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

  • Younger men more bothered after prostate cancer treatment

    By Shereen Lehman

    (Reuters Health) - After treatment for localized prostate cancer, changes in quality of life will vary by age, as will men's reactions to those changes, according to a new study.

    "While older and younger men start with different baseline quality of life function, older men may be less bothered by certain declines that may affect younger patients more," Dr. Lindsay Hampson told Reuters Health in an email.

    Prostate cancer is the most common malignancy in men of all ages in the U.S. Almost 60 percent of new cases are diagnosed in men over the age of 65, and the average age is 66.

    Older men are often diagnosed with more aggressive disease and are less likely to get treatment, in part because they worry about the impact on their sexual and urinary function, Hampson and her colleagues write in European Urology.

    Determining quality of life priorities is vital to ensuring that patients make well-informed treatment decisions, said Hampson, a urologist at the University of California San Francisco.

    The researchers reviewed national data on 5,362 men diagnosed between 1999 and 2013 with aggressive prostate cancer that had not spread. The men received various treatments, including surgery, brachytherapy, external beam radiation, or androgen deprivation, or active surveillance.

    Before treatment, and again within two years later, the men filled out surveys that included quality of life questions about their urological functioning and symptoms.

    Overall, men over 70 had worse quality of life after treatment than those under 60 - except in terms of mental health - but the younger men were more bothered by quality of life declines.

    For sexual function, 40 percent of the younger men reported a decline after treatment, compared to 46 percent of the older men. But 39 percent of younger men reported worsening sexual "bother" versus just 17 percent of the older men.

    More men under 60 had declines in urinary function, with 14 percent reporting some negative change, compared to 9 percent of older men.

    It's likely that older men start out with a lower level of function, and lower expectations, and therefore are less bothered by declines, the study team writes. Or, perhaps older men have just learned to cope better with fluctuations in their functioning, they note.

    Hampson said quality of life is a very important consideration when contemplating treatment for prostate cancer, and physicians can help patients make appropriate decisions.

    "The first critical question is whether the cancer needs treatment because many prostate cancers can be safely followed with active surveillance," she said.

    "Treatment should not be deferred for older men just because of quality of life concerns, just as younger men also need to be counseled about potential changes in quality of life after treatment," Hampson said.

    Sexual and urinary problems are the most common problems after prostate cancer treatment, said Katrina Balter, a researcher at Karolinska Institute in Stockholm, Sweden, who was not involved in the study.

    "It is important to discuss potential side effects associated with different treatment options," Balter said. "If a man is sexually active, he might prioritize treatments with less risk of side effects or go for 'watchful waiting' (i.e. no treatment) whereas others may prioritize local treatment and potentially improved survival," she told Reuters Health by email.

    SOURCE: http://bit.ly/1COp3ZE European Urology, online February 2, 2015.

  • Inhaled drug may help with sociability in autism

    By Kathryn Doyle

    (Reuters Health) - In an early study, inhaling the hormone oxytocin appeared to encourage men with autism to make more eye contact.

    But this was a small experiment with several limitations and does not mean oxytocin should immediately become a therapy for autism, experts cautioned.

    Oxytocin has been touted as the "love hormone" and the "moral molecule" in the past. Naturally released during intercourse and breastfeeding, it seems to at least make people more social, if not actually more loving.

    For the new study, researchers from the Autism Research Centre at the University of Cambridge in the UK and other European institutions compared 32 men with Autism Spectrum Disorder (ASD) or Asperger Syndrome and another 34 men without those disorders but of similar age and IQ.

    Individually, the men video-chatted with a female researcher twice. Before one interview, participants inhaled oxytocin. Before the other, they inhaled a placebo spray.

    The video-chat software included eye tracking, which recorded how often the subject focused on the eyes, mouth or other face areas during the interviews.

    The female interviewer asked the men how they were doing, how the nasal spray made them feel, how they liked or didn't like being in the study and similar questions for about five minutes.

    With placebo, men with autism focused on the interviewer's eyes less often and for less time than men without autism.

    With oxytocin, the number of times men with autism looked at the interviewer's eyes rose from an average of 0.59 per second to more than 0.7 per second. For men without autism, glances at the eyes rose from 0.83 to almost 0.9 per second, the authors reported in Translational Psychiatry.

