The Kentucky Neuroscience Institute (KNI) integrates the expertise of the University of
Kentucky’s neurology and neurosurgery physicians and researchers. KNI is a regional
referral center dedicated to providing comprehensive care to our patients. Physicians
and scientists from both disciplines work collaboratively to find the causes and design
new treatments for neurological disorders.
Neurosurgeons and neurologists at KNI provide diagnosis and management of a wide
spectrum of neurological conditions involving the brain, spine and nervous system.
We are comprised of a highly experienced team of physicians that can treat children
and adults. Our team of world-renowned clinicians uses the most advanced surgical
and medical treatments for brain diseases and disorders. UK is on the leading edge
of patient care and is taking the next step by putting the power of an entire team of
specialists to work on your condition.
UK is first in the U.S. to conduct trial of new Parkinson’s disease treatment. A clinical trial being conducted at UK is investigating a new treatment strategy for Parkinson’s disease that, if successful, could drastically change future treatment of the disease and possibly halt or reverse brain degeneration. UK is the first in the U.S. to conduct the clinical trial.
Craig van Horne, MD, associate professor of neurosurgery in the College of Medicine and principal investigator of the clinical trial, came to the Kentucky Neuroscience Institute only two years ago, but he is already making significant contributions to research and patient care related to Parkinson’s disease. If successful, this procedure could significantly change the treatment of Parkinson’s disease and could have an impact on other neurodegenerative disorders as well. Learn more.
UK HealthCare's Stroke Program has received the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award. The award recognizes the program’s commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines. Read more about the Gold Plus Award »
Stroke patients at the Kentucky Neuroscience Institute have access not only to the region's top doctors, but also to the most advanced medical technology. The stroke center at UK Chandler Hospital was the first in the region to be designated as a Comprehensive Stroke Center.
Because a quick response can mitigate the effects of a stroke, it's critical to know the warning signs and get help as soon as possible, says Lisa Bellamy, director of the Stroke Care Network under the UK HealthCare/Norton Healthcare umbrella. That's why the network created SCOPE -- Stroke Community Outreach Prevention and Education Program.
“We call stroke a brain attack," says Bellamy. "Even young children can recognize stroke symptoms, and we emphasize the importance of calling 9-1-1 if they think someone is having a stroke. We want them to have a sense of urgency because once the damage happens from a stroke, it’s irreversible.”
These young students caught on quickly, she said.
“Every second, brain cells die and if too many die, your body just can’t work,” said 10-year-old Jamison Gordon, explaining what happens when blood flow to the brain is interrupted. “A stroke can easily kill you if you don’t catch it in time.”
FAST stands for Face, Arms, Speech and Time. For example, if a person’s face or smile is distorted because the muscles aren’t receiving signals from the brain, that’s a clear indication to call for help. Likewise, if the victim cannot raise one arm overhead or if their speech is garbled, it’s best to summon an ambulance. And the time factor is crucial: the sooner a stroke victim gets emergency care, the higher their chances of surviving a stroke with minimal deficits.
Stroke is the No. 1 cause of disability and the No. 5 cause of death in the United States. ACE P.E. teacher Kristi Landversicht booked SCOPE because she thought this age group could comprehend the basics. “The information is pretty easy to learn and good to know,” said Landversicht, who planned to quiz the students in their next class.
While SCOPE's colorful PowerPoint and cartoon video clips presented details in child-friendly terms, they didn’t sugarcoat the seriousness of the topic. “You can literally save a life,” Crystal Vires-Smith, SCOPE clinical associate, told students gathered in the gym.
Vires-Smith and SCOPE co-chair Carrie Sawyers touched on how the brain is the control center for the body and noted how a clogged artery or burst vessel can cut off crucial blood flow. “Every second lost, there’s more damage to the brain,” Sawyers stressed. “It’s an emergency. It’s a 9-1-1 event if there ever was one,” Vires-Smith added. The youngsters also asked poignant questions such as “Are the results permanent?” “Can you have a stroke twice?” and “Can stroke be contagious?”
The good news is that stroke is mostly a lifestyle event – that is, lifestyle choices can make a difference in the risk factors – and 88 percent of strokes are preventable. That’s why half of SCOPE’s “Brain Protector” lesson emphasized how students can reduce their risk through healthy living such as avoiding cigarette smoke, exercising regularly outdoors, and eating nutritious foods. “If I start at a young age, I’m less likely to have a stroke,” said 10-year-old Cooper Handshoe.
UK’s Bellamy agreed that establishing healthy habits in childhood is a great strategy. “The ideal scenario with stroke is you prevent it before it happens,” she said. “But there are risk factors you can’t do anything about like your family history, so we try to focus on the risk factors that can reduce the incidence of stroke.”
The Stroke Community Outreach Prevention and Education Program (SCOPE) offers free “Brain Protector” sessions for elementary schools. To schedule, call clinical associate Crystal Vires-Smith at (859) 218-0954.
Article co-authored by Tammy L. Lane , FCPS
LEXINGTON, Ky. (Feb. 10, 2015) -- The University of Kentucky's Kentucky Neuroscience Institute, Office of Clinical Simulation, and the UK HealthCare/Norton Healthcare Stroke Care Network have joined forces to offer a new kind of symposium for neuroscience and stroke care.
The Clinical Neuroscience Winter Expo, set for March 6 and 7, will be an informative, interactive event exploring the latest advancements in the neurosciences and stroke care.
