Inspired - Fall 2013 - University of Chicago Medicine

InspiredFALL 2013

BRAIN MATTERS

Stroke neurointervention

Congenital anomalies

Medication- resistant seizures

Adult and pediatric

brain tumors

Multiple sclerosis research

MISTIE and CLEAR trials

also in this issue:

John Maunsell, PhD, to Lead New Neuroscience Institute

a PhYsiCian

PuBliCation

The University of Chicago Medicine

& Biological Sciences has been at the

forefront of medical care, research and

teaching for more than 90 years. Located

in historic Hyde Park on the South Side

of Chicago, the University of Chicago

Medicine & Biological Sciences includes:

Patient Care

» Bernard A. Mitchell Hospital

» Center for Care and Discovery

» Comer Children’s Hospital

» Duchossois Center for Advanced Medicine

» Numerous outpatient locations

throughout the Chicago area

Teaching Programs

» Pritzker School of Medicine

» Master’s and doctoral degree programs

» Postdoctoral programs

Research

» Medical and basic science units

Among our many honors and

acknowledgments: 12 Nobel laureates;

ranked 8th of all U.S. medical schools;

one of only 41 National Cancer

Institute-designated Comprehensive

Cancer Centers; ranked third in nation

for National Institutes of Health grant

support per researcher.

University of Chicago Medicine & Biological

Sciences Executive Leadership

Kenneth S. Polonsky, MD, Dean of the

University of Chicago Biological Sciences

Division and the Pritzker School of Medicine,

and executive vice president for Medical

Affairs for the University of Chicago

Sharon O’Keefe, president of the

University of Chicago Medical Center

Jeffery Glassroth, MD, dean for clinical

affairs, University of Chicago Medicine

T. Conrad Gilliam, PhD, dean for

research and graduate education,

Biological Sciences Division

Holly J. Humphrey, MD, dean for medical

education, Pritzker School of Medicine

INSPIRED iS PubliSHeD THRee TiMeS

a yeaR by THe univeRSiTy Of CHiCaGO

MeDiCine & biOlOGiCal SCienCeS.

editors

Anna Madrzyk and Gretchen Rubin

email us at: [email protected]

Design

TOKY Branding + Design

Contributing writers

Thea Grendahl Christou, Tanya Cochran,

Elizabeth Gardner, Kevin Jiang,

Eileen Norris, Gretchen Rubin, Anita Slomski

and Anne Stein

Contributing photographers

David Christopher, Robert Kozloff,

Jean Lachat, Bruce Powell and Jason Smith

aDDReSS

The university of Chicago Medicine

5841 S. Maryland Ave., Chicago, IL 60637

The university of Chicago Medicine

Comer Children’s Hospital

5721 S. Maryland Ave., Chicago, IL 60637

Telephone 1-773-702-1000

appointments 1-888-824-0200

Follow the University of Chicago Medicine

on Twitter at twitter.com/uChicagoMed or

visit our Facebook page at facebook.com/

uChicagoMed. You can read more about our

news and research at uchospitals.edu/news

and at sciencelife.uchospitals.edu.

This publication does not provide medical

advice or treatment suggestions. If you have

medical problems or concerns, contact a

physician who will determine your treatment.

Do not delay seeking medical advice

because of something you read here.

For urgent needs, call 911 right away.

Read Inspired online at

uchospitals.edu/inspired.

Our physicians, surgeons and scientists work in close

association to develop and apply the latest treatments.

Few specialties speak

to the advantages

of academic medicine

better than neurology.

A complex field,

it often demands

the collaboration of multiple specialists

and technologies to deliver an accurate

diagnosis and to chart a course toward

a successful outcome. This is one

of our strengths at the University of

Chicago Medicine.

Whether testing vaccines to attack

glioblastoma multiforme, employing

noninvasive imaging to identify seizure

types or designing nanoparticles to

deliver vital medications, our physicians,

surgeons and scientists work in close

association to develop and apply the

latest treatments. Coupled with our

commitment to healing the whole patient,

not just the disease, the result is a

comprehensive approach to care.

Throughout this issue of Inspired are

stories of patients who have benefited

from our comprehensive care. We also

introduce you to our new neurosciences

facilities in the Center for Care and

Discovery, and examine some of our top

neurology programs, including our Center

for Comprehensive MS Care, a nationally

recognized center of excellence.

Our most exciting news, however, is

the arrival of internationally recognized

neuroscientist John Maunsell, PhD, who

will join the University of Chicago as

the inaugural director of the Grossman

Institute for Neuroscience, Quantitative

Biology and Human Behavior. He will

oversee the development of a highly

collaborative, world-class neuroscience

institute that builds upon our diverse

strengths, ranging from evolutionary

and quantitative biology to economic

and social behaviors.

Thank you for trusting the University

of Chicago Medicine with your patients.

We look forward to continuing this

relationship well into the future.

aT THe fORefROnT Of MeDiCine®

Dear Colleagues ,

KEnnETh S. PoLonSKy, MD

Dean of the University of Chicago Biological Sciences Division and the Pritzker School of Medicine, and executive vice president for Medical Affairs for the University of Chicago

Physician RefeRRal line 1-800-824-2282 | UCHOSPITALS.edU | UCHICAGOKIdSHOSPITAL.ORG » 1

ALS Clinic Provides Full Range of Services, Including Diaphragm Pacing

The University of chicago Medicine offers comprehensive, multidisciplinary care and access to clinical trials for patients with amyotrophic lateral sclerosis (als).

studies show that als patients whose treatment is managed in multidisciplinary clinics have an improved quality of life and longer survival, said Raymond P. Roos, MD, director of the als Multidisciplinary clinic, which is funded by the Greater chicago chapter of the als association. Roos also currently has several research grants investigating novel treatments for the disease.

feeding tube placement can be risky in als patients with respiratory muscle weakness; the clinic has a dedicated team for that purpose. Two pulmonologists help guide end-of-life decisions. Other services include speech, occupational and physical therapy, nutrition counseling and help with assistive devices.

leading-edge treatments include the neuRx Diaphragm Pacing system (DPs), an implantable device developed for quadriplegics to breathe without a ventilator that’s been approved for als patients.

