UT Medicine’s Full Spectrum of Neurosciences Care Lives in South Texas

By: Carrie Frye
Sunday, February 22, 2015

With clinical care, research and academics at the forefront, UT Medicine’s neurosciences program serves both adults and children with the most comprehensive neurological and neurosurgical services.

A team of more than 30 of the leading neurologists and neurosurgeons in the nation in their areas of specialization — including stroke, epilepsy, amyotrophic lateral sclerosis (ALS), muscular dystrophy (MD), craniosynostosis, Parkinson’s disease and a host of other neurological disorders — physicians in UT Medicine’s neurosciences program embrace a multidisciplinary, yet highly differentiated, approach to patient care. Specialty clinics utilize teamwork for hands-on clinical medicine and consultations built upon an academic foundation that fosters research and innovation.

“Scientific breakthroughs in the laboratory cannot move forward toward FDA approval without the involvement of patients willing to sacrifice their time in clinical trials. Due to the large number of patients we follow at UT Medicine with neuromuscular diseases such as myasthenia gravis, ALS and muscular dystrophy, we have been involved in more than 30 clinical trials in the past 10 years.”
— Carlayne E. Jackson, MD, FAAN, Professor of Neurology and Otolaryngology; Assistant Dean of Ambulatory Services; Chief Medical Officer, UT Medicine San Antonio

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Robin Brey, MD, FAAN, Chair of the Department of Neurology; Edna Smith Dielmann Distinguished University Chair

“We do everything from epilepsy surgery to deep brain stimulation to Botox for migraines, and for any neurological problem, we have a specialist to handle it,” says Robin Brey, MD, FAAN, Chair of the Department of Neurology at the School of Medicine at the UT Health Science Center and the Edna Smith Dielmann Distinguished University Chair. “That is different from any other program in our region. It is absolutely crucial to have neurosurgeons and neurologists on the same team to build and implement programs and support each other clinically. One facet of this interdependence is the way in which neurosurgery provides support to neurology when we identify issues with patients, and vice versa. We also do benchmark neuroscience research that includes both clinical trials for many neurological disorders and basic neuroscience research.”

Networked Stroke Care

Collaboration in the latest interventional studies for stroke care requires both sets of expertise. Together, neurological and neurosurgical excellence enabled the establishment of a Primary Stroke Center at University Hospital, the inpatient facility for the University Health System in San Antonio, which requires both neurologists and neurosurgeons with stroke expertise. Recognized with the American Stroke Association’s Get with the Guidelines-Stroke Gold Plus Quality Achievement Award in 2014, the stroke team includes Dr. Brey and other specialists providing round-the-clock access to immediate stroke rescue therapies to treat this fifth-leading cause of death in the United States. The group is currently working toward Comprehensive Stroke Center certification.

“After the first stroke center was established in San Antonio, others followed,” says David Jimenez, MD, Professor and Chair of the Department of Neurosurgery at UT School of Medicine San Antonio, who was instrumental in working with Baptist Health System to provide the neurosurgical expertise needed for Primary Stroke Center certification at their hospitals. “There was a definite community need, and today, we have 10 stroke centers in San Antonio. Now, when patients have a stroke, within 20 minutes of arriving at the ER, they are taken care of completely.”

Additional telestroke programs provide smaller hospitals in more rural areas with immediate access to UT Medicine’s neurology consultations to better serve and expedite care for stroke patients.

“With funding from the Texas legislature, we were able to develop a stroke telemedicine research network in collaboration with UT Southwestern, UT Houston, Baylor Medical Center, Seton Healthcare Family and Texas Tech,” Dr. Brey says. “Each institution is a hub to which we recruit community spoke hospitals. The idea is to raise stroke awareness in the community and allow more patients who might be eligible for studies to participate. We are just getting some stroke trials set up, and it is really a terrific project.”

Less Invasive Craniosynostosis

During their tenure and leadership of UT Medicine’s Neurosurgery Department, Constance Barone, MD, FACS, Clinical Professor in UT Medicine’s Department of Neurosurgery and Dr. Jimenez accomplished another innovative neurosurgical advancement by developing less invasive surgical techniques to repair craniosynostosis, a birth defect that causes misshapen heads in infants. This neurological abnormality occurs in four out of 10,000 live births, according to the CDC.

