Neurological Institute 2008 Annual Report

Neurological Institute 2008 Annual Report

Contents 

02 C H A I R M A N ’ S W E L C O M E 

04 C L E V E L A N D C L I N I C N E U R O L O G I C A L I N S T I T U T E O V E R V I E W 

10 O U R C E N T E R S 

22 PAT I E N T C A R E 

24 C O M M U N I T Y C A R E 

26 2 0 0 8 O U T C O M E S 

30 T E C H N O L O G Y A N D I N N O VAT I O N 

38 R E S E A R C H 

50 E D U C AT I O N 

54 N E W S TA F F 

56 N E U R O L O G I C A L I N S T I T U T E S TA F F 

62 S E R V I C E S F O R P H Y S I C I A N S A N D PAT I E N T S 

On the cover: Neurosurgeon Jorge Gonzalez-Martinez, MD, PhD, joined the Neurological Institute’s Epilepsy Center in 2008. 

Subsequently, he performed North America’s first stereoelectroencephalography (SEEG) procedure, which opens the possibility of 

new treatment options for patients with intractable focal epilepsy.

Cleveland Clinic’s Neurological Institute achieved significant growth in patient and 

surgical volumes in 2008. This annual report chronicles the progress that underlies the 

numbers: geographic expansion, new research insights, innovative treatment modalities, 

extended educational opportunities for healthcare professionals and the public, accelerated 

collection of clinical data, the addition of talented staff and promising affiliations with 

new partners. All these advances are driven by a fundamental goal: to provide exceptional 

patient care and improve outcomes.

Michael T. Modic, MD, FACR

Dear Colleagues 

In Cleveland Clinic’s Neurological Institute, our patient-centered 

approach incorporates a strategic design for geographic diversity, 

predicated on the notion that the widely dispersed population we 

serve is entitled to a uniformly high level of care. Our goal is to 

distribute technology and expertise so that, whether an individual 

needs emergency or continuing care, location is never an issue. 

In fact, patient proximity is an integral component of our tem- 

plate for growth throughout Cleveland Clinic. We are resolved 

to function as an enterprise-wide entity, rather than as a chain of 

discrete facilities. Consequently, the health system is adopting a 

coordinated, continuous longitudinal care model, with variable 

resources at different regional sites. This configuration benefits 

our locally and nationally based patient populations alike. To the 

former group, broadened reach promises a consistent level of 

expertise close to home, no matter where home happens to be; 

for the latter, it augurs improved access and outcomes as well as 

unvarying standards of excellence. 

This thinking is reflected in the Neurological Institute’s new Lou 

Ruvo Center for Brain Health, with addresses in Cleveland and 

Las Vegas; our new Center for Behavioral Health, which consoli- 

dates psychiatric resources at designated regional sites; our Sleep 

Disorders Center, which offers patients a common, high-quality 

experience at seven community-based overnight sleep labora- 

tories; a new, hospital-based suburban Cleveland neurological 

site that addresses even the most complex disorders; and the 

Department of Physical Medicine and Rehabilitation, now part of 

our institute, with inpatient and outpatient locations throughout 

northeast Ohio. 

clevelandclinic.org/neuroscience | 866.588.2264 

Welcome 3 

When we measure clinical outcomes, one variable we do not chart is geography. There are many reasons people do 

or do not survive acute events such as stroke, but there is no dispute that superior outcomes often correlate with 

immediate access to a medical center equipped with the resources to rapidly provide treatment according to updated, 

nationally recommended standards. 

The principal enabler of this shift is technology. In the Neuro- 

logical Institute, we are leveraging the technical infrastructure 

through our imaging capabilities, which are now distributed 

across the community, and the enhanced electronic medical 

record. The institute’s Knowledge Program © is focused on stan- 

dardizing data collection within each patient’s record to better 

track outcomes and analyze information. 

A complementary initiative, critical to regional growth, is the 

codification of standardized care pathways across the entire hos- 

pital system. I alluded to stroke care, possibly the best example in 

the Neurological Institute. With the population aging and stroke 

incidence rising, these patients are being diagnosed rapidly and 

treated appropriately, consistent with Get With The Guidelines SM 

protocols, at every Cleveland Clinic facility. 

Ultimately, the key to any successful undertaking is people. 

Here, the commingling of Cleveland Clinic and independent 

physicians, working together as one team, is an essential piece. 

Collaboration is a tenet of the multidisciplinary Neurological 

Institute and the foundation for a truly integrated system. 

In this annual report, we are pleased to demonstrate how this 

system is evolving and expanding to serve patients better and to 

prepare for the inevitable healthcare challenges to come. I look 

forward to continuing to document our progress. 

Sincerely, 

Michael T. Modic, MD, FACR 

Chairman, Cleveland Clinic Neurological Institute

4 Overview 

Cleveland Clinic 

Neurological Institute Overview 

The multidisciplinary Cleveland Clinic Neurological Institute includes more than 250 medical, surgical and research 

specialists dedicated to the treatment of adult and pediatric patients with neurological and psychiatric disorders. The 

institute offers a disease-specific, patient-focused approach to care. Our unique, fully integrated model strengthens 

our current standard of care, allows us to measure quality and outcomes on a continual basis, and enhances our ability 

to conduct research. 

U.S.News & World Report’s “America’s Best Hospitals” survey 

ranked our neurology and neurosurgery programs sixth in the 

nation in 2008 and again in 2009. Our pediatric neurology and 

neurosurgery programs were ranked fourth in the nation in both 

years. Our neurology, neurosurgery, pediatric neurology/neuro- 

surgery and psychiatry programs are also ranked best in Ohio. 

The institute model allows our patients to access the care they 

need through specialized, multidisciplinary, disease-specific cen- 

ters that integrate the expertise of neurologists, neurosurgeons, 

orthopaedic surgeons, psychiatrists, psychologists, physiatrists, 

neuroradiologists and others into the comprehensive care of a 

single disease: 

• Cleveland Clinic Lou Ruvo Center for Brain Health 

• Brain Tumor and Neuro-Oncology Center 

• Cerebrovascular Center 

• Epilepsy Center 

• Mellen Center for Multiple Sclerosis Treatment and Research 

• Center for Neuroimaging 

• Center for Neurological Restoration 

• Center for Pediatric Neurology and Neurosurgery 

• Neurological Center for Pain 

• Neuromuscular Center 

• Department of Physical Medicine and Rehabilitation 

• Department of Psychiatry and Psychology 

• Center for Regional Neurology 

• Sleep Disorders Center 

• Center for Spine Health 

In 2008, the Neurological Institute served 140,000 patients 

and performed 7,500 surgeries. We provide care across the 

spectrum of neurological disorders, including primary and 

metastatic tumors of the brain, spine and nerves; pediatric and 

adult epilepsy; headache, facial pain syndromes and associated 

disorders; movement disorders such as Parkinson’s disease, 

essential tremor and dystonia; neurocognitive disorders such as 

dementia and Alzheimer’s disease; cerebral palsy and spasticity; 

hydrocephalus; metabolic and mitochondrial disease; fetal and 

neonatal neurological problems; multiple sclerosis; stroke; cere- 

bral aneurysms; brain and spinal vascular malformations; carotid 

stenosis; intracranial atherosclerosis; nerve and muscle diseases, 

including amyotrophic lateral sclerosis, peripheral neuropathy, 

myasthenia gravis and myopathies; sleep disorders; and mental/ 

behavioral health disorders and chemical dependencies. 

Right: A dedicated 16-bed Neurointensive Care Unit is staffed with neurologists, neurosurgeons, specially trained nurses, respiratory therapists, 

nutritionists and pharmacists, all under the direction of neurointensivists. The full-service unit, which treats more than 1,300 patients a year, is 

equipped to manage any neurological condition regardless of severity. 

Cleveland Clinic Neurological Institute | 2008 Annual Report

Expert, Specialized Diagnosis 

Neurological Institute physicians draw on advanced diagnostic 

capabilities and experience. 

Our imaging services include structural and functional magnetic 

resonance imaging (MRI), computed tomography (CT), 

positron emission tomography (PET), myelography, diagnostic 

cerebral/spinal angiography, interventional neuroradiology, and 

carotid and transcranial Doppler ultrasound. Our neuroimaging 

staff subspecializes in specific disease entities such as epilepsy 

and cerebrovascular disease, ensuring accurate, in-depth 

interpretations. 

Additional diagnostic tools are found in our epilepsy monitoring 

units, sleep laboratories, neuropsychological testing facilities, 

electromyography laboratory, autonomic laboratory and cutane- 

ous nerve laboratory. 

The Latest Treatment Modalities 

Patients receive leading-edge treatment options at the Neurologi- 

cal Institute, where we continue to advance such innovations as 

deep brain stimulation (brain pacemakers), epilepsy surgery, 

stereotactic spine radiosurgery, endovascular treatment of 

cerebral aneurysms and vascular malformations, and neuroen- 

doscopy. Distinctive services such as our three-week outpatient 

program for sufferers of chronic headaches and our Headache 

Infusion Suite provide intensive therapy when needed. The Brain 

Tumor and Neuro-Oncology Center’s Translational Therapeutics 

Program is accelerating the process of bringing novel therapeu- 

tic agents from the laboratory to the patient. Joint Commission 

certification as a Primary Stroke Center and accreditation by the 

American Academy of Sleep Medicine are just two examples of 

our commitment to providing the most advanced and highest 

quality of care to our patients. 

Relevant Research 

We strive to conduct research directly related to conditions expe- 

rienced by our patients, with programs in translational research, 


Overview 7 

The Cerebrovascular Center’s neurovascular intervention and operating 

suite is designed for traditional microsurgical procedures and for 

advanced, highly technical endovascular procedures. 

clinical trials of drug and device interventions, neuroimaging 

research, epidemiology and health outcomes, behavioral and 

psychiatric research, and research into better diagnostic meth- 

ods. Typically, more than 100 clinical research trials are under 

way at any time in the Neurological Institute. In 2008, we were 

awarded more than $17.9 million in neurological-based grants 

and research contracts. 

Convenient Care in the Community 

We are committed to making access to world-class care conve- 

nient for all our patients, whether they come to us from down the 

street or half a world away. Our Neurological Institute regional 

centers represent a systemwide expansion of our services to 

Cleveland Clinic regional hospitals and family health centers 

throughout the community. 

