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In This Issue
Neuroscience Institute: Neurology, Neurosurgery and Neuro-Endoscopy
Fall 2015
Eliminating facial pain with
endoscopic microvascular
decompression
Peter Jannetta, MD,
persists with discovery
and inspiration
MS study sheds light on
highly effective drug
ALS Center provides
quality of life at AHN
New drugs may prevent
migraines from ever starting
Neuroscience
Institute
Innovative Epilepsy
Monitoring Unit a
breakthrough in
diagnosis and treatment
AHN.org/Neuro
Allegheny Health Network
Neuroscience Institute
Volume 1, Issue 1
Publisher
Donald Whiting, MD
System Chair, AHN Neuroscience Institute
AHN Chairman of Neurosurgery
James Valeriano, MD
AHN Chairman of Neurology
Editor
Nestor Tomycz, MD
Marketing Director
Mary Beth Lowery
Writer
Dana Allwein
Graphic Designer
Monika Thimons
Photographers
Alex Jones
Kristin Petersen
1
Contents
Brainwaves is published by the Allegheny
Health Network Neuroscience Institute
in cooperation with the Department of
Marketing and Communications. It is
produced biannually for physicians and
patients interested in the latest diagnostics,
treatments and research at the AHN
Neuroscience Institute.
Chairmen’s Message
2
Minimally Invasive Surgery
for Facial Pain
AHN Neuroscience Institute
Clinical Studies
8
3
Positive Results from MS
Treatment Clinical Trial
Epilepsy Monitoring Unit
for Diagnosis and Treatment
9
4
In the News
11
Peter Jannetta, MD, Profile
5
AHN ALS Center: National
Center of Excellence
New Medications for
Migraine Patients
13
7
High-Tech Surgical Training
Lab at AGH
14
Message from the Chairmen
Medicine is not an individual sport. Teamwork makes medicine more effective because it merges
the great minds of those who share their strengths for the same common goal of restoring a
person’s health and optimism. At the AHN Neuroscience Institute, we are compelling this to
happen by uniting our highly specialized departments into one exceptional establishment where
patients can have every aspect of their disease or condition addressed by some of the finest
experts in neuroscience.
Under the direction of Donald Whiting, MD, AHN System Chair of Neurosurgery, we have
formally integrated the Department of Neurosurgery and Neuro-Endoscopy, the Department
of Neurology, and the Neuroscience Research Center. We will continue to offer innovative
treatments, extensive resources and extremely personalized care to people from all over the
country who suffer with neurological or neurosurgical conditions. Only now, we will carry this out
in a more synergistic style, utilizing the combined and often overlapping talents of physicians to
ensure that each person receives an all-encompassing treatment plan for the best possible results.
This comprehensive approach also makes things easier for our patients. As a strong and vast
network, we can provide people with convenient access to specialists in a timely, conciergestyle fashion. In some cases, a patient can be seen by multiple doctors in a single visit for such
conditions as epilepsy, stroke and movement disorders. And no matter which AHN Neuroscience
Institute location a patient visits, our healthcare team adheres to the best medical practices and
lives up to our stringent objectives of achieving exceptional patient satisfaction and safety.
Finally, one of the most beneficial aspects of our unification is the broadened abilities of our
research endeavors that continually allow for more effective treatments. We can ensure that our
patients are offered clinical trials of new medications, surgeries and devices that sometimes allow
for the most promising chance of improved health.
We are truly excited to venture down this undeniably promising path. Our commitment will be
evident in the months and years to come through the first-rate, team-driven care that is the only
one of its kind in the region. Our team is prepared to serve every person who walks through our
doors looking for restored health and a renewed sense of hope.
Sincerely,
Donald Whiting, MD
System Chairman, AHN Neuroscience Institute
AHN Chairman of Neurosurgery
James Valeriano, MD
AHN Chairman of Neurology
2
Life Without Facial Pain has Florida
Man Smiling Again
The former state auditor blended in with
all the other retirees who enjoyed a life of
sunshine and relaxation in Florida.
Wearing khaki shorts and his customary
Florida State University Seminoles golf shirt,
he walked through his local park, smiled
and nodded to a familiar face with a “good
morning.”
This was a rare good day for Grady Doss.
3
The Tallahassee resident, 69, can smile now
even though memories of the pain aren’t
too distant. In November, 2014, Grady flew
to Allegheny General Hospital in Pittsburgh
with his daughter and son-in-law to meet
with Hae Dong Jho, MD, PhD. They wanted
to discuss the possibility of having Dr. Jho
perform an innovative procedure called
endoscopic microvascular decompression
(MVD).
“I was at a point where
On the majority of
I couldn’t take it
his days, a smile
“That evening following
because the pain was
was difficult, if not
the procedure, I realized
so bad and medication
impossible. Grady had
that
I
could
touch
areas
of
was not helping
to turn away from a
my
face
that
I
hadn’t
been
anymore, not even
morning shower so
a narcotic. Plus, the
able
to
touch
in
years.