AT THE FOREFRONT OF NEUROSCIENCE

John Maunsell, PhD, has been named the inaugural director of the Grossman institute for neuroscience, Quantitative Biology and human Behavior.

Maunsell, an internationally recognized quantitative neuroscientist from harvard Medical school, will oversee the development of a highly collaborative, world-class neuroscience institute.

The Grossman institute builds upon the University of chicago’s diverse strengths, ranging from evolutionary and quantitative biology to economic and social behaviors. it leverages the close integration of research, education and patient care in the academic medical center.

faculty will be drawn from across the biological, physical and social sciences and engineering to address fundamental questions related to neuroscience and behavior in the context of biological, environmental and social interaction data.

Maunsell has served since 2008 as editor-in-chief of the Journal of Neuroscience, one of the top peer- reviewed journals in its field and the chief publication of the society for neuroscience, the world’s largest neuroscientist organization. he is a member of the american association for the advancement of science and was a howard hughes Medical institute investigator.

JOHN MAUNSELL, PHD,

Joins the University of Chicago to Lead New Neuroscience Institute

Immunotherapy Clinical Trials Target Aggressive Cancer

University of chicago Medicine neuro-oncologists and neuro-surgeons are studying novel treatments for glioblastomas.

“These studies, all in different clinical phases, are designed to use a vaccine to target cancer-related proteins on the tumor’s surface or to extract a complex of proteins and tumor antigens from the patient’s tumor to create a customized vaccine,” said M. Kelly nicholas, MD, PhD, director of the neuro-oncology program. neuro-oncologist Rimas lukas, MD, and neurosurgeon Maciej s. lesniak, MD, are co-investigators.

a vaccine designed to trigger an immune response to a mutant form of the epidermal growth factor receptor (eGfRviii), a protein expressed on the surface of tumors in a third of patients with glioblastoma, is being investigated in combination with standard-of-care therapies in separate studies for newly diagnosed and recurrent glioblastomas.

Researchers also are investi-gating a vaccine against the Wilms tumor antigen (WT1), overexpressed in 80 percent of patients with malignant brain tumors, and a heat-shock protein vaccine.

2 » the uniVeRsitY oF ChiCaGo MeDiCine insPiReD MaGaZine | FALL 2013

RaRe sYMPtoM

FoR neuRoBlastoMa

neuroblastoma, which stems from immature nerve cells generally found near the adrenal glands, can also develop near a child’s spine or within the chest or abdomen, most often in children under 2 years of age. a team of physicians at the university of Chicago Medicine Comer Children’s hospital, in collaboration with international researchers, noted a rare condition in three patients subsequently diagnosed with paraspinal neuroblastoma. The researchers, led by pediatric neurologist Kenneth silver, MD, found narcolepsy-cataplexy, a rapid onset of the reM sleep stage combined with sudden muscular weakness, in all three patients. In two cases, neurological symptoms resolved with treatment of the tumor and immunosuppression therapy. The findings, published in the July issue of Pediatric Neurology, marked the second documentation of narcolepsy-cataplexy as a presenting symptom of paraspinal neuroblastoma.

RaCial DisPaRitY

in olFaCtoRY DeCline

a new study shows that age-related smelling loss is significantly worse in african americans than in Caucasians. olfactory loss may lead to impaired nutrition and be an early warning sign of neurodegenerative diseases such as alzheimer’s and Parkinson’s. The study, published in the Journal of Gerontology: Medical Sciences, is the first to report racial or ethnic differences, said author Jayant Pinto, MD, associate professor of surgery at the university of Chicago Medicine.

“The racial disparity was almost twice as large as the well-documented difference between men and women,” Pinto said. The cause of this disparity is not clear, but genetic variation may play a role, as could exposure to nerve-damaging substances in the environment.

enCouRaGinG news FoR anoRexia neRVosa

shifting treatment emphasis from only weight recovery to also include better quality of life, reduction of mood disorders and enhanced social adjustment led to sur- prising improvements in patients with severe and persistent anorexia nervosa in a multinational clinical trial.

More than 85 percent of patients completed treatment — almost three times the usual retention rate.

goals for cognitive behavioral therapy and specialist supportive clinical management emphasized retention, improving quality of life and avoiding “further failure experiences.” The patients, whose average duration of illness was more than 15 years, participated in goal setting. results from these approaches showed significant improvements on many measures, including increases in BMI and decreased depression. The study, reported online in Psychological Medicine in May, was the first randomized clinical trial for patients with severe and enduring anorexia nervosa. The university of Chicago eating Disorders Program served as data coordinating center.

BioPaRtiCle shows PRoMise FoR Ms

neurologist richard P. Kraig, MD, PhD, has been awarded a five-year, $1.5 million nIh grant to develop stimulated dendritic cell-derived exosomes that show promise as a treatment for multiple sclerosis and other neurological diseases involving loss of myelin, the insulation around nerve fibers. exosomes produced in the blood appear to play a causal role in the protective effects of regular exercise and learning, collectively known as “environmental enrichment,” on the brain. These exosomes contain specific micrornas that promote myelination of aging brain as well as brain damaged by multiple sclerosis

modeled in animal brain tissues. Based on this discovery, the Kraig lab is currently exploring the possibility of using cultured dendritic cells to

recreate this effect. To do so will open new research opportunities for treatment of disorders that occur with a loss of myelin.

Image courtesy of the NIH Common Fund.

$1.5 million nih grant to develop stimulated dendritic cell-derived exosomes

Research News

The university of Chicago’s designated Center of Excellence in Gambling Research focuses on a multi-disciplinary approach to gambling disorders and other impulse- related addictions.

at the FoReFRont

UCM_Inspired_5_v10.indd 2 9/10/13 12:27 PM

PhysICIan referral lIne 1-800-824-2282 | uChosPitals.eDu | uChiCaGoKiDshosPital.oRG » 3


is designated a Center for

Comprehensive MS Care by the National

Multiple Sclerosis Society.

