Inspired FALL 2013
a P h Ys i C i a n P u B l i C at i o n
Adult and pediatric brain tumors
BRAIN MATTERS Medicationresistant seizures
Multiple sclerosis research a l s o i n t h i s i ss u e :
John Maunsell, PhD, to Lead New Neuroscience Institute
MISTIE and CLEAR trials
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
aT T H e f O R e f R O n T O f M e D i C i n e
of Chicago, the University of Chicago 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; ranked 8th of all U.S. medical schools; one of only 41 National Cancer
Our physicians, surgeons and scientists work in close association to develop and apply the latest treatments.
Institute-designated Comprehensive Cancer Centers; ranked third in nation for National Institutes of Health grant support per researcher.
University of Chicago Medicine & Biological Sciences Executive Leadership 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 Sharon O’Keefe, president of the University of Chicago Medical Center Jeffery Glassroth, MD, dean for clinical
Few specialties speak
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Discovery, and examine some of our top
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for Comprehensive MS Care, a nationally
affairs, University of Chicago Medicine
the collaboration of multiple specialists
T. Conrad Gilliam, PhD, dean for
and technologies to deliver an accurate
recognized center of excellence.
diagnosis and to chart a course toward
Our most exciting news, however, is
a successful outcome. This is one
the arrival of internationally recognized
education, Pritzker School of Medicine
of our strengths at the University of
neuroscientist John Maunsell, PhD, who
INSPIRED iS PubliSHeD THRee TiMeS
will join the University of Chicago as
research and graduate education, Biological Sciences Division Holly J. Humphrey, MD, dean for medical
a yeaR by THe univeRSiTy Of CHiCaGO MeDiCine & biOlOGiCal SCienCeS.
the inaugural director of the Grossman Whether testing vaccines to attack
Institute for Neuroscience, Quantitative
glioblastoma multiforme, employing
Biology and Human Behavior. He will
noninvasive imaging to identify seizure
oversee the development of a highly
types or designing nanoparticles to
collaborative, world-class neuroscience
deliver vital medications, our physicians,
institute that builds upon our diverse
Thea Grendahl Christou, Tanya Cochran,
surgeons and scientists work in close
strengths, ranging from evolutionary
Elizabeth Gardner, Kevin Jiang,
association to develop and apply the
and quantitative biology to economic
latest treatments. Coupled with our
and social behaviors.
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commitment to healing the whole patient,
Jean Lachat, Bruce Powell and Jason Smith
not just the disease, the result is a
Thank you for trusting the University
comprehensive approach to care.
of Chicago Medicine with your patients. We look forward to continuing this
The university of Chicago Medicine 5841 S. Maryland Ave., Chicago, IL 60637 The university of Chicago Medicine Comer Children’s Hospital
Throughout this issue of Inspired are
relationship well into the future.
stories of patients who have benefited
5721 S. Maryland Ave., Chicago, IL 60637 Telephone 1-773-702-1000 appointments 1-888-824-0200 Follow the University of Chicago Medicine 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 Inspired online at uchospitals.edu/inspired.
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 JOHN MAUNSELL, PHD,
Joins the University of Chicago to Lead New Neuroscience Institute John Maunsell, PhD, has been named the inaugural director of the Grossman institute for neuroscience, Quantitative Biology and human Behavior. Maunsell, an internationally recognized quantitative neuroscientist from harvard Medical school, will oversee the development of a highly collaborative, world-class neuroscience institute.
The Grossman institute builds upon the University of chicago’s diverse strengths, ranging from evolutionary and quantitative biology to economic and social behaviors. it leverages the close integration of research, education and patient care in the academic medical center. faculty will be drawn from across the biological, physical and social sciences and engineering to address fundamental questions related to neuroscience and behavior in the context of biological, environmental and social interaction data.
ALS Clinic Provides Full Range of Services, Including Diaphragm Pacing The University of chicago Medicine offers comprehensive, multidisciplinary care and access to clinical trials for patients with amyotrophic lateral sclerosis (als). studies show that als patients whose treatment is managed in multidisciplinary clinics have an improved quality of life and longer survival, said Raymond P. Roos, MD, director of the als Multidisciplinary clinic, which is funded by the Greater chicago chapter of the als association. Roos also currently has several research grants investigating novel treatments for the disease.
feeding tube placement can be risky in als patients with respiratory muscle weakness; the clinic has a dedicated team for that purpose. Two pulmonologists help guide end-of-life decisions. Other services include speech, occupational and physical therapy, nutrition counseling and help with assistive devices. leading-edge treatments include the neuRx Diaphragm Pacing system (DPs), an implantable device developed for quadriplegics to breathe without a ventilator that’s been approved for als patients.
Maunsell has served since 2008 as editor-in-chief of the Journal of Neuroscience, one of the top peerreviewed journals in its field and the chief publication of the society for neuroscience, the world’s largest neuroscientist organization. he is a member of the american association for the advancement of science and was a howard hughes Medical institute investigator.
