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

  • Sleep apnea tied to memory problems

    By Andrew M. Seaman

    (Reuters Health) - The ability to remember locations and directions may suffer when deep sleep is disrupted by breathing difficulties, a new study suggests.

    People with sleep apnea tended to score worse on spatial memory tests after sleeping without their breathing aid, compared to mornings after they'd used their breathing aids at night, researchers found.

    "There had been some evidence in animal models that REM sleep or dreaming sleep is important for spatial memory, but no one had shown or proven that in people," said Dr. Andrew Varga, the study's lead author from NYU Langone Medical Center in New York City.

    "Spatial memory" helps people remember how to get to their children's schools, or where they left their keys, for example.

    It's thought that people may have difficulty forming new spatial memories if their deep sleep and shallow sleep are interrupted, according to Varga.

    People with sleep apnea - some 18 million Americans, according to the National Sleep Foundation - experience numerous pauses in breathing that can last from seconds to minutes. As a result, people with sleep apnea are often tired when they wake.

    To see whether individuals with sleep apnea tended to have more difficulty forming new spatial memories, the researchers recruited 18 such people to spend two nights in their sleep center, about two weeks apart.

    The volunteers had always slept with a so-called CPAP machine to eliminate sleep apnea. During one night in the sleep lab, they slept with CPAP. The other night, their CPAP was reduced or turned off during deep sleep to induce apnea.

    On each of the two nights, before they went to bed, participants were asked to complete a video game maze. The next morning, they completed the maze again.

    After a night of sleep with their CPAP machine, the time it took the volunteers to complete the maze improved by about 30 percent. They also traveled farther in the maze and spent less time backtracking.

    But after a night with sleep apnea, the volunteers were about 4 percent slower at completing the maze, compared to the night before.

    "People had no improvement and actually on average they got a bit worse," Varga said. "We interpret that to mean their consolidation in spatial memory wasn't as good when REM (deep) sleep was disrupted."

    The researchers can't say whether the worse performance is directly from the disruptions in sleep caused by the apnea, or whether it's the lack of oxygen the condition causes.

    Varga said they are testing the apnea or oxygen question now. They are also looking at whether apnea during shallow sleep affects spatial memory.

    "The thought is that you need both (deep and shallow sleep)," he said. "If you don't have one or the other, you don't' have the ability to consolidate the information."

    Varga said he hopes the results of the study, published in The Journal of Neuroscience, will encourage more doctors to treat sleep apnea early - instead of waiting until the condition worsens.

    "Apnea is very common and has a variety of deleterious effects that have to do not only with cardiovascular health, but also there is an emerging dataset - of which this paper is only one piece - to suggest there are really cognitive effects also," he said.

    SOURCE: The Journal of Neuroscience, online October 29, 2014.

  • "Wandering eye" may raise risk of falls for older adults

    By Shereen Lehman

    (Reuters Health) - Older people with strabismus, where one eye points slightly inward or outward affecting vision, are about 27 percent more likely than people without the condition to be injured by a fall, according to a new study.

    The disorder, often called "wandering eye," becomes more common with age and can cause double vision or depth perception problems because the two eyes are not pointing in the same direction.

    Previous studies have shown that having other eye disorders like cataracts, glaucoma or age-related macular degeneration increases the risk of injuries, fractures or falls, the study team writes in JAMA Opthalmology. But this is the first to examine whether so-called binocular vision problems have the same effect.

    "Strabismus in adults is becoming more prevalent as the aging population increases and we do not know the impact of strabismus on patient quality of life and morbidity," lead author Dr. Stacy Pineles told Reuters Health in an email.

    "We hypothesized that strabismus could cause double vision or diminished depth perception, and we wanted to see whether this was associated with injuries such as falls, fractures, and musculoskeletal injuries," said Pineles, an ophthalmologist with the Jules Stein Eye Institute at the University of California, Los Angeles.

    Pineles and her colleagues looked at a random sample of Medicare claims for more than two million beneficiaries over the years 2002 to 2011.

    They found almost 100,000 diagnoses of binocular vision problems. The great majority were either strabismus or diplopia, meaning double vision, which often goes along with strabismus. On average the patients were older, white, were more often male and had other health problems like diabetes and heart disease.

    About 75 percent of those with binocular vision problems had also reported some type of musculoskeletal injury, fall or fracture during that 10-year time span, compared to about 60 percent of patients without a binocular visual disorder.

    After taking into consideration age, region and other potential contributors to falling, such as other illnesses, the researchers calculated that people with binocular vision disorders had a 27 percent higher risk of falls, fractures and injuries overall.

    For people with a specific diagnosis of diplopia, the risk was 36 percent higher.

    The study team cautions that they don't know if the injuries occurred before the vision problems were diagnosed or afterward, so they can't say for certain that the eye disorders are to blame for the falls. They also don't know which patients were being treated for their vision problems.

    Still, Pineles said that elderly patients with vision problems should be sure they optimize lighting in their homes, get help when navigating unfamiliar areas and use low-vision aids if necessary.

