Neurosciences



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

  • Athletes' biological clocks affect their performance

    By Andrew M. Seaman

    (Reuters Health) - A week before the Super Bowl, a new study suggests that players' performances may depend at least in part on how the game's timing aligns with their body clocks.

    Athletes' performances are best predicted by how long it's been since their body's natural wake-up time, researchers found.

    "The reason why we did this study is that all the existing literature talking about circadian rhythm in sports performance came to the same conclusion: that athletes give their best performance in the evening," said Roland Brandstaetter, the study's senior author from the University of Birmingham in the UK.

    As reported in the journal Current Biology, Brandstaetter and colleagues studied the performance of 121 athletes who competed in competitions.

    When the researchers separated the athletes into three groups based on their internal clocks, they found that those who naturally get up early reached peak performance in the early afternoon. Those who naturally sleep the latest would likely reach their peak in the evening.

    Specifically, natural early and intermediate risers reached their peak performances about six hours after their internal wakeup time. Late risers reached their peaks about 11 hours after their internal wakeup time.

    Overall, the researchers found that individual performance during the day can vary by 7 to 10 percent among early and intermediate risers, and by up to 26 percent among late risers.

    The researchers say that just a 1 percent improvement among the fourth place athletes in the women's road race, 400 meter swim or 400 meter sprint at the 2008 Olympics may have propelled them to a gold medal.

    Brandstaetter said the improvements in peak performance may easily apply to areas other than sports.

    "Physical performance and mental performance go hand in hand," he said. "If you're physically exhausted, then your brain isn't working either. . . . Also, if you're mentally tired, you won't be at the top of your physical performance."

    While it's possible to change the body's internal clock, Brandstaetter said it takes time.

    "If you just change your wakeup time on the day of the competition or the day of your performance, it wouldn't make much of a difference," he said. "You would need to start in advance and retrain your biological clock."

    Brandstaetter said it might be difficult for people to know when their internal wakeup times are. It's not simply the time the alarm clock goes off in the morning.

    "If you're really agenda free and not going out until one o'clock in the morning, then you start getting an idea about it," he said.

    "Try to listen and understand your internal biological clock," Brandstaetter said. "Try to live with it instead of trying to live against it."

    SOURCE: http://bit.ly/1vfHoir Current Biology, online January 29, 2015.

  • Computer tracks eye movements to detect concussions

    By Andrew M. Seaman

    (Reuters Health) - A new piece of technology that tracks eye movements after a head injury might be able to detect concussions and determine their severity, researchers say.

    The new technology is essentially like a doctor moving a finger in front of a person's eyes after a hit to the head - except now it's automated, said Dr. Uzma Samadani of NYU Langone Medical Center in New York City.

    And the results are reproducible, whereas with the follow-my-finger method, Samadani said, "Each doctor is going to have variability in how well they're going to be able to assess how well a person is getting better."

    Samadani said she developed the new technology because she needed a reliable way to assess concussions. Accurate diagnoses would improve patients' care, allowing for more accurate assessments of when they could safely return to work or play after a hit to the head, she said.

    The Centers for Disease Control and Prevention defines a concussion as a type of brain injury "caused by a bump, blow, or jolt to the head that can change the way your brain normally works."

    In her team's study, 75 people who'd been in accidents (but not necessarily head accidents) plus 64 healthy volunteers all watched a four-minute video while their eye movement was tracked by a computer. The computer could tell when their eyes are moving in opposite directions. So-called disconjugated eye movement has been tied to brain injuries for centuries.

    People with hits to the head had less ability to control their eye movements, compared to people who had no known injuries, the researchers wrote in the Journal of Neurotrauma.

    The computer also detected signs of concussion in some patients without any noticeable brain injury on a CT scan.

    Images, like those from a CT scan, "tell you what (the brain) looks like - not how it functions," Samadani said.

    The researchers also found that the severity of symptoms from concussion was tied to the severity of their eye movement problems.

    The technology is currently only available in research settings, but Samadani hopes the U.S. Food and Drug Administration will clear it for use by the end of this year.

    "I think we're going to change how we diagnose and define brain injury and concussion," she said.

    Future research needs to focus on other factors that may influence the results of the test, such as alcohol, morphine and sleep deprivation.

    "What we're finding so far is that these things affect eye movement, but in different ways than brain injury does," Samadani said. "So we're hoping to tease out the differences."

    SOURCE: http://bit.ly/1CI4Cyx The Journal of Neurotrauma, online January 29, 2015.

  • U.S. proposes effort to analyze DNA from 1 million people

    By Toni Clarke and Sharon Begley

    WASHINGTON (Reuters) - The United States has proposed analyzing genetic information from more than 1 million American volunteers as part of a new initiative to understand human disease and develop medicines targeted to an individual's genetic make-up.

    At the heart of the initiative, to be announced on Friday by President Barack Obama, is the creation of a pool of people - healthy and ill, men and women, old and young - who would be studied to learn how genetic variants affect health and disease.

