Tag Archives: neurosurgery

Novel Zebrafish Research Contributes to More Effective Diagnosis, Treatment of Neurodegenerative Disorders

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

Zebrafish research

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.

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Pipeline® Embolization Device Features Improved Delivery System

Since the Food and Drug Administration (FDA) approved the Pipeline® Embolization Device (PED) for flow diversion in large or giant wide-necked aneurysms in 2011 after the multicenter Pipeline for Uncoilable or Failed Aneurysms (PUFs) trial proved its safety and efficacy1, the revolutionary device continues to improve treatment of the most complex aneurysms. The latest version, the Pipeline™ Flex, features a vastly improved delivery system. According to Kevin Cockroft, M.D., M.Sc., co-director, Penn State Comprehensive Stroke Center, “We now have the ability to reposition the device, which allows for more precise placement instead of always needing to hit the exact target on the first attempt, and this appears to have shortened the learning curve for clinicians.” Hershey Medical Center was one of the first in the country to offer treatment with the PED, and has performed close to 70 of the procedures to date.

Digital subtraction angiogram

Digital subtraction angiogram in lateral view before and six months after treatment.

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Early Testing Aids in Correctly Diagnosing, Potentially Treating Patients with Autonomic Dysfunction

Autonomic Dysfunction TestingOver one million Americans are impacted with a primary autonomic system disorder, and the more common forms of these conditions include Postural Orthostatic Tachycardia Syndrome (POTS), Neurocardiogenic Syncope (NCS), Pure Autonomic Failure (PAF) and Multiple Systems Atrophy (MSA).1 In addition, seemingly vague symptoms such as unexplained palpitations, gastroparesis, orthostatic hypotension, syncope, flushing, unexplained sweating, abnormal nasal secretions or lachrymation, or sexual dysfunction can signal autonomic dysfunction (AD), especially in patients with diabetes. Other conditions commonly associated with AD are Parkinson’s disease and migraine. AD is often underdiagnosed or even dismissed, since patients may not recognize or report their symptoms, but early diagnosis of AD can be crucial. In diabetes patients in particular, AD has been shown to correlate with poor cardiovascular outcomes.2 Patients with any of these conditions who display symptoms of AD should receive testing, as this can show the severity of the dysfunction, indicate which body systems are involved, and direct a treatment plan.

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Newer Treatment Options Show Promise for Improved and Individualized Migraine Prevention and Treatment

Migraine prevention and treatment

Single-pulse transcranial magnetic stimulation, marketed as SpringTMS™, is indicated for PRN acute management of migraine pain. Image courtesy of ENeura®.

Migraine headaches are among the most common neurological disorders, with an estimated 12 to 23 percent of U.S. adults having had a migraine in the past three months.1 Despite their frequency, migraines are often treated incorrectly, with prevention strategies underutilized and acute therapies used inappropriately.1 Several steps are needed to advance the quality of migraine treatment, says Stephen Ross, M.D., vice chair, Penn State Department of Neurology. “It’s important that both clinicians and patients are more aware of what is available, and clinicians understand that other effective treatment options are available to replace medications such as opioids, which have been shown to be problematic.” Continue reading

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Breakthrough Technology Advances Diagnosis and Treatment of Epilepsy

Epilepsy treatment

Michael Sather, M.D., surgical director, Penn State Hershey Comprehensive Epilepsy Center, performing open surgery to place subdural electrodes directly on the surface of the brain with the ROSA™ system, which allows for precise placement of the relevant electrodes.

Technological improvements to both testing and treatment have revolutionized the field of epilepsy care in recent years. Clinicians seek to pinpoint the location of seizures to administer more targeted treatment. “There is a growing interest in identifying the seizure focus more precisely and noninvasively,” says Jayant Acharya, M.D., medical director, Penn State Hershey Comprehensive Epilepsy Center of Penn State Hershey Neuroscience Institute.

One example of this breakthrough technology is dense-array EEG, a noninvasive diagnostic technique that records electroencephalography with up to 256 electrodes versus standard techniques that typically employ 19-21 scalp electrodes.1 Past research has shown that information is lost unless EEG sampling provides an intersensor distance of no more than 2 cm, which would require 500 EEG channels distributed evenly over the head.2 This 256-channel sampling technology can approximate adequate spatial sampling and identify the precise area of neurological dysfunction.2 Acharya concludes, “In our setting, the most important feature is that it’s much more sensitive and specific in terms of localizing the seizure focus.” Continue reading

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Additional RLS Research Examines Iron Deficiency

James R. Connor, Ph.D., vice-chair of neurosurgery at Penn State Hershey Medical Center, has been continuing research that began as a collaboration with scientists at The Johns Hopkins Hospital over a decade ago. These prior autopsy studies indicated the brain is iron-deficient in RLS patients, and proved a biological basis for the condition, as patients had a low ferritin level in common. This iron deficiency has multiple consequences that will provide further insights into therapeutic targets. “One of these consequences is the activation of hypoxic pathways, since there is not enough iron to use the oxygen,” says Connor. “This is clearly related to reduced peripheral blood flow.” In combination with the research being conducted by Dr. Stephanie Patton, this information may deepen the scientific and clinical knowledge of a poorly-understood condition and open multiple doors to future treatment options.


