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

  • U.S. cancer incidence, mortality largely stable or decreasing

    By Andrew M. Seaman

    (Reuters Health) - The rate of people being diagnosed or killed by cancer in the U.S. is stable or decreasing for men and women, according to a new report.

    "For the main cancers, it's really pretty much good news, incidence and mortality is decreasing," said Recinda Sherman, an author of the new report from the North American Association of Central Cancer Registries (NAACCR) in Springfield, Illinois.

    A highlight of the report is that for the first time it breaks breast cancer into specific groups based on how it responds to hormones, said Ahmedin Jemal, vice president of surveillance and health service research at the American Cancer Society (ACS).

    The type of breast cancer largely dictates which treatment approach doctors will take, he told Reuters Health by phone. "This is really a nutshell what is special about this annual report to the nation."

    "This is an assessment of the burden of subtypes and in the future we'll be able to look at these trends and see what's going up and what's going down," Sherman said.

    She added that the report can provide guidance in where to focus resources to educate the public. For example, she said so-called triple-negative breast cancer, which is the most aggressive type, represents about 13 percent of breast cancers for all women, but represents about 23 percent of breast cancers among black women.

    Because triple-negative breast cancer is less likely to be caught by mammography, Sherman said there may be opportunities to target black women with messaging about that specific type of breast cancer.

    The analysis, published in the Journal of the National Cancer Institute, is the latest in a series of annual reports on cancer compiled since 1998 by the NAACCR, the ACS, the Centers for Disease Control and Prevention and the National Cancer Institute.

    The organizations found decreases over the past 20 years in the number of new cases for several of the major cancers diagnosed among men, including prostate, lung, colon, stomach, brain and throat cancers. There were also decreases among colon, ovary, cervix, oral and stomach cancers among women.

    Overall, cancer diagnoses decreased by 1.8 percent each year between 2007 and 2011 among men, and remained stable among women.

    Among children, cancer diagnosis rates continue to increase at about 0.8 percent each year over the last decade, which is a trend that has remained steady since 1992.

    For children and adults, however, overall death rates from cancer declined.

    There are areas of concern, Sherman told Reuters Health in a phone interview.

    For example, liver cancers are increasing, likely due to an increase in hepatitis C infections that goes back decades.

    "A couple decades ago, the rate of hepatitis C infections increased and that in turn is being reflected in liver cancer rates," Sherman said. Fortunately, two of the biggest risk factors for liver cancer are hepatitis C infection and alcohol abuse, which are preventable and treatable, she said.

    There has also been an increase in uterine cancers, with a larger increase among black women. Sherman said it's unclear what's behind those trends.

    There are bright spots, too. For example, lung and colorectal cancer rates continue to improve.

    The improvement in lung cancer rates is connected with the decreasing use of tobacco, Sherman said, adding that colorectal rates are likely tied to increased screenings among the public.

    "We continue to make progress in reducing cancer death rates in the U.S.," said Jemal. "You can already see from the report that the rates have been decreasing overall since the 1990s."

    Sherman also said that while the report is largely positive, cancer remains a enormous burden to the U.S. population.

    "Our work is not even close to being done, because many of these disease are preventable," Sherman said.

    SOURCE: Journal of the National Cancer Institute, online March 30, 2015.

  • Feet: the foundation for fitness and health

    By Dorene Internicola

    NEW YORK (Reuters) - Feet are a part of the anatomy many exercisers ignore while pounding the treadmill or honing a headstand, but fitness experts say they are the very foundation of physical well-being.

    A quarter of the body's bones are contained in the feet and ankles. It is where most movement begins and, much like a building's foundation, it determines stability.

    "The feet are perhaps the most neglected complex structure in the body," said Katy Bowman, biomechanist and the author of "Whole Body Barefoot: Transitioning Well to Minimal Footwear."

    Bowman, founder and director of the Restorative Exercise Institute near Seattle, Washington, said when feet are strengthened it decreases whole body imbalance or instability.

    Almost eight in 10 adult Americans have experienced a foot problem, according to a 2014 survey by the American Podiatric Medical Association (APMA). The poll also showed that one in four adults was unable to exercise because of foot pain.

    Dr. Howard Osterman, an APMA spokesman, said most foot injuries are due to overuse, or trying to do too much with limited support.

    "We don't need the toes to have the dexterity of fingers but we do need some dexterity," he said. "We need the muscles to have strength."

    As a podiatric consultant to the Washington Wizards professional basketball team, Osterman recommends that team trainers make sure players do their foot exercises religiously.

    Simply trying to pick up a washcloth, towel or marbles with the feet fires up the muscles that build arch strength, he said. Standing on one foot for 10 seconds is also a good way to build core strength.

    "(It) stimulates the nerve endings from the brain down to the small nerves in the feet," he said. "It's especially important to train the brain of elderly people at a greater risk of falls."