In 2008, the Neurological Institute expanded to Lakewood 

Hospital, providing comprehensive services to Cleveland’s West 

Side and western suburbs. The Cleveland Clinic Neurological 

Institute at Lakewood Hospital offers patients access to multiple 

specialists in a convenient location where they can receive evalua- 

tion, treatment, rehabilitation, preventive care and other services 

they require. In addition, Cleveland Clinic neurologists oversee 

inpatient care at a number of other Cleveland Clinic hospitals. 

Left: The first stereoelectroencephalographic (SEEG) procedure in North America is performed at Cleveland Clinic. 

SEEG targets specific brain areas to localize the epileptogenic zone more precisely and less invasively.

8 Overview 

Our Sleep Disorders Center has also extended its regional presence 

with seven community-based overnight sleep laboratories, 

including five hotels where sleep studies are performed with 

patients’ convenience and comfort in mind. 

With the recent formation of our Center for Behavioral Health, 

we are building a regional network of mental health and psychiatric 

services to improve patient access to care and ensure quality 

and efficiency. 

For Neurological Institute nurses, opportunities abound on the job as 

well as through continuing education programs that enable subspecialization 

for those who are interested. 

Integrated Nursing Services 

The Neurological Institute integrates inpatient and ambulatory 

nursing, enhancing the continuum of patient care. This unique 

structure lends itself to greater information sharing and process 

improvement opportunities. Through continuing education programs, 

learning opportunities range from basic nursing instruction 

to subspecialization in neurological nursing, enabling nurses, 

like their physician colleagues, to provide specialized care. 

Pioneering the Collection of Data and Outcomes 

The Knowledge Program © , a joint initiative of the Neurological 

Institute, the Imaging Institute and the Information Technology 

Division, is designed to harness routinely collected electronic 

clinical and administrative data to allow us to optimize patient 

care and outcomes. Data from multiple electronic sources, including 

imaging results and clinical information collected during 

patient encounters, such as disease-specific measures of patients’ 

health status, are consolidated in a clinical data warehouse that 

can be accessed and queried by healthcare personnel. An integral 

part of this initiative is the standardization of clinical information 

documented within the electronic medical record. Information 

gained from the Knowledge Program informs and guides clinical 

care, quality improvement and research. 

Patients First 

We recognize that a patient’s healthcare experience is defined by 

both superior clinical outcomes and compassionate, personalized 

care: Did we respond when a patient needed us? Were that individual 

and his or her family treated with the dignity and respect 

that every person deserves? We have committed to measure this 

intensely human variable, patient satisfaction, and we have appointed 

a Patient Experience Officer to oversee this initiative. 

At Cleveland Clinic’s Neurological Institute, we are dedicated to 

maximizing both patient care outcomes and the patient experience. 

In addition, advancing medical education and research in 

neurology, neurosurgery and psychiatry are institutional priorities. 

Right: A nurse in one of the Neurological Institute’s inpatient units assesses a patient’s functionality. Since 2003, Cleveland Clinic has held 

Magnet hospital status, the highest national designation of nursing excellence. Bestowed by the American Nurses Credentialing Center, Magnet 

status is the gold standard for patient care. 


Our Centers 


Our Centers 11 

With the formation of two new specialized, multidisciplinary centers for brain health and behavioral health, the 

Neurological Institute continued to grow in 2008, extending its model of integrated expertise for delivery of diseasespecific, 

patient-focused care. 

Cleveland Clinic Lou Ruvo Center for Brain Health 

A collaboration between the Neurological Institute and the Las 

Vegas-based Lou Ruvo Brain Institute has resulted in creation 

of this highly specialized clinical center for advancement of 

research, early detection and treatment of cognitive disorders 

such as Alzheimer’s disease. 

The Cleveland Clinic Lou Ruvo Center for Brain Health brings 

together an interdisciplinary team of neuroscientists, physicians, 

therapists, surgeons, imaging specialists and other medical 

experts dedicated to preventing the disabling symptoms of 

chronic brain disease and prolonging healthy, vital aging in 

people at risk for dementia or cognitive disorders. 

“New discoveries and emerging science tell us that cognitive 

disorders can be identified earlier than previously believed and 

potentially altered,” says Michael T. Modic, MD, FACR, Chairman 

of the Neurological Institute. “Our hope is to bring together 

world-class clinicians and researchers to advance our understanding 

of cognitive disorders and provide the best care possible for 

people who suffer from them, as well as their caregivers.” 

The center will offer services in both Cleveland and Las Vegas, 

where a $100 million facility designed by renowned architect 

Frank Gehry recently welcomed its first patients. It houses clinical 

space, a diagnostic center, neuroimaging rooms, physician 

offices and laboratories devoted to clinical research. 

Randolph B. Schiffer, MD, a nationally known neurologist/ 

psychiatrist, serves as Director of the Cleveland Clinic Lou Ruvo 

Center for Brain Health. Dr. Schiffer spent 10 years as Chairman 

of the combined Department of Neuropsychiatry and Behavioral 

Science at Texas Tech University Health Sciences Center. 

“The Neurological Institute was thinking about establishing a 

creative new medical program for cognition at precisely the same 

time the Lou Ruvo Brain Institute was being founded in Las 

Vegas to the same purpose,” Dr. Schiffer says. “The Neurological 

Institute brings with it almost 100 years of tradition and medical 

science in Cleveland. The Lou Ruvo Brain Institute brings with it 

a window to the great resources and populations of the Southwest. 

Together, we will create the pre-eminent program in the 

world for care of the cognitive impairment disorders. “ 

The center provides the most technologically advanced diagnostic 

services, including 3 Tesla MR and, in the future, PET/CT, 

performed by one of the world’s leading neuroimaging academic 

medical centers. A multimodal treatment program for people 

with mild symptoms of impairment incorporates physical 

exercise, cognitive rehabilitation and cognitive-enhancing 

medications. 

The late Lou Ruvo, from whom the center takes its name, suffered 

from Alzheimer’s disease. To his son, Larry Ruvo, Chairman 

of the Lou Ruvo Brain Institute, the center is the realization of 

a long-held dream: “This is a perfect integration of Cleveland 

Clinic’s mission and excellence in patient care, research and 

education and what we want to create here in Las Vegas … With 

Cleveland Clinic as our operational partner, we will be able to hit 

the ground running.” 

Left: Early peri-ventricular white matter signal changes in this 55-year-old woman with hypertension and glucose intolerance may be 

forward-looking warnings that she is at risk for one of the age-related cognitive loss syndromes during the decade ahead.

12 Research 


The institute model allows patients to better access care through specialized, multidisciplinary, disease- 

Department of Psychiatry and Psychology 

The Department of Psychiatry and Psychology is restructuring 

under a new Center for Behavioral Health. The center includes an 

abundance of behavioral health resources widely dispersed across 

the Cleveland Clinic health system, which includes the main 

campus, 10 community hospitals and 17 family health centers 

throughout northeast Ohio. Consolidation of key services at 

designated regional locations will improve patient access to care 

as well as facilitate more effective patient management, ensure 

quality of care and drive operational improvements. In addition, 

this reorganization will encourage refinement of existing programs 

and development of innovative new behavioral healthcare 

models. 

Under the Center for Behavioral Health concept, selected 

Cleveland Clinic facilities will house specialized resources such 

as adult psychiatry, child and adolescent psychiatry, chemical 

dependency services and geropsychiatric programs. Geographically 

dispersed but closely integrated, this regional network will 

promote collaboration among behavioral health specialists and 

reinforce the team’s ability to deliver comprehensive therapeutic 

services that return patients to full functionality. 



specific centers that integrate the expertise of neurologists, neurosurgeons, orthopaedic surgeons, psychiatrists, 

psychologists, physiatrists, neuroradiologists and others into the comprehensive care of a single disease. 

Cleveland Clinic psychiatrists, psychologists, clinical nurse specialists, 

social workers, counselors and therapists provide a full spectrum of 

mental health and chemical dependence services. 

Patients will be triaged to the particular site where an appropriate 

concentration of skills and services can best meet their needs. 

This centralization of knowledge and expertise will, in turn, 

result in better clinical outcomes, more enlightened research and 

outcomes data based on a broad regional population, which will 

be especially relevant to referring physicians considering where to 

send their patients for specialized care. 

Brain Tumor and Neuro-Oncology Center 

The Brain Tumor and Neuro-Oncology Center (BTNC) is a 

national leader in the diagnosis, treatment and research of brain 

tumors. A multidisciplinary team of physicians and scientists 

focuses almost exclusively on brain tumors, facilitating opportunities 

to participate in international research protocols, share 

information on new developments and combine therapeutic 

approaches. As a result, the center brings the most promising new 

treatments to the clinical realm in an environment that emphasizes 

individualized patient care. 

The center is a pacesetter in the development, application and 

refinement of sophisticated therapies for life-threatening tumors. 

Each year, the team records approximately 8,000 outpatient 

visits and performs some 950 surgical procedures. The BTNC’s 

Cleveland Clinic Gamma Knife ® Center, established in 1997, 

offers patients a nonsurgical option for treatment of brain and 

spinal metastases and other brain disorders. 

The Cleveland Clinic Gamma Knife Center is one of only a few 

such facilities worldwide certified by Elekta, sole manufacturer 

of the Gamma Knife, to train physicians in this precise form of 

stereotactic radiosurgery. In 2008, four hands-on courses drew 

more than 30 participants, bringing the total number trained to 

more than 400. 

Left: Intraoperative image guidance allows neurosurgeons to remove brain tumors via minimal-access craniotomies.

14 Our Centers 

The Cerebrovascular Center’s state-of-the-art angiography room allows 

for endovascular and open craniotomy treatment of patients with cerebrovascular 

disease. 

Cerebrovascular Center 

The Cerebrovascular Center integrates neurologists, neurosur- 

geons, neuroradiologists and neurointensivists who offer expert 

diagnosis and medical, endovascular and surgical management 

of patients with all cerebrovascular conditions. 

With a unique mix of physician subspecialties, the center delivers 

endovascular therapy and care of the highest quality. Stroke care 

emphasizes aggressive acute intervention. The center is a Joint 

Commission-certified Primary Stroke Center and has one of the 

highest stroke-related volumes in North America, with more than 

3,200 patient visits annually. 

