Penn Comprehensive Neurosciences | Penn Medicine

Revolutionary Minimally-invasive Surgical Approach Pioneered by Penn Cleared by the FDA

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:14:56 PST

TransOral Robotic Surgery (TORS), the revolutionary, minimally-invasive robotic surgery technique developed by head and neck surgeons at Penn Medicine has been cleared by the U.S. Food and Drug Administration (FDA).

TORS is the world’s first group of minimally-invasive, transoral otolaryngologic surgical procedures to treat benign tumors and select malignant tumors of the mouth and throat in adults. Utilizing the daVinci® Surgical System (Intuitive Surgical, Inc., Sunnyvale California), this landmark breakthrough results in shorter, virtually scarless head and neck surgery. Designed to avoid incisions for primary site resection, TORS is performed through the patient’s mouth and provides unprecedented access to the small and often difficult-to-reach areas of the mouth and throat.

An Historic Legacy
Bert W. O’Malley, Jr., MD, Gabriel Tucker Professor and Chairman, and Gregory S. Weinstein, MD, Professor and Vice Chair of Penn Medicine’s Department of Otorhinolaryngology – Head and Neck Surgery, are pioneers in the field of robotic surgery. In 2004, they founded the world’s first TransOral Robotic Surgery (TORS) program at Penn, where they developed and researched the TORS approach for a variety of robotic surgical approaches for both malignant and benign tumors of the mouth, voice box, tonsil, tongue and other parts of the throat. Drs. O’Malley and Weinstein invented the TORS technique, and have performed more TransOral Robotic Surgery (TORS) procedures than any other physicians in the world.

Revolutionizing and Redefining the Treatment of Head and Neck Cancer
Since 2005, approximately 370 Penn Medicine patients have participated in the world’s first prospective clinical trials of TORS. These research trials comprise the largest and most comprehensive studies of the technology on record. “TORS has dramatically improved the way we treat head and neck cancer patients, completely removing tumors while preserving speech, swallowing, and other key quality of life issues,” said Dr. O’Malley.

The standard surgical and non-surgical approaches to the management of laryngeal, hypopharyngeal and oropharyngeal cancers, while in many ways successful, had significant limitations. Head and neck tumor treatments often involve a combination of surgery, radiation therapy, and chemotherapy. In many cases, surgery offers the greatest chance of cure; yet conventional surgery may require an almost ear-to-ear incision across the throat or splitting the jaw, resulting in speech and swallowing deficits for patients.

In comparison, TORS outcomes are markedly improved when compared to standard chemotherapy, radiation or traditional open surgical approaches for oropharyngeal cancer. When compared to traditional surgeries, after their cancers have been removed successfully, patients have been able to begin swallowing on their own sooner and leave the hospital earlier.

Additional benefits to patients that undergo transoral robotic surgery (TORS) can include shorter hospitalization, a quicker return to normal activity, fewer complications compared to traditional open surgery, less scarring than traditional open surgery, less risk of blood transfusion when compared to open surgery, and no routine use of tracheostomy during surgery compared to routine use for open surgery.

“Based on our data and patient outcomes, coupled with the national and international enthusiasm and interest for TORS, we are changing the way oropharyngeal cancer and tumors will be treated now and in years to come,” noted Dr. Weinstein. “We are already investigating new TORS treatments for other conditions such as sleep apnea, and collaborating with colleagues in Penn Neurosurgery to use TORS to remove skull base tumors and repair cervical spine disease.”

Teaching the Teachers
The TORS program benefits not only patients seeking state-of-the-art care, but also physicians who come from around the world to observe and learn about this groundbreaking procedure. Drs. Weinstein and O’Malley created the first and only training program in TransOral Robotic Surgery (TORS) in the world. They have trained numerous surgical teams from 12 different countries, many of whom have started TORS programs at their respective institutions. With the FDA approval (December, 2009) of the daVinci System for transoral otolaryngology, Penn Medicine has expanded its well-established training program to include surgical teams from the United States.

“It is very exciting that a concept conceived at Penn, evaluated in pre-clinical experimental models at Penn, tested in clinical trials at Penn, and then taught to key surgeons and institutions both within the US and internationally has been officially recognized by our federal governing agencies and peers around the world as a new and improved therapy for select neck cancers and all benign tumors,” Dr. O’Malley concluded.

For more information about the Penn TORS Program, please visit pennmedicine.org/ent or call 800-789-PENN.

45,000 Americans and approximately 500,000 people worldwide are diagnosed with head and neck cancers each year.

Penn Neurosurgeons Advance Spine Care Giving Hope to Patients and Yielding Improved Results and Proven Success

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:16:49 PST

Penn Neurosurgery is a regional and national leader in providing quality spine care utilizing a multidisciplinary team approach, and implementing the latest advances in techniques and technology.

One of the hallmarks of Penn’s acclaimed spinal surgery program is the personalized treatment plan each patient receives. No matter the condition or problem, Penn Medicine neurosurgeons possess a vast arsenal of tools to evaluate, diagnose and treat the most complex disorders of the spine.

Sophisticated Diagnostic Techniques
Penn specialists are backed by the most extensive neurodiagnostic and imaging facilities in the region. Patients are diagnosed utilizing the latest neuroradiological and electrodiagnostic techniques including high resolution MRI scanners, CT myelography, EMG and discography, and electrophysiological testing.

Comprehensive Spine Care Team
A targeted treatment plan is developed for each patient by a specialized team led by five neurosurgeons, in addition to neurologists, rheumatologists, oncologists, orthopaedists, rehabilitation specialists, physical therapists, radiologists, and pain management specialists. This extensive and collaborative team approach to spine care ensures a thorough consideration of both surgical and non-surgical treatment of pain and neurological symptoms.

The Highest Quality Treatment with the Best Outcomes Possible
Conditions treated cover all aspects of spine disorders including degenerative disease (disc herniations, neck and back pain, spinal stenosis), spinal tumors and spinal trauma.

Penn physicians strive to discover new ways and new devices to improve patient outcomes. Treatments and procedures available include decompression (discectomy and laminectomy); fusion (cervical, thoracic and lumbrosacral) as well as artificial disc technology and motion sparing procedures.

“The neurosurgical spine program is continuing to advance and become even more comprehensive,” said William C. Welch, MD, FACS, FICS, Professor and Vice Chair of Neurosurgery and Chief of Service at Pennsylvania Hospital. “We are performing cutting-edge treatments that have never been done here before.” Penn neurosurgeons are continually working to find new methods and devices to improve patient outcomes, integrating the latest technologies and cutting-edge surgical techniques including robotic surgery and minimally-invasive treatments as well as surgical devices such as the ultrasonic bone cutter and CO2 laser.

Research efforts go hand-in-hand with patient care at Penn Medicine, where clinicians and researchers are applying basic science and clinical research to improve patient care. The Penn Neurosurgical Spine Center has increased research efforts in the lab. There is a new biomechanical research laboratory at Pennsylvania Hospital where new spinal devices and techniques are being tested and studies are performed to increase the fundamental understanding of spine physiology.

Award-Winning Innovation
Independence Blue Cross has designated the Hospital of the University of Pennsylvania and Pennsylvania Hospital as Blue Distinction Centers® for Spine Surgery. Blue Distinction is a designation awarded by the Blue Cross and Blue Shield companies to medical facilities that have demonstrated expertise in delivering quality healthcare for spine surgery.

Penn Medicine continues to be the choice for complex conditions of the spine. For more information, visit PennMedicine.org or call 800-789-PENN.

The Penn Multiple Sclerosis Center — Setting the Standard for Comprehensive MS Care in the Region

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:17:39 PST

The Multiple Sclerosis (MS) Program at Penn Medicine provides comprehensive evaluation, diagnosis and treatment for patients with MS and other demyelinating disorders of the central nervous system. In addition to maintaining the highest standards for clinical service, the Penn MS program is a leader in MS training and in clinical and laboratory-based research.

The Penn MS Program provides consultative services and ongoing care for more than 3,000 patients yearly. The program includes eight full-time faculty members and specializes in quality, state-of-the-art clinical care with a personal approach. Patients are evaluated by a multidisciplinary team that includes physicians and highly-trained nurse practitioners who are experts in symptom management, treatment, patient education, health maintenance and general well-being for patients with MS.

Individualized Clinical Evaluation, Diagnosis, Treatment and Support
Neuroradiologists at Penn are developing new MRI technologies that enhance the diagnosis of MS and the assessment of disease activity. Cutting-edge imaging protocols and techniques including the use of 3-Tesla magnets have been implemented through collaborative efforts of Penn’s MS researchers and radiologists for use in MS trials as well as in clinical care.

The Penn MS Center’s team meets regularly at case conferences. A comprehensive, multidisciplinary approach is employed, involving regular consultations with departments including rehabilitation medicine, physical and occupational therapy, urology, neuropsychology, and ophthalmology.

Additional patient support is key to helping patients manage their treatment and the potential side effects. Nurse practitioners and MS-certified nurses provide individualized training and support for symptom management; physical therapy is available where appropriate; and support groups organized by MS Center staff offer opportunities for patient education and support.

