Imagine FALL 2013
Smart Approaches to Brain Disorders
PA G E 3
Everything for Multiple Sclerosis Under One Roof PA G E 8
Hope for Hard-to-Treat Seizures
rac e ca r d r i v e r :
g r o o m -to - b e :
f i t n e ss b u f f :
behind the wheel again after a stroke
living life without tremors
headache free and headed to the altar
tumor gone, back to daily workouts
The University of Chicago Medicine & Biological Sciences has been at the forefront of medical care, research and teaching for more than 90 years. Located in historic Hyde Park on the South Side of Chicago, the University of Chicago
GReeTinGS fROM THe fORefROnT Of MeDiCine
Medicine & Biological Sciences includes: Patient Care » Bernard A. Mitchell Hospital » Center for Care and Discovery » Comer Children’s Hospital » Duchossois Center for Advanced Medicine » Numerous outpatient locations throughout the Chicago area Teaching Programs » Pritzker School of Medicine » Master’s and doctoral degree programs » Postdoctoral programs Research » Medical and basic science units Among our many honors and acknowledgments: 12 Nobel laureates;
Throughout this issue are stories of patients who have beneﬁted from our comprehensive approach to neurological and neurosurgical care.
ranked 8th of all U.S. medical schools; one of only 41 National Cancer Institute-designated comprehensive cancer centers; ranked third in nation for National Institutes of Health grant
Few specialties speak
stock car racing, early-morning exercise,
to the advantages
even getting engaged. We also introduce
Sciences Executive Leadership
of academic medicine
you to our new neurosciences facilities
Kenneth S. Polonsky, MD, Dean of the
better than neurology.
in the Center for Care and Discovery,
A complex field, it
and examine some of our top programs,
often demands the
including the Center for Comprehensive
support per researcher. University of Chicago Medicine & Biological
University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago Sharon O’Keefe, president of the University of Chicago Medical Center Jeffrey Glassroth, MD, dean for clinical affairs, University of Chicago Medicine T. Conrad Gilliam, PhD, dean for research and graduate education,
collaboration of multiple specialists
MS Care, a nationally recognized center
and technologies to deliver an accurate
diagnosis and to chart a course toward a cure. This is one of our strengths at the
Our most exciting news, however, may
University of Chicago Medicine.
be the arrival of internationally recognized neuroscientist John Maunsell, PhD, who
Biological Sciences Division Holly J. Humphrey, MD, dean for medical education, Pritzker School of Medicine ImagIne iS PubliSHeD THRee TiMeS A YeAR bY THe univeRSiTY Of CHiCAGO MeDiCine & biOlOGiCAl SCienCeS. editors Anna Madrzyk and Gretchen Rubin email us at firstname.lastname@example.org Design TOKY Branding + Design Contributing writers Thea Grendahl Christou, Tanya Cochran, Elizabeth Gardner, Kevin Jiang,
Whether testing vaccines to attack brain
will join the University of Chicago as
tumors, employing noninvasive techniques
inaugural director of the Grossman
to identify seizure types or designing
Institute for Neuroscience, Quantitative
nanoparticles to deliver vital medications,
Biology and Human Behavior. He will
our physicians, surgeons and scientists
oversee development of a world-class
work hand in hand to develop and apply
institute that continues the advancement
the latest treatments. Coupled with
our commitment to healing the whole patient, not just the disease, the result is
It is heartening to see the strides being
a comprehensive approach to care.
made by the physicians and scientists of the University of Chicago in treating
Eileen Norris, Gretchen Rubin, Anita Slomski and Anne Stein
Throughout this issue of Imagine are
epilepsy, amyotrophic lateral sclerosis
David Christopher, Robert Kozloff,
stories of patients who have benefited
(ALS), multiple sclerosis, aneurysms, brain
Jean Lachat, Bruce Powell and Jason Smith
from our comprehensive approach and
tumors and other neurological conditions.
have returned to what they love best:
We hope that you are as inspired by these
ADDReSS The university of Chicago Medicine 5841 S. Maryland Ave., Chicago, IL 60637
successes as we are.
The university of Chicago Medicine Comer Children’s Hospital 5721 S. Maryland Ave., Chicago, IL 60637 Telephone 1-773-702-1000 Appointments 1-888-824-0200 Follow the University of Chicago Medicine
Sharon o’KEEfE President of the University of Chicago Medical Center
on Twitter at twitter.com/uChicagoMed or visit our Facebook page at facebook.com/ uChicagoMed. You can read more about our news and research at uchospitals.edu/news and at sciencelife.uchospitals.edu. This publication does not provide medical advice or treatment suggestions. If you have medical problems or concerns, contact a physician who will determine your treatment. Do not delay seeking medical advice because of something you read here. For urgent needs, call 911 right away. Read Imagine online at uchospitals.edu/imagine.
KEnnETh S. PoLonSKy, MD Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago
AT THE fOREfROnT Of nEUROSCiEnCE
ALS (LoU GEhrIG’S DISEASE)
improving Quality of life, Searching for new Treatments While there is no cure for amyotrophic lateral sclerosis (ALS), studies show that patients whose care is managed in a multidisciplinary clinic live longer and have a better quality of life. The ALS Multidisciplinary Clinic at the University of Chicago Medicine, which is funded by the Greater Chicago Chapter of the ALS Association, offers comprehensive care for people with the fatal neurodegenerative disorder. Raymond P. Roos, MD, director of the clinic, has been caring for people with ALS for more than two decades. Roos currently has several grants for research directed at investigating novel treatments for the disease. The clinic is one of the first two centers in the Chicago area offering the NeuRx Diaphragm Pacing System (DPS), a surgically implanted device that has helped people with spinal cord injuries breathe on their own and has been approved for ALS use. Other services include physical, occupational and speech therapy, nutrition counseling, speech and swallowing guidance, and help with assistive devices, including wheelchairs and braces. An on-site ALS Association representative helps provide support and case management of patients, and coordinates free transportation to the clinic, home visits, ongoing support groups and equipment lent at no charge.
