The peripheral nerve program at Penn State Hershey Neuroscience Institute uses nerve transfer procedures to treat complex cases. Division Chief of Peripheral Nerve Surgery, Kimberly S. Harbaugh, M.D., explains one option, “Oberlin transfer is a procedure in which the clinician harvests part of one of the nerves from the hand and transfers it to the nerve in the patient’s bicep muscle. In this way, we have been able to restore significant levels of elbow flexion.” This has multiple potential applications, even in patients with spinal cord injuries. A portion of the nerves that are still intact above the level of the injury can be transferred to areas below the injury. In this way, spinal cord injury patients may be able to reclaim some finger and hand function, leading to improved self-care options.¹
Assistant Professor of Neurosurgery, Elias B. Rizk, M.D., M.Sc., details a recent case: “I had a male patient in his mid- 20s with a direct injury to his brachial plexus. He had been in a car accident, and in a state of semi-consciousness, he tried to release himself by using a pocket knife. He stuck it into his chest wall, severing one of the nerves to the arm. As a result, he lost his functional elbow movement. After six months, we elected to do an Oberlin nerve transfer to his bicep muscle. He had a very good recovery, with restoration of elbow flexion, and is now back to work.” Continue reading
Penn State Hershey Neuroscience Institute, has a global perspective when it comes to providing quality, multi-disciplinary care. This is best represented by the Institute’s expansive global exchange program among neuroscience clinicians and researchers, spanning four continents. Every neurosurgical resident is given the opportunity to hone his or her skills abroad, and almost half choose to do so. The primary exchange program is with the Bureau of Public Health in Tianjin, China, a formal relationship that began in 2006. Through a grant funded by Integra Foundation, eight Penn State Hershey Medical Center faculty members have studied there, while thirty-four exchange students have learned alongside Penn State College of Medicine faculty.
The exchange program functions as part of a developing program to encourage collaboration between clinicians and researchers at Penn State Hershey Medical Center and Tianjin’s largest hospitals. These reciprocal relationships enable providers to share best practices and advanced technology to improve patient outcomes. From a clinical standpoint, foreign physicians can gain experience with virtually every neurosurgical procedure that is currently performed at Penn State Hershey Medical Center. In the research arena, groundbreaking studies are being conducted through the Center for Neural Engineering and Penn State Hershey Neurosurgery laboratory. Research is ongoing in neurodegenerative disease, brain iron deficiency, brain tumors, epilepsy, and brain-machine interfaces. Physicians from the US and China also collaborate on clinical trials, mutually benefiting with shared data from their genetically disparate populations. Continue reading
Robert Harbaugh, M.D., professor and chair of Penn State Department of Neurosurgery and director of Penn State Hershey Neuroscience Institute, encourages all members of his department to take an active role in the field. “One thing we encourage in our residency training, aside from the usual missions of education, patient care, and research, is involvement in organized neurosurgery.” As they train new residents, Penn State Hershey Neurosurgery faculty members also encourage younger physicians to pass on their knowledge and adopt a citizenship role in the field.
Harbaugh himself holds multiple leadership positions, including president of the Society of Neurological Surgeons. He previously served as immediate past president of the American Association of Neurological Surgeons and director and member of the Advisory Council of the American Board of Neurological Surgery. Harbaugh has traveled extensively to lecture on various topics, including his clinical specialty of cerebrovascular neurosurgery and his research work on computer modeling of intracranial aneurysms.
Robert E. Harbaugh, M.D., FAANS, FACS, FAHA
Director, Penn State Hershey Neuroscience Institute
Distinguished Professor and Chair, Department of Penn State Hershey Neurosurgery
Professor, Department of Engineering Science and Mechanics
RESIDENCY: Neurological Surgery, Dartmouth Hitchcock Medical Center
MEDICAL SCHOOL: Penn State College of Medicine
The American Heart Association/American Stroke Association has recognized Penn State Hershey Medical Center for its high-level care of stroke patients. The Medical Center has received the Get With The Guidelines®-Stroke Gold-Plus Quality Achievement Award for the sixth consecutive year by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients.
The award is the highest level of recognition available for treatment of patients with stroke and recognizes Penn State Hershey for implementing specific quality improvement measures outlined by the AHA/ASA for the treatment of stroke patients.
Penn State Hershey also received the association’s Target: Stroke Honor Roll for meeting stroke quality measures that reduce the time between hospital arrival and treatment with the clot-buster tPA.
Penn State Hershey is one of only seven Comprehensive Stroke Centers in Pennsylvania, the only one in Central Pennsylvania, and one of only seventy-eight in the country.
Open communication between participants enhances the success of the Penn State Hershey LionNet telestroke system.