    Dr. Lawrence Scahill, director of clinical trials at the Marcus Autism Center at Emory University in Atlanta, who was not involved in the new research, told Reuters Health by email, "This is a step forward, but we should be careful not to over-interpret the results. As noted by the authors, findings with (oxytocin) in ASD have been inconsistent."

    Video interviews are not natural interaction, he noted, and the study participants with autism were "high functioning," having been medication-free for at least a year.

    The findings do add to mounting evidence that oxytocin enhances attention to the eyes, said Tobias Grossman, a developmental psychologist specializing in the brain processes underpinning social interaction at the University of Virginia in Charlottesville.

    "However, it is unclear whether increased looking to the eyes actually improves social functioning," Grossman, who was also not involved in the new study, told Reuters Health.

    Prior work with children with autism shows that oxytocin increases brain function in regions involved in social processing but doesn't affect performance of other tasks, he said.

    In other words, oxytocin may increase glances at eyes, and also brain response to eyes, but without affecting behavior when responding to eye cues, Grossman said.

    Reduced eye contact is one of the earliest warning signs in young children with autism and might be evident as soon as two to six months of age, he said. Much of what happens for these infants developmentally, and how much oxytocin may be involved, remains unknown.

    Grossman and Scahill agree that the new findings are not evidence that oxytocin should be used as a therapy for children with autism.

    SOURCE: http://bit.ly/198lLql Translational Psychiatry, online February 10, 2015.

  • Dyslexia needn't hold doctors back

    By Randi Belisomo

    (Reuters Health) - Failing kindergarten was the first of many school struggles for Blake Charlton. Diagnosed with dyslexia, he was relegated to remedial classes that he barely passed. Now, at 35, reading still poses a challenge. He's a self-described "crummy" speller who manages written communications by relying on abbreviations. People who recall his academic difficulties are often surprised at the abbreviation that now follows his name: M.D.

    "For much of high school and college, I didn't think medical school was a possibility," said Charlton, who's now a medical resident at the University of California, San Francisco and an editorial fellow for the American Medical Association journal JAMA Internal Medicine. "I spent a lifetime having to ride the short bus, identifying as someone who needs help."

    Several years after Charlton finished college, his father was diagnosed with cancer. Caring for his father, Charlton realized that his desire to become a doctor outweighed his fear of failure.

    Receiving time accommodations to take the Medical College Admission Test (MCAT), Charlton earned entry into Stanford University School of Medicine. Most classmates didn't know of his disability, and his patients don't, either.

    Charlton is a dyslexic doctor, and although studies are scant, researchers say he is one of many. Charlton knows of two others at UCSF alone.

    According to the Dyslexia Research Institute, up to 15 percent of Americans are affected by this neurological difference, resulting in language, perceptual and processing difficulties. The percentage of dyslexic doctors is difficult to measure, as many fear that disclosure could thwart professional development and compromise the trust of patients.

    For a recent paper in the Postgraduate Medical Journal, Jean Robson at Dumfries & Galloway Royal Infirmary in Dumfries, UK, and colleagues interviewed seven dyslexic first-year physicians in the Scottish National Health Service. Most said they had not disclosed their dyslexia and had experienced difficulty with communication, time-management and anxiety. (The paper is online here: http://bmj.co/1LKRIB4.)

    Commenting on those interviews, Dr. Sally Shaywitz, a physician and professor of learning development at the Yale University School of Medicine, told Reuters Health, "I think it's a really important topic but an extraordinarily small sample. One doesn't know how representative it is, because there was no control group."

    Shaywitz cites a need for more research into the experiences of dyslexic doctors, whom she says are far more numerous than most believe.

    "They worry what others will think, because there is terrible misinformation that people who are dyslexic aren't smart," Shaywitz said. "But because they have difficulties reading, they have learned to be very careful."

    Charlton said his first-hand awareness of personal deficiencies has made him a compassionate physician. He also said he re-reads everything he writes, never failing to run a spell-check. Being careful doesn't distinguish him among colleagues, however. "Doctors are very meticulous people," he said. "You wouldn't get to where we are if you were not."