An internationally recognized neuroscientist will lead a new institute at the University of Chicago where scientists address fundamental questions related to neuroscience and behavior.
BrAIn TUMor rESEArCh
fighting a Deadly Cancer Using the Body’s Own Defense System Researchers at the University of Chicago Medicine are testing novel vaccines that help the immune system fight the most deadly form of brain cancer.
John Maunsell, PhD, has been named the inaugural director of the Grossman institute for neuroscience, Quantitative Biology and Human Behavior. Maunsell, who comes to Chicago from Harvard Medical School, will oversee the development of a highly collaborative, world-class neuroscience institute. The Grossman institute will leverage the close integration of research, education and patient care at the University of Chicago Medicine. faculty will be drawn from across the biological, physical and social sciences and engineering. Over the course of his distinguished career, Maunsell has made fundamental contributions to our understanding of the neuroscience of vision, perception and attention. He has served since 2008 as editor-in-chief of the Journal of neuroscience, the leading publication of the world’s largest neuroscientist organization.
Neuro-oncologists M. Kelly Nicholas, MD, PhD, and Rimas Lukas, MD, and neurosurgeon Maciej S. Lesniak, MD, are conducting several clinical trials using vaccines to treat glioblastoma, the most common and aggressive primary brain cancer. The trials study different vaccine approaches, combined with chemotherapy or used alone, to treat newly diagnosed or recurrent disease. “These studies are designed to either extract substances from a patient’s tumor cells or target mutated proteins already on the tumor’s surface, which the immune system then recognizes as foreign bodies much like viruses and bacteria,” Nicholas said. Results from earlier studies have been promising, with some patients in remission for several years. University of Chicago Medicine neurosurgeons, radiation oncologists and neuro-oncologists have a wide array of clinical trials to offer patients. “Finding new approaches to treating brain cancer is part of our comprehensive care that leaves ‘no stone unturned’ in fighting this disease,” Nicholas said.
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UnDEr ThE InfLUEnCE
What puts the happy in happy hour? It may seem to be what’s in the glass, but it could be the company you’re keeping. In a recent experiment, volunteers were tested as they drank alone or as they shared drinks with another person of the same sex. The paired drinkers were not told whether their beverages contained alcohol or a placebo. Test subjects said they felt more buzzed when they were sharing drinks, even when their own “cocktail” contained no alcohol. Surprisingly, they reported feeling even more intoxicated when their partner was drinking alcohol. “The drunk person somehow ‘brought along’ a placebo-treated person,” said Matthew Kirkpatrick, PhD, postdoctoral fellow at the University of Chicago, who reported the study with Harriet de Wit, PhD, professor of psychiatry and behavioral neuroscience, in the journal Psychopharmacology.
Imagine that! A nEw wAy To hELP fAMILIES
Clinical psychologist Christina WarnerMetzger, PhD, offers real-time coaching for parents of children ages 2 to 6 who are exhibiting disruptive behavioral issues. Warner-Metzger, PhD, is an expert on ParentChild Interaction Therapy (PCIT) and a member of the child and adolescent psychiatry team at the University of Chicago Medicine. Watching from a separate room through a video camera, Warner-Metzger observes the natural dynamic between parent and child as they engage in a play session. When critical opportunities for positive reinforcement or behavioral correction arise, she guides the parent through the use of a Bluetooth earpiece. “Through PCIT, we can teach advanced parenting techniques to try and help alleviate behavioral problems, with immediate feedback,” said Warner-Metzger, who is
Caring for Our Community CoMMUnITy oUTrEACh
Psychiatry residents at the University of Chicago Medicine spend two months with the Thresholds Mobile Assessment Unit, an outreach program for homeless people who have severe mental health issues as a result of schizophrenia, psychosis, traumatic brain injury or substance abuse. The goal is for residents to learn how to develop relationships with these vulnerable people, who often are afraid or unwilling to accept help. TELEPSyChIATry
Many communities face a shortage of psychiatrists to treat people with severe mental illness, especially children and adolescents. The University of Chicago Medicine is working toward a collaboration with a community mental health center in downstate Illinois and a family health center on Chicago’s South Side to offer telepsychiatry services. Evidence shows outcomes are as good when assessment and treatment are conducted via Internet videoconferencing as in traditional office visits.
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one of only 18 PCIT International Certified Master Trainers worldwide. PCIT has also begun to show promise in helping children with mood, anxiety or attention issues, as well as autism spectrum disorder. uchospitals.edu/physicians/ christina-warner-metzger.html
Young athletes and others who have had concussions can be evaluated at the University of Chicago Medicine’s neurosurgery concussion clinic before returning to sports or activities. The clinic is open Thursdays from 10 a.m. to 3 p.m. at the Duchossois Center for Advanced Medicine on the Hyde Park campus. AT ThE forEfronT
The University of Chicago’s designated Center of Excellence in Gambling Research focuses on a multidisciplinary approach to gambling disorders and other impulserelated addictions.