Penn State Hershey Medical Center spearheads a sophisticated telestroke system, LionNet, expanding the capabilities of partner hospitals. By exposing more patients to specialized neurological care, LionNet can dramatically increase positive outcomes for patients with both ischemic and hemorrhagic stroke.
Using advanced computer systems with webcams, LionNet allows a Penn State Hershey stroke neurologist or neurosurgeon to consult in real-time with an ED doctor at a partner facility. The specialist examines the patient remotely, reviews scans, and makes a recommendation regarding whether to begin intravenous tPA therapy or transport the patient for possible neurosurgical intervention at Penn State Hershey Medical Center.
Penn State Hershey Movement Disorders Center is home to a research study focused on the early diagnosis of Parkinson’s Disease (PD) and a program for measuring the efficacy of deep brain stimulation (DBS) treatment in advanced cases of the disease.
Associate Professor of Neurosurgery James McInerney, M.D., states, because PD symptoms can be mistaken for other disorders, an accurate PD diagnosis often does not occur until up to 80 percent of dopamine neurons have died. His colleague, Vice Chair for Research and Professor of Neurosurgery Xuemei Huang, M.D., Ph.D., leads a team that studies the dynamics of arm swing coordination during walking in both PD patients and controls, to identify any marked differences.1 Continue reading
As many as 70 percent of epilepsy patients can be controlled with anti-seizure medications; however, the remaining 30 percent are thought to have drug-resistant epilepsy with poorly-controlled seizures. The addition or substitution of medications usually does not significantly improve outcomes in this population; in one study, as few as 1 percent of patients receiving a third medication for epilepsy were seizure-free.1
Image of brain after the completion of Stereoelectroencephalography (SEEG).
The Comprehensive Epilepsy Center at Penn State Hershey Medical Center, designated as a level IV epilepsy center by the National Association of Epilepsy Centers (NAEC), specializes in the treatment of complicated epilepsy cases, and coordinates multi-disciplinary care for the diagnosis, evaluation, and treatment of both adult and pediatric epilepsy. Medical Director Jayant Acharya, M.D., points out that since the facility also participates in both surgical and medical research, eligible patients may have access to pre-approval medications through participation in clinical trials.
If results of both standard and ambulatory EEG prove inconclusive, more extensive monitoring takes place in the inpatient Epilepsy Monitoring Unit (EMU), where patients are monitored by a team of experts while various tests are performed, from noninvasive video-EEG monitoring up to invasive intracranial monitoring with subdural or intracerebral depth electrode placement.
Robert Harbaugh, M.D., professor and chair of Penn State Hershey Neurosurgery and director of Penn State Hershey Neuroscience Institute, has been chosen as president-elect of the Society of Neurological Surgeons (SNS). The SNS is the oldest neurological society in the world and includes leaders in neurosurgical residency education. Harbaugh also serves as president of the American Association of Neurological Surgeons and as vice-chair of the American Board of Neurological Surgery.
Penn State Center for Neural Engineering has combined its research mission with the clinical mission of Penn State Hershey Neuroscience Institute to develop a Smart ICU, using the data collection and synthesis method known as predictive modeling to deliver patient-specific care. Although its use in medicine is relatively new, predictive modeling has proven successful in areas as diverse and complex as weather forecasting and aviation.1
Currently, medical practitioners are presented with a multitude of variables relating to critically ill patients—as many as 200 during one session of rounds alone—and must make time-sensitive clinical decisions based on these data. This can contribute to ongoing information overload and even lead to preventable medical errors.2
J. Christopher Zacko, M.D., director of Penn State Hershey Neuroscience Critical Care Unit, states, “In addition to the standard measurement of intracranial pressure (ICP), factors such as microdialysis, cerebral blood flow, sodium levels, and cerebral oxygen pressure can all be important in the treatment of brain-injured patients.” Continues Steven Schiff, M.D., Ph.D., director of the Center for Neural Engineering, “When all this data is collected and analyzed in real time—we can better determine what’s going on with a patient. It’s too much data to keep in your head, but a predictive computer model can produce recommendations. Call it the ‘Big Data’ approach.” He cites a patient in whom intracranial pressure (ICP) is not yet elevated. Predictive modeling may suggest treatment methodologies that would prevent ICP from rising in the first place – which it almost surely would do otherwise.
Penn State Milton S. Hershey Medical Center’s designation as the only comprehensive stroke center in central Pennsylvania means that patients who require treatment beyond administration of the clot-busting tPA drug can get the care they need.
Several hospitals in the central Pennsylvania region have now become certified or primary stroke centers [see graphic for explanation on the differences between certifications].
Many hospitals have increased their rates of diagnosis and tPA administration as a result of a telemedicine partnership with Penn State Hershey.
Still, about a quarter of stroke patients need advanced interventions that only an academic or comprehensive stroke center like Penn State Hershey can provide.