Research — Shaping the Future of MS Treatment
Penn MS Center researchers lead clinical and laboratory-based research programs that are recognized at both regional and international levels for their contributions to the advancement of MS treatment. Research projects are sponsored by organizations including the National Institutes of Health, the National MS Society and industry.

As active and consistent participants in pivotal MS treatment trials, faculty and staff in the MS program have provided important contributions to the development of immunomodulatory and other forms of therapy. Neuroradiology and immunology research at Penn is continuing to advance techniques and models of disease to advance diagnosis and treatment. Other research efforts are studying the genetic aspects of MS to determine which patients are at most risk of progressing and who might benefit from specific therapy.

The MS Center is the international epicenter of vision research in MS. Current collaborative studies with Johns Hopkins University and UT Southwestern in Dallas are underway to determine which visual function tests and ocular imaging (OCT) measures best detect MS-related visual symptoms and provide the best markers for gauging the effectiveness of MS therapies.

“This is an exciting time in the field,” remarked Laura Balcer, MD, MSCE, Professor of Neurology, Ophthalmology, and Epidemiology and Chief of the Penn MS Division. “Research being developed at Penn is leading to new treatment options for patients with MS. Every step we take brings us closer to effectively targeting the mechanisms by which MS causes disability,” Dr. Balcer concluded.

From Bench to Bedside – A Spotlight on Research – Neurodevelopmental Genomics: Trajectories of Complex Phenotypes

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:19:40 PST

Many mental illnesses are common disorders that emerge during childhood and adolescence and may continue into adulthood, often with debilitating results. In order to prevent these consequences it is important to identify early risk factors and manifestations of these conditions.

A collaborative research effort between the Brain Behavior Laboratory at the University of Pennsylvania and the Center for Applied Genomics at the Children’s Hospital of Philadelphia (CHOP) is focusing on articulating how these factors contribute to shaping the development of brain systems that underlie complex behavior.

The research study is led by renowned researchers and clinicians Raquel E. Gur, MD, PhD at the University of Pennsylvania and Hakon Hakonarson, MD, PhD at the Children’s Hospital of Philadelphia.

Within the past three years, children who presented to CHOP for various reasons, including both sick visits and well visits, were genotyped. In the Fall of 2009, as part of the American Recovery and Reinvestment (ARRA) stimulus grants, the aforementioned Penn and CHOP researchers received grant funding to phenotype 10,000 children and adolescents between the ages of eight to twenty-one from the Philadelphia region. They were able to draw from the data set that had already been genotyped at CHOP. This group of children and adolescents and their families had already agreed to be contacted for further research.

The grant’s main focus is to phenotype or characterize the children and adolescents who have already been genotyped from the perspective of brain and behavior. All children and their parents who consented to the study provided a blood sample for DNA and genotype, and gave their permission to be followed for the duration of the study. They will be assessed for behavioral dimensions indicating vulnerability to major mental illnesses. The assessment will include measures of key features including attention deficit, anxiety, mood, psychosis proneness and substance abuse as well as measures of cognitive and emotion processing.

Researchers are administering a computerized neurocognitive battery of tests to the 10,000 individuals. Following this, 1,000 of these children will return for MRI studies. The results of this random sample will be added to the brain behavior measures and genetic information. The imaging performed includes functional MRI, structural MRI, and diffusion tensor imaging (DTI).

Comprehensive research such as this can build an unprecedented information infrastructure that combines genomics and brain behavior measures and will enable follow-up of subsamples of children with different disorders. This rich data set will not only enable researchers to learn a lot about brain behavior and how it interacts with genetic factors, it will also enable researchers to gather information from subsets of both typically-developing children as well as those children with brain disorders. The information can be used for more in-depth research and also offers the opportunity to develop new treatments.

For example, researchers may be able to identify which genes contribute to the brain system that regulates attention — both normal attention, and disrupted attention in children with disorders of attention
like ADHD.

In addition to the EMR (electronic medical records) that are available, the researchers are also conducting direct evaluations that cover healthy development and major neuropsychiatric disorders that emerge in childhood. Testing covers questions about personal history, education, and social measures, in addition to computerized neurocognitive testing that measures attention, memory, language, mental flexibility, spatial skills, and emotion processing.

A staff of more than 40 people have been hired to assist in conducting the study, including psychometricians, as well as experts in genomics, bioinformatics, and imaging. This two-year study began in October 2009 and runs through August 2011.

This rich data set will not only enable researchers to learn a lot about brain behavior and how it interacts with genetic factors, it will also enable researchers to gather information from subsets of both typically-developing children as well as those children with brain disorders.

New Hope for Patients with Addiction

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:20:12 PST

Penn Medicine’s Charles O’Brien Center for Addiction Treatment is an outpatient facility offering state-of-the-art addiction treatment provided by nationally-renowned experts in the field. Named for Dr. Charles O’Brien, one of the preeminent addiction researchers in the world, the Center offers treatment for all addictive substances, including alcohol, cocaine, heroin, pain killers, and marijuana.

As part of Penn Behavioral Health, the Charles O’Brien Center is dedicated to providing the highest quality of addiction treatment. At their first visit to the Charles O’Brien Center for Addiction Treatment, new patients receive a comprehensive evaluation of their addictive behaviors and their global physical and mental health. Family members are encouraged to participate in the initial evaluation and, when appropriate, ongoing education and treatment. Following the evaluation, the team develops an individualized plan for patients and their families.

Treatment fully integrates the psychological and biological interventions that are most likely to lead to sustained recovery, including pharmacological treatments, as well as individual, family and group therapy. In addition, if needed, treatment of addiction can be coordinated with treatment of anxiety, depression, or other mental health concerns.

As an added benefit, physicians at Penn are on the cutting-edge of medical research and involved in clinical trials, allowing them to have access to breakthrough medications that are becoming available and could make a difference in patient recovery. When patients have achieved their treatment goals and are ready to discontinue regular treatment at the Charles O’Brien Center, the treatment team works with them to design a plan for sustaining their success.

The Charles O’Brien Center for Addiction Treatment provides individualized addiction treatment with sustained results. For information on how to refer a patient or to schedule an appointment, call (215)222-3200, ext. 106, or visit the website at www.med.upenn.edu/addiction.

When patients have achieved their treatment goals and are ready to discontinue regular treatment at the Charles O’Brien Center, the treatment team works with them to design a plan for sustaining their success.

Stimulus-Funded Research Grants

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 08:47:44 PST

Research is one of the cornerstones of the Penn Medicine Neuroscience Center, aiding in its mission to bolster the practice of translational medicine. Faculty from throughout the University of Pennsylvania as a whole submitted grant applications to institutions such as the National Institutes of Health and the National Science Foundation. In response, the American Recovery and Reinvestment Act (ARRA) has awarded more than $30 million total in research funding to Penn.

The importance of the neurosciences as a national health priority is evidenced by the fact that departments from throughout the Penn Medicine Neuroscience Center (PMNC) were awarded almost half of that total figure, more than $14 million in recent stimulus-funded research grants.

As of August, 2009, PMNC departments were awarded 24 grants as part of the ARRA funding program. Departments included Anesthesiology, Neurology, Neuroscience, Neurosurgery, Otorhinolaryngology—Head and Neck Surgery, Pathology and Laboratory Medicine, and Psychiatry.

Some of the grants highlighted include:

Murray Grossman, MD, Associate Professor of Neurology, received a grant from the National Institute on Aging/NIH/DHHS to study Conceptual Processing in Alzheimer’s disease. This work will improve the understanding of the cognitive and neural basis for semantic memory, lead to improved diagnostic accuracy in Alzheimer’s disease, and suggest several potential avenues for improving the quality of life in these patients.

M. Sean Grady, MD, Charles Harrison Frazier Professor and Chairman, Department of Neurosurgery, received a grant from the National Institutes of Health to study the Functional Reorganization of Limbic Circuitry After Traumatic Brain Injury. Traumatic brain injury (TBI) is the leading cause of death and disability in children and young adults. Despite initial cognitive deficits, many individuals experience significant recovery. This study investigates how the ability to learn and recall information recovers. The compensatory mechanisms demonstrated in the contralateral hippocampus may lead to a better understanding of cognitive recovery in human TBI and lead to novel strategies for improving speed and extent of recovery.

Brian M. Salzberg, PhD, Professor of Neuroscience and Physiology, was awarded a grant from the National Institutes of Health for an Optical Study of Secretion in Mammalian Nerve Terminals. Secretion is central to diverse biological functions such as information processing, reproduction, motility, temperature regulation, metabolism, the immune response, and signal transduction. However, the full elucidation of its mechanism(s) remains a challenge to cell physiologists. This study seeks to identify some of the cellular events that define calcium-dependent excitation coupling in mammalian peptidergic nerve terminals.

Barry L. Ziober, PhD, Adjunct Associate Professor of Otorhinolaryngology–Head and Neck Surgery received a grant from the National Institutes of Health to study the Molecular Analysis of OSCC Tumor Invasion. In addition to identifying the best signature for prediction of osee nodal disease, the results from this study will identify genes, biomarkers and signaling pathways in the tumor microenvironment that can be targeted for diagnostic, prognostic and therapeutic studies. The lymph node metastasis gene signature identified will have a profound clinical utility for reducing osee patient mortality and morbidity.

