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

  • Fears of addiction keep cancer patients from getting pain relief

    By Randi Belisomo

    NEW YORK (Reuters Health) - Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say.

    "At the end of life, we should feel comfortable providing whatever necessary to control pain," said Joel Hyatt, assistant regional director at Kaiser Permanente. Concerns about overdose and addiction, he told Reuters Health, should not prevent terminally ill patients from obtaining relief.

    Pain undertreatment is estimated to affect half of cancer patients, according to a recent report in the Journal of Clinical Oncology.

    Opioids, a type of narcotic, work in the spinal cord and brain to reduce the intensity of pain signals reaching the brain. The opioids hydrocodone (Vicodin), hydromorphone (Dilaudid) and oxycodone (Oxycontin, Percocet) are commonly prescribed painkillers. Hydrocodone is the most prescribed medication in the U.S., according to the International Narcotics Control Board.

    Opioid overuse and abuse are a widespread problem that gets lots of attention in the news media - and that may keep cancer patients and doctors from using them appropriately.

    "On one hand, we're told we overuse opioids," Hyatt said. "On the other, we're told we underuse them."

    Underuse worries Judith Paice, a pain specialist at Northwestern University Feinberg School of Medicine in Chicago. Part of the problem, she said, is that it's sometimes hard for patients to convey to doctors how severe the pain is.

    Most pain is controllable, she maintains; patients must describe symptoms, and physicians must seriously consider them.

    "All pain is real to the person experiencing it," Paice told Reuters Health. "But unlike infections we measure with blood samples, it doesn't have an objective marker."

    Doctors often ask patients to rate their pain on a 0 to 10 scale. But severity, experts say, should be described in more detail than that.

    "The zero to ten scale was a good beginning when introduced to quantify pain," said Paice. "Unfortunately, it's now a check in the box. It's another thing physicians ask, and patients feel frustrated because they don't feel doctors take it to the next step and work on their pain."

    She advises patients to elaborate. Diaries may help detail sites of pain, severity and factors prompting pain to worsen. "Whether it's when walking, coughing, sitting or lying flat, those give clues where pain comes from," she said. "What words describe it?" Adjectives could include aching, throbbing, tingling, burning, electrical or shooting.

    Narcotics are not the only option for treating pain. Patrick Fehling, a University of Colorado Hospital addiction psychiatrist, says anxiety often makes pain worse. In some cases, he told Reuters Health, pain should be treated with interdisciplinary counseling from social workers, clergy or psychologists. Research suggests complementary treatments such as massage and acupuncture may also be beneficial.

    "Patients might say, 'I have pain and would like it taken away,'" said Fehling. "But their experience might be they felt pain on a three out of ten level, and they wanted zero. That's not always realistic."

    Some populations are at particularly high risk for inadequate pain control. For example, research has shown that patients in minority care settings are three times more likely to receive undertreatment than those in non-minority settings. Sixty percent of African-American and 74 percent of Hispanic outpatients with cancer-related pain reported inadequate prescriptions.

    "This is a most vulnerable population," said Egidio Del Fabbro, a Virginia Commonwealth University palliative specialist. "To undertreat them is something we should avoid at all costs." Research cites unrelieved pain as the greatest fear among the terminally ill.

    While stigmas may be keeping doctors from prescribing adequate pain medication in certain patient populations, similar misconceptions may keep patients from seeking relief.

    "There is a stigma surrounding opioids, with morphine more than others," Paice said. Many people, she added, associate morphine with dying; they think it's only used in the final hours. In fact, she said, can be used anytime during cancer treatment to maintain mobility, appetite and quality of life.

    "Pain keeps patients from being able to enjoy whatever time they have left," Paice said.

    When time is precious, however, balancing relief and alertness is essential, Del Fabbro maintains. The sedative effects of opioids may be troubling.

    "Families want to recognize the loved one they know," he told Reuters Health. "What you get with excessive opioids is sedation, delirium, cognitive changes, and that's not the person they love. You want the best of both worlds. You want patients to be themselves and their pain controlled."

  • New test may predict worker hearing loss

    By Madeline Kennedy

    NEW YORK (Reuters Health) - Not everyone exposed to high noise levels at work experiences hearing loss as a result, and a new study suggests a simple test can predict which workers will be affected.

    Researchers caution that low accuracy in predicting who would not suffer hearing loss means the test shouldn't be used to select employees to work under high noise conditions.

    Nor should the test be used "to exclude workers from occupational noise exposure, but for improving counseling especially concerning use of hearing protectors and for a tighter schedule for hearing tests," said one of the study authors, Dr. Michael Kundi, at the Institute of Environmental Health in Vienna, Austria.