    Officials hope genetic data from several hundred thousand participants in ongoing genetic studies would be used, and other volunteers recruited to reach the 1 million total.

    The near-term goal is to create more and better treatments for cancer, Dr. Francis Collins, director of the National Institutes of Health (NIH), told reporters on a conference call on Thursday. Longer term, he said, the project would provide information on how to individualize treatment for a range of diseases.

    The initial focus on cancer, he said, is due partly to the lethality of the disease and partly because targeted medicine, known also as precision medicine, has made significant advances in cancer, although much more work is needed.

    The president has proposed $215 million in his 2016 budget for the initiative. Of that, $130 million would go to the NIH to fund the research cohort and $70 million to NIH's National Cancer Institute to intensify efforts to identify molecular drivers of cancer and apply that knowledge to drug development.

    A further $10 million would go to the Food and Drug Administration to develop databases on which to build an appropriate regulatory structure; $5 million would go to the Office of the National Coordinator for Health Information Technology to develop privacy standards and ensure the secure exchange of data.

    The effort may raise alarm bells for privacy rights advocates who in the past have questioned the government's ability to guarantee that DNA information is kept anonymous. They have expressed fear participants may become identifiable or face discrimination.

    SEQUENCING 1 MILLION GENOMES

    The funding is not nearly enough to sequence 1 million genomes from scratch. Whole-genome sequencing, though plummeting in price, still costs about $1,000 per genome, Collins said, meaning this component alone would cost $1 billion.

    Instead, he said, the national cohort would be assembled both from new volunteers interested in "an opportunity to take part in something historic," and existing cohorts that are already linking genomic data to medical outcomes.

    The most ambitious of these is the Million Veteran Program, launched in 2011 by the Department of Veterans Affairs. Aimed at making genomic discoveries and bringing personalized medicine to veterans, it has enrolled more than 300,000 veterans and determined the DNA sequences of about 200,000.

    The VA was a pioneer in electronic health records, which it will use to link the genotypes to vets' medical histories.

    Academic centers have, with NIH funding, also amassed thousands of genomes and linked them to the risk of disease and other health outcomes. The Electronic Medical Records and Genomics Network, announced by NIH in 2007, aims to combine DNA information on more than 300,000 people and look for connections to diseases as varied as autism, appendicitis, cataracts, diabetes and dementia.

    In 2014, Regeneron Pharmaceuticals Inc launched a collaboration with Pennsylvania-based Geisinger Health System to sequence the DNA of 100,000 Geisinger patients and, using their anonymous medical records, look for correlations between genes and disease. The company has finished 50,000 samples, spokeswoman Hala Mirza said.

    Perhaps the most audacious effort is by the non-profit Human Longevity Inc, headed by Craig Venter. In 2013 it launched a project to sequence 1 million genomes by 2020. Privately funded, it will be made available to pharmaceutical companies such as Roche Holding AG, with which the institute has a research partnership.

    "We're happy to work with them to help move the science," Venter said in an interview, referring to the administration's initiative.

    But because of the many regulations surrounding medical privacy and human volunteers, he said, "we can't just mingle databases. It sounds like a naive assumption" if the White House expects existing cohorts to merge into its 1-million-genomes project.

    Venter raced the government-funded Human Genome Project to a draw in 2000, sequencing the entire human genome using private funding in less time than it took the public effort.

    ALTERING THE REGULATORY LANDSCAPE

    Collins conceded that mingling the databases would be a challenge but insisted it is doable.

    "It is something that can be achieved but obviously there is a lot that needs to be done," he said.

    Collating, analyzing and applying all this data to the development of new drugs will require changes to how products are reviewed and approved by health regulators.

    Dr. Margaret Hamburg, the FDA's commissioner, said on the conference call that the emerging field of precision medicine "presents a set of new issues for us at FDA." The agency is discussing new ways to approach the review process for personalized medicines and tests, she added.

  • Medical marijuana advocates concerned by Illinois licensing delay

    By Mary Wisniewski

    CHICAGO (Reuters) - Advocates for medical marijuana in Illinois are concerned that delays in issuing distribution licenses, exacerbated by a change in governors, is keeping the drug from patients who need it.

    Former Democratic Governor Pat Quinn, who supported medical marijuana, left office in January without issuing licenses for growth and distribution, leaving it to his successor, Republican Governor Bruce Rauner.

    Rauner, who has expressed skepticism about the licensing process, wants a thorough legal review, his office said, which means more time before the 2013 law can be implemented.

    For patients that means no hope of getting the drug until at least June even if the Rauner administration issues licenses in the next month, said Chris Lindsey, legislative analyst for the Marijuana Policy Project, a Washington, D.C.-based non-profit.

    The law requires plants to be grown in Illinois, which takes 4-1/2 months in the best of circumstances.

    "We're pretty concerned - we've been waiting for a long time," Lindsey said. Supporters had hoped licenses would be issued last fall.

    Illinois is one of 23 states plus the District of Columbia that permit medical marijuana. Illinois' trial program expires in 2017.