    Radiologist Beryl Benacerraf is one of those meticulous dyslexic doctors. She's also a Harvard Medical School professor who was an adult before her dyslexia was diagnosed. When Benacerraf entered medical school in the mid-1970s, she says it wasn't due to academic achievement or test scores. She credits her father, immunologist Baruj Benacerraf, who later won a Nobel Prize, with pulling strings at Harvard. That help was all she needed.

    "I never was accommodated, I had to swim in the waters with everybody else," Benacerraf said. She developed "work-arounds," relying on lectures more than textbooks. She now considers her dyslexia to be a gift. Because she was naturally good at pattern recognition, radiology was a perfect fit. (She gets to look at images rather than read words.)

    "You develop the ability to be a big-picture person rather than a detail-oriented person," Benacerraf said. "Dyslexics think much faster, and it's a more creative way of thinking. I'm very proud of it."

    Charlton agrees. "A lot of us are coming to realize that there are significant downers, but there are certain things we tend to be pretty good at. There's no reason to suppose that people with this kind of brain are not good at things."

  • Terminal cancer care should do more to treat depression

    By Janice Neumann

    (Reuters Health) - Depression could be clouding the last 24 hours of life for a significant number of people with advanced cancer, pointing to a need for better - and earlier - psychological help, according to a large study from Norway.

    Although it's challenging to tease apart depression symptoms from the pain, fatigue and cognitive problems associated with end-stage cancer, more can be done to alleviate depression and anxiety, researchers said.

    "Health care providers may think this is a normal part of the dying process," said lead author Dr. Elene Janberidze from the European Palliative Care Research Center at the Norwegian University of Science and Technology in Trondheim.

    "However, some patients experiencing depressive symptoms and/or depression can be treated and thus both the patients and their families may have a better quality of life," Janberidze told Reuters Health in an email.

    Previous studies have estimated the rates of depression in patients with advanced cancer at anywhere from 2 percent to 56 percent, she and her colleagues write in the journal BMJ Supportive and Palliative Care.

    Janberidze said that her team chose to focus on patients in their last 24 hours of life because this group had not been well investigated.

    They used data from a 2005 nationwide survey of doctors who had signed the death certificates of patients that died within the past two months. The researchers examined data on 1,363 cancer patients during their last 24 hours of life, assessing the symptoms reported by their attending physicians and rating their level of depression.

    After accounting for symptoms of the individuals' illness, the researchers found that overall 37 percent of patients were depressed. More women than men were severely or very severely depressed, and patients aged 17 to 65 were more likely to be moderately depressed than those 80 years or older.

    Geriatricians were four times more likely than other doctors to assess their patients as seriously or severely depressed. Pain specialists, palliative care consultants, psychiatrists and psychologists were also more often tending to patients with symptoms of serious depression than to those with mild or moderate depression.

    Mild or moderately depressed patients were more likely to feel tired, anxious and confused than those without depression symptoms. Individuals who were severely or very severely depressed also tended to feel anxious.

    Holly Prigerson, who directs the Center for Research on End-of-Life Care at Cornell University, said she admired the authors for trying to gauge depression in cancer patients who were so close to death.

    "The study is novel in that it evaluates retrospectively the depressive symptom severity of patients within 24 hours of death," Prigerson said in an e-mail to Reuters Health. "I'm unaware of any other study that has attempted this."

    But Prigerson also noted some of the study's limitations, such as trying to assess patients who could be unconscious or delirious, have multiple organ failure and difficulty communicating their emotions.

    Physicians also need to distinguish physical and psychological symptoms and might not always have enough information on a patient's psychological state when they are dying or might not have enough training to diagnose their "psychological distress," she said.

    "It is also difficult to draw conclusions regarding the clinical implications of the study," Prigerson said. "Given patients are actively dying, it is doubtful that a psychosocial intervention or administration of an antidepressant will effectively improve the patients' quality of death.

    "Psychosocial interventions and care in the months and weeks leading up to the death can have a profound impact on patients' quality of life prior to death, however," Prigerson said.

    Janberidze said doctors should be checking cancer patients for physical and psychological pain and integrating palliative care with their cancer management earlier in their disease. She also said family members could help monitor the patient's pain.

