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

  • Celiac disease showing up in many forms and at all ages

    By Janice Neumann

    (Reuters Health) - A classical set of celiac disease symptoms no longer reflects the profile of most newly-diagnosed patients, according to a new study from Italy.

    Instead, doctors need to take other symptoms into account and consider the possibility of celiac disease, even when patients don't fit the old image of the condition, researchers say.

    "It's been a gradual phenomenon since the 1970s that fewer people are presenting with the classical diarrhea and more with non-classical or silent presentation, both in adults and children," said Dr. Peter Green, who wasn't involved in the study.

    "We don't actually know why one person has diarrhea and another presents with abdominal pain or osteoporosis," said Green, director of the Celiac Disease Center at Columbia University in New York.

    Dr. Umberto Volta and his coauthors write in the journal BMC Gastroenterology that just 15 years ago, celiac disease was still thought of mainly as a rare pediatric food intolerance, whose most common signs were diarrhea and intestinal damage that was diagnosed through a biopsy.

    The disease is now known to be an autoimmune disorder, caused by an inability to tolerate the gluten protein in wheat, barley and rye.

    Eating gluten typically causes inflammation of the intestinal lining in people with celiac disease and makes it hard to absorb nutrients.

    Research shows that more than 1 percent of people worldwide have the disease, but most may not know it, the authors of the study note. The diagnosis is based on a blood test for signs of the abnormal immune response, such as antibodies, as well as biopsy in some cases.

    With his colleagues, Volta, a professor of medicine at the University of Bologna in Italy and vice president of the Ethical Committee at St. Orsola-Malpighi University Hospital, looked at the celiac patients diagnosed over the course of 15 years at that hospital.

    The study involved 770 patients, 599 of them female, diagnosed between 1998 and 2007. Nearly half were diagnosed during the first 10 years of the study period and the rest in the last five years, indicating a steep rise in rates of diagnosis.

    Among all the patients, 610 people, or 79 percent, had symptoms when they were diagnosed. But most of their problems were not the typical diarrhea and weight loss, but rather "non-classical" issues like bloating, osteoporosis and anemia. Diarrhea was a symptom in just 27 percent of patients.

    Indeed, classical symptoms became less common over the years, decreasing from 47 percent of patients during the first 10 years to 13 percent in the last five. Meanwhile, other problems, as well as a lack of any significant related illness, increased by more than 86 percent.

    "The most striking change in clinical presentation of celiac disease over time has been the decrease of diarrhea as the leading symptom and the progressive increase of other non-classical gastrointestinal symptoms (such as constipation, bloating and alternate bowel habits as well as gastro-esophageal reflux, nausea, vomiting and dyspepsia)," Volta said in an e-mail to Reuters Health.

    "A high proportion of celiac disease patients did not show any gastrointestinal symptom, but they displayed extra-intestinal manifestations such as iron-deficiency anemia, unexplained osteoporosis, abnormalities of liver-function tests and recurrent miscarriages," he said.

    The most common illness associated with celiac was thyroid disease. Only half the patients had severe intestinal damage, and 25 percent had partial damage.

    In later years, more patients were diagnosed through blood tests. That may be one factor accounting for the changing pattern of typical symptoms, Volta said, because the patients were diagnosed earlier, before gluten had done its damage.

    "The effects of gluten weren't as severe yet," Volta said. "The story of celiac disease has been radically changed by the discovery celiac disease-related antibodies, which identify plenty of unsuspected cases."

    Green agreed that testing has vastly improved diagnosis of the disease. He said that in the United Kingdom, anyone with iron deficiency or migraine is tested for celiac disease.

    While most celiac specialists understand the varied symptoms, other physicians might not, he said. Green pointed out that in the United States, only 17 percent of people with the disease are actually diagnosed.

    "Anyone can have celiac disease, it's common and underdiagnosed," said Green. "The message we want to get out is if you think you've got celiac disease, don't just go on a gluten-free diet, test for it."

    Volta said he hoped the study reminded doctors about the many problems that can signal celiac disease.

    "I hope doctors keep in mind that celiac disease is a very frequent food intolerance, which should be investigated not only in patients with diarrhea and overt malabsorption, but also in people (with other symptoms)," Volta said.