Youhai H. Chen, MD, PhD, Associate Professor of Pathology and Laboratory Medicine was awarded a grant from the National Institutes of Health for his research on Autoimmune Encephalomyelitis and C-REL. Multiple sclerosis (MS) afflicts more than 300,000 people in the United States alone. Through enhanced understanding of how a specific transcriptional regulator mediates autoimmune encephalomyelitis, this work aims to not only help elucidate the pathogenic mechanisms of multiple sclerosis but also aid in developing specific strategies to treat or prevent the disease.

Anna R. Childress, PhD, Research Associate Professor of Psychology in Psychiatry received a grant to study the Extinction of Limbic Activation to “Unseen” Cocaine Cues from the National Institutes of Health. Cocaine patients show a remarkable persistence of desire and arousal to cocaine cues, months or even years after the last dose of the drug. These “extinction-resistant” responses may be due to cocaine patients’ documented (structural and functional) deficits in the prefrontal cortex (PFC) — a region necessary for modulating the downstream limbic (“GO!”) regions — and for the new learning that underlies extinction. This study tests whether extinction of the brain response to cocaine cues can occur outside awareness, and whether extinction can be facilitated by the partial agonist varenicline.

The Penn Medicine Neuroscience Center is dedicated to the advancement of the understanding of the brain, spine and peripheral nervous system. Grants such as those referenced above are continuing to foster the PMNC’s critical “Bench to Bedside” mission.

At Penn, the schools, centers, and institutes across the campus are brought together in the PMNC to create an integrated approach to patient care, education and research. Thus, the ground-breaking discoveries and research being launched with these studies will ultimately lead to advances in clinical care for these patients.

Penn Neurovascular Center Treatment for Cerebral Aneurysms

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:25:34 PST

The Penn Neurovascular program is the only comprehensive cerebrovascular and endovascular center in the Philadelphia region and is one of only a few in the United States. The Center is a nationally-recognized primary referral center for the treatment of aneurysms, arteriovenous malformations (AVMs), arteriovenous fistulas (AVFs), strokes and TIA’s, carotid artery and vertebral artery atherosclerotic disease (hardening of the arteries), intracranial stenosis as well as other conditions such as cavernous malformations and Moyamoya disease.

Penn’s world-renowned multidisciplinary team of neurovascular specialists, backed by the most extensive neurodiagnostic and imaging facilities in the region, perform more than 2000 procedures each year involving the most complex neurological disorders. Each patient’s case is discussed at a weekly Neurovascular conference where a personalized treatment plan is developed based on the patient’s specific needs. Center physicians work closely with referring physicians and provide a rapid and thorough evaluation of patients with all types of neurovascular disorders.

A complete, highly specialized array of services is available, from diagnosis, treatment and outpatient consultations to access to Penn’s brand new NeuroIntensive Care Unit. A Level I Trauma Center and Acute Brain Injury Center, Penn’s NeuroIntensive Care Unit is the most technologically advanced and sophisticated neuro-critical care unit on the eastern seaboard and the only academic facility of its kind in the region.

One Phone Call for allNeuroemergency Transfers
Penn’s Neuroemergency Transfer Policy is simple, seamless, and takes only one phone call. Calls to the PennTransfer Center about any neuroemergency are immediately transferred to the attending neurosurgeon or neurologist on duty. Working directly with the attending physician, the Transfer Center handles all transportation to the Hospital of the University of Pennsylvania or Pennsylvania Hospital as well as all other details, including bed assignment in the NeuroIntensive Care Unit.

For transfers of all patients with acute neuroemergencies, please call the Penn Transfer Center directly at (215) 662-3555.

Diagnostic and Treatment Resources
State-of-the-art diagnostic tools include computed tomography (CT) scan; Spiral CT, 3D CT-angiography, magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), MR-spectroscopy, cerebral angiography, biplane angiography, 3-D rotational angiography and Xenon CT, SPECT and PET scanning.

The Center employs the latest treatment modalities, including microsurgery (skull-base surgery; neurovascular surgery; and aneurysm clipping) as well as endovascular surgery such as coiling, stenting, angioplasty, and embolization.

Penn neurosurgeons are applying minimally-invasive endovascular technology to the treatment of cerebral aneurysms. Endovascular coiling is a technique developed as a safer alternative to surgical clipping that does not involve open cranial surgery and is typically performed in less time with quicker recovery. Analysis has determined that endovascular coiling is associated with a lower risk of new symptoms or disability after treatment, shorter hospital stays and shorter recovery times compared with surgery. More recently, physicians of the Neurovascular Center have begun to use a copolymer, embolic material, or glue, to treat cerebral aneurysms. This material produces total or near-total filling of the aneurysm and allows excellent aneurysm neck and parent vessel reconstruction.

“Patients are benefiting from this new technology,” said Michael F. Stiefel, MD, PhD. In fact, the only evidence of an endovascular procedure afterward is a small scar in the leg. “Patients have better outcomes, shorter hospital stays, and quicker recoveries,” continued Dr. Stiefel.

A Worldwide Center of Excellence — The Penn Parkinson’s Disease and Movement Disorders Center

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:26:42 PST

The Penn Parkinson’s Disease and Movement Disorders Center (PD&MDC) provides comprehensive care to patients with Parkinson’s disease (PD) and other parkinsonian syndromes, dystonia, Tourette’s syndrome, Huntington’s disease and other movement disorders. The Center’s mission is to provide a comprehensive treatment program where patients have access to all aspects of care under one roof.

Recognized by the National Parkinson Foundation as a worldwide Center of Excellence, the PD&MDC is one of the largest of its kind in the country and the most pre-eminent in the Philadelphia region, providing care to nearly 3,000 patients each year.

Patients at the Parkinson’s Disease and Movement Disorders Center receive state-of-the-art care managed by a multidisciplinary team of neurologists, neurosurgeons, physical therapists, psychotherapists, social workers and nurses. After careful evaluation, the team designs a treatment program individually tailored to the patient’s needs.

“Our goal is to provide state-of-the-art, comprehensive clinical care and to conduct innovative research into the causes of PD,” said Matthew Stern, MD, neurologist and Director of the PDMCC. “Our unique, full-service program integrates all services in a way that provides patients with the best of all treatment options and the benefits of ongoing research.” This can range from treatment protocols to modify the course of the disease to symptom control for the most advanced cases.

Clinicians utilize a variety of medications to treat the symptoms of all movement disorders in order that patients can achieve and maintain their best level of function.

In addition, the team of neurologists and neurosurgeons from Penn’s Center for Functional and Restorative Neurosurgery at Pennsylvania Hospital offer neurosurgical treatment to patients who no longer respond satisfactorily to medical management.

A revolutionary procedure called Deep Brain Stimulation or DBS, can relieve rigidity, improve mobility and eliminate tremor and other involuntary movements. Penn is the leading center on the East Coast and one of the foremost centers in the world for DBS.

Penn researchers and clinicians have consistently led the way in studying the risk factors for neurodegenerative disease. Penn is spearheading a large-scale clinical trial that follows first-degree relatives of Parkinson’s patients to determine their risk of developing the disease. The term “Parkinson’s Disease at Risk Syndrome,” or PARS, describes the various stages of the disease before recognizable symptoms emerge. It is hoped that by developing a variety of screening tools, physicians will one day be able to predict who will develop PD and initiate therapies that will delay or prevent its onset.

In addition, the PD&MDC and the Center for Neurodegenerative Disease Research at the University of Pennsylvania were recently named the newest Morris K. Udall Center of Excellence for Parkinson’s Disease Research by the National Institute of Neurological Disorders and Stroke (NINDS), joining 12 other distinguished academic institutions in the US with this distinction. Clinicians and basic scientists at the new Penn Udall Center are conducting research to understand and develop better treatments for the cognitive impairment and dementia associated with PD. Penn is the only national Udall Center to focus specifically on cognitive functions in PD.

The Philadelphia Veteran’s Administration Center is also a research site, one of the six Parkinson’s Disease Research, Education and Clinical Centers (PADRECC) in the country.

The PD&MDC works in concert with physicians at all career stages and is one of the foremost training grounds for physicians both nationally and internationally who are interested in pursuing careers in PD and movement disorders. This partnership extends to the relationship between Center staff and referring physicians. The PD&MDC works to ensure that the lines of communication are open allowing information about patients to continually flow effectively.

The expert physicians and staff at the PD&MDC are committed to a complete, multi-faceted treatment approach that includes not only exceptional patient care, but also basic and clinical research, professional and community education, and social support services for both patients and their caregivers. “When we identify a service that our patients can benefit from, such as the Dan Aaron Parkinson’s Rehabilitation Center, the counseling service or the new support groups that arise from the needs of our patient population, we find a way to make it happen,” said Suzanne Reichwein, PD&MDC Program Coordinator.