    Bowman suggests doing exercises such as spreading, pointing and individually lifting the toes, rolling a tennis ball underfoot, and standing on tiptoe to strengthen the calves.

    "For the fit person, give yourself a 15-minute foot exercise routine that you do without your shoes," she recommends.

    Bowman believes foot fitness is integral to every movement.

    "Every exerciser is worried about the position of their ankles, knees and hips, but so much of that stability starts at the foot," she said. "It's very much a whole body issue."

  • For disabled vets, playing team sports boosts quality of life

    By Janice Neumann

    (Reuters Health) - Wheelchair basketball and other adaptive sports could help disabled veterans boost their self-esteem and lead healthier lives, early research suggests.

    "Adaptive" sports have been modified to accommodate people with disabilities. While the study doesn't prove the benefits of adaptive sports for disabled veterans, the researchers say they found a strong association between this special form of recreation and happier and healthier individuals.

    "A number of patients have told me even after going through rehabilitation and even after being able to accomplish activities of daily living . . . they never truly felt like themselves until they participated in adaptive sports," said Justin Laferrier, the study's lead author and a U.S. Army veteran.

    The number of disabled U.S. veterans has more than doubled since 2001 to 5.5 million because of the many wounded service members from the conflicts in Afghanistan and Iraq, the authors note.

    Laferrier, now at the University of Connecticut, formerly led amputee physical therapy at the Walter Reed National Military Medical Center in Maryland and at the Center for the Intrepid at Fort Sam Houston in Texas.

    He and his team write in American Journal of Physical Medicine & Rehabilitation that wheelchair sports date back to shortly after World War II, when neurologist Sir Ludwig Guttmann organized the first games at Stoke Mandeville Hospital in Aylesbury, England.

    Although many disabled people have benefited from adaptive sports and the moral support of comrades since then, hard evidence is needed, said Laferrier.

    "If you ask 100 people in a room if they thought adaptive sports and recreation was beneficial both physically and psychologically, 100 would say 'yes,' but then if you ask for money, they'd say, 'Well, we don't have any real evidence behind that, so we can't give you money,"' Laferrier said in a phone interview with Reuters Health.

    To test the effect of adaptive sports, 220 disabled veterans were recruited in 2009 and 2010 from the National Disabled Veterans Winter Sports Clinic, U.S. Olympic Committee Warrior Games and National Veterans Summer Sports Clinic. Activities included sled hockey, archery, swimming and wheelchair basketball.

    Researchers looked at participation in individual sports, team sports or a combination of the two. They used various self-esteem and quality of life scales, noting physical and psychological health, social relationships and environment.

    The veterans had spinal cord injuries, posttraumatic stress disorder and upper or lower limb amputations, but also chronic diseases like arthritis, digestive problems, heart trouble and diabetes.

    The more the veterans participated in the sports after they were injured, the significantly better their quality of life.

    The more years they participated, the higher their self-esteem climbed, too. Those with more than 10 years of participation since their injury scored 27 on a self-esteem scale (with the highest rate being 30), compared to veterans with one to five years, who scored 23.

    Veterans who participated mainly in individual sports and recreation had much lower self-esteem scores at 22, whereas those who did team events or a combination of team and individual events scored higher at 25.

    Irene Davis of the Department of Physical Medicine and Rehabilitation at Harvard Medical School in Boston told Reuters Health by e-mail that the study "was very suggestive" of the benefits of sports/exercise for disabled veterans, although it was limited because it lacked a comparison group and focused only on athletes at athletic events.

    "As many veterans had been very physically active prior to their injury, the loss due to their disability can be extremely difficult for them to deal with," said Davis, who was not involved in the study. "Engaging in sports and exercise can have a very significant impact on their self-esteem."

    Davis directs a research project for the Department of Defense on improving function and quality of life in soldiers who have lost limbs or had them mangled in blast injuries and has worked in spinal cord rehabilitation, seeing the benefits of wheel chair basketball for this population,

    "They began to dress like athletes and they definitely carried themselves differently - with an air of confidence," said Davis, who also directs the Spaulding National Running Center in Cambridge.

    Laferrier said veterans can turn to several organizations for adaptive sports, including U.S. Paralympics, Disabled Sports USA and rehabilitation hospitals or U.S. Veterans Administration hospitals.

    SOURCE: American Journal of Physical Medicine & Rehabilitation, March 12, 2015.

  • ReWalk Robotics plans India launch of walking device by 2nd qtr

    By Amrutha Penumudi

    (Reuters) - ReWalk Robotics Ltd plans to launch its wearable robotic exoskeleton device in India by the second quarter of 2015, Chief Executive Larry Jasinski said.

    The device, ReWalk, provides powered hip and knee motion to enable people with lower-limb disabilities, such as paraplegia, to stand upright, walk, and in some cases, climb stairs.