Immunotherapy Clinical Trials Target Aggressive Cancer University of chicago Medicine neuro-oncologists and neurosurgeons are studying novel treatments for glioblastomas. “These studies, all in different clinical phases, are designed to use a vaccine to target cancer-related proteins on the tumor’s surface or to extract a complex of proteins and tumor antigens from the patient’s tumor to create a customized vaccine,” said M. Kelly nicholas, MD, PhD, director of the neuro-oncology program. neuro-oncologist Rimas lukas, MD, and neurosurgeon Maciej s. lesniak, MD, are co-investigators.
a vaccine designed to trigger an immune response to a mutant form of the epidermal growth factor receptor (eGfRviii), a protein expressed on the surface of tumors in a third of patients with glioblastoma, is being investigated in combination with standard-of-care therapies in separate studies for newly diagnosed and recurrent glioblastomas. Researchers also are investigating a vaccine against the Wilms tumor antigen (WT1), overexpressed in 80 percent of patients with malignant brain tumors, and a heat-shock protein vaccine.
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RaRe sYMPtoM FoR neuRoBlastoMa
neuroblastoma, which stems from immature nerve cells generally found near the adrenal glands, can also develop near a child’s spine or within the chest or abdomen, most often in children under 2 years of age. a team of physicians at the university of Chicago Medicine Comer Children’s hospital, in collaboration with international researchers, noted a rare condition in three patients subsequently diagnosed with paraspinal neuroblastoma. The researchers, led by pediatric neurologist Kenneth silver, MD, found narcolepsycataplexy, a rapid onset of the reM sleep stage combined with sudden muscular weakness, in all three patients. In two cases, neurological symptoms resolved with treatment of the tumor and immunosuppression therapy. The findings, published in the July issue of Pediatric Neurology, marked the second documentation of narcolepsy-cataplexy as a presenting symptom of paraspinal neuroblastoma. 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.
Research News BioPaRtiCle shows PRoMise FoR Ms
neurologist richard P. Kraig, MD, PhD, has been awarded a five-year, $1.5 million nIh grant to develop stimulated dendritic cell-derived exosomes that show promise as a treatment for multiple sclerosis and other neurological diseases involving loss of myelin, the insulation around nerve fibers. exosomes produced in the blood appear to play a causal role in the protective effects of regular exercise and learning, collectively known as “environmental enrichment,” on the brain. These exosomes contain specific micrornas that promote myelination of aging brain as well as brain damaged by multiple sclerosis modeled in animal brain tissues. Based on this discovery, the Kraig lab is currently exploring the possibility of using cultured dendritic cells to recreate this effect. To do so will open new research opportunities for treatment of disorders that occur with a loss of myelin. Image courtesy of the NIH Common Fund.
$1.5 million nih grant to develop stimulated dendritic cell-derived exosomes enCouRaGinG news FoR anoRexia neRVosa
shifting treatment emphasis from only weight recovery to also include better quality of life, reduction of mood disorders and enhanced social adjustment led to surprising improvements in patients with severe and persistent anorexia nervosa in a multinational clinical trial.
More than 85 percent of patients completed treatment — almost three times the usual retention rate. goals for cognitive behavioral therapy and specialist supportive clinical management emphasized retention, improving quality of life and avoiding “further failure experiences.” The patients, whose average duration of illness was more than 15 years, participated in goal setting. results from these approaches showed significant improvements on many measures, including increases in BMI and decreased depression. The study, reported online in Psychological Medicine in May, was the first randomized clinical trial for patients with severe and enduring anorexia nervosa. The university of Chicago eating Disorders Program served as data coordinating center.
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RaCial DisPaRitY in olFaCtoRY DeCline
a new study shows that age-related smelling loss is significantly worse in african americans than in Caucasians. olfactory loss may lead to impaired nutrition and be an early warning sign of neurodegenerative diseases such as alzheimer’s and Parkinson’s. The study, published in the Journal of Gerontology: Medical Sciences, is the first to report racial or ethnic differences, said author Jayant Pinto, MD, associate professor of surgery at the university of Chicago Medicine. “The racial disparity was almost twice as large as the well-documented difference between men and women,” Pinto said. The cause of this disparity is not clear, but genetic variation may play a role, as could exposure to nerve-damaging substances in the environment.
INSPIRED TO DISCOvER: MuLTIPLE SCLEROSIS Definitive Diagnosis and Comprehensive Treatment for MS university of Chicago Medicine physicians helped develop and test most of the currently available therapies for multiple sclerosis, including interferon, which 20 years ago became the first fDa-approved treatment for Ms. “Because we’ve had years of experience in clinical trials and see patients with more complicated disease, we can handle the toughest cases,” said anthony reder, MD, a neurologist in the university of Chicago Medicine’s extensive Ms program. “often, when new drugs come out, we’re ahead of the game because we’ve already been using the drugs in clinical trials.” reder directs the neurology and Inflammatory Disease Infusion Center, where fDa-approved and investigational therapies are used to treat Ms and other diseases. advanced MrI techniques aid our experts in evaluating whether a medication is working or if a different drug is needed. nine medications (three are taken orally) are available to treat Ms, and more are in the pipeline. nationally, there are 50 clinical trials of Ms drugs under way.
occurs in the first year. “for patients with Ms, early treatment is imperative,” reder said.