Patients receive comprehensive care in the 16-bed Neuroin- 

tensive Care Unit. Additionally, the center is home to a Neuro- 

endovascular Research Laboratory, which focuses on cerebral 

aneurysm treatment, imaging research, blood-brain barrier 

function and cerebral hemorrhage management. 

Epilepsy Center 

Superior diagnostic capabilities, extensive medical and surgical 

clinical treatment programs, and an active research focus have 

made Cleveland Clinic Epilepsy Center a site of national and 

international prominence for the management and investigation 

of epilepsy. 

The Epilepsy Center has one of the world’s foremost epilepsy 

programs, with more than 4,000 adult and 2,000 pediatric 

patient visits annually. In 2008, epilepsy neurosurgeons 

performed more than 300 surgical procedures, including lobec- 

tomies, hemispherectomies, and implantation of vagal nerve and 

responsive neurostimulators. Patients have gained an improved 

quality of life due to the expertise of the clinical staff and the 

availability of leading-edge technologies such as stereoelectro- 

encephalography (SEEG): chronic intracranial EEG monitoring 

with stereotactically implanted intracerebral electrodes. Cleve- 

land Clinic introduced the first SEEG program in North America, 

thus offering patients with intractable focal epilepsy a more pre- 

cise, less invasive approach to targeting the epileptogenic zone. 

Mellen Center for Multiple Sclerosis Treatment and Research 

The Mellen Center has the largest, most comprehensive program 

for MS care and research worldwide, managing more than 

20,000 patient visits annually. 

The center offers the most advanced specialized treatments, 

supported by an extensive program of research and education. 

Patients are evaluated by a multidisciplinary team that makes 

individualized treatment recommendations. 

The Mellen Center utilizes standardized tests, such as the 9-Hole Peg 

Test, to track disease progression and symptom management in multiple 

sclerosis patients. 

Right: The Epilepsy Center’s adult and pediatric monitoring units use digital video EEG technology to locate seizure origin, a prelude to epilepsy 

surgery in appropriate candidates. Once considered a last resort, surgery in the hands of experts has become a safe, effective treatment for carefully 

selected patients who are refractory to medical therapy. 


Basic and clinical research at Cleveland Clinic continues to shed 

light on MS. Mellen Center physicians fill leadership roles in 

multinational trials of promising new therapies, and they offer 

their patients opportunities to enroll in clinical research protocols. 

These physicians and their patients are true partners in the 

pursuit of new insights and treatments that can improve care. 

Center for Neuroimaging 

The Center for Neuroimaging houses specialists in structural 

and functional imaging of the central nervous system for a wide 

variety of neurological disorders. Subspecialization in disease 

entities (e.g., epilepsy, cerebrovascular disease, oncology) ensures 

accurate, in-depth, relevant interpretations. 

Across Cleveland Clinic, the Center for Neuroimaging supervises 

and interprets more than 60,000 CT scans and more than 

50,000 MR scans each year. In cooperation with the Cerebrovascular 

Center, Neuroimaging provides cerebrovascular ultrasound, 

angiography and interventional neuroradiology services. The 

latter category includes more than 3,000 cerebral angiograms 

per year as well as management of acute stroke and internal/ 

external carotid artery embolizations, treatment of vasospasm and 

atherosclerotic occlusive disease, and carotid artery stenting. 

Neurological Center for Pain 

A leader in treatment of patients with pain disorders, this 

center integrates two pioneering Cleveland Clinic programs. 

Combined DTI and fMRI mapping of the motor system. Expressive and 

receptive language regions are in orange. The multicolored lines connecting 

them are the fiber tracts that make up the language network. 



Patients in the Chronic Pain Rehabilitation Program are taught to reduce 

negative emotions that result from and worsen their pain. 

The Headache Program brings an interdisciplinary approach to 

diagnosis and treatment of migraine, tension headache, daily 

headache and cluster headache, including intensive outpatient 

therapy known as IMATCH (Interdisciplinary Method for the 

Assessment and Treatment of Chronic Headache). The Section 

of Pain Medicine tailors comprehensive, innovative behavioral 

health and medical services to the needs of people in chronic 

pain. The section operates the Chronic Pain Rehabilitation 

Program, which combines physical rehabilitation, stress and pain 

control regimens, and medication management for patients who 

are functionally and psychosocially disabled by intractable pain. 

Center for Neurological Restoration 

This center is among the first in the world to bring together an 

interdisciplinary team of renowned neurologists, neurosurgeons, 

psychiatrists, neuropsychiatrists, researchers and other specialists 

who offer the latest medical and surgical treatments for patients 

with neurological and psychiatric disorders. Center physicians 

have earned wide recognition for expertise in medical manage- 

ment and innovation in the surgical treatment of movement 

disorders such as Parkinson’s disease and dystonia, as well as 

behavioral disorders such as obsessive-compulsive disorder and 

depression. The surgical team is world renowned for performing 

hundreds of deep brain stimulation surgeries. 

Left: Neurosurgeon Andre Machado, MD, PhD, performs deep brain stimulation (DBS) on a patient with Parkinson’s disease. The Center for Neurological 

Restoration, which Dr. Machado directs, is an acknowledged world leader and innovator in DBS surgery, having implanted hundreds of brain 

pacemakers in patients with intractable neurological and psychiatric disorders.

18 Our Centers 

The Neuromuscular Center uses electromyography (EMG) to detect 

abnormal electrical activity in muscles and nerves. With one of the 

largest EMG laboratories in Ohio, the center performs more than 3,000 

such exams yearly. 

Neuromuscular Center 

The Neuromuscular Center treats patients with and conducts 

research on nerve and muscle disease, including amyotrophic 

lateral sclerosis and related disorders, peripheral neuropathy, 

myasthenia gravis and myopathies. The center’s electromyography 

laboratory is among the largest in Ohio, with locations at 

Cleveland Clinic’s main campus and six regional facilities, and 

a worldwide reputation for excellence and reliability. Additional 

resources include a highly specialized autonomic laboratory 

offering cardiovascular autonomic and tilt table tests, the quantitative 

sudomotor axon reflex test, quantitative sensory test, 

sympathetic skin response test, infrared dynamic pupillometry 

test and thermoregulatory sweat test. The center’s cutaneous 

nerve laboratory provides muscle, nerve and skin biopsies; 

histopathological preparation of skin specimens; and pathological 

interpretation of skin biopsies for the diagnosis of small-fiber 

peripheral neuropathy. 

Center for Pediatric Neurology and Neurosurgery 

Cleveland Clinic pediatric neuroscience specialists see more 

than 10,000 children each year for an array of neurological 

disorders. The team offers state-of-the-art subspecialty care for 

children with brain malformations, neurofibromatosis, cerebral 

palsy and spasticity, headache, autonomic disorders, cyclic vomiting, 

hydrocephalus, myelomeningocele, metabolic and mitochondrial 

disorders, multiple sclerosis and other white matter disease, 

Tourette syndrome and other movement disorders, neuromuscular 

disease and muscular dystrophy, fetal and neonatal neurological 

problems, brain and spinal cord tumors, cerebrovascular 

disease, neurological complications of cardiac disease and 

epilepsy. Comprehensive advanced neurosurgical services, including 

neuroendoscopy, are available. 

Pediatric neurological and neurosurgical specialists collaborate 

with the Cleveland Clinic Pediatric Institute & Children’s Hospital, 

providing comprehensive advanced care for all pediatric 

neurological disorders. 

Department of Physical Medicine and Rehabilitation 

Physical Medicine and Rehabilitation helps patients with 

impairments and disabilities in the areas of mobility, self-care, 

communication, swallowing and cognition. These conditions 

result from accident, illness or natural causes. A team approach to 

Vernon Lin, MD, PhD (right), Chairman of Cleveland Clinic’s Department of 

Physical Medicine and Rehabilitation, and colleagues demonstrate how a 

noninvasive magnetic stimulator they developed can be applied over clothing 

to activate respiratory muscles in spinal cord injury patients. 

Right: U.S.News & World Report ranks Cleveland Clinic’s pediatric neurology and neurosurgery services among the top four such programs in the nation. 

Specialists collaborate with the Cleveland Clinic Pediatric Institute & Children’s Hospital, providing comprehensive advanced care for all pediatric neurological 

disorders. 


Neurological Institute physicians draw on advanced diagnostic capabilities and experience. Patients receive 

leading-edge treatments and have opportunities to participate in clinical research trials. 

rehabilitation helps restore as much independence as possible so 

that patients can overcome physical, psychosocial, cognitive and 

vocational limitations. 

A full range of services spans inpatient rehabilitation, skilled 

nursing care and outpatient care, enabling the staff to address 

individual needs during each phase of the rehabilitation process. 

This approach also allows effective coordination of care so that 

patients return to the community with the best chance to maintain 

the gains they have achieved. 

Center for Regional Neurology 

As part of Cleveland Clinic’s nationally recognized Neurological 

Institute, the regional neurology program combines physicians 

and other healthcare providers in neurology, neurosurgery, 

neuroradiology and behavioral sciences, who treat adult and 

pediatric patients with neurological disorders. Regional facilities 

extend advanced treatments, technologies and the expertise of 

Cleveland Clinic into the surrounding communities and greater 

metropolitan areas, making it even easier for patients to access 

specialists who treat the most complex neurological conditions, 

including aneurysm and stroke, brain tumor, epilepsy, headache, 

multiple sclerosis, and sleep and spine disorders. 

Sleep Disorders Center 

Cleveland Clinic’s Sleep Disorders Center is a multispecialty, 

comprehensive program dedicated to the diagnosis and treatment 

of sleep disorders in children and adults. Accredited by 

the American Academy of Sleep Medicine, the center comprises 

specialists in neurology, pediatrics, pulmonary medicine, internal 

medicine, psychiatry, psychology, otolaryngology and dentistry. 

More than 4,000 sleep studies are performed annually in seven 

laboratories throughout northeast Ohio. 



The Sleep Disorders Center performs more than 4,000 adult and pediatric 

sleep studies annually. 

The Sleep Disorders Center is committed to advancing understanding 

of sleep disorders, their causes and treatment, and their 

relationship with other disorders. To this end, the center offers 

patients enrollment in investigational studies conducted in conjunction 

with national and international consortia or designed by 

Cleveland Clinic physicians. 

