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

  • Showing cell phone callers the road might improve driver safety

    By Shereen Lehman

    NEW YORK (Reuters Health) - Providing a caller with views of the driver and the road ahead might reduce cell phone distraction for the driver, suggests a new study.

    Researchers used a driving simulator and video phones to examine how a driver's conversation partner - either on the phone or in the car - could affect their safety on the road.

    At any given time, about 5 percent of drivers in the U.S. are using their cell phones, but the devices are cited as a cause of distraction in 18 percent of crashes, say the authors.

    "For a number of years, we've been thinking about 'how might we make a cell phone partner - that is someone who is speaking to a driver who might be using legally a hands free cell phone . . . more like a passenger'," Arthur Kramer told Reuters Health in an email.

    Kramer, who led the study, is director of the Beckman Institute at the University of Illinois at Urbana-Champaign.

    "Because we know in the great majority of studies, the passengers, at least adult passengers who are drivers themselves, tend to be useful to drivers - it's another pair of eyes, and experienced eyes, if it's another driver," he said.

    Kramer said he and his colleagues thought it might be interesting to give the conversation partner at home or in a different location similar information to what a passenger sitting in the car would have, using a video-capable smartphone.

    "And that's what we did - we provided essentially a split screen video of the driver's face and outside the windscreen," Kramer said.

    Kramer and his team designed the study to see if the video information could make the conversation partner more like a passenger.

    They enrolled 48 college students who had two or more years of driving experience and set up four driving scenarios: the driver alone in the simulator, the driver speaking to a passenger who was also in the simulator, the driver speaking on a hands-free cell phone to someone in a different location and the driver speaking on a hands-free cell phone to someone who could see the driver and the driving scene out the front windshield with a video phone.

    Having a regular cell-phone conversation tripled the risk of collision compared to driving alone, and doubled the risk when compared with driving with a passenger or talking on the phone to a person who could see the driver and the road ahead.

    Interestingly, the study team notes in Psychological Science, drivers were least likely to remember which road signs they had seen when they drove alone as compared to having a passenger or being on either type of cell-phone call.

    The researchers also analyzed conversations between the drivers and either the passenger or the callers.

    "We found when the individuals at home or somewhere else had the split screen video they behaved, in terms of how they used language, more like the passenger," Kramer said. "That is, they were able to stop speaking when they perceived the driver was being busy."

    He added that cell phone partners with video would also reference driving events such as bicyclists or cars in close proximity, much like a passenger normally would.

    Kramer is cautiously optimistic, but still thinks talking on a cell phone while driving - even hands free - is "a stupid thing to do." He also isn't sure the video technology would be helpful for teens who might just find it more of a distraction.

    "I don't want to encourage more people to use the cell phone when they're driving but since it is indeed legal in every state in the United States, this could be one way to reduce accidents," he said.

    The study was only a simulation, so it's not clear how the technology would impact drivers in the real world.

    Arthur Goodwin, a researcher with the Highway Safety Research Center at the University of North Carolina, thinks it's an intriguing study that also provides information on how passengers might be helpful for drivers.

    Studies show that adult drivers "are less likely to be involved in a crash if they have a passenger with them, but we don't necessarily know why that's the case," Goodwin, who wasn't involved in the new study, told Reuters Health.

    "These findings suggest that passengers do pay attention to what drivers are doing and will adjust their own behavior accordingly, either by mentioning things that might be happening on the roadway or perhaps talking a little bit less than they normally would compared to somebody else who's on a cell phone," Goodwin said.

    SOURCE: http://bit.ly/1vnE95L Psychological Science, online October 8, 2104.

  • REFILE-'Exposure therapy' helps patients with prolonged grief

    (Corrects misspelling in byline, no change to article text)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Adding one-on-one sessions focused on reliving the experience of losing a loved one to regular group therapy appears to help more patients with prolonged grief, according to a new study.

    Most people who lose a loved one feel stress, grieve and adapt over time. But seven to 10 percent of people get stuck in the grief phase and have persistent yearning for the deceased, difficulty in accepting the death, a sense of meaninglessness, bitterness about the death and difficulty in engaging in new activities, said lead author Richard A. Bryant of the School of Psychology at the University of New South Wales in Sydney, Australia.

    People with these symptoms for at least six months may be diagnosed with Prolonged Grief Disorder (PGD), although that is a relatively new diagnosis and still controversial for some psychologists, Bryant said.