For information on how the Parkinson’s Disease and Movement Disorders Center is making a difference for patients in the region, or to refer a patient or make an appointment, call 800-789-PENN.

“Our unique, full-service program integrates all services in a way that provides patients with the best of all treatment options and the benefits of ongoing research.”

The Penn Comprehensive Depression Center

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:27:40 PST

Nearly 21 million Americans suffer from depression (14.8 million), bipolar illness (5.7 million) or other mood disorders each year. All too regularly, depressive illnesses are under-diagnosed and undertreated, often with tragic end results.

Depression is the leading health burden and cause of disability in the US according to the World Health Organization. Statistics reveal that one in five people will experience depression in their lifetime. Nearly 21 million Americans suffer from depression (14.8 million), bipolar illness (5.7 million) or other mood disorders each year. All too regularly, depressive illnesses are under-diagnosed and undertreated, often with tragic end results.

Every day, the expert clinicians and researchers in Penn Psychiatry and Penn Behavioral Health work to combat the enormous physical, emotional, and financial toll of these serious illnesses. In recognition of this fact, the University of Pennsylvania has formed the Penn Comprehensive Depression Center, which has joined 15 of the nation’s leading academic medical centers as an Inaugural member of the National Network of Depression Centers (NNDC). Disorders treated at Penn’s Comprehensive Depression Center include major depression, dysthmia, bipolar disorder, anxiety disorders, mood disorders secondary to medical conditions, as well as post-partum and perinatal depression.

The Penn Comprehensive Depression Center offers a full continuum of care for patients with these disorders, featuring outpatient services, inpatient clinical care, and both bench and clinical treatment research. The Center’s state-of-the-art assessment and treatment programs include pharmacotherapy, psychotherapy, including cognitive-behavioral therapy, couples and family therapy, women’s behavioral health and wellness, geriatrics, and adolescents as well as numerous research efforts studying the pathophysiology of mood disorders and efficacy of different treatments.

Some of the components of the Penn Depression Center with active treatment components include:

The Psychiatric Neuromodulation Program offers novel treatments for depression such as transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS), and, working in close collaboration with Penn’s Department of Neurosurgery, deep brain stimulation (DBS).

The Mood Disorders Comprehensive Consultation Service provides comprehensive, state-of-the-art assessments and second opinions for individuals with mood and anxiety disorders, including bipolar disorder, major depression, dysthymia, mood disorders secondary to medical conditions, and anxiety disorders.

The Center for Women’s Behavioral Wellness, one of only few such programs in the country, focuses on the specialty needs of women by treating and studying psychiatric disorders such as depression and anxiety occurring over the female life cycle. The program builds on and expands the existing collaborations between Penn’s Departments of Psychiatry and Obstetrics and Gynecology.

The Mood and Anxiety Disorders Program specializes in studying causes and treatments of depression and anxiety disorders. By studying both marketed and investigational medications, researchers are working to establish the safety and effectiveness of new medications as well as look for better and/or new ways to use and prescribe current medications.

The Center for the Treatment and Study of Anxiety focuses on the development and testing of treatments for various anxiety disorders, which often occur alongside or have symptoms of mood disorders, such as depression. Treatments offered include Cognitive Behavioral Therapy and Prolonged Exposure Therapy (PE), a theoretically-based and highly efficacious treatment for chronic PTSD and related depression.

6 Spruce at Pennsylvania Hospital – This 18-bed secure inpatient unit at Pennsylvania Hospital provides comprehensive psychiatric treatment for adult patients with mood and anxiety disorders. The unit also specializes in treating patients whose psychiatric illnesses are complicated by active medical problems. Medication management and electroconvulsive therapy treatments are offered, in addition to individual and group therapy.

DNA Detectives: Penn Scientists Unraveling the Mystery of Alzheimer’s Disease… One DNA Strand at a Time

noreply@blogger.com (Penn Medicine) — Wed, 15 Dec 2010 12:33:09 PST

Gerard Schellenberg, PhD, Professor of Pathology and Laboratory Medicine at the University of Pennsylvania School of Medicine, has received an $18.3 million five-year grant from the National Institute on Aging (NIA), a division of the National Institutes of Health. Dr. Schellenberg is leading a genome-wide association (GWA) study to identify genes that may point to the risk for Alzheimer’s disease.

Research such as this requires a large data sample in order for significant change to be detected. A consortium of 29 NIA-funded Alzheimer’s Disease Centers (ADC) around the country is providing an important source of data and patients for the study. Penn’s own Alzheimer’s Disease Center is one of these programs.

Dr. Schellenberg’s study is utilizing data from 17,000 ADC patients in addition to donated tissue. The composition of the sample population includes a mixture taken from three data sources: 40 percent from patients who have already been diagnosed with Alzheimer’s disease; 40 percent from individuals that are normal, serving as “controls”; and 20 percent from patients who are exhibiting mild cognitive impairment but have not been diagnosed with Alzheimer’s disease.

The research team will then compare results among the three populations to determine which genes contain risk factors for Alzheimer’s disease. Researchers will be studying the entire genome, looking at 600,000 different sites of genetic variability in every person studied. “When we find a gene that is a risk factor for Alzheimer’s disease, that gene makes a protein,” said Dr. Schellenberg. “We then know that that specific protein is involved in the disease process and can focus on it and try to better understand Alzheimer’s disease.”

Although there is no cure for Alzheimer’s disease at this time, determining the risk of developing this disease will enable scientists to know which patients should be receiving preventative treatments sooner, with the hope of being able to intervene earlier and stop the deterioration of the brain.

In addition, the research team will be looking for susceptibility genes that potentially influence the age of the disease’s onset and the rate of progression through various disease phases – from the first symptoms through mild cognitive impairment (MCI)– leading up to full-blown Alzheimer’s disease.

The NIA grant is a five-year study but first results will be available by the early part of 2010.

Through research and clinical efforts, Penn researchers, working in cooperation with fellow scientists nationwide, are making great strides in unlocking the mysteries of Alzheimer’s disease.

“When we find a gene that is a risk factor for Alzheimer’s disease, that gene makes a protein. We then know that that specific protein is involved in the disease process and can focus on it and try to better understand Alzheimer’s disease.”

Deep Brain Stimulation

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 08:50:44 PST

One of the hallmarks of the Penn Medicine Neuroscience Center (PMNC) is its multidisciplinary, collaborative nature and integration of programs. This is evident in the innovative, cutting-edge work being developed by physicians in the Penn Center for Functional and Restorative Neurosurgery and the pioneering partnerships among departments including Neurosurgery, Neurology and Psychiatry.

Deep Brain Stimulation (DBS) is a breakthrough surgical treatment for patients with movement disorders including Parkinson’s Disease (PD), essential multiple sclerosis tremor, and dystonia. This life-changing procedure was FDA-approved in 2002, and can greatly reduce motor symptoms that accompany Parkinson’s disease, and improve a patient’s ability to perform daily activities, ultimately creating a better quality of life and emotional well-being.

The expert neurosurgeons and neurologists at Pennsylvania Hospital’s Center for Functional and Restorative Neurosurgery are world leaders in this innovative treatment and have performed more cases than anyone else in the world last year. To date, more than 500 DBS procedures have been performed at Penn, making it the largest treatment center in the United States.

The DBS procedure is based on the principle that electronic stimulation of particular regions of the brain can improve the major symptoms of some movement disorders. The procedure involves guiding electrodes deep inside the brain to the tiny subthalmic nucleus (STN), a structure only about 6 mm to 8 mm in size.

Electrophysio-logic mapping, completed in the operating room under stereotactic guidance, provides more precise localization. When the electrode is in place, the STN is stimulated and the surgical team observes the effect on the patient, who is awake during the operation. A second electrode is placed on the right side of the brain and a battery-powered pacemaker-like device is implanted under the right collarbone now stimulating both sides of the brain.

Parkinson’s disease affects 1.5 million Americans including approximately 2,000 to 3,000 people in the Philadelphia region. Over time, patients tend to have a fluctuating response to the medications, which may leave them with severe tremors and walking difficulties.

For patients, DBS can bring about monumental life changes such as living independently, going back to work, or driving. Besides taking about half of the medication that was necessary before the DBS, most have a remarkable decrease in tremors and rigidity, improvement in walking, and less drug-induced dyskinesia, a common side effect of the medications. Although not a cure for PD, the positive results of the surgery seem to be lasting for many patients.

Most recently, results of a national study led by Penn neurologist Dr. Matthew Stern and his colleagues were cited in the Journal of the American Medical Association. The study compared six month outcomes for patients with PD who received deep brain stimulation and for patients who received medical therapy. Results found that in this randomized controlled trial, deep brain stimulation was more effective than best medical therapy. It helped reduce symptoms of PD, including slowness, freezing, stiffness and tremor.

Deep Brain Stimulation is also being explored in the treatment of epilepsy. In a clinical trial sponsored by Medtronic, Inc., DBS has significantly reduced the number and severity of epileptic seizures among patients with medically refractory epilepsy with partial onset seizures. This is a form of the condition that does not respond well to antiepileptic drugs. The study is known as the SANTE® study — (Stimulation of the Anterior Nucleus of the Thalamus in Epilepsy). It is believed that this groundbreaking treatment will gain Class 1 FDA approval within two years.