Center for Spine Health 

The Center for Spine Health brings together the expertise of 

specialists in neurosurgery, orthopaedic surgery and medical 

spine care to provide medical and surgical management of the 

full scope of back and spine problems, including scoliosis and 

kyphosis, spondylolisthesis, spinal stenosis, primary and 

metastatic spinal tumors, mature spine, cervical fractures and 

degenerative diseases of the spine. Physicians work closely with 

physical therapists and occupational therapists to develop a complete 

individualized treatment plan for each patient, integrating 

the functions of research, clinical practice and education with the 

goals of improving patient care, promoting collaboration among 

staff, and developing unique technologies and subspecializations. 

Left: A cervical spine X-ray shows posterior spinal instrumentation. Center for Spine Health surgeons have one of the country’s highest success 

rates for even the most complex procedures, including lumbar surgeries, cervical and thoracic procedures, spinal deformity and spine tumor.

Patient Care 

Daily Huddle 

Drawing on the Neurological Institute’s multidisciplinary team 

structure, the daily huddle is a methodology to facilitate direct 

communication among professionals involved in the care of the 

neurological patient. Gathering at the same time each morning, 

this group of caregivers discusses the plan of care for the day for 

each patient. This coordinated effort allows direct input from all 

team members on medical, social and disposition issues related 

to the patient’s medical condition. 

Nursing Leadership Group 

This weekly session joins Neurological Institute nurse managers 

from the ambulatory and inpatient settings with adult and pediatric 

operating room nurses, who treat many neurological patients. 

Assistant nurse managers, clinical nurse specialists and clinical 

instructors also attend. Group diversity is a strength as members 

present new initiatives and discuss issues such as stroke treatment 

and postoperative pain that cross all areas. 

Patient Advisory Council 

Established in May 2008, this collaborative group of patients, 

family members, staff and employees works on projects to 

improve patient care. Their input led to the remodeling of the 

Neurointensive Care Unit waiting area and the development of a 

new patient resource guide. 

Health Experience/Outcomes Team 

Neurological Institute researchers are working to quantify the 

impact of the patient experience on clinical outcomes. The focus 


Patient Care 23 

At Cleveland Clinic, responsibility to patients extends beyond providing expert diagnosis and advanced treatment modalities. 

In the belief that patient satisfaction is a critical component of a successful clinical experience, the Neurological 

Institute is implementing new strategies to enhance communication and collaboration among staff and with patients. 

is Cleveland Clinic’s Healing Solutions Program, which offers 

meditation, Reiki, massage, spiritual care and individualized 

patient services. 

Patient Service Navigator 

A Patient Service Navigator visits hospitalized patients daily to 

address any needs or concerns. The navigator serves as a liaison 

for the patient and the care team, providing on-the-spot problem 

solving and regular feedback. Issues are tracked and reviewed by 

the inpatient arm of the institute’s Patient Experience Team. 

Patient Support Groups 

Patients coping with serious or chronic illness are encouraged to 

share their experiences and socialize with others in similar situations 

through support groups such as the following: 

• The Brain Tumor Support Group meets monthly at Cleveland 

Clinic Taussig Cancer Center. Open to patients, their family 

members and friends, this helpful forum invites participants 

to exchange information on practical concerns such as how 

a brain tumor affects job, family and ability to carry out daily 

activities. Nurse practitioners assist, providing information and 

answering questions about treatments, medications, available 

resources and other pertinent issues. 

• The Pediatric Epilepsy Support Group addresses the needs 

of families caring for a child with refractory epilepsy, who 

often find their emotional resources depleted. Weekly group 

meetings become a source of strength and comfort for parents 

confronting difficult decisions about epilepsy surgery and 

guiding their child through difficult procedures such as invasive 

monitoring of seizures for accurate surgical planning. 

Left: The daily huddle is a forum for staff physicians, residents, fellows, rehabilitation specialists and other professionals to exchange information 

and develop a personalized care plan for each Neurological Institute inpatient.

24 Community Care 

Community Care 

The Neurological Institute expanded geographically in 2008, reaching out to a broadly distributed patient population 

through the Center for Regional Neurology. This program combines physicians and other healthcare providers 

in neurology, neurosurgery, neuroradiology and behavioral sciences who care for adult and pediatric patients with 

neurological disorders. Regional facilities extend advanced treatments, technologies and the expertise of Cleveland 

Clinic into the surrounding communities and greater metropolitan areas, making it even easier for patients to access 

specialists who treat the most complex neurological disorders. 

Cleveland Clinic Neurological Institute 

at Lakewood Hospital 

This facility opened in this suburban Cleveland Clinic hospital in 

October 2008, offering a full spectrum of services for adult and 

pediatric patients with neurological disorders. These services, 

which ensure continued growth of the hospital’s well-respected 

neuroscience program, include: 

• general neurology 

• neurosurgery 

• cerebrovascular testing and treatment 

• TCD/carotid ultrasound testing 

• headache infusion clinic 

• diagnostic evaluation and treatment for epilepsy 

• evaluation, follow-up and infusion treatments for multiple 

sclerosis 

• electromyogram testing 

• neurorehabilitation and spasticity management 

The staff of the Lakewood institute comprises neurologists, neurosurgeons, 

neuroradiologists, neuroendovascular and cerebrovascular 

surgeons, therapists and specialized nurses. This team 

applies the most advanced treatments and technologies to the 

most complex conditions in a modern, comfortable setting close 

to patients’ homes. 

Center for Mood Disorders Treatment and Research 

at Lutheran Hospital 

In January 2008, an adult inpatient unit for diagnosis and treatment 

of mood disorders opened at Lutheran Hospital. The center 

ranks as the first in northeast Ohio offering both inpatient and 

outpatient programs dedicated to the treatment of mood disorders 

such as major depression and bipolar disorder. 

Depending on individual needs, these programs explore issues 

such as: 

• assertiveness 

• grief and loss 

• healthy lifestyle 

• development of new coping methods 

• problem solving 

• self-esteem 

• comorbid anxiety and substance abuse 

• stress and anger management 

The center’s team includes physicians, nurses, social workers, 

therapists and programming staff committed to improving and 

maintaining patients’ mental health and well being. With a supportive, 

caring and structured approach, these professionals help 

patients reduce mood disorder symptoms, regain lost confidence 

and hope, and improve their functioning and quality of life. 


Cleveland 

Clinic 

Lorain 

LORAIN COUNTY 

Regional Sleep Centers 

Cleveland Clinic’s Sleep Disorders Center joined with Cleveland 

Clinic health system’s Marymount Hospital sleep program in 

2008, resulting in expedited access for referring physicians and 

patients. The combined program has seven overnight sleep labs 

conveniently located throughout the region. 

Five of these labs are based in hotels, where adults and children 

12 and older can undergo routine overnight sleep studies, including 

polysomnograms and positive airway pressure titrations. 

Geriatric Behavioral Health Services 

At selected community hospitals throughout the region, specialized 

multidisciplinary teams work with older adults, helping 

them adapt to age-related changes and improve their quality of 


Lake Erie 



Westlake 

MEDINA 

COUNTY 

CUYAHOGA COUNTY 


Strongsville 


Brunswick 

Children’s 

Hospital, 

Shaker 

Marymount 

Hospital 


Independence 


Broadview Heights 


Wooster 


Willoughby Hills 


Clinic Solon 

SUMMIT COUNTY 

Community Care 25 

Neurological Institute physicians provide services at Cleveland Clinic’s main campus and at Cleveland Clinic community hospitals and family health 

centers throughout northeast Ohio, increasing patient access to specialized care. 

s Hospitals 

n Family Health Centers 



Avon 



Avon Lake 



Elyria 

Chestnut 

Commons, 

Elyria 



Lakewood 

Fairview 

Hospital 

Lakewood 

Hospital 

Medina Hospital 

Lutheran 

Hospital 

(WAYNE COUNTY) 

Euclid 

Hospital 

life. Under the direction of board-certified psychiatrists, clinical 

professionals provide holistic assessment, diagnosis and treatment 

for conditions such as: 

• significant changes in mental health 

• confusion 

• memory lapses and/or forgetfulness 

• depression 

• anxiety and/or nervous behaviors 

• grief reaction 

• difficulty adapting to change 

• medication concerns 

• suicide threats or attempts 

• alcohol and/or substance abuse and misuse 

LAKE COUNTY 

Huron Hospital 

Cleveland Clinic Hillcrest Hospital 


Beachwood 

South Pointe 

Hospital 


Chagrin Falls 

PORTAGE 

COUNTY 

GEAUGA 

COUNTY

2008 Outcomes 

Brain Tumor 

• Spine radiosurgery is a palliative treatment for pain, typically 

used in end-stage cancer patients whose disease has metastasized 

to the spine. Among 103 patients with painful spinal 

metastases who were treated with single-fraction Novalis ® spine 

radiosurgery in 2007 and 2008, pain scores showed a statistically 

significant improvement just one week after treatment, 

and these results remained stable over time. 


Outcomes 27 

The Neurological Institute strongly supports continuous measurement and transparent reporting of clinical 

outcomes, in the belief that making accurate information available to patients and their physicians will result in better 

healthcare decisions. Through the Knowledge Program © , we are reinforcing our capability to collect and analyze 

clinical data, with the ultimate goal of improving the quality of our care and our outcomes. 

• Clinical research trials are important discovery and therapeutic 

options for brain tumor patients. Almost 300 individuals 

were enrolled in these trials through Cleveland Clinic’s Brain 

Tumor and Neuro-Oncology Center in 2008. 

• Patients who underwent supratentorial craniotomy had 

30- and 180-day survival rates of 99.1 percent and 

93.5 percent, respectively. 

• Among patients who underwent brain biopsies, 30- and 180day 

survival rates reached 94.1 percent and 80.4 percent, 

respectively. 

• Among pituitary surgery patients, 30- and 180-day survival 

rates exceeded 95 percent. 

• Inpatient mortality following pituitary surgery was zero 

percent. 

Cerebrovascular 

• Intravenous tissue plasminogen activator is indicated for treatment 

of acute ischemic stroke, if administered within 180 

minutes of stroke onset symptoms. Cleveland Clinic’s 2008 

performance surpassed both the national average and the goal 

for the “Get With The Guidelines” SM Stroke Silver Performance 

Award. GWTG is a hospital-based quality improvement program 

for the American Stroke Association and the American 

Left: Before meeting with her clinician, a patient enters self-assessment data directly into the Knowledge Program © electronic tablet. All Neurological 

Institute patients complete standardized health questionnaires prior to their appointments.