    "We ship the first few units within the next 10 days," Jasinski told Reuters. "We'll go through a period of training preparation with the distributor."

    The device, already available in several countries including Australia, Germany, Japan and Taiwan, is powered by a rechargeable battery encased in a backpack worn by the patient.

    ReWalk, approved in the United States and the European Union, was invented by the company's Israeli founder, Amit Goffer, a quadriplegic.

    The company will launch the device in north India through a deal with New Delhi-based surgical products distributor Saimed Innovations.

    India, the world's second most populated country, is a largely untapped market for such advanced devices, with most patients currently using crutches, wheelchairs and rigid braces for support.

    ReWalk Robotics estimates there are about 800,000 paraplegics in India.

    A number of patients have already made inquiries and are waiting to the see the product and test it, said Rishi Kapoor, a partner at Saimed Innovations.

    Jasinski declined to estimate how many devices the company expected to sell in its first year in the country.

    ReWalk Robotics, which went public in the United States in September, has a market value of about $162 million.

    The company sold 74 devices in 2014.

    ReWalk Robotics plans to sell the device at about 4.6 million-4.7 million Indian rupees ($73,217-$74,808), similar to the pricing in the United States and Europe.

    The company and its Indian partner are looking at various options including working with government agencies and not-for-profit organizations to make the device more accessible.

    "For instance, the device can be introduced in government rehabilitation centers, where patients can be rehabilitated on a rental model," Kapoor said.

    ReWalk Robotics shares closed at $13.52 on Thursday on the Nasdaq. Up to Thursday's close, the stock had nearly halved in value since its strong debut on Sept. 12.

    ($1 = 62.83 Indian rupees)

  • With diabetic nerve damage, walking can pose fall risk

    By Lisa Rapaport

    (Reuters Health) - Diabetics with nerve damage are more likely to have an uneven stride and struggle to maintain their balance even when walking on flat ground, a small study finds.

    So-called peripheral neuropathy, or diabetic nerve damage, can lead to numbness and pain in the feet, legs and hands. It is the most common complication of diabetes, and though it has long been linked to an increased risk of falls, less is known about how specific body movements contribute to balance problems during daily activities such as walking or climbing stairs.

    "By investigating the activities during which falls are more likely to occur, we can look to identify specific detriments of the underlying balance mechanisms, allowing a more targeted and educated approach to preventing falls within this population in the future," lead author Steven Brown, of Manchester Metropolitan University in the UK, said in an email interview.

    About one in nine adults has diabetes, and the disease will be the seventh leading cause of death by 2030, according to the World Health Organization.

    Most of these people have type 2 diabetes, which is linked to obesity and advanced age and happens when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy.

    Roughly 70 percent of diabetics have some form of neuropathy, according to the National Institutes of Health. While the risk increases the longer people live with diabetes, nerve damage may be limited by keeping blood sugar as close to normal as possible.

    To understand how nerve damage impacts gait and balance, Brown and colleagues analyzed the body mechanics of 22 diabetics with neuropathy while walking on flat ground and going up and down stairs. They compared the results to 39 diabetics without neuropathy and a control group of 28 people without diabetes.

    The researchers did a gait analysis using a 10-camera motion capture system to collect data as participants moved on stairs and on flat ground. Everybody wore similar shoes, to ensure that footwear didn't influence results.

    The diabetics with nerve pain moved at significantly slower speeds than the other study participants.

    On stairs, front-to-back sway as well as side-to-side sway, which increase with poor balance, was significantly higher for the diabetics with neuropathy than for the people without diabetes. And front-to-back sway was also significantly greater for diabetics with nerve pain when they walked on level ground.

    Standing still with open eyes, the diabetics with neuropathy had more front-to-back and side-to-side sway than the other study participants, and more than the control group when the test was repeated with eyes closed.

    The diabetics with nerve pain also tended to stand with their feet spread further apart, a stance probably adopted to compensate for balance issues that can, in fact, increase the risk of falls, the researchers write in Diabetes Care.

    There are some steps diabetics can take to stay on their feet even when they suffer from nerve pain, said Dr. James Richardson, a researcher at the University of Michigan Health System.

    To decrease the chances of falling, diabetics need to have good vision or good control of ankle movements, strong hips, good reflexes, and avoid distractions while moving, said Richardson, who wasn't involved in the study.

    Regular eye exams and good light can help with vision problems, and lightly touching a railing or wall can help with balance when it's hard to see, Richardson noted. And some exercises may be able to strengthen muscles around the hips.

    At the end of the day, though, concentration is key.

    "It doesn't matter if the muscles are strong if they are strong three seconds after you lose your balance," he said. "You only have about half a second before you hit the ground."

    SOURCE: Diabetes Care, online March 12, 2015.