I
was
the water didn’t hit
medication made me
his face, and a cool
pain free. The sensation
ill. I started to research
breeze blowing on his
was
completely
gone.”
on the Internet about
face would take his
my condition and
breath away. He had
look for treatments,”
to time eating and
— Grady Doss of Florida
Grady said.
drinking around the
effectiveness of his
He landed upon
pain medication, and
information about MVD and the surgery’s
he brushed his teeth whenever he could
pioneer, Peter Jannetta, MD, neurosurgeon
tolerate the movement.
at the AHN Neuroscience Institute. The
Intense jolts of excruciating facial pain kept
Grady from living life normally for 15 years.
He suffered with a chronic condition called
trigeminal neuralgia – when a blood vessel
presses on the trigeminal nerve, which
carries sensation from the face to the brain.
It can cause bouts of searing, electric shocklike pain in the face without warning, or it
can be triggered by touching specific areas
of the face.
“It’s not predictable at all and even
sometimes just movement would activate
it,” said Grady, who had been unable to fully
enjoy his retired life after spending 35 years
with the Office of the Auditor General of
Florida. “It would start at my right upper lip
then move from my nose to my eye to the
top of my eyebrow. It was debilitating; it
became so frustrating that there were days
I didn’t want to get out of bed and have to
deal with it.”
procedure involves separating the blood
vessel that is pressing on the trigeminal
nerve by placing a felt pad between the
two. Although he retired from surgery two
years ago, Dr. Jannetta still works diligently
on research involving future uses of MVD.
“I saw his website and sent an email asking
for more information,” Grady said. “Then one
morning I got a call from Dr. Jannetta. He
talked to me for a while about my condition
and the procedure. Then he let me know
that Dr. Jho performed the procedure and
in a minimally invasive way that would have
me home in a few days.”
Dr. Jho, who worked alongside Dr. Jannetta
for 20 years, performs MVD but uses
an endoscope instead of an operating
microscope, which allows Dr. Jho to
visualize the procedure through a much
smaller incision.
“Dr. Jannetta’s contribution on microvascular
decompression changed neurosurgical
practice all over the world for decades,” Dr.
Jho said. “I gained so much knowledge and
insight from Dr. Jannetta and was able to
use his surgery to develop a less invasive
approach, which allows patients to recover
more quickly.”
continued on page 4
Hae Dong Jho, MD, PhD, is among only
a handful of surgeons in the country
to perform endoscopic microvascular
decompression.
continued from page 3
Since discovering this minimally invasive
method in 1991, Dr. Jho has applied
endoscopic surgery to a variety of cranial
conditions, including aneurysm and brain
tumors, and also to spine surgeries.
For Grady, it was Dr. Jho’s development of
the endoscopic method that convinced
him to choose Dr. Jho for a consultation,
even though he was 900 miles away. Grady
met with Dr. Jho, and he recommended
that Grady have the surgery the very next
day.
“That evening following the procedure, I
realized that I could touch areas of my face
that I hadn’t been able to touch in years,”
Grady said. “I was pain free. The sensation
was completely gone.”
Dr. Jho explained that Grady’s surgery was
successful, as he returned home in two days
with minor numbness in his face, which has
improved. He expects Grady’s numbness to
be completely gone in a few months.
Back in Florida, Grady rolls down the
window of his car and lets the air hit his face
as he takes in a deep breath. His schedule
no longer revolves around his pain. He
exercises with a therapist in the afternoon,
cares for his elderly mother and has dinners
with his daughter without worrying if the
pain medication will take effect in time to
chew.
“The surgery was a blessing. Sometimes I
still can’t believe that I’m living without pain,
and living again.”
Clinical Trial Drug Shows
Reduction in MS Activity
For more than a decade, physicians at
Allegheny Health Network have been
testing, reconfiguring and improving a
treatment regimen for relapsing multiple
sclerosis (MS). After 13 years, the research
team – as part of a multicenter study –
has determined that no other drug has yet
matched the effectiveness of natalizumab,
a monoclonal antibody that has shown a
70 percent reduction in common measures
of MS activity.
This medication is administered by
intravenous infusion every 28 days and is
designed to reduce flare ups in patients
with relapsing MS and slow the progression
of the disease. It targets white blood cells
that are thought to be responsible for the
inflammatory process that damages myelin
in MS. Natalizumab depletes these cells, and
it’s believed that the cells that regenerate
following treatment will be less harmful to
the nervous system.
“We are proud to have been a principal site
for these trials, and it is through the efforts
of the entire research team that we have
successfully come to the end of this long
road,” said Thomas Scott, MD, director of the
Allegheny Health Network MS Treatment
Center. “Although we have
trialed other agents in the 13
years since our first patient
received natalizumab, none
has yet matched it by efficacy.”
MS is a chronic disease that
affects the nervous system
by damaging myelin, the
protective coating covering
nerves. People with MS
experience progressive
deterioration of myelin which
may result in pain, tingling
Thomas Scott, MD, Director of the AHN MS
Treatment Center
4
or burning sensations, vision loss, mobility
difficulties, muscle spasms or stiffness,
difficulty with balance and speech and
impaired memory and cognitive function.