EvERYTHinG fOR MUlTiPlE SClEROSiS UnDER OnE ROOf Collaborative Research and Treatment The University of Chicago Medicine recently was designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society. “This places us among other nationally recognized centers for excellence,” said neurologist Jacqueline Bernard, MD. The designation is awarded to centers providing coordinated multidisciplinary care for people with MS, including medical, psychosocial and rehabilitation services. Diagnosing and treating MS is complex. “For MS patients, quality of living is linked directly to the timeliness and appropriateness of the care they receive, beginning with diagnosis and continuing through each phase of the disease,” Bernard said. “We offer the full range of services a patient may need.” Our physicians and scientists have a long history of improving the quality of life for people with MS. The Multiple Sclerosis Clinic opened in 1976, and since then our researchers have helped develop and test most of the currently available therapies for the disease. The same physicians who treat patients in the clinic also are MS researchers.
A hISTory of DISCoVEry Our physicians helped develop the first drug for MS more than 20 years ago. now there are nine medications in use and 50 clinical trials of new drugs under way in the U.S.
ToDAy The University of Chicago Medicine is designated a Center for Comprehensive MS Care by the national Multiple Sclerosis Society.
Nine medications are being used now to treat MS; three of those drugs are taken orally. Choosing the right drug can be a tricky process. “We have more effective drugs to treat MS, but along with that come more
side effects, such as suppressed immune systems and virus infections,” said Anthony Reder, MD, who directs the Neurology and Inflammatory Disease Infusion Center. “Because we’ve had years of experience in clinical trials and see patients with more complicated disease, we can handle the toughest cases. Often, when new drugs come out, we’re ahead of the game because we’ve already been using the drugs in clinical trials.” With extensive experience using approved and experimental drugs, the University of Chicago Medicine infusion center is equipped to handle any side effects or reactions to new, more complex medications. “Our team is ready to go if there is a rare reaction,” Reder said. The evidence is clear: The medications work. In the last 20 years, there has been a 50 percent reduction in death from MS with one of the therapies.
An early diagnosis is key, since most damage to the central nervous system occurs in the first year. Patient Ken Mauge, 53, of Tinley Park, Ill., has been on the same drug since he came to the University of Chicago Medicine in 1989. Mauge, who works full time in the adult probation department for Cook County, injects interferon beta (Betaseron) every other day. “I am totally ambulatory without any MS attacks since I’ve been on the drug,” said Mauge. “Dr. Reder’s great. I see him once a year, and call him in the meantime if I need to.”
AT ThE forEfronT
The eyes are a window into the nervous system. Neurologist Jacqueline Bernard, MD, is studying how optical coherence tomography (OCT) — a noninvasive technique that provides 3-D images of the retina — can be used to evaluate the extent of neurodegenerative disease, responses to treatment and unexpected side effects.
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SMART APPROACHES TO BRAin DiSEASES Every day, our neuroscience physicians solve the most difficult cases so patients can get back to their lives. Here are four stories:
Patrick O’Brien’s hands shook so much he could barely tie his own shoes. now he’s living life without tremors. ChALLEnGE
The joke in Patrick O’Brien’s house was that if his wife was angry she’d make soup for dinner, because his tremors made it nearly impossible for O’Brien to avoid spills. These days, however, soup is no longer a dangerous weapon for the south suburban police officer/paramedic. In January 2013, O’Brien, 43, had deep brain stimulation (DBS), a surgical treatment for patients with movement XIE disorders such as Parkinson’s disease, dystonia or, as in O’Brien’s case, essential tremor. “Most of the outcomes are phenomenal,” said neurologist Tao Xie, MD, PhD, medical director of the movement disorder program. “During the procedure we can immediately see the tremors decreasing.”
In November, O’Brien and his wife heard University of Chicago Medicine neurosurgeon Peter Warnke, MD, director of stereotactic and functional surgery, and Xie speak about pharmacological and surgical treatments for movement disorders. O’Brien made an appointment to meet with both physicians. “These guys spoke to me in a way that really boosted my confidence and made me believe that they’re among the best at what they do,” O’Brien said. “They’re personable, easy to talk to, and even today they answer every question before I walk out the door. They continue to get grants to do research and move things forward within Parkinson’s and essential tremor so they know what’s out there.”
DBS involves placing an electrode in the brain to deliver high-frequency electrical stimulation to control movements. Over the past few years, O’Brien’s quality of life had been increasingly affected by the shaking in his hands and arms. “It got so bad at work that when I was fingerprinting offenders, they thought I was afraid,” O’Brien said with a chuckle. “And when I was talking to victims, they’d ask me why I was so nervous.” Two years ago, he was diagnosed by a neurologist at a local hospital and started taking medications, but they caused serious side effects.
“This surgery has been life-changing for me.”
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The Center for Parkinson’s Disease and Movement Disorders combines clinical expertise with state-of-the-art therapies and groundbreaking research. Experts in neurology, neurosurgery, psychiatry, otolaryngology and rehabilitation treat a variety of movement disorders — including Parkinson’s disease, tremor, dystonia and chorea — with exercise, medication, botulinum toxin injection and DBS. Like O’Brien, many patients turn to the center, dedicated as a Center for Advanced Research by the American Parkinson Disease Association, after seeking help elsewhere. “I can tie my shoes and I can eat a hamburger loaded with toppings without anything spilling out,” said O’Brien proudly. “This surgery has been life-changing for me.” To learn more about the Center for Parkinson’s Disease and Movement Disorders, visit uchospitals.edu/movement-disorders.