The University of Chicago Medicine is designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society.
The Multiple sclerosis Clinic at the university of Chicago Medicine has a well-established track record of providing definitive diagnoses and comprehensive treatments to help patients manage their symptoms and to limit flare-ups. The clinic recently received the Center for Comprehensive Ms Care designation from the national Multiple sclerosis society, awarded to centers that provide coordinated, multidisciplinary care for people with Ms, including medical, psychosocial and rehabilitation services. “This places us with nationally recognized centers for excellence in meeting all the needs of Ms patients,” said neurologist Jacqueline Bernard, MD.
Because we’ve had years of experience in clinical trials and see patients with more complicated disease, we can handle the toughest cases. anthonY ReDeR, MD
neurologists at the university of Chicago Medicine are active Ms researchers. With a four-year, $850,000 grant from the national Multiple sclerosis society, reder and his colleagues are working on a blood test that could serve as an inexpensive method for diagnosing Ms and choosing a treatment. Bernard is studying how safe, inexpensive, but advanced, optical coherence tomography (oCT) and specialized neurology software can be used to determine the extent of disease in patients with Ms and other neurological disorders, responses to treatment and side effects.
Prompt diagnosis is key, since most damage to the patient’s central nervous system at the FoReFRont
neurologist Jacqueline Bernard, MD, is studying the neurodegenerative aspects of Ms and other disorders using optical coherence tomography (oCt), which gives researchers a view of unmyelinated axons.
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COLLABORATIvE NEuROLOGICAL & NEuROSuRGICAL CARE four approaches to treating complex conditions therapies and research. experts in neurology, neurosurgery, psychiatry, otolaryngology and rehabilitation provide multidisciplinary care to patients and families, using advanced and practical approaches to diseases including Parkinson’s, ataxia, dystonia, chorea, tremor, tics and myoclonus.
Deep brain stimulation (DBS) for medication-refractory tremors
Patrick O’Brien, left, and Tao Xie, MD, PhD
Two years ago, police officer/paramedic Patrick o’Brien’s shaky hands were so noticeable that offenders would crack jokes when he fingerprinted them. “I was a detective and my partner at the time said, ‘you need to get that looked at,’” the 43-year-old south suburban resident recalled. o’Brien was diagnosed with essential tremor and tried medication first, but the side effects were intolerable. Then he heard university of Chicago Medicine physicians Peter Warnke, MD, director of stereotactic and functional neurosurgery, and Tao Xie, MD, PhD, medical director of the movement disorder program, give a talk about pharmacological and surgical treatments for movement disorders. To learn more about the Center for Parkinson’s Disease and Movement Disorders, visit uchospitals.edu/ movement-disorders.
o’Brien decided to undergo deep brain stimulation (DBs), a surgical treatment for movement disorders such as Parkinson’s disease, dystonia or essential tremor. Warnke performed the surgery in January 2013. Today, o’Brien can tie his own shoes, eat soup without spilling it and overall, enjoys a much better quality of life. “Most of the DBs outcomes are phenomenal,” said Xie. The procedure involves placing an electrode in deep parts of the brain to deliver continuous high-frequency electrical stimulation to control movements. This stimulation is thought to suppress abnormal patterns of activity in these brain areas and bring them closer to normal. “During the procedure we can immediately see the tremors decreasing,” Xie said. The university of Chicago Center for Parkinson’s Disease and Movement Disorders combines clinical expertise, state-of-the-art
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“We can quickly apprise patients and referring physicians of the most advanced research in patient care,” Xie said. “for example, we’ve found that by programming the frequency of deep brain stimulation, we can improve some gait disorders and vocal and swallowing function.” The university of Chicago Medicine’s program is designated a Center for advanced research by the american Parkinson Disease association. Xie is actively involved in clinical trials for Parkinson’s disease, deep brain stimulation, progressive supranuclear palsy and huntington’s disease. Warnke’s research focuses on molecular and physiological imaging of movement disorders to tailor surgical approaches to the patient’s individual pathophysiology. “We always try medication first but as a disease progresses, medications may fail, lose their benefit or cause other complications, so we consider other possibilities,” Xie said. “We’re happy to continue working with referring physicians and we have ongoing research to constantly improve treatment.”
Clinical trials for movement disorders: Parkinson’s disease Deep brain stimulation Progressive supranuclear palsy huntington’s disease
Stent placement for intracranial arterial stenosis when medical management fails When a 2011 multicenter trial concluded that medical therapy is superior to angioplasty and stent placement for patients with intracranial arterial stenosis, university of Chicago Medicine interventional neuroradiologist seon-Kyu lee, MD, PhD, was surprised.
“The consequences were preventing him from doing what he loves, and he was at high risk for another stroke.” Cox’s medical team, lee and neurologist James r. Brorson, MD, planned a conservative treatment approach. Brorson first treated him with medications. But the severity of the vessel blockages continued to hinder blood flow to the brain. as the next step, lee performed balloon angioplasty, gradually inflating the balloons (1.5 mm to 3 mm) just enough to slightly improve blood flow. Cox’s condition initially improved, but the symptoms eventually returned. “I started blacking out,” he recalled, describing his vision as seeing “slivers in a cracked mirror.”