There are approximately 400,000 people
living in the United States and more
than 2.3 million are affected worldwide,
according to the National Multiple
Sclerosis Society.
Established in 2002, the MS Treatment
Center at Allegheny Health Network
provides care for approximately 2,000
patients each year, making it one of the
largest MS programs in the United States.
The center’s team of physicians, nurses,
and ancillary staff collaborate with physical
therapists and patient educators from
the National Multiple Sclerosis Society to
provide patients with comprehensive care
as well as access to the newest treatments
and clinical trials designed to expand our
knowledge of MS.
continued on page 6
Peter Jannetta, MD
Continuing His Journey of
Neurosurgical Discoveries
Medicine has never been work for
neurosurgeon Peter Jannetta, MD.
The years when he was a teenager in York,
Pa., carrying a hod full with bricks up and
down a ladder, sweating through each
day as a union laborer, that was work,
Dr. Jannetta said.
5
Working with a microscope to find the
blood vessel that was invisible to the
naked eye, Dr. Jannetta entered through
the base of the brain to hoist the blood
vessel off the cranial nerve. He then slid
in scraps of felt to separate the vessel
from the nerve, relieving the patient from
strikingly unbearable pain.
“It was a time that he was in the infancy
Considered one of the pioneers of
of his career, and when he was to learn
modern neurosurgery, Dr. Jannetta, 83,
from his leaders and not challenge the
has dedicated more than half a century to
giving people with significant neurological already established gold standards in
surgery with such
impairments their
an unconventional
lives back. Today,
approach,” said
he continues
“Knowing you’re right
Donald Whiting, MD,
to extend the
about an idea makes you
system chairman,
boundaries of medical
AHN Neuroscience
possibilities at the
smile sweetly at night.
Institute. “Dr.
AHN Neuroscience
Not because I’m saying
Jannetta’s discovery
Institute by devoting
‘Hey, look at me,’
and surgery created
his days to research
but because of what the
such an intense
and thinking outside
the box.
result can do for people.” reaction – from
both proponents
and detractors –
“With medicine, it’s
—
Peter
Jannetta,
MD
but he was very
what I love, and it’s
thorough, educated
my passion. I really
and careful, and had
don’t need a vacation
enough infectious optimism to convince
because being a neurosurgeon and
researching about what more can be done colleagues across the country to also
is something I have always enjoyed. It takes perform the procedure.”
about 20 years to get a new idea across,
On June 1, 1966, Dr. Jannetta completed
and I have another 20 years in me.”
the first microvascular decompression
(MVD) operation and eliminated a 41
Dr. Jannetta began to revolutionize the
year-old man’s facial pain. His revolutionary
face of his specialized medical field in
research was eventually heralded by
1965 when he was just in his 30s as a
colleagues around the world and is now
neurosurgery resident at the University
widely regarded as one of the greatest
of California. His investigations into the
modern-day breakthroughs in the field
cause of trigeminal neuralgia, a condition
of neurological disease, as it has been
of chronic debilitating facial pain, came to
used for other conditions. Dr. Jannetta has
light during an operation when he saw a
performed more than 6,000 procedures of
blood vessel pressing on the nerve that
a similar nature with an overall success rate
transmits sensation from the face to the
that has stood the test of time.
brain.
“Knowing you are right about an idea
makes you smile sweetly at night,” Dr.
Jannetta laughed. “Not because I’m saying
‘Hey, look at me,’ but because of what the
result can do for people.”
Over the years, MVD has been refined
with innovative surgical instruments and
techniques. Hae Dong Jho, MD, PhD,
Director of the AHN Department of
Neuro-Endoscopy, worked with Dr.
Jannetta for decades and was instrumental
in developing minimally invasive
endoscopic brain and spine surgery,
including surgery to treat trigeminal
neuralgia. Dr. Jho’s endoscopic approach
typically allows patients to recover more
quickly than with traditional surgery.
“Dr. Jannetta is both an incredible
neurosurgeon because of his talent and
ingenuity, and an incredible man because
of his extraordinary character and sincere
passion,” Dr. Jho said. “He has dedicated his
career to exploring applications for MVD
and teaching others how to perform the
procedure.”
Dr. Jho described Dr. Jannetta as his
lifelong teacher who has made a
significant difference in his life. His
respect for Dr. Jannetta is on full display
as he enthusiastically explains how Dr.
Jannetta’s creativity and new ideas often
take other neuroscientists a longer time to
understand their true value.
continued on page 6
continued from page 5
“He has dedicated his career to exploring
neuroscience, particularly complex
relationships in vasculo-neural related
disorders and developing their treatment
remedies. His numerous current works
will be further pursued by followers,”
Dr. Jho said.