    "At the moment, many doctors are probably treating them with antidepressants but we know this is quite different from depression," Bryant told Reuters Health.

    Exposure therapy, which emphasizes reliving and processing painful memories and feelings, is the "treatment of choice" for people with post traumatic stress disorder, according to Bryant (see Reuters Health story of July 17, 2013 here: http://reut.rs/1rrKXJP).

    Others have tried to adapt exposure therapy and cognitive behavioral therapy to prolonged grief, which has been successful, though having patients relive the death of a loved one is also a painful process, Bryant said.

    "What this study did is try to answer the question: do you really need to do that to treat grief?" he said.

    The study included 80 patients with PGD who all received 10 weekly two-hour group therapy sessions using cognitive behavioral therapy (CBT) techniques, like learning to manage avoidance and rumination about the death, learning distraction techniques and cultivating positive memories and new goals for the future.

    They also received four individual one-hour therapy sessions. Half of the group continued with CBT techniques, while the other half began exposure therapy focused on facing grief head-on and integrating the loss into memory.

    In exposure therapy, the patient spent 40 minutes giving a first-person, present tense account of the death of the person, including their own emotional, mental and physical experiences at the time. In addition to doing this at each of the four individual sessions, they were instructed to do the same exercise as "homework" once a week.

    Over the four sessions, therapists had the patients hone in on particularly painful aspects of the experience to be sure they were engaging fully.

    Over the course of the study, patients in the exposure group experienced greater decreases in prolonged grief symptoms, decreases in depression symptoms and increases in psychological functioning than the comparison group that got CBT alone.

    By the final therapy sessions, six people in the exposure therapy group still qualified for a PGD diagnosis, compared to 13 in the CBT-alone group.

    "Quite emphatically the findings demonstrated that patients who received (exposure therapy) did markedly better," Bryant said.

    "One of the ironies, the paradoxes about prolonged grief is that they are yearning for the deceased, but also engaged in avoidance," he said. "The loved one may have died many years earlier and they've never really gone back and felt about it. Some people may visit the gravesite every day, may set meals for the loved one every night."

    Past research suggests that some 10 percent of bereaved people experience PGD, Bryant and his colleagues write in JAMA Psychiatry. That would translate to about one million new cases each year in the United States alone.

    Since PGD is a new diagnosis, it is hard to predict who will experience grief and adapt and who will not be able to adapt, but in general those who experience prolonged grief were very emotionally dependent on the deceased, he said.

    It seems more likely to occur after certain kinds of losses, such as after a suicide or the sudden and unanticipated death of a child, said Dr. Sid Zisook of the University of California, San Diego School of Medicine.

    Zisook, who was not involved in the new study, studies treatments for "'complicated grief," another name for PGD.

    "(Complicated grief) causes great pain, interferes with ongoing life and tends to remain present for prolonged periods in the absence of treatment," Zisook told Reuters Health by email. "We recommend seeking support from family, friends and spiritual leaders (if consistent with the person's beliefs and life style) and also seeking professional help."

    In his program, patients with CG receive about 20 weeks of therapy sessions, and some start to see improvements in the first few weeks, he said.

    Many Hospices now provide bereavement care and be a valuable resource, he said.

    "If I feel that years have gone by and I still can't deal with this, I should be findings a therapist who can give me CBT," Bryant said. "People who really want to be helping people come unstuck and develop better adaptation, emotionally engaging with memories of the death, as painful as that may be, does help."

    SOURCE: http://bit.ly/1s2kpii JAMA Psychiatry, online October 22, 2014.

  • REFILE-'Exposure therapy' helps patients with prolonged grief

    (Corrects misspelling in byline, no change to article text)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Adding one-on-one sessions focused on reliving the experience of losing a loved one to regular group therapy appears to help more patients with prolonged grief, according to a new study.

    Most people who lose a loved one feel stress, grieve and adapt over time. But seven to 10 percent of people get stuck in the grief phase and have persistent yearning for the deceased, difficulty in accepting the death, a sense of meaninglessness, bitterness about the death and difficulty in engaging in new activities, said lead author Richard A. Bryant of the School of Psychology at the University of New South Wales in Sydney, Australia.

