Specializing Institutions

Neurology specifically deals with the diagnoses and treatment of diseases involving central, peripheral and autonomic nervous systems. During a neurological examination, neurologists test a patient’s mental status, function of the cranial nerves, strength, coordination, reflexes and sensation. There are over 600 known neurological disorders and conditions. Specialties within neurology include stroke or vascular neurology, interventional neurology, epilepsy, neuromuscular, neurorehabilitation, behavioral neurology, sleep medicine, and pain management. Neurological disorders are common and can be life threatening, like brain tumors and strokes, or less harmful but potentially debilitating like tension and headaches.

A stroke or “brain attack” occurs when a blood clot blocks an artery or a blood vessel breaks, interrupting blood flow to an area of the brain. It is unpredictable and it can affect anyone. In the United States, stroke is the third leading cause of death, claiming about 137,000 lives each year, and a leading cause of serious, long-term adult disability. Smoking, obesity and alcohol are all stroke risk factors. Industry experts work hard every day to reduce the incidence and impact of stroke by developing compelling educational programs focused on prevention, treatment and rehabilitation support for all impacted by stroke. Every day, neurosurgeons and specially trained staff work tirelessly to bring the best stroke prevention and treatment services to San Antonio.

Institutions at the South Texas Medical Center provide patients in need of neurological intervention the highest level of care. The world-renowned Endoscopic Craniectomy was developed in one of our institutions and continues to improve the lives of patients suffering from this congenital defect. The cause of craniosynostosis is unknown, but thanks to this minimally invasive procedure patients can be treated with remarkable consistency and safety.

Epilepsy is one of the most common neurological disorders, affecting more than 2.5 million Americans. Patients at the South Texas Medical Center benefit from one of the highest accredited epilepsy programs in the nation, offering patients the most advanced medical, dietary and surgical therapies. Pediatric and adult epilepsy surgery is also offered at the South Texas Medical Center. Other special services include sophisticated neuroimaging (MRI), ictal single-photon-emission (SPECT) and position emission tomography (PET) testing.

Another common neurological disorder affecting many patients today is Parkinson’s Disease. Caused by a loss of nerve cells in the brain, Parkinson’s causes muscle rigidity, tremors at rest, the slowing down of movements, and instability. There is no treatment to cure Parkinson’s. However, patients with Parkinson’s can benefit from advanced services offered by our institutions. Utilizing the latest in technology and the latest treatments, our neurologists and neurosurgeons collaborate with a devoted team of healthcare experts to maximize the quality of life for our patients.

Neuroscience Articles

  • Kids, dogs touch same soft spots in the brain: study

    By Janice Neumann

    NEW YORK (Reuters Health) - Brain scans showing that human responses to our dogs are not unlike those evoked by our children suggest a deep evolutionary bond, according to a recent study.

    The findings are in line with dogs' special place as mankind's best friend, and may support the benefits of dog-assisted therapies, researchers say.

    "The overlap says a lot about how similar the relationships could be, but we're only speculating," said Lori Palley, who led the study with Luke Stoeckel at Massachusetts General Hospital in Boston.

    The experiments involved 14 mothers ages 22 to 45, each with at least one child between two and 10 years old and one dog owned for at least two years.

    Each woman underwent magnetic resonance imaging, or MRI, (which measures brain activity by detecting changes in blood flow) and viewed images of her own child and dog as well as unfamiliar children and canines.

    Afterwards the mothers took an 11-question multiple choice test that asked about the hair color of their child and dog, the number of pictures viewed and had the women rate images based on their emotional value.

    "Basically we compared the human-pet bond with that of the maternal-child relationship and analyzed patterns of brain activity when moms viewed the images with the aim of understanding what areas might be common and what areas distinct," said Palley, who is assistant director of Veterinary Services at the hospital's Center for Comparative Medicine.

    When mothers looked at pictures of their own kids and their own dogs, areas of their brains associated with emotion, reward, visual processing and social cognition showed increased activity on the scans.

    But there was more brain activity in areas involved in bond formation (typically maternal-child and romantic bonds) when mothers viewed their own children versus their own dogs, the study team reports in the journal PLOS ONE.

    "What's really interesting about this is we suspect that perhaps there is some evolutionary significance to that," said Palley. "It would make sense that would be an area where you would want it to be kind of specific for relationships that should be sustained at all cost."

    In all cases, brain responses were strongest when the women viewed their own child versus one they didn't know, and their own dog versus an unknown dog.

    An area of the brain involved in visual and social processing was more active when moms looked at their pets than at their kids.

    "I think perhaps we process the dog's face differently than we process the human face, but we don't know that. We'd actually have to do more work to look at that area more specifically to determine exactly what this finding means," Palley said.