"We wanted this to be very different from traditional symposia, so the Expo was designed to be highly interactive," said Dr. Michael Dobbs, director of UK HealthCare's Stroke Network. "Through the use of interactive learning methods and patient simulation equipment, our goal is to help attendees learn by doing and translate this new-found experience to current treatment practices."
Three different tracks are available to attendees: medical, interventional and research tracks are staggered throughout the day so that attendees are able to follow a single track or choose from each track according to their interests.
The keynote speaker will be Dr. Avindra Nath, clinical director of the National Institute of Neurological Disorders and Stroke (NINDS), the director of the Translational Neuroscience Center and chief of the Section of Infections of the Nervous System at the National Institutes of Health in Washington D.C., who will present, "Cracking the Code of Neuroinflammatory Disorders."
Pointing to the fact that the human and economic impact of neurological disorders is exacerbated by a prevailing shortage of neuroscience specialists and the burgeoning aging population, Dr. Dobbs emphasized that augmenting multi-specialty provider groups’ neuroscience awareness and knowledge base is key to improving equitable access and patient outcomes.
"Our goal with the Winter Expo is to provide that guidance in a new and interesting way, to the ultimate benefit of patients."
For more information about the Expo or to register, go to http://neurowinterexpo.com/.
LEXINGTON, Ky. (Jan. 29, 2015) – Dr. Larry B. Goldstein, a highly acclaimed expert in stroke and related disorders, has been named the next chairman of the Department of Neurology at the University of Kentucky College of Medicine and co-director of the Kentucky Neuroscience Institute.
Goldstein will be joining UK from Duke University where he is professor of neurology and Chief of the Division of Stroke and Vascular Neurology and director of the Duke Stroke Center and an attending neurologist at the Durham VA Medical Center.
“We are very pleased to welcome Dr. Goldstein to our team at the University of Kentucky and look forward to the leadership and expertise he will provide to the neurology department and the Kentucky Neuroscience Institute,” said Dr. Frederick C. de Beer, Dean of the College of Medicine. Goldstein will begin his post in June.
Dr. Goldstein received his bachelor’s degree in 1977 from Brandeis University and his medical degree from Mount Sinai School of Medicine in 1981. His subsequent professional training included an internship and neurology residency at Mount Sinai Medical Center, New York, and a research fellowship in cerebrovascular disease at Duke University.
Dr. Goldstein’s focus in his clinical, research, educational and service activities is on stroke and ischemic neurologic disorders. He has published more than 650 peer-reviewed journal articles, editorials, book chapters, abstracts, and other professional papers.
His research has spanned stroke-related laboratory-based studies, clinical trials, quality of care and care delivery studies, as well as clinical effectiveness and epidemiological investigations.
“I am extremely excited to be given this opportunity to come to UK and look forward to working with an incredible group of colleagues to further the work being done in the Department of Neurology and the Kentucky Neuroscience Institute," said Goldstein.
LEXINGTON, Ky. (Jan. 13, 2015) -- Today, Cheryl Castle sat with her three boys and thanked her doctors at UK HealthCare for choosing her to be the first Kentucky patient to receive Neuropace, a novel device that helps lessen the frequency and severity of her crippling epileptic seizures.
"I've been essentially housebound, and if I have a seizure during those few times I go out, it's embarrassing for me and my family," Cheryl says.
Cheryl is one of 3 million Americans with epilepsy, and one of the unfortunate 30-40 percent whose seizures are uncontrolled. For those patients, life is extremely limited: they cannot drive or hold a job. Furthermore, they are often stigmatized, which can lead to isolation and depression.
There are many different types of seizure, though a grand mal seizure, which involves a loss of consciousness and violent muscle contractions, is the type most people picture when they think about seizures. And Cheryl had grand mal seizures. Lots of them.
"I once had 42 grand mal seizures in 3 hours," she says. "I couldn't cope, my family couldn't cope. There was a lot of family tension."
Epilepsy is a neurological condition where disturbances in the normal electrical function of the brain cause recurrent seizures. People can have a single seizure from a high fever or an injury, but epilepsy is the diagnosis when seizures recur.
Cheryl's seizures began 18 years ago, stopping only during her pregnancies. Doctors unfamiliar with epilepsy gave her varying diagnoses, and even suggested her problems were psychological. The Lowmansville, Ky. native then made the 2 1/2 hour trek to UK, where Dr. Meriem Bensalem-Owen, director of the Epilepsy Program at UK HealthCare's Kentucky Neuroscience Institute, began the process of pinpointing the location of her seizures and drawing from an arsenal of treatments to help Cheryl.
"Medicine is almost always the first line of treatment and the vast majority of epilepsy patients are able to control their seizures with drugs," Dr. Bensalem-Owen said. "Unfortunately, we tried several different drugs, and none of them helped Cheryl."
Cheryl said the side effects of some of the drugs were intolerable. "Even if they did help -- and most of the time they didn't -- I was a walking zombie," she said.
Dr. Bensalem-Owen then tried a procedure called vagus nerve stimulation, in which a small device delivers regular impulses of electrical energy to the brain via a large nerve in the neck called the vagus nerve. It didn't work either.
Even worse, brain mapping showed that the focus of her seizures was in a crucial area of the brain controlling motor function. Surgery to remove the brain tissue, the usual next step in the treatment process, was not an option for Cheryl without the potential for permanent paralysis.
