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Neuroscience (SNI) Blog

'SNI' Neuroscience (SNI) posts

Exciting Advances in Multiple Sclerosis from ECTRIMS

There is exciting news from last week’s 26th Congress of the European Committee for the Treatment and Research in Multiple Sclerosis (ECTRIMS) in Gothenburg, Sweden.

ALEMTUZUMAB. 5-year data from a Phase II extension study for alemtuzumab, an intravenously administered monoclonal antibody, showed that the drug:

  • reduced annualized rate of relapse to 0.14 compared with 0.28 for interferon
  • reduced the risk for sustained accumulation of disability in remitting relapsing multiple sclerosis by 87% compared to 62% with interferon.

This is a remarkable agent with excellent activity in MS. Adverse events included immune thrombocytopenic purpura, thyroiditis and anti-glomerular basement membrane disease.

TERIFLUNOMIDE. A Phase III trial of oral teriflunomide in remitting relapsing MS showed:

  • a 31% reduction in relapse rate and increased time to first relapse compared with placebo
  • reduced the risk of sustained disability progression by 29.8%.

Side effects were mild and included diarrhea, nausea, liver function abnormalities and hair loss.

Alemtuzumab and teriflunomide are currently in Phase III clinical trials at SNI.

SNI PRESENTATIONS:

  • Dr. Jim Bowen presented a poster about ongoing demyelination and neurodegeneration in a patient who had undergone autologous stem cell transplantation.
  • Drs. Jung Henson and Mayadev reviewed the beneficial effects of exercise on functional and quality of life outcomes from SNI’s MS wellness program

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.

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

Hot off the press! Summer 2010 BrainWaves available

The Summer 2010 Edition of BrainWaves is now available online.

BrainWaves is the newsletter of the Swedish Neuroscience Institute. Published quarterly, BrainWaves provides information about neurological conditions treated at the Institute, and also profiles the programs, services, and new initiatives of the institute and its staff.

Also check out our past editions of the BrainWaves newsletter.

Comprehensive Spine Center at SNI

Neck pain and low back pain are common health problems in the US. They are among the top reasons for doctor visits. They are also the number one cause of disability for people under 45 years of age in the US. The Comprehensive Spine Center at SNI consists of spine surgeons, physiatrists, interventional pain specialists, neuroradiologists, and physical therapists. All these spine specialists can provide the best and most advanced spine care to our patients in the same clinic. We strive to make spine care as convenient as possible to our patients.

The spine center at SNI provides a wide spectrum of surgical procedures to treat spine disorders caused by degeneration, neoplasm, infection, congenital malformation, and trauma. We distinguish ourselves not only by providing superb care to our patients, but also driving new technologies in spine surgery. SNI is the leading center in large clinical trials for cervical artificial disc implants and lumbar artificial facet joint implants. These new spine devices may revolutionize the future of cervical spine and lumbar spine surgeries and further develop motion-preservation technology.

We also provide minimally invasive spine surgery to our patients with appropriate indications. The minimally invasive spine surgery includes lumbar fusion surgery, microdiskectomy and kyphoplasty. With the newly-added state-of-the-art equipment at SNI, we believe the development of the new technology will push minimally invasive spine surgery to a higher level.

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

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

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