At West Virginia University, the confluence of globally recognized research and clinical practice translates to comprehensive, personalized neurological and neurosurgical care.
From mobile computerized tomography scans that allow real-time imaging in the operating room to innovative uses of transcranial Doppler to monitor the mechanisms of stroke, neurologists and neurosurgeons at West Virginia University (WVU) Healthcare are equipped with a 21st century armamentarium to treat the gamut of neurological and neurosurgical disorders.
“We combine technological innovation with subspecialty expertise across the board,” says Charles L. Rosen, MD, PhD, Professor and Chair of the Department of Neurosurgery at WVU School of Medicine. “There is no neurosurgical procedure that can’t be performed at WVU.”
“At WVU Healthcare, we have the expertise to treat the spectrum of neurological disease states. If the complexities of a condition require other specialty involvement, the breadth and depth of our specialists is notable. We partner with physicians across the state to care for their most challenging patients.”
— Charles L. Rosen, MD, PhD, Professor and Chair of the Department of Neurosurgery at the WVU School of Medicine
To optimally treat neurological disorders, WVU Healthcare’s Neurosciences Programs provide a multidisciplinary approach delivered by a broad range of specialists, ranging from neurosurgeons, neurologists and neuroradiologists to occupational therapists and social workers.
Collaborative Care: Case in Point
Erich O. Richter MD, FAANS
As many as 20 clinicians may be involved in the care of a patient with Parkinson’s disease, a collaborative approach that illustrates the treatment model at WVU Healthcare.
“Parkinson’s disease is the most common of the various movement disorders we treat,” says Erich O. Richter, MD, FAANS, Director of the WVU Center for Functional Neurosurgical Restoration and Associate Professor of Neurosurgery at WVU School of Medicine. “The course of care can be divided into phases. In the first, medical management is optimal, but somewhere between five and 10 years after diagnosis, most patients progress into the second phase. In terms of maintaining normal activity, surgical therapy is usually very important in this second phase. The optimal time for surgical intervention is before significant disability develops, because surgery can stabilize and reduce much of the symptomatic variability patients experience throughout the day.”
While effective for treating symptoms during the first phase of Parkinson’s, medications can elicit side effects that reduce quality of life as the disease progresses. Pinpointing the ideal time for surgical intervention allows symptomatic relief to continue after pharmacological strategies become ineffective.
“It’s a common misconception that surgery is for patients who are unresponsive to medications,” Dr. Richter says. “In fact, we’re looking for patients whose sinemet or dopaminergic medical strategies have been successful but are at the point of inadequately controlling side effects.”
Making the Right Call
Other diseases and syndromes mimic symptoms of Parkinson’s disease, and surgical intervention is contingent upon confirming the idiopathic Parkinson’s diagnosis. Patients undergo a comprehensive evaluation process by movement disorder neurologists, neuropsychologists and neuroradiologists.
Annie Killoran, MD, MS, at right
Annie Killoran, MD, MS, Director of the Movement Disorder Clinic and Assistant Professor of Neurology at WVU School of Medicine, performs the first evaluation to determine surgical efficacy.
“I perform evaluations for patients with and without medication,” she says. “This tells us whether or not they’re likely to have a good response to surgery. But it’s also only indicated for idiopathic Parkinson’s disease, so we have to rule out other conditions that are similar to the disease, such as Parkinson’s plus syndromes, multisystem atrophy, progressive supranuclear palsy or even vascular Parkinson’s.”
Annie Killoran, MD, MS
Neuroradiologists use positron emission tomography (PET) imaging to assess the degree of cerebral atrophy, and neuropsychologists rule out the presence of dementia, which contraindicates surgery.
“Neuropsychologists rule out significant cognitive decline,” Dr. Killoran says. “Surgery for Parkinson’s can exacerbate thinking problems associated with underlying cognitive disorders, and thorough psychological testing can identify the presence of such conditions.”
Deep Brain Stimulation and Beyond
Although there is no cure for Parkinson’s disease, deep brain stimulation (DBS) offers notable improvements in quality of life by significantly reducing the severity of the disease’s symptoms.
