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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. All rights reserved. NURO 35999 mt 27055 14 Neuroscience Institute 320 East North Avenue Pittsburgh, PA 15212 Non-Profit Organization U.S. Postage PAID Pittsburgh, PA Permit No. 2885