28 Outcomes 

Patients Receiving Intravenous Tissue Plasminogen Activator in the 

Emergency Department within 180 Minutes of Onset of Stroke Symptoms 


2008 

GWTG Silver 

Performance Award Goal 

National Average* 

Heart Association. Cleveland Clinic was a 2008 recipient of 

the Stroke Silver Performance Award. 

• While the Cerebrovascular Center saw an 11 percent increase 

in the number of procedures for ruptured cerebral aneurysm 

between 2007 and 2008, inpatient mortality remained below 

the expected rate (based on national normative data and APR- 

DRGs for the last three years). 

• No inpatient deaths occurred in 2008 from nonruptured 

cerebral aneurysm. Mortality has remained below expected 

levels for three years. 

The Epilepsy Center’s adult and pediatric monitoring units feature the latest 

technology, including all-digital video EEG equipment. Operating around the 

clock, these units are staffed by dedicated teams. 

Epilepsy 

0 20 40 60 80 100 

Percent 

* Hospitals participating in GWTG for five or more years (N = 2,095) 

• In a random sample of patients who underwent epilepsy 

surgery between January 2007 and November 2008, average 

seizure frequency was reduced from 12.3 times per month 

before surgery to 2.2 times per month after surgery, with 

74 percent reporting no seizures postoperatively. 

• Long-term seizure freedom was assessed in 550 Epilepsy 

Center patients who underwent temporal lobe surgery from 

1997 through 2008. One year after surgery, 81 percent were 

seizure free; 70 percent maintained seizure freedom at five 

years. Among patients with persistent seizures following the 

surgery, seizure frequency declined an average 73 percent 

postoperatively. 

Movement Disorders 

• Among 27 Parkinson’s disease patients implanted with deep 

brain stimulators in 2008, the average improvement in motor 

function was 57 percent after surgery (Unified Parkinson’s 

Disease Rating Scale). 

Multiple Sclerosis 

• The Mellen Center for Multiple Sclerosis Treatment and 

Research has treated more than 250 patients with intrathecal 

baclofen therapy (ITB) since 1990. In 2008, 17 patients 

underwent implantation of a baclofen pump. Mean spasticity 

scores showed a statistically relevant reduction following ITB 

therapy (Modified Ashworth Scale). 

Pain/Headache 

• In 2008, 196 patients with status migrainosis, transformed 

migraine, cluster headache and chronic daily headache 


eceived intravenous infusion therapy lasting one to five days at 

the Neurological Center for Pain. Nearly 60 percent reported 

a 50 percent or greater reduction in pain immediately after 

treatment. 

• Sixty-four individuals completed the center’s Interdisciplinary 

Method for the Assessment and Treatment of Chronic Head- 

ache (IMATCH) outpatient program in 2008. Patients’ self- 

rated pain and disability scores decreased after the intensive 

treatment. 

• The Chronic Pain Rehabilitation Program (CPRP) treats indi- 

viduals who are emotionally and physically devastated by pain. 

Continuing a long-term trend in 2008, patients’ mean pain 

scores decreased and their functional status improved after 

enrollment in the CPRP (Pain Disability Index). 

Pediatric Neurology 

• Among 46 pediatric patients treated for headache in 2008, 

both headache frequency and number of rescue medications 

needed in the previous three months showed improvement. 

Group means for headache frequency improved 46 percent 

in the mean seven-month interval between visits one and two 

(Pediatric Migraine Disability Assessment). 

• In children with severe headaches, the average number of 

complete and partial school days missed in the preceding three 

months declined from 10.8 to 2.5. 

Pediatric Neurosurgery 

• Inpatient mortality remained below expected levels after 

surgery for Chiari malformation, with no deaths from 2006 

through 2008. 

Psychiatric Disorders 

• After one year of participation in the outpatient Women’s 

Mental Health Management Group, 29 women diagnosed 

with major depression registered a group mean decrease of 2.2 

points in depression severity score (PHQ-9). Group medica- 

tion management had a positive effect on remission of depres- 

sive symptoms. 


• Among 202 inpatients treated in 2008 at the Center for 

Mood Disorders Treatment and Research at Lutheran Hospital, 

a Cleveland Clinic hospital, a statistically significant reduction 

in mean severity of depression occurred from admission 

to discharge (Hamilton Depression Scale, Montgomery-Asberg 

Depression Rating Scale). 

Sleep Disorders 

• Sleepiness decreased among 217 sleep apnea patients who 

received positive airway pressure (PAP) treatment in 2008 

(Epworth Sleepiness Scale). 

• Functional status improved among 216 PAP-compliant sleep 

apnea patients who assessed their status before and after treatment 

(Functional Outcomes of Sleep Questionnaire). 

Spinal Cord Disease 

Outcomes 29 

• The Center for Spine Health uses a team approach to diagnosis, 

treatment, patient satisfaction and quality for individuals with 

spine tumors. This strategy is credited for annual increases in 

spine patients and cases studied at the weekly Spine Tumor 

Review Board, which engages surgeons, radiologists, pathologists 

and other specialists in a logic-based decision-making process. 

From 2006 through 2008, both the numbers of patients 

and cases studied more than doubled. 

Weekly Spine Tumor Review Board meetings involve multidisciplinary 

clinical teams that evaluate complex cases through a logic-based 

decision-making process.

Technology and Innovation 


Prospective First-in-Man Safety Trial of Laser Treatment 

Cleveland Clinic’s Brain Tumor and Neuro-Oncology Center 

(BTNC) was the first in the world to use a new, laser-based system 

in a human for minimally invasive treatment of a brain tumor. 

The AutoLITT (laser interstitial thermal therapy) system 

coagulates tumors through a special laser probe, precisely 

directed into the tumor, with the heating process monitored by 

specialized software and thermal MRI techniques. Gene Barnett, 

MD, FACS, leads this trial of a technology that could offer the 

benefits of conventional surgery for some inoperable tumors and 

spare patients more invasive interventions. 

Stereotactic Radiosurgery for Spinal Tumors 

Led by neurosurgeon Lilyana Angelov, MD, Cleveland Clinic’s 

Spine Radiosurgery (SRS) program provides patients with 

specialized, integrated care for complex problems related to 

spine tumors. This program, the first of its kind in Ohio, is the 

state’s largest and most established. To date, Dr. Angelov and her 

multidisciplinary spine care team have reviewed and approved 

management of more than 600 spine tumor cases and per- 

formed more than 250 spine radiosurgeries. 

Metastasis to the spinal column in cancer patients is often associ- 

ated with disabling pain, and may result in neurological dysfunc- 

tion and paralysis related to direct compression of the spinal cord 

or nerve roots by tumor or instability of the spinal column. 


Technology and Innovation 31 

Patients benefit from the latest treatment modalities at the Neurological Institute, where scientists and clinicians 

working together continue to advance innovations and accelerate the process of bringing novel therapeutic agents 

from the laboratory to the bedside. 

Cleveland Clinic’s SRS program uses a novel modality, the 

Novalis ® Shaped Beam Surgery system, to deliver a high dose of 

radiation to spinal metastases in a precise, conformal fashion, 

enveloping the tumor in three dimensions without significant 

scatter or spread beyond the target to sensitive adjacent organs 

such as the spinal cord. 

SRS can be used as a stand-alone treatment or as an adjunct to 

other modalities. It can even be used as salvage therapy after con- 

ventional radiation for spine metastases has failed. A noninvasive 

outpatient procedure with minimal recovery time, this highly 

selective, precise radiation therapy results in effective, rapid relief 

of pain and exceptional tumor control. 

Among patients treated at Cleveland Clinic, pain scores improved 

by nearly 80 percent as early as one week post-treatment com- 

pared with immediately before SRS. Moreover, this post-treatment 

pain relief was durable, with almost 90 percent of evaluable 

patients experiencing continued pain improvement at 12 months 

following SRS. Radiographic tumor control was obtained in 

approximately 90 percent of evaluated cases, including tumors 

traditionally perceived to be radioresistant, such as renal cell 

carcinoma and melanoma. 

Tailoring Treatment of Oligodendroglioma 

The discovery of a genetic alteration in oligodendrogliomas that 

was prognostic of improved response to treatment and survival 

was a landmark event in neuro-oncology. However, it was not 

entirely clear how best to use this information to tailor therapy for 

Left: Brain Tumor and Neuro-Oncology Center neurosurgeons perform more than 950 brain tumor surgeries each year, aided by the latest technological 

innovations. More than 25 percent of new brain tumor patients travel to Cleveland Clinic from outside Ohio.

32 Technology and Innovation 

maximal benefit, without the harmful side effects associated with 

radiation and chemotherapies. 

Michael Vogelbaum, MD, PhD, has been a coleader of an inter- 

national effort to define how best to use the information provided 

by analysis of this alteration, also referred to as 1p/19q codele- 

tion. In 2008, he was the lead author of a paper published in 

the journal Neuro-Oncology, reporting the results of a study he 

led with the Radiation Therapy Oncology Group that examined a 

chemotherapy-only treatment for patients with malignant oligo- 

dendroglial tumors. He is now the U.S. Principal Investigator for 

a European-led Phase III trial of radiation and/or chemotherapy 

for 1p/19q non-codeleted anaplastic gliomas and the U.S. co-PI 

for another Phase III trial of radiation and/or chemotherapy for 

1p/19q codeleted anaplastic gliomas. These studies will define 

the optimal treatment for patients with grade III gliomas. 


Enhanced Localization Ability with Magnetoencephalography (MEG) 

The MEG laboratory at Cleveland Clinic’s Epilepsy Center 

has enhanced the center’s diagnostic capabilities. Cleveland 

Clinic is among a select number of institutions in the world with 

this technology, which measures magnetic fields produced by 

electrical activity in the brain to localize the epileptic focus. 

MEG is used routinely to better identify epileptic sources in 

patients in whom the area of the brain causing the seizures would 

otherwise be difficult to identify. Since its inception, the MEG 

laboratory has tested more than 50 clinical patients. Results, 

taken with the rest of the clinical evaluations, have been used to 

refine the location of the epileptic focus, help guide the place- 

ment of intracranial recording electrodes or ascertain that the 

patient is not a surgical candidate. 