Because we’ve had years of experience in

clinical trials and see patients with more

complicated disease, we

can handle the toughest cases.

anthonY ReDeR, MD

Definitive Diagnosis and Comprehensive Treatment for MSuniversity of Chicago Medicine physicians helped develop and test most of the currently available therapies for multiple sclerosis, including interferon, which 20 years ago became the first fDa-approved treatment for Ms.

“Because we’ve had years of experience in clinical trials and see patients with more complicated disease, we can handle the toughest cases,” said anthony reder, MD, a neurologist in the university of Chicago Medicine’s extensive Ms program. “often, when new drugs come out, we’re ahead of the game because we’ve already been using the drugs in clinical trials.”

reder directs the neurology and Inflammatory Disease Infusion Center, where fDa-approved and investigational therapies are used to treat Ms and other diseases. advanced MrI techniques aid our experts in evaluating whether a medication is working or if a different drug is needed. nine medications (three are taken orally) are available to treat Ms, and more are in the pipeline. nationally, there are 50 clinical trials of Ms drugs under way.

Prompt diagnosis is key, since most damage to the patient’s central nervous system

INSPIRED TO DISCOvER:MuLTIPLE SCLEROSIS

occurs in the first year. “for patients with Ms, early treatment is imperative,” reder said.

The Multiple sclerosis Clinic at the university of Chicago Medicine has a well-established track record of providing definitive diagnoses and comprehensive treatments to help patients manage their symptoms and to limit flare-ups. The clinic recently received the Center for Comprehensive Ms Care designation from the national Multiple sclerosis society, awarded to centers that provide coordinated, multidisciplinary care for people with Ms, including medical, psychosocial and rehabilitation services.

“This places us with nationally recognized centers for excellence in meeting all the needs of Ms patients,” said neurologist Jacqueline Bernard, MD.

neurologists at the university of Chicago Medicine are active Ms researchers. With a four-year, $850,000 grant from the national Multiple sclerosis society, reder and his colleagues are working on a blood test that could serve as an inexpensive method for diagnosing Ms and choosing a treatment.

Bernard is studying how safe, inexpensive, but advanced, optical coherence tomography (oCT) and specialized neurology software can be used to determine the extent of disease in patients with Ms and other

neurological disorders, responses to treatment and side effects.

neurologist Jacqueline Bernard, MD, is studying the

neurodegenerative aspects of Ms and other disorders

using optical coherence tomography (oCt), which

gives researchers a view of unmyelinated axons.

at the FoReFRont



MoVeMent DisoRDeRs

Deep brain stimulation (DBS) for medication-refractory tremors

Two years ago, police officer/paramedic Patrick o’Brien’s shaky hands were so noticeable that offenders would crack jokes when he fingerprinted them. “I was a detective and my partner at the time said, ‘you need to get that looked at,’” the 43-year-old south suburban resident recalled.

o’Brien was diagnosed with essential tremor and tried medication first, but the side effects were intolerable. Then he heard university of Chicago Medicine physicians Peter Warnke, MD, director of stereotactic and functional neurosurgery, and Tao Xie, MD, PhD, medical director of the movement disorder program, give a talk about pharmacological and surgical treatments for movement disorders.

o’Brien decided to undergo deep brain stimulation (DBs), a surgical treatment for movement disorders such as Parkinson’s disease, dystonia or essential tremor. Warnke performed the surgery in January 2013. Today, o’Brien can tie his own shoes, eat soup without spilling it and overall, enjoys a much better quality of life.

“Most of the DBs outcomes are phenom-enal,” said Xie. The procedure involves placing an electrode in deep parts of the brain to deliver continuous high-frequency electrical stimulation to control movements. This stimulation is thought to suppress abnormal patterns of activity in these brain areas and bring them closer to normal.

“During the procedure we can immediately see the tremors decreasing,” Xie said.

The university of Chicago Center for Parkinson’s Disease and Movement Disorders combines clinical expertise, state-of-the-art

therapies and research. experts in neurology, neurosurgery, psychiatry, otolaryngology and rehabilitation provide multidisciplinary care to patients and families, using advanced and practical approaches to diseases including Parkinson’s, ataxia, dystonia, chorea, tremor, tics and myoclonus.

“We can quickly apprise patients and referring physicians of the most advanced research in patient care,” Xie said. “for example, we’ve found that by programming the frequency of deep brain stimulation, we can improve some gait disorders and vocal and swallowing function.”

The university of Chicago Medicine’s program is designated a Center for advanced research by the american Parkinson Disease association. Xie is actively involved in clinical trials for Parkinson’s disease, deep brain stimulation, progressive supranuclear palsy and huntington’s disease. Warnke’s research focuses on molecular and physiological imaging of movement disorders to tailor surgical approaches to the patient’s individual pathophysiology.

“We always try medication first but as a disease progresses, medications may fail, lose their benefit or cause other complications, so we consider other possibilities,” Xie said.

“We’re happy to continue working with referring physicians and we have ongoing research to constantly improve treatment.”

To learn more about the Center for Parkinson’s Disease and Movement Disorders, visit uchospitals.edu/

movement-disorders.

COLLABORATIvE NEuROLOGICAL &

NEuROSuRGICAL CAREfour approaches to treating complex conditions

Patrick O’Brien, left, and Tao Xie, MD, PhD

Clinical trials for movement disorders:

Parkinson’s disease

Deep brain stimulation

Progressive supra-

nuclear palsy

huntington’s disease



stRoKe

Stent placement for intracranial arterial stenosis when medical management fails

When a 2011 multicenter trial concluded that medical therapy is superior to angio-plasty and stent placement for patients with intracranial arterial stenosis, university of Chicago Medicine interventional neuroradiologist seon-Kyu lee, MD, PhD, was surprised.

“My patients did not experience the problems with stenting reported in the study,” said lee, who has performed more than 60 of the procedures.

other neurovascular specialists in the country also reported success with the neurointerventional technique.