James R. Connor, Ph.D.James R. Connor, Ph.D.
Distinguished Professor of Neurosurgery, Neural and Behavioral Sciences and Pediatrics
Vice-Chair of Neurosurgery
PHONE:
717-531-4541
E-MAIL:
jconnor@hmc.psu.edu
POSTGRADUATE STUDY:
University of California, Berkeley, Calif.
POSTDOCTORAL TRAINING:
Boston University School of Medicine, Boston, Mass.


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Training Future Neurosurgery Leaders

Neurosurgical practice has evolved greatly over the last decade, and has often been at the forefront of technological advancement.¹ Penn State Hershey Neuroscience Institute has increased its focus on fellowships and residencies to meet the growing demands of the field, including an increasing number of tumor resections and a trend towards coiling rather than clipping cerebral aneurysms.¹ Penn State Hershey features the largest number of fellowships in the country approved by CAST (Committee on Advanced Subspecialty Training, a committee of the Society of Neurological Surgeons).² Residents participate in a year of independent study, during which they may apply for one of the six CAST-accredited fellowships offered in peripheral nerve surgery, endovascular neurosurgery, functional neurosurgery, neuro-oncology, neurocritical care and spine surgery.² Continue reading

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Research Examines Customization of Brain-Computer Interface (BCI) Technology in Patients with ALS and Cognitive Decline

The novel technology of brain-computer interface (BCI) uses brain activity, as measured by electroencephalogram (EEG) to control external devices, facilitating paralyzed patients’ ability to communicate. This technology¹ can allow patients with amyotrophic lateral sclerosis (ALS) to communicate even after they have lost the gaze control necessary for eye-tracking communication programs.¹ For maximum efficacy, BCI programs must account for aspects of disease heterogeneity, such as cognitive impairment, according to Andrew Geronimo, Ph.D., instructor, Penn State Hershey Neurosurgery.

“Our primary contribution to the ongoing ALS patient research is to account for cognitive impairment as we customize BCI programs for each patient,” says Geronimo, who is conducting ongoing studies in the area. “It represents the future direction of this field.” Cognitive decline is present in 50 percent of patients with ALS, once thought to be a purely motor neuron disease, with 15 percent of patients meeting the clinical criteria for dementia. While most clinicians are aware of this fact, the majority of BCI designers are not, a knowledge gap that Geronimo hopes to bridge with his work. Continue reading

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New Targeted Therapy: Nanotechnology Breakthrough Allows Chemotherapeutic Agents To Cross Blood-Brain Barrier, Target Astrocytoma Cells

Two major challenges of treating glioblastoma multiforme have been the type and location of these aggressive brain tumors.¹ Surgical tumor resection is difficult due to the widespread nature of gliomas. Chemotherapeutic treatments are often unable to cross the blood-brain barrier or cannot be confined to cancerous cells only, thus causing toxicity in normal tissue.¹ One viable option is targeted therapy, which can result in both improved chemotherapeutic and surgical results.

Research initiated by Achuthamangalam Madhankumar, Ph.D., assistant professor of neurosurgery at Penn State Hershey, has shown it is possible to use targeted nanovesicles to carry anti-cancer drugs or contrast agents selectively to tumor cells. The latter approach enhances tumor visibility, enabling the surgeon to more accurately assess the extent of the tumor. In addition, because of the unique expression of the interleukin-13 (IL-13) receptor on certain types of brain tumors, this targeted delivery system may be useful in the diagnosis of tumors.

Targeted and Untargeted DXR/LIPThe research used a murine model to test parameters including the efficacy of targeted versus untargeted liposomal doxorubicin, a chemotherapeutic agent.¹ Mice with intracranial tumors measuring five millimeters received fifteen milligrams of doxorubicin for each kilogram of body weight once a week.¹ Over six weeks, the size of the tumor decreased to less than one millimeter in the group receiving targeted liposomes, but did not decrease in the two of eight surviving mice receiving untargeted liposomes with doxorubicin.¹ There was a significant decrease in the tumor volume on contrast MRI images in the targeted liposome group, as seen in the figure.¹ Continue reading

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Multi-Disciplinary Approach and Collaborative Research Spawn Innovations, New Fellowship in Peripheral Nerve Program

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

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