    She added that she was interested in the health benefits of pet ownership and animal-assisted therapy and, in this study, wanted to examine the science involved.

    "How do you better understand the human animal-connection or figure out for whom perhaps pet or animal assisted-therapy would be more beneficial," Palley said. "What is going on in the brain?"

    Palley cautioned that the results would need to be replicated in a larger study involving other people, including women without kids and men.

    The findings help support what many researchers already suspected, according to Alan M. Beck, professor and director of the Center for the Human-Animal Bond at Purdue University School of Veterinary Medicine.

    "We have a long history, a kind of affiliation," said Beck of the relationship people have with dogs. "Dogs learn from us, we learn from dogs, so it's not surprising that even brain activity would show how inborn it is."

    Beck, who has done a number of studies and written extensively on human-animal bonds, also said the study might add some scientific legitimacy to pet ownership.

    "It was kind of cool," Beck said of the study. "It's just one of the tools that allows a better understanding that this is a true biological/species behavior as opposed to something we've learned from our mothers to be nice to animals."

    The study might also help show that people who love pets can also love people.

    "We are wired to some degree to be nurturers of critters that evoke a desire of being nurtured and cared for," Beck said. SOURCE: PLOS ONE, online October 3, 2014.

  • Joan Rivers died of complication during medical procedure

    By Patricia Reaney

    NEW YORK (Reuters) - Comedian Joan Rivers, who passed away last month at the age of 81, died of a complication during a medical procedure, the New York Chief Medical Examiner's Office said on Thursday.

    Rivers was having an examination of the back of the throat and vocal cords at a New York clinic when she stopped breathing and was rushed to Mount Sinai Hospital, where she was put on life support.

    "The manner of death is therapeutic complication," the medical examiner said in a statement, "the death resulted from a predictable complication of medical therapy."

    It listed the cause of death as anoxic encephalopathy, a condition caused when brain tissue is deprived of oxygen and there is brain damage.

    Rivers, the brash, pioneering comedian who paved the way for women in stand-up comedy, died in hospital on Sept. 4, a week after the outpatient procedure.

    "We continue to be saddened by our tragic loss and grateful for the enormous outpouring of love and support from around the world," the comedian's daughter, Melissa Rivers, said in a statement after the release of the autopsy report.

    She had no further comment to make at this time.

    Following her death, the State Health Department launched an investigation into Yorkville Endoscopy where Rivers was treated. It reviewed records and documents and questioned doctors at the clinic which opened in 2013.

    The clinic denied media reports that it had administered a general anesthesia or conducted a vocal cord biopsy on Rivers. Last month the clinic said the doctor who performed the procedure was not currently working there or serving as its medical director.

    The clinic and its spokeswoman did not immediately respond to requests for comment.

    The Brooklyn-born comedian, who once described herself as "the plastic surgery poster girl" and often joked about her numerous cosmetic enhancements, was known for the catchphrase, "Can we talk?"

    Her career as a stand-up comedian, author, talk show host and reality TV star spanned five decades. She starred with her daughter in the reality TV show "Joan & Melissa: Joan Knows Best?", with Rivers living with her grown child.

    Most recently, Rivers was the host of cable television channel E!'s "Fashion Police," commenting on the unfortunate red carpet choices of Hollywood celebrities.

  • Mentoring kids in poverty helps lower their health risks: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - African American adolescents growing up in conditions of worsening poverty are more likely than other kids to have risk factors for chronic illnesses - but strong emotional support from caretakers seems to offset the effects of the stressful environmental, researchers found.

    "That level of emotional support from that social network completely protected those young people from having any biological changes," said Gene Brody of the University of Georgia in Athens, the study's lead author.

    It's been theorized that children and teens living in high poverty areas will also have more risk factors for chronic conditions like heart disease and stroke, Brody and his colleagues write in Pediatrics.

    Past research, mostly on adults, has found that the chronic psychological and physical stresses of poverty, including frequent exposure to violence, produce chronically elevated stress hormones, which in turn exert wear and tear on the body that harms health (see Reuters article of October 30, 2013, here:

    But little research has tested that idea among children or looked at what happens when they grow up in neighborhoods where poverty rates change over the course of their childhood, the study team notes.

    For the new study, the researchers took a measure of overall health known as allostatic load from 420 African American 19-year-olds who participated in annual checkups since 2000-2001, when they were 11 years old.

    Allostatic load is the total physical toll on the body of chronic stress, and it can be gauged with measures of blood pressure, body mass and levels of certain compounds like the stress hormone cortisol found in urine.

    "By adding them together, they turn out to be a fairly good indicator that those people will go on to develop one of the chronic diseases of aging," Brody told Reuters Health.