Patients participating in the trial (called saMMPrIs for stenting and aggressive Medical Management for Preventing recurrent stroke in Intracranial stenosis) had survived a stroke attributed to stenosis in a major artery. enrollment was halted at 451 patients when stroke or death was reported in 14 percent of patients who had undergone stenting versus 6 percent in patients who had medical therapy. respecting the trial conclusions, lee and his colleagues are currently applying intracranial angioplasty and stent placement only in patients for whom medical management has failed.

“until new trial data proves otherwise,” lee said, “we will be cautious about the treatment and use it only as a last resort.”

Just such caution was taken with Jim Cox, a former helicopter test pilot and late-model stock car enthusiast from Dyer, Ind. Cox came to the medical center with symptoms of double vision, slurred speech and balance difficulties after suffering a stroke.

“Jim’s stroke left one artery in the brain completely blocked and another one 90 percent narrowed,” lee said.

“The consequences were preventing him from doing what he loves, and he was at high risk for another stroke.”

Cox’s medical team, lee and neurologist James r. Brorson, MD, planned a conservative treatment approach. Brorson first treated him with medications. But the severity of the vessel blockages continued to hinder blood flow to the brain.

as the next step, lee performed balloon angioplasty, gradually inflating the balloons (1.5 mm to 3 mm) just enough to slightly improve blood flow. Cox’s condition initially improved, but the symptoms eventually returned. “I started blacking out,” he recalled, describing his vision as seeing “slivers in a cracked mirror.”

lee and Brorson determined that Cox’s condition left angioplasty and stenting as the only alternative. on april 23, 2013, lee placed and inflated progressively larger balloons until he opened a 4 mm balloon at the catheter tip. The blood vessel wall widened to 90 percent, and lee positioned the stent in place.

By the time Cox left the hospital, his symptoms were gone. follow-up tests showed his brain blood flow has been normalized. according to lee, the risk of the artery narrowing again is less than 15 percent.

“I’ve encouraged him to go back to his normal life,” lee said.

| lefT, a | Before neuroendovascular treatment, one of the vertebral arteries in Jim Cox’s brain was almost completely blocked. | lefT, B | After balloon angioplasty with stent placement, the artery opened to 90 percent.

lee

For more about neurointerventional surgery, visit uchospitals.edu/

neurointerventional.

B

a

Jim Cox



BRain tuMoRs

Experienced neurosurgeon removes challenging brain stem meningioma

susan Tyra had forgotten about the meningioma in her brain. Diagnosed when she was in her early 40s, the pea-sized benign tumor didn’t cause any symptoms for nearly two decades.

But when the Wheaton, Ill., resident started experiencing daily headaches and dizzy spells a few years ago, she became concerned and saw her family physician. a CT scan revealed that the meningioma had grown to a 5 cm oval. The consensus from family members and friends: go to a major medical center for treatment.

When Tyra and her husband, rick snyder, met with university of Chicago Medicine neurosurgeon Bakhtiar yamini, MD, they were sure they had found the right physician.

“We knew it the minute he walked into the room,” Tyra said. “he ‘got’ that the diagnosis was shocking. he exuded confidence and empathy. he had a lot of training and did this type of surgery all of the time.”

The meningioma was pressing on Tyra’s brain stem, yamini explained to the couple,

and needed to be removed. “The tumor was not yet threatening susan’s life, but it was likely still growing,” he said. “as it got bigger, symptoms would have progressed to weakness in the arms and legs, headaches and then coma.”

yamini and his colleagues in the Brain Tumor Center at the university of Chicago Medicine have vast experience in the diagnosis and treatment

of brain tumors, including all types of metastatic tumors as well as acoustic neuromas and meningiomas, the most common benign tumors.

“for benign tumors less than 3 cm in diameter, we often do radiosurgery — a one-time, focused radiation dose to the tumor,” yamini said. “But for larger ones, such as the meningioma in susan’s brain, surgical intervention is usually the best option.”

The surgery took place three weeks later. after making an incision behind Tyra’s right ear, yamini lifted the cerebellum. he meticulously removed the tumor, avoiding critical blood vessels, taking pressure off the brainstem and dissecting

the cranial nerves that were wrapped around the lesion. electrophysiologists monitored Tyra’s motor and sensory function throughout the operation.

During the eight-hour procedure, yamini determined that a small amount of tumor, deep in the brain and attached to the cranial nerves, was too difficult to remove safely. Because it could be a source for recurrence, Tyra underwent six weeks of targeted radiation therapy to kill the remaining tumor cells.

after the surgery, Tyra experienced some drooping on the right side of her face, double vision and deafness on one side. But six months later, only the hearing loss remained. “Dr. yamini told me before the operation that I could lose my hearing in the right ear, so I was expecting it,” she said. “It was just a small price to pay for the miracle of being around for many more years.”

For more about brain tumor care, visit uchospitals.edu/

brain-tumor.

BAKHTIAR yAMINI, MD, IS

TESTING A

NANOPARTICLE “SHELL”

capable of selectively

targeting therapeutics to

brain tumor cells.

at the FoReFRont

yaMInI

| lefT | Pre-op image shows a homogeneously enhancing mass in the CP angle compressing the brainstem. | r IghT | Post-op image shows gross total resection of the mass, decompression of the brainstem and the residual presence of thickened dura at the petrous apex.

Susan Tyra



ConGenital neRVous sYsteM DisoRDeRs

Multidisciplinary program provides care for adults born with anomalies of the nervous system

adult patients with congenital anomalies of the nervous system often have a hard time finding treatment. The university of Chicago Medicine has one of the few programs in the nation providing comprehensive lifetime care for complications of hydrocephalus, Chiari malformation, spina bifida, syringomyelia and craniosynostosis.

“We understand the complex nature of these illnesses as well as the challenges patients face as children and as adults,” said David M. frim, MD,

PhD, chief of neurosurgery. The program includes experts in neurosurgery, neurology, orthopaedic surgery, urology, rehabilitation medicine and genetics.

