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

  • Alcohol blackouts common in UK teens

    By Andrew M. Seaman

    (Reuters Health) - About a third of 15-year-olds in the UK have blacked out due to alcohol, a new survey indicates - and the rate rises to nearly three-quarters by the time they reach 19, researchers found.

    "Blackout is associated with pretty severe intoxication," said Dr. Marc Schuckit, the study's lead author from the University of California, San Diego. It occurs when the blood alcohol level "is about double what is legally drunk."

    "We found that (blackouts) were shockingly common" among the teens in the survey, Schuckit told Reuters Health.

    Although there are some variations among U.S. states, most set a blood alcohol content of 0.08 percent as the legal limit. The National Transportation Safety Board recommended lowering that level to 0.05 percent, which is the cutoff in many European countries.

    Schuckit believes teens, and popular culture, view blacking out as funny. But it's very serious, he said, adding that when blood alcohol levels are high enough to cause blackouts, "people are very likely to get into trouble."

    The 1,402 teens in the study, all of whom reported drinking when surveyed at age 15, were surveyed again at ages 16, 18 and 19.

    At age 15, 30 percent reported drinking to the point where they could not remember what happened the next day. By age 19, about 74 percent had experienced an alcohol-related blackout.

    There were four distinct drinking patterns, researchers found. About 5 percent of participants did not report any blackouts. In about 30 percent, blackouts increased rapidly as kids got older. In about 45 percent, blackouts slowly increased with age. And in about 20 percent, there was a steady rate of blackouts throughout the study.

    "What is really important is the 'never had a blackout' group was relatively uncommon, compared to the other groups," Schuckit said.

    Some students were more likely to report alcohol-related blackouts, compared to other students.

    "The first was a surprise to me," Schuckit said. "That is if you're female."

    His group also reports in the journal Alcoholism: Clinical and Experimental Research that drinking more, smoking, having fewer inhibitions and having more friends thought to be drinking and using drugs were all tied to an increased number of blackouts.

    While Schuckit said these numbers may be less dramatic among U.S. teens, "there's no way I'm ever going to see a kid from (age) 14 on without asking about their drinking pattern."

    If doctors do suspect a teen is on a dangerous path with drinking, he said "what you do is as a clinician is a brief intervention."

    A brief intervention is a quick session to make a person think about their drinking and giving them resources to drink more responsibly.

    Parents, Schuckit said, should start a discussion about drinking.

    SOURCE: Alcoholism: Clinical and Experimental Research, online December 16, 2014.

  • Federal judge rebuffs NCAA concussion settlement

    By Reuters Staff

    (Reuters) - A federal judge on Wednesday rebuffed a $75-million NCAA settlement that aimed to end a massive class-action lawsuit over head injuries suffered by student athletes, court records show.

    U.S. District Judge John Lee wrote in a 21-page opinion that while the proposed agreement was a step in the right direction, the $70 million devoted to fund concussion testing and diagnosis for players might not cover potential costs, among other issues.

    "Although these concerns may prove surmountable, the Court cannot grant preliminary approval of the settlement as currently proposed," Lee wrote.

    There was no immediate reply to a request for comment from the National Collegiate Athletic Association (NCAA), which had previously welcomed the agreement as a way to improve sports safety.

    The lawsuit was first filed in 2011 on behalf of former Eastern Illinois football player Adrian Arrington, who said he suffered headaches and seizures as a result of five documented concussions. The proposed settlement covers other cases.

    The deal also addressed some guidelines, such as barring a student with a concussion from returning to play or practice on the same day and requiring a doctor's clearance.

    It would have also set aside $5 million for concussion research, although research done by member schools can be credited toward that amount.

    The opinion highlighted that not all plaintiffs in the case were happy with the settlement, with some taking issue over the provision barring players from bringing bodily injury claims as a class.

    The proposed NCAA settlement came a few weeks after a federal judge's preliminary approval of an open-ended settlement between the National Football League and thousands of former players in June.

    The NFL settlement money was intended to resolve all the personal injury claims for the plaintiffs' out of pocket damages.

    The danger of concussions and other head injuries has received increased attention in college and professional sports in recent years, with much of the focus on football.

    More than 450,000 NCAA student athletes compete in 23 sports. The NCAA makes revenue of about $740 million each year, court documents show.

  • Knee pain may run in the family

    By Shereen Lehman

    (Reuters Health) - People whose parents had a total knee replacement due to osteoarthritis are more than twice as likely to develop knee pain in midlife as those with no family history of knee surgery, according to a new study.

    The Australian authors say the link between parents and adult children shows that genetics may have much to do with knee problems and the pain that goes with them.

