Giving Back People’s LivesDiseases of the brain and nervous system can be devastating. They can leave people unable to walk, unable to talk. Incapable of doing their jobs or getting a good night’s sleep. Powerless to remember faces or simply hold the people they love.
In the not-too-distant past, there was little physicians could do for patients with most neurological diseases. Take stroke, for example. Safwan Jaradeh, MD, Medical College of Wisconsin neurologist and chair of Neurology, put it in a nutshell: “Years ago, if you had a stroke, the neurologist could diagnose you, but could offer little else.”
Today, that outlook has changed dramatically. “Now, a stroke is like a heart attack — something we can treat,” Dr. Jaradeh said. In fact, if a stroke victim gets to the hospital fast enough, physicians can often use a catheter device to literally pull stroke-causing blood clots out of the patient’s brain.
That’s just one of the remarkable treatments now available at the Froedtert & theMedical College of Wisconsin Neurosciences Center. Thanks to scores of recent advances, physicians here are helping patients with neurological problems get back on their feet, back to work and back to family and friends.
Common Conditions, New OptionsThe Neurosciences Center is built around expert physicians who provide leading-edge care to patients with complex neurological diseases. These specialists use advanced interventions to treat the full range of brain, spine, nervous system and muscular disorders. The range of these disorders is wider than many people think.
“Neurological diseases are incredibly common,” Dr. Jaradeh said. Stroke, he noted, is the third leading cause of death in the United States. Spinal problems are the second leading cause of disability. One of every 10 Americans lives with nerve pain, numbness or weakness in the limbs. (This is called peripheral neuropathy.) Two in 10 suffer from sleep disorders – half of which, like restless legs syndrome, have neurological causes. Other neurological diseases include degenerative diseases such as Parkinson's disease or Alzheimer's disease, brain tumors, epilepsy, multiple sclerosis, neuromuscular diseases such as muscular dystrophy, and autonomic disorders like excessive sweating and fainting.
While the list is long, there is good news about many of these conditions: where once patients had little hope, they now have options.
Dr. Jaradeh has witnessed the change. “As a neurologist, I know I can treat these diseases better than I did 10 years ago — and 10 years ago I could treat them better than 10 years before that,” he said. “I’ve seen changes, and there is no question. There are many more choices now and they are better.”
Epilepsy: Regaining IndependenceSome of the biggest changes have occurred in epilepsy care. Twenty years ago, there were only three anti-epileptic drugs. Epilepsy surgery was attempted only when a patient also had a brain tumor or a large cyst. Today, the story is different.
One person who knows this firsthand is Chris Winkels of Oconomowoc. Chris had his first seizure when he was a high school sophomore. In the years that followed, doctors prescribed several anti-seizure medications.
Although there are now more than a dozen effective drugs for epilepsy, none worked well for Chris. By his early 20s, he was having seizures almost daily. He had to give up his driver’s license, and his medications made him feel tired all the time. Earlier this year, Chris turned to the Froedtert & the Medical College Comprehensive Epilepsy Program.
The Comprehensive Epilepsy Program specializes in treating patients whose illness is difficult to control with medications. It is regarded as one of the top 10 epilepsy programs in the country and includes a team of neurologists, neurosurgeons, neuropsychologists and radiologists who are all involved in developing the best treatment approach for each individual. Chris worked with Wade Mueller, MD, a Medical College of Wisconsin neurosurgeon who is a nationally recognized authority on epilepsy surgery. After a series of tests and evaluations, Chris's physician team determined he was a good candidate for surgery.
The surgery had two parts. First, Dr. Mueller implanted a strip of electrodes directly on the surface of Chris’s brain. This allowed the care team to pinpoint the exact location of the seizure activity. A few days later, Chris underwent a second operation in which Dr. Mueller removed the part of the brain causing the seizures.
Chris is now completely seizure-free. He has regained his driver’s license, feels more energetic than ever and is back to work at full speed. “I’m feeling excellent now,” he said. “The surgery is the best thing that ever happened to me.”
Focus on Return to WorkReducing disability is a focus of the Neurosciences Center and treating spinal cord injury is one of the center’s priorities.
The Spinal Cord Injury Center at Froedtert & the Medical College is recognized as one of the top five of its kind in the nation. In fact, physicians who have received advanced specialty training through fellowships at Froedtert & the Medical College have gone on to lead other major spinal cord injury programs across the country.
The spine specialists at the Neurosciences Center play an important role in caring for injured patients treated at the Froedtert & the Medical College Trauma Center. They also focus on a broader population through the innovative SpineCare Program. Dennis Maiman, MD, PhD, Medical College of Wisconsin neurosurgeon, explained what makes the SpineCare Program different.
“Most care for spinal problems is episodic. The patient does a little here, a little there — medications, chiropractor, therapy — but the foundation of the pathology remains unrecognized.” SpineCare, Dr. Maiman said, provides an organized, multidisciplinary approach to spine and back problems. “We look at a patient from all different perspectives and then put together a coordinated program. As a result, we achieve much better outcomes,” he said. “Our surgical rate is dramatically lower than average, and our return-to-work rate is probably double the average.”