Although Dr. Jannetta retired two years
ago from performing surgery, quitting is
not in his vocabulary. He has helped to
raise six children, including two daughters
who are also surgeons, and he has enjoyed
life as a grandfather of nine with his wife,
Diana. A gregarious soul whose personality
cup overflows with warmth and charisma,
Dr. Jannetta is a man of many talents and
interests – an ardent art collector, a gifted
sculptor and an accomplished banjo
player.
And yet, Dr. Jannetta still finds hours in
his days to work on intensive research at
Allegheny General Hospital that continues
to affect the lives of thousands. More
recently, as an outcome of research by
Dr. Jannetta and his colleagues, MVD is
proving effective in treating essential
Clinical Trial Drug
continued from page 4
In 2002, the MS Treatment Center began
enrolling patients to receive natalizumab.
Early difficulties were encountered with
a very rare – but severe side effect –
progressive multifocal leukoencephalopathy
(PML), which led to natalizumab being
taken briefly off the market in February
2005. During this time, patients in AHN’s
study were carefully monitored as part of a
quickly designed and executed follow-up
hypertension, the most common form
of high blood pressure, as well as many
cases of facial twitching, vertigo, type II
diabetes, Parkinson’s disease and cardiac
arrhythmias.
The depths of his accomplishments
include a list of publications and lectures
that could fill a library, but Dr. Jannetta’s
true professional pride remains his
students. Over the past 30 years, more than
150 neurosurgeons have received their
training under Dr. Jannetta, including 22
who are now or have been chairs of their
respective neurosurgery departments.
“You have to speak to the young people
and direct your talks toward them because
they are the ones who are going to
repeat the work and have the courage
to try something new,” Dr. Jannetta said.
“Everything that I have accomplished in
medicine I owe to the patients who have
entrusted me with their well-being. They
are the true pioneers in this story. That is
what humbles me and what continues
to inspire my dedication and drive to
progress medicine.”
trial. This trial determined that PML would
only be encountered in approximately 1
patient per 1,000 patients in the first two
years of treatment and also determined that
withdrawal symptoms from this medication
were not severe.
In tandem with this multicenter study,
Allegheny General’s long-term natural
history registry allowed physicians to
predict which patients are at high-risk for
Quality Neuro Care in the
Top 5% Nationally
Comparion Medical Analytics, 2015
National Quality Rating Database,
Major Neurological Surgery
Medical Excellence.
Dr. Jannetta Persists with Discovery
and Inspiration
• While a resident, he discovered the explanation for why patients experience the striking pain of trigeminal neuralgia.
• His solution for this pain is
called microvascular
decompression (MVD) surgery,
and it is considered one of the
most important modern-day
breakthroughs in the field of
neurological disease.
• MVD – which Dr. Jannetta has
performed on more than 6,000
patients – has become the gold
standard treatment for the
disease.
• He has mentored hundreds of
neurosurgeons, 22 of whom are
chairs of their respective
neurosurgery departments.
• As an outcome of research by Dr.
Jannetta and his colleagues, MVD
is proving effective in treating
essential hypertension, the most
common form of high blood
pressure, as well as many cases
of facial twitching, vertigo,
type II diabetes, Parkinson’s
disease and cardiac arrhythmias.
severe progression, justifying the risks and
inconvenience of natalizumab. Long-term
safety data were collected over the next
several years, without any new unexpected
findings, Dr. Scott said.
The next step in the development of
natalizumab involved a refinement of
risk stratification for the development of
PML. The multicenter study ran for more
than four years, collecting data regarding
immunological responses to the JC virus,
which led to a highly accurate method for
determining risk of PML.
“We know the benefits outweigh the risk
for some patients,” Dr. Scott said. “With
multiple treatments available for MS, we
are entering an era of highly individualized
therapy. The natalizumab studies stand as a
shining example of how refinement of risk/
benefit can be achieved through careful
investigation.”
6
Allegheny Health Network
ALS Center Improves Patients’
Quality of Life
AHN ALS Center employees cool off
during the Ice Bucket Challenge.
Last year, the ALS Ice Bucket Challenge
propelled awareness of the disease and the
fight against it to incredible heights thanks
to viral videos and countless generous
donations.
7
Today, the movement continues at the
ALS Center at Allegheny Health Network
(AHN) where people travel from across
Pennsylvania, West Virginia and Ohio to
receive exceptional care for managing
amyotrophic lateral sclerosis (ALS), often
referred to as Lou Gehrig’s disease. The
Center is designated by the ALS Association
and its Western Pennsylvania Chapter as a
Certified Treatment Center of Excellence
for its outstanding standards of care. It is
the only ALS treatment program in western
Pennsylvania recognized by the ALS
Association for meeting the highest levels
of established national criteria in treating
and controlling the disease.
“There is no cure yet for ALS, but we provide
patients and their families with the best
all-around care that involves specialists from
many different areas, and a team that is
compassionate and extremely committed
to their patients,” said Sandeep Rana, MD, a
neurologist and medical director of the ALS
Center at AHN. “Our multidisciplinary team
addresses all aspects of a patient’s needs
because it is truly a disease that takes a
village in order to give each person the best
life possible.”