    People with these symptoms for at least six months may be diagnosed with Prolonged Grief Disorder (PGD), although that is a relatively new diagnosis and still controversial for some psychologists, Bryant said.

    "At the moment, many doctors are probably treating them with antidepressants but we know this is quite different from depression," Bryant told Reuters Health.

    Exposure therapy, which emphasizes reliving and processing painful memories and feelings, is the "treatment of choice" for people with post traumatic stress disorder, according to Bryant (see Reuters Health story of July 17, 2013 here: http://reut.rs/1rrKXJP).

    Others have tried to adapt exposure therapy and cognitive behavioral therapy to prolonged grief, which has been successful, though having patients relive the death of a loved one is also a painful process, Bryant said.

    "What this study did is try to answer the question: do you really need to do that to treat grief?" he said.

    The study included 80 patients with PGD who all received 10 weekly two-hour group therapy sessions using cognitive behavioral therapy (CBT) techniques, like learning to manage avoidance and rumination about the death, learning distraction techniques and cultivating positive memories and new goals for the future.

    They also received four individual one-hour therapy sessions. Half of the group continued with CBT techniques, while the other half began exposure therapy focused on facing grief head-on and integrating the loss into memory.

    In exposure therapy, the patient spent 40 minutes giving a first-person, present tense account of the death of the person, including their own emotional, mental and physical experiences at the time. In addition to doing this at each of the four individual sessions, they were instructed to do the same exercise as "homework" once a week.

    Over the four sessions, therapists had the patients hone in on particularly painful aspects of the experience to be sure they were engaging fully.

    Over the course of the study, patients in the exposure group experienced greater decreases in prolonged grief symptoms, decreases in depression symptoms and increases in psychological functioning than the comparison group that got CBT alone.

    By the final therapy sessions, six people in the exposure therapy group still qualified for a PGD diagnosis, compared to 13 in the CBT-alone group.

    "Quite emphatically the findings demonstrated that patients who received (exposure therapy) did markedly better," Bryant said.

    "One of the ironies, the paradoxes about prolonged grief is that they are yearning for the deceased, but also engaged in avoidance," he said. "The loved one may have died many years earlier and they've never really gone back and felt about it. Some people may visit the gravesite every day, may set meals for the loved one every night."

    Past research suggests that some 10 percent of bereaved people experience PGD, Bryant and his colleagues write in JAMA Psychiatry. That would translate to about one million new cases each year in the United States alone.

    Since PGD is a new diagnosis, it is hard to predict who will experience grief and adapt and who will not be able to adapt, but in general those who experience prolonged grief were very emotionally dependent on the deceased, he said.

    It seems more likely to occur after certain kinds of losses, such as after a suicide or the sudden and unanticipated death of a child, said Dr. Sid Zisook of the University of California, San Diego School of Medicine.

    Zisook, who was not involved in the new study, studies treatments for "'complicated grief," another name for PGD.

    "(Complicated grief) causes great pain, interferes with ongoing life and tends to remain present for prolonged periods in the absence of treatment," Zisook told Reuters Health by email. "We recommend seeking support from family, friends and spiritual leaders (if consistent with the person's beliefs and life style) and also seeking professional help."

    In his program, patients with CG receive about 20 weeks of therapy sessions, and some start to see improvements in the first few weeks, he said.

    Many Hospices now provide bereavement care and be a valuable resource, he said.

    "If I feel that years have gone by and I still can't deal with this, I should be findings a therapist who can give me CBT," Bryant said. "People who really want to be helping people come unstuck and develop better adaptation, emotionally engaging with memories of the death, as painful as that may be, does help."

    SOURCE: http://bit.ly/1s2kpii JAMA Psychiatry, online October 22, 2014.

  • Blue-light blocking glasses may help sleep after screen time

    By Kathryn Doyle

    NEW YORK (Reuters Health) - The blue glow from televisions and other screens suppresses natural mechanisms that help us fall asleep at night, but blocking just the blue wavelength may restore normal nighttime sleepiness, according to a new study.

    Teen boys who used computers and other digital devices while wearing the glasses every evening for a week felt markedly more relaxed and sleepy at bedtime than when they just wore clear glasses, Swiss researchers found.

    "LED screens are widely-used in smart phones, tablets, computer monitors and TVs," said study coauthor Vivien Bromundt of the Centre for Chronobiology at the Psychiatric Hospital of the University of Basel.