    "In general it is important for family members with loved ones who have advanced stage cancer to pay attention to the signs and symptoms of depression and inform healthcare providers immediately. Doctors should investigate the patient further and recommend psychological interventions as needed," Janberidze said.

    SOURCE: http://bmj.co/1LeAEoL BMJ Supportive and Palliative Care, online February 9, 2015.

  • UPDATE 1-Daily tasks predict hospitalization, death for heart failure patients

    (Updates Source link at bottom, no change to article text)

    By Kathryn Doyle

    (Reuters Health) - Heart failure patients who struggle with daily tasks like bathing or dressing are more likely to be hospitalized and tend to die sooner than those who are more independent, according to a new study.

    More than five million people in the U.S. have heart failure, meaning their hearts cannot supply enough blood and oxygen to other organs, and about half die within five years of diagnosis, according to the Centers for Disease Control and Prevention. Treatments include medications, a low-salt diet and daily physical activity.

    "I certainly suspected that patients who had increasing difficulty with daily living would be at increased risk for death," but just how accurately a brief questionnaire could predict hospitalization and death was surprising, said Dr. Shannon Dunlay, lead author of the study and an advanced heart failure cardiologist at the Mayo Clinic in Rochester, Minnesota.

    For the study, more than 1,000 people with heart failure, and an average age of 75, filled out questionnaires assessing their ability to perform nine activities of daily living, including feeding themselves, dressing, using the toilet, housekeeping, climbing stairs, walking and bathing.

    Many of the participants had other health problems like high blood pressure, diabetes or past strokes.

    Those who had difficulty with things like bathing or housekeeping were classified as having "moderate difficulty" and those who struggled to feed themselves, use the toilet or dress themselves were classified as having "severe difficulty."

    Almost 60 percent of people reported difficulty with at least one of the nine activities. Around one quarter had moderate difficulty and 13 percent had severe difficulty.

    After about three years, more than half of the patients had died and more than 900 had been hospitalized at least once.

    The study team adjusted for other illnesses, and found that compared to people with no difficulty with daily activities, those with moderate difficulty were 50 percent more likely to die, and those with severe difficulty were more than twice as likely to die during the study.

    Those with moderate or severe difficulty were also more likely to be hospitalized for heart problems or for any reason than those with no difficulty, according to the results published in Circulation: Heart Failure.

    People with heart failure tend to be elderly and to have other chronic health conditions, so it can be difficult to separate out what is actually causing the decline in function, Dunlay told Reuters Health.

    Doctors do ask their patients about their ability to get around the house and complete daily tasks, but sometimes it can be hard to fit this conversation in with a regular clinic visit, Dunlay said.

    Adding a quick questionnaire to the appointment could be a good tool for doctors to assess their patients' risk of death and hospitalization, which can vary widely for people with heart failure, she said. Some patients do maintain most functional ability, while others will have severe disability.

    Many patients become asymptomatic with therapy, according to Dr. Eldrin F. Lewis of the cardiovascular division at Brigham and Women's Hospital in Boston, who wrote an editorial accompanying the new research. "Providers should always aim to get patients to the point where they can do all of the things that they enjoy," he told Reuters Health by email.

    "When I first meet a patient, I often ask them about their hobbies so that I can be realistic with them regarding their ability to eventually do those activities," he said.

    People who were older, female, unmarried and had other health conditions like diabetes, dementia or morbid obesity tended to have more difficulty with daily activities and were therefore at higher risk of hospitalization and death, the authors note.

    People who are married have a partner to help with daily tasks and may not notice their functional decline as much as those who are widowed, Dunlay said. Women may have worse outcomes because they tend to be slightly older than men when they develop heart failure.

    "Certainly the next step is to better understand whether there are interventions we can do to improve or halt the progression of decline," both to extend life expectancy and to improve quality of life immediately, Dunlay said.

    "Is there an optimal time to catch patients, and intervene with physical therapy?" she said. "For some patients quality of life is as, or more, important than living longer."

    Even before a doctor asks, family are probably already aware that a person with heart failure is having trouble with daily activities, and shouldn't hesitate to bring it up in the doctor's office, she said.

    SOURCE: http://bit.ly/1weXaVR Circulation: Heart Failure, online February 25, 2015.