    Dr. Jamie Rosenberg, an ophthalmologist at Montefiore Medical Center in New York who specializes in strabismus, said that eye problems can sometimes seem less important to elderly patients compared to other illnesses they may have. But "they can affect their life in a significant way and keeping them safe from falls is a huge part of keeping older people healthy."

    Rosenberg, who wasn't involved in the new study, said there are treatment options for strabismus, such as wearing special glasses with prisms that help align the double images seen by people with diplopia.

    "Even though the eyes aren't straight the two images that are being processed by the brain will be one," she said.

    Surgery may also be an option. "A lot of people think that older people can't have strabismus surgery to straighten their eyes but that's actually not true at all," Rosenberg said.

    The new study may underestimate the magnitude of the problem, noted Priscilla Rogers, an aging and vision loss expert at the American Foundation for the Blind's Vision Aware program.

    "Only people who seek medical care from a fall would be included, so the problem is probably bigger and greater than this study suggests," she told Reuters Health in an email.

    Access to eye care may be one obstacle keeping older people from getting help for vision disorders, she noted. "Medicare does not pay for new glasses and people on a fixed income may not want to buy new glasses because they cost too much," Rogers said. "They can, after all, see - they just may not see well enough to avoid a trip or fall."

    Rogers said that fall prevention programs such as "A Matter of Balance" offered in several states ( ) can help reduce the risk of injuries among people with visual impairments.

    SOURCE: JAMA Ophthalmology, online October 23, 2014.

  • Oregon woman visits Grand Canyon ahead of planned assisted suicide

    By Reuters Staff

    (Reuters) - A 29-year-old Oregon woman with terminal brain cancer has ticked off the Grand Canyon from her bucket list and said in a video released this week that she might end her life through assisted suicide in a couple of days.

    Brittany Maynard was diagnosed in January with a glioblastoma brain tumor and has said she plans to take prescribed medication to die when her pain becomes unbearable. She has moved from her San Francisco Bay area home to Oregon, which allows assisted suicide for terminally ill patients.

    Maynard is raising funds through a group called Compassion & Choices to advocate for assisted suicide as an option for terminally ill patients. The group released her latest video on Wednesday.

    Opponents of assisted suicide say some people who are ill, especially among the elderly, might be unduly influenced by people close to them to end their lives and that other ways exist to ease the suffering of the terminally ill.

    Maynard, who has stressed that her decision to end her life is her own, had previously told People magazine, which featured her on the front page of its Oct. 27 issue, that she had picked Nov. 1, as the day she planned to die, although she also said she might change her mind.

    In her latest video, Maynard said: "So if Nov. 2 comes along and I've passed, I hope my family is still proud of me and the choices I made.

    "If Nov. 2 comes along and I'm still alive, I know that we'll still be moving forward as a family out of love for each other and that decision will come later."

    On the website of Compassion & Choices, Maynard wrote that she traveled to the Grand Canyon with her husband and her parents during the week before Oct. 24 to make her bucket list dream come true.

    Maynard suffered her worst seizure the morning after the Grand Canyon visit. Her speech was paralyzed for some time after she regained consciousness, she wrote.

    "Sadly, it is impossible to forget my cancer," she wrote.

    A representative for Compassion & Choices did not return calls.

    Since 1997, more than 750 patients in Oregon have died from ingesting medications prescribed under the state's death with dignity law, according to the Oregon Public Health Division. Four states beside Oregon allow assisted suicide.

  • Speed of weight loss may have little impact on success at keeping it off

    By Roxanne Nelson

    (Reuters Health) - In a trial of weight loss approaches, the rate at which people dropped excess pounds was not linked to their success in keeping the weight off over the next three years.

    Researchers say the small study shows that current guidelines advising slow and steady weight loss should be revised, and the focus should be instead on improving methods for helping people maintain their weight over the long term.

    The long-held belief that losing weight gradually produces better long-term outcomes seems to stem from the perception that obesity is a behavioral problem and that gradual weight loss allows more time for habits to change, the Australian study team writes in The Lancet Diabetes & Endocrinology.

    "Obesity is not just a lifestyle disease as it is commonly believed but is largely genetic," senior author Joseph Proietto, Sir Edward Dunlop Professor of Medicine at the University of Melbourne, told Reuters Health.

    Scientific evidence also does not support the superiority of a gradual approach in achieving or maintaining weight loss, he said. Regardless of how pounds are lost, many individuals have difficulty staying at their new weight and often gain it all back.

    To test whether the rate of weight loss affects whether people regain weight, Proietto and his colleagues designed a two-part trial.

    In the first part, 200 obese adults were randomly assigned to either a 12-week rapid weight loss program on a very-low-calorie liquid meal-replacement diet of 450 to 800 calories a day, or to a 36-week program of gradual weight loss. The gradual diet was based on current Australian healthy eating dietary recommendations and included one or two liquid meal replacements per day, with a goal of reducing the participants' calorie intake by 400 to 500 a day.