“My patients did not experience the problems with stenting reported in the study,” said lee, who has performed more lee than 60 of the procedures. other neurovascular specialists in the country also reported success with the neurointerventional technique.
Patients participating in the trial (called saMMPrIs for stenting and aggressive Medical Management for Preventing recurrent stroke in Intracranial stenosis) had survived a stroke attributed to stenosis in a major artery. enrollment was halted at 451 patients when stroke or death was reported in 14 percent of patients who had undergone stenting versus 6 percent in patients who had medical therapy. respecting the trial conclusions, lee and his colleagues are currently applying intracranial angioplasty and stent placement only in patients for whom medical management has failed.
lee and Brorson determined that Cox’s condition left angioplasty and stenting as the only alternative. on april 23, 2013, lee placed and inflated progressively larger balloons until he opened a 4 mm balloon at the catheter tip. The blood vessel wall widened to 90 percent, and lee positioned the stent in place. By the time Cox left the hospital, his symptoms were gone. follow-up tests showed his brain blood flow has been normalized. according to lee, the risk of the artery narrowing again is less than 15 percent. “I’ve encouraged him to go back to his normal life,” lee said.
“until new trial data proves otherwise,” lee said, “we will be cautious about the treatment and use it only as a last resort.”
| l e f T, a | Before neuroendovascular treatment, one of the vertebral arteries in Jim Cox’s brain was almost completely blocked. | l e f T, B | After balloon angioplasty with stent placement, the artery opened to 90 percent.
For more about neurointerventional surgery, visit uchospitals.edu/ neurointerventional.
Just such caution was taken with Jim Cox, a former helicopter test pilot and late-model stock car enthusiast from Dyer, Ind. Cox came to the medical center with symptoms of double vision, slurred speech and balance difficulties after suffering a stroke. “Jim’s stroke left one artery in the brain completely blocked and another one 90 percent narrowed,” lee said.
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| l e f T | Pre-op image shows a homogeneously enhancing mass in the CP angle compressing the brainstem. | r I g h T | Post-op image shows gross total resection of the mass, decompression of the brainstem and the residual presence of thickened dura at the petrous apex.
Experienced neurosurgeon removes challenging brain stem meningioma susan Tyra had forgotten about the meningioma in her brain. Diagnosed when she was in her early 40s, the pea-sized benign tumor didn’t cause any symptoms for nearly two decades. But when the Wheaton, Ill., resident started experiencing daily headaches and dizzy spells a few years ago, she became concerned and saw her family physician. a CT scan revealed that the meningioma had grown to a 5 cm oval. The consensus from family members and friends: go to a major medical center for treatment.
the cranial nerves that were wrapped around the lesion. electrophysiologists monitored Tyra’s motor and sensory function throughout the operation.
and needed to be removed. “The tumor was not yet threatening susan’s life, but it was likely still growing,” he said. “as it got bigger, symptoms would have progressed to weakness in the arms and legs, headaches and then coma.”
During the eight-hour procedure, yamini determined that a small amount of tumor, deep in the brain and attached to the cranial nerves, was too difficult to remove safely. Because it could be a source for recurrence, Tyra underwent six weeks of targeted radiation therapy to kill the remaining tumor cells.
yamini and his colleagues in the Brain Tumor Center at the university of Chicago Medicine have vast experience in the yaMInI diagnosis and treatment of brain tumors, including all types of metastatic tumors as well as acoustic neuromas and meningiomas, the most common benign tumors.
after the surgery, Tyra experienced some drooping on the right side of her face, double vision and deafness on one side. But six months later, only the hearing loss remained. “Dr. yamini told me before the operation that I could lose my hearing in the right ear, so I was expecting it,” she said. “It was just a small price to pay for the miracle of being around for many more years.”
When Tyra and her husband, rick snyder, met with university of Chicago Medicine neurosurgeon Bakhtiar yamini, MD, they were sure they had found the right physician. “for benign tumors less than 3 cm in diameter, we often do radiosurgery — a one-time, “We knew it the minute he walked into the focused radiation dose to the tumor,” room,” Tyra said. “he ‘got’ that the diagnosis yamini said. “But for larger ones, such as was shocking. he exuded confidence and the meningioma in susan’s brain, surgical empathy. he had a lot of training and did intervention is usually the best option.” this type of surgery all of the time.” The surgery took place three weeks later. The meningioma was pressing on Tyra’s after making an incision behind Tyra’s brain stem, yamini explained to the couple, right ear, yamini lifted the cerebellum. he meticulously removed the tumor, avoiding critical blood vessels, taking For more about brain pressure off the brainstem and dissecting tumor care, visit uchospitals.edu/ brain-tumor.
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at the FoReFRont BAKHTIAR yAMINI, MD, IS
TESTING A NANOPARTICLE “SHELL” capable of selectively targeting therapeutics to brain tumor cells.
