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

  • Brain study hints at how fibromyalgia works

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Brain scans show that people with the pain disorder fibromyalgia react differently to what others would consider non-painful sights and sounds, new research suggests.

    The small new study provides clues to what might be going wrong in the nervous system of people with fibromyalgia, along with possible new approaches to alleviating their pain.

    "If we understand the mechanism, we may come up with new and potentially better forms of treatment," said lead author Marina López-Solà of the department of Psychology and Neuroscience at the University of Colorado, Boulder.

    Fibromyalgia, which patients experience as widespread muscle pain and fatigue, affects as many as five million Americans, most commonly middle-aged women, according to the U.S. Department of Health and Human Services.

    Its cause is unknown and there is no cure, but medications can treat the symptoms.

    The new results suggest not only that fibromyalgia is related to greater processing of pain-related signals, but also potentially to a misprocessing of other types of non-painful sensory signals that may be important to address during treatment, Lopez-Sola told Reuters Health by email.

    She and her team used "functional magnetic resonance imaging," which measures blood flow changes in the brain, to assess brain responses among 35 women with fibromyalgia and 25 similar women without the disorder.

    The fibromyalgia patients were more sensitive to non-painful stimulation compared to people without the disorder, they report in Arthritis and Rheumatism.

    Researchers showed the subjects some colors, played some tones and asked subjects to perform very simple motor tasks at the same time, like touching the tip of the right thumb with another finger.

    Areas of the brain's cortex primarily responsible for processing visual, auditory and motor signals were significantly activated in the healthy comparison group, but not in the fibromyalgia group.

    However, other brain regions that are not relevant for primary processing were activated in fibromyalgia sufferers but not in healthy controls.

    What seems to be happening is that the brains of fibromyalgia patients are under-processing certain forms of sensory information at the first stages of processing, but are also amplifying the signal at a later level of sensory integration of multiple sensory inputs, Lopez-Sola said.

    "When you are in pain, it is probable that you are more concentrated on your own pain than on the tasks you have to pay attention to," said Dr. Pedro Montoya of the Research Institute on Health Sciences at the Universitat Illes Balears in Palma de Mallorca, Spain, who was not part of the new study.

    "For me, these findings provide further support for the idea that psychological strategies aimed at changing the focus of attention from the body to external cues could be useful for these patients," Montoya said.

    There were only a small number of people involved in the study, and the researchers did not account for other mental health conditions the participants may have had, both factors that limit the results, said Dr. Winfried Hauser, associate professor of Psychosomatic Medicine at Technische Universitat Munchen in Germany.

    People with fibromyalgia often also have conditions like depression, so some people believe the disorder has a mental basis, said Michael E. Geisser, professor in the department of physical medicine and rehabilitation at the University of Michigan in Ann Arbor.

    But evidence for a neuro-anatomical basis for fibromyalgia is growing, said Geisser, who was not part of the new study.

    "There is increasing evidence that fibromyalgia is not just a pain condition," he told Reuters Health by email. "More recent research done on persons with fibromyalgia, such as the research by Lopez-Sola and colleagues, suggests that persons with fibromyalgia suffer from a central processing deficit of multiple types of sensory stimuli, not just pain."

    "It's as if the volume control for sensation in persons with fibromyalgia is turned up, or louder, for many types of sensation compared to persons without the disorder," he said.

    That might help explain why many people with fibromyalgia also often suffer from fatigue, cognitive problems or mood disturbance, Geisser said.

    Currently, people with the disorder can take anticonvulsant medications, such as pregabalin (Lyrica), and antidepressants such as duloxetine (Cymbalta) and milnacipran (Savella), which have been FDA approved for treating fibromyalgia.

    Further research to improve understanding of where there are problems in the brain for people with the disorder could lead to the development of new treatments, Geisser said.

    For example, it would be interesting to see if a treatment targeted at dampening response in an area of the brain that "overreacted" in this study helped to treat fibromyalgia symptoms, he said.

    SOURCE: http://bit.ly/1mbOikg Arthritis and Rheumatism, online September 15, 2014.

  • Docs urge action to stop young drivers' texting

    By Janice Neumann

    NEW YORK (Reuters Health) - Texting while driving could be contributing to thousands of car crashes, especially among teens, and the American College of Preventive Medicine (ACPM) wants policy makers, doctors and parents to do something about it.

    Texting by novice drivers raises the chances of an accident almost four-fold, the authors of a new position statement point out. But they say new laws, combined with public education, could help eradicate this unnecessary risk on the roadways.

    "I was surprised that statistically the risks, given the little hard data we have, are comparable or worse than those of individuals who are driving under the influence," said Dr. Kevin Sherin, director of the Florida Department of Health in Orange County and lead author of the recommendations published in the American Journal of Preventive Medicine.

    The new recommendations focus on teens because they text or Internet browse nearly twice as much as adults. A recent study found that drivers with less than two years' experience are eight times more likely to crash if they use a cell phone, and seven times more likely if they reach for a cell phone (see Reuters Health story of January 1, 2014, here: http://bit.ly/19F1LID).