"She was disconsolate, and we were worried, as Cheryl was at extremely high risk for sudden death from her seizures," said Dr. Bensalem-Owen.
By then, however, Drs. Bensalem-Owen and Craig van Horne, the KNI neurosurgeon working with Cheryl, had heard of a novel therapy called Neuropace that was in clinical trials.
"Previous research has demonstrated that electrical stimulation of the brain can stop seizure activity," Dr. van Horne said. Based on this premise, scientists developed an implantable device that continuously monitors electrical activity in the brain, detects abnormal electrical activity and delivers imperceptible levels of electrical stimulation to normalize that activity before the patient can sense an oncoming seizure.
The system includes a box about the size of a flash drive that is implanted in the skull, two wires containing electrodes that rest on the area of seizure focus, and two external components: a remote monitor and a programmer.
"Metaphorically speaking, it's a defibrillator for the brain, much like a pacemaker for the heart or the paddles they use in the ER to shock a heart attack victim back to life," Dr. Van Horne said.
According to Dr. Van Horne, the device also records seizure activity, which Cheryl retrieves every day using a special monitor and sends to a database. "We can access and analyze Cheryl's data between appointments and assess whether adjustments need to be made," Dr. van Horne explains.
Dr. van Horne implanted the device in a 5-hour surgery last November. After four weeks of recovery, Dr. Bensalem-Owen took the device "live." Cheryl says she can already tell it's helping.
"I feel as if I'm having half as many seizures as before, and my seizures seem much less severe," she says. "I can't wait to get out more and do things with my family."
More importantly, Cheryl says, her sons Mitchell, 18, Michael, 15, and Nathaniel, 12, are reaping the benefits.
"I have more time to do homework and hang out with my friends now because my mom doesn't need me around to take care of her as much," Nathaniel says.
Dr. Bensalem-Owen stresses that Neuropace is not a cure -- Cheryl will continue to have seizures, but "we hope they will be fewer in number and less severe," she says.
"To the extent that Neuropace gives Cheryl relief and helps her resume a more normal life, it's a helpful treatment."
LEXINGTON, Ky. (Dec. 22, 2014) – UK HealthCare has temporarily amended its inpatient hospital visitation policy to be proactive in helping protect the health and well-being of patients and health care workers during this flu season. Visitation restrictions are in effect as of 7 a.m. Monday, Dec. 22.
The measures include:
o No visitors under the age of 12
o No visitors with any symptoms of flu-like illness
o Only two visitors will be permitted in a patient’s room at one time
o Visitors may be issued masks or other protective clothing for use when visiting
o Additional restrictions may be in place in special care units such as women's and children’s units, critical care and oncology units.
o Compassionate visitation exceptions will be made on a case-by-case basis.
"Due to an increasing number of flu cases in Kentucky, UK HealthCare will be instituting these procedures designed to help protect patients, visitors and staff from exposure to the flu and are in effect at all UK HealthCare inpatient units including University of Kentucky Chandler Hospital, Kentucky Children's Hospital, UK Good Samaritan Hospital and Eastern State Hospital," said Kim Blanton, enterprise director for infection prevention and control at UK HealthCare.
Last week, the Centers for Disease Control and Prevention reported that the flu was widespread in 29 of the 54 states and territories that it tracks -- including Kentucky. This time last year, it was widespread in only four.
It is still recommended everyone six months of age and older who hasn't received a flu shot yet, receive one, Blanton said. "A flu vaccine is still the first and best way to prevent influenza," she said.
Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Flu antiviral drugs are available and work best for treatment when they are started within two days of getting sick. However, starting them later can still be helpful, especially if the sick person has a high risk health condition or is very sick from the flu.
MEDIA CONTACT: Kristi Lopez, 859-806-0445 or firstname.lastname@example.org
LEXINGTON, Ky. (Dec. 23, 2014) -- Headaches are a common ailment; the World Health Organization estimates that almost half of us have a headache at least once a year. Unfortunately, because headaches are so common, they are often dismissed as insignificant. That's a pity, since many new options are available for the treatment of headaches, including medications and other therapies, lifestyle changes, and/or homeopathic remedies.
There are many different types of headache. Some examples include sinus headaches (usually associated with sinus infections), cluster headaches (tend to happen in groups, or clusters, with periods of relief between clusters), and tension headaches (the most common type, usually characterized by non-specific head pain).
Perhaps the most misunderstood is the migraine. Migraines are severe, pounding headaches made worse by routine activities and associated with nausea and sensitivity to light and sound. A migraine usually begins above the eyes, typically affects one side of the head, and tends to throb intensely, especially when you become more physically active and/or bend over. Some migraines have associated neurologic symptoms, known as aura, which cause disturbances in vision, language, and sensation.
Many patients find it helpful to keep a diary to identify possible headache triggers, such as cheese, red wine or foods with MSG. Too much caffeine from coffee or soda or over-the-counter pain treatments might actually increase headache frequency. Eating regular meals and getting plenty of sleep may also help.
Not all headaches should be regarded as a temporary nuisance. In fact, headache can sometimes be the only symptom of a more serious medical emergency, such as meningitis, stroke, or aneurysm. Learn to “SNOOP” out the cause of a headache to determine whether it requires immediate attention:
· Symptoms in addition to headache. Do you have fever, recent weight loss or other risk factors like HIV or cancer? Are you taking medicines that affect the immune system?