ConGenital neRVous sYsteM DisoRDeRs
Multidisciplinary program provides care for adults born with anomalies of the nervous system adult patients with congenital anomalies of the nervous system often have a hard time finding treatment. The university of Chicago Medicine has one of the few programs in the nation providing comprehensive lifetime care for complications of hydrocephalus, Chiari malformation, spina bifida, syringomyelia and craniosynostosis. “We understand the complex nature of these illnesses as well as the challenges patients face as children and as adults,” frIM said David M. frim, MD, PhD, chief of neurosurgery. The program includes experts in neurosurgery, neurology, orthopaedic surgery, urology, rehabilitation medicine and genetics. Dan Kricke, 27, had a shunt inserted for obstructive hydrocephalus shortly after birth. although he had many revision surgeries as a child, the shunt performed well for most of his young adult life. But in his mid-20s, the corporate communications specialist sought medical help after experiencing worrisome symptoms, including lethargy, consistent pressure in his head and “feeling strange overall.”
Comprehensive lifetime care for complications of: hydrocephalus Chiari malformation spina bifida syringomyelia craniosynostosis
For more about care for adults with congenital anomalies of the nervous system, visit uchospitals.edu/congenitalanomalies.
With a likelihood of ongoing shunt complications, frim suggested Kricke consider endoscopic third ventriculocisternostomy (eTV). In some cases, the internal bypass procedure helps the shunt work better; and in other instances, the patient no longer needs the device. frim told Kricke that eTV would provide a long-term solution to hydrocephalus. Kricke responded, “let’s do it.” on february 6, 2013, frim performed the minimally invasive surgery. using a neurosurgical endoscope, he created a perforation in the floor of the third ventricle, allowing the cerebrospinal fluid to escape into its normal pathway for circulation. Today, Kricke reports that his headaches are gone and that he feels fine. frim’s team has turned off the shunt and told their patient that it can be permanently removed. But Kricke wants to wait a few years before undergoing brain surgery again. he proposed to his girlfriend this past summer at a music festival in Chicago. now, he said, “I’ll concentrate on getting married.”
Kricke 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 related nervous system disorders. eventually, Kricke’s search led him to the university of Chicago Medicine. frim’s neurosurgical team performed two revision procedures on Kricke, each time modifying or replacing a few parts of the shunt. “We did as little as possible to make improvements without causing too much harm or trauma to the brain,” frim said. “for example, we upgraded to an externally programmable valve.” Dan Kricke and fiancée Gayle Shier
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at the FoReFRont MeMoRY loss
The Memory Center at the university of Chicago Medicine offers comprehensive evaluations and treatment for people with dementia and other memory problems. “We specialize in difficult-to-diagnose atypical dementia, but we also provide full-service care for patients with alzheimer’s disease,” said James Mastrianni, MD, PhD, director of the center. The team of specialists includes neurologists, geriatricians, psychiatrists, neuropsychologists, nurses and social workers. Basic and clinical research teams are working on a variety of aspects of dementia, including the biological underpinnings of disease, early detection using specialized MrIs that focus on areas of the brain affected first, and new investigative therapies. sleeP PRoBleMs
restful sleep is necessary for good health. 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 for each patient. The university of Chicago Medicine was at the forefront of sleep research even before rapid eye movement (reM) sleep was discovered here in 1953. Current research examines links between sleep disorders, diabetes and overeating.
Comprehensive Approach to Treating Medication-Resistant Seizures in Adults and Children for most epilepsy patients, today’s medications control seizures effectively with minimal side effects. But for the one in three individuals who experience intractable seizures, advanced diagnosis and treatments are available at the university of Chicago Medicine’s adult and pediatric epilepsy centers. Both the adult and pediatric programs are recognized by the national association of epilepsy Centers (naeC) as providing the highest level Ta o of care for complex epilepsy. To achieve this designation, an epilepsy center must offer advanced neurodiagnostics and a broad range of therapies, including surgery. “We take a very comprehensive approach when treating patients who have not been well controlled,” said neurologist James Tao, MD, PhD, director of the university of Chicago Medicine’s electroencephalography lab. The state-of-the-art capabilities in the medical center’s epilepsy monitoring unit include digital eeg recording; outpatient ambulatory eeg monitoring; inpatient video eeg recording and analysis; and high-resolution CT, Mr and PeT imaging. Data from all imaging modalities are combined to produce a 3-D image of the brain and determine if surgery — often the first choice because of its high efficacy rate — is a viable option.
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These sophisticated diagnostic techniques help our team plan surgical procedures in advance and with greater precision. studies show surgery can significantly help up to 80 percent of patients who have medicationresistant seizures. When the focus of a patient’s seizures is difficult to pinpoint or when it is too close to vital brain functions, the best treatment strategy may be an implantable vagus nerve stimulator. The device reduces the frequency of seizures by half for many patients, and eliminates seizures for 3 to 5 percent of patients.
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.
In some instances, individuals are taking the wrong medications for their type of seizure. Tao refers to these cases as “pseudo-intractable.” “Diagnosis and classification can be challenging in hospitals that don’t have advanced diagnostic equipment,” he said. “When we match the seizure type with the right medication, magic can happen.”
at the FoReFRont
Advanced Treatment for Complex Stroke, Including MISTIE and CLEAR Trials
Complex stroke patients are those who may benefit from advanced interventions, such as thrombectomy. Patients who have suffered an intracerebral hemorrhage may be eligible to receive a groundbreaking treatment in a clinical trial.
