Penn State Health Milton S. Hershey Medical Center specialists are working together to form a center for the comprehensive, multidisciplinary management of patients with neurofibromatosis (NF). Leading the team are Dawit Aregawi, MD, assistant professor, neuro-oncology, Kimberly S. Harbaugh, MD, associate professor of neurosurgery, chief, division of peripheral nerve surgery, and Elias Rizk, MD, assistant professor of neurosurgery. The Hershey Medical Center team is focused on adult NF management for better function preservation, earlier detection of cases with malignant tumor progression and better management of associated comorbidities. Dr. Harbaugh explains, “If patients have access to regular monitoring at an NF specialty center closer to their homes, it’s likely that tumors and associated complications will be detected earlier, possibly helping to avoid significant nerve and soft tissue damage and to preserve function.” Dr. Aregawi says, “Despite the fact that NF is a fairly common autosomal dominant disorder [1 in 3,000]¹, many adult patients are seen by specialists only when a problem arises, with routine follow-up mostly done in the primary care setting.” A major barrier to accessing specialty care is the limited care options closer to patients’ homes, with many required to travel long distances to see an NF specialist. Continue reading
With studies revealing that nearly half of neurologists experience at least one symptom of burnout1,2 a special task force was launched in 2016 by the American Academy of Neurology (AAN) to research the problem. According to Sankar Bandyopadhyay, MD, associate professor of neurology, Penn State Health Milton S. Hershey Medical Center, “The first step in solving any problem, including burnout, is to recognize it. Physicians in general tend to deny, even to themselves, that they may be experiencing burnout.” Physician burnout is marked by feeling emotionally exhausted, being less empathetic with patients and being unsatisfied at work; in some cases there may be depression and substance use, abuse or addiction.3 The abbreviated Maslach Burnout Inventory is a validated self-administered questionnaire that identifies the presence and severity of burnout symptoms.4
Dr. Bandyopadhyay points out that there are evidence-based, proven interventions that those experiencing burnout can use to help themselves.5-7 “Maybe the most powerful of these is ‘mindfulness.’ It’s a strategy to reduce stress and re-frame how we think, to experience less frustration and boredom,” he says. In several trials with physician participants, formal mindfulness training significantly decreased depersonalization, emotional exhaustion and overall burnout scores.5-7 Continue reading
I looked at the clock. It showed 2:58 am. The ED hadn’t paged in 30 minutes. No calls from the floor either in at least 15. It was now or never. I hurried over to the refrigerator and threw my microwave dinner in to heat. Two minutes later, I heard the beep. My stomach was growling; I realized I hadn’t eaten anything in about 12 hours. Then, I realize the beeping wasn’t the microwave at all. BRAIN ATTACK arriving with ETA of 5 minutes…. I looked at the microwave and then the door and then back at the microwave. Shall I try to take a few bites before I run down to the ED? Do I bring it with me? Then, the pager goes off again, outside caller trying to reach an on-call doc. Forget it. I grabbed my laptop and ran to the ED to meet the incoming patient. No food, no water. I dial the outside line, “Neurology Emergency Line, this is the on-call doctor…” and my pager goes off a third time as I head down the steps…
Burnout (Noun): 1. The reduction of a fuel or substance to nothing through use or combustion. 2. Physical or mental collapse caused by overwork or stress.1
Impaired retinal vasodilator responses may be an early marker of microvascular disease or endothelial dysfunction and a potential predictor of cerebrovascular risk based on findings from studies in diabetic and prediabetic patients.1,2 Kerstin Bettermann, MD, PhD, associate professor, department of neurology, Penn State Health Milton S. Hershey Medical Center, explains, “Retinal blood flow is controlled by autoregulatory metabolic and pressure mechanisms, which are impaired in diabetes. We also know that impairment of the retinal microvasculature is associated with cerebral ischemia.3 Given these two facts, looking at retinal vasodilator responses may be a low-cost, non-invasive strategy to assess risk for stroke and possibly other cerebrovascular risks in a wide range of individuals in the community.” Dr. Bettermann believes that with further validation, screening for retinal vasculopathy may become part of routine eye exams.
Retinal arterial vasoreactivity over time following flicker light stimulation
Patients with aggressive, high-grade malignant brain cancers, like glioblastoma multiforme (GBM) and anaplastic astrocytoma (AA), have a poor prognosis with no known curative treatment using standard resection, radiation and chemotherapy approaches. With this bleak clinical outlook, the U.S. Food and Drug Administration (FDA) has fast-tracked clinical development of several new therapies.1 According to Brad Zacharia, MD, MS, assistant professor of neurosurgery, Penn State Neuroscience Institute, and co-director of neuro-oncology, Penn State Cancer Institute, “With aggressive tumors like GBM and AA, neuro-oncologists worldwide are exploring biological and immune-targeted therapies, to identify more effective treatments. We (Penn State Health Milton S. Hershey Medical Center) are an investigational site for a number of clinical trials for these types of cancers.” (See chart.) Continue reading
LionNet, Penn State Health Milton S. Hershey Medical Center’s virtual telestroke program, partners with 16 regional hospitals. The telestroke network provides stroke patients rapid access to expert stroke neurologists and neurosurgeons, no matter how remote or rural the community hospital. Stroke patients at a partner site emergency department (ED) are assessed in real-time via audio/ video feed by a stroke neurologist or neurosurgeon at Hershey Medical Center; physicians at both sites can share patient imaging, charts, and test results. Since its July 2012 inception, the program has grown exponentially and more than 5,000 patient consults (approximately 2,000 of which were ischemic stroke patients) have now been performed using LionNet. Continue reading
In January 2016, Penn State Children’s Hospital launched ‘Capable Kids,’ a care coordination program involving more than 200 patients. The program aims to better manage the complex medical needs of children with serious neurological diagnoses and reduce the burden on families. William Trescher, MD, division chief, pediatric neurology and president of the Child Neurology Foundation, says, “This idea stemmed from a Penn State Health Milton S. Hershey Medical Center retreat in 2014 when a number of clinicians from multiple specialties came together to explore ways to provide improved care for our patients and families.” Physicians, including those from pediatric gastroenterology, pulmonology, orthopedics and neurology, participate in the program, working together to address the needs of kids with very debilitating illnesses. Capable Kids is uniquely tailored to the needs and challenges of families in the surrounding community, which is largely rural or semi-rural. Continue reading
Researchers at Penn State Neuroscience Institute not only conduct pre-human scientific studies of various medical conditions, but also see patients daily, giving these physicians a perspective not found in most laboratories. Mark Stahl, M.D., Ph.D., assistant professor of neurology and neural and behavioral sciences, details one such study involving “molecular tweezers” to break up the aggregation of misfolded proteins known as α -synuclein.1 These aggregated proteins are associated with the development of neurodegenerative disorders such as Parkinson’s disease, for which there are currently symptomatic therapies but no treatments that can alter the disease course.1
LEFT: Zebrafish overexpressing neuronal human alpha-synuclein (red) have poor morphology, neuronal death and poor survival. RIGHT: “Molecular tweezers” like CLR-01 can rescue this phenotype.