· Neurologic symptoms. Are you experiencing confusion, decreased alertness, vision changes, dizziness, numbness, or weakness?
· Onset. Did your headache arrive suddenly or abruptly?
· Older. New headaches in middle age, especially 50 years or older, can be a troubling sign.
· Previous headaches. Is this your first headache? Or is this headache different from your previous headaches (change in frequency, severity or associated symptoms)?
If you answer "yes" to one or more of the above, seek immediate medical attention.
Do not be embarrassed or afraid to seek help if you suffer from headaches. A physician who specializes in treatment of headaches can help you manage your pain. If your headache is a symptom of something more serious, the good news is that many of these conditions are treatable, especially if caught early. SNOOPing in this case is a good thing.
Dr. Paul Gadient is a neurologist at the UK HealthCare's Kentucky Neuroscience Institute
This column appeared in the December 21, 2014, edition of the Lexington Herald-Leader.
LEXINGTON, Ky. (Dec. 8, 2014) — Celeste Shearer beat leukemia at the age of 5 only to develop crippling seizures as a child. By the time she was in high school, the Hart Countian was having three to four seizures a month. Many of them were "clustered," meaning she'd have several over the space of a day or two, with dormant periods in between.
Epilepsy is a common neurological condition where electrical disturbances in the brain can cause seizures. Outward signs of a seizure are extremely varied, but might include twitching, repeated blinking of the eyes or rapid eye movement, garbled speech or other speech difficulties, or a loss of consciousness. Nearly 3 million Americans have epilepsy, and upwards of 30 percent of those people are severely affected.
Epileptics cannot drive for safety reasons, and epilepsy can interfere with schoolwork, extracurricular activities and a social life.
"It's an understatement that I didn't have a normal childhood," Celeste says. "It was difficult to even spend a lot of time at a friend's house or go to a slumber party, because my parents would worry that I might have a seizure."
Celeste tried six different types of medication — both alone and in combinations — to prevent her seizures, without success. The medications also had terrible side effects that left her anxious, angry, depressed, and disinterested in food. At one point she weighed just 80 pounds.
Worst of all, Celeste was an avid performer. The possibility of a seizure was a constant threat for this singer, French horn player, and "Poetry Out Loud" competition finalist.
Her father, Greg Shearer, watched helplessly as Celeste suffered.
"She was so frustrated by her school situation," he said. "She still tried to do marching band and theater, but the seizures would interfere. She had to be carried off the practice field several times."
Then Celeste and her parents met Dr. Sid Kapoor, director of the UK Epilepsy Network. In that first appointment, Kapoor knew immediately that Celeste's epilepsy was refractory, or drug resistant. Celeste's only option was to have surgery to remove the parts of her brain that were causing her seizures.
Usually this surgery involves removing about 4.5 centimeters of tissue from the left side of the brain and 6.5 centimeters from the right.
"It's normal to assume that all patients want the same outcome for their surgery: to preserve the left part of the brain, which controls speech," Kapoor said. "Thankfully, I asked Celeste what was important to her. She made it clear right from the start that her aspirations to become a professional performer meant that she also needed to preserve her ability to sing and perform — which can involve the right side of the brain."
For Celeste, Dr. Kapoor and his team needed to chart new territory: determining how much to take from the right side of the brain without compromising Celeste's ability.
That involved revamping the usual process. The team met to develop a series of complicated tests designed specifically to pinpoint the areas of Celeste's brain that responded to music.
"There were a lot of people involved," Kapoor said. "This went way beyond the usual process for an epilepsy patient."
First, Celeste underwent a functional MRI, during which Kapoor's team played music for her.
Then came highly sophisticated WADA testing. Celeste was kept awake while a catheter was snaked into her skull to deliver a medicine that “disconnects” small parts of the brain for about three minutes.
As the clock ticked, the team asked Celeste to sing. They repeated this process multiple times, using the collected data to map exactly which portions of Celeste's brain to preserve.
"It was an elegant solution to a challenging problem," Kapoor said. "The team worked together so seamlessly, forging new territory, to achieve this goal."
Kapoor and his team ended up taking less tissue from the right side than the usual 6.5 cm. It worked. Within a month, Celeste was seizure free and singing again. In fact, removing the tissue that was short-circuiting her brain and causing the seizures has actually improved her singing ability.
"We asked Celeste to sing for some colleagues, and she chose 'Under the Sea' from 'The Little Mermaid.' Everyone in the room was moved. I don't think there was a dry eye in the house," Dr. Kapoor said.
"The summer after my surgery was the first summer I could be a real teenager," Celeste says. "I could stay up late with friends and not worry about getting overtired, which would bring on a seizure."
Then Northern Kentucky University called offering Celeste a fine arts scholarship. Her dream was back on track.
"We are delighted that Celeste has the opportunity to pursue her dreams of performing on stage," said Greg Shearer. "Even though we have moved to the other side of the state we still go to UK for our major health care needs. I don't think I could trust anyone else."
LEXINGTON, Ky. (Dec. 4, 2014) – UK HealthCare has announced that The Medical Center at Bowling Green has become the newest member of the Norton Healthcare/UK HealthCare Stroke Care Network, a community-based stroke initiative providing the highest quality clinical and educational programs to hospital staff and the community. The Medical Center is the only hospital in south central and Western Kentucky to join the network that includes 25 affiliate hospitals.