“Craniosynostosis affects children born with a seam in the skull that closes prematurely,” Dr. Jimenez explains. “Traditionally, operations to correct it took nine to 10 hours and required massive blood transfusions and a weeklong hospital recovery. Dr. Barone and I created a procedure that is much less invasive and takes approximately 45 minutes.”

The physicians’ research and innovation led to the development of the Center for Endoscopic Craniosynostosis Surgery. Pediatric patients receiving this less invasive procedure have minimal blood loss during surgery and only stay overnight in the hospital. Drs. Jimenez and Barone perform these neurosurgical procedures to treat coronal, lambdoidal, metopic and sagittal suture synostosis.

Epilepsy Center of Excellence

Another UT Medicine neuroscience initiative formed the South Texas Comprehensive Epilepsy Center. A dedicated team of five highly skilled epileptologists and one of the largest video-EEG neuromonitoring units in Texas serve patients coping with debilitating epilepsy, which affects one in 26 people and is the fourth most common neurological disorder.

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Linda Leary, MD, conducts epilepsy monitoring rounds, reviewing video EEG recording of seizures with the team.

“There are multiple levels of treatments available at the center,” says Linda Leary, MD, Associate Clinical Professor of Neurology and Pediatrics at UT Health Science Center at San Antonio. “We can provide video-EEG monitoring with 24/7 trained technician coverage to better characterize seizure types and determine the brain regions where the seizure begins, including advanced imaging technologies to localize the seizure onset zone and important brain functions. We perform vagus stimulation in hospitalized patients and offer an array of epilepsy surgery procedures when needed.”

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Charles Szabo, MD, Chief of Epilepsy and Co-director of Epilepsy Surgery and of the South Texas Comprehensive Epilepsy Center, examines a 3-year-old who underwent surgery several months earlier.

“Seventy to 80 percent of patients have seizure-free outcomes with temporal lobectomy,” says Charles Szabo, MD, Chief of Epilepsy and Co-director of Epilepsy Surgery and of the South Texas Comprehensive Epilepsy Center. “If patients do qualify for surgery, we have highly skilled neurosurgeons who are trained and experienced in intracranial electrode placement, surgical resections and implantation of neurostimulators, as well as neuropsychologists to evaluate the impact surgery may have on cognition and behavior. All of these factors are vital to the success of our program.”

UT Medicine neurosurgeons at the center perform 20–25 epilepsy surgeries each year, including temporal lobectomy, the most common epilepsy procedure, which removes a portion of the temporal lobe identified as the cause of the seizures.

Neuromuscular Clinics

As one of only 44 designated Muscular Dystrophy and ALS Research Centers— and one of just 40 ALS Association Certified Centers of Excellence — in the nation, the neuromuscular disorders clinics at UT Medicine serve more than 800 adult and child patients in South Texas each year. UT Medicine’s neuromuscular clinics have treated more than 300 new patients in the past year, and nearly half of those are newly diagnosed with ALS.

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Pamela Kittrell, MSN, RN, Clinical Research Nurse–Senior, reviews notes with Carlayne Jackson, MD, FAAN, neurologist and Director of the ALS Clinic.

Created and led by Carlayne Jackson, MD, FAAN, Professor of Neurology and Otolaryngology, Assistant Dean of Ambulatory Services and Chief Medical Officer at UT Medicine in San Antonio, these multidisciplinary centers balance clinical trials and research with a keen focus on patient care.

The MD/ALS clinics embody a true multidisciplinary approach every day, as practitioners and clinicians move from patient to patient to proactively meet ever-changing needs in respiratory care, swallowing and weakness due to disease progression.

“Every clinic is focused on a specific neuromuscular condition, and every patient’s needs are different. Each patient is in a private room and sees providers representing all relevant disciplines,” says Pamela Kittrell, MSN, RN, Clinical Research Nurse-Senior in the Department of Neurology. “We espouse practice guidelines of multidisciplinary care that make a difference in patients’ longevity.”