“The field of neuromodulation has really revolutionized functional neurosurgery, and new indications are continuing to emerge,” said Dr. Gordon Baltuch, Penn Neurosurgeon and Director of the Penn Center for Functional and Restorative Neurosurgery. “A very exciting new development in the field has emerged surrounding DBS for treatment-resistant depression.”

Fifteen to twenty million people in the United States suffer from major depression. For ten percent of them, their depression is beyond treatment. It is for these two million individuals that DBS is now being explored. This treatment is being researched for people with the most severe and intractable forms of depression that has not responded to any other treatment methods — including psychotherapy, multiple medications, electroconvulsive therapy (ECT), and Transcranial Magnetic Stimulation (TMS).

“These patients are at the end of the line, and both they and their families are suffering greatly,” said Dr. John O’Reardon, Director of the TMS Program at Penn and Principal Investigator at the Penn site for this study. This treatment is not for typical cases of major depression. It is meant for extremely severe cases where patients have already exhausted a panoply of other treatment options, and yet depression has persisted in a severe and debilitating way. “These patients are often terribly demoralized and hopeless with chronic suicidal feelings combined with marked functional impairments such as an inability to maintain employment,” continued Dr. O’Reardon.

Early results from pilot work done to date have been encouraging. In the 30 plus DBS cases worldwide thus far, outcomes at one year have shown very meaningful improvements. About 60% of patients had a sustained response to DBS. Response here is defined as either much or very much improved compared (at least 50% improvement in symptoms) to where patients were before DBS.

Now that the pilot work has been done, work is advancing to large-scale, multicenter clinical trials in the hope of securing FDA approval for this treatment. As such, a large-scale, randomized, controlled trial of Deep Brain Stimulation in severe depression will begin in the Spring of 2009. In this trial, electrodes will be inserted bilaterally deep in the patient’s brain. Electrode placement is accurate to within one millimeter, allowing the physicians to gauge the best placement. The patient will be awakened in the operating room. Along with the neuro-surgeon, the psychiatrist will work with the patient in the operating room to determine the precise contact points on the electrodes that produces the most fruitful mood changes.

The University of Pennsylvania is one of five academic medical centers in the United States that will be participating. The ultimate goal of this trial is to secure FDA approval for DBS as a new, 21st-century, cutting-edge neuromodulation treatment for individuals who are basically crippled by the devastation of severe depression.

The DBS procedure is based on the principle that electronic stimulation of particular regions of the brain can improve the major symptoms of some movement disorders.

Shining the Light on Research...Auditory Cognition

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 08:53:44 PST

The Penn Medicine Neuroscience Center (PMNC) is committed to research as one of its primary missions. Departments throughout the PMNC are collaborating on important studies in fields throughout the neurosciences with the ultimate goal of translating the findings into information that will improve patient care.

Yale E. Cohen, PhD, is studying auditory cognition, or the recognition and identification of sounds. His research touches the fields of Otorhinolaryngology, Neurosciences, and Psychology.

According to Dr. Cohen, “the primary benefit of this work is to advance our knowledge about the basic principles that govern how we hear and understand the meaning of sounds.” “This line of research may have important clinical ramifications. As we are studying the brain’s involvement in understanding speech, this study may provide insights into diseases hallmarked by communication disorders such as autism and other general speech disorders.” Information provided by these studies might also influence the next generation of cochlear and/or brainstem-auditory implants.

Dr. Cohen studies primates. In one area of his research, he tests a region of the rhesus-monkey’s brain that is called the auditory cortex. This area is critically involved in the capacity to hear and understand sounds. Dr. Cohen is particularly interested in whether this region of the brain is involved in the understanding of communication sounds like human speech. To address these goals, Dr. Cohen and his colleagues train rhesus monkeys to discriminate between different types of sounds. While they are participating in this discrimination, electrical activity from brain cells is recorded. “By correlating brain activity with the monkey’s behavioral performance, we can begin to understand how communication signals are represented in the brain,” relates Dr. Cohen.

In addition, Dr. Cohen is studying the prefrontal cortex region of the brain, the area that is involved in the human capacity to form decisions based on communication signals that we hear and see. The primary benefit of this work is to advance knowledge about the basic principles that govern how we use communication signals to form decisions and actions.

This type of research also has significant clinical implications. “Since we are studying how the brain is involved in understanding speech,” explained Dr. Cohen, “this study may provide insights into diseases hallmarked by communication disorders such as autism.” “Additionally, the prefrontal cortex plays an important role in goal-directed behavior and executive function, both of which are noticeably impaired in patients with prefrontal damage and schizophrenia.”

It is the scientists’ hope that data obtained from this study may be a means toward understanding impairments following prefrontal damage, for the design of diagnostic assays, and for developing appropriate rehabilitation programs. To address these goals, Dr. Cohen and his colleagues train rhesus monkeys to discriminate between different types of sounds and visual stimuli. In some of the experiments, the monkeys sit passively and view visual stimuli and listen to sounds. While they are engaged in this activity, the electrical activity from their brain cells is recorded. By correlating brain activity with the monkey’s behavioral performance, scientists can begin to understand how communication signals are represented in the brain.

Penn researchers such as Dr. Cohen and his colleagues are working to find clinical applications to their research, a fundamental goal of the PMNC and its collaborative mission.

“Since we are studying how the brain is involved in understanding speech,” explained Dr. Cohen, “this study may provide insights into diseases hallmarked by communication disorders such as autism.”

Leading the Way— The Penn Neuro-Oncology Program

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 06:42:54 PST

Penn Medicine’s Neuro-Oncology program exemplifies the positive impact that the collaboration and cooperation among departments throughout the Penn Comprehensive Neuroscience Center is making for patients. The program provides comprehensive evaluation, diagnosis and treatment for patients with tumors of the brain and spinal cord and other cancer-related neurological, central and peripheral nervous system problems.

Each patient benefits from the expertise of a multidisciplinary team of world-renowned experts including physicians and other health care providers from the fields of neurology, neurosurgery, radiation oncology, neuropathology, neuroradiology, rehabilitation medicine, and neuro-psychiatry.

At a tumor board meeting held each week, the team meets to map out the best course of treatment individually tailored for each patient, assuring that the patient is offered the most up-to-date therapy that is appropriate for them. The ultimate goal is to provide the best chance for a cure while preserving quality of life for each patient.

Setting the Standard for Care in the Region
Penn physicians are committed to research and are leaders in the development and testing of the latest treatment approaches. This ensures that the latest technological advances, including the most effective imaging methods, surgical techniques and management strategies are available to each patient.

Evaluation and Diagnosis
Penn offers several diagnostic tools not available elsewhere in the Philadelphia area, including:

High-resolution MRI (3T) using the most powerful magnet available in the U.S.
Advanced MR imaging techniques including
Magnetic Resonance Spectroscopy and Perfusion
PET (Positron Emission Tomography) scanning

Individualized Treatment Plan
The latest medical, surgical and therapeutic approaches are utilized, including:

Radiation Therapy
Penn’s radiation oncologists utilize special techniques to maximize the impact of radiation and minimize the affect on normal surrounding body tissue.

Intensity Modulated Radiation Therapy (IMRT)
Gamma Knife® – non-invasive, stereotactic radiosurgery
Brachytherapy
Proton Beam Therapy – Opening in late 2009

Neurosurgery

Intraoperative MRI-based neuronavigation for image-guided neurosurgery
Awake craniotomy with intraoperative speech and motor mapping
3-D Dextroscope workstation for surgical planning and intraoperative navigation
Frameless MRI-based stereotactic biopsy
Targeted surgical therapeutics and brachytherapy delivery
Genetic testing for brain tumors

The Latest Treatment Advances
Penn Medicine is the only participant in the region in the NCI-funded Adult Brain Tumor Consortium (ABTC) giving our neuro-oncologists access to novel clinical trials.

Clinical trials utilizing novel chemotherapies
Anti-tumor vaccines and other immunotherapies
Biologic response modifiers and genetic-based therapies
Patients receive the latest therapies not offered anywhere else in the region

Making a Difference and Treating the Whole Patient
A wide variety of support services are available to Neuro-Oncology program patients. These include a full-time social worker dedicated to providing counseling, support and assistance to brain tumor patients and their families; a brain tumor support group where patients and their families can gain both knowledge and support while sharing experiences; as well as rehabilitation and at-home services enabling patients to maintain their independence.

Penn’s Neuro-Oncology program is a regional and national leader in improving outcomes and advancing recoveries for patients with tumors of the brain and spinal cord.

The Penn Epilepsy Center

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 06:42:54 PST

What is Epilepsy?
Epilepsy is a chronic neurological disorder that is characterized by recurrent, unprovoked seizures. It is tremendously debilitating and common in .5 to 1 percent of the population worldwide. Seizures can occur at any time, often without warning. The frequency of epileptic seizures varies from person to person and can occur from many per day, to one per year.

