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Neuroscience (SNI) Blog

'neurology' Neuroscience (SNI) posts

Clinical Neurophysiology Lab Receives Accreditation

Congratulations are in order for the Clinical Neurophysiology Laboratory for attaining Accreditation by the EEG Laboratory Accreditation board of ABRET. We are the first and only Lab to receive Accreditation in Washington State and one of only 10 labs west of the Mississippi. Accreditation means the Lab has met strict standards and is recognized as a place where patients and physicians can have confidence they are receiving quality diagnostics. Thanks for all the great work and CONGRATULATIONS to everyone on the team who made this possible!

-Colleen Douville

Director for Cerebrovascular Ultrasound
Program Manager for Clinical Neurophysiology

The neurophysiology laboratory at Swedish is a critical component to the Epilepsy program.

Staying Fit to Prevent Stroke

A brisk walk for as little as 30 minutes a day can improve your health in many ways and may reduce your risk for stroke. Join me, and one of our exercise physiologists to learn how to stay fit and reduce your risk for stroke. Free blood pressure screening will also be available.

Cherry Hill - Pinard Foyer

Tuesday, Oct. 12, 11 a.m.-1 p.m

For more information, please contact Sherene Schlegel:

sherene.schlegel@swedish.org

Office: 206-320-3484

SNI Fellowship Opportunities Available

The Swedish Neuroscience Institute (SNI) at Swedish Medical Center in Seattle, Washington, is committed to improving the delivery of neurologic care through evidence-based protocols, research and education. SNI offers advanced training through five fellowships:

Applications are reviewed as received, with fellowships beginning bi-annually on January 1 and July 1. For one hundred years Swedish has been the premier health-care provider in the Pacific Northwest and a trusted resource for people when it truly counts. As a high-volume, urban medical center located at the epicenter of the Puget Sound area, Swedish attracts nationally recognized physicians and scientists, and provides a broad population base that enhances the patient care, research and education efforts at SNI. Applying for an SNI fellowship You can also email your inquiries to SNIFellowships@swedish.org

Gamma Knife Radiosurgery for Treatment of Essential Tremor

Essential tremor (ET) is the most common type of movement disorder, affecting approximate­ly four out of 1000 people, and is significantly more common, though less recognized, than Parkinson’s disease. ET affects men and women equally and is inherited as an autosomal-dominant condition in about 60 percent of cases.

Although often referred to as benign essen­tial tremor, it is hardly benign in patients who may not be able to write legibly, hold a glass of water or use a knife and fork. ET is primarily an action tremor of the upper extremities but may involve resting tremor of the head and neck and/or lower jaw, and also tremor of the voice. The latter may be so severe that speech becomes unintelligible.

Medication and surgical treatment options

Primidone and beta blockers are useful in re­ducing tremor in the early stages of ET, but as the tremor progresses, medical management often becomes less effective or side effects can prevent the use of adequate doses of medication. ET pa­tients then are candidates for surgical or radiosur­gical treatment.

The mainstay of the surgical treatment of ET is deep brain stimulation (DBS), in which an electrode is implanted in the ventral inter­mediate nucleus (VIM) of the thalamus. Neurosurgeons Peter Nora, M.D., and Ryder Gwinn, M.D., have been implant­ing DBS electrodes at Swedish Medical Center for several years. The treatment is effective, but it requires implantation of permanent hardware (wires and batteries) into the brain and chest wall. Patients who take anticoagulants or have severe cardio­vascular disease are not suitable candidates for DBS. These patients, however, may be candidates for radiosurgical treatment.

A new option for difficult-to-treat patients

Neuromodulation Symposium

The symposium "Advances in Neuromodulative Therapies: 2010 and Beyond" will be held August 27, 2010 starting at 7:15 am in the Swedish Education and Conference Center at the Cherry Hill campus.

See more information

A broad array of local and national experts will speak on current and future applications of neuromodulation in the treatment of neurological disorders.

The Odd Syndrome of Bilateral 8th Nerve Tumors

Bilateral 8th cranial nerve tumors, also known as vestibular schwannomas or acoustic neuromas (see figure), are pathognomonic of a fascinating syndrome called central neurofibromatosis or neurofibromatosis type 2 (NF-2). NF-2 is a rare, autosomal-dominant disease with an incidence of 1 in 30,000 live births. The mechanism by which the genetic changes underlying NF-2 produce these tumors of a cranial nerve remains a mystery. Interestingly, two other associations are also sufficient to make a diagnosis of NF-2. These are unilateral VS at early age (< 30 years) plus two other specific lesions (meningioma, schwannoma other than VS, glioma or pre-senile cataract), and unilateral VS at early age with an affected first-degree parent, sibling or child. Patients with NF-2 usually present between the ages of 18 and 24 years with tinnitus, hearing loss and balance difficulties. Symptoms of unilateral tinnitus, asymmetric hearing loss or unresolving vertigo or imbalance warrant a gadolinium-enhanced MRI with a neurotological consultation to rule out brainstem pathology.

NF-2 is caused by inactivation of the NF-2 tumor suppressor gene on chromosome 22 (22q12.2) which encodes the "Merlin" protein. Like a double negative, inactivation of a tumor suppressor gene produces an autosomal-dominant inheritance pattern identical to classical activating mutations.

When a diagnosis of NF-2 is entertained, evaluation should include a complete family history; a detailed head and neck and neurological examination with attention to cranial nerve deficits, and an MRI of the brain with dedicated images to detect bilateral VS, meningiomas and optic gliomas. Spinal MRI with gadolinium should be performed to look for spinal meningiomas or schwannomas, and ophthalmologic evaluation should be obtained in cases with visual loss or with suspicion of juvenile cataracts.

Unilateral VS and NF-2

Defining Tertiary Care for Neurological Diseases

Health care for patients with neurological diseases in the United States occurs across mul­tiple levels, ranging from primary to tertiary care and, less common­ly, quaternary care.

The World Health Organization has defined primary care as the point where first medical contact occurs, and where coordination and continu­ity of medical services is managed. Primary care focuses on a broad range of ser­vices, rather than the diagnosis and treatment of diseases of a specific organ system, and thus primary-care providers (PCPs) have varying levels of comfort in the treatment of neurologi­cal disorders.

Secondary care is provided by specialists, such as general neurologists, who focus on dis­eases affecting a specific organ system, usually upon referral by a PCP. Both primary care and secondary care are provided in an outpatient setting or a general hospital setting.

Tertiary neurological care is provid­ed by subspecialists who treat a subset of conditions that affect the nervous system. Examples include:

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