One reason for SpineCare’s success is that it emphasizes patient involvement. “We want to help patients establish responsibility for their own problems,” Dr. Maiman said. At SpineCare, patients learn strategies for getting better, staying better and taking care of recurrences without resorting to a doctor or the emergency room. “There is so much you can do to get healthy that does not require an insurance card.”
Fully Integrated, Start to FinishOne thing that sets the Neurosciences Center apart is its emphasis on comprehensive care. Physicians have advanced fellowship training in all aspects of neurological disease and provide a complete range of services, from diagnostics and treatment, through surgical care, to rehabilitation, recovery and ongoing monitoring.
A highlight is the Neurosciences Center’s dedicated Neuro Intensive Care Unit, or NICU. By providing specialized critical care for neurological patients, the NICU improves patient outcomes and reduces the length of hospital stays.
Patients also have access to specialized rehabilitative care. “Our rehabilitation services are well-integrated with the Neurosciences Center,” said John McGuire, MD, Medical College of Wisconsin physical medicine and rehabilitation specialist. “We offer the whole array of rehabilitation services related to neurological patients, and we get involved in the care of injured patients very early in the process.”
Services include physical, occupational and speech therapy, psychological services and other support care. The program also offers cutting-edge therapies involving electrical stimulation technology, including an experimental device that has helped some stroke and brain injury patients regain a degree of arm movement.
“What makes this place unique is that it truly is multidisciplinary,” Dr. McGuire said. “The departments all work together, and the way the hospital is set up, you can have the same team manage the patient from acute injury, through the NICU and through inpatient rehabilitation. Froedtert & the Medical College are among few places in the country where you have this level of continuity.”
Research Puts Patients AheadWhile patients benefit from integrated care, they also profit from the fact that their physicians are active in patient care and research. “There is a back and forth interplay between what we learn from patients and what we learn in the lab,” said Thomas Gennarelli, MD, Medical College of Wisconsin neurosurgeon and chairman of Neurosurgery. “It is unique. This is one of the few places in the country where this happens.”
Medical College of Wisconsin scientists helped pioneer the use of functional magnetic resonance imaging (fMRI) to locate critical brain tissues, including structures that enable speech and memory. Surgical patients at Froedtert & the Medical College were among the first in the world to benefit from this advance. “Thanks to tissue tracking with fMRI, brain surgery is now safer,” Dr. Gennarelli said.
Medical College of Wisconsin physicians at the Neurosciences Center are also actively involved in studying brain trauma. “We now have a better understanding of the mechanism of brain injury,” Dr. Gennarelli explained. “Years ago, we thought that when a patient hit a windshield or fell off a ladder, the damage was done and there wasn’t much you could do.”
That viewpoint has changed fundamentally in just the last five years. “We now understand brain injury is a series of events that is not complete for hours, days or weeks,” he said. “Our focus now is on finding ways to interrupt the process, hopefully to repair the injury, but at least to keep it from progressing.”
Closing in on the TargetAs science’s understanding of the brain advances, physicians are getting closer to treating neurological problems at the very root. One striking example is a procedure called deep brain stimulation (DBS). Over the last few years, physicians from the Neurosciences Center at Froedtert & the Medical College have used DBS to treat hundreds of people with Parkinson’s disease.
Jerilynn Boettner, 55, of Sheboygan is one of them. Like others with Parkinson’s disease, her medications became less effective over the years. The turning point came when Jerilynn found she could barely hold her baby granddaughter. That’s when she decided to explore DBS.
In the DBS procedure, surgeons implant a thin electrode in the patient’s brain at a target spot that controls the symptoms of Parkinson’s. An implanted battery pack provides low-level stimulation, which has the effect of normalizing the brain’s electrical flow. For the right patients, DBS can result in reduced symptoms and less medication.
Jerilynn’s surgery took place at the Froedtert & the Medical College in June 2006. During the procedure, her surgical team placed implants on both sides of her brain. The entire procedure lasted eight hours. Jerilynn was awake part of the time. “There was no pain because the brain can’t feel pain,” she said. “When they finished one side, they wanted to know if my movements were more fluid. They brought me ‘out’ of anesthesia to better determine my status.”
Almost a Miracle
For Jerilynn, DBS worked wonders. Her symptoms have subsided and her physician reduced her medications by 75 percent. “I take the lowest dose you can get prescribed,” she said. Best of all, Jerilyn is looking forward to traveling to Florida this fall to hold her second grandchild in her arms.
Jerilynn’s husband, Phil, said the transformation has been remarkable. “It’s almost a miracle to see how the surgery changed her,” he said.
Jerilynn agrees. “It gave me my life back.”
Source: Froedtert Today
Date: October 2007