“I’ll race every Saturday night.”
A blocked artery in Jim Cox’s brain prevented him from driving. Today he’s back behind the wheel of his race car. ChALLEnGE
After retiring from two careers, first as a U.S. Army helicopter test pilot and later as a corporate engineer, Jim Cox looked forward to spending more time on his favorite hobby — building and driving late-model stock cars. But after having a stroke three years ago, the racing enthusiast from Dyer, Ind., was sidelined by episodes of double vision, slurred speech and balance difficulties. “Jim’s stroke left one artery in the brain completely blocked and another one 90 percent narrowed,” explained interventional neuroradiologist Seon-Kyu Lee, MD, PhD. “The consequences were preventing him from doing what he loves and putting him at high risk for another stroke.” Lee, an expert in neurointerventional care, and neurologist James R. Brorson, MD, an expert in stroke evaluation and treatment, teamed up to develop a care plan for Cox. Brorson first treated the 67-year-old conservatively with medications.
But because the vessel was severely blocked, the symptoms persisted. As the next step, Lee advised balloon angioplasty — a minimally invasive technique to expand the narrowed vessel. In the winter of 2012, Lee inserted a tiny catheter (thinner than a strand of angel hair pasta) through an artery in Cox’s groin up to the narrowed artery in his brain. Because angioplasty carries a risk of rupturing the delicate brain artery, Lee gradually dilated the narrowed vessel. Cox’s condition initially improved, but the symptoms eventually returned. “I started blacking out,” he recalled, LEE describing his vision as resembling “slivers in a cracked mirror.”
Having completed more than 60 of these procedures, Lee is highly experienced in the technique. In April 2013, Lee performed the intervention on Cox. Starting with the smallest balloon, he placed and inflated progressively larger ones. The vessel wall opened to 90 percent and Lee positioned the stent. By the time Cox left the hospital, his symptoms were gone. “Jim is now getting normal blood flow to his brain, which is about five to six times more blood than before the procedure,” Lee said, putting the risk of the artery narrowing again at less than 15 percent. For more about neurointerventional surgery, visit uchospitals.edu/ neurointerventional.
It wasn’t long before Cox felt well enough to take his car back out on the racetrack. “Dr. Lee and Dr. Brorson did an outstanding job,” he said. “I am so thankful to them for getting this done for me.”
Lee then recommended a second balloon angioplasty, along with placement of a flexible mesh tube, or stent, to keep the vessel open.
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“I wouldn’t want to go through it again, but I had such good care.”
A golf ball–size tumor was growing in Gloria fletcher’s head. after surgery, she’s back to work and working out. ChALLEnGE
Most weekdays, Gloria Fletcher wakes up between 4 and 4:30 a.m. to exercise before going to work. But on a sunny spring day, it wasn’t her alarm but rather a throbbing headache and nausea that woke her. Glancing at the light coming through her window felt “excruciating.” The 57-year-old Park Forest, Ill., resident attempted to drive herself to a nearby hospital. Before reaching the emergency room, she pulled over and called 911. “I was able to tell the paramedics what was going on,” Fletcher recalled. But by the time the ambulance reached the ER, she was in and out of consciousness. After reviewing diagnostic scans, physicians told Fletcher there was a growth in her brain that needed to be surgically removed. YAMINI On the advice of a relative, Fletcher transferred her care to University of Chicago Medicine neurosurgeon Bakhtiar Yamini, MD, an expert in the surgical treatment of all types of brain tumors.
The tumor in Fletcher’s brain was a meningioma, a lesion that develops in membranes, called meninges, that surround and protect the brain and spinal cord. The 5-centimeter growth (a little larger than a golf ball) had formed on the back at the top right side of her head. “Although the tumor was on the perimeter, it was ‘mushrooming’ into her brain and pushing into the region of her visual pathway,” Yamini said. “It was probably growing and so could become more and more difficult to remove. It had to come out.” Surgery was scheduled for two weeks later to give one of Fletcher’s two daughters, a U.S. Army major stationed in Germany, time to fly home with her family. Yamini’s team contacted the military and the American Red Cross to help facilitate her quick return. Understandably, Fletcher was worried about having brain surgery. She was concerned her vision would be permanently damaged. “Dr. Yamini eased my fears and calmed me down,” she said.
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“My family was anxious, but on the day of the operation, I felt peaceful and wasn’t afraid anymore.” When Fletcher woke from the four-hour surgery, she glanced up as her daughters walked into her room and said, “Hi Hollye. Hi Dee.” Both were surprised their mother was talking and calling them by name so soon after a brain operation. Fletcher moved out of the ICU in less than a day and went home just three days later. After recuperating for six weeks, she returned to work as a quality assurance specialist and resumed her early morning workout routine. Reflecting on her experience, Fletcher said, “I wouldn’t want to go through it again, but I had such good care. It was a pleasant stay in the hospital. Someone was always there when I needed help. From the doctors and nurses to housekeeping, the whole staff was good to me.” AT ThE forEfronT Bakhtiar Yamini, MD, is testing a
nAnOPARTiClE “SHEll” capable of selectively targeting therapeutics to brain tumor cells.
For more about brain tumor care, visit uchospitals.edu/brain-tumor.