“This affiliation with the Norton Healthcare/UK HealthCare Stroke Care Network will enhance The Medical Center’s ability to carry out our mission to care for people and improve the quality of life in the communities we serve,” said Connie Smith, president and chief executive officer of Commonwealth Health Corporation, parent company of The Medical Center. “Through collaboration with affiliate members, we will ensure patients in South central Kentucky have access to the most advanced stroke treatment and prevention.”
As part of the Norton Healthcare/UK HealthCare Stroke Care Network, the medical center will continue to be a first-line stroke treatment center. The collaboration will allow for the sharing of best practices and outcomes data to promote continuous quality improvement in stroke care.
“By educating members of the community and Emergency Medical Services personnel in the region, we work together to provide valuable information about recognizing the signs of stroke and the importance of early treatment,” said Dr. Michael R. Dobbs, director of the Norton Healthcare/UK HealthCare Stroke Care Network. “Our affiliate hospitals teach us about their communities and their patients. Meanwhile, we provide access to the resources and knowledge we have as an academic medical center.”
The Medical Center is the first hospital that was already designated as a Primary Stroke Center by The Joint Commission before joining the network. Other hospitals in the network obtained their Primary Stroke Center designation after becoming affiliates of the network.
“Primary Stroke Center designation by The Joint Commission is testament to the outstanding stroke care already provided by The Medical Center for stroke prevention, diagnosis and treatment,” said Smith. “This affiliation will further enhance the stroke care we provide by allowing us to tap into the resources and expertise of other affiliate members.”
Lexington, Ky. (Oct. 31, 2014)- A team from The University of Kentucky's Neurosurgery Residents program placed second in their first year of competition at The Congress of Neurological Surgery Resident Academic Competition. Dr. Steven Grupke and Dr. Farhan Mirza were the two residents selected for the team.
The live competition, which was held at the annual congress in Boston in Oct. 15-22, featured the top nine teams from an initial pool of 105 neurosurgery resident programs from the United States and Canada. The elimination process for the competition began with year-long serious of multiple timed internet quizzes about neurology.
The finals were formatted like a college bowl with rapid-fire questions. Points were awarded to the team who buzzed in first and correctly answered the question. For incomplete or wrong answers points were deducted. In the semifinals, UK dominated Thomas Jefferson and Cedars-Sinai by more than 100 points before losing to Walter-Reed in the finals (1,600-1,100).
"We in Neurosurgery are very proud of this showing and the positive statement this makes about the academic excellence of our program here in Lexington. Our congratulations go out to Drs. Grupke and Mirza, and to Program Director Dr. Thomas Pittman," said Dr. Phillip Tibbs, chair for the Department of Neurology and director of the UK Spine Center. "UK bested 103 of 105 of the teams in the competition, including powerhouses like Yale, Harvard, Duke, and the Mayo Clinic."
The dream team plans to compete in next year's competition.
"Now that they have been exposed to the format in person, who knows what will happen?" said Tibbs.
LEXINGTON, Ky. (Oct. 21, 2014) -- Dr. Ruhel Boparai, resident in the University of Kentucky's Department of Psychiatry, is a contributing author on one of the chapters in "Treatment of Neurodevelopmental Disorders: Targeting Neurobiological Mechanisms."
The book brings advances in genetics, neurobiology, and psychopharmacology to the clinic to enhance treatment for neurodevelopmental disorders.
Boparai assisted in the writing of fourth chapter, entitled "Neurodevelopmental and Neurobiological Aspects of Major Depression: From theory to therapy."
"Significant progress has been made in identifying the neurobiological mechanisms of several disorders," Boparai said. "However, the ability to utilize this knowledge has not been summarized in one place for the practicing clinician. This book will fill that gap by providing the theoretical underpinnings and the latest advances in targeted treatments."
Several neurodevelopmental disorders are reviewed in detail including clinical features and behavioral phenotypes, standard treatments and new targeted treatments based on the latest advances in neurobiology and the animal model studies that have lead to new treatments.
The disorders covered include psychiatric disorders: schizophrenia, depression, autism and ADHD; single gene disorders including Tuberous Sclerosis, Fragile X Syndrome and fragile X- associated disorders, Angelman Syndrome, PKU, and Muscular Dystrophies; and complex genetic disorders such as Down syndrome. This book also highlights the commonalities across disorders and new genetic and molecular concepts.
More information can be found at http://ukcatalogue.oup.com/product/9780199937806.do
LEXINGTON, Ky. (Oct. 2, 2014) — After Cony Puac delivered her daughter Evany, birthing attendants placed the newborn in her arms and cleared the room.
Born in a remote Guatemalan village surrounded by snow-capped volcanoes, even in the first moments of life, children born with facial clefts are ostracized from society. Evany was diagnosed with a severe midline cleft palate by an orthodontist in her community. An opening at the center of her face spanned from her bottom lip to the space between her eyes. On either side of the opening, her eyes were separated by 38 centimeters — 20 centimeters wider than that of an average child's. Evany's nostrils were pushed to the left side of her face in cluster of tissue. At the crown of her head, Evany suffered from several holes in the cranium bone beneath the skin.
Evany also lacked an upper lip, which she needed to receive nourishment early in life through breastfeeding. In order to feed Evany, her parents obtained special bottles designed for children with severe cleft palates from a charity called Evelyn's Baskets of Love and Life. Adapting to her condition, Evany learned to feed herself without a palate by mashing solid foods with her fist and the inside of her mouth. As she continued to grow in her first year, the facial cleft impeded Evany's speech development. Only able to form sounds in the back of her throat, she replaced the word "Papa" with the sound of "a-a."