    "It was abundantly clear that genes were a strong contributor to risk of osteoarthritis but there had been limited success in finding these genes," said Dr. Graeme Jones of the University of Tasmania in Hobart, the study's senior author.

    "Thus, a better way may be to look at mechanisms by which genes lead to arthritis and the best way of doing this was to study the adult children of people who have had knee replacements for osteoarthritis," Jones told Reuters Health in an email.

    By age 45, about one-quarter to one-third of adults have had knee pain that lasted for at least one week, the study authors write in the Annals of the Rheumatic Diseases .

    The causes of knee pain aren't always clear, but previous studies have also suggested a genetic link.

    The new study is the first to examine whether people who have a family history of osteoarthritis of the knee have a greater risk of worsening knee pain, according to the authors.

    They enrolled 186 adults with at least one parent who had knee replacement surgery at one of the hospitals in Hobart, and an additional 186 adults whose parents had no history of knee arthritis or knee replacement surgery.

    At the beginning of the study, participants answered questionnaires reporting any knee pain they had experienced over the past year, and had X-rays and MRI scans of their right knees. These measures were all repeated two years later and again 10 years after the initial enrollment.

    The adults whose parents had knee replacement surgery tended to be heavier and there were more smokers compared to the control group, but there were no differences between the groups as far as visible damage to the knee joints at the beginning of the study.

    After two years both groups had about the same number of participants with knee pain - just over half. But after ten years, 74 percent of the children of parents with knee replacements had knee pain compared to 54 percent of those with no family history of knee surgery.

    Over those eight years there was also an increase in total knee pain in members of both groups, but the offspring of parents with knee surgeries tended to have a greater increase in pain.

    Even after accounting for actual structural problems in the participants' knees, the researchers found that offspring of people with knee replacement surgery were 2.2 times as likely to report that their pain had worsened compared to the controls.

    "I suppose there are many mechanisms by which genes lead to arthritis - some we can help, some we can't," Jones said. "Offspring have more pain, weigh more, are more susceptible to the effects of smoking, have weaker muscles, more splits in the cartilage and menisci and greater cartilage loss over time."

    Since differences in arthritis and other structural knee problems did not explain the differences between groups in knee pain, Jones said that genetics most likely accounted for the outcomes - for instance, a greater sensitivity to pain that might be influenced by genes.

    Still, other factors, such as aspects of the environment, that were shared by both parents and adult children could not be ruled out, he said.

    To avoid knee pain, Jones suggests that people maintain an ideal body weight, minimize their risk of knee injury, exercise more when they're younger and refrain from smoking.

    "Develop ways of decreasing pain severity, and manage stress better," he added. "Consider medications such as glucosamine if at high risk."

    SOURCE: Annals of the Rheumatic Diseases, online December 4, 2014.

  • REFILE-Colorado awards $8 million to study medical marijuana uses

    (Corrects paragraph 7 to clarify that funding comes from patient registration fees, not taxes on medical marijuana sales)

    By Keith Coffman

    DENVER (Reuters) - Colorado health officials awarded $8 million in research grants on Wednesday to study the use of medical marijuana in the treatment of symptoms associated with Parkinson's disease, childhood epilepsy and post-traumatic stress disorder.

    Colorado was one of the first two U.S. states to legalize recreational pot use, and it is among 23 states and the District of Columbia that permit use of the drug for medicinal purposes.

    But weed remains illegal under federal law for any reason, leading to a dearth of funding for medical marijuana research, and meaning results are limited and largely anecdotal.

    Awarding eight grants for landmark peer-reviewed studies into an array of maladies, the Colorado Department of Public Health and Environment said it sought to provide objective scientific research on the efficacy of medical marijuana.

    "The grant program ... should not be construed as encouraging tor sanctioning the social or recreational use of marijuana," the department said in a statement.

    Colorado lawmakers set up a Medical Marijuana Scientific Advisory Council last year and allocated $10 million to administer a program to conduct the studies. The council received some three dozen applications, from which it chose the eight approved by the department on Wednesday.

    Funding for the program is derived from registration fees paid by medical marijuana patients in the state.

    Six of the grants will go to the University of Colorado Anschutz Medical Campus, said university spokesman Mark Couch.

    Researchers there will study whether marijuana in its various forms can alleviate the tremors associated with Parkinson's and whether it can provide relief for children with brain tumors or pediatric epilepsy.

    Other projects will research using marijuana to treat irritable bowel syndrome in adolescents and young adults, and how cannabis compares with the pain medication Oxycodone.

    Teams at the University of Pennsylvania will conduct two separate studies on whether cannabis is effective in treating patients suffering from post-traumatic stress disorder, including combat veterans.

