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what is neuroscience and how does it affect you?

BON SECOURS NEUROSCIENCE INSTITUTE


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Sharing expertise, saving lives

The Bon Secours Neuroscience Institute serves patients in eight acute care facilities in Richmond, Hampton Roads, and Rappahannock. Patients at each location benefit from the expertise of all Bon Secours’ physicians, thanks to an advanced teleneurology system — the largest stroke teleneurology network in Virginia. Teleneurology is a system by which a boardcertified neurologist is available via a high-definition video link to rapidly evaluate patients with neurologic emergencies.

The Bon Secours Neuroscience Institute

This technology has allowed Bon Secours to save lives. For example, the average national rate for treating stroke patients with a clot-busting drug called tPA is about 4 percent. Why is it so low? tPA should be delivered within 3 hours of symptom onset and within one hour of a stroke patient’s arrival at the hospital, according to the American Stroke Association’s guidelines. Meeting these deadlines is difficult, as patients often do not recognize the signs and symptoms of stroke because they’re not in pain or they don’t think a stroke could be happening.

The complexity of the human brain is astonishing. Your brain contains more than 100 billion neurons (brain cells) and more than 100 trillion synapses (neural connections) — more than the number of stars in the galaxy. Above: Stroke patients can be assessed rapidly by a board-certified neurologist

Disorders of the brain and central nervous system — such as epilepsy, via Bon Secours’ teleneurology network. Top left: The Bon Secours Neurology migraines, dementia, Alzheimer’s disease and stroke — are as complex as Clinic at Watkins Centre offers comprehensive care for neurological conditions. the brain itself. The Bon Secours Neuroscience Institute offers a continuum Using teleneurology, Bon Secours’ facilities have been able to speed this of advanced care, from diagnostics to treatment, for these and other conditions. Its caring doctors do more than treat patients; they also help them process and now approach 15 percent tPA treatment rates for acute stroke. Bon Secours St. Francis Medical Center has received the American understand their diagnosis and navigate a road to recovery. Stroke Association’s Target: Stroke Award for consistently being able to treat acute stroke under 60 minutes. The Bon Secours difference

Bon Secours • March 12, 2014

What’s unique about Bon Secours’ approach to treating neurological disorders? Dr. Stacey Epps, executive medical director of the Bon Secours Neuroscience Institute, puts it succinctly: “The team approach.” The physicians and medical professionals of the Institute work together, across several disciplines, to ensure every patient receives the best care for his or her condition and gets the knowledge and support needed to handle it.

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As part of the only Catholic healthcare system in Virginia, Bon Secours Neuroscience Institute strives to fulfill the mission of bringing compassion to health care and to being good help to those in need. “A patient who may be going through a rough time and has no insurance and little or no means to pay for treatments can receive the same care as those who have health care coverage,” Dr. Epps says, “and he can receive that care with kindness and respect, allowing him to keep his dignity in the face of personal misfortune.”

The Bon Secours Neuroscience Institute in Richmond includes two dedicated neuroscience clinics, four stroke centers, an epilepsy monitoring unit, a comprehensive neurodiagnostic center, the Neurovascular Center and several other neurology, neurosurgery and neurointerventional practices. The two comprehensive neuroscience clinics are located at:

Bon Secours Medical Group Neurology Clinic Memorial Regional Medical Center 8262 Atlee Road, MOB III, Suite 201 Mechanicsville, VA 23116 • (804) 325-8720

Bon Secours Neurology Clinic at Watkins Centre 601 Watkins Centre Parkway, Suite 250 Midlothian, VA 23114 • (804) 325-8750

Neurology Clinic at St. Mary’s Hospital Coming Soon!


Stroke and Aneurysm

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The brain consumes an incredible amount of oxygen, using 20 percent of your body’s supply. A stroke occurs when the blood supply to the brain is interrupted or there is bleeding in the brain. The resulting loss of oxygen causes cells to die and may lead to long-term disability or death. The majority of strokes are ischemic, occurring when a blood clot blocks the flow of blood to the brain. Other strokes are hemorrhagic, characterized by the rupture of a blood vessel in the brain. In treating stroke, speed is essential. Early treatment can lessen the effects of stroke and save lives. Bon Secours provides rapid treatment options that include intravenous thrombolytic (clot-busting) medication called tPA or Alteplase and advanced neuroendovascular procedures, in which the blood clot is mechanically removed from a vessel in the brain. All of Bon Secours’ hospitals in Richmond are Joint Commission Certified Primary Stroke Centers, a certification given only to facilities that adhere to strict, evidence-based standards of stroke care. One common cause of hemorrhagic stroke is cerebral aneurysm, which is a weak area in a blood vessel that balloons over time and may rupture, causing bleeding in the brain and a hemorrhagic stroke. At Bon Secours, aneurysm can be detected and treated with neurointerventional surgery.