University of Kentucky pediatric reconstructive plastic surgeon Dr. James Liau said children born with craniofacial cleft palates in countries with limited medical resources are deprived of the chance to live a normal life. Facial clefts and cleft palates are widely misunderstood abnormalities that affect babies across countries and cultures, although environmental conditions and hereditary factors could contribute to the condition. At the University of Kentucky, Liau helps counsel families that have severe facial clefts while babies are still in the womb, and he intervenes as soon as possible after birth. In Guatemala, most rural populations don't have access to surgical experts who can correct these facial abnormalities in children.
"I feel very lucky to have the opportunity to do what I can do," Liau said. "In Guatemala, that's it. Your child dies, or you try to find someone overseas that can help you. It's sad, but it's an unfortunate fact of life."
Liau travels to Guatemala once a year with the Children of the Americas, a nonprofit dedicated to providing medical and surgical services to women and children in rural Guatemala. Liau packs a small surgical kit to perform cleft lip and palate surgeries during his volunteer trips in conjunction with other medical professionals. When he encountered Evany and her family during a trip in January 2014, he knew that correcting Evany's condition would require a major procedure that couldn't safely be performed in Guatemala.
"Her case was pretty severe and pretty dramatic," Liau said of Evany's facial cleft. "It's probably one of the most exotic facial clefts that you'll ever see."
Working with a national network of doctors and volunteers, Children of the Americas, arranged for Evany and her mother to travel to the UK Chandler Hospital for the first, and the most intensive, of three reconstructive surgeries. Evany's craniofacial surgery involved a team of UK HealthCare specialists representing the divisions of anesthesiology, pediatric neurosurgery and pediatric plastic surgery.
Cony Puac and 18-month-old Evany arrived in Kentucky on May 12 and visited the UK Chandler Hospital for a pre-surgery cat scan on May 23. While in the waiting room, the new walker clanged a tambourine and grinned while playing games, oblivious to the impending surgery. Puac, 19, quietly sat with translator Jennifer Christmann, who is also interim director of facilties planning and development at UK HealthCare and volunteers with Children of the Americas.
Puac traveled away from her husband and 3-year-old son in Guatemala to accompany Evany through the surgery. A volunteer family based in New Albany, Indiana, hosted the Guatemalan mother and daughter for several weeks before and after the surgery. While Puac's host family treated her to shoe shopping and Culver's cheeseburgers, she said she missed her home and family.
"She knows she is here for a purpose," Christmann said.
On May 30, Evany underwent a cranial vault reconstruction at the UK Chandler Hospital to bring the orbits of her eyes closer together. Liau worked with UK HealthCare pediatric neurosurgeon Dr. Thomas Pittman to correct Evany's cranial bone structure, laying the groundwork for future soft tissue surgeries. During the surgery, Liau and the plastic surgery team removed a part of her skull, and then united the facial bones at the location where they plan to reconstruct Evany's nose. Evany was held in the pediatric intensive care unit for a few days as part of post-operative protocol.
Walking with more confidence in an examination room two weeks after surgery, Evany recovered with her same playful and sweet spirit as before, which Liau said was a good sign. Her hair would eventually cover a scar left from a line of stitches marking the incision made at the crown of her head. With the adjustments to the orbits of her eyes, Evany was now seeing straight ahead. She inspected Liau as he held her in his lap, speaking in Spanish and calling her "sweet pea." Mom, Cony Puac, was overwhelmed with gratitude to Liau and the surgical team.
"It’s a big change, and I am very happy that she’s changed." Puac said of her daughter through a translator. "I am very happy (Liau) did such a good job. I am very appreciative and very thankful to him."
Liau said moving the cranial and facial bones into place was the hardest step in Evany's journey. The next two surgeries, which will be performed by Liau in Guatemala, will involve reconstructing the soft tissue features of Evany's face. Liau will use existing tissue to construct Evany's nose and upper lip during the second surgery in January. He will return the following year to perform a procedure that will rebuild the palate. Through the course of two years and three surgeries, Liau hopes to achieve the closest semblance to "normal" for Evany. He believes all children deserve a chance to live a normal life.
"A cleft palate should not keep you from having a healthy, normal, productive life," Liau said. "We are at a stage in cleft care when you should just continue on with what you're supposed to be doing, which is to be happy and have a family and have a life. The ability to do that either here in Kentucky or overseas is something I'm really happy to have."
LEXINGTON, KY. (Sept. 29, 2014) -- We've strayed far from the Dr. Marcus Welby persona -- in popular television, at least. But even Dr. Gregory House, the irascible main character in the Fox television drama, has moments of compassion.
In real life, compassion is still very much an important part of a physician's practice. And there is perhaps no clearer example of a physician's need for compassion than in the treatment of headaches.
Chronic pain -- including headaches -- affects more than 36 million Americans. But the vague nature of symptoms and a lack of patient awareness often inhibit sufferers from seeking help. Furthermore, some doctors aren't completely aware of the full range of pain management options or even that headache pain of unknown origin is a legitimate thing. Sufferers end up limping through life, thinking there's no help for them, maybe even thinking it's all in their head.
Their personal and family lives aren't the only casualties. One study estimates that migraines cost employers $13 billion in lost productivity each year. Tonya Morgan has first-hand knowledge of that.
