Treating Movement Disorders: Parkinson’s Disease, Essential Tremor and Dystonia

Posted by Brigham and Women's Hospital January 6, 2017

For some people with movement disorders, deep brain stimulation can offer an effective treatment for symptoms that don’t respond to medications. Above: Imaging in the AMIGO Suite at Brigham and Women’s Hospital.

Contributor: Michael T. Hayes, MD, is Neurological Director of the Functional Neurosurgery Program for Movement Disorders at Brigham and Women’s Hospital (BWH).

Movement disorders are a group of neurological conditions that cause abnormal voluntary or involuntary movements, or slow, reduced movements. These disorders can affect movements such as walking, and complex tasks like playing the piano or writing.

“No two patients with a movement disorder are alike, so treatment must be tailored to the individual. In order to achieve the best outcome each patient must be continually evaluated to decide the appropriate treatments, which may involve injections, medications, or in some cases surgery,” said Dr. Michael T. Hayes, the Neurological Director for Functional Neurosurgery at BWH. Read More »

Herniated Discs: New Treatment Option Relieves Pain, Preserves Mobility

Posted by Brigham and Women's Hospital July 19, 2016

ProDisc_ProDiscC_main_03

In artificial disc replacement (ADR), the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc.

Contributor: John H. Chi, MD, MPH, Director of Neurosurgical Spine Cancer and a spine surgeon in the Department of Neurosurgery at Brigham and Women’s Hospital. Dr. Chi is also an Assistant Professor of Neurosurgery at Harvard Medical School.

If you are experiencing numbness and pain in your arms and shoulder, it may be a sign of a herniated disc in your neck (the cervical region of the spine).

“A herniated disc occurs when the soft inner gel that cushions the spine’s vertebrae protrudes into the spinal canal, placing pressure on nearby nerves. This pressure can lead to pain, tingling, numbness or weakness in the shoulders and arms,” says Dr. Chi.

A herniated cervical disc may be managed with medication, physical therapy, and pain management. When patients continue to experience symptoms, surgery may be recommended .

Balancing Pain Relief versus Mobility

Until recently, patients requiring surgery for cervical disc herniation had one option, anterior cervical disc fusion (ACDF), in which the damaged disc is removed and repaired to help relieve pressure on the nerves and the spinal cord. The ACDF procedure also requires the bones above and below the repaired disc to be fused together.

Though ACDF relieves the pain caused by a herniated cervical disc, some patients may experience a reduction in their range of motion due to the fusion of discs in the neck. Furthermore, there is a chance that discs adjacent to the fusion may later herniate, requiring a second surgery.

 Artificial Disc Replacement to Preserve Range of Motion

Today, spine surgeons can offer certain patients with cervical disc herniation another option – artificial disc replacement (ADR). During the ADR procedure, the damaged disc is removed and replaced with an artificial one that moves and shifts like a real disc, preserving a patient’s range of motion.

Recently, Dr. Chi performed an ADR procedure on a patient who had previously undergone disc fusion (ACDF). Though the disc fusion initially relieved the patient’s pain, a disc adjacent to the fusion also herniated. The patient started experiencing significant pain again. This time, the patient opted to undergo ADR. Compared to his first surgery, Dr. Chi’s patient had a shorter hospital stay, a faster recovery, and maintained his full range of motion while finding relief from his chronic pain.

Are You a Candidate for Artificial Disc Replacement?

Artificial disc replacement is not for everyone. You may be a candidate for ADR if you are younger than 55 years and have been experiencing symptoms for at least three months but not longer than 18 months.

It’s not known how long artificial discs will last; however, they have been in worldwide use for almost 20 years and for 12 years in the U.S. So far, there has been no evidence to suggest that artificial discs will require replacement after a certain period of time.  Research also indicates that ADRs may lead to better outcomes than fusion.  Dr. Chi advises checking with your insurer to verify coverage if you are considering ADR.

Learn more about the Comprehensive Spine Center at Brigham and Women’s Hospital.

-Jamie R.

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Sleeping through Deep Brain Stimulation?

Posted by Brigham and Women's Hospital July 12, 2016

At BWH, DBS electrode placement is performed in the AMIGO Suite, which enables magnetic resonance imaging (MRI) to be obtained directly in the operating room.