A Multi-Faceted Approach
The Penn Epilepsy Center (PEC) provides the highest standard of care to patients with epilepsy, seizure disorders, and related problems. The Center offers a comprehensive, full continuum of care including state-of-the-art diagnostic techniques, cutting-edge research, medical treatments, surgery, and support services to patients with epilepsy. Both outpatient evaluation and inpatient care are available via this multidisciplinary,
full-service facility.

A Team Effort
Staff members of the PEC are internationally recognized leaders in the research, diagnosis, medical and surgical treatment of epilepsy. Faculty members have published hundreds of clinical and scientific articles relating to epilepsy and are funded by the National Institutes of Health. A fully-integrated team works collaboratively at the Center, including seven neurologists with specialty training in the care and treatments of epilepsy patients, neurosurgeons specializing in epilepsy surgery, as well as nursing staff, clinical research coordinators, registered technicians, neuro-psychologists, and social workers.

State-of-the-art Technology
The Center offers digital electroencephalography (EEG), and neuroimaging studies including high-resolution magnetic resonance imaging (MRI), positron emission tomography (PET), and single photon emission computed tomography (SPECT). These studies provide the ability to diagnose and classify epileptic seizures without requiring a hospital admission.

Epilepsy Monitoring Unit
Penn’s state-of-the-art, inpatient Epilepsy Monitoring Unit is designed for the evaluation of individuals with difficult-to-manage epilepsy who are candidates for surgery and for differential diagnosis of seizures. Monitoring allows the physicians to pinpoint where in the brain the seizures are coming from, to design a treatment plan and to determine whether they are a candidate for surgery.

Evaluation begins with long-term monitoring using EEG and video to capture the electrical activity and symptoms that occur during a seizure. Specialists from neurology, neurosurgery, neuropsychology and psychiatry combine their expertise to evaluate each patient. Depending on the type of surgery being considered, a number of other diagnostic tests may be required. Sometimes individuals experience events that may or may not be epileptic seizures. Capturing these events with video and EEG monitoring often points to the correct diagnosis and correct therapy. Intracranial monitoring with electrodes implanted in the brain is sometimes necessary for a definitive evaluation prior to surgery.

Surgery as a Treatment Option
A wide variety of surgical treatments are available to patients with epilepsy. When performed by a qualified neurosurgeon on appropriately selected patients, epilepsy surgery can often eliminate seizures. Surgical procedures performed include the following:

Temporal lobectomy
Extratemporal neocortical resection
Corpus callosotomy
Vagal nerve stimulation

Cutting-edge Research
The research performed at the Penn Epilepsy Center focuses on understanding the causes of and developing new treatments for epilepsy as well as developing a better understanding about why and how seizures occur. The Center offers patients whose seizures are not controlled by standard antiepileptic medications the opportunity to participate in investigational drug studies and clinical trials and other therapies to treat epilepsy. In addition, Penn physicians and researchers are investigating the molecular genetics of epilepsy, seizure prediction, as well as designing specific therapies for people with brain injury
and epilepsy.

Patient and Family Support Services
Epileptic seizures can have many far-reaching implications on a patient’s quality of life. These are not only medical, but also can greatly impact a person’s psychological and emotional life as well. The Penn Epilepsy Center offers a variety of support services for people with all types of epilepsy. Neuropsychologists on staff assess patients to identify and monitor mental, behavioral, and emotional symptoms before and after treatment. They also provide behavioral therapies to help patients and their families cope with the psychological changes associated with epilepsy.

Team Science:The Penn Alzheimer’s Disease Core Center and The Penn Memory Center

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 06:48:27 PST

The Penn Alzheimer’s Disease Core Center and the Penn Memory Center are examples of team science at work within the Penn Comprehensive Neuroscience Center and the Institute on Aging. In the Penn Alzheimer’s Disease Core Center and the Penn Memory Center, research scientists and clinicians work hand-in-hand studying all aspects of Alzheimer’s disease.

The National Institute on Aging (NIA) currently funds 28 Alzheimer’s Disease Centers (ADCs) at major medical institutions across the United States. The University of Pennsylvania has been a designated and funded ADC since 1981 at which time the Penn Memory Center also was established in partnership with the Institute on Aging which celebrates its 30th anniversary this year.

At Penn, scientists work to translate research advances into improved care and diagnosis for Alzheimer’s patients while, at the same time, focusing on the program’s long term goal — finding a way to cure and possibly prevent Alzheimer’s disease.

The major goals of the Penn Alzheimer’s Disease Core Center are to develop ways to diagnose and treat Alzheimer’s disease earlier than clinicians are currently able to do. When individuals are diagnosed with the disease today, it may already be too late for effective intervention because the brain is already damaged beyond repair.

Those people most at risk for Alzheimer’s disease are individuals between the ages of 60 and 90. The risk increases after age 60. Measures of the disease can include memory complaint, mild cognitive impairment, and abnormal neuropsychological test scores with no dementia. These individuals are at risk to convert to Alzheimer’s disease at the rate of 15 percent per year.

Penn is the site of the chemical biomarker core of the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a study designed to identify ways to diagnose Alzheimer’s disease at its earliest stage when therapies will be most effective. The link between the Penn Alzheimer’s Disease Core Center and the Penn Memory Center and its flow of patients enables researchers to be able to have access to important data and biological fluids that could yield new tests for the earliest diagnosis of Alzheimer’s disease. For this study, researchers are banking the biological fluids (blood, urine and spinal fluid) from 800 people. 200 of the group have Alzheimer’s disease, 200 are an elderly control group and 400 have been diagnosed with mild cognitive impairment. By studying their imaging and body fluids, we can identify common traits among them and then determine who will convert to Alzheimer’s disease in the future.

Drugs in clinical trial are focusing on disease-modifying therapy that would arrest the disease. These drugs have failed thus far, perhaps because they are administered too late to have an impact. This is yet another reason why it is critical to identify those people likely to respond to therapy.

“Alzheimer’s disease is a problem that affects five million people in the US today,” said John Q. Trojanowski, MD, PhD, Director of the Penn Alzheimer’s Disease Core Center, Co-Director for the Center for Neurodegenerative Disease Research (CNDR) and Director of the University of Pennsylvania Institute on Aging (IOA). “We are living longer than ever before. Advanced age is the greatest risk factor for Alzheimer’s disease. In 2050, the number of Americans with Alzheimer’s disease will increase to 15 to 20 million people. The current cost is >$100 billion and will increase to $400 billion by 2050. This is a looming national disaster and there is a great urgency to develop therapy. With sufficient resources, we can find early diagnosis of Alzheimer’s disease so we can intervene and slow disease progression and delay onset.”

The Penn Memory Center is the clinical arm of the Penn Alzheimer’s Disease Core Center. This facility provides clinical care, including evaluation and management for people with cognitive disorders of aging, especially memory problems related to Alzheimer’s disease and mild cognitive impairment. Conditions treated also include Lewy body disease, frontotemporal lobar degeneration and related diseases.

Patients with mild cognitive impairment are at the highest risk of developing Alzheimer’s disease. The Penn Memory Center is working to target those individuals and diagnose them early so that their treatment can begin earlier.

The Center’s expanded multidisciplinary program includes physicians trained in neurology, geriatric medicine, geriatric psychiatry and neuropsychology. Additional support staff includes psychologists, social workers, nurse clinicians, psychometricians, and research coordinators.

The emphasis is not only on serving the patient, but also their family. Psycho-educational groups and psychotherapy services are available for family caregivers of people with Alzheimer’s disease.

The Alzheimer’s Disease Core Center and Penn Memory Center conduct several types of research studies related to dementia, and specifically Alzheimer’s disease. These include clinical trials examining the effectiveness and safety of new medications, vitamins, or compounds; diagnostic studies utilizing technologies such as magnetic resonance imaging (MRI), and examining samples of blood, urine, and cerebrospinal fluid to better understand the physiological changes that occur over time with Alzheimer’s disease; and genetic studies.

Currently, approved medications for Alzheimer’s disease can provide symptomatic benefit, but they are not very effective. Thus, there is a major emphasis on offering medication in clinical trials. “The only way to help prevent Alzheimer’s disease is through research,” comments Steven Arnold, MD, Director of the Penn Memory Center, Associate Director of the Alzheimer’s Disease Core Center, Associate Director of IOA and leader of the ADC Clinical Core.

“There is no effective disease-modifying treatment as yet and that is why it is critical that we partner with our patients in our research efforts. Through clinical care and research we are hoping to make a difference and more successfully treat Alzheimer’s disease and other dementias,” said Dr. Arnold.

Welcome to the Inaugural Issue of the Penn Comprehensive Neuroscience Center Newsletter.

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 08:55:59 PST

The Penn Medicine Neuroscience Center (PMNC) is dedicated to the advancement of the understanding of the brain, spine and peripheral nervous system.

Built on the foundations of the philosophy, “Bench, Bedside and Beyond,” the multidisciplinary PMCNC facilitates and strengthens the integration of Penn’s neuroscience programs within the areas of clinical care, research and education. This publication will highlight the exciting, collaborative work of the clinical specialists, basic science and clinical researchers, and educators who are part of Penn’s world-class neuroscience programs.