    "The effect of screen light on the circadian physiology is particularly high in devices which are used in close distance to our eyes," Bromundt told Reuters Health by email. "Looking at these screens in the evening can keep teenagers awake since it involves light exposure, particularly in the blue-wavelength range to which the biological clock and its associated arousal promotion has its greatest sensitivity."

    Looking at computer screens in bed has been linked to insomnia and to difficulty waking up in the morning in previous studies. Light impacts circadian rhythms and sleep-wake cycles, the authors note.

    Teenagers already have a pronounced preference for staying up late, the study team writes in the Journal of Adolescent Health. But having to wake up early for school builds up a chronic sleep debt that affects teens' mood and focus.

    Light-emitting diode (LED) screens give off short-wavelength light, which has been shown to block a natural evening rise in the hormone melotonin that promotes sleepiness. Exposure to this blue light keeps the brain alert and "activated" when it should be slowing down to shift into sleep mode, the researchers say.

    For the new study, they used orange-tinted "blue-blocker" glasses that filter out short wavelengths of light in the blue portion of the visible spectrum.

    The researchers recruited 13 healthy boys between ages 15 and 17 and for one week, the teens kept to their regular sleep schedule at home but did not go out in the evenings or have caffeine drinks.

    They wore blue-blocker glasses from 6 p.m. until bed time each evening, while keeping diaries of how long they wore the glasses and how much time they spent with LED and non-LED screens as well as a sleep-wake log.

    At the end of the week, the participants spent one overnight in the laboratory, sitting for two hours in dim light, darkness for half an hour and then three hours in front of a backlit LED computer screen wearing the blue blocker glasses. They completed cognitive tests and provided saliva samples.

    Then the participants went to sleep for eight hours, and performed the same cognitive tests and saliva samples upon waking in the lab again.

    All participants went through the weeklong study protocol twice, once wearing blue-blocker glasses and once wearing clear glasses for comparison.

    The kids reported spending the same number of hours with LED screens with blue-blocker and clear glasses. They reported feeling sleepier with the blue blocker glasses, especially toward the end of the evening.

    Based on their saliva samples, kids who wore clear glasses had less melatonin, called the "darkness hormone," at bedtime. Kids who wore the blue blocker glasses had higher melatonin levels from 90 minutes to five minutes before sleep.

    The type of glasses did not seem to make a difference on the length or perceived quality of sleep itself.

    The short-wavelength photoreceptors in the eye which respond to blue light act to reset the timing of the internal clock, suppress melatonin production, improve alertness and performance, and elevate brain activation, Bromundt said.

    "Blue blockers therefore can prevent those light responses which are not helpful in the evening hours when our body and mind has to prepare for sleep," she said.

    But the blue-blocker glasses also blocked a significant amount of light generally, not just blue light, said Mary A. Carskadon, who researches associations of sleep regulatory mechanisms with sleep-wake behavior of children, adolescents and young adults at Brown University in Providence, Rhode Island.

    "Not only were they blocking blue, but they were also blocking a lot of light so it was dimmer in general," said Carskadon was not involved in the new study. "So it's hard to detect what really is inducing the effects that they see, which were not very large."

    If it is not the blue light, but the general dimness making a difference, there might be the same effect if kids just turn down the brightness on their devices, she said.

    Kids wearing clear glasses performed better on the cognitive tasks and had faster reaction times than those wearing blue blocker glasses.

    "If kids are looking at screens, playing a videogame, they are not going to want to have their performance affected," Carskadon said.

    Although they did not change sleep timing, latency or other measurable aspects of sleep quality after one week of use in this study, the blue-blocker glasses did seem to increase sleep readiness for the male teens, Bromundt said.

    The results would likely be the same for female teens as well, she said.

    "More and more suppliers of light therapy devices offer blue-blocker glasses in their range of products, because both bright light at the appropriate time of day and darkness or light-blocking devices in the evening and night are applied to consolidate our sleep-wake cycle and can therefore improve sleep and well-being," Bromundt said.

    Brown or yellow tinted glasses may reduce light transmittance also, but do not block as much light in the blue wavelength range as orange glasses, she said.

    Having and setting limits on screen time can be as difficult for adults as for kids, Carskadon told Reuters Health.

    "Many adults spend more time than is probably healthy using these devices when they could be and should be sleeping," she said. "Common sense has gone out the window a bit."