Dan Kricke, 27, had a shunt inserted for obstructive hydrocephalus shortly after birth. although he had many revision surgeries as a child, the shunt performed well for most of his young adult life. But in his mid-20s, the corporate communications specialist sought medical help after experiencing worrisome symptoms, including lethargy, consistent pressure in his head and “feeling strange overall.”

Kricke contacted the children’s hospital where he was initially treated, only to learn pediatric neurosurgeons there didn’t care for adults with his condition. During his search for an adult specialist in Chicago, he discovered that most neurosurgeons do not treat older patients who have hydrocephalus or other related nervous system disorders.

eventually, Kricke’s search led him to the university of Chicago Medicine. frim’s neurosurgical team performed two revision procedures on Kricke, each time modifying or replacing a few parts of the shunt. “We did as little as possible to make improvements without causing too much harm or trauma to the brain,” frim said.

“for example, we upgraded to an externally programmable valve.”

With a likelihood of ongoing shunt complications, frim suggested Kricke consider endoscopic third ventricu-locisternostomy (eTV). In some cases, the internal bypass procedure helps the shunt work better; and in other instances, the patient no longer needs the device. frim told Kricke that eTV would provide a long-term solution to hydrocephalus. Kricke responded, “let’s do it.”

on february 6, 2013, frim performed the minimally invasive surgery. using a neurosurgical endoscope, he created a perforation in the floor of the third ventricle, allowing the cerebrospinal fluid to escape into its normal pathway for circulation.

Today, Kricke reports that his headaches are gone and that he feels fine. frim’s team has turned off the shunt and told their patient that it can be permanently removed. But Kricke wants to wait a few years before undergoing brain surgery again.

he proposed to his girlfriend this past summer at a music festival in Chicago. now, he said, “I’ll concentrate on getting married.”

frIM

Comprehensive lifetime care for

complications of:

hydrocephalus

Chiari malformation

spina bifida

syringomyelia

craniosynostosis

For more about care for adults with congenital anomalies of the

nervous system, visit uchospitals.edu/congenital-

anomalies.

Dan Kricke and fiancée Gayle Shier



at the FoReFRont

Both the adult and pediatric epilepsy centers at the university of Chicago Medicine are national

association of epilepsy Centers (naeC) level 4 centers

offering the most advanced medical and surgical care.

Comprehensive Approach to Treating Medication-Resistant Seizures in Adults and Children for most epilepsy patients, today’s medications control seizures effectively with minimal side effects. But for the one in three individuals who experience intractable seizures, advanced diagnosis and treatments are available at the university of Chicago Medicine’s adult and pediatric epilepsy centers.

Both the adult and pediatric programs are recognized by the national association of epilepsy Centers (naeC) as providing the highest level of care for complex epilepsy.

To achieve this designation, an epilepsy center must offer advanced neurodiagnostics and a broad range of therapies, including surgery.

“We take a very comprehensive approach when treating patients who have not been well controlled,” said neurologist James Tao, MD, PhD, director of the university of Chicago Medicine’s electroencephalography lab.

The state-of-the-art capabilities in the medical center’s epilepsy monitoring unit include digital eeg recording; outpatient ambulatory eeg monitoring; inpatient video eeg recording and analysis; and high-resolution CT, Mr and PeT imaging. Data from all imaging modalities are combined to produce a 3-D image of the brain and determine if surgery — often the first choice because of its high efficacy rate — is a viable option.

These sophisticated diagnostic techniques help our team plan surgical procedures in advance and with greater precision. studies show surgery can significantly help up to 80 percent of patients who have medication-resistant seizures.

When the focus of a patient’s seizures is difficult to pinpoint or when it is too close to vital brain functions, the best treatment strategy may be an implantable vagus nerve stimulator. The device reduces the frequency of seizures by half for many patients, and eliminates seizures for 3 to 5 percent of patients.

In some instances, individuals are taking the wrong medications for their type of seizure. Tao refers to these cases as “pseudo-intractable.”

“Diagnosis and classification can be challenging in hospitals that don’t have advanced diagnostic equipment,” he said.

“When we match the seizure type with the right medication, magic can happen.”

MeMoRY loss

The Memory Center at the university of Chicago Medicine offers comprehensive evaluations and treatment for people with dementia and other memory problems. “We specialize in difficult-to-diagnose atypical dementia, but we also provide full-service care for patients with alzheimer’s disease,” said James Mastrianni, MD, PhD, director of the center. The team of specialists includes neurologists, geriatricians, psychiatrists, neuropsychologists, nurses and social workers.

Basic and clinical research teams are working on a variety of aspects of dementia, including the biological underpinnings of disease, early detection using specialized MrIs that focus on areas of the brain affected first, and new investigative therapies.

sleeP PRoBleMs

restful sleep is necessary for good health. The university of Chicago Medicine’s sleep medicine program is equipped to handle the most challenging sleep disorders in adults and children. our board-certified sleep medicine experts work closely with neurologists, psychiatrists, surgeons, cardiologists and other specialists to develop a customized treatment plan for each patient.

The university of Chicago Medicine was at the forefront of sleep research even before rapid eye movement (reM) sleep was discovered here in 1953. Current research examines links between sleep disorders, diabetes and overeating.

Tao



Collaborating with Local Physicians on CCMs The university of Chicago Medicine is a center of expertise for cerebral cavernous malformation (CCM) treatment and research.

Issam a. awad, MD, director of neurovascular surgery at the university of Chicago Medicine, is one of the world’s leading authorities on the disorder. The angioma alliance has designated his clinic as the preferred referral site for patients with the CCM3 mutation, the least common and most aggressive form of the disease.

awad is monitoring about 100 CCM patients from around the world. he and his team have developed advanced MrI techniques to count the number of lesions in the brain more accurately and analyze their composition and the condition of the surrounding brain tissue. awad uses this information to assess how the disease is progressing and anticipate lesions that may require surgical intervention. “We study the scans and share our impressions with the patient’s local physician,” awad said.

In the laboratory, awad and his colleagues are working to identify biomarkers of the disease and create drugs to halt lesion development. In a study published in Stroke, the researchers demonstrated that the drug fasudil prevented the formation of CCM lesions in laboratory models.

| lefT | Advanced MRI techniques being developed at the university of Chicago Medicine detect CCM lesions (SWI) more accurately and track iron leakage in each lesion (QSM).