    In part two, people who had lost 12.5 percent or more of their body weight were able to continue into a weight maintenance program that would run for about three years. The maintenance program included an individualized eating plan and meetings with a dietician every 12 weeks.

    In the first part of the study, the researchers found, participants who lost weight faster were more likely to achieve their target weight loss. Overall, 81 percent of those in the rapid weight loss group lost 12.5 percent or more of their body weight, compared to 50 percent in gradual weight loss group.

    And in part two, the speed at which individuals had lost weight did not appear to play a role whether they regained weight or how much. Both groups gained back about 71 percent of the weight that they had initially lost.

    As observed in this study, very low calorie diets can lead to robust weight loss in a very short time, but this type of diet should only be undertaken with medical supervision, said Dr. Kishore M Gadde, from the Pennington Biomedical Research Center in Baton Rouge, Louisiana. He was not involved in the study, but wrote an accompanying editorial in the same issue of the journal.

    Keeping the weight off is all too frequently the problem, Gadde said. "Once desired weight loss is achieved, individuals need to make intensive efforts to maintain their lost weight."

    The study showed that seeing a nutrition counselor every three months is not adequate support for weight maintenance, Gadde noted.

    "Exercise can help prevent weight regain to some extent, but the intensity of exercise needed to prevent regain is difficult to incorporate into our daily lives," he told Reuters Health.

    Using diet and exercise, unfortunately only about 15 percent may be able to successfully lose weight and keep it off, he said. "Pharmacotherapy could be a consideration for those regaining weight," he said. "But, we do not have solid evidence at this time that pharmacotherapy confers long-term success."

    Proietto and his colleagues had also measured hunger-related hormones and appetite among participants in their study to see how the rate of weight loss might affect changes in feelings of hunger, both long- and short-term.

    "The rate of weight loss also did not influence the changes in hunger controlling hormones that occur with weight loss," said Proietto, who also heads the weight control clinic at Austin Health in Melbourne.

    From 2005 to 2010, Proietto chaired the Optifast Medical Advisory Committee for Nestlé Healthcare Nutrition Australia Ltd. But the company did not fund the current study.

    Proietto feels that while appetite suppression after weight loss should be considered, the problem is that there are not many effective agents and none of them have been tested for long-term safety.

    "Our study shows again that drugs are not essential for achieving weight loss but they are probably important for assisting with weight maintenance," he said.

    SOURCE: The Lancet Diabetes and Endocrinology, online October 16, 2014.

  • People with celiac disease more likely to fracture bones

    By Katryn Doyle

    (Reuters Health) - People diagnosed with celiac disease are almost twice as likely as those without it to break a bone, according to a new review of the evidence.

    More studies are needed, though, to see if people whose celiac hasn't been diagnosed yet are at similar risk, researchers say.

    About two million Americans have celiac disease - in which the immune system attacks the small intestine in response to gluten, a protein found in wheat, rye and barley - according to the National Institutes of Health.

    For the new review, researchers from the University of Tampere and Seinäjoki Central Hospital in Finland, and the University of Nottingham in the UK analyzed 16 studies that compared the incidence of bone fractures among people with and without a celiac disease diagnosis.

    In studies that looked at one point in time, people with celiac disease were almost twice as likely to have had a bone fracture in the past.

    In studies that followed people over time, those who had a diagnosis of celiac disease at the start were about 30 percent more likely to suffer a bone fracture and 69 percent more likely to have a hip fracture than others, according to the analysis published in the Journal of Clinical Endocrinology and Metabolism.

    There were only two studies of bone fractures among people with undiagnosed celiac disease - but whose blood tests showed celiac-specific antibodies - and it was not clear if there was a link to broken bones, the authors write.

    Since the disease affects nutrient absorption in the small intestine, it could lead to poor absorption of vitamin D and calcium, or chronic intestinal inflammation could interfere with bone formation, they write.

    Other possibilities to explain the connection to bone breaks include hormonal changes or a gluten-free diet, which is often low in minerals, they write.

    Other studies have found that bone density tends to go down as symptoms become worse for people with celiac disease, according to Professor Julio C. Bai at the Hospital de Gastroenterologia Dr. Carlos Bonorio Udaondo in Buenos Aires, Argentina.

    "Therefore and based on our findings, it seems reasonable to consider to evaluate bone density in those patients with symptomatic celiac disease," said Bai, who was not involved in the new study.

    Symptoms can include abdominal bloating and pain, chronic diarrhea, constipation and weight loss.

    Physical activity can help strengthen bones, he said.

    "Some areas of bone are more vulnerable to the damage induced by celiac disease," said Dr. Peter H.R. Green, an expert on celiac disease at Columbia University in New York who wasn't involved in the new review. "This relates to the type of bone and its rate of turnover."

    Everyone newly diagnosed with celiac disease is routinely given a bone density scan, as they should be, he told Reuters Health by email.

    "We have shown that a gluten free diet together with replacement of calcium and vitamin D, when necessary, results in improvement in bone density," he said.

    SOURCE: Journal of Clinical Endocrinology and Metabolism, online October 3, 2014.