    Additionally, the researchers collected data on economic conditions in the children's neighborhoods, and on interactions between the children and their caregivers to determine the amount of emotional support kids received.

    From the beginning of the study 10 years earlier, the researchers found that 284 of the original 420 kids had remained in the same 41 areas. The number of households in those areas living in poverty had increased from about 22 percent in 2000 to about 25 percent in 2010.

    Overall, the teens living in areas with worsening poverty during the study had the highest allostatic load, which put them at greatest risk for chronic diseases later in life.

    The link held even after the researchers accounted for factors like individual habits and family income that could influence the child's health.

    Having strong emotional support during adolescence appeared to protect the participants from any possible effects from living in areas with worsening poverty, however.

    The allostatic scores of adolescents who grew up in areas of worsening poverty without strong emotional support were about double that of those with emotional support, Brody said.

    "We did not find effects on allostatic load for living in increasing levels of poverty when youths had a very supportive social network," he said. "Meaning they had a network of parents, friends and community mentors who could offer them support, problem solving and guidance for any number of the challenges that life presents."

    The researchers cannot explain why living in areas of worsening poverty is linked to an increased health risk. They write that it could be a combination of factors, including exposure to crime, violence, drug use and the lack of an environment that promotes healthy living.

    Brody said emotional support may protect against the negative effects of increasing poverty by offering a measure of empowerment to cope with problems.

    "In the day to day course of life, as challenges come up, these young people have access to people who will listen to their concerns and help find solutions to the challenges they face," he said.

    Brody said an important area of research is how to effectively deploy prevention programs that will shield adolescents from the possible negative effects of worsening poverty.

    "We think we can have a positive effect on their health," he said.

    SOURCE: Pediatrics, online October 13, 2014.

  • Female orgasm: battleground of science?

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Hapless lovers are not the only ones who get lost down there: even sexologists can't agree on what's what, and where, among women's female parts.

    At least, that's according to a father-daughter team of researchers in Italy, Drs. Vincenzo and Giulia Puppo.

    In a new review in the journal Clinical Anatomy, Vincenzo, of the Italian Center of Sexology in Bologna, and Giulia, a biologist at the University of Florence, point out some problems with some of newer anatomical and physiological terms researchers have been using since the mid-1990s.

    The G-spot? Out. Vaginal orgasm? Out. Female penis? In. It's the best way to refer to female erectile organs, according to the Puppos.

    Sexological and sexual medicine textbooks today often neglect the embryology, anatomy and physiology of the female erectile organs, Vincenzo said.

    He and his coauthor cite dozens of such publications by other researchers, largely from within the last 15 years, pointing out the use of terms like "inner clitoris" that are, admittedly, not very well defined in those papers.

    "The internal clitoris does not exist, the entire clitoris is an external organ," Vincenzo said. It is composed of an externally visible glans and body, like the male penis, and of roots, which are hidden, he said.

    But to back their assertions regarding the correct terminology to use, the Puppos employ no actual subjects or data and instead use 12 diagrams, 11 of which come from their own previous publications (the 12th is from Wikipedia).

    What sexologists sometimes refer to as "clitoral bulbs" should in fact be called "vestibular bulbs," and the areas that are stimulated and become erect during sex should not be called the "clitoral complex" but instead the "female penis," they write.

    That won't be useful information for most women, who don't typically meet up for coffee to chat about anatomical terminology. But some other assertions could make a difference.

    For one thing, the authors insist that researchers stop using the term G-spot for a spongy area of the front vaginal wall anecdotally linked to orgasm, because it has no basis in science.

    We should phase out that term if possible, agreed Dr. Amichai Kilchevsky, a urologist at the Yale School of Medicine in New Haven.

    "I don't think very many scientists or urologists would argue that there is an actual G-spot," he told Reuters Health. "I don't think it does any favors to women to refer to it as one spot, it's probably a system of vascular structures that are all kind of interplaying."

    It is wrong to say there is one specific location called the G-spot that, when stimulated, leads to orgasm for every woman, he said.

    But the Puppos go one step further, arguing that the vagina is never involved in orgasm since it is not part of what they call the "female penis."

    As a consequence, they say, the term "vaginal orgasm" should be thrown out. Orgasm is only possible by stimulation of the clitoris, they write. Using the catchall term "female orgasm" will include both actual clitoral orgasms and the vaginal orgasms women may think they are having because they have been misled by the media.

    Other experts disagree.

    "Puppo is ignorant of, or dismisses, published evidence showing that applying mild pressure to the clitoris, vagina, or cervix activates distinctly different regions of the sensory cortex," said Barry R. Komisaruk, a distinguished professor of psychology at Rutgers University in Newark, New Jersey.

    Women with spinal injuries who have no sensation of the clitoris can still feel sensation in the vagina and cervix, Komisaruk told Reuters Health in email.