The university of Chicago Medicine offers advanced interventions for acute stroke, including clinical trials of minimally invasive surgery for intracerebral hemorrhages. “We have developed a time-critical diagnosis protocol to facilitate transfers of complex stroke patients,” said neurologist James r. Brorson, MD, medical director of the Joint Commission–certified stroke center at the university of Chicago Medicine. “We have the advantages of an outstanding neuro-Intensive Care unit staffed by neurointensive care specialists and the collaborative interaction between neurovascular surgeons and neuroradiologists with expertise in endovascular treatment for stroke,” Brorson said.
For more information on multispecialty stroke and neurovascular care, visit uchospitals.edu/ stroke-neurovascular.
The university of Chicago Medicine is participating in the ongoing nIh-funded study of minimally invasive surgery with thrombolysis in intracerebral hemorrhage evacuation (MIsTIe). In the procedure, rtPa is used to thin the hematoma so it can be evacuated through a catheter. Issam a. awad, MD, director of neurovascular surgery and a pioneer in surgery for stroke for 20 years, is the co-principal investigator of the MIsTIe phase 3 trial. The inter-national, multicenter study is funded by the national Institutes of health (nIh) and will enroll 500 patients worldwide. The university of Chicago Medicine houses the trial’s surgical center and will monitor catheter placement and overall surgical performance and quality at 60 participating institutions. awad also is the co-principal investigator in a parallel nIh-funded study assessing clot lysis in intraventricular hemorrhage (Clear). In this procedure, the clotbusting agent is distributed through a catheter to quickly remove the blood from the cerebral ventricles.
The University of Chicago Medicine houses the
SuRGICAL CENTER for an international, 60-center study of minimally invasive surgery for hemorrhagic stroke.
3-D computer reconstruction of patient’s blood casts as seen on CAT scan of the brain (red), with dual catheters in place to break the clot (blue tubes).
After drug lysis of the clot.
Collaborating with Local Physicians on CCMs The university of Chicago Medicine is a center of expertise for cerebral cavernous malformation (CCM) treatment and research. 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 has designated his clinic as the preferred referral site for patients with the CCM3 mutation, the least common and most aggressive form of the disease.
awad is monitoring about 100 CCM patients from around the world. he and his team have developed advanced MrI techniques to count the number of lesions in the brain more accurately and analyze their composition and the condition of the surrounding brain tissue. awad uses this information to assess how the disease is progressing and anticipate lesions that may require surgical intervention. “We study the scans and share our impressions with the patient’s local physician,” awad said. In the laboratory, awad and his colleagues are working to identify biomarkers of the disease and create drugs to halt lesion development. In a study published in Stroke, the researchers demonstrated that the drug fasudil prevented the formation of CCM lesions in laboratory models. | l e f T | Advanced MRI techniques being developed at the university of Chicago Medicine detect CCM lesions (SWI) more accurately and track iron leakage in each lesion (QSM).
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AT THE fOREfRONT Of NEuROSCIENCES
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 conditions, gait and balance disorders, and ataxias. gomez is a leader in the field of diagnosis, management and basic laboratory research on the ataxias. his laboratory research concentrates on the molecular and cellular mechanisms of neurodegenerative disease. In a study that could change the way scientists view the process of protein production in humans, gomez and his colleagues discovered a single gene that encodes two separate proteins from the same sequence
of messenger rna. Their finding, published in Cell, opens the door for new therapeutic strategies for one of the most common adult ataxias. what sets neuRoloGY anD neuRosuRGeRY CaRe at the uniVeRsitY oF ChiCaGo aPaRt?
our specialists are not only clinicians but also educators and scientists. With multiple clinical trials going on, we are able to offer the latest treatments to our patients. our highly collaborative, multidisciplinary approach gives patients access to several experts in one place. We are thrilled to work with referring physicians to treat patients with these complex disorders. what MaKes the uniVeRsitY oF ChiCaGo MeDiCine a leaDeR in tReatinG BRain DisoRDeRs?
our multiple sclerosis program, established in 1976, has grown through the years to
P h Ys i C i a n R e l at i o n s Please contact your dedicated liaison by phone or email with any request. We are here to serve you. CaRol MaRshall
Director 1-773-702-9205 carol.marshall@ uchospitals.edu
Northwest Indiana 1-773-230-8496 michael.delarosa@ uchospitals.edu
Assistant Director 1-773-230-5236 email@example.com
South and Southwest Suburbs, 1-773-729-0822 anthony.turner@ uchospitals.edu
DeMetRia aVant Regional and Western Suburbs 1-773-717-0458 demetria.avant@ uchospitals.edu
Dionne MeeKins-MiChauD North and Northwest Suburbs, 1-773-717-0457 dionne.michaud@ uchospitals.edu
become a leading Ms program nationally. our neuroradiologists use very sophisticated imaging of the brain for early detection of diseases such as Parkinson’s. for epilepsy and brain tumors, we offer advanced diagnostic and surgical approaches. finally, we have a team of outstanding neurointensive care physicians. what Do You see as the FutuRe FoR tReatMent oF neuRoloGiCal Diseases?