Imaging in the AMIGO Suite at Brigham and Women’s Hospital enables patients who are candidates for DBS to have this procedure performed under general anesthesia.

For some people with movement disorders like Parkinson’s disease and essential tremor, deep brain stimulation (DBS) can offer an effective treatment for symptoms that are not responding to medications. The traditional procedure to place the DBS electrodes, however, has required patients to remain awake during surgery. Patients who are candidates for DBS may now have this procedure performed under general anesthesia.

“This is a huge advance for patients opting for DBS,” said Dr. G. Rees Cosgrove, Director of Epilepsy and Functional Neurosurgery at Brigham and Women’s Hospital (BWH), the only hospital in New England and one of few nationwide to offer asleep DBS. “The imaging that we use while we perform the procedure enables us to confirm that we’ve reached the exact locations that we are trying to target in the brain while we are in the operating room, without the need to keep patients awake.”

At BWH, DBS electrode placement is performed in the Advanced Multimodality Image Guided Operating (AMIGO) Suite, which enables images, such as magnetic resonance imaging (MRI), to be obtained directly in the operating room. During surgery in AMIGO, MRI is used to guide placement of DBS electrodes and confirm the targets to reduce symptoms without adversely affecting language or other key areas.

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Stroke Prevention and Treatment

Posted by Brigham and Women's Hospital May 31, 2016

Each year, stroke impacts approximately 750,000 to 800,000 individuals in the United States. A leading cause of disability, many stroke survivors are left with significant speech, motor, and memory difficulties. More than half can’t return to work. For American Stroke Month, we’ve gathered our blog posts about stroke prevention, recognition, and treatment.


Stroke-1Do You Know Your Risk of Stroke?

Though you can’t change risk factors such as age, gender, and family history, you can reduce your risk of stroke. Pay attention to health measures (such as blood pressure, cholesterol, and body mass index), eat healthy foods, and develop healthy lifestyle habits (such as exercising regularly for 30 minutes or more each day). Learn more about reducing risk of stroke.

 

Stroke-2Stroke – Five Things You Need to Know

When it comes to stroke, think FAST. The acronym FAST (face, arms, speech, and time) is a quick way to determine if someone is having a stroke. Difficulty smiling, lifting both arms, and repeating a simple phrase are warning signs of stroke. If you observe these symptoms in someone, note the time and call 911 immediately. Learn more about the symptoms of stroke.

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Brain Cancer Patient: Can Access to Medical Data Save Lives?

Posted by Brigham and Women's Hospital May 24, 2016

The MRI image above shows a tumor in Steven Keating’s frontal left lobe.

The MRI image above shows a tumor in Steven Keating’s frontal left lobe.

After participating in a brain research study, Steven Keating avidly collected and examined his personal medical data. Steven’s curiosity ultimately helped to identify his own brain tumor, a glioma, which was removed in the Advanced Multimodality Image Guided Operating Suite (AMIGO) at Brigham and Women’s Hospital in 2014.  Based on this experience, Steven is now a vocal advocate of providing patients with open access to their medical information. In this video, Steven shares the incredible story of how his life-long curiosity helped identify his brain tumor – and how curiosity about medical data also can help others.

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Meningioma: Treatment Options for a Common Brain Tumor

Posted by Brigham and Women's Hospital May 12, 2016

Dr. Ian F. Dunn

Dr. Ian F. Dunn, BWH Department of Neurosurgery

Author: Ian Dunn, MD, neurosurgeon in the Department of Neurosurgery at Brigham and Women’s Hospital and an Associate Professor of Neurosurgery at Harvard Medical School. Dr. Dunn’s interests include surgery for meningiomas, chordomas and other skull base tumors.

People who have been diagnosed with a common brain tumor known as a meningioma have several treatment options. I recommend that patients and their families carefully evaluate and discuss the risks and benefits of each option with their physician. Other factors that will affect the choice of treatment are a patient’s age, overall state of health, and where the patient will receive treatment.

What is a Meningioma?

A meningioma is a type of tumor that develops from the meninges, the membrane that surrounds the brain and spinal cord. About 85 percent of meningiomas are categorized as benign tumors. Because most benign meningiomas grow slowly, they may reach a relatively large size before causing symptoms, such as headaches, blurred vision, seizures, numbness, weakness in the arms or legs, or speech difficulty.