Dan Kricke couldn’t find a surgeon experienced in treating adults born with hydrocephalus. now he’s headache free and headed to the altar. ChALLEnGE
In his day-to-day life, Dan Kricke didn’t give much thought to the shunting device in his brain. “I knew it was keeping me alive,” said the corporate communications specialist. “But that was about it.” Kricke, 27, was born with obstructive hydrocephalus — a blockage in his brain that interferes with the flow of cerebral spinal fluid and raises pressure in the brain’s ventricles. Just after his birth, doctors inserted a shunt to divert excess fluid away from his brain. Shunting devices are usually permanent, but need lifelong monitoring and maintenance.
Frim’s neurosurgical team performed two revisions on Kricke’s device, each time modifying shunt parts. “We did as little as possible to make improvements without causing too much trauma to the brain,” he said.
On February 6, 2013, Frim performed the minimally invasive surgery. Using an endoscope, he opened a tiny hole in the third ventricle, allowing cerebrospinal fluid to escape into its natural pathway. Today, Kricke’s headaches are gone. The shunt is no longer needed and could be removed. But he wants to wait awhile before undergoing brain surgery again. “I’m ready to have a little fun,” Kricke said. Part of that plan: propose to the girlfriend who never left his side when he had brain surgery. She said yes.
With the likelihood of shunt complications continuing, Frim suggested Kricke undergo endoscopic third ventriculocisternostomy (ETV) — an internal bypass in the brain to reroute excess cerebrospinal fluid. In some cases, ETV helps the shunt work better; and in other instances, the shunt is no longer necessary.
For more about care for adults with congenital anomalies of the nervous system, visit uchospitals.edu/congenitalanomalies.
Kricke had several surgeries to fine-tune the shunt before he turned 13, but then the device performed well for years. But in his mid-20s, after experiencing symptoms including lethargy, consistent pressure in his head and “feeling strange overall,” Kricke sought medical help. He contacted the children’s hospital where he was initially treated, only to learn pediatric neurosurgeons there didn’t care for adults with his condition. During his search for an adult specialist in Chicago, he discovered that most neurosurgeons do not treat older patients who have hydrocephalus or other congenital nervous system disorders, such as Chiari malformation, spina bifida, syringomyelia and craniosynostosis. Eventually, Kricke’s search led him to David M. Frim, MD, PhD, chief of neurosurgery at the University of Chicago FRIM Medicine. Frim leads one of the few programs in the nation that provide lifetime care for patients with these conditions. The team includes experts in neurosurgery, neurology, orthopaedic surgery, urology, rehabilitation medicine and genetics. “We understand the complex nature of congenital anomalies as well as the challenges patients face as children and as adults,” Frim said.
“now I can concentrate on getting married.” Dan Kricke proposes to girlfriend Gayle Shier at the 2013 Pitchfork Music festival in Chicago.
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The Memory Center at the University of Chicago Medicine offers comprehensive evaluations and treatment for people with dementia and other memory problems. Compassionate care is delivered by a team that includes neurologists, geriatricians, psychiatrists, neuropsychologists, nurses and social workers.
“We’re not afraid of atypical cases that are difficult to solve, but we also provide full-service care for patients with Alzheimer’s disease,” said James Mastrianni, MD, PhD, director of the Memory Center.
The University of Chicago Medicine’s sleep medicine program is equipped to handle the most challenging sleep disorders in adults and children. Our board-certified sleep medicine experts work closely with neurologists, psychiatrists, surgeons, cardiologists and other specialists to develop a customized treatment plan.
AT ThE forEfronT UnIVErSITy of ChICAGo MEDICInE SLEEP SCIEnTISTS
DISCoVErED rEM SLEEP (rAPID EyE MoVEMEnT) In
Hope for Adults and Children with Hard-to-Treat Seizures Different types of seizures respond to different medications. At the University of Chicago Medicine, our epilepsy experts use noninvasive, state-of-the-art technology to accurately characterize seizures. “When we match a seizure type with the right medication, magic can happen,” said neurologist James Tao, MD, PhD, director of the electroencephalography (EEG) laboratory. Advanced techniques include outpatient digital EEG recording; outpatient ambulatory EEG monitoring; inpatient TA O video EEG recording; and high-resolution CT, MR and PET imaging. Data from various scans are used to create functional 3-D models of patients’ brains that help pinpoint the exact source of seizures. These sophisticated diagnostic techniques also help the team plan surgical procedures in advance and with greater precision. “We specialize in working with individuals who have intractable epilepsy, defined as having failed with two or more drugs at appropriate doses in appropriate time frames,” said Michael Kohrman, MD, director of the pediatric epilepsy program. “At that point, we consider a different diagnosis, other medications and different options for therapy.” If testing shows that the seizure activity is localized to a single part of the brain, surgery often is recommended, Kohrman said.
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Studies show that surgery can significantly help up to 80 percent of patients with medication-resistant seizures. Sometimes, the best strategy is an implanted vagus nerve stimulator — a “pacemaker for the brain” — that reduces the frequency of seizures for many patients and eliminates seizures for a small number of patients. Treatments on the horizon include two new nerve stimulators now in clinical trials, new minimally invasive surgical techniques and new anticonvulsants currently approved or in clinical trials at the University of Chicago and other sites. In addition to offering the latest diagnostics and treatments, our multidisciplinary epilepsy teams offer a strong supportive network of specialists to help with the challenges of this condition. Unlike some centers, our epilepsy program provides seamless care for all ages, so there is no need to switch hospitals when a young patient reaches adulthood. “Our understanding of epilepsy’s impact on patients and families guides the individualized care we provide,” Tao said.