“We are the No. 1 center in the San Antonio area doing research and cutting-edge work. When patients are referred to UT Medicine, they will receive the most advanced care in the region. We can provide the full spectrum of neurosurgery and neurology for epilepsy and beyond. We have it all.”
— David Jimenez, MD, Professor and Chair of the Department of Neurosurgery, UT School of Medicine San Antonio

Recent research efforts at the neuromuscular disorder clinics in both drooling and pseudobulbar affect — uncontrollable emotional outbursts — have been beneficial in supporting the use of medications to treat such effects of neuromuscular diseases.

“These medicines do not cure the root condition, but they make a big difference in symptoms and quality of life for patients,” Kittrell says. “We routinely employ standard-of-care therapies and expedite them to make the most difference.”

Although there is no cure for ALS, UT Medicine’s ALS Clinic continues riluzole therapies, the only FDA-approved medication to treat ALS. Research efforts focus on creating better outcomes for all neuromuscular disorders.

Collaborative Care, Collegial and Familial

There are many ways to participate in UT Medicine’s diverse neurological and neurosurgical network: referring a patient, becoming a spoke in the telestroke program, or joining in a conference or research effort. Whatever the connection, when providers collaborate with the UT Medicine neurologists and neurosurgeons, they are helping make advanced levels of care more accessible in the greater South Texas community.

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David Jimenez, MD, Chair of Neurosurgery, reviews a case prior to craniosynostosis surgery.

“When patients can be cured, that’s the best outcome any of our programs can attain,” Dr. Brey says. “One area that exemplifies this is our success rate in our epilepsy surgery program, where many patients are either cured or experience a significant reduction in seizure frequency. It really takes neurosurgeons and neurologists working together to manage these patients. Another is the less invasive craniosynostosis program developed by Drs. Jimenez and Barone.

“However, many patients have chronic or incurable conditions. Treating the whole person and providing excellent symptom management is the best we can do for the patient’s well-being.”

In that effort, UT Medicine specialists rely on community resources, including referring providers and patients’ family networks. In fact, another success in UT Medicine’s collaborative approach is the relationships fostered among physicians, patients and the patients’ families. Family members often become part of the care team and are encouraged to attend medical appointments and share involvement in the process.

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Epilepsy specialists, surgeons, psychiatrists, neuropsychologists, physician assistants and nurses meet weekly at the Epilepsy Surgery Case Conference to review and discuss the care plan for surgery candidates.

“The goal is always optimal quality of life to maintain as much independence as possible for the patient, with the right medication and treatment options and a focus on the family,” Dr. Leary says. “Many neurological diseases impact the patient’s immediate circle, so treatment becomes a whole-family endeavor.”

“We treat our patients and their families as if they were our own,” Dr. Jimenez adds. “We have created a neuroscience program that covers every field — from vascular and spine to pediatrics. We are committed to practicing honest, solid medicine and providing quality care to the people of our community.”

The Unparalleled Work of THE South Texas Comprehensive Epilepsy Center

The only specialized center in the region, and the only one recognized with a Level 4 designation by the National Association of Epilepsy Centers, the South Texas Comprehensive Epilepsy Center treats more than 5,000 patients annually.

The center — a partnership of the University Hospital System and UT Medicine — utilizes a multidisciplinary approach, combining neurology and neurosurgical expertise under the leadership of Charles Szabo, MD, Director of Clinical Services at the center, Chief of Epilepsy, Professor and Co-director of Epilepsy Surgery at the UT Health Science Center at San Antonio.

Extending its reach to an underserved patient population in the Lower Rio Grande, the center offers outreach epilepsy clinics in Eagle Pass, Laredo and Del Rio.

The center’s most exclusive feature is a 14-bed — 10 adult and four pediatric — video-EEG neuro-monitoring unit at University Hospital, equipped with state-of-the-art technology and managed by a highly trained staff available 24 hours a day to follow patients experiencing seizures in order to evaluate them and design a plan of care.

Wada tests in the angiography suite help physicians establish which side of the brain controls memory and language, while other imaging techniques, including SPECT, MRI, PET and functional brain MRI, can identify the area of the brain causing the seizures. Innovative neurosurgical approaches may then be employed.

“Our goal is always to make a patient seizure-free, and we work toward that with medication combinations and, if necessary, surgical intervention to provide patients with the best quality of life and the ability to live productively,” Dr. Szabo says.

For more information about UT Medicine’s comprehensive neurosciences program, visit utmedicine.org.