What is neurointerventional surgery?

Neurointerventional surgery is a minimally invasive surgery technique to treat hemorrhagic stroke, brain aneurysm and other vascular diseases. Instead of performing traditional brain surgery, a neurointerventional radiologist makes a tiny incision, inserts a catheter into a vein or artery, and moves it up to reach the problem area. This procedure presents significantly less risk and a shorter recovery time than more invasive surgery.

Above: Dr. John Gaughen, Neurointerventional Surgeon

Working in tandem with university and private practice physicians, the Bon Secours Neuroscience Institute has the largest neurointerventional practice in Virginia. Surgeons can fill an aneurysm with a small platinum coil to prevent it from bursting; perform an embolectomy in advanced stroke, extracting the clot that’s blocking an artery in the brain; and perform other highly specialized endovascular therapies.

The Stroke Clinic

Experiencing a stroke can be frightening and overwhelming, both for the patient and his or her family. Patients often leave the hospital with lingering questions about what happened to them and how their lives have changed. That’s why Bon Secours Neurology Clinic created the Stroke Clinic, a special program to improve recovery and help prevent future strokes. One to two weeks after discharge, each patient has a follow-up appointment with the Stroke Clinic to review the imaging and test results, rehabilitation plan and prescribed medications. If a family’s having trouble affording medications, doctors will adjust them to lighten that financial burden. Most importantly, the clinic gives every patient and family the chance to ask questions about their stroke and get a map for the road to recovery, as well as education regarding controllable personal risk factors in an attempt to prevent another stroke.

To help identify stroke, remember the acronym FAST: Face: Sudden weakness or drooping of the face, or vision problems Arm: Sudden weakness or numbness of one or both arms Speech: Difficulty speaking; slurred or garbled speech Time: Don’t wait! Call 911 immediately if stroke is suspected.

Bon Secours • March 12, 2014

What should you do if you suspect stroke?

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Epilepsy Epilepsy, or seizure disorder, affects about 2.5 million Americans and is caused by abnormal electrical impulses in the brain. An individual’s epilepsy may be traced to any of a broad range of causes, including head injuries, brain tumors, stroke or inherited imbalances in sodium or sugar. In many cases, the cause can’t be determined. “Living with epilepsy is a challenge for both patients and their families,” says Dr. Meghan Rodden. “I have experienced this myself with my own father with seizures.” Going through that experience has helped her gain a greater understanding of patients and families’ needs, she says.

Clockwise from top: Dr. Meghan Rodden, Medical Director of the Epilepsy Monitoring Unit. Dr. Stacey Epps, Executive Medical Director of the Bon Secours Neuroscience Institute, addresses walkers at the Epilepsy Walk at Sunday Park. Sheila Broughton, Advance Practice Nurse at Bon Secours Neuroscience Institute.

Dr. Rodden is the medical director of the epilepsy monitoring unit (EMU) at St. Mary’s Hospital. Patients who are concerned about having seizures or who have seizures that aren’t well controlled can be admitted into the EMU so doctors can observe them and record their brain activity. Doctors can then determine the appropriate treatment. “This is optimal care for patient with spells or seizures,” Dr. Rodden says. “I am so grateful we are able to provide this service.”

Innovative epilepsy therapies

While medications are effective for most epilepsy patients, surgery is also an option. Bon Secours’ physicians stay up to date on the latest interventions, such as vagus nerve stimulation. In vagus nerve stimulation (VNS), a surgeon implants a silver dollar-sized, pacemaker-like device under the skin in the upper part of the chest. It’s connected via a wire to the vagus cranial nerve in the neck. The device is then programmed to electrically stimulate the nerve at regular, adjustable intervals. A patient can also control the device, turning it on to help stop a seizure in progress.

Bon Secours • March 12, 2014

Brain surgery can also control severe seizures. If neurologists are able to identify the exact location in the brain where seizures originate, called the seizure focus, surgery may be recommended to remove that area or interrupt the nerve pathways that conduct seizure impulses.