Meningiomas are one of the most common brain tumors within the general population. They are more common among women and occur with increasing frequency as people get older. Meningiomas are found in about three percent of people over the age of sixty.

There are three treatment options for meningiomas: observation, surgery, and radiation. There are also clinical trials underway to identify new therapies.

Observation versus Surgery

Meningiomas that are smaller in size and are not causing symptoms may be observed by your physician. We commonly perform periodic CT or MRI scans at intervals of six to 12 months and consider medical intervention if growth is observed over time or if symptoms develop.

Surgery and Recovery

Surgery is the primary treatment for meningiomas. The goal of surgery is to remove all of the meningioma and the membranes from which it originates. The location of a meningioma determines the complexity of surgery to remove it. Meningiomas located at the surface of the brain (convexity) are more easily accessed than those at the skull base, those that involve the blood vessels in the brain (sagittal sinus or cavernous sinus), or meningiomas in the optic nerve sheath. Neurosurgeons at Brigham and Women’s Hospital have particular expertise treating meningiomas located in any area of the brain..

Recovery can vary according to the length and type of your surgery. Usually, patients are observed in the neurosurgery intensive care unit (ICU) overnight. The next day, they can expect to be transferred to a regular hospital floor, where they will be walking, eating, and drinking. A common hospital stay is between two to five days. Occasionally, patients may need to recover at a rehabilitation facility prior to returning home.

Once home, patients can expect to be walking and moving around, but they may be more tired than usual in the first seven to 10 days after surgery. Patients may resume normal activities, including driving, as soon as they feel strong enough. Patients should plan on being absent from work for four to eight weeks, depending on the type of surgery.

Radiation Therapy

Radiation is often used in combination with surgery, to more fully treat patients with aggressive types of meningiomas. Newer ways of delivering radiation, such as stereotactic radiosurgery, stereotactic radiotherapy, or intensity-modulated radiotherapy, deliver more focused radiation, minimizing radiation exposure to the normal brain tissue surrounding the tumor. Radiation may be given in one large dose (stereotactic radiosurgery) or in multiple small doses (stereotactic radiotherapy).

Meningioma Clinical Trials

There are no approved drugs for meningioma, although clinical research may lead to drug treatments for patients with recurrent meningiomas.

Researchers at Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC) are studying the genetic factors related to the growth of meningiomas. By studying our patients’ tumors, we and others have identified important new genes in meningioma growth. Two of these genes have formed the basis of a clinical trial for patients with specific genetic changes in their tumors.

In patients with more aggressive meningiomas, researchers at DF/BWCC are also conducting a clinical trial in which they are studying whether the immune system can be stimulated to kill tumor cells. This has approach has shown great promise in other brain tumor types.

Don’t hesitate to consult your doctor if you need more information about your diagnosis, treatment choices, or anything to do with your meningioma or related health issues.

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Defying the Odds: Neurosurgery Patient Walks Again

Posted by Brigham and Women's Hospital April 21, 2016

Anthony Hodges is walking again after a car accident left him paralyzed.

Dr. Yi Lu, a neurosurgeon at Brigham and Women’s Hospital (BWH), was moved to tears when 23-year-old Anthony Hodges walked into the Neurosurgery clinic for a follow-up appointment.

“I couldn’t believe it,” says Dr. Lu, who performed emergency spine surgery on Anthony after a car accident left him paralyzed. “With his type of complete spinal cord injury, Anthony had less than a five percent chance of ever walking again. His case was a miracle.”

In July 2015, Anthony, the former captain of the Salem State University basketball team, was riding in the passenger seat during a car accident. The crash left Anthony unable to move his hands, legs, or feet. He was rushed to BWH for surgery, where doctors determined that he had a complete spinal cord injury – an injury that often results in the permanent loss of function below the injury site, which, in Anthony’s case, was a spinal disc near the back of his neck. During surgery, which occurred just six hours after the accident, a surgical team removed a broken vertebra that was pressing on Anthony’s spinal cord and replaced it with a bone graft that was stabilized with a titanium plate.