Both the adult and pediatric epilepsy centers at the University of Chicago Medicine are national Association of Epilepsy Centers (nAEC) Level 4 centers offering the most advanced medical and surgical care.
For more information on epilepsy treatment and research, visit uchospitals.edu/specialties/epilepsy/ and uchicagokidshospital.org/ specialties/epilepsy/.
Zane Smith, 4, on his way from England to the University of Chicago Medicine to see one of the world’s top experts on his rare brain condition. uchospitals.edu/ Zane-story
Advanced Treatment for the Most Severe Strokes With no time to waste, a patient having stroke symptoms should be treated at the nearest hospital certified for stroke treatment. After this initial care, some patients may benefit from the advanced interventions available at the University of Chicago Medicine. Our neurologists, neurosurgeons and interventional neuroradiologists can offer treatments that go beyond the standard first-line therapy of clot-busting drugs for patients with severe strokes caused by blood clots. Advanced procedures include thrombectomy, a minimally invasive technique to extract blood clots from arteries in the brain.
For more information on multispecialty stroke and neurovascular care, visit uchospitals.edu/ stroke-neurovascular.
Strokes caused by burst blood vessels are less common than those caused by clots, but often are more devastating. Up to half of all patients die, and many survivors of hemorrhagic stroke are left with severe disabilities.
The University of Chicago Medicine is participating in groundbreaking clinical trials of minimally invasive surgery to evacuate the blood from the brain through a catheter. “There really is hope for patients with intracerebral hemorrhages to make remarkable recoveries,” said Issam A. Awad, MD, director of neurovascular surgery at the University of Chicago Medicine and co-principal investigator of large NIH-funded clinical trials of minimally invasive surgery for intracerebral and intraventricular hemorrhage. Stroke patients in need of critical care are attended by a team of neurointensive care specialists in a unit equipped with advanced monitoring in the new Center for Care and Discovery. Our stroke experts also offer a customized, interdisciplinary approach to stroke prevention. “We tailor the best preventive treatments for each individual patient,” said neurologist James R. Brorson, MD, medical director of the University of Chicago Medicine’s Joint Commission– certified stroke center. Strategies may include blood pressure- and cholesterol-lowering drugs and diet and lifestyle changes. “We also can go beyond that, in individual cases, to consider other procedures that may lower the risk,” Brorson said. | B E L OW | neurologist James R. Brorson, MD, right, and interventional neuroradiologist Seon-Kyu lee, MD, PhD, collaborate on advanced treatment for severe strokes.
Expertise Draws Patients from Around the World Cerebral cavernous malformations (CCM) are brain lesions that form caverns where tiny blood vessels can expand like a balloon and leak. Issam A. Awad, MD, director of neurovascular surgery at the University of Chicago Medicine, is one of the world’s leading authorities on the disorder. The Angioma Alliance, a patient advocacy organization, designated Awad’s clinic as the preferred referral site for patients with the CCM3 mutation, the least common and most aggressive form of the disease. About half of children with CCM3 require brain surgery because of serious bleeds before age 10. Patients are monitored with advanced MRI studies to identify new lesions and assess how existing ones are changing. Awad and his colleagues are now working to identify biomarkers of the disease and to create drugs that will one day be used to prevent the lesions from developing or to control existing lesions. AT ThE forEfronT
The University of Chicago Medicine houses the
SURGiCAl CEnTER for an international, 60-center study of minimally invasive surgery for hemorrhagic stroke.
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THE BEST MinDS Ask the Expert: Christopher Gomez, MD, PhD Christopher M. Gomez, MD, PhD, is chairman of neurology at the University of Chicago Medicine. He specializes in neurogenetic disorders, gait and balance disorders, and a group of rare neurodegenerative diseases known as ataxias. Gomez, along with several colleagues, recently made a discovery that could lead to a treatment for one of the most common adult ataxias and potentially other neurological disorders. whAT IS MoST SIGnIfICAnT ABoUT yoUr rECEnT DISCoVEry?
It’s never before been seen that human messenger RNA could carry the coding sequence to make two separate proteins — that’s the new thing. Upon discovering this novel genetic mechanism, we immediately
recognized a strategy to potentially treat it, and we’re currently working on that strategy now. whAT MAKES ThE UnIVErSITy of ChICAGo MEDICInE A LEADEr In TrEATInG BrAIn DISorDErS?
We have a team of extremely well-trained neurologists, who are clinicians, educators and scientists. We have many clinical trials going on, and we are often able to offer the latest treatments to our patients. We are well known for our collaborative, multidisciplinary approach to treating patients with these complex disorders. Our multiple sclerosis program, established in 1976, has grown through the years to be a leading MS program nationally. Our neuroradiologists use very sophisticated imaging of the brain for early detection of
diseases such as Parkinson’s disease. We offer advanced surgical approaches for epilepsy and brain tumors. And we have a team of outstanding neurointensive care physicians. whAT Do yoU SEE AS ThE fUTUrE for TrEATMEnT of nEUroLoGICAL DISEASES?
I think the advances at the molecular level in the laboratory and at the engineering level are all going to be focused on providing many, many more diagnostic tools, drug targets and bioengineering strategies to modulate abnormal movements, detect and prevent seizures, and even potentially provide function where it was not present before.