The neurocomputing and clinical neurophysiology teams have 

added capabilities to the basic MEG system, making it uniquely 

advanced. These new developments include: 

• specialized software to post-process the recorded MEG 

waveforms 

• continuous, synchronized digital video recording to enable 

direct correlation of the patient’s physical actions with MEG 

waveforms 

• online annotations that provide second-by-second testing and 

clinical information during a MEG recording 

• an online database that keeps raw results as well as interpretations 

to facilitate ongoing quality assessment 


Optical Coherence Tomography to Monitor Axonal Injury 

Optical coherence tomography (OCT) is a rapid, noninvasive, 

painless test that generates high-resolution images of the retina. 

Cleveland Clinic researchers are exploring utilization of OCT to 

measure the thickness of the retinal nerve fiber layer and the volume 

of the macula. The optic nerve is an important site of injury 

in MS, and the ability to monitor the degree of injury would be 

an important advance in both clinical practice and experimental 

treatment trials. 


Correcting Motion-Corrupted Imaging Data 

High-Angular Resolution Diffusion-Weighted Imaging (HARDI) 

presents a challenge with regard to intrascan subject motion. 

Image volumes are acquired serially on subjects, varying the 

direction of diffusion sensitivity gradually throughout the scan. 

Robust calculation of the final diffusion tensor assumes no 

intrascan motion of the subject. HARDI acquisitions can take 

10 minutes or more to acquire; thus, the assumption of no intrascan 

motion is problematic. Cleveland Clinic neuroradiologists 

demonstrated that a previously published tensor-fit method is 

sufficient in most cases when iterated up to 20 times on a single 

data set. Motion effects can be removed to the 0.2 mm level, thus 

reducing the error on the diffusion direction below 0.2 degree. 

Defining Anatomic-Based Seeds for Functional Connectivity Analysis 

Assessment of functional connectivity in the human brain, 

using low-frequency blood oxygen level-dependent (BOLD) 

Right: Magnetoencephalography (MEG) can evaluate the brain’s spontaneous activity or its response to specific stimuli. With a very large number 

of sensors, as well as the absence of any effect from skull or scalp, MEG has an inherently high resolution and provides superior accuracy, especially 

when combined with MRI. 


34 Technology and Innovation 

fluctuation present in dynamically sampled MRI data, has 

become a common technique. The most common method of 

assessing connectivity is to measure the temporal correlation 

between two functional brain regions. 

Due to individual variation in functional localization in the 

human brain, a standard technique for identifying regions of 

interest is to perform task-based functional MRI. This imposes a 

serious limitation on the ability to analyze functional connectivity 

in studies in which activation data also have been obtained. 

Cleveland Clinic researchers introduced a method for defining 

connectivity reference regions, based on combining anatomic 

landmarks with a regional measure of temporal coherence. This 

measure, derived from Kendall’s coefficient of concordance, 

results in robust measures of functional connectivity. 

Monitoring System for Deep Brain Stimulators during MRI 

Performing functional MRI (fMRI) studies of implanted deep 

brain stimulators (DBS) is important in understanding the 

mechanisms of this therapy. To date, all fMRI has been done with 

externalized DBS leads connected directly to a pulse generator in 

the MRI console room immediately after surgical placement of 

the lead. In this configuration, it is straightforward to program 

the pulse generator such that the timing between acquired MRI 

data and the stimulation is known. 

When using implantable pulse generators (IPGs), it becomes 

problematic to determine the state of the IPG during the acquisition 

of MRI data. Cleveland Clinic developed a passive radiofrequency 

(RF) monitoring system, which, when placed over the 

implant on the patient’s chest, determines the state of the pulse 

generator from characteristic low-frequency RF energy emissions. 

This enables researchers to correlate stimulation with regional 

changes in BOLD-weighted MRI signal. 

Working with Patients to Improve Functional MRI Quality 

Functional MRI studies are performed daily with standardized 

paradigms to provide consistent preoperative localization of 

motor, speech generation and receptive speech areas, with an 

85 percent success rate. A program was developed in which a 

neuroradiologist interviews every patient to individualize the 

study when indicated, provide instructions for the paradigms, 

and emphasize the consequences of inattention and movement. 

A study that examined the effect of the prescan patient interview 

in improving scan quality showed that an intensive intervention 

can reduce unacceptable sequences from 15 percent to 

5 percent. 

Previously, language fMRI examinations were conducted only 

in English. The paradigms have been extended to include other 

languages, such as Spanish and French. Also, for language-challenged 

patients such as children and those with injuries such as 

strokes, simpler paradigms are available, incorporating pictures 

and simpler language. This change has resulted in a significant 

improvement in reliability of all clinical studies. 

Lateralization Score for fMRI Studies to Judge Hemispheric 

Speech Dominance 

The major clinical utility for performing fMRI studies is presurgical 

planning, particularly for epilepsy and brain tumor patients. 

The important issue is to identify the essential eloquent cortical 

areas governing language and motor activity so the surgeon can 

provide adequate margins to minimize post-surgical morbidity. 

Often, this issue is resolved by determining language lateralization, 

a process hitherto determined by the neuroradiologist based 

on a qualitative impression of the fMRI images. 

Recent work has extended the qualitative impression of language 

lateralization with a quantitative lateralization index or score, 

which is computer-generated and based on an analysis of 42 

patients who had both fMRI and Wada lateralization. Wada is the 

gold standard; however, because it involves catheter angiography, 

it carries significant risk. Work at Cleveland Clinic shows how 

this computer-generated lateralization index more accurately 

identifies and quantifies the degree of qualitative language 

lateralization. For studies in which quality is not significantly 

degraded by motion or inattention, a qualitative lateralization 

Right: Postoperative X-ray shows placement of bilateral deep brain stimulation (DBS) leads and electrodes in a patient with obsessive-compulsive 

disorder (OCD). Cleveland Clinic is among four centers worldwide where psychiatric neurosurgery teams have collaborated to investigate the 

safety and efficacy of DBS for refractory OCD. 


correlation of R2=0.34 is increased to R2=0.60 when the neuroradiologist 

is assisted by the computer-generated index. 

Integration of Diffusion Tensor Imaging 

With diffusion tensor imaging (DTI), also known as tractography, 

neuroscientists are noninvasively probing the long-neglected 

white matter pathways in the brain. The significance of this 

technological leap forward was illustrated at the 2008 Cleveland 

Clinic Medical Innovations Summit, where DTI was among 10 

breakthroughs that Cleveland Clinic physicians cited as most 

likely to impact medicine in the coming year. 

In clinical practice, Cleveland Clinic neuroscientists are utilizing 

DTI to create a detailed spatial wiring map of the brain, which 

can enhance surgical planning and prognosis accuracy. In the 

research laboratory, they are applying DTI to advance understanding 

of a wide range of brain disorders, including Parkinson’s 

disease, epilepsy, multiple sclerosis and traumatic brain injury. 

Neurological Center for Pain/Center for Neurological Restoration 

Neurostimulation for Treatment of Cluster Headaches 

The Center for Neurological Restoration conducted an IRBapproved 

study in collaboration with the Neurological Center for 

Pain to assess the safety and efficacy of acute neurostimulation of 

the sphenopalatine ganglia (SPG) for treatment of severe cluster 

headaches. Five patients underwent SPG stimulation and three 

returned for a second trial, for eight total treatment sessions. Four 

treatment sessions (in three patients) produced complete resolution 

of at least one cluster attack within two minutes, suggesting 

that this technique may hold promise for treatment of these and 

other types of headache. 


Multidisciplinary CPAP Compliance Group Therapy 

Continuous Positive Airway Pressure (CPAP) therapy is the 

standard treatment for sleep apnea, but an estimated 30 percent 


Technology and Innovation 37 

to 50 percent of patients are noncompliant, for both mechanical 

and psychological reasons. 

Cleveland Clinic’s Sleep Disorders Center started a group therapy 

initiative to target these patients. Led by a sleep specialist, a 

psychologist and a sleep technician, the groups of six to eight 

patients meet in sessions that last about 90 minutes. Patients 

discuss their problems with CPAP and receive tips from professionals, 

while learning from other patients. They have opportunities 

to try other CPAP masks and devices and, depending on the 

nature of the problem, they receive detailed individual treatment 

plans. Patient feedback has been highly positive. 

Biofeedback for Chronic Insomnia 

Chronic insomnia affects 10 percent to 15 percent of adults. 

Although hypnotic medicines are effective in some patients, they 

are not always safe for long-term use. 

Cleveland Clinic’s Sleep Disorders Center is one of a very few 

centers in the country with a dedicated biofeedback program for 

chronic insomnia. The most commonly used forms of treatment 

are EMG biofeedback, respiratory biofeedback, thermal biofeedback 

and neurofeedback. 

Psychologists and sleep specialists offer the treatment in weekly 

sessions for five to six weeks. More than two-thirds of patients 

report significant improvement in chronic insomnia symptoms. 


Delaying Recurrences of Myxopapillary Ependymomas 

The Center for Spine Health is the largest center in the United 

States conducting adjuvant radiation therapy (ART) studies. A 

center study found the use of therapeutic radiation beneficial in 

delaying a second occurrence of myxopapillary ependymomas. 

Patients who did not receive ART had a median time to recurrence 

of 1.1 years, while those who received ART had a median 

time to recurrence of 9.6 years. 

Left: An MRI of a lumbar spine shows some involvement of Level 5 with an infectious or tumorous process. The Center for Spine Health utilizes 

advanced imaging technologies to diagnose a variety of spine-related conditions.

Research 

In 2008, grant and contract research dollars funding neurologi- 

cal investigations in the Neurological Institute, Lerner Research 

Institute and Department of Neuroradiology totaled more than 

$17.9 million. Additional metrics from 2008 help quantify an 

expanding program: 

Number of new clinical research trials: 42 

Number of active clinical research trials: 139 

Staff leading clinical research trials: 50 

New patients enrolled in clinical research trials: 772 

Number of patients enrolled in clinical research trials: 1,690 

Number of National Institutes of Health grants and contracts 

(includes Lerner Research Institute and Neuroradiology): 91 

Number of non-NIH neurological grants 

(includes Lerner Research Institute and Neuroradiology): 167 

This support was instrumental to a number of noteworthy 

advances within the Neurological Institute. 

Cranial Radiosurgery for the Older Old 

Although the incidence of cancer increases with age, research 

studies have traditionally excluded older patients, especially those 

75 and older. In cancer that spreads to the brain from another 


Research 39 

The Neurological Institute conducts a robust research program that fosters a culture of innovation and collaboration. 