Advanced Treatment for Complex Stroke, Including MISTIE and CLEAR TrialsThe university of Chicago Medicine offers advanced interventions for acute stroke, including clinical trials of minimally invasive surgery for intracerebral hemorrhages.

“We have developed a time-critical diagnosis protocol to facilitate transfers of complex stroke patients,” said neurologist James r. Brorson, MD, medical director of the Joint Commission–certified stroke center at the university of Chicago Medicine.

“We have the advantages of an outstanding neuro-Intensive Care unit staffed by neurointensive care specialists and the collaborative interaction between neuro-vascular surgeons and neuroradiologists with expertise in endovascular treatment for stroke,” Brorson said.

Complex stroke patients are those who may benefit from advanced interventions, such as thrombectomy. Patients who have suffered an intracerebral hemorrhage may be eligible to receive a groundbreaking treatment in a clinical trial.

The university of Chicago Medicine is participating in the ongoing nIh-funded study of minimally invasive surgery with thrombolysis in intracerebral hemorrhage evacuation (MIsTIe). In the procedure, rtPa is used to thin the hematoma so it can be evacuated through a catheter.

Issam a. awad, MD, director of neurovascular surgery and a pioneer in surgery for stroke for 20 years, is the co-principal investigator of the MIsTIe phase 3 trial. The inter-national, multicenter study is funded by the national Institutes of health (nIh) and will enroll 500 patients worldwide. The university of Chicago Medicine houses the trial’s surgical center and will monitor catheter placement and overall surgical performance and quality at 60 participating institutions.

awad also is the co-principal investigator in a parallel nIh-funded study assessing clot lysis in intraventricular hemorrhage (Clear). In this procedure, the clot- busting agent is distributed through a catheter to quickly remove the blood from the cerebral ventricles.

3-D computer reconstruction of patient’s blood casts as seen on CAT scan of the brain (red), with dual catheters in place to break the clot (blue tubes).

After drug lysis of the clot.

The University of Chicago Medicine houses the

SuRGICAL CENTER

for an international, 60-center study of

minimally invasive surgery for hemorrhagic stroke.

at the FoReFRont

For more information on multi-

specialty stroke and neurovascular

care, visit uchospitals.edu/

stroke-neurovascular.


neuRosCienCes

from Bench to BedsideWei Wei, PhD, is one of the more than 80 physician-scientists and lab-based neuroscientists at the university of Chicago who focus their efforts on neurological disorders. The assistant professor of neurobiology studies the assembly of neural circuits during development to perform specific visual tasks. The retina is a classic model system for studying how synaptic circuits perform neural computations, because visual processing begins when light strikes retinal photoreceptors. The retina collects information and sends abstract visual features, such as color, motion and contrast, to higher brain centers.

Wei’s work is designed to provide definitive answers to the outstanding questions about how retinal circuits function, but it may also contribute to better vision care. “Dysfunction of retinal circuits is the ultimate cause of visual impairment in most eye diseases,” she explained.

The alfred P. sloan foundation recently named Wei a 2013 sloan research fellow — an award for early career scholars of outstanding promise who have the “unique potential to make substantial contributions to their field.”

PhYsiCian Relations

Ask the Expert: Christopher Gomez, MD, PhDChristopher M. gomez, MD, PhD, is chairman of neurology at the university of Chicago Medicine. he specializes in neurogenetic conditions, gait and balance disorders, and ataxias.

gomez is a leader in the field of diagnosis, management and basic laboratory research on the ataxias.

his laboratory research concentrates on the molecular and cellular mechanisms of neurodegenerative disease. In a study that could change the way scientists view the process of protein production in humans, gomez and his colleagues discovered a single gene that encodes two separate proteins from the same sequence

of messenger rna. Their finding, published in Cell, opens the door for new therapeutic strategies for one of the most common adult ataxias.

what sets neuRoloGY anD

neuRosuRGeRY CaRe at the

uniVeRsitY oF ChiCaGo aPaRt?

our specialists are not only clinicians but also educators and scientists. With multiple clinical trials going on, we are able to offer the latest treatments to our patients. our highly collaborative, multidisciplinary approach gives patients access to several experts in one place. We are thrilled to work with referring physicians to treat patients with these complex disorders.

what MaKes the uniVeRsitY oF

ChiCaGo MeDiCine a leaDeR in

tReatinG BRain DisoRDeRs?

our multiple sclerosis program, established in 1976, has grown through the years to

become a leading Ms program nationally. our neuroradiologists use very sophisticated imaging of the brain for early detection of diseases such as Parkinson’s. for epilepsy and brain tumors, we offer advanced diagnostic and surgical approaches. finally, we have a team of outstanding neurointensive care physicians.

what Do You see as the

FutuRe FoR tReatMent oF

neuRoloGiCal Diseases?

advances will come from molecular studies in the laboratory and at the engineering level. These may bring about many more diagnostic tools, drug targets and bioengineering strategies to modulate abnormal movements, detect and prevent seizures, and even potentially provide function where it wasn’t present before.


Please contact your dedicated liaison by phone or email with any request. We are here to serve you.

CaRol MaRshall

Director 1-773-702-9205 carol.marshall@ uchospitals.edu

aMBeR naiK

Assistant Director 1-773-230-5236 [email protected]

DeMetRia aVant

Regional and Western Suburbs 1-773-717-0458 demetria.avant@ uchospitals.edu

MiKe DelaRosa

Northwest Indiana 1-773-230-8496 michael.delarosa@ uchospitals.edu

anthonY tuRneR

South and Southwest Suburbs, 1-773-729-0822 anthony.turner@ uchospitals.edu

Dionne MeeKins-MiChauD

North and Northwest Suburbs, 1-773-717-0457 dionne.michaud@ uchospitals.edu

AT THE fOREfRONT

Of NEuROSCIENCES

Wei Wei, PhD



DouGlas R. DiRsChl, MD, chairs the newly created Department of orthopaedic surgery and rehabilitation Medicine at the university of Chicago Medicine. Dirschl previously was chair of orthopaedics at the university of north Carolina school of Medicine. he is the former president of the american orthopaedic association.