ALS is a progressive neurodegenerative
disease that affects nerve cells in the
brain and spinal cord. Eventually, people
with ALS lose the ability to initiate and
control muscle movement, which often
leads to total paralysis and death within
two to five years of diagnosis. AHN’s team
includes specialized physicians, respiratory
therapists, speech therapists, physical and
occupational therapists, nutritionists and
mental health specialists whose primary
goal is to offer the highest level of evidencebased quality care and services to patients
and their families.
For Sue Pfeiffer, having Dr. Rana and the
healthcare team at the ALS Center care for
her husband of 30 years, Brian, has been
extremely positive and valuable. Brian, 52,
who was diagnosed in 2007, owns a metal
fabricating company that is now being
operated by the couple’s son. A close-knit
family, they also have a daughter who will
graduate from college in December 2015.
With help from others, Brian is still able to
enjoy his computer to watch YouTube and
remain connected with others on
Facebook.
The ALS Association offers Certified
Treatment Center of Excellence
designation for institutions, like
AHN, that meet rigorous eligibility
criteria, including: diversity of
professional expertise in ALS; access
to coordinated, multidisciplinary
care; a strong, ongoing relationship
with the local ALS Association
chapter; and evidence of active
participation in ALS research.
Sandeep Rana, MD, Director of the
ALS Center at AHN
“Before Brian was placed on a ventilator,
he would be seen by a physical therapist,
an occupational therapist, a wheelchair
specialist, a nutritionist and Dr. Rana,
who would medically evaluate him,” Sue
said. “Now the nutritionist works with
me to make sure that Brian is getting the
nourishment he needs, and they’re always
available for any medical care that Brian
needs.”
“Research has shown that having physicians
and other healthcare professionals
collaborate to provide the most
continued on page 8
continued from page 7
comprehensive treatment plan for patients
helps people with ALS have a better quality
of life and actually prolongs life in most
cases,” said Merritt Holland Spier, executive
director of the Western Pennsylvania
Chapter.
“Our chapter works closely with and
financially supports the ALS Center at
Allegheny Health Network to foster an
ideal care environment for the patients and
families we serve.”
Since opening its doors in 2003, the ALS
Center has made significant strides to
maximize patients’ abilities, gain daily
relief and extend their lives. Dr. Rana
explained that doctors intervene earlier
with respiratory support by using a Bilevel
Positive Airway Pressure (BiPAP) machine.
A non-invasive form of therapy often
used to treat sleep apnea, BiPAP delivers
pressurized air that keeps the throat
muscles from collapsing and reduces
obstructions by acting as a splint. The AHN
team also provides feeding tubes early
on in the disease to ensure nourishment,
mental health support to patients and
family members for coping strategies, and
handicap-accessible set up in each patient’s
home.
A cornerstone of its mission, extensive
research is continually facilitated at AHN’s
ALS Center to identify the cause for the
debilitating disease, slow its progression
and, ultimately, determine a cure. Dr. Rana
said that AHN’s research team completed
two clinical trials this past year that studied
the effectiveness of new drugs to treat ALS
patients. The center also plans to collaborate
with other researchers to develop better
designs of daily living equipment, including
cervical collars, hands splints and speech
devices, and partake in research endeavors
involving gene therapies and stem cell
transplants.
“Dr. Rana works diligently to make our ALS
Center one of the finest in the country
and to pursue research funding so that
his team can find ways to give patients a
better quality of life,” said James Valeriano,
MD, AHN Chairman of Neurology. “He has
ensured that we are immersed in the ALS
scientist community so that we can partner
to halt or reverse the disease.”
AHN Neuroscience
Institute Clinical Studies
As we strive to improve patient care and outcomes, clinical research remains an
integral component of the AHN Neuroscience Institute. We greatly appreciate the
patients who enroll in clinical studies and help us to determine better therapies for
the future. Below is a short summary of our ongoing clinical studies:
DYNESYS dynamic stabilization: A study of spinal instrumented fusion surgery
with a novel non-fusion stabilizing implant in patients with lumbar degenerative
disease.
ESTEEM-A: A multicenter study on the safety of the drug Tecfidera™ (Dimethyl
Fumarate) in patients with multiple sclerosis.
FORWARD: A multicenter study of efficacy, safety, and tolerability of BOTOX® and
Topiramate for adults with chronic migraines.
INTREPID: A study of the novel Boston Scientific deep brain stimulation device in
patients with medically refractory Parkinson’s disease.
Ipad: A study to characterize cognitive and motor functioning in patients with
multiple sclerosis.
POP-Plegridy™ (peginterferon β 1a): An observational study of an interferon drug
in patients with multiple sclerosis.
RESPOND-A: A multicenter study of oral Tecfidera™ (dimethyl fumarate) delayedrelease capsules in patients with relapsing forms of multiple sclerosis after
suboptimal response to glatiramer acetate.