advances will come from molecular studies in the laboratory and at the engineering level. These may bring about many more diagnostic tools, drug targets and bioengineering strategies to modulate abnormal movements, detect and prevent seizures, and even potentially provide function where it wasn’t present before.
from Bench to Bedside Wei Wei, PhD, is one of the more than 80 physician-scientists and lab-based neuroscientists at the university of Chicago who focus their efforts on neurological disorders. The assistant professor of neurobiology studies the assembly of neural circuits during development to perform specific visual tasks. The retina is a classic model system for studying how synaptic circuits perform neural computations, because visual processing begins when light strikes retinal photoreceptors. The retina collects information and sends abstract visual features, such as color, motion and contrast, to higher brain centers. Wei’s work is designed to provide definitive answers to the outstanding questions about how retinal circuits function, but it may also contribute to better vision care. “Dysfunction of retinal circuits is the ultimate cause of visual impairment in most eye diseases,” she explained. The alfred P. sloan foundation recently named Wei a 2013 sloan research fellow — an award for early career scholars of outstanding promise who have the “unique potential to make substantial contributions to their field.”
10 » the uniVeRsitY oF ChiCaGo MeDiCine insPiReD MaGaZine | FALL 2013
Wei Wei, PhD
chairs the newly created Department of orthopaedic surgery and rehabilitation Medicine at the university of Chicago Medicine. Dirschl previously was chair of orthopaedics at the university of north Carolina school of Medicine. he is the former president of the american orthopaedic association.
DouGlas R. DiRsChl, MD,
is the new section chief of pediatric surgery and surgeon-inchief at the university of Chicago Medicine Comer Children’s hospital. Kandel, an authority on the surgical treatment of childhood cancers, comes to Chicago from Columbia university College of Physicians and surgeons in new york. her expertise includes the development of groundbreaking treatments for vascular anomalies in children.
JessiCa J. KanDel, MD,
ChRistoPheR h. wiGFielD, MD,
joined the university of Chicago Medicine as assistant professor of surgery and associate surgical director of lung transplantation. Wigfield was director of lung transplantation and vice president for research and education at loyola university Medical Center. he is the educational affairs director at the International society for heart and lung Transplantation. husaM h. BalKhY, MD, has been named director of robotic and minimally invasive cardiac surgery. Balkhy, an associate professor of surgery, came to the university of Chicago Medicine from Medical College of Wisconsin and The Wisconsin heart hospital. he was chair of cardiothoracic surgery at TWhh and director of the Center for robotic and Minimally Invasive Cardiac surgery.
associate dean for clinical research, has been named section chief of hematology/oncology. stadler, director of the genitourinary program, had served as interim section chief since January.
insPiReD TO DISCOvER, TEACH & GIvE BACK eRnst lenGYel, MD, PhD, has been appointed chair of the Department of obstetrics and gynecology at the university of Chicago Medicine. lengyel specializes in the surgical treatment of gynecological cancers, including ovarian and endometrial cancer. JeFFReY B. Matthews, MD, chair of surgery and surgeon-in-chief at the university of Chicago Medicine, has been named president-elect of the Chicago surgical society. Matthews’ term as president begins in 2014. JeFFReY GlassRoth, MD, has been appointed dean for clinical affairs and head of the faculty practice plan. glassroth formerly was president and chief executive officer of the northwestern Medical faculty foundation, the faculty practice at northwestern’s feinberg school of Medicine. issaM a. awaD, MD, director of neurovascular surgery, received the shield of Distinction and Merit, the highest recognition from the lebanese order of Physicians. MiChael B. Gluth, MD, is the new medical director of the Comprehensive listening Center at the university of Chicago Medicine. gluth, who provides care for adults and children with ear and hearing disorders, came to uChicago from the university of arkansas for Medical sciences, where he was on faculty.
at the FoReFRont
walteR M. staDleR, MD,
joined the medical staff as assistant director of the aortic diseases program. ota, an expert in the surgical treatment of aortic diseases, was an assistant professor of surgery at Columbia university Medical Center. taKeYoshi ota, MD, PhD,
CHARLES RuBIN, MD, director of the Brain and Spinal Cord Tumor Program at the University of Chicago Medicine Comer Children’s Hospital, has been providing compassionate care for children with cancer for 25 years.
Two physicians have joined the staff at the university of Chicago Medicine Comprehensive Cancer Center at silver Cross hospital in new lenox, Ill. Medical oncologist GRaCe K. suh, MD, comes from Indiana university–Iu health. radiation oncologist Daniel w. GolDen, MD, is moving his practice from the university of Chicago Medicine main campus. professor of radiology and surgery, was recently recognized by the radiological society of north america with a 2013 honored educator award.
aYteKin oto, MD,
assistant professor of surgery, joins the Department of orthopaedic surgery and rehabilitation Medicine from Madigan army Medical Center in Washington. he completed his residency at uCsf and fellowship in spine surgery at Cedars-sinai Medical Center in los angeles.
