Archive for the 'Brain Waves' Category

SNI Communication Tools

John W. Henson, MD, Swedish Neuroscience Institute     

 

SNI is leveraging communication tools that deliver information to patients, referring physicians and the public as a crucial part of providing care at the advancing edge of neu­rological knowledge. The goals of these tools are two-fold. One goal is to update established patients and their doctors regarding the latest developments in our programs and centers. The other is to lower the barrier for patients and physicians who are facing a new neuro­logical problem to discover tertiary subspe­cialty care.

A new SNI communication tool

Dan Rizzuto, Ph.D., director of SNI research, and John Henson, M.D., recently launched SNIblog.com to complement other commu­nication efforts and to provide a communication outlet for the staff of SNI. SNIblog.com offers brief notes about advances in neurological care provided in SNI’s centers, as well as news items about the institute that are of interest to our patients and referring physicians.

Blog content is more dynamic than Web content. Search engines are able to detect targeted key words within each entry, which helps direct highly relevant Web traffic to the blog. This aids in the dissemination of infor­mation to patients and physicians. Viewers also can subscribe to an e-mail notification system that will alert them to newly posted material.

As is the case with any communication tool, however, blogs also have limitations. For example, blogs are not able to incorpo­rate the interactive features of social media that exponentiate information transfer to a selected audience. Therefore, SNI will build upon its existing menu of communication tools by launching social media outlets in the near future.

Other SNI communication tools

At SNI we provide print and electronic options to meet the needs of various audi­ences.

BrainWaves. This print news letter is de­signed to be an educa­tional resource about neurological topics for physicians in thePacific Northwest. Each issue focuses on conditions treated at SNI. Staff members au­thor the articles.

Physicians Practice. Swedish has the exclu­sive contract with this practice management journal to customize content in six issues annually. Although the journal is not exclu­sively used for SNI in­formation, many neu­rological topics have been covered in recent issues. Swedish maintains an online library of past content in the Health Professionals sec­tion of its website at www.swedish.org.

Swedish Neuroscience Institute website. Earlier this year the SNI website took on a new look as part of a project to redesign the entireSwedishMedicalCenter website. SNI members are now able to directly update information about their programs, and are actively developing online patient resources for each of SNI’s programs. The SNI website is a repository of information about our neurological services, research, clin­ical trials and professional expertise.

Our goal is to continuously improve ac­cess to neurological information and the de­livery of that information to interested groups of patients and referring physicians.

Winter Issue of BrainWaves Now Available

The Winter 2010 edition of BrainWaves is now available online.  

BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.

 

Also check out our past editions of the BrainWaves newsletter.

FROM BRAINWAVES: Detection of Cerebral Microemboli by Transcranial Doppler

FROM BRAINWAVES: Since its introduction in 1982, transcranial doppler ultrasound (TCD) has evolved into a portable, multimodality, noninvasive method for real-time imaging of intracranial vasculature. The detection of cerebral microemboli is among the more remarkable capabilities of TCD. Emboli create countable signals in the ultrasound display due to the higher reflection of sound waves compared to the blood cells. Experimental models have shown a high sensitivity and specificity for detection of a variety of substrates, including thrombotic, platelet and atheromatous emboli.

Microembolic signals (MES) within the intracranial vasculature are most frequently identified in patients with large-vessel atherosclerotic disease, such as carotid stenosis. They have also been reported in intracranial arterial stenosis, arterial dissection, cardiac disease and atheroaortic plaque. Additionally, they have been seen in arteries distal to coiled aneurysms.

There is strong evidence that MES detection predicts future ipsilateral stroke risk in patients with symptomatic carotid stenosis (Markus HS, et al.; King A, et al.). A recent study of patients with asymptomatic carotid stenosis demonstrated that MES predicted subsequent ipsilateral stroke and TIA, and also ipsilateral stroke alone, and that it is helpful in selecting patients who will benefit from carotid endarterectomy.

Identification of active embolization provides crucial pathophysiological information to the neurologist and can also aid in the selection of tailored therapy aimed at reducing the risk of stroke. Emboli from different sources have unique compositions and require specific therapy, such as antiplatelet agents for emboli from large artery atherosclerotic plaque and anticoagulants for cardiac emboli.

Future advances in TCD technology will permit full automation and better identification of the composition and size of circulating embolic materials, thus improving its value for patients with cerebrovascular disease.

For more information about TCD for detection of cerebral microemboli, contact Colleen Douville at colleen.douville@swedish.org or 206-320-4080.

Clinical Neurophysiology Lab Receives Accreditation

Congratulations are in order for the Clinical Neurophysiology Laboratory for attaining Accreditation by the EEG Laboratory Accreditation board of ABRET.  We are the first and only Lab to receive Accreditation in Washington State and one of only 10 labs west of the Mississippi. 

Accreditation means the Lab has met strict standards and is recognized as a place where patients and physicians can have confidence they are receiving quality diagnostics.

 Thanks for all the great work and CONGRATULATIONS to everyone on the team who made this possible!

-Colleen Douville
Director for Cerebrovascular Ultrasound
Program Manager for Clinical Neurophysiology

The neurophysiology laboratory at Swedish is a critical component to the Epilepsy program.

Hot Off the Press!

The Summer 2010 Edition of BrainWaves is now available online. 

BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.

Also check out our past editions of the BrainWaves newsletter.