MEET OUR nEW lEADERS
Jessica J. Kandel, MD
Douglas R. Dirschl, MD
Section Chief, Pediatric Surgery
Chair, Orthopaedic Surgery & Rehabilitation Medicine
hemangiomas and venous Jessica J. and lymphatic malformations. Kandel, MD, is the new “I’m excited about working section chief to advance the renowned of pediatric programs at the University surgery and surgeon-in-chief of Chicago Medicine and to at the University of Chicago push the boundaries of what Medicine Comer Children’s is possible for the benefit of Hospital. Kandel specializes children,” she said. in the surgical treatment of Kandel came to the University pediatric tumors, including Wilms tumor, neuroblastoma of Chicago from Columbia University College of Physand hepatoblastoma. She icians and Surgeons in helped develop groundNew York and Morgan breaking treatments for Stanley Children’s Hospital of vascular anomalies such as NewYork-Presbyterian Hospital.
Douglas R. Dirschl, MD, a nationally recognized orthopaedic surgeon, has been appointed chair of the Department of Orthopaedic Surgery and Rehabilitation Medicine. In his new role, Dirschl plans to expand on the department’s strengths as well as establish new and innovative programs for orthopaedic patients.
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Dirschl came to the University of Chicago from the University of North Carolina School of Medicine, where he was chair and a distinguished professor in the department of orthopaedic surgery. As the past president of the American Orthopaedic Association, Dirschl was instrumental in launching “Own the Bone,” a campaign designed to increase awareness of the serious consequences of bone loss and the growing prevalence of osteoporosis.
COMPASSION & CARE fOR ChIlDREN wITh CANCER Charles Rubin, MD, designed a custom treatment for a boy with a rare tumor. Today, the college freshman is pursuing his dreams as his doctor cheers him on. Bill and Barb Dawes were pretty sure their young son, William, wasn’t going to be winning any college sports scholarships, or even playing Little League baseball. “William was stumbling and falling a lot from about age 5,” Barb Dawes said. “At first we thought he was uncoordinated.” Later, his parents noticed William’s left leg was becoming thinner and shorter than the right and one side of his body was weak. MRI scans showed a tumor had invaded William’s spinal cord. “William has a slow-growing astrocytoma, which is the most common pediatric brain tumor, but its location in the spinal cord is rare,” said Charles Rubin, MD, director of the Brain and Spinal Cord Tumor Program at the University of Chicago Medicine Comer Children’s Hospital. Neurosurgeon David M. Frim, MD, PhD, removed as much of the tumor as possible, but most of it remained enmeshed in the spinal cord’s fibers. Only 7 years old at the time, William was too young for radiation treatment, which would have harmed his developing nervous system. Chemotherapy was the only option. Rubin had to adapt William’s yearlong chemotherapy regimen from pediatric
brain-cancer research studies, since none had been done on astrocytomas in the spine. Now 17, William is a freshman at North Central College, where he plans to study broadcast communications. His dream — to be a play-by-play announcer for the Chicago Cubs. The tumor is still present, but it hasn’t progressed since treatment. The Woodridge, Ill., teen didn’t play sports — the tumor caused him to develop scoliosis and his left leg has not caught up to the right — but he was the manager of his Montini Catholic High School football team, an announcer for the baseball team and a member of the jazz band and several honor societies. He became an Eagle Scout as a freshman. At one football game, a fundraiser for pediatric cancer research, William was surprised to find Rubin in the stands, rooting for his patient as much as for the team. “He’s a great guy,” William said. “He was always there during my treatments, is genuinely interested in me, and encouraged me to do what I wanted. I don’t know what I would have done without him.”
Dawes and Rubin
Children’s Cancer Clinics University of Chicago Medicine Comer Children’s Hospital HyDE PARK
University of Chicago Medicine Comprehensive Cancer Center at Silver Cross Hospital NEw LENOx, ILL.
Additional office locations NAPERvILLE, ILL. PALOS HEIGHTS, ILL. MERRILLvILLE, IND.
For more information on cancer care at the University of Chicago Medicine Comer Children’s Hospital, visit uchicagokidshospital.org.
SUNDAy, OCT. 6, 2013 » 9:00 AM Join us for the University of Chicago Medicine Comer Children’s hospital RBC Race for the Kids. Events include a 5K Run/walk, Kids’ Dash and Kids’ Mile. Contributions fund our lifesaving pediatric research programs.
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THE ART Of HEAlinG Brain cancer patients inspire a physician’s artwork and a nurse’s dedication “One aspect of making and viewing art is its healing power. it works at a very different level than traditional medicine, but it has the potential to transform, to widen experience and to brighten one’s life.”
Voices Against Brain Cancer in Chicago this year honored Kelly nicholas MD, PhD, with the Gary Lichtenstein humanitarian Award and Jean Arzbaecher, rn, APn, with the Compassionate Caregiver Award.
An art major in college, M. Kelly Nicholas, MD, PhD, directs the neurooncology program at the University of Chicago Medicine. Emotions evoked in his abstract works of ink on paper are colored by his experiences as a physician.
“We celebrate good scans and cancer-free anniversaries and give confidence and hope when challenges arise.”
“I work with people who have very serious medical conditions and they undergo a number of personal transformations in the course of living with brain cancer,” he said. “My art has evolved in response to the impact that my patients have had on me.” Nicholas is working on several pieces to be considered for display in the University of Chicago Medicine Center for Care and Discovery. “I left ‘art school’ behind when I entered medical school, but I never stopped thinking about art making.”