    "The treatment by gluten-free diet improves the quality of life in symptomatic patients and prevents complications in all celiac disease patients including those without symptoms," he said.

    SOURCE: http://bit.ly/1ATNpT3 BMC Gastroenterology, Nov. 18, 2014.

  • Hormones only one factor in sexual function during menopause

    By Kathryn Doyle

    (Reuters Health) - Testosterone and other reproductive hormones do play a role - but probably a small one - in women's feelings of sexual desire during menopause, according to a new study.

    Factors like emotional wellbeing and quality of the intimate relationship may be more important, says lead author Dr. John F. Randolph, Jr., of the University of Michigan Health System in Ann Arbor.

    "The big thing that came out of this is it has long been assumed or theorized that hormones played a big role, but it's been hard to prove," Randolph told Reuters Health. "Hormones definitely do play a role but it's not a big one."

    For the new study, researchers studied data from more than 3,000 middle-aged women participating for at least 10 years in an ongoing study that included annual questionnaires about sexuality and blood tests to measure hormone levels.

    The women were between 42 and 52 years old at the beginning of the study. By the 10th year, 77 percent were post-menopausal and 7 percent were using hormone replacement therapy.

    Yearly questionnaires addressed how often the women felt desire in the past six months to engage in any form of sexual activity either alone or with a partner, and how frequently they had done so. Those who reported having sexual activities with a partner were asked about their levels of arousal, ability to climax, frequency of vaginal or pelvic pain during intercourse and lubricant use.

    Women with higher levels of testosterone tended to report more frequent masturbation, more sexual desire and arousal than those with lower levels, according to the results published in the Journal of Clinical Endocrinology and Metabolism.

    Women who had higher levels of follicle stimulating hormone, which rises during menopause, tended to report masturbating, feeling arousal and experiencing orgasm less often than others.

    Hormones did not appear to be linked to pain with intercourse. Even for the other measures of sexual function, hormones only accounted for part of the picture, Randolph said.

    Those who said they had fewer sad moods and higher levels of satisfaction in their relationships also reported better sexual function.

    "Women's sexual function is pretty complicated and it would be naïve to assume only one factor is important," Randolph said.

    Men have 10 times as much testosterone as women, so it's harder to measure the influence of the hormone for females, he said. And it's new to consider a metric like masturbation frequency, which hasn't been studied much for this age group of women but is an important indicator of sexual function, he said.

    "Our work shows that there are a lot of other things that are equally or more likely to be important, the big ones are partner relationship and mood," Randolph said.

    "This is an article confirming the potential role of testosterone in women's sexuality independently from a partner and it adds a piece to the story that sexual function is driven by androgen but sexual behavior is related to the context, especially the partner," said Dr. Rossella Nappi of the Research Center for Reproductive Medicine and Unit of Gynecological Endocrinology and Menopause at the University of Pavia in Italy.

    Nappi was not involved in the new research.

    "Some women retain the ability to masturbate and climax across menopause because of higher androgen levels but maybe their sexual function with a partner is impaired due to many other reasons," she told Reuters Health by email.

    Testosterone seems to have a modest effect on sexual health for menopausal women, but it remains to be seen how it affects women at older ages, and whether or not testosterone therapy will at some point be a viable therapy, Randolph said.

    "It's a really hot topic with men right now because more people are asking for it and doctors are prescribing it," he said. "From a treatment perspective, we really don't know what the long term effects of giving testosterone are, and we need more information."

    The Endocrine Society has recommended against testosterone therapy for women based on the evidence at this point.

    "There are other things that probably have a bigger bearing on what's going on," Randolph said. "We should look at the whole picture rather than focusing on one single thing, and probably that means that testosterone as a treatment is not going to be something the vast majority of women will need."

    SOURCE: http://bit.ly/1pmxpEU Journal of Clinical Endocrinology and Metabolism, online November 20, 2014.

  • Mindfulness program may improve some rheumatoid arthritis symptoms

    By Shereen Lehman

    (Reuters Health) - A two-month program combining gentle yoga with meditation techniques, known as Mindfulness Based Stress Reduction, seemed to ease tenderness, pain and stiffness among patients with rheumatoid arthritis in a new study.