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Early Diagnosis of Dementia

Receiving a diagnosis of early-onset dementia is devastating for patients and their families. The good news is that an early diagnosis can lead to treatment that may delay problems with thinking or memory loss. There are many causes of dementia, including Alzheimer’s disease, vascular disease, frontotemporal lobar degeneration (FTLD), and dementia with Lewy bodies. Bon Secours takes an innovative approach to diagnosing and treating early-onset dementia. Clinical neuropsychologist Dr. Salmaan A. Khawaja conducts neuropsychological evaluations to help patients, their families, and their treatment providers better understand how issues involving the brain and body impact one’s thinking, memory, attention, concentration, judgment, mood, behavior, and day-to-day functioning. The Bon Secours team can also track the progression of dementia and determine the effectiveness of treatment. “Many times, a neuropsychological evaluation is the best method to determine why the problems are happening, and more importantly how to treat those problems so that our patients can enjoy life as mentally, socially, and physically healthy as possible,” Dr. Khawaja says. Having his neuropsychology practice integrated with a comprehensive neurosciences team allows physicians to identify and treat problems that have been missed elsewhere, Dr. Khawaja says, as well as expedite the treatment process. “I love that the excellent doctors, nurse practitioners, nurses, psychometrists, technicians, and staff with whom I work are as compassionate about our patients and what we do as I am,” he says. Below: Dr. Salmaan Khawaja, Neuropsychologist

Migraines

The word “headache” seems inadequate to describe the intense throbbing and pain that characterizes a migraine. Migraines are often accompanied by nausea, vomiting and sensitivity to light and sound. The causes of migraines are not well understood, although it’s known that certain things can trigger them, including: hormonal changes, stress, certain food additives, alcohol, caffeine, and certain foods, such as salty or processed foods. While there’s no permanent cure for migraine, there are several treatments available to help prevent them and lessen their severity. Pain-relieving medications such as triptans and glucocorticoids help many patients when taken after a migraine has begun. Other medications, such as antidepressants or cardiovascular drugs, may help prevent migraines from occurring. Another treatment option at Bon Secours is to administer therapeutic Botox injections in the forehead and neck muscles of some patients with intractable migraines.

Concussions

Most often caused by a blow to the head, a concussion is head trauma that can cause memory loss and problems with balance, coordination and concentration. The long-term effects of concussion, especially multiple concussions, may include epilepsy or cognitive impairment.

Bon Secours • March 12, 2014

Although concussions are common in contact sports and in falls, and may seem minor, it’s important to remember that a concussion is a traumatic brain injury. Carefully monitor young children after bumps on the head for signs of concussion, such as listlessness, unsteadiness, and changes in sleeping and eating patterns. If your child sustains a possible concussion while playing sports, don’t allow him or her to return to the game without being evaluated by a doctor. Seek emergency care anytime someone with a head injury loses consciousness, has a seizure, vomits repeatedly or seems confused.

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Bon Secours • March 12, 2014

Brain Tumors

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also engage neurosurgeons from Neurosurgical Associates to collaborate on your case so that you get a multidisciplinary team of experts consulting on your care.

Help coping with a brain tumor diagnosis

Brain tumors are masses of abnormal cells in the brain. Some are benign tumors, while others are cancerous. How do you know if you have a brain tumor? There are no universal symptoms. Brain tumors may cause sudden changes in personality or behavior; seizures; problems with balance, speech, hearing or vision; headaches that grow increasingly severe; or confusion. Brain tumor symptoms often mimic those of stroke, so it is critical to seek assistance as soon as symptoms are noticed. Whether a tumor is benign or malignant, all tumors can result in changes in lifestyle and quality of life. The Neuroscience Institute team assists patients in addressing not only your treatment for the tumor, but also how you live with the tumor afterwards.

If you or a loved one is diagnosed with a brain tumor, you don’t have to face this condition alone. The Cullather Brain Tumor and Quality of Life Center is a free resource center run by a brain tumor nurse expert, Dr. Sherry Fox, a patient advocate, Cathy Willis, and a licensed clinical social worker, Lee Carter. Together they offer free personal consultations with patients to help them understand what to expect and to provide practical help with appointments, referrals and other resources. The services of the center are open to any patient, regardless of where you are being treated for your tumor. The center also helps patients with free access to yoga, massage and other therapies. The Cullather Center is located at 5875 Bremo Rd., Suite 108, in the South Medical building at St. Mary’s Hospital. Please call the center at 804-287-7809 to discuss how the staff can help you.

If a brain tumor is suspected, the physicians at the Bon Secours Neuroscience Institute will carry out a neurological exam as well as imaging tests, such as magnetic resonance imaging (MRI), computerized tomography (CT) scans or positron emission tomography (PET). Our team will

Below: Thanks to the generosity of donors like these, the Cullather Center provides free support and resources to brain tumor patients and their families; Mark Stepanian, Maureen Stepanian, Jack Cullather, Tony Markel, Linda Stepanian, Leon Stepanian, Dr. Sherry Fox, Maribeth Carr, Tom Carr.


