The adult brain weighs approximately 3 pounds, yet this small organ impacts every part of the body. When things go wrong, correcting them is a complex task. The Neuroscience Center at Cleveland Clinic in Florida addresses this complexity with a collaborative approach to medicine, encompassing several modalities and areas of expertise.
Nearly two decades ago, Barry Dickman’s hand shook so hard he couldn’t feed himself or brush his teeth. His diagnosis had been familial essential tremor, a nerve disorder causing uncontrollable shaking in different parts of the body. Having been a patient of Nestor Galvez-Jimenez, MD, at Cleveland Clinic since his first deep brain stimulation (DBS) device in 1996, Mr. Dickman came to Cleveland Clinic in 2006 for placement of a second device.
Just one of the many innovative treatments offered by the Neuroscience Center at Cleveland Clinic in Florida, DBS delivers small electrical shocks to specific areas of the brain like a heart pacemaker. Dr. Galvez-Jimenez, chief of neurology and director of the Movement Disorders Program at Cleveland Clinic, pioneered the use of DBS since the original clinical trials in the mid-1990s. In addition to essential tremor, DBS is also used to treat movement disorders such as Parkinson’s disease, dystonia and Tourette syndrome.
Growing Field of Movement Disorders
“Movement disorders are alterations in motor control. This includes balance, gait, speed of movement, tremors, jerks or abnormal postures,” says Dr. Galvez-Jimenez. “It’s a field that we are continuing to expand at Cleveland Clinic.”
Movement disorders can be very debilitating, as Mr. Dickman knows. He was diagnosed with familial essential tremor at 15. As he got older, it grew worse. He was unable to perform daily grooming tasks, and vocal cord tremors caused him to stutter. The worst part, he says, “was that I couldn’t even help my daughters button their dresses.”
“In the past, a lesion was created in the areas of the brain that were abnormal in order to treat movement disorders,” says Badih Adada, MD, a neurosurgeon at Cleveland Clinic. “Now, instead of injuring the brain, we electrically stimulate it to re-establish normal movements with minimum risk to other areas of the brain.”
An Intricate Procedure
Placing the electrode for DBS is a complex procedure, requiring the combined expertise of well-trained neurologists, neurosurgeons and support staff. First, the neurologist evaluates the patient and employs nonsurgical treatments. If these do not provide relief, the medical team at Cleveland Clinic considers DBS.
Both specialists work together through the surgery. The neurologist closely watches the patient’s brain electrical activity, while the surgeon places the electrodes. This collaboration is vitally important because the difference between success and failure is measured in millimeters.
“Two highly trained and experienced physicians use their expertise to ensure patients achieve the very best outcomes possible,” says Dr. Galvez-Jimenez. “The surgeon relies on the neurologist to give a correct diagnosis and supervise the recordings that optimize placement. The neurologist relies on the surgeon to take care of the technical issues. It is a very interdependent relationship.”
For Barry Dickman, the difference in his life is nothing less than phenomenal.
“My tremors are so well controlled that most people don’t even know I have a problem,” he says, “Dr. Galvez-Jimenez and the staff at Cleveland Clinic helped me regain control of my body and my life.”
Award-Winning Treatment for Stroke
When the Stroke Center at Cleveland Clinic takes care of patients with strokes or other problems of the blood vessels of the brain, they do it in an award-winning fashion.
“The American Heart Association and American Stroke Association have a series of performance measures that outline the preferred way to treat stroke patients to achieve the best outcomes,” says Efrain Salgado, MD, co-director of the Stroke Center and a neurologist specializing in neurovascular disorders at Cleveland Clinic. “We are quite proud to be one of only a few hospitals nationwide to be recognized at the highest level with the Gold (Sustained) Performance Award for meeting or exceeding these measures two years in a row.”
Neurologists use medications to treat ischemic strokes from blocked blood vessels. One such treatment is the use of “clot-busting drugs,” which are available to many patients who make it to the emergency room within three hours of stroke symptom onset. Roughly 9 percent of stroke patients at Cleveland Clinic in Florida are treated at the Stroke Center in time to get this medication, about three times the national average.
Stroke patients who do not receive the “clot-busting” drugs are treated with medications that prevent new clots from forming. Other preventive therapies treat deep vein thrombosis, a condition that blocks blood flow from the legs to the heart and lungs; screen for swallowing problems resulting from brain injury; and lower bad cholesterol with medications.
Hemorrhagic strokes occur when an aneurysm or other weakness in the arteries of the brain bursts and causes bleeding. Clipping or placing coils in the blood vessels can prevent problems. Cleveland Clinic physicians work hard, focusing on giving patients the best outcomes possible.
Many patients go into surgery wondering how they will be changed. “You will be as you are now, only without the aneurysm,” says Dr. Adada. “This is what we expect and these are our high standards.”
New Approaches to Neuro-Oncology
When many other hospitals say brain tumors are “inoperable,” Cleveland Clinic in Florida says, “Let’s take a look.” Marlene Erickson is happy they did.
Other doctors Ms. Erickson saw wanted to use radiation to stabilize her brain tumor. The biggest drawback was that it wouldn’t cure the blindness the tumor had caused or help her walk again.
“New surgical techniques we use, such as skull-base microsurgery, mean tumors considered inoperable elsewhere can be safely removed,” says Dr. Adada. “The best approach is to remove the tumor completely without causing harm. Radiation and chemotherapy should be reserved for malignant tumors after they have been removed surgically.”
The advanced surgical methods allow Cleveland Clinic surgeons to directly approach and remove the tumor with much less damage to surrounding areas.
Best Possible Outcomes
“They gave me my life back,” says Ms. Erickson. “The doctors at Cleveland Clinic operated for over 13 hours to get it all. I can see again and walk for the first time in over a year, which would not be possible if I had followed the radiation treatment plan recommended elsewhere.”
As with other disciplines at Cleveland Clinic, collaboration is exercised to promote the best possible outcomes. Support from radiation and medical oncologists is key to making sure the tumor does not return.
“The 1970s and 1980s were the decades of heart surgery, when it advanced to the point that it is nearly routine and viewed with less stigma,” says Dr. Adada. “The 21st century is the time when we can do brain surgeries safely, where patients can expect to have normal lives without significant brain damage. Hopefully, it will become as routine as heart surgery.”