The 30-year-old chemist had experienced occasional migraines all through college, but one day in 2011 came a headache that wouldn't go away.
"I couldn't even get out of bed, let alone go to work," Morgan remembers. Her pain was so debilitating that her mother moved to Georgetown from Owen County to help out. They visited many doctors for answers, without relief.
Going from full-time work to having no life at all was emotionally devastating for Morgan. "I was so sensitive to noise that I could lie in my bed and hear my mother down the hall eating potato chips. Going to a restaurant, driving, going to church -- all of those became unbearable. I was miserable."
After 11 one-week stints at the Cleveland Clinic, Morgan was told she required extremely risky brain surgery. By now she was being prescribed upwards of 30 different types of medicine a day. "They weren't working," Morgan says flatly.
Instead of the surgery, Morgan ended up seeing Dr. Siddharth Kapoor, director of the Headache Clinic at the Kentucky Neuroscience Institute at UK HealthCare.
"The first thing he said to me was, 'I promise I won't give you any more meds unless we can prove they're working,'" Morgan says. "I could tell immediately that he cared about me and my pain and would do everything he could to fix it."
Dr. Kapoor and his colleague Dr. Jonathan Smith, spend a lot of time with each patient, learning as much as possible about their headaches and finding the most effective way to alleviate them. Others echo Morgan's devotion to these physicians -- their letters of praise are filled with words like "caring," "patient," "empathetic," and "godsend." Many of them say Drs. Kapoor and Smith gave them their personal cell numbers or came in on their lunch breaks to administer a needed treatment. Some of them say they'd never heard of a headache doctor until they met Kapoor and Smith. All of them say they now have their lives back.
"Headache is an extremely complex neurological process, and there usually isn't a quick fix for pain relief," Kapoor says. "Unless you spend a lot of time with each patient, listening to their problems and asking a lot of questions, it's nearly impossible to find the right way to help them."
In Morgan's case, Kapoor tried several options without success. Nerve blocks helped, but with temporary and decreasing effect. After consultation with other UK physicians, Morgan underwent a procedure called radiofrequency ablation, during which high-frequency electric current is targeted at specific nerves in the brain, destroying the tissue responsible for Morgan's headaches. She is now headache free.
"Myths about headache abound," Smith says. "For example, the emphasis of diet as a trigger for migraine isn't panning out. And the theory that migraines are caused by changes in blood vessels in the brain has been debunked."
Smith explains that, historically, the only option for headache relief was symptom management, but new research into understanding headache triggers and the neurological processes involved combined with advances in pain management have leveled the playing field somewhat.
"We can now attack headache on many fronts," says Smith, ticking the options off on his fingers. "We can try to prevent migraines using existing drugs, such as blood pressure or anti-seizure medicines or antidepressants. Botox, which appears to deactivate the pain fibers in the head, offers potential relief. Nerve blocks are useful for acute treatment. If none of those work, there are other options, like Tonya's ablation."
Furthermore, Smith says, there has been more understanding and acceptance of non-medical treatments for headache, such as biofeedback and acupuncture. In other words, he says, "We've come a long way from 'take two aspirin and call me in the morning.'"
Indeed, UK has come a long way as well, with its headache program considered among the top 20 accredited programs in the country. UK HealthCare's Orofacial Pain program, which complements the services of the Headache Clinic, is one of just 12 accredited programs nationally, and the only one in the entire midwest and south.
"Headache is quite complicated, but because we are a multi-disciplinary program, we can coordinate resources to treat the patient," Kapoor says. "We have a range of treatments available for headache sufferers that is unmatched in this area, including the only orofacial pain clinic in the state. With a combination of the right treatments along with lifestyle changes, it can bring about a significant change in the management of headaches."
Morgan has resumed a normal life, driving, working, and attending Zumba classes. Her mother has moved to a new place close by, and now has some freedom to pursue her own personal interests. Both of them have a new appreciation for their good health, which Morgan "pays it forward" by teaching a health class at her church.
"I want everyone to know that headaches are not a life sentence," she says. "There is hope if you get to the right person. I'm living proof of that."
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LEXINGTON, Ky. (Aug. 19, 2014) – A new web-based program developed by University of Kentucky Markey Cancer Center researchers will provide a simple, free way for healthcare providers to determine which brain tumor cases require testing for a genetic mutation.
Gliomas – a type of tumor that begins in the brain or spine – are the most common and deadly form of brain cancer in adults, making up about 80 percent of malignant brain cancer cases. In some of these cases, patients have a mutation in a specific gene, known as an IDH1 mutation – and patients who have this tend to survive years longer than those who do not carry the mutation.
Developed by UK researchers Li Chen, Eric Durbin, and Craig Horbinski in collaboration with software architect Isaac Hands of the UK Markey Cancer Center Cancer Research Informatics Shared Research Facility, the program uses a statistical model to accurately predict the likelihood that a patient carries the IDH1 mutation and requires screening.
Gliomas are often tested for IDH1 mutation following surgery to remove the tumor, but undergoing this type of testing often requires stringent insurance pre-approvals due to rising healthcare costs, Horbinski says.
"Currently, there are no universally accepted guidelines for when gliomas should be tested for this mutation," Horbinski said. "Obtaining insurance pre-approval for additional molecular testing is becoming more commonplace, and this program will assist healthcare providers with an evidence-based rationale for when IDH1 screening is necessary."