    "I think these findings are pretty consistent with other studies of mindfulness and chronic conditions," said Mary Jo Kreitzer, who was not involved in the research.

    Although it was small, and relatively brief, the study's findings were impressive, said Kreitzer, the founder and director of the University of Minnesota Center for Spirituality and Healing.

    "I would say more research is needed to really understand how the mechanisms work," Kreitzer told Reuters Health, "so this trial is incredibly encouraging, but it's not definitive."

    Mindfulness Based Stress Reduction (MBSR) is a program developed decades ago at the University of Massachusetts to help seriously ill patients cope with pain, such as from advanced cancer or AIDS. But in recent years that program has been adapted and offered more widely to people seeking relief from pain and stress of many kinds.

    "Mindfulness training involves the cultivation of nonjudgemental attention to unwanted thoughts, feelings and bodily experiences via meditation and may help ameliorate both psychological and physical symptoms of chronic disease," write the study authors in Annals of the Rheumatic Diseases.

    Previous research has found mixed success when MBSR is used by sufferers of various conditions. For instance, in one trial among patients with fibromyalgia - a widespread pain syndrome of unknown cause - MBSR had little effect (see Reuters Health story of December 28, 2010 here: http://reut.rs/1HG0Sja).

    But Francesca Fogarty at the University of Auckland in New Zealand, who led the new study, and her coauthors note that past research has found MBSR improves the psychological wellbeing of rheumatoid arthritis patients.

    They wanted to see if mindfulness techniques had any impact on the disease process itself.

    Rheumatoid arthritis is a chronic disease caused by the immune system attacking tissue in the joints, especially in the hands and feet, and sometimes causes problems in other parts of the body, such as the eyes, skin, lungs and blood vessels.

    For their study, Fogarty's team enrolled 42 patients with rheumatoid arthritis who had no previous experience with meditation. Twenty one participants were put into a treatment group, and the other 21 served as a comparison group who were told they could go through the MBSR program after the study.

    The treatment group participated in an eight-week program of meditation, gentle stretching and light yoga. Right after the program ended, and again at two, four and six months later, the study team assessed participants' disease symptoms.

    These included the number of tender and swollen joints, levels of C-reactive protein (a marker of inflammation) and the patients' own assessments of their stiffness and pain based on a scale of 1 to 100.

    On average, and throughout the follow-up period, morning stiffness, tenderness and pain scores were lowered among those who had gone through MBSR, but not in the comparison group.

    There were no differences, however, in objective measures of disease activity like C-reactive protein levels and number of swollen joints between the MBSR and comparison groups.

    The authors conclude that MBSR likely helped participants by changing their "experience" of the disease.

    "This pattern of effects is also consistent with evidence linking mindfulness training to improved pain regulation and well-established links between reduced pain and greater wellbeing among people with rheumatoid arthritis," the authors write.

    "I think it follows the line of so many studies that have been coming out about mindfulness-based stress reduction over the last 15 years. Literally hundreds of studies have come out," Kreitzer said.

    "Mindfulness is a way to slow down and be in the present moment and that's what mindfulness training is, so in a mindfulness class people focus on breathing and relaxation and that's sort of how they ease into a practice of meditation," she said.

    Kreiter said she thinks the study also demonstrates how important self-care and self-management approaches are. There's so much that people can do on their own," she said, adding that for many a sense of empowerment comes from being able to do something about their symptoms.

    MBSR classes are widely available at hospitals and privately, as well as through online programs (http://bit.ly/1vjU4kG), Kreiter said.

    "People can just check with local healthcare facilities or even use Google to see if there are any mindfulness programs in their communities," she said.

    SOURCE: http://bmj.co/1HEG0J5 Annals of the Rheumatic Diseases, online November 18, 2104.

  • Full-day preschool programs promote kindergarten readiness

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Kids who attended full-day preschool programs were more ready for kindergarten and had fewer absences than kids who attended half-day preschool programs, according to a new study.

    It is surprising that full-day preschoolers performed better in many different domains, including language, math, socio-emotional and physical health, according to lead author Arthur J. Reynolds of the Institute of Child Development and Human Capital Research Collaborative at the University of Minnesota in Minneapolis.