    In the study, the test did do a better job of predicting which workers would experience hearing loss than traditional risk factors like how long workers were exposed to noise and how often they wore hearing protection.

    Approximately 15 percent of Americans between the ages of 20 and 69 have hearing loss that is possibly caused by noise at work or during leisure activities, according to the National Institute on Deafness and Other Communication Disorders.

    According to the U.S. Occupational Safety and Health Administration (OSHA), 30 million Americans are exposed to hazardous noise levels at work.

    Researchers have long sought to understand differences in hearing loss experienced by people exposed to similar noise levels in the workplace. Studies at the authors' institute have found that variations in the inner ear's reaction to noise are partly responsible, meaning some people are more susceptible to hearing loss than others, likely due to genetics.

    One indicator of a person's susceptibility is how quickly the cells of the inner ear recover from noise exposure, which can be detected by measuring so-called temporary threshold shift (TTS) - a temporary hearing loss that's also known as aural fatigue or auditory fatigue.

    The TTS test exposes participants to frequencies between 200 and 500 Hertz at about 100 decibels. After the exposure, the researchers perform an audiogram at 4 kilohertz for at least 10 minutes.

    The magnitude of TTS after 2.5 minutes may indicate whether the person is more likely to suffer permanent noise-induced hearing loss, according to the authors.

    For their study, published in Occupational and Environmental Medicine, they followed 125 white, male teenage apprentices working as fitters and welders at a steel company in Austria.

    They measured the participants' hearing at the start of the apprenticeship in the morning hours, before workers were exposed to workplace noise. The study followed the apprentices, conducting hearing tests every three to five years for an average of 13 years.

    The study team found that 82 percent of the workers considered vulnerable to hearing loss based on the initial test did lose hearing over the years.

    When predicting who was not likely to experience hearing loss, however, the test was correct only 53 percent of the time.

    OSHA requires employers to implement a "hearing conservation program" when workers are exposed to noise of 85 decibels or more over an eight-hour shift. The rule requires "employers to measure noise levels, provide free annual hearing exams and free hearing protection, provide training, and conduct evaluations of the adequacy of the hearing protectors in use" (see: http://1.usa.gov/1vnyj2o).

    The current study suggests that such restrictions may be more effective for some workers than others, Kundi notes. Although he doesn't recommend the test be used to assign workers to noisy jobs or exclude them, the TTS test could identify people who are particularly vulnerable.

    The test is not expensive, he said, and can be done during regular occupational hearing tests. A person concerned about hearing loss could also get this test on his or her own. An ear, nose and throat specialist with an audiometer and a noise generator can perform it, Kundi said.

    "It would be premature to recommend this screening method for general use until these findings have been replicated by an independent group," said Dr. Robert Dobie, an ear specialist at the University of Texas Health Science Center in San Antonio. "Even then, its apparently poor performance (especially its low specificity) would dampen enthusiasm," Dobie told Reuters Health by email.

    Dobie, who was not involved in the study, also worries that "it might lead to inadequate prevention and counseling efforts for people who appeared - by this test - to be resistant to noise damage," he said. "At this point in time, it seems best to treat everyone as susceptible."

    For workers concerned about noise exposure, Dr. Hanns Moshammer, who led the Austrian study, said it's important to let the inner ear recover by reducing noise in activities outside of work.

    After a person has been exposed to loud noise, "for recovery, the cells need calm conditions for the rest of the day," he said. Increasingly, "recreational noise, games and loud music threaten our hearing faculty," he added, and advised that people exposed to noise at work avoid noisy leisure activities.

    Hans-Peter Hutter, senior author of the study, added in an email that "noise induced hearing loss (NIHL) represents a public health challenge as numbers are increasing - we think that our findings are a further step in the prevention of this health problem."

    SOURCE: bit.ly/1tlA284 Occupational & Environmental Medicine online July 25, 2014.

  • UK and French police hunt for seriously ill boy taken from hospital

    By Reuters Staff

    LONDON (Reuters) - British and French police launched a major hunt on Friday to find a seriously ill young boy taken from a hospital by his parents, saying that unless he was found quickly his life could be at risk.

    Ashya King, 5, who has a brain tumour, was removed from Southampton General Hospital in southern England by his mother, Naghemeh, and father, Brett, on Thursday afternoon and later, with his six siblings, the family boarded a ferry to France.

    "If we do not locate Ashya today there are serious concerns for his life," said Detective Superintendent Dick Pearson.