    SOURCE: http://bit.ly/1vOgtb0 Journal of Adolescent Health, online October 3, 2014.

  • Two doctor visits a year linked to better blood pressure control

    By Shereen Lehman

    NEW YORK (Reuters Health) - People who went to their doctor's office at least twice a year were more likely to keep their blood pressure under control compared to those who went once a year or not at all, says a new study.

    Having health insurance and following treatment for high cholesterol were also linked to better blood pressure control.

    "Folks that go to the doctor at least twice a year are more likely to be aware of their blood pressure, more likely to be treated, more likely to be controlled when treated and have significantly better control rates," Dr. Brent Egan, who led the study, told Reuters Health.

    "People with uncontrolled high blood pressure have a greater risk for having a stroke, having a heart attack, having heart failure and even memory loss without having a stroke," said Egan, of University of South Carolina School of Medicine in Greenville.

    He added that most people may not be aware of the fact that memory loss with aging is greater in people who have high blood pressure that's uncontrolled.

    "So there are number of reasons why it's a good thing to get the blood pressure control," said Egan, who is also medical director of the non-profit Care Coordination Institute.

    About one of every three Americans has high blood pressure, which is defined as having a reading above 140/90 mmHg. Only about half of adults with high blood pressure have it under control, the study team writes in the journal Circulation.

    A national health promotion and disease prevention initiative called Healthy Living 2020 established goals to reduce the rate of high blood pressure in the U.S. from 30 percent of all adults to 27 percent, and to increase the rate of blood pressure control to greater than 60 percent of people with high blood pressure.

    Egan and his colleagues designed the study to see how those goals are coming along. They looked at data on participants in the annual National Health and Nutrition Examination Survey who had their blood pressure checked during the period from 1999 to 2012.

    The researchers found that people who were obese, didn't have insurance and didn't see their doctors were more likely to have untreated high blood pressure.

    Egan and his team also examined what factors were associated with good blood pressure control.

    "One of the things we were looking at in this analysis was some of the modifiable variables that might, if we paid more attention to them, might help move us towards the goal," Egan said.

    The study team discovered that people who saw their doctors at least two times a year were more than three times more likely to get their blood pressure under control as those who saw a doctor less often.

    People with health insurance were about 70 percent more likely than those without it to have their blood pressure controlled.

    In addition, people who had high blood pressure and were being treated for high cholesterol were almost twice as likely to have their blood pressure under control.

    "Many people, in fact the majority of people with high blood pressure, also have a cholesterol problem," Egan said. "What our data shows is that if they're also being treated for the cholesterol they're more likely to get their blood pressure under control."

    Egan said that when doctors control both high blood pressure and cholesterol, "we reduce heart disease and stroke by about 60 percent; if we treat only one we reduce it by about 30 percent, so it's a really good idea to get both treated."

    Egan also said he thinks the Healthy Americans 2020 target of 61.2 percent, or a little over three out of every five people, with high blood pressure being controlled is an excellent goal.

    "Right now we're 10 percent below the goal and it looks like we've pretty much stabilized for the last six to seven years, and so it's clearly going to require some new efforts to get another round of progress," Egan said

    "It's sort of what we've known for years, that about a third of Americans are hypertensive and hypertension correlates with obesity," Dr. Ronald Wharton told Reuters Health.

    "Patients who tend to go to the doctor more are going to be in tune with their health and be more likely to take their health seriously," said Wharton, a cardiologist with Montefiore Medical Center in New York who wasn't involved in the study.

    Wharton said that obesity, cholesterol problems, hypertension and diabetes are not "independent parameters" - they're all interrelated.

    "When people take care of one problem, they're really taking care of multiple problems at the same time," Wharton said.

    But, "the data says we've come a long way and we've got a long way to go," Wharton added.

    "What we're facing in healthcare with obesity and hypertension, diabetes and all the ramifications is going to put an expense on the healthcare system that's going to make smoking-related illnesses look like a drop of sand on the beach," Wharton said.

    Egan said that cardiovascular disease is projected to increase healthcare costs tremendously over the next 15 years or so, roughly doubling the current cost.

    "Treating hypertension certainly is one of the ways to reduce that health burden," he said.

    SOURCE: http://bit.ly/1t48i9Y Circulation, online October 20, 2014.