JaMes M. MoK, MD,
associate professor of medicine, joins the university of Chicago Medicine as director of clinical cancer services. nabhan previously was with advocate health Care, where he served as chief of oncology and medical director of the Cancer Institute at advocate lutheran general hospital.
ChaDi naBhan, MD,
MiChael howell, MD, is the new associate chief medical officer for clinical quality at the university of Chicago Medicine. he comes to uChicago from harvard university and Beth Israel Deaconess Medical Center.
section chief of hospital medicine, was named a Master of hospital Medicine, the highest designation in the specialty. The society of hospital Medicine reserves the honor for hospitalists who have distinguished themselves through significant contributions to the field and to health care.
DaViD o. MeltZeR, MD, PhD,
DoRiane C. MilleR, MD, associate professor of medicine and director of the Center for Community health and Vitality, was appointed to a one-year term on the Patient-Centered outcomes research Institute (PCorI) advisory Panel on addressing Disparities. Miller is co-chair of the advisory panel. Continued on page 12
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Continued from page 11 university of Chicago Medicine cancer researcher Janet D. RowleY, MD, and oluFunMilaYo i. oloPaDe, MD,
associate dean for global health and director of the Center for Clinical Cancer genetics, were named to the first class of fellows of the american association for Cancer research academy. DaViD GoZal, MD, chairman of pediatrics and physician-in-chief at the university of Chicago Medicine Comer Children’s hospital, is the new secretary-treasurer of the american Thoracic society and will serve as aTs president beginning in 2016.
the Blumriese Professor of human genetics and obstetrics and gynecology, has been named chair of the Department of human genetics at the university of Chicago. CaRole oBeR, PhD,
professor of surgery and director of the Center for esophageal Diseases, is presidentelect of the International society of surgery, based in switzerland. Patti’s term as president begins in 2015.
MaRCo G. Patti, MD,
chief of endocrine surgery and associate director of the Maclean Center for Clinical Medical ethics, received the excellence in Medical ethics award from the american association of Clinical endocrinologists.
PeteR anGelos, MD, PhD,
MoniCa PeeK, MD, MPh,
assistant professor of medicine, was selected by the society of general Internal Medicine as the 2013 outstanding Junior Investigator of the year in recognition of her contributions to the field of academic general internal medicine. s. MuRRaY sheRMan, PhD,
chairman of neurobiology, has been elected president of the association of Medical school neuroscience Department Chairpersons (aMsnDC). his two-year term begins in 2014.
CME & EDuCATIONAL OPPORTuNITIES
The university of Chicago Medicine Comprehensive Cancer Center at Silver Cross Gastrointestinal Cancer CME Series
STEMI 2013: Treatment Options and Management for the Complex Patient 3rd Annual update on STEMI and Acute Coronary Syndromes DeCeMBeR 7, 8aM–12:30 PM
University of Chicago Gleacher Center 450 N. Cityfront Plaza Drive, Chicago
noVeMBeR 6: Colorectal cancer
11th Annual Current Concepts in Primary Care Sports Medicine
DeCeMBeR 5: Esophageal cancer
FeBRuaRY 27–MaRCh 1, 2014
Cooper’s Hawk Winery & Restaurant 15690 S. Harlem Ave., Orland Park, Ill.
Millennium Knickerbocker Hotel 163 E. Walton Place, Chicago
oCtoBeR 3: Pancreatic cancer
All events begin at 6:30 p.m. Dinner is provided. Space is limited. Register at cme.uchospitals.edu. For more information, call 1-773-702-3576.
2nd francis L. Lederer foundation Symposium on Esophageal Cancer Research oCtoBeR 14
University of Chicago Gleacher Center 450 N. Cityfront Plaza Drive, Chicago
Heart Rhythm Management 2013: State-of-the-Art Evidence Based Medicine oCtoBeR 26, 8aM–3PM
University of Chicago Gleacher Center 450 N. Cityfront Plaza Drive, Chicago
Endoscopic ultrasonography Live 2013 noVeMBeR 8–9
The University of Chicago Medicine Center for Care and Discovery 5700 S. Maryland Ave., Chicago
27th Annual Challenges for Clinicians DeCeMBeR 6–8
The Drake Hotel 140 E. Walton Place, Chicago
12 » the uniVeRsitY oF ChiCaGo MeDiCine insPiReD MaGaZine | FALL 2013
Beyond LDL Cholesterol: Risk Assessment and Biomarkers in Special Populations MaRCh 1, 2014, 8aM–2PM
University of Chicago Gleacher Center 450 N. Cityfront Plaza Drive, Chicago
MaRK YouR CalenDaR:
7th Annual Cancer Genetics and Applications to Clinical Practice aPRil 11–12, 2014
Hyatt Chicago Magnificent Mile 633 N. St. Clair St., Chicago
Novel Approaches for Complex valvular Heart Disease aPRil 26, 2014, 8aM–1PM
University of Chicago Gleacher Center 450 N. Cityfront Plaza Drive, Chicago
University of Chicago Medicine physicians are available to present in-office CME courses in greater Chicagoland and Northwest Indiana. For information, please contact Uchenna Hicks, firstname.lastname@example.org.
Register for CME events at cme.uchicago.edu .
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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