Neurosurgeons use MRI and neurophysiological mapping to implant electrodes into specific brain regions. An impulse generator, implanted under the collarbone, sends an electrical impulse through the electrodes to the areas of the brain causing tremors and other symptoms.
Intraoperative PET scanning under development at WVU will help improve current DBS methodologies by enabling neurosurgeons to perform awake surgery for movement disorders.
“Intraoperative PET imaging will show changes in regional blood flow and differences in cortical activity as we place and turn on the electrodes in an awake patient,” Dr. Richter explains. “This should have groundbreaking effects on our abilities to perform awake surgery for movement disorders.”
Charles L. Rosen, MD, PhD
The Neurosurgery Department provides comprehensive surgical treatment for patients of all ages with any neurological condition requiring surgery. Routine and complex neurological conditions alike are treated collaboratively, leveraging subspecialty expertise from across the care spectrum.
“Brain tumors grow in a way that makes different parts of the tumor challenging for different specialists,” Dr. Rosen explains. “Often, we’ll have ophthalmologists, ear, nose and throat surgeons, and neurosurgeons operating on a tumor together so that each specialist operates to his or her strengths. This allows us to tackle dangerous tumors in a safe manner.”
Other complex conditions, such as aneurysms, sometimes require challenging surgical interventions. Traditional treatments, such as clipping or coiling the enlarged portion to block it off may not always be effective. For these patients, Dr. Rosen performs intracranial bypass, where he removes a vessel from the leg or arm and creates a vessel bypassing the aneurysm.
Breakthroughs in Stroke Care
Amelia Adcock, MD, Assistant Professor of Neurology at WVU School of Medicine
WVU Healthcare also has a comprehensive stroke program in which clinicians diligently work to improve protocols for stroke care and conduct research trials to build upon and improve current treatments.
Time is of the essence when treating patients suspected of suffering a stroke, and protocols established at Ruby Memorial Hospital ensure the fastest door-to-treatment times possible.
Tissue plasminogen activator (tPA) is one of the most effective treatments for dissolving blood clots in appropriate patients, but it must be administered within three hours of symptom onset. To provide more patients with potentially lifesaving treatment, the WVU Center for Neuroscience is participating in several clinical trials to assess the efficacy of administering tPA or intravenous (IV) tPA for patients who do not meet traditional criteria, such as those who have surpassed traditional time limits or whose symptoms have improved.
Amelia Adcock, MD
“As it turns out, the primary reason people aren’t treated with IV tPA within the prescribed time window is because they’re thought to have had a mild stroke or their symptoms are rapidly resolving,” says Amelia Adcock, MD, Assistant Professor of Neurology at WVU School of Medicine. “You might think a ‘mild stroke’ doesn’t sound that bad, but if you follow these patients, you’ll see that they can have significant disability.”
Through the trial, this patient population will receive IV tPA to prevent such functional deficits.
Through another trial, in addition to receiving IV tPA, patients with a first large vessel proximal occlusion — a stroke caused by a blockage in one of the first points at which major blood vessels branch off — may be offered interventional treatments, in which the clot is extracted mechanically, or intra-arterial tPA to dissolve the clot.
An Extensive Network
In order to provide expert advice to medical centers that may not have a stroke specialist, WVU’s Neurology Department plans to expand its telestroke network. Using a computer interface resembling Skype, neurologists can remotely evaluate patients suspected of having suffered a stroke and recommend tPA administration or further intervention.
Erich O. Richter, MD, FAANS, (right) and Garrett Jackson, MD
“We’re increasing our efforts to provide treatment for people suffering an acute stroke,” Dr. Adcock says. “Whether it’s transporting patients here for care, reaching out via the telestroke network, or simply calling for a second opinion or consult, our lines of communication are always open in order to expand access to stroke care.”
For more information about WVU Healthcare’s Neurosciences Programs, visit wvuhealthcare.com. To refer a patient, call 800-WVA-MARS.