Physicians and scientists within the institute work closely with colleagues in the Lerner Research Institute, the basic 

science research arm of Cleveland Clinic, pursuing laboratory-based and clinical research as well as translational 

research that applies laboratory findings to improve patient care. 

site, data from patients younger than 65 suggested that increas- 

ing age was associated with a poorer prognosis, irrespective of 

whether the patient received surgery, whole brain radiation or 

stereotactic radiosurgery (SRS). 

Despite the known efficacy of SRS in treating brain metastasis, 

little was known of its efficacy in older patients. Robert Weil, MD, 

and colleagues from the Brain Tumor and Neuro-Oncology Center 

performed the first large analysis of a consecutive series of patients 

75 and older treated with SRS, which was generally the sole 

treatment for their brain metastases. In 44 patients treated over 

13 years, SRS of one or more brain metastases produced results 

comparable to those found in younger patients: Average survival 

exceeded seven months, with more than one-third of patients 

surviving one year and longer. Patients tolerated the treatment 

well, with no loss of physical function. 

This study supports the idea that aggressive, multimodal treat- 

ment of cancer that spreads to the brain can be effective and safe 

in older patients, with results similar to those experienced by 

younger patients. 

Understanding Combat-Related Traumatic Brain Injury 

Traumatic brain injury (TBI) caused by improvised explosive 

devices is fast becoming the signature wound of the Iraq and 

Afghanistan wars. With a $1.4 million grant from the U.S. 

Left: Neural stem cells generate various types of cells. They can generate astrocytes, oligodendrocytes and neurons, according to the stimuli 

they are under. These cells are prime candidates for stem cell transplantation therapies.

40 Research 

Stem cell biology and the resulting regenerative medicine hold the promise of moving medicine beyond simply 

dealing with symptoms. 

Department of Defense, Cleveland Clinic cognitive neuroscientist 

Stephen Rao, PhD, and collaborators are using advanced brain 

imaging techniques to better understand blast-related TBI. 

Dr. Rao, the Principal Investigator, is working with colleagues 

at Baylor College of Medicine. Their research will determine 

if blast-related TBI, thought to be produced by wave-induced 

changes in atmospheric pressure, can be differentiated from the 

better-studied civilian TBI, which is caused primarily by mechani- 

cal forces such as the sudden jolt from an auto accident or fall. 

Functional magnetic resonance imaging and diffusion tensor 

imaging will be used to identify differences and parallels between 

military and civilian TBI. 

As many as 20 percent of soldiers returning from Iraq and 

Afghanistan have TBI. Approximately 40 percent of these are 

mild cases that are often overlooked because they do not show 

up on traditional screening tests. Yet, if a solider returns to 

combat without treatment for a mild TBI, a second or third blast 

injury can be much more crippling, according to Dr. Rao. Each 

successive injury further depletes the neural reserve, hampering 

recovery. 

Grahame Kidd, PhD, left, and Bruce Trapp, PhD, analyze images of 

“new neurons” in multiple sclerosis brain sections. 

Furthermore, the effects of even one mild TBI can linger, manifested 

months or years later in memory problems, mood swings 

and constant frustration. Thus, research to identify damage 

caused by the first blast injury assumes even greater relevance. 

New Neuron Growth in Adult Brains 

Lerner Research Institute researchers discovered evidence of the 

generation of new neurons in adult brains. The findings, published 

in Brain, challenge views that the adult human brain lacks 

the ability to grow new neurons. 

This research, led by Bruce Trapp, PhD, Chairman of the Department 

of Neurosciences at Lerner Research Institute, involved 

examination of neurons in the brains of nine patients with 

multiple sclerosis (MS) and four healthy control group subjects. 

The study used advance staining techniques to detect and characterize 

neurons in normal subcortical white matter and acute and 

chronic demyelinated brain lesions. In MS, the immune system 

destroys the myelin sheaths that surround and protect nerves. The 

nerves then “misfire,” slowing or disrupting impulses. 

Dr. Trapp’s team found that neurons occupying the white matter 

also are destroyed during demyelination. In a small percentage 

of old MS lesions, however, white matter neurons increased 

72 percent compared with normal brain regions. 

The study suggests that demyelinated tissues produce signals that 

can enhance the generation of new neurons in damaged areas of 

the brain. Thus, there is evidence to support the thesis that new 

neurons can regrow in MS lesions. 

It is unclear how much function the new tissues have, but this 

basic science discovery may provide a basis for development of 

new therapies for MS and other neurodegenerative diseases. 

Collaborating with Dr. Trapp on the research were Susan 

Staugaitis, MD, PhD, and neurologists at the Mellen Center for 

Multiple Sclerosis Treatment and Research. 


Unlocking Stem Cell Potential 

Jeremy Rich, MD, nationally known for his research on cancer 

stem cells and brain tumors, was recruited from Duke University 

Medical Center in 2008 to serve as Chairman of Lerner Research 

Institute’s newly created Department of Stem Cell Biology and 

Regenerative Medicine. 

Brain precursor cells that give rise to myelin-forming cells are important 

for repairing damage from demyelinating diseases like multiple 

sclerosis. In this population, all precursor cells expressed a common 

marker molecule (red), but only a subset also expressed a marker 

associated with cell maturation (green). 

Stem cell biology and the resulting regenerative medicine hold 

the promise of moving medicine beyond simply dealing with 

symptoms. Dr. Rich’s goal is to develop a comprehensive research 

group to study stem cells, from the basic science to implementation 

of new therapies to treat a variety of diseases. He plans to 

recruit about 10 faculty members in the next five years to build a 

department with approximately 100 employees. 

Forced Exercise Reduces Parkinson’s Symptoms 

Sometimes, insight comes in an unlikely setting. Jay Alberts, PhD, 

Department of Biomedical Engineering, had just completed a 

450-mile bicycle trip across Iowa to raise awareness of Parkinson’s 

disease when a patient mentioned that she had no symptoms during 

the ride, and the tremor in her hand was gone afterward. The 

patient had been paired with a rider who set a faster pace than 


Research 41 

she would have pedaled alone. Dr. Alberts set out to investigate 

whether “forced exercise,” in which people are pushed beyond 

their normal limits, is therapeutic for Parkinson’s patients. 

To test the theory, he designed a tandem bicycle that forces 

patients to pedal at accelerated rates. Among the early findings: 

Motor function improved significantly in patients’ arms, even 

though they were working only their legs, which suggests to Dr. 

Alberts that forced exercise impacts higher brain function and 

improves central motor function. 

Patients averaged a 30 percent improvement in their symptoms, 

and these gains were sustained for four weeks after they stopped 

forced exercising. 

Dr. Alberts posits that driving the central nervous system beyond 

its normal capacity can lead to biochemical changes necessary for 

these improvements. 

Further research is needed to understand the underlying mecha- 

nisms. Mark Lowe, PhD, of Cleveland Clinic’s Imaging Institute, 

and Micheal Phillips, MD, Section Head of Imaging Sciences in 

the Department of Diagnostic Radiology, are collaborating on 

the project. 

Novel Oral Therapies for Multiple Sclerosis 

MS researchers are poised for a breakthrough in the form of the 

first-ever oral agents for treatment of the disease, which are now in 

Phase III testing. Neurologists at Cleveland Clinic’s Mellen Center 

for Multiple Sclerosis Treatment and Research are closely involved 

in these promising investigations, as are the study participants 

among their patients. 

Mellen Center Medical Director Robert Fox, MD, is Principal 

Investigator on a Phase III study of the oral immunomodulator 

fumarate. Jeffrey Cohen, MD, Director of Experimental Thera- 

peutics at the Mellen Center, was PI on a Phase III trial of the oral 

drug fingolimod. Dr. Cohen also serves on the adjudication board 

for an ongoing study of oral cladribine and the steering committee 

for trials of the immunomodulator laquinimod.

42 Research 

The Spine Research Laboratory includes a state-of-the-art biomechanics laboratory. Biomechanical testing involves eccentric axial loading of a 

spinal motion segment to determine stress distribution within the intervertebral disc. 

Plasma Exchange as Treatment for Rare Complication 

The drug natalizumab helps treat multiple sclerosis by inhibiting 

white blood cells from entering the brain and attacking nerves, 

but this drug also lowers the patient’s immunity. Some patients 

taking natalizumab have suffered an uncommon, but usually 

fatal, infection called progressive multifocal leukoencephalopathy 

(PML). 

In a study published in the journal Neurology, Robert Fox, MD, 

and colleagues examined the effect of plasma exchange in 12 MS 

patients taking natalizumab. This study showed that monoclonal 

antibodies can be removed from the body with plasma exchange, 

and this removal leads to improved immune function. Using 

population modeling, Dr. Fox and colleagues suggested that 

five plasma exchanges are needed to effectively remove natali- 

zumab from the bodies of patients receiving this therapy. Plasma 

exchange may help convert PML into a manageable complication 

of treatment with natalizumab, which would improve the overall 

safety of this therapy. 

Tissue Collection Supports Multiple Sclerosis Research 

Many MS basic research studies require brain and spinal cord 

tissue from diseased patients. Because brain biopsies are rare, 

autopsy collection of tissues is vital in providing the required 

resources for these studies. Cleveland Clinic has developed an 

effective MS Tissue Donation Program. 

An advanced directive program includes educational materials, 

written informed consent, donor identification card, and a secure 

database with patient demographics and disease characteristics. A 

rapid autopsy protocol ensures 24/7 transportation, postmortem 

imaging and tissue procurement. 

At the time of death, calls from family and care providers are 

routed to the on-call MS tissue donation nurse coordinator, 

who activates the ambulance transport and notifies the imaging, 

autopsy and tissue-processing teams. The body undergoes 


postmortem MRI, followed by brain and spinal cord removal and 

processing by a neuropathologist and the tissue-processing team. 

Local pathologists are utilized for distant patients. 

A total of 224 patients have enrolled in the advanced directive 

program. Since 1997, 64 patients have donated their tissues. 

Median postmortem interval (time from death to fixation) was 

6.1 hours. 

This program has been successful in effectively procuring and 

rapidly processing MS tissues, and has supported high-impact 

publication in The New England Journal of Medicine, Annals of 

Neurology and Archives of Neurology. 