Movement Disorders

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Movement disorders are neurological conditions that cause slowed, abnormal or involuntary muscle movements. Bon Secours’ movement disorders team brings together a group of neurosurgeons and neurologists with special expertise in the diagnosis and treatment of Parkinson’s disease, dystonia, essential tremor, and other movement disorders.



Parkinson's disease

In Parkinson’s disease, neurons begin to malfunction and die. This decreases the brain’s production of dopamine, a chemical essential for the control of movement and coordination. The most common symptoms of Parkinson’s are tremors of the hands, arms, legs or jaw; muscle rigidity or stiffness of the limbs and trunk; slowed movements; and impaired balance and coordination. While Parkinson’s disease is not fatal, symptoms worsen over time, significantly affecting patients’ quality of life.

If you experience tremors or other symptoms, the Bon Secours Neuroscience Institute’s experienced physicians will perform a thorough neurological examination and appropriate testing to formulate a diagnosis.

Innovative treatments for movement disorders

While there is no cure for Parkinson’s disease and other movement disorders, there are many effective treatments that can alleviate symptoms. Medication is the first route. In about 10 percent of cases, surgery may be used to control symptoms of Parkinson’s disease and improve the quality of life when medication ceases to be effective or when medication side effects, such as jerking, tremor, rigidity and dyskinesias, become intolerable. Deep brain stimulation is considered the most effective surgical treatment for reducing tremors. This minimally invasive procedure implants electrodes that use electrical impulses to stimulate a target area in the brain, altering disruptive movement patterns and allowing normal functioning. Many patients regain control of their body movements with this device, which can be adjusted over time or even turned off.

Bon Secours • March 12, 2014

Advanced neurology diagnostic testing all at one facility. St. Francis Watkins Centre provides unique and one-of-a-kind services in the Richmond-area. This Automatic Nervous System (ANS) test is on the tilt table to determine autonomic neuropathy, a possible complication of a number of diseases. The tilt table monitors balance and equilibrium. It is a test of the peripheral nervous system. ANS affects heart rate, digestion, respiration rate, salivation, perspiration, Pupil diameter, urination and sexual arousal. Lavon Harris, medical assistant, with patient, at the Neurology Clinic.

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Pain Management Affecting approximately 100 million Americans, chronic pain is a debilitating condition. Unlike normal, temporary pain sensations, chronic pain persists. Sometimes the cause is evident — such as migraine, arthritis or nerve damage — and sometimes it’s unknown. As many as 20 to 40 percent of patients who suffer from neurological disorders also experience chronic pain. The Bon Secours Neuroscience Center for Pain Management provides treatments to patients experiencing all types of pain, including joint, back, neck, face and head pain. The Institute’s experienced neurologists are specially trained in pain medicine and apply innovative methods to manage and relieve pain.

THURSDAY, APRIL 10, 2014 5-8PM DOORS OPEN AT 4:45PM HIPPODROME THEATER 528 N. 2ND STREET RICHMOND, VA 23219

For patients who are experiencing chronic pain because of spinal conditions, our interventional pain management specialists can perform diagnostic nerve blocks to determine the source of the pain and follow up with other procedures that will potentially reduce the pain for a much longer period of time.

procedures to relieve chronic pain:

• SI Joint injections for chronic hip or buttock pain

• Facet joint injections for chronic back or neck pain due to arthritis of the back joints

HEAR ALL THE RIGHT NOTES TO BEAT STROKE. Get your groove on and stay in tune with your health at Bon Secours’ free evening of jazz at the Hippodrome Theater. Join us for a healthy dinner, wine tasting, jazz band and door prizes. And also learn about diabetes, good sleeping, healthy eating and more.

Bon Secours • March 12, 2014

Enjoy advice from an expert panel of physicians on stroke prevention, heart health, and how to have conversations with your primary care physician.

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Seats are limited, so register today. 359-WELL (9355) | bonsecours.com/jazzupyourhealth

BON SECOURS NEUROSCIENCE INSTITUTE

• Radiofrequency ablation: Once a diagnostic nerve block confirms the source of the pain, this procedure (applying electrical current near the sensory nerves) can provide four to eight months of significant pain reduction. • Epidural steroid injections for pain due to cervical or lumbar disc herniation or pinched nerves • Spinal cord stimulation trials for patients with persistent arm or leg radicular pain, chronic back pain after back surgery, or certain other chronic neuropathic pain conditions (severe diabetic neuropathy, complex regional pain syndrome, etc.) • Trigger point injections: injecting a small amount of lidocaine or other numbing medication into painful muscle areas to reduce spasm • Occipital nerve block to treat severe headaches originating in the upper neck, back of the head • Supraorbital nerve block to treat severe pain or headache in the for head, above the eyebrow

Bon Secours - What Is Neuroscience?  

What is neuroscience and how does it affect you?

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