    The Puppos dispute peer-reviewed, published evidence without performing research to test or refute that evidence, he said.

    "Obviously women do have vaginal orgasms," Kilchevsky said. "I don't think the media or anyone else is leading females into believing they are experiencing something they are not."

    The Puppos emphasize that perpetuating the myth of the G-spot or vaginal orgasm is unfair to women who may try to find or achieve them and feel "less-than" because they cannot.

    But they also state that since the vaginal orgasm, according to their argument, does not exist, the duration of penile-vaginal intercourse is not important for a woman's orgasm. Every woman is able to achieve a clitoral orgasm "if the clitoris is simply stimulated with a finger," they write.

    The Puppos arguments for a more anatomically accurate terminology are mostly sound, but will probably not be widely adopted, and the semantic argument is mostly relevant for researchers, Kilchevsky said. "If those are the terms he feels are appropriate, more power to him," he said.

    Anatomical structures which were once named for their appearance are today named for their function, Komisaruk said. (Puppo) is simply replacing conceptual terms sexologists already accept, like "clitoral complex,"' with his own conceptual term "female penis," he said.

    "I absolutely see no reason to begin using the phrase "female penis" and am pretty certain most American women and men would agree," given that men interested in women don't want to talk about stimulating their partner's penis, nor do most women want to think of themselves as having a penis, said Debra Herbenick, an associate research scientist at Indiana University Bloomington School of Public Health.

    "We also have no evidence that all women can or do experience orgasm from any kind of stimulation, including direct clitoral stimulation," she told Reuters Health by email. "Yes, most women can and do experience orgasm but most sexuality researchers and educators recognize the enormous variety of turn-ons, forms of physical stimulation, and types of sexual pleasure and orgasm that are an important part of women's sexual experiences."

    The reality is there are multiple ways for women to have an orgasm and to say that the cause is always the same is not accurate, Kilchevsky said. "I think every woman should embrace what they feel works for them," which won't be the same for all the billions of women on the planet, he said.

    SOURCE: Clinical Anatomy, October 6, 2014.

  • Stem cells from human embryos prove safe, improve vision -study

    By Sharon Begley

    NEW YORK (Reuters) - The longest-running trial of stem cells derived from a human embryo found that the cells caused patients none of the problems scientists feared, such as forming tumors, and reversed partial blindness in about half the eyes receiving transplants, researchers reported on Tuesday.

    The results, published in The Lancet, could help re-invigorate the controversial quest to harness stem cells, which have the ability to turn into any of the 200 kinds of human cells, to treat diseases.

    In an accompanying commentary, Dr. Anthony Atala of the Wake Forest Institute for Regenerative Medicine called the work "a major accomplishment."

    After intense excitement among scientists and the public about the promise of stem cells and ethical debates about destroying human embryos to obtain them, the field stumbled when a high-profile trial for spinal cord injury was halted by Geron Corp in 2011 and the interest of other companies waned.

    The small study's main goal was assessing the safety of the transplanted cells. Called retinal pigment epithelial cells, they were created by taking stem cells from a days-old embryo created in a fertility clinic and inducing them to differentiate into the specialized cells.

    The study "provides the first evidence, in humans with any disease, of the long-term safety and possible biologic activity" of cells derived from embryos, said co-author Dr. Robert Lanza, chief scientific officer of Advanced Cell Technology, which produced the cells and funded the study.

    Nine patients with Stargardt's disease (which causes macular degeneration in childhood) and nine with dry age-related macular degeneration (a leading cause of adult blindness) received implants of the retinal cells in one eye. The other eye served as a control.

    Four eyes developed cataracts and two became inflamed, probably due to the patients' age (median: 77) or the use of immune-supressing transplant drugs.

    The retinal cells, which help keep the eye's rods and cones alive and functional, survived in all 18 patients, most of whose vision improved. In those with macular degeneration, treated eyes saw a median of 14 additional letters on a standard eye chart a year after receiving the cells, with one patient gaining 19 letters. The untreated eyes got worse, overall. The Stargardt's patients had similar results.

    In real-life terms, patients who couldn't see objects under 12 feet (4 meters) tall can now see normal-size adults.

    The vision of one 75-year old rancher who was blind in the treated eye (20/400) improved to 20/40, enough to ride horses again, Lanza said. Others became able to use computers, read watches, go to the mall or travel to the airport alone for the first time in years.

    While calling the results "encouraging," stem cell expert Dusko Ilic of Kings College London, who was not involved in the work, warned that even if the larger clinical trial planned for later this year is also successful, "it will take years before the treatment becomes available."

    SOURCE: The Lancet, online October 14, 2014.

    (Reporting by Sharon Begley; editing by Andrew Hay)