JessiCa J. KanDel, MD, is the new section chief of pediatric surgery and surgeon-in-chief at the university of Chicago Medicine Comer Children’s hospital. Kandel, an authority on the surgical treatment of childhood cancers, comes to Chicago from Columbia university College of Physicians and surgeons in new york. her expertise includes the development of groundbreaking treatments for vascular anomalies in children.

ChRistoPheR h. wiGFielD, MD, joined the university of Chicago Medicine as assistant professor of surgery and associate surgical director of lung transplantation. Wigfield was director of lung transplantation and vice president for research and education at loyola university Medical Center. he is the educational affairs director at the International society for heart and lung Transplantation.

husaM h. BalKhY, MD, has been named director of robotic and minimally invasive cardiac surgery. Balkhy, an associate professor of surgery, came to the university of Chicago Medicine from Medical College of Wisconsin and The Wisconsin heart hospital. he was chair of cardiothoracic surgery at TWhh and director of the Center for robotic and Minimally Invasive Cardiac surgery.

walteR M. staDleR, MD, associate dean for clinical research, has been named section chief of hematology/oncology. stadler, director of the genitourinary program, had served as interim section chief since January.

taKeYoshi ota, MD, PhD, joined the medical staff as assistant director of the aortic diseases program. ota, an expert in the surgical treatment of aortic diseases, was an assistant professor of surgery at Columbia university Medical Center.

eRnst lenGYel, MD, PhD, has been appointed chair of the Department of obstetrics and gynecology at the university of Chicago Medicine. lengyel specializes in the surgical treatment of gynecological cancers, including ovarian and endometrial cancer.

JeFFReY B. Matthews, MD, chair of surgery and surgeon-in-chief at the university of Chicago Medicine, has been named president-elect of the Chicago surgical society. Matthews’ term as president begins in 2014.

JeFFReY GlassRoth, MD, has been appointed dean for clinical affairs and head of the faculty practice plan. glassroth formerly was president and chief executive officer of the northwestern Medical faculty foundation, the faculty practice at north-western’s feinberg school of Medicine.

issaM a. awaD, MD, director of neurovascular surgery, received the shield of Distinction and Merit, the highest recognition from the lebanese order of Physicians.

MiChael B. Gluth, MD, is the new medical director of the Comprehensive listening Center at the university of Chicago Medicine. gluth, who provides care for adults and children with ear and hearing disorders, came to uChicago from the university of arkansas for Medical sciences, where he was on faculty.

Two physicians have joined the staff at the university of Chicago Medicine Comprehensive Cancer Center at silver Cross hospital in new lenox, Ill. Medical oncologist GRaCe K. suh, MD, comes from Indiana university–Iu health. radiation oncologist Daniel w. GolDen, MD, is moving his practice from the university of Chicago Medicine main campus.

aYteKin oto, MD, professor of radiology and surgery, was recently recognized by the radiological society of north america with a 2013 honored educator award.

JaMes M. MoK, MD, assistant professor of surgery, joins the Department of ortho-paedic surgery and rehabilitation Medicine from Madigan army Medical Center in Washington. he completed his residency at uCsf and fellowship in spine surgery at Cedars-sinai Medical Center in los angeles.

ChaDi naBhan, MD, associate professor of medicine, joins the university of Chicago Medicine as director of clinical cancer services. nabhan previously was with advocate health Care, where he served as chief of oncology and medical director of the Cancer Institute at advocate lutheran general hospital.

MiChael howell, MD, is the new associate chief medical officer for clinical quality at the university of Chicago Medicine. he comes to uChicago from harvard university and Beth Israel Deaconess Medical Center.

DaViD o. MeltZeR, MD, PhD, section chief of hospital medicine, was named a Master of hospital Medicine, the highest designation in the specialty. The society of hospital Medicine reserves the honor for hospitalists who have distinguished themselves through significant contributions to the field and to health care.

DoRiane C. MilleR, MD, associate professor of medicine and director of the Center for Community health and Vitality, was appointed to a one-year term on the Patient-Centered outcomes research Institute (PCorI) advisory Panel on addressing Disparities. Miller is co-chair of the advisory panel. Continued on page 12

insPiReD TO DISCOvER,

TEACH & GIvE BACK

CHARLES RuBIN, MD, director of the Brain and Spinal

Cord Tumor Program at the

University of Chicago Medicine

Comer Children’s Hospital, has

been providing

compassionate

care for children

with cancer

for 25 years.

at the FoReFRont

Wei Wei, PhD



Continued from page 11

university of Chicago Medicine cancer researcher Janet D. RowleY, MD, and oluFunMilaYo i. oloPaDe, MD,

associate dean for global health and director of the Center for Clinical Cancer genetics, were named to the first class of fellows of the american association for Cancer research academy.

DaViD GoZal, MD, chairman of pediatrics and physician-in-chief at the university of Chicago Medicine Comer Children’s hospital, is the new secretary-treasurer of the amer-ican Thoracic society and will serve as aTs president beginning in 2016.

CaRole oBeR, PhD, the Blum-riese Professor of human genetics and obstetrics and gynecology, has been named chair of the Department of human genetics at the university of Chicago.

MaRCo G. Patti, MD, professor of surgery and director of the Center for esophageal Diseases, is president-elect of the International society of surgery, based in switzerland. Patti’s term as president begins in 2015.

PeteR anGelos, MD, PhD, chief of endocrine surgery and associate director of the Maclean Center for Clinical Medical ethics, received the excellence in Medical ethics award from the american association of Clinical endocrinologists.

MoniCa PeeK, MD, MPh, assistant professor of medicine, was selected by the society of general Internal Medicine as the 2013 outstanding Junior Investigator of the year in recognition of her contributions to the field of academic general internal medicine.

s. MuRRaY sheRMan, PhD, chairman of neurobiology, has been elected president of the association of Medical school neuroscience Department Chairpersons (aMsnDC). his two-year term begins in 2014.

