 hospital transfers or physician consults 800.553.5056

Neurological Institute Contact Center

Centralized scheduling that allows patients to make appointments with any Neurological Institute physician at any location

216.636.5860 or toll-free 866.588.2264

Web

clevelandclinic.org/neuroscience

Services for Physicians

Physician Directory View all Cleveland Clinic staff online at clevelandclinic.org/staff.

Physician Liaison Referring physicians have a direct and personal link to Cleveland Clinic with our Physician Liaison. For help with any interaction involving Cleveland Clinic, contact Physician Liaison Kate Kenny at clevelandclinic.org/ContactKate.

Critical Care Transport Worldwide Cleveland Clinic’s critical care transport team serves critically ill and highly complex patients across the globe. The transport fleet comprises mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed by physicians, critical care nurse practitioners, critical care nurses, paramedics and ancillary staff, and are customized to meet the needs of the patient. Critical care transport is available for children and adults.

To arrange a transfer for acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage), STEMI (ST elevated myocardial infarction) or aortic syndromes, call 877.379.CODE (2633).

For all other critical care transfers, call 216.444.8302 or 800.553.5056.

Track Your Patient’s Care Online Whether you are referring from near or far, DrConnect offers secure access to your patient’s treatment progress at Cleveland Clinic. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

Outcomes Data Available The latest Outcomes book from the Cleveland Clinic Neurologi-cal Institute is available. Our Outcomes books contain clinical outcomes data and information on volumes, innovations, research and publications. To view Outcomes books for many Cleveland Clinic institutes, visit clevelandclinic.org/quality.

CME Opportunities Live and Online Cleveland Clinic’s Center for Continuing Education’s website, clevelandclinicmeded.com, offers convenient, complimentary learning opportuni-ties, from webcasts and podcasts to a host of medical publications and a schedule of live CME courses. Many live CME courses are hosted in Cleveland, an economical option for business travel. Physicians can manage their CME credits by using the myCME Web Portal, available 24/7.

Services for Patients

Remote Consults Request a remote medical second opinion from Cleveland Clinic. MyConsult is particularly valuable for patients who wish to avoid the time and expense of travel. Visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext. 43223.

Medical Concierge Complimentary assistance for out-of-state patients and families,800.223.2273, ext. 55580, or email [email protected].

Global Patient Services Complimentary assistance for national and international patients and families, 001.216.444.8184 or visit clevelandclinic.org/gps.

Stay Connected to Cleveland Clinic

Contents

02 C H A I R M A N ’ S W E L C O M E

04 C L E V E L A N D C L I N I C N E U R O L O G I C A L I N S T I T U T E O V E R V I E W

10 O U R C E N T E R S

22 PAT I E N T C A R E

24 C O M M U N I T Y C A R E

26 2 0 0 8 O U T C O M E S

30 T E C H N O L O G Y A N D I N N O VAT I O N

38 R E S E A R C H

50 E D U C AT I O N

54 N E W S TA F F

56 N E U R O L O G I C A L I N S T I T U T E S TA F F

62 S E R V I C E S F O R P H Y S I C I A N S A N D PAT I E N T S

On the cover: Neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, joined the Neurological Institute’s Epilepsy Center in 2008. Subsequently, he performed North America’s first stereoelectroencephalography (SEEG) procedure, which opens the possibility of new treatment options for patients with intractable focal epilepsy.

The Neurological Institute is one of 26 institutes at Cleveland Clinic that group multiple

specialties together to provide collaborative, patient-centered care. The institute is a

leader in treating the most complex neurological disorders, advancing innovations such as

deep brain stimulation, epilepsy surgery, stereotactic spine radiosurgery and blood-brain

barrier disruption. Annually, our staff of more than 250 specialists serves 140,000 patients

and performs 7,500 surgeries. Cleveland Clinic is a nonprofit multispecialty academic

medical center, consistently ranked among the top hospitals in America by U.S.News &

World Report. Founded in 1921, it is dedicated to providing quality specialized care and

includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education

institute and a research institute.

Cleveland Clinic ©2009

DESIGN: Chip Valleriano | EDITOR: Terry Pederson | MARKETING: Colleen Burke, Kim Kerver, Cathy Luck, Jennifer Lynch, Laura Vasile

PHOTOGRAPHY: Ken Baehr, Al Fuchs, Don Gerda, Neil Lantzy, Russell Lee, Yu Kwan Lee, Willie McAllister, Tom Merce, Steve Travarca

PRINT PRODUCTION: Paul DurrantCert no. SW-COC-002546

Neurological Institute 2008 Annual Report

Cleveland C

linic Neurological Institute 2

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8 A

nnual Report

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