Additionally, Horbinski notes that the program will help conserve research dollars by helping brain cancer researchers narrow down which specific older gliomas in tumor banks – previously removed in a time before IDH1 testing was routine – should be tested as data for research projects.
Horbinski's research on the program was published in the May issue of Neuro-Oncology. The work was funded through a grant from the National Cancer Institute, the Peter and Carmen Lucia Buck Training Program in Translational Clinical Oncology, and the University of Kentucky College of Medicine Physician Scientist Program.
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LEXINGTON, Ky. (Aug. 11, 2014) – With multiple concussions between the two of them, Dan Han and Lisa Koehl's latest research interest isn't surprising.
"I played competitive soccer through high school and continue to play recreationally," says Koehl, a doctoral candidate in the University of Kentucky's Department of Psychology, "so I have firsthand experience with the dynamics that come into play when a teen suffers a concussion."
As a former high school assistant principal in the Chicago public school system, Han was responsible for overseeing student-athletes' return to school after a concussion. Han left educational administration to pursue his doctorate in neuropsychology. Now director of the Multidisciplinary Concussion Program at UK HealthCare, Han has a reputation for top-notch clinical work and research on concussion.
"There aren't many places in Kentucky where you find a true multidisciplinary concussion program," Han says. "UK HealthCare's Multidisciplinary Concussion Program embraces an interdepartmental group effort -- from neurology, from neurosurgery, sports medicine, physical medicine and rehabilitation, from the trauma team -- we all work together to look at how brain injury affects the cognitive, physical and emotional state of our patients."
This group effort puts the athlete's safety first. For that reason, UK HealthCare's concussion program is the go-to for the athletics programs at Fayette County Public Schools, the University of Kentucky, Eastern Kentucky University, and Kentucky State University, who all rely on the UK Multidisciplinary Concussion Program's clinical expertise in sports concussion for state-of-the-art input to help make decisions affecting an athlete's return to play.
Add to Han's clinical skills a lifelong love of full contact martial arts (Han practices kickboxing and Brazilian jujitsu), and it's easy to see how Han and Koehl are well-suited to study the symptoms of sports concussions.
Drawing from a large UK database of patients with brain injury, Koehl and Han used a subset of 37 athletes aged 12 to 17 to explore post-concussion changes in physical, emotional, and cognitive symptoms over time.
According to Koehl, 22 of the 37 study participants demonstrated post-concussive emotional symptoms. Of those, 23 percent were sensitive to light while 14 percent were sensitive to noise. In comparison, of the 15 teens without emotional symptoms, 13 percent were sensitive to light and no teens were sensitive to noise.
There were no differences between the two groups in factors such as what percentage experienced loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of severity of concussion.
"We discovered a bidirectional relationship between both emotional symptoms developing in conjunction with physical symptoms, and also emotional symptoms developing because of the physical symptoms," said Koehl.
In other words, said Koehl, "This research gives us a better understanding of the interaction between physical and emotional symptoms in concussion and will allow us to explore ways to help adolescents recover in a more timely fashion."
According to Han, teens in the study who reported anxiety were 55 percent more likely to experience attention difficulties than those without anxiety, while teens with irritability/aggression were 35 percent more likely to self-report problems with attention than teens without irritability.
"While these findings are preliminary and require a larger sample size to predict outcomes with more confidence, we are intrigued by the potential these data offer in terms of providing teens with a better treatment plan based on their unique cognitive, physical and emotional response to concussion," Han said.
"Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery.”
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LEXINGTON, Ky. (July 29, 2014) – University of Kentucky Endowed Chair of Neuroscience Dr. Diane Snow was recently elected by her colleagues to serve as president-elect of the National Neurotrauma Society (NNS). With this appointment, Snow will hold the position of president in 2015-2016.
Since joining the NNS in 2003, Snow has championed women's contributions to neurotrauma research and mentorship opportunities for young members of the profession, including students, postdoctoral fellows and young professors. She served as the three-term president of Women in Neurotrauma Research (WINTR), an arm of the NNS that promotes gender equality in neurotrauma research. She also proposed the society's Ask An Expert online database for young professionals and students to make connections with practicing clinicians and researchers who are senior NNS members.
The NNS is a society committed to promoting neurotrauma research, providing a forum for clinicians and supporting members of the profession in their endeavors to discover new treatments for neurotrauma victims. Snow was inducted as president-elect during the society's annual symposium, June 29-July 2, in San Francisco.
Snow graduated with a bachelor's degree in biology and German, and a master's degree in neuroscience from the University of Akron and Northeast Ohio University College of Medicine. She completed her doctorate in neuroscience at Case Western Reserve and postdoctoral work at the University of Minnesota. In 1996, she joined the University of Kentucky as an assistant professor in anatomy and neurobiology and currently serves as an endowed chair and professor of the Spinal Cord and Brain Injury Research Center. She is also the interim director of the UK Honors Program and the director of the Office of Undergraduate Research.
"I'm really looking forward to the opportunity to advance the society by providing a platform conducive for training and sharing of knowledge, in the hopes of finding a cure for people with traumatic brain injuries," Snow said. "Of the many societies I belong to, this is the most nurturing of young scientists and clinicians and is the most interactive. They are always concerned about mentoring and providing opportunities."
Snow's primary duties as president will be fundraising and selecting a site for the 2016 annual meeting. For the first time, the NNS will consider Lexington as one of three possible host sites in 2016.
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