    "He is receiving constant medical care within the UK due to recent surgery and ongoing medical issues. Without this specialist, 24-hour care Ashya is at risk of additional health complications which place him at substantial risk."

    Police said the family were travelling in a grey Hyundai car while Ashya, who cannot communicate verbally and is immobile, was likely to be in a wheelchair or a stroller.

  • With high blood pressure, light to moderate drinking may protect heart

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Drinking alcohol has been tied in the past to a higher risk of high blood pressure, but in a new analysis of past studies, researchers found that a drink or two a day seemed to protect even those with hypertension from heart disease and death.

    People with high blood pressure who have never been drinkers shouldn't start now based on the evidence from studies like these, said senior author Qi-Qiang He of the School of Public Health/Global Health Institute at Wuhan University in China.

    Observational studies only include data on what people do in their lives and what happens to them, and can't say for sure that one action, like drinking alcohol, causes a particular result.

    The new meta-analysis combines the data from nine previous studies involving a total of nearly 400,000 people with high blood pressure. In all of the studies, alcohol consumption, including wine, beer and spirits, was recorded, as were cases of heart disease, stroke, heart failure and death from any cause.

    The researchers divided the participants into four groups: occasional or never drinkers, those who drank about 10 grams (about a third of an ounce) of ethanol - pure alcohol - per day, and those who drank 20 or 30 grams of ethanol per day.

    In the U.S., a five-ounce glass of wine, a 12-ounce bottle of beer and a 1.5-ounce shot of liquor each contain about 14 grams of alcohol.

    Overall, He's team found that cardiovascular disease, heart attacks, strokes and other risks went down as alcohol consumption went up, according to the results published in Mayo Clinic Proceedings.

    This study included relatively few heavy drinkers, and other studies have found that the heart risk decline disappears for very heavy drinkers or binge drinkers, the authors caution.

    For all causes of death, the risk was lowest among those who drank between eight and 10 grams of alcohol per day, and the risk was higher for those who drank more or did not drink at all. Light to moderate drinkers were about 18 percent less likely to die over the course of a study than people who did not drink.

    "This was firstly found true in people with normal blood pressure," He told Reuters Health by email.

    In the general population, some studies suggest that alcohol consumption might enhance heart rate variability or keep plaque from building up inside arteries, but the mechanism is still not clear, He said.

    If anything, beneficial effects of alcohol should be even more pronounced for people without high blood pressure, said Dr. Franz H. Messerli a cardiology expert at the Icahn School of Medicine at Mount Sinai in New York.

    "One to 2 drinks daily is said to be the goldilocks amount of alcohol," Messerli told Reuters Health by email.

    But even these small amounts of alcohol have been associated with an increased risk for high blood pressure, he said.

    "We don't know whether moderate drinking is truly cardioprotective or if it is merely a marker of a healthy lifestyle," Messerli said.

    Moderate alcohol drinkers also tend to be part of the healthiest subset of the social landscape, he said.

    "Non-drinkers are usually older, eat a less healthy diet and exercise less than moderate drinkers," he noted.

    Messerli agreed that the study results should not be taken as encouragement for non-drinkers to take up drinking.

    Suggesting that people start having a few drinks here and there to reduce their risk of various heart problems may actually lead to binge drinking which increases the risk of stroke, Messerli said.

    SOURCE: http://bit.ly/1vSuiUa Mayo Clinic Proceedings, online August 1, 2014.

  • German Green's ice bucket challenge lights up dope debate

    By Reuters Staff

    BERLIN (Reuters) - A German Greens party leader has taken the "ice bucket" charity challenge to a new high, standing next to a marijuana plant while dousing himself with water in a tacit call for the legalization of cannabis.

    Cem Oezdemir is one of many public figures and ordinary citizens around the world to take the challenge - pouring a bucket of ice water over one's head to raise funds to fight Amyotrophic Lateral Sclerosis (ALS).

    But Oezdemir, whose party supports legalizing the drug for adults, acknowledged that the waist-high plant by his side in a video filmed on a Berlin rooftop was indeed a "subtle political statement."

    "Yes, it is a cannabis plant," Oezedmir told the Essen-based Westdeutsche Allgemeine Zeitung (WAZ) after speculation about the plant gripped social media.

    "In a free society it should be up to each individual person to decide whether they want to consume cannabis and take the associated risks," he told the newspaper.

    Possession, cultivation and consumption of cannabis is illegal in Germany although carrying small amounts is tolerated. In July, a court ruled that seriously ill patients could cultivate their own.