    Their risk of crashing increases 3.9 times by sending or receiving texts or using the Internet while driving, the same study found. Of drivers under 20 years old, 11 percent involved in fatal vehicle crashes said they were distracted and nearly one in five said those distractions came from using a cell phone.

    Distractions played a role in 17 percent of motor vehicle crashes in 2011 and 3,331 deaths, according to the National Highway Traffic Safety Administration. Cell phones were involved in 12 percent of the deaths.

    "I have personally observed my teens sending texts and admitting they were driving . . . despite my safety warnings and my own public health, preventive medicine and public safety awareness and special knowledge," said Sherin, whose children are now in their 20s.

    "It certainly did make me interested in effecting (change in) state and national policy," said Sherin, who also teaches at the Florida State University College of Medicine and the University of Central Florida College of Medicine in Tallahassee.

    The recommendations include state bans against texting and driving, public relations campaigns about the dangers, beefed up penalties for violations and educating future drivers when they apply for licenses. Primary care doctors and parents should also work at explaining the dangers of texting while driving to adolescents, starting at age 15, the authors say.

    They added that more research is needed on the role of texting in distracted driving, and on effective educational tools, ad campaigns and how best to counsel patients against it.

    According to the Governors Highway Safety Administration, 14 states have banned handheld cell phone use for all drivers, 38 states and Washington, D.C. prohibit cell phone use for new drivers, 20 states and D.C. prohibit cell phone use for school bus drivers and 44 states have banned texting while driving. Some states use primary enforcement laws for the infractions and others secondary enforcement laws.

    "I personally think the penalties for texting and driving should be as harsh as those for driving under the influence," Sherin said. "The risks are similar.

    Television ads in after-school time slots (like the ads against drugs and alcohol) could highlight the dangers of texting while driving for teens, the ACPM committee said.

    Dr. Linda Hill, clinical professor in the Department of Family and Preventive Medicine at the University of California, San Diego, told Reuters Health she agrees with the recommendations but thinks they should have also focused on the dangers of hands-free and hand-held cell phone use while driving. Hill was not involved in the recommendations, though she is a member of the ACPM.

    Employers also need to be involved since they often expect employees to answer their phones, even while driving, said Hill, who studies distracted driving and has launched several driver safety programs, including one for businesses.

    In a 2011-2012 survey of 5,000 college students in California, Hill found 90 percent were texting and 90 percent talking on the phone while driving. The survey also found that 50 percent sent texts while driving on the freeway.

    "We thought that was pretty scary," Hill said. "What shocked us was that 46 percent of the kids thought they were capable of distracted driving but thought only 8 percent of other drivers were."

    That unwarranted self-confidence in multitaskers is common, according to Zhen Joyce Wang at the Center for Cognitive and Brain Sciences, The Ohio State University. She told Reuters Health that texting while driving can be particularly dangerous.

    "It is because the capacities demanded by the tasks are more than what a person can typically afford," said Wang, who has published several studies on distracted driving. "We found both behavioral and eye movement (indicating visual attention) evidence that suggest texting and driving could be more dangerous than making phone calls while driving," Wang said in an email.

    SOURCE: http://bit.ly/1uHC58a American Journal of Preventive Medicine, published online Sept. 10, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • REFILE-Falls indoors may signal frailty, linked to shorter survival

    (corrects third paragraph to say study was led by Bailly)

    By Shereen Lehman

    NEW YORK (Reuters Health) - Women in their eighties who fell indoors, rather than outdoors or from a height like a ladder, died sooner than their peers, a new French study finds.

    Indoor falls could be an indicator of frailty and a sign that protective measures should be taken, say the authors.

    The study was led by Sebastien Bailly, a researcher with Hospices Civils de Lyon in France. He and his coauthors write in the journal Maturitas, "The mean survival time of women with inside falls was nearly 1.6 years shorter than that of women with other falling profiles."

    Bailly and his colleagues studied 4,574 women who were over the age of 74 when they joined the study, could walk by themselves and were not living in institutional settings.

    The researchers called the women every four months for the first four years of the study to find out if they had fallen at some time during the previous week and where.

    The study team distinguished among falls by their location, whether they were due to inattention or to an environmental obstacle, and how serious the resulting injuries were.

    Along these lines, they classified the falls as environmental falls, such as slipping or tripping on something outdoors, falls from a height like a ladder or stairs, and inside or outside falls in general.

    Looking at information on 329 women who had fallen the week before the phone call follow-ups, the researchers found that 26 percent were so-called environmental falls, 19 percent were outside falls, 43 percent were inside falls and 12 percent were falls from height.

    The study team followed up again after another 13 years and found that 269 women had died. And those who had fallen indoors had an average survival time of 7.6 years, compared with 9.2 years for women who had any other type of fall.