The Penn Medicine Neuroscience Center Breaking New Ground and Setting the Standard by Which Others Are Measured

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 09:00:07 PST

Through a unifying vision, strategic thinking, program development and shared resources, the PMNC’s mission is to bolster the practice of translational medicine. The Center’s collaborative framework facilitates an efficient natural flow of information. Ground-breaking discoveries and fundamental research lead to clinical trials, and ultimately, to advances in clinical care for patients with diseases of the brain, spinal cord and peripheral nervous system.

Departments represented under the PMNC include Neurology, Neurosurgery, Psychiatry, Neuro-ophthalmology, Neuro-radiology, Neuroscience, Otorhinolaryngology, Neuro-anesthesiology, and Neuro-pathology.

This pioneering initiative reflects the scientific distinction that is the hallmark of Penn’s neuroscience programs. Penn’s strengths in the neurosciences are widely and frequently cited within the medical community. Each department within the PMNC is actively engaged in a wide range of research and is one of the top recipients of research funding by the National Institutes of Health and is staffed by world-renowned, pre-eminent experts who are routinely listed among the Best Doctors in America and the Top Doctors in the Philadelphia region.

This historic undertaking is part of the enduring legacy of excellence that can be traced back to the early days of medical science at the University of Pennsylvania.

Penn’s Neurology department was the first in the country, having been founded in the early 1870’s. Penn’s department of Neurosurgery served as one of the three original centers from which American neurosurgery originated. In addition, Penn’s leadership in psychiatry dates back to Benjamin Rush, founder of the University of Pennsylvania School of Medicine and “father” of American psychiatry. Today, Penn neurosciences are consistently ranked as the best and most preferred services in the Philadelphia area.

To refer a patient or for more information on the PMNC,
please call 800-789-PENN, or visit www.uphs.upenn.edu/neuroscience-center/.

Shining the Light on Minimally-invasive Skull-base Surgery

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 07:27:00 PST

Skull-base tumors are some of the most challenging, complex and technically-demanding tumors to treat. Physicians from the departments of Neurosurgery and Otorhinolaryngology: Head and Neck Surgery are bringing new hope to patients with these tumors through their work in minimally-invasive treatments for both benign and malignant tumors in the skull base, sinuses and brain.

Historically, skull-base tumors were very difficult to approach and access, leading to poor patient outcomes and high morbidity. Today, Penn is making great strides in battling these tumors via a targeted, comprehensive, multidisciplinary approach that embraces minimally-invasive techniques from surgery to radiation.

Prior to the 1980’s, surgery for tumors of the skull-base was accomplished by approaching the tumor through the brain, leading to a high rate of patient morbidity. In the 1980’s and 1990’s, collaboration between the departments of Neurosurgery and Otorhinolaryngology: Head and Neck Surgery was moving forward at a brisk pace. Surgical techniques were improving, and the era of “classic” skull-base surgery, utilizing craniotomy and open facial surgery was the surgical procedure being used most frequently. The use of the microscope in surgery was also becoming the norm and improving outcomes.

Today in 2008, Penn surgeons are regional and national leaders in the “new millennium” in skull-base surgery. Minimally-invasive, endoscopic surgical approaches are changing and saving lives for patients with tumors of the Cranial-Base. This incision-less surgery has revolutionized the ability to perform skull-base surgery. Cancers and other tumors which were routinely being removed through facial and scalp incisions are, in our hands, routinely being removed entirely through the nose," said Dr. Jason Newman. "This, in combination with the lack of retraction of the brain, has really improved the speed of recovery and the cosmetic outcome for these patients." These endoscopic techniques utilize zero-degree and angled scopes that enable surgeons to look around corners. High-definition imaging, advances in optics, and other technology is moving surgical navigation to the next level. Additional techniques and tools include using materials like the patient’s own tissue as well as biologic adhesives to aid in reconstruction of the skull base following surgery.

Penn is pioneering even newer minimally-invasive robotic approaches to expand on endoscopic techniques and build on the progress that has already been accomplished. Robotic surgery is now being explored as a new treatment for patients with both benign tumors and cancer of the skull-base. This surgery is the first of its kind in the world and is being developed by the same team that developed Trans-oral Robotic Surgery, or TORS, for tumors of the head and
neck.

The advantages of robotic surgery are numerous. It allows surgeons to see the surgical site more closely than human vision allows and to work at a smaller scale. The end of the surgical instrument moves exactly like a hand does, operating as if the surgeon’s hands have been miniaturized in the small cavity in which they are operating. Thus, the robot is not operating independently, but rather as an extension of the surgeon.

Recently, Penn’s departments of Neurosurgery and Otorhinolaryngology: Head and Neck Cancer have established a pre-clinical skull base robotics testing laboratory where they are working together to develop novel robotic and minimally invasive surgical approaches and procedures for future application in the care of patients with skull base tumors.

Penn possesses a powerful arsenal featuring the latest treatment modalities to combat skull-base tumors. Two of these exciting innovations are Gamma Knife® radiosurgery and Proton therapy. These minimally-invasive techniques delivery high doses of radiation targeted directly to the tumor, sparing the normal brain and surrounding tissue. Patients at Penn’s Center for Cranial-Base Surgery are exposed to, and able to avail themselves of, a variety of the latest treatment options and cutting-edge techniques and procedures available today, so that their tumors can be treated most effectively, with the best outcomes possible.

To this end, a multidisciplinary team collaborates and determines a treatment plan designed expressly for each patient. World-renowned physicians from departments including Neurosurgery, Otorhinolaryngology: Head and Neck Surgery, Radiation Oncology, and Pathology meet weekly at a skull-base tumor conference where each patient’s case is discussed and treatment plans are formulated.

“One of the advantages of our multidisciplinary approach to Cranial-Base tumors is that we have many of the best tools in our armamentarium to treat these cancers, “said Dr. John Lee. "From minimally-invasive surgical approaches, to Gamma Knife and Proton therapy, to our expert team of physicians and other providers, we leave no stone unturned in aggressively treating these cancers."

Developing novel robotic and minimally- invasive surgical approaches for future care of patients with skull base tumors.

The Neuro-Intensive Care Unit

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 07:27:00 PST

The Penn Neuro-Intensive Care Unit, part of the Penn Comprehensive Neuroscience Center, is a Level I Trauma Center and Acute Brain Injury Center, offering a total comprehensive, multi-disciplinary approach to caring care for patients with severe neurological injuries. Located at the Hospital of the University of Pennsylvania, a nationally recognized medical center, this distinguished unit is the most technologically advanced and sophisticated neuro-critical care unit in the nation, and is the only academic facility of its kind in the region.

Penn’s Neuro ICU is dedicated solely to patients with severe neurological injuries, including traumatic brain injury and spinal cord trauma, stroke, aneurysms, neurovascular disease, brain tumors, brain infection, epilepsy and neuromuscular emergencies. In addition, neurosurgery patients receive specialized post-operative care in this ICU. Dedicated facilities such as this are rare throughout the U.S. As such, our nationally-renowned site often hosts visiting clinicians and educators from around the world to train them in the latest techniques and information.

The Center is staffed by a team of expert clinicians in the fields of neurology, neurosurgery, radiology, anesthesiology, nutrition, pharmacology, physical therapy, and social work. Physicians and staff set the standard for care in the region and are leaders in advancing the field through research and patient care. In recognition of its lifesaving efforts, the Neuro-critical care unit was awarded the prestigious Beacon Award for excellence in critical care.

The department offers a full continuum of care, with coverage 24-hours-per-day,
365-days-a-year. In addition, the PennSTAR flight program provides critical care air
medical transportation within a 100-mile radius of to the Hospital of the University
of Pennsylvania.

The Center employs multiple modalities of cutting-edge brain monitoring such as continuous EEG, brain oxygen monitoring, and cerebral microdialysis, allowing physicians to determine brain oxygenation, cerebral blood flow, brain tissue chemistry, and intracranial pressure. Staff also performs invasive and non-invasive tests and studies right at the bedside, including neuro-imaging such as conventional and xenon CT scans, CT angiography and perfusion tests, and transcranial Doppler. The latest medical and surgical therapies to preserve brain function are also available.

As the only academic Neuro-ICU in the region, the department is staffed by internationally-renowned researchers specializing in brain injury. These investigators are leading the way in uncovering breakthroughs in the treatment of traumatic brain and spinal cord injury, subarachnoid hemorrhage, brain tumor, stroke, and more. In fact, research generated from the Center is now part of the Brain Trauma Foundation guidelines.

Penn’s award-winning Neuro-Intensive Care Unit at the Hospital of the University of Pennsylvania is working to improve neurological outcomes and quality of life, advancing remarkable recoveries, and saving lives.

As the only academic Neuro-ICU in the region, the department is staffed by internationally-renowned researchers specializing in brain injury.

The Penn Pain Medicine Center

noreply@blogger.com (Penn Medicine) — Tue, 10 May 2011 11:49:39 PDT

As one of the leading pain management centers in the Philadelphia region and part of the Penn Comprehensive Neuroscience Center, the Penn Pain Medicine Center is a renowned resource, providing integrated, interdisciplinary pain care for patients with complex pain problems. Whatever the cause, the goal of Penn Pain Medicine Center is to alleviate as much pain as possible and improve the patient’s quality of life.