The university of Chicago Medicine Comprehensive Cancer Center at Silver Cross Gastrointestinal Cancer CME Series

oCtoBeR 3: Pancreatic cancer

noVeMBeR 6: Colorectal cancer

DeCeMBeR 5: Esophageal cancer

Cooper’s Hawk Winery & Restaurant

15690 S. Harlem Ave., Orland Park, Ill.

All events begin at 6:30 p.m.

Dinner is provided.

Space is limited. Register at

cme.uchospitals.edu. For more

information, call 1-773-702-3576.

2nd francis L. Lederer foundation Symposium on Esophageal Cancer Research

oCtoBeR 14

University of Chicago Gleacher Center

450 N. Cityfront Plaza Drive, Chicago

Heart Rhythm Management 2013: State-of-the-Art Evidence Based Medicine

oCtoBeR 26, 8aM–3PM



Endoscopic ultrasonography Live 2013

noVeMBeR 8–9


Center for Care and Discovery

5700 S. Maryland Ave., Chicago

27th Annual Challenges for Clinicians

DeCeMBeR 6–8

The Drake Hotel

140 E. Walton Place, Chicago

STEMI 2013: Treatment Options and Management for the Complex Patient

3rd Annual update on STEMI and Acute Coronary Syndromes

DeCeMBeR 7, 8aM–12:30 PM



11th Annual Current Concepts in Primary Care Sports Medicine

FeBRuaRY 27–MaRCh 1, 2014

Millennium Knickerbocker Hotel

163 E. Walton Place, Chicago

Beyond LDL Cholesterol: Risk Assessment and Biomarkers in Special Populations

MaRCh 1, 2014, 8aM–2PM



MaRK YouR CalenDaR:

7th Annual Cancer Genetics and Applications to Clinical Practice

aPRil 11–12, 2014

Hyatt Chicago Magnificent Mile

633 N. St. Clair St., Chicago

Novel Approaches for Complex valvular Heart Disease

aPRil 26, 2014, 8aM–1PM



University of Chicago Medicine

physicians are available to present

in-office CME courses in greater

Chicagoland and Northwest Indiana.

For information, please contact Uchenna

Hicks, [email protected].

Register for CME events at cme.uchicago.edu.

CME& EDuCATIONAL OPPORTuNITIES


Donors Collaborate on a Cure

When Winnetka resident Bill Davis learned he had a life-threatening condition, the words of a physician he had yet to meet put him at ease.

neurosurgeon Issam a. awad, MD, called the retired executive immediately after reviewing his scans. “he said, ‘I am going to help you; we know how to fix this,’” Davis recalled.

awad, director of neurovascular surgery at the university of Chicago Medicine, is an expert on vascular malformations of the brain. he is co-author of the only medical textbook on dural arteriovenous malformations, including abnormal connections, or fistulas, between veins and arteries that develop in the covering of the brain. Blood flow through the brain becomes sluggish and congested, and the condition, if untreated, can lead to paralysis or stroke.

“so it’s like your sump pump failing, and the brain’s blood drainage backing up,” awad said.

To treat Davis, retired chairman, president and Ceo of r.r. Donnelley & sons Company, awad teamed with seon-Kyu lee, MD, PhD, director of interventional neuroradiology. Working through a small hole in the groin, lee threaded a tiny catheter to the point of the

malformation. Then he injected medical “superglue” to block the fistula, successfully shutting down the abnormal connection between arteries and veins.

“Whenever possible, we treat the lesion using this less invasive catheter technique to avoid much riskier open brain surgery,” lee said. “We were extremely pleased that we were able to repair Mr. Davis’ fistula.”

Davis’ condition was so rare that many neurosurgeons do not see a case like it in their entire careers, awad said.

he suggested further testing, which uncovered a rare blood clotting tendency that may have caused the fistula to develop. This can be treated with medication to prevent future problems, awad said.

grateful for the expert care he received, Davis and his wife, Judy, asked awad about his research on cerebrovascular malformations. The couple contributed $1 million to establish the Judy and Bill Davis research fund in neurovascular surgery.

This fund will allow awad to expand basic and clinical research efforts, leveraging the team’s recent discoveries in the laboratory to make a broader impact on patients.

“Bill and Judy’s gift is the ultimate recognition of our contribution to his life,” added awad. “fate brought us together, and we are so happy for this bridge between excellent care and our mission of discovery.”

For more information or to support neurovascular research at the University of Chicago Medicine, please contact Stephanie Dahl at [email protected].

Bill and Judy Davis (left) and Issam A. Awad, MD

COUPLE SUPPORTS

SuRGEON’S RESEARCH



5841 S. Maryland Ave.

Chicago, IL 60637

If you receive an extra copy of this publication, please share it with a neighbor or

friend. If you prefer to be removed from our mailing list, please call 1-855-622-6116.

Join the ConVeRsation

CancerConversations.uchospitals.edu

UChicago Cancer Conversations is the new University of Chicago Medicine & Biological Sciences

blog focused on building a community around cancer research,

treatment and patient care.

Posts from UChicago clinicians, physicians and researchers are

augmented by enterprising stories on cancer trends and innovations, patient treatments and research.

The goal is to become a destination for scientific and clinical discovery

in the fight against cancer.

Please check back often, send us your ideas and follow

us on Twitter.

NONPROfIT ORGANIzATION u.S. POSTAGE PAID CAROL STREAM, ILPERMIT NO. 2003

@uChicagoCancer

u C hiC aGo CanCeR

CONVErSATIONS

FeatuReD Posts:

+ virus-Carrying Stem Cells used to Treat Deadly Brain Cancer in Laboratory Models

+ fast five: Q&A with the New Section Chief of Hematology/ Oncology

+ Adults are Eligible for Many Pediatric Clinical Trials


Inspired - Fall 2013 - University of Chicago Medicine

Documents

Transcript of Inspired - Fall 2013 - University of Chicago Medicine