    "It's true that little research has been done due to federal restrictions. I think that will change as more states are legalizing," said Brian Smith, a spokesman for the Washington State Liquor Control Board, which oversees legalized recreational cannabis there.

    Voters in Oregon and Alaska cast ballots in November to join Colorado and Washington in legalizing recreational pot use.

  • Heart experts warn of air pollution dangers

    By Janice Neumann

    (Reuters Health) - Air pollution should be one of the avoidable heart risk factors - just like smoking and excess fat - that doctors warn patients to steer clear of, according to a new statement from 20 heart experts.

    Citing pollution's heavy toll on cardiovascular health, the panel urges people to take steps to protect themselves from breathing heavy traffic fumes or industrial air pollution whenever possible, and public officials to pass laws to reduce air pollution.

    "Cardiovascular disease is a huge global problem, causing immense suffering and premature death, as well as placing severe strain on national healthcare budgets and/or family finances," said Dr. Robert Storey, a professor of cardiology at the University of Sheffield in the UK and senior author of the new position paper.

    Air pollution causes more than 3 million deaths worldwide each year and causes 3.1 percent of all cases of disability, Storey and his coauthors write in the European Heart Journal.

    Air pollution is also ninth most important on a list of modifiable heart-disease risk factors - ranking above low physical activity, high-salt diet, high cholesterol and drug use, the authors point out.

    Although gaseous air pollutants can be dangerous too, Storey said, airborne particles are the biggest contributor to cardiovascular disease because they cause inflammation of the lungs and enter the circulation, inflaming blood vessels, provoking clots and causing heart rhythm disturbances.

    Particulate matter includes coarse particles from road dust, construction work and industrial emissions and fine particles from traffic, power plants and industrial and residential burning of oil, coal or wood for heating.

    The bulk of particulate air pollution is made up of these fine particles, known as PM2.5, that are less than 2.5 micrometers - about one fifth the size of visible dust.

    The World Health Organization sets the safe outdoor exposure limit for PM2.5 at an average of 25 micrograms, or 25 millionths of a gram, per cubic meter of air over a 24-hour period, or average annual levels of 10 micrograms per cubic meter. In 2013, the U.S. Environmental Protection Agency lowered the 24-hour exposure limit to an average of 12 micrograms.

    European studies have found that PM2.5 levels are often markedly higher near heavy traffic zones compared to elsewhere in the same city, and that the levels can more than double during rush hours, according to the position statement.

    Some of the authors' advice for people to protect themselves is as simple as walking, cycling and using public transportation instead of driving cars, and exercising in parks or gardens, rather than near busy roads.

    And everyone should avoid being outside when pollution is highest, though this is especially important for infants, elderly and people with heart problems, the authors say.

    People who live in heavily polluted areas should also consider ventilation systems with filtration in their homes, since a large portion of outdoor pollution can penetrate buildings.

    The use of fossil fuels for heating and energy should also be decreased, according to the statement.

    "Many countries have made good progress towards reducing risk factors such as smoking, high cholesterol and high blood pressure but much less effort has been extended on reducing exposure to air pollution," Storey said in an email to Reuters Health.

    Studies have shown even short-term exposure to high PM2.5 levels increases deaths from heart disease and respiratory disease, and that people living in places with high PM2.5 have an 11 percent greater risk of dying from heart attacks, strokes and heart failure than those who live in cleaner areas.

    Dr. Robert Brook, a cardiologist at the University of Michigan Health System and another author of the policy statement, said many people don't realize the dangerous effects of air pollution on the heart.

    "While most people can readily observe and believe that air pollution may cause lung diseases, it is in fact cardiovascular diseases that are the largest adverse health effect of fine particulate matter exposure," Brook said in an email.

    Dr. Alan Abelsohn of the Dalla Lana School of Public Health at the University of Toronto in Canada, called the statement an important reminder. Too few cardiologists and primary care doctors advise their patients of pollution's risks, he said.

    "It's a very important and neglected area of prevention," he said.

    Abelsohn, who was not involved in the position statement, noted that national-level guidelines on allowable amounts of pollution can only do so much. He said individuals should always pay attention to the local Air Quality Index, which rates the level of air pollution according to health risk, and reduce their exposure accordingly.

    Brook said that while the U.S. has made great strides reducing air pollution since the 1970s or even 2000, the efforts should continue.

    "What we should not do is lessen our regulations and pose a threat to the cardiovascular health of the nation in the name of expediency or supposed economic growth or stimulus," Brook said.

    SOURCE: European Heart Journal, online December 9, 2014.