Contact Michele Birgelen at 412.359.4810 if you would like more information
about these studies, including enrollment.
8
Epilepsy Monitoring Unit Provides Treatment
Breakthrough
Many people experience seizures for years
without knowing the cause or when the
next one will occur. Their daily activities
are often significantly compromised –
they can’t drive a car, their energy level
plummets, and they withdraw from social
interactions for fear of having a public
seizure.
9
But a breakthrough in how seizures are
evaluated and diagnosed is instilling hope
into the lives of people with epilepsy.
Located at Allegheny General Hospital,
the inpatient Epilepsy Monitoring Unit at
the AHN Epilepsy Center features state-ofthe-art technology to aid in quickly and
efficiently diagnosing epilepsy. It earned
Level 4 distinction from the National
Association of Epilepsy Center, the highest
level the center gives.
injury and abnormal brain development,
but in many cases, the cause is unknown.
EEG has long been used as a method of
detecting abnormal electrical activity in the
brain, which can cause epilepsy. By pairing
the EEG reading with video, physicians are
given extensive insight into how seizures
or other behaviors are tied to brain activity
and how to identify the location in the brain
where the seizures begin. The technology
also records accurate accounts of seizures
that patients may not even know they’re
having.
continued on page 10
The unit offers patients optimal
comfort with private rooms, each
equipped with leading-edge video
electroencephalography (EEG) technology
that records a patient’s behavior and
electrical activity. The unit features a
centralized station adjacent to the patients’
rooms from where physicians and EEG
technicians observe each patient’s video
EEG activity around the clock. Inpatient
monitoring also facilitates diagnosis by
allowing patients to reduce or eliminate
antiepileptic drugs during their stay in a
safe and controlled environment.
“The live video feed is an exceptional
component in determining how to best
treat each patient,” said James Valeriano, MD,
chairman, AHN Department of Neurology.
“We are able to monitor patients and
determine an appropriate combination
of medications specific to what they are
experiencing.”
Epilepsy is a brain disorder that causes
people to have recurring seizures. The
seizures happen when clusters of nerve
cells, or neurons, in the brain send out the
wrong signals. People may have strange
sensations and emotions or behave oddly,
or they may have violent muscle spasms
or lose consciousness. Epilepsy has many
possible causes, including illness, brain
The Epilepsy Monitoring Unit at AGH
continued from page 9
“This helps us to identify the type of
seizure a patient is having and how the
patient’s brain functions between seizures,”
Dr. Valeriano said.
The Epilepsy Center at Allegheny Health
Network is one of the largest referral centers
in the tristate area with physicians who
are nationally recognized as leaders in
their field. The center unites experts from
neurology, neurosurgery, neuroradiology,
psychology and social services so that every
aspect of a patient’s condition is addressed.
Each patient’s treatment plan is highly
personalized. Physicians provide drug
therapy options, which include some of the
latest clinical trials geared toward improving
quality of life. Some patients are excellent
candidates for brain surgery, which involves
removing a small part of a patient’s brain
that is causing the seizure. Others are
suitable for a vagus nerve stimulator, a
device implanted under the skin near the
chest to send regular electrical energy to
the brain through the vagus nerve. The
Each year, approximately 200,000
people are diagnosed with
epilepsy. Although there is no
cure for epilepsy, it can typically
be managed well with proper
treatment.
10
center also offers the latest innovation in
epilepsy treatment called the NeuroPace,
a device implanted onto the brain’s surface
to detect abnormal activity then send
electrical impulses to that area to prevent
a seizure from occurring.
“We want our patients to live full and
productive lives, and we focus all of
our efforts on one patient at a time to
determine the cause of their seizures and
then how to best stop them from occurring
any longer,” Dr. Valeriano said.
AHN has a multidisciplinary team of
specialists who work together to develop
comprehensive and highly effective
treatment plans for each patient.
In the News
AHN Offers Innovative
Minimally Invasive
Procedure for Recurring
Back Pain
Pittsburgh Magazine
“Best Doctors 2015”
11
Five physicians from the
Allegheny Health Network
Neuroscience Institute were
recognized in the May 2015
issue of Pittsburgh Magazine
for being among the
region’s best doctors in
their respective fields.
The publication’s annual
“Best Doctors” list is
excerpted from The Best
Doctors in America®
2015 database. The
AHN neurosurgeons
include: Khaled Abdel
Aziz, MD; Eugene
Bonaroti, MD;
Michael Y. Oh,
MD; Donald Whiting, MD; and
neurologist Susan Baser, MD.
AGH Study to Determine Best Practices for Treating
Epilepsy in the ER
Allegheny General Hospital is one of
39 medical centers across the country
participating in a clinical trial to help
determine better ways to treat patients
with prolonged seizures in Emergency
Departments. Currently, there is not a
standardized protocol for emergency
treatment of Status Epilepticus (SE), a
seizure or recurrent seizures lasting longer
than five minutes without stopping or
waking up. A person whose seizure doesn’t
stop after receiving a full dose of medicine
designed to stop seizures is considered to
have Established Status Epilepticus (ESE).