    Separate from the type of falls women had, the researchers also found that women with advanced age, signs of frailty, slow walking speeds and comorbidities - that is, other health conditions - also had shorter survival times.

    However, women with frailties, for example, "who experienced outside falls or falls from height had no increased mortality despite more serious injuries," the researchers note.

    "Among community-dwelling women, some fall more frequently than others," the study team concludes. "These women should draw the caregivers' attention because their falls may be indicators of frailty. Non-injurious falls are also of concern because women experiencing this type of fall may suffer from unfavourable underlying conditions and be at risk of short survival."

    "The study is very well done," Dr. Kathleen Walsh told Reuters Health. "It has been shown in prior studies that for indoor falls the mortality tends to be worse, and longevity is diminished," said Walsh, who was not involved in the French research.

    Walsh, a geriatric and emergency medicine specialist at the University of Wisconsin Hospital in Madison, said there are different reasons that people fall inside and one of the questions that would be have been interesting to ask was how much time the patients were spending indoors or outdoors.

    "In general, people who fall inside have to stay inside for a reason and that's because of comorbidities - they're not super active and may not be active for different reasons," she said.

    But, Walsh said, family members shouldn't panic and tell their elderly loved ones that they need to move into assisted living after they've had a fall.

    "Because if you panic without having things evaluated by the physician that person will probably not tell you again when they have fallen," she said. "Staying calm is the number one thing."

    Walsh also said that physicians should ask their elderly patients if they have fallen within the previous year. If they have fallen, the doctors should find out what the patient remembers about the fall and if it was caused by certain movements, or if the patient could get up after the fall.

    "The red flags are, did they pass out before they fell," she said. "It's all in the history, if you take a good history you can usually figure things out."

    Walsh said that family members help to prevent falls by doing things like removing rugs and putting bars in bathrooms. In addition, she suggests elderly patients take classes to improve their balance and strength, such as the Stepping On class (http://www.steppingon.com).

    "Stepping is usually held at a local hospital or senior center and it's all about things that you can do while you're washing dishes or doing odds and ends around the house so you don't have to go to the physical therapist," she said.

    SOURCE: http://bit.ly/1oHXLKv Maturitas, online August 4, 2014.

  • Secure Italian military lab to grow medical marijuana

    By Steve Scherer

    ROME (Reuters) - Italy said on Thursday it would grow medical marijuana at a secure military lab outside Florence and distribute it through pharmacies to slash costs and make it more easily available to the sick.

    The use of medical marijuana or cannabis derivatives to treat patients has been legal in Italy since 2007, but only a few dozen people took it through the national healthcare system in 2013 because of its prohibitive cost.

    The military lab produces so-called "orphan" drugs no longer made by large pharmaceutical companies that are needed to treat rare diseases, Defense Minister Roberta Pinotti said after signing an agreement with Health Minister Beatrice Lorenzin.

    "The institute already produces some medicines," Pinotti said, explaining the unusual case of tasking the military to grow pot. "And we can guarantee security conditions."

    Lorenzin said she wanted to "debunk all the cultural or ideological myths" about using certain drugs in healthcare.

    "We already allow the use of drugs in medical treatment that are opiate or cocaine derivatives, and now we'll use cannabis," she told reporters.

    "Recreational drug use is harmful. But cannabis can be used to help treat certain pathologies or alleviate pain," she said.

    Possessing, selling and growing marijuana are illegal in Italy, which now imports all of its medical supplies of the drug, mostly from the Netherlands.

    Tax and transportation more than double the cost, with the retail price reaching almost 38 euros ($49) per gram, Dr. Francesco Crestani, an anesthesiologist and president of Italy's Association for Therapeutic Cannabis, told Reuters.

    PILOT PROJECT

    While several Italian regions have drafted laws aimed at cutting the cost of medical marijuana for people suffering from pathologies like cancer or multiple sclerosis, they have run into fierce opposition.

    Many argue that allowing the use of marijuana, even by the sick, sends the wrong message to teenagers, whose use of the drug is growing. One in four between the age of 15 and 19 has smoked it last year, a parliamentary report said this week.

    Italy's choice to keep tight control of the production of marijuana contrasts with developments in the United States, where almost half the 50 states allow sick people to grow their own, or in some states to buy it from dispensaries.

    The agreement, which the ministers described as a "pilot project", should result in the medicines being delivered to pharmacies by the end of 2015, Lorenzin said.

    Private pharmaceutical companies will not be able to produce medical marijuana "given the delicacy of this issue," she said.

    Each of Italy's 20 regional governments will establish the exact cost of the medicine to patients, Lorenzin added, but the retail cost of medical marijuana in Italy should be "more than halved."

    "This is a positive step," said therapeutic cannabis proponent Crestani, adding he hopes production is not delayed by bureaucratic snags.

    Due to the costs, most sick people who want marijuana have been buying it from the local drug dealer, Crestani said.

    "It's not safe to buy it on the street because there is no control over how it is produced. And the more you can cut the cost of the medicine, the better it is for the patient."