A Multidisciplinary Approach to Pain Management
The Penn Pain Medicine program offers care to patients with many different needs via a powerful multi-faceted approach to pain management that consists of three clinical services— the Penn Pain Medicine Center, the Anesthesia Pain Service (APS), and the Symptom Management and Palliative Care Program (SYMPAC).

The APS provides advanced pain care to hospitalized patients. This care includes the use of epidural patient-controlled analgesia and intravenous patient-controlled analgesia. In addition, the APS provides interventional pain management when necessary to inpatients with cancer-related pain that need these techniques as well as pain consultation to inpatients who are experiencing poorly controlled chronic pain. The APS, in coordination with the admitting physician, assists in the evaluation of the patient’s pain and the development of a treatment plan. For those patients with chronic pain, the plan often includes continued therapy as an outpatient at the Penn Pain Medicine Center.

SYMPAC provides inpatient consultation to patients requiring palliative care services at the Hospital of the University of Pennsylvania. In addition, SYMPAC provides outpatient palliative care services through its clinic currently located at 15 Penn Tower. SYMPAC will soon be caring for outpatients 3 half-days a week at Perelman Center for Advanced Medicine.

Outpatient pain care is provided at the Penn Pain Medicine Center located in the Tuttleman Center on the Penn Medicine Rittenhouse campus. The Center offers coordinated interdisciplinary treatment that includes medication management, interventional therapy, behavioral therapy, physical therapy and alternative medicine therapies such as acupuncture. Psychological services are provided by faculty of the Department of Psychiatry, and physical therapy is provided through a partnership with Good Shepherd Penn Partners Therapy and Fitness.

The Center treats the most complex pain problems, including those associated with arthritis; back and neck pain; cancer pain; complex regional pain syndrome Type 1 (CRPS -1) formerly known as reflex sympathetic dystrophy (RSD); complex regional pain syndrome Type 2 (CRPS -2) formerly known as causalgia (pain from nerve injury such as amputation); fibromyalgia; myofascial pain syndrome; headache including migraine; neuropathic pain including peripheral neuropathies and post-herpetic neuralgia.

Individualized Treatment Plans
The best chance for treating pain is through the use of several treatment options in a coordinated manner. Each patient’s treatment plan is individually selected based on that patient’s needs and goals for therapy.

Interventional techniques include but are not limited to neural blockades, including neurolysis for selected patients with cancer; implantable drug delivery systems; spinal cord stimulation; cryoablation; and peripheral nerve stimulators. Non-invasive therapies include medication management, palliative care, cognitive-behavioral therapy, relaxation training/mindfulness meditation, physical therapy and acupuncture.

Our Team
The Penn Pain Medicine Center team is comprised of nationally-renowned leaders in the fields of pain medicine and palliative care. The physician faculty is comprised of board-certified anesthesiologists, family physicians, neurologists, and psychiatrists. In addition the team includes psychologists, physiatrists, medically-licensed acupuncture specialists, nurse practitioners, and physician assistants. Physical therapy is provided through a partnership with Good Shepherd Penn Partners Therapy and Fitness.

Education
The Penn Pain Medicine Center provides education to three pain medicine fellows, anesthesiology residents and trainees from other specialties who are interested in developing their skills in pain medicine and palliative care. The faculty are committed to providing high-quality education to the next generation of physicians.

Pushing the Envelope
Faculty and staff of the Penn Pain Medicine Center are active in a variety of pain-related research. Projects include a clinical research center in which phase 1-4 clinical trials are conducted. The Center recently signed an agreement to partner with the FDA to investigate the use of medications to prevent chronic pain following mastectomy or thoracotomy. In addition, the Center received a grant to implement a comprehensive disease-specific measure of health to track outcomes in its patients. It is the hope that this work in outcome measurement can be used to improve the quality of care provided to patients with pain.

Integrated, interdisciplinary pain care for patients with complex pain problems.

Shining the Light on Research: Sleepless Flies

noreply@blogger.com (Penn Medicine) — Mon, 04 Feb 2013 09:03:33 PST

Sleepless Flies
One of the most important missions charged to the Penn Medicine Neuroscience Center is research. Departments from throughout the PMNC are collaborating on important studies in fields throughout the neuroscience spectrum with the ultimate goal of translating their findings into information that will improve patient care. One of the areas making headlines is in the realm of sleep research.

Amita Sehgal, PhD, Professor of Neuroscience and a member of Penn’s Center for Sleep and Respiratory Neurobiology has made fascinating discoveries in the field of sleep in her study of fruit flies.

Why Study Sleep?
Humans spend one third of their lives sleeping. Although it is not known why we sleep, it is known that sleep is very important. Loss of sleep can have serious health consequences and seriously affect performance, cognitive function, and the ability to think, evaluate and judge. It has been recognized that sleep is critical, but very little is known, and we need to know more about this process.

How Fruit Flies are Changing the Way We Learn About Sleep
Studying animals (like fruit flies) has helped to begin to answer some of the most important questions in biological research. There are many advantages to working with flies for research. Researchers can grow and breed large numbers, flies are inexpensive to maintain, and the breeding cycle is short so there can be rapid movement between many generations. This is a great asset in the study of genetics. In addition, due to the fact that there are a lot of genetic markers in flies, it is easy to genetically map things. Thus, in order to understand the genetic basis of something, these animals become even more important.

Scientific knowledge and understanding of how animals and humans maintain their 24 hour rhythms, of which the sleep/wake cycle is one, is growing. Unlike rodents, which sleep during the day, flies have sleep/wake cycles like humans, sleeping at night. A lot of what we know about the nervous system as well as our own internal body clock has come from what we have learned about the fly.

A Genetic Discovery
In a recent study conducted of 3,500 lines of fruit flies, Dr. Sehgal and her team have identified a gene that controls sleep. The research was performed by introducing mutations in the flies randomly and then looking for a gene mutation that affected sleep. What they discovered was a mutation in one specific gene that they called Sleepless. This mutation led to really, really short sleep times. Fruit flies typically sleep 12 hours per day. Those flies with the normal form of this gene had normal sleep; those with the mutation survived on little to no sleep, sleeping only one or two hours per day, or not at all.

Researchers found that when the flies were unable to sleep, they were uncoordinated and lived about half as long as those fruit flies that did not carry the mutation.

The scientists believe that the Sleepless gene makes a protein that affects the activity of potassium channels in the brain that are needed for neurons to be silenced during sleep. The mutated form of the gene does not make that protein, thus the neurons are not silenced and the animals are awake most or all of the time. "We are still working to determine exactly how Sleepless controls the potassium channel to silence neurons and regulate neural activity," said Dr. Sehgal.

Dr. Sehgal, her research team and her colleagues at the Penn Sleep Center were the first to find the gene Sleepless. This is only the second gene to be found that affects sleep through a completely unbiased approach with no pre-conceived notions.

Future research will focus on finding and isolating the human equivalent of the Sleepless gene by comparing sequences and protein structures. “We hope that finding this will not only further our understanding of human sleep, but will also possibly serve as drug targets to promote sleep or treat insomnia,” said Dr. Sehgal.

Transcranial Magnetic Stimulation (TMS) New Hope for People with Major Depression

noreply@blogger.com (Penn Medicine) — Thu, 16 Dec 2010 07:27:00 PST

An exciting new approach to treatment, Transcranial Magnetic Stimulation (TMS), is now available at the Penn Comprehensive Depression Center. In October, the Food and Drug Administration approved the first TMS device to treat major depression.

TMS is a novel, outpatient-based, brain stimulation therapy for mood disorders that applies focused magnetic pulses to the cerebral cortex. In addition, this treatment has shown significant promise as a treatment for other conditions such as bipolar depression, post-stroke depression, post-traumatic stress disorder, and other neuropsychiatric disorders including Tourette’s syndrome, pain, and migraine.

John O’Reardon M.D., Director of the TMS program at Penn and principal investigator at the Penn site for the study that led to the FDA indication for TMS for major depression, commented: “TMS is an exciting new approach that offers hope to patients with depression that have not responded to antidepressants or psychotherapy. With further research, we are optimistic that TMS may prove to be beneficial in other disorders as well.”

A TMS session is delivered in a psychiatrist’s office and lasts about 30 minutes. Patients are fully conscious and aware throughout the procedure and no post-session recovery period is needed. Afterwards patients are able to resume their normal activities like work or driving without interruption. Sessions are usually administered in five day blocks (Monday to Friday), but sometimes may also be conducted three days per week depending on the individual case.

A course of TMS for major depression can be anywhere from 15 to 30 sessions depending on its severity. Maintenance TMS sessions can be provided subsequently to prevent recurrence of symptoms, if indicated, with a frequency from one per week to as little as one per month. TMS is a very safe procedure and lacks side effects that are common with some medications such as weight gain, sedation, and sexual dysfunction. Its most common side effect is a headache in 10-30% of patients which is usually mild and transient.