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Brigham and Women’s Hospital Jumps to #6 on U.S. News Honor Roll

Posted by Brigham and Women's Hospital August 6, 2015

For the twenty-third year in a row, Brigham and Women’s Hospital (BWH) has been named to U.S. News & World Report’s Honor Roll of America’s Best Hospitals, moving up three spots to number six. The Honor Roll highlights just 15 hospitals, out of nearly 5,000 nationwide, for their breadth and depth of clinical excellence.  

In today’s post, we’ve gathered a collection of videos highlighting life-giving breakthroughs in our top-ranked clinical specialties.

#2 Gynecology

Christopher P. Crum, MD, Division Chief of Women’s and Perinatal Pathology, discusses ovarian cancer risk and techniques for detecting ovarian cancer at earlier stages of the disease.

The Department of Obstetrics and Gynecology supports women through all the stages of their lives, offering specialized evaluation and treatment for complex women’s health conditions, including gynecologic cancers.

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Understanding Meningiomas and Surgical Treatment

Posted by Brigham and Women's Hospital May 26, 2015

Pre-operative MRI of a meningioma

Authors: Tracy Ansay, MD, neurosurgeon, and Stanley Mui, physician assistant, of the Department of Neurosurgery at Brigham and Women’s Hospital. Dr. Ansay is also an Instructor in Neurosurgery at Brigham and Women’s Hospital.

We recently cared for a patient who was experiencing seizures despite being prescribed anti-seizure medications. He also was experiencing bouts of confusion. Both the seizures and episodes of confusion were very debilitating and impacted his performance at work. He was not able to drive and also was experiencing side effects from the anti-seizure medications, including irritability, cloudy thinking, and fatigue. An MRI indicated he had a brain tumor called a meningioma located in an area deep within the brain, next to an area called the cavernous sinus. His seizures were the result of pressure to the temporal lobe caused by the meningioma.

How Common are Meningiomas?

MRI after skull base surgery to remove the meningioma

Meningiomas are among the most common brain tumors. They are more common among women and occur with increasing frequency as people get older. Meningiomas are found in about three percent of people over the age of sixty.

Meninigiomas are typically attached to the covering of the brain called the dura, and they originate from cells within it. Approximately 90 percent of meningiomas are benign tumors. They also are slow-growing, with a diameter growth of about one millimeter per year. Atypical meningiomas, which grow more quickly, make up about seven percent of meningiomas. Malignant meningiomas, which are very rare, account for about two percent of meningiomas. Because meningiomas are usually benign and slow-growing, most patients can expect good outcomes after treatment.

Due to their attachment to the dura, meningiomas typically cause pressure on the brain, but do not actually invade brain tissue. Symptoms vary depending on where they are they located and may include weakness, numbness, or seizures. Most patients, however, do not experience any symptoms.

Restoring Quality of Life

Despite the challenging tumor location, our team was able to successfully remove this patient’s meningioma, with minimal disruption to the surrounding brain tissues, using a modified skull base surgical procedure. By using a less invasive surgical approach, our patient was able to return home two days after his surgery. Examination of the patient’s tumor indicated that it was benign. Follow-up MRI scans confirmed the tumor was completely gone and had not regrown. Our patient was tapered off his anti-epileptic medications, and his bouts of confusion and seizures stopped. Most importantly, he has been able to resume his normal activities and enjoy life once again

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Advancing the Treatment of Malignant Gliomas

Posted by Brigham and Women's Hospital May 14, 2015

Gliomas can arise anywhere in the brain.

Malignant gliomas are a set of tumors that can arise anywhere in the brain. Tumor cells divide to create a mass, as well as infiltrate into normal brain tissue. The current standard of treatment for malignant gliomas is surgery to remove as much of the tumor as possible, often followed by chemotherapy and radiation. There are, however, many new treatment approaches being evaluated for malignant gliomas.

In the following video, Dr. E. Antonio Chiocca, Chair of the Department of Neurosurgery and Co-Director of the Institute for the Neurosciences at Brigham and Women’s Hospital, describes a promising new approach called oncolytic virotherapy. This involves the use of common viruses to treat malignant gliomas. Studies of the herpes simplex virus type 1 have shown that the virus invades tumor cells and destroys them, while also stimulating the immune system to create a vaccine-like effect against the tumor.

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