The Established Status Epilepticus
Treatment Trial (ESETT) will study three
commonly used medicines given in
the Emergency Department for ESE,
phenoytoin, valproic acid and levetiracetam,
to determine which of these is safest and
most effective.
“Physicians use their best judgment to treat
seizures in an emergency setting, but there
currently is no substantial clinical evidence
to show that one medication stands out
above the rest,” said Andrea Synowiec,
DO, principal investigator of the study at
Allegheny General. “The data that we collect
in the ESETT Trial will enable physicians
to determine best practices and create a
standard protocol for emergency treatment
of ESE that will yield the best possible
outcomes for patients, no matter where
they are treated.”
To learn more about the study, including
the opportunity to decline participation,
visit www.esett.org or call 412.359.5075.
Allegheny Health Network is among the
first medical centers in the nation to offer a
new, minimally invasive surgical alternative
for one of the most common types of back
pain. AHN surgeons are using the iFuse
Implant System to stabilize the sacroiliac (SI)
joint. For many patients, chronic low back
pain is caused by damage or wear and tear
to the SI joint, which joins the bottom of the
spine to the pelvis.
“Low back pain originating from the SI
joint can mimic pain caused by herniated
discs, degenerative disc disease and other
sources,” said Michael Oh, MD, Chief of
the Division of Functional Neurosurgery
at Allegheny General Hospital. “About 25
percent of patients with low back pain
actually suffer from SI joint dysfunction.
While it’s difficult to diagnose, once it’s
identified, it can generally be treated very
successfully.”
Symptoms of SI joint dysfunction include
pain in the lower back, buttocks or thigh.
Sacroiliac joint dysfunction is particularly
common in women of child-bearing age
who have given birth as the ligaments
surrounding the SI joint stretch to
accommodate the growing baby and
prepare for delivery. Other possible causes
continued on page 12
continued from page 11
of sacroiliac joint dysfunction are repetitive
lifting and twisting movements or traumatic
events such as car accidents. It’s also more
common in patients who have already
undergone disc fusion surgery.
The minimally invasive iFuse procedure
takes about an hour and involves the
insertion of three small titanium implants
across the SI Joint via an incision about 3
centimeters long on the side of the hip.
Approaching the joint from the side enables
physicians to reduce blood loss and tissue
damage. Traditional surgery accessing the
SI joint from the back requires a 5-to 6-inch
incision and the removal of ligaments.
Canonsburg Hospital Introduces Unique Rehab Therapy
for Neurological Disorders
The Rehabilitation Services Department at
Canonsburg Hospital is offering a unique,
new therapy regimen designed to help
patients with Parkinson’s disease and
other neurological conditions significantly
improve their speech, communication
and motor skills. Certified therapists at
Canonsburg are specially trained in LSVT
LOUD® and LSVT BIG®, two advanced and
proven methods of helping those with
Parkinson’s disease, stroke, multiple sclerosis
and related conditions learn to speak more
clearly and improve their mobility.
LSVT LOUD® (speech) therapy is considered
the gold standard in treating speech
disorders in people with Parkinson’s disease.
Through a systematic hierarchy of exercises
that stimulate the muscles of the voice
box, the treatment uses loudness training
to bring the voice to an improved, healthy
vocal with no strain.
LSVT BIG® teaches patients repetitive,
exaggerated exercise movements that
focus on improving movement levels for
the same population of patients. Research
on LSVT BIG® physical/occupational therapy
has documented improved ratings on
tests of motor functioning in people with
Parkinson’s disease following treatment,
including faster walking and bigger steps,
improved balance and increased trunk
rotation.
For more information or to schedule an
appointment, call 724.745.3919.
AHN Advances Regional Stroke Care through Telemedicine Program
AHN has launched a state-of-the-art
telemedicine program at six community
hospitals to greatly enhance critical
access to stroke neurologists who are
most capable of diagnosing patients and
directing a successful course of treatment.
Stroke-trained neurologists from
Allegheny General Hospital (AGH), a Joint
Commission-accredited Comprehensive
Stroke Center, now provide rapid, aroundthe-clock telemedicine consultations for
patients at AHN’s Allegheny Valley, Forbes,
Jefferson and West Penn hospitals, and for
those at independent affiliates Heritage
Valley Sewickley and Ohio Valley hospitals.
The program is expected to also be in
place at Canonsburg and Saint Vincent
hospitals by the end of 2015.
“The longer it takes to recognize stroke
symptoms, make a diagnosis and initiate
treatment, the greater the potential for
permanent damage to brain tissue and
increased disability,” said Ashis Tayal, MD,
Medical Director of the Comprehensive
Stroke Center at AGH. “Telemedicine
allows us to close that critical
window of time for patients
in rural areas where access
to advanced stroke care has
been limited.”