    Lindsey said he believes Rauner is "trying to be careful, but in the process he's really failing our seriously ill patients in Illinois."

    The Quinn administration prepared lists of businesses qualified to receive the licenses before he left office, according to recently released documents.

    A Quinn administration spokesperson said that while state agencies made substantial progress evaluating applicants, Quinn decided to turn the job over to Rauner for proper review.

    Rauner's office said it will refer its findings to the state Attorney General's office.

    Democratic State Representative Lou Lang, a medical marijuana supporter, said Quinn's staff used blind scoring procedures to eliminate favoritism in picking who should get licenses, and it was a shame Quinn didn't issue them.

    "Now we have a governor who's not a big fan of the program and has to be convinced to move forward," Lang said.

    Lang said a patient or potential distributor who got a high qualifying score may sue to move things along.

    Marla Levi, 51, who has multiple sclerosis, said she felt betrayed by Quinn.

    But she doesn't mind the Rauner administration going through the lists again to ensure the right people will be growing and dispensing the drug.

    "We know how government has worked in Illinois ... we want to know everything," Levi said.

  • After heart attacks, most don't get enough statins

    By Kathryn Doyle

    (Reuters Health) - In the U.S., less than a third of older heart "event" patients being discharged from the hospital get the recommended high-intensity statins, according to a new study that looked at prescriptions filled.

    National guidelines from the American College of Cardiology and American Heart Association say the majority of patients should be on a high-dose statin following a serious heart disease-related event like heart attack or bypass surgery.

    "It appears that there's tremendous reticence in prescription of statin therapy," said lead author Dr. Robert S. Rosenson of the Icahn School of Medicine at Mount Sinai in New York.

    "Whatever the dose of statin people were taking when they came to the hospital was the dose they went out on, the acute event didn't change it," he told Reuters Health. "This is very disappointing."

    The authors studied a random sample of Medicare beneficiaries ages 65 to 74 who filled a statin prescription after having a heart attack or bypass surgery between 2007 and 2009.

    Of more than 8,000 people who filled a statin prescription after one of these events, only 27 percent of the first post-discharge prescriptions were for "high-intensity" statins, such as 40 to 80 milligrams of atorvastatin (Lipitor) or 80 milligrams of simvastatin (Zocor).

    Less than 25 percent of people who were not taking a statin before their hospitalization filled a high-intensity statin prescription on their release, and less than 10 percent of those who had been taking a low-intensity statin switched to a high-intensity one.

    About 80 percent of people who had already been taking high-intensity statins filled another such prescription immediately upon leaving the hospital, according to the results in the Journal of the American College of Cardiology.

    Of the patients whose first post-discharge prescription fill was for a low-intensity statin, less than 12 percent switched to a high-intensity dosage within the following year.

    "There's a tremendous amount of confusion," Rosenson said. Though the clinical guidelines, which are supported by rigorous studies and high quality results, indicate that high dose statins are better than low dose statins after an acute cardiac event, many doctors appear not to be following them.

    High intensity statins have been linked to better health outcomes in the short and long term for these patients, he said.

    "It could be that either the doctors are not aware of the guidelines that high intensity therapy is proven to be better, or more likely they are focusing on the (low-density lipoprotein) cholesterol level," he said.

    There has been confusion on whether or not to dose statins based on LDL cholesterol readings for some patients, but for those who have suffered an acute cardiac event, a high dose is better, he said.

    "If statins are fairly safe and highly effective agents particularly for these types of patients, yet only about 50 to 60 percent of these patients are on what has been recommended and proved, why is that?" asked Dr. Prakash Deedwania of the University of California San Francisco School of Medicine in Fresno who wrote an editorial accompanying the new results.

    Side effects from statins are rare, he noted, and cost of the drugs - which are mostly generic, inexpensive, and covered by insurance including Medicare - should not be an issue. There is some risk of developing what is know as "chemical diabetes," but the benefits of the drugs far outweigh this risk, Deedwania told Reuters Health.

    "The benefit is 10-fold greater than any sort of harm," he said.

    When doctors know that an oversight body is going to be looking at their prescribing data, they are more likely to follow guidelines, he said.

    "We should be doing this without anyone looking, but unfortunately it doesn't work like that," Deedwania said.

    Though the authors focus on doctors likely not prescribing the recommended statin dose, there could be confusion or reluctance on the patient side as well, he said.

    Much like blood pressure medication, statins don't provide immediate symptom relief while they are acting in the body. Since patients don't feel a difference when they take the medication, they may not be motivated to continue taking it, he said.

    "The burden is on us to educate our patients, tell them precisely in simple terms what are the benefits of statins," Deedwania said.

    In addition to reducing the risk of another heart attack and making a bypass graft more durable over time, statins reduce the risk of stroke, he said.

    "That resonates really well," Deedwania said. "Everybody wants to get extra benefits,"

    SOURCE: http://bit.ly/1CQS8Tc JACC, online January 19, 2015.