Creating the future through research at SNI

Dan Rizzuto, PhD, Research Manager, Swedish Neuroscience Institute

Clinical research is an essential component of Swedish Neuroscience Institute (SNI). It provides our patients therapeutic options that would otherwise be unavailable to them and places our staff at the forefront of medical knowledge as they evaluate leading-edge drugs and medical devices. The majority of SNI investigations assess the safety and efficacy of new drugs and devices. These studies are typically sponsored by the federal government, or pharmaceutical and medical device companies, with oversight provided by the U.S. Food and Drug Administration. Investigator-initiated trials at SNI answer questions about current standard-of-care therapies. These trials play an important role in supporting evidence-based medicine and advancing patient care.

Initiating a research study at SNI begins with a physician identifying a research question or a sponsor asking a physician to investigate a new therapy. After the physician defines the study protocol, he or she presents an overview to the SNI Research Committee to ensure sufficient patient access, financial support and staffing resources are available. After the committee has approved the protocol, the Swedish Institutional Review Board performs its federally-required review, which is designed to protect the welfare of research participants.

As research manager, I oversee the financial and regulatory aspects of clinical research at SNI, including budget, contract negotiations with study sponsors and the assignment of study coordinators to assist with IRB submissions and patient visits. This allows the investigator to focus on providing patient care, overseeing patient safety and collecting efficacy data.

Research at SNI currently includes 54 active investigations across nine programs, and is supported by more than $2 million dollars in annual funding. Thirty-seven of these studies are sponsored and financially supported by pharmaceutical and device companies, eight are investigator-initiated and nine are funded by the federal government or other non-profit organizations.

Research at SNI has a very bright future with many new and exciting trials on the horizon. The movement disorders program has ramped up its first clinical trial of a Parkinson’s disease treatment, and the Ivy Center for Advanced Brain Tumor Treatment is at the forefront of developing personalized medicine for brain cancer patients. One of the most exciting developments involves the bridging of two disciplines: deep brain stimulation (DBS) and psychiatry. The DBS program and the Swedish psychiatry program are evaluating clinical trials that use DBS for treatment resistant obsessive compulsive disorder and major depression. DBS offers hope for the most severely affected of these patients who continue to exhibit severe symptoms even after adequate trials of currently available therapies.

As a neuroscience center of excellence, SNI is uniquely designed to meet the healthcare challenges of the 21st century and beyond. We pursue evidence-based medicine by combining an academic focus on learning and research with high-quality clinical programs. The power to meet these challenges resides within each of us, and I encourage you to think about how you can be a pioneer in the advancement of medicine through clinical research.

If you would like to participate in clinical research activities at SNI, please contact:

Dan Rizzuto, Ph.D.

dan.rizzuto@swedish.org

Gamma Knife Radiosurgery for Treatment of Essential Tremor

Ronald Young, MD, Neurology, Swedish Neuroscience Institute

Essential tremor (ET) is the most common type of movement disorder, affecting approximate­ly four out of 1000 people, and is significantly more common, though less recognized, than Parkinson’s disease. ET affects men and women equally and is inherited as an autosomal-dominant condition in about 60 percent of cases.

Although often referred to as benign essen­tial tremor, it is hardly benign in patients who may not be able to write legibly, hold a glass of water or use a knife and fork. ET is primarily an action tremor of the upper extremities but may involve resting tremor of the head and neck and/or lower jaw, and also tremor of the voice. The latter may be so severe that speech becomes unintelligible.

Medication and surgical treatment options

Primidone and beta blockers are useful in re­ducing tremor in the early stages of ET, but as the tremor progresses, medical management often becomes less effective or side effects can prevent the use of adequate doses of medication. ET pa­tients then are candidates for surgical or radiosur­gical treatment.

The mainstay of the surgical treatment of ET is deep brain stimulation (DBS), in which an electrode is implanted in the ventral inter­mediate nucleus (VIM) of the thalamus. Neurosurgeons Peter Nora, M.D., and Ryder Gwinn, M.D., have been implant­ing DBS electrodes at Swedish Medical Center for several years. The treatment is effective, but it requires implantation of permanent hardware (wires and batteries) into the brain and chest wall. Patients who take anticoagulants or have severe cardio­vascular disease are not suitable candidates for DBS. These patients, however, may be candidates for radiosurgical treatment.

A new option for difficult-to-treat patients

A Gamma Knife® device is used to fo­cus high-energy gamma rays precisely on the VIM in a single outpatient treatment. This results in the death of the brain cells that generate ET. We recently published our experience in the radiosurgical treat­ment of more than 200 patients with ET. More than 80 percent of the treated pa­tients showed significant reduction in tremor, including nearly 50 percent who were entirely free of tremor. Patients could write legibly, drink without spilling and, in general, perform activities of daily living with minimal or no disability (see figure). These results are comparable to the data published for the use of DBS in the treat­ment of ET. Follow-up MRI scans in these patients demonstrated the development of lesions of about 6 mm in diameter precisely located in the VIM thalamus. Eight percent of patients developed lesions which were larger than expected. These large lesions occasionally resulted in sensory loss, hemi­paresis or speech difficulty. In about half of these patients, the neurological symptoms recovered over time, so the permanent rate of complications was about 4 percent. At present we have not been able to identify what factors may predict the development of an excessively large lesion.

Gamma Knife radiosurgery offers a means for the treatment of ET that is safe and effective without the need for implant­ed hardware. The rate of tremor relief and the complications compare favorably with DBS. Radiosurgery can be offered to all pa­tients who are candidates for surgical treat­ment of ET, but it is particularly useful for patients who are not candidates for DBS.