AHN’s new, wireless
telehealth technology
platform from InTouch Health
provides secure, real-time
video connections and allows
AGH’s neurologists and
endovascular neurosurgeons
to evaluate patients, review brain scans
and work with Emergency Department
and Intensive Care Unit staff at remote
hospitals. Physicians providing video
consultations are able to do so from any
location, using a computer, laptop, tablet
or smartphone.
12
New Medications for
Migraine Patients
Migraine headaches are debilitating for the
people who experience these attacks. The
intense throbbing and pounding pain is
usually accompanied by nausea and vomiting
and extreme sensitivity to light and sounds.
One migraine attack can last for hours to
days, and sometimes a sufferer can only find
comfort by retreating to a quiet, dark room to
lie down.
People with migraines are prescribed a variety
of treatments – some provide pain relief, others
minimize queasiness and vertigo. But in recent
years, promising clinical trials have focused
on blocking a neurotransmitter that plays a
significant role in migraines occurring, which
would result in preventing the migraine from every starting.
“The medications traditionally taken to prevent migraines have been borrowed,
for lack of a better word, from the classes of drugs typically used to treat epilepsy
or depression,” said Andrea Synowiec, DO, a neurologist at the AHN Neuroscience
Institute. “For many people, these medications work. However, each brain responds
differently to medications, and some migraine sufferers are left without any effective
treatments. These clinical studies are encouraging difference-makers that could fill
that void.”
13
Facts about Migraines
• About 12 percent of the U.S. population
experiences migraines.
• Migraines are three times more
common in women than men.
• Migraines differ from headaches in
that they are accompanied by nausea,
vomiting and sensitivity to light.
•
Migraines tend to run in families;
researchers believe the cause of
migraines is related to genes that
control the activity of some brain cells.
• Medicines help to relieve symptoms,
and new medicines can potentially
help prevent attacks.
The growing anticipation revolves around the arrival of an assortment of monoclonal
antibodies that target the calcitonin gene-related peptide (CGRP) pathway to avert
migraines. Dr. Synowiec explained that CGRP levels become elevated during a
migraine attack and decrease as it resolves.
After researchers found that interfering with the CGRP conduit may prevent head
pain in a very direct and specific way, several pharmaceutical companies have been
working to obtain Federal Drug Administration (FDA) approval for a drug that would
do just that.
“This means that people who now miss work or social events or time with their
families because they’re lying in a dark room with a migraine may soon have a
treatment option,” Dr. Synowiec said. “This is extremely encouraging progress that we
will continue to monitor closely and provide our patients with opportunities as they
are approved by the FDA.”
AHN
Neuroscience
Institute
High-Tech Surgical Training Lab Built
at AHN
Construction of a modern, high-tech laboratory for training future physicians and surgeons
has begun at the AHN Neuroscience Institute at Allegheny General Hospital. Named
the Center for Surgical Arts (CSA), the unique facility to open this fall will place AHN at
the forefront of surgical education and become a hub for testing innovative medical
breakthroughs.
“The Surgical Arts Laboratory will be a state-of-the-art facility and the largest of its kind in
the country,” said Donald Whiting, MD, system chairman, AHN Neuroscience Institute. “This
facility will provide the ideal venue for local, national and international courses designed to
train individuals of every area of healthcare in the latest techniques.”
Equipped with the latest technology, including microscopes, navigation equipment and
imaging capabilities, the CSA will have 21 stations that may be configured to best adapt to
specific procedures. Whether it is for basic anatomy purposes, surgical approach training or
device technology, the lab will be able to accommodate both large and small groups.
AHN staff, as well as external allied health personnel, will be welcome to use the facility,
and administrators plan to organize 50 programs during the first year. Spearheaded by
the Department of Neurosurgery, the CSA will also be used by multiple AHN departments,
including orthopaedic and trauma surgery, anesthesia/pain management, cardiothoracic
surgery, cardiology and general surgery.
Department of Neurosurgery
Pedro Aguilar, MD
Eric Altschuler, MD
Khaled Aziz, MD Parviz Baghai, MD Eugene Bonaroti, MD James Burgess, MD
Brian Dalton, MD
Steven Gillman, MD
Peter Jannetta, MD
David Jho, MD
Hae-Dong Jho, MD
Daniel Loesch, MD
Daniel Muccio, MD
Michael Oh, MD
David Oliver-Smith, MD E. Richard Prostko, MD Ashvin Ragoowansi, MD Howard Senter, MD
Nestor Tomycz, MD
Donald Whiting, MD
James Wilberger, MD
Alexander Yu, MD
Department of Neurology
Susan Baser, MD
Troy Desai, MD
Robert Fishman, MD
Kevin Kelly, MD
Timothy Leichliter, MD
Ye Vivian Liang, MD
Sandeep Rana, MD
Barry Reznick, MD
Carol Schramke, PhD
Thomas Scott, MD
George Small, MD
Andrea Synowiec, DO
Ashis Tayal, MD
James Valeriano, MD
Ruchi Wanchoo, MD
Crystal Wong, MD
David Wright, MD
©2015 Allegheny Health Network
An equal opportunity employer.
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