As a nurse specializing in treating brain cancer, Jean Arzbaecher, RN, APN, knows how difficult daily life can be for her patients, especially when tumors alter speech, mobility, memory, cognition and mood. “Brain cancer affects every aspect of who you are, and the biggest issue is helping people maintain their independence,” said Arzbaecher, who has advanced certification in neuroscience nursing. So when Arzbaecher couldn’t find a nearby support group to help her patients learn strategies to deal with brain cancer– related disabilities, she started one with
the help of a patient, Rich Portwood, and his wife, Chris. Three years later, the group, which meets in Homewood, Ill., is one of the largest in the country — more than 100 patients and caregivers strong. “Jean’s commitment, knowledge and caring are the reasons why our support group is so successful,” said Chris Portwood, who has lived with her husband’s brain cancer for 26 years. “Her calm advice is reassuring and comforting.” Added Rich: “Jean is an amazing person. I’ve never asked her a question she couldn’t answer.” Always intrigued by the complexity of the brain, Arzbaecher likes personalizing care to each patient’s unique treatment, symptoms and challenges. “I try to make people better when I can, but I know I can always strive to make their lives better by helping them through their journey with cancer,” she said. Jean Arzbaecher, Rn, APn
T h E B E S T M I n D S I n M E D I C I n E C o L L A B o r AT I n G w I T h yo U o n yo U r h E A LT h Q U E S T I o n S & C o n C E r n S
Events 1, 2 and 3 take place at Wellness House: 131 N. County Line Road, Hinsdale, Ill. To register, please call 1-888-824-0200.
Breast Cancer Reconstruction Workshop OCt. 17 | 6:30 to 8 p.m. David H. Song, MD, chief of plastic and reconstructive surgery, will provide information about options for breast reconstruction, factors to consider in making the decision, and what to expect during and after reconstruction surgery.
Carcinoid Cancer Update NOv. 16 | 10 to 11:30 a.m. Oncologist Blase Polite, MD, an expert on gastrointestinal malignancies, will give an overview of treatment options, the current standard of care and tools to manage the side effects of carcinoid cancer.
treating Multiple Myeloma, Leukemia and Lymphoma with Stem Cell transplants
Prostate Cancer: Is a PSA test Worth the trouble? NOv. 19 | 6:30 to 7:30 p.m.
NOv. 19 | 6:30 to 8:00 p.m. Michael Bishop, MD, director of the Hematopoietic Stem Cell Transplantation Program, will talk about the types of stem cell transplants, what to expect before and after a transplant, and treatment options for recurrences or secondary cancers. Bishop also will discuss the lifestyle impacts of a transplant.
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Radiation oncologist Daniel Golden, MD, will discuss prostate cancer screening, diagnosis and treatment options. University of Chicago Medicine Comprehensive Cancer Center at Silver Cross Hospital 1890 Silver Cross Blvd., New Lenox, Ill. To register, call 1-888-660-hEAL.
CO U P L E S U P P O RTS
SURGEOn’S RESEARCH Donors Collaborate on a Cure When Winnetka resident Bill Davis learned he had a life-threatening condition, the words of a physician he had yet to meet put him at ease. Neurosurgeon Issam A. Awad, MD, called the retired executive immediately after reviewing his scans. “He said, ‘I am going to help you; we know how to fix this,’” Davis recalled. Awad, director of neurovascular surgery at the University of Chicago Medicine, is an expert on vascular malformations of the brain. He is co-author of the only medical textbook on dural arteriovenous malformations, including abnormal connections, or fistulas, between veins and arteries that develop in the covering of the brain. Blood flow through the brain becomes sluggish and congested, and the condition, if untreated, can lead to paralysis or stroke. “So it’s like your sump pump failing, and the brain’s blood drainage backing up,” Awad said. To treat Davis, retired chairman, president and CEO of R.R. Donnelley & Sons Company, Awad teamed with Seon-Kyu Lee, MD, PhD, director of interventional neuroradiology. Working through a small hole in the groin, Lee threaded a tiny catheter to the point of the
malformation. Then he injected medical “superglue” to block the fistula, successfully shutting down the abnormal connection between arteries and veins. “Whenever possible, we treat the lesion using this less invasive catheter technique to avoid much riskier open brain surgery,” Lee said. “We were extremely pleased that we were able to repair Mr. Davis’ fistula.” Davis’ condition was so rare that many neurosurgeons do not see a case like it in their entire careers, Awad said. He suggested further testing, which uncovered a rare blood clotting tendency that may have caused the fistula to develop. This can be treated with medication to prevent future problems, Awad said. Grateful for the expert care he received, Davis and his wife, Judy, asked Awad about his research on cerebrovascular malformations. The couple contributed $1 million to establish the Judy and Bill Davis Research Fund in Neurovascular Surgery. This fund will allow Awad to expand basic and clinical research efforts, leveraging the team’s recent discoveries in the laboratory to make a broader impact on patients. “Bill and Judy’s gift is the ultimate recognition of our contribution to his life,” added Awad. “Fate brought us together, and we are so happy for this bridge between excellent care and our mission of discovery.”
For more information or to support neurovascular research at the University of Chicago Medicine, please contact Stephanie Dahl at email@example.com.
Bill and Judy Davis (left) and issam A. Awad, MD
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