    Full-day preschoolers also had 45 percent fewer chronic absences than half-day preschoolers, he noted.

    Reynolds and his coauthors evaluated preschoolers at the end of the 2012-2013 school year in 11 Chicago schools, including predominantly black or Hispanic children age four to five.

    For the full-day program, 409 kids attended the Child-Parent Center for seven hours a day, while 573 kids had attended the three-hour version of the program.

    Kids in the seven-hour programs scored higher on language, math, socio-emotional development, and physical health tests, though the differences were modest in some cases.

    Literacy and thinking skill scores were similar for both groups, according to results in JAMA.

    Full-day kids had fewer absences than kids in the three-hour programs.

    Around half of the kids in the full-day programs were 'chronically absent,' missing at least 10 percent of school days, compared to almost 72 percent of kids in half-day programs.

    Full-day preschoolers averaged 936 hours of instruction for the year, compared to 418 hours for the half-day preschoolers, more than double the hours of instruction, Reynolds noted.

    "The general expectation is that greater exposure to a good program should yield better results than lesser exposure, and this study is an example of that," said Lawrence J. Schweinhart of the HighScope Educational Research Foundation in Ann Arbor, Michigan.

    "But some studies have not confirmed this general expectation, probably because the programs were not so good," he told Reuters Health by email.

    Schweinhart wrote an editorial about the results.

    The measured differences in school readiness were equivalent to a four to five month advantage for the full-day group, Reynolds said. More than 80 percent of full-day preschoolers met national norms for total school readiness compared to 59 percent of half-day preschoolers.

    It is possible, but very unlikely, that kids in the full-day program might be different from kids in the half-day program in other ways that would explain the advantage in school readiness, Reynolds told Reuters Health by email.

    "We focused on children in the same schools and they had equivalent performance at the beginning of the year and were similar in many characteristics," he said.

    Cost is the main drawback of full-day preschool programs, which are nearly double the cost of part-day programs, he said.

    "Higher income families have this choice, but most lower income families that rely on state pre-k or school programs don't have much choice," Reynolds said.

    Typical state pre-k or head start programs are only part-day, he said.

    "Our study shows the advantages of increasing the availability of full-day publicly funded programs," he said. "Not enough full-day programs are available today, especially that are high in quality."

    The Midwest Child-Parent Center program in this study has highly qualified teachers, small classes, active learning opportunities, many supports for families, and support for staff that are essential for high quality learning experiences, he noted.

    As the study only included preschoolers, it did not link kindergarten readiness with later academic performance or other measures of success.

    "I have my doubts that the added value of full-day over part-day found in this study will show up in longer-term results," Schweinhart said.

    But preschool will likely lead to better long-term results than no preschool, he said.

    SOURCE: http://bit.ly/1xYwLk6 JAMA, online November 25, 2014.

  • Double arm transplant recipient thanks doctors in Boston

    By Richard Valdmanis

    BOSTON (Reuters) - A 40-year-old quadruple amputee on Tuesday thanked the Boston surgeons who performed a rare dual arm transplant on him last month and described the experience of getting the new limbs as surreal.

    Will Lautzenheiser, who lost his arms and legs to a streptococcal infection in 2011, said he has limited function in the new arms, which are encumbered by wrappings to help with healing.

    The arms were attached from an anonymous donor in a nine-hour operation at Brigham & Women's Hospital.

    "I want to thank the doctors for their great service," an emotional Lautzenheiser said at a news conference at the hospital. "I want to thank everyone."

    He said having the new limbs was "incredible" and "surreal."

    Lautzenheiser, a former professor of film production and screenwriting at Boston University and Montana State University, has a long stretch of therapy ahead but hopes to return to his career.

    The family of the anonymous donor told Lautzenheiser in a statement issued Tuesday that it hoped he would make a "wonderful recovery, and that your loved ones will be able to enjoy your warm embrace."

    The surgery involved 35 medical staff, including 13 surgeons, according to Brigham & Women's Hospital.

    While rare, there have been other double-arm transplants in the United States recent years. In 2012, a U.S. soldier who lost all four limbs in a roadside explosion in Iraq had double-arm transplant surgery at Johns Hopkins in Baltimore.