Spine Research Laboratory at Lutheran Hospital 

Eighty percent of American adults experience back problems at 

some point in their lives. Cleveland Clinic’s Spine Research 

Lab (SRL), which relocated in 2008 to Lutheran Hospital, a 

Cleveland Clinic hospital, is dedicated to improving quality of life 

for people with spinal disorders through research, innovation and 

education. 

The SRL strengthens the comprehensive spine program developed 

in recent years at Lutheran. The program is noted for medical and 

surgical spine care and inpatient rehabilitation. The addition of 

the SRL, under the direction of Lars Gilbertson, PhD, intensifies a 

complementary focus on research and education. 

The SRL hosts medical students, bioengineering students, 

residents and fellows from the departments of Neurosurgery and 

Orthopaedic Surgery, along with research fellows from around 

the world. 

With the SRL, the spine program at Lutheran is fast becoming an 

integrated continuum with Cleveland Clinic’s main campus and 

the Neurological Institute, as Dr. Gilbertson and staff work closely 

with Center for Spine Health Director Gordon Bell, MD, and his 

clinical staff. 

In recognition of its commitment to spinal care and research, 

the SRL received a five-year grant from Ohio’s Third Frontier 

Commission. In its new home, the SRL seeks to establish itself 

as a national leader in spinal innovation and to educate the next 

generation of spine researchers and clinicians. 


Neurological Institute Chairs 

Research 43 

Holders of the following endowed chairs are entrusted with the 

stewardship of funds generated by the gifts of Cleveland Clinic’s 

generous supporters. 

Gene Barnett, MD, FACS 

Director, Brain Tumor and Neuro-Oncology Center 

The Rose Ella Burkhardt Chair in Neurosurgery 

William Bingaman, MD 

Vice Chairman, Clinical Areas, Neurological Institute 

The Shusterman Endowed Chair 

Irene Katzan, MD, MS 

The Wamberg Family Endowed Chair in Stroke Research 


Chairman, Neurological Institute 

The William P. and Amanda C. Madar Endowed Chair and Professorship 

Imad Najm, MD 

Director, Epilepsy Center 

The Joseph and Ellen Thomas Endowed Chair 

Stephen Rao, PhD 

Director, The Ralph and Luci Schey Foundation Center for Advanced Cognitive 

Function 

The Ralph and Luci Schey Endowed Chair in Cognitive Function 

Ali Rezai, MD * 

The Jane and Lee Seidman Chair in Functional Neurosurgery 

Richard A. Rudick, MD 

Vice Chairman, Research and Development, Neurological Institute 

Director, Mellen Center for Multiple Sclerosis Treatment and Research 

The Hazel Prior Hostetler Endowed Chair 

Tanya Tekautz, MD 


The Karen Colina Wilson Endowed Chair in Pediatric Brain Tumor Research 

Jerrold Vitek, MD, PhD 


The Edward F. and Barbara A. Bell Family Endowed Chair 

Michael Vogelbaum, MD, PhD 

Associate Director, Brain Tumor and Neuro-Oncology Center 

The Robert W. and Kathryn B. Lamborn Chair for Neuro-Oncology 

Robert J. Weil, MD 

Director of Laboratory Research, Brain Tumor and Neuro-Oncology Center 

The Melvin H. Burkhardt Chair in Neuro-Oncology Clinical Research 

Currently Unassigned Endowed Chairs 

The Andrea L. and Joseph F. Hahn, MD, Endowed Chair 

The Jane and Lee Seidman Chair in Functional Neurosurgery 

* Until July 2009

44 Research 

Selected Publications 

Neurological Institute staff authored more than 470 publications in 2008, including the following. For a complete 

list, go to clevelandclinic.org/nipublications. 


Balmaceda C, Peereboom D, Pannullo S, Cheung YKK, Fisher 

PG, Alavi J, Sisti M, Chen J, Fine RL. Multi-institutional 

phase II study of temozolomide administered twice daily in the 

treatment of recurrent high-grade gliomas. Cancer. 2008 Mar 1; 

112(5):1139-1146. 

Chao ST, Barnett GH, Vogelbaum MA, Angelov L, Weil 

RJ, Neyman G, Reuther AM, Suh JH. Salvage stereotactic 

radiosurgery effectively treats recurrences from whole-brain 

radiation therapy. Cancer. 2008 Oct 15;113(8):2198-2204. 

Georgitsi M, De Menis E, Cannavo S, Makinen MJ, Tuppurainen 

K, Pauletto P, Curto L, Weil RJ, Paschke R, Zielinski G, Wasik A, 

Lubinski J, Vahteristo P, Karhu A, Aaltonen LA. Aryl hydrocarbon 

receptor interacting protein (AIP) gene mutation analysis in 

children and adolescents with sporadic pituitary adenomas. Clin 

Endocrinol (Oxf ). 2008 Oct;69(4):621-627. 

Gibson SE, Zeng WF, Weil RJ, Prayson RA. Aurora B kinase 

expression in ependymal neoplasms. Appl Immunohistochem Mol 

Morphol. 2008 May;16(3):274-278. 

Guo S, Chao ST, Reuther AM, Barnett GH, Suh JH. Review 

of the treatment of trigeminal neuralgia with gamma knife 

radiosurgery. Stereotact Funct Neurosurg. 2008;86(3):135-146. 

Kang TY, Jin T, Elinzano H, Peereboom D. Irinotecan and 

bevacizumab in progressive primary brain tumors, an evaluation 

of efficacy and safety. J Neurooncol. 2008 Aug;89(1):113-118. 

Kim SH, Weil RJ, Chao ST, Toms SA, Angelov L, Vogelbaum 

MA, Suh JH, Barnett GH. Stereotactic radiosurgical treatment 

of brain metastases in older patients. Cancer. 2008 Aug 15; 

113(4):834-840. 

Marko NF, Toms SA, Barnett GH, Weil R. Genomic expression 

patterns distinguish long-term from short-term glioblastoma 

survivors: a preliminary feasibility study. Genomics. 2008 

May;91(5):395-406. 

Pineyro MM, Makdissi A, Faiman C, Prayson RA, Reddy SK, 

Mayberg MC, Weil RJ, Hamrahian AH. Poor correlation of 

serum alpha-subunit concentration and magnetic resonance 

imaging following pituitary surgery in patients with 

nonfunctional pituitary macroadenomas. Endocr Pract. 2008 

May;14(4):452-457. 

Sade B, Lee JH. High incidence of optic canal involvement 

in clinoidal meningiomas: rationale for aggressive skull base 

approach. Acta Neurochir (Wien). 2008 Nov;150(11):1127- 

1132. 


Albuquerque FC, Levy EI, Turk AS, Niemann DB, Aagaard- 

Kienitz B, Pride GL Jr, Purdy PD, Welch BG, Woo HH, 

Rasmussen PA, Hopkins LN, Masaryk TJ, McDougall CG, 

Fiorella DJ. Angiographic patterns of wingspan in-stent 

restenosis. Neurosurgery. 2008 Jul;63(1):23-27;discussion 

27-28. 

Bhatt A, Vora NA, Thomas AJ, Majid A, Kassab M, Hammer MD, 

Uchino K, Wechsler L, Jovin TG, Gupta R. Lower pretreatment 

cerebral blood volume affects hemorrhagic risks after intraarterial 

revascularization in acute stroke. Neurosurgery. 2008 

Nov;63(5):874-878. 

Cucullo L, Couraud PO, Weksler B, Romero IA, Hossain M, 

Rapp E, Janigro D. Immortalized human brain endothelial cells 

and flow-based vascular modeling: a marriage of convenience for 

rational neurovascular studies. J Cereb Blood Flow Metab. 2008 

Feb;28(2):312-328. 

Fan QY, Ramakrishna S, Marchi N, Fazio V, Hallene K, Janigro 

D. Combined effects of prenatal inhibition of vasculogenesis and 

neurogenesis on rat brain development. Neurobiol Dis. 2008 

Dec;32(3):499-509. 

Kelly ME, Turner RD IV, Moskowitz SI, Gonugunta V, Hussain 

MS, Fiorella D. Delayed migration of a self-expanding 

intracranial microstent. AJNR Am J Neuroradiol. 2008 

Nov;29(10):1959-1960. 


Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic 

and clinical benefits of portable head/neck CT imaging 

in the intensive care unit. Radiol Manage. 2008 Mar- 

Apr;30(2):50-54. 

Nagel MA, Cohrs RJ, Mahalingam R, Wellish MC, Forghani 

B, Schiller A, Safdieh JE, Kamenkovich E, Ostrow LW, Levy 

M, Greenberg B, Russman AN, Katzan I, Gardner CJ, Hausler 

M, Nau R, Saraya T, Wada H, Goto H, de Martino M, Ueno M, 

Brown WD, Terborg C, Gilden DH. The varicella zoster virus 

vasculopathies: clinical, CSF, imaging, and virologic features. 

Neurology. 2008 Mar 11;70(11):853-860. 

Tayal AH, Tian M, Kelly KM, Jones SC, Wright DG, Singh D, 

Jarouse J, Brillman J, Murali S, Gupta R. Atrial fibrillation 

detected by mobile cardiac outpatient telemetry in cryptogenic 

TIA or stroke. Neurology. 2008 Nov 18;71(21):1696-1701. 

Turk AS, Levy EI, Albuquerque FC, Pride GL Jr, Woo H, Welch 

BG, Niemann DB, Purdy PD, Aagaard-Kienitz B, Rasmussen PA, 

Hopkins LN, Masaryk TJ, McDougall CG, Fiorella D. Influence 

of patient age and stenosis location on wingspan in-stent 

restenosis. AJNR Am J Neuroradiol. 2008 Jan;29(1):23-27. 

Turner RD, Byrne JV, Kelly ME, Mitsos AP, Gonugunta V, 

Lalloo S, Rasmussen PA, Fiorella D. Delayed visual deficits 

and monocular blindness after endovascular treatment of large 

and giant paraophthalmic aneurysms. Neurosurgery. 2008 

Sep;63(3):469-474. 


Bautista JF, Kelly JA, Harley JB, Gray-McGuire C. Addressing 

genetic heterogeneity in complex disease: finding seizure 

genes in systemic lupus erythematosus. Epilepsia. 2008 

Mar;49(3):527-530. 

Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, 

Naugle RI, Nair D, Najm IM. Poor presurgical performance on 

both verbal and visual memory measures is associated with low 

risk for memory decline following left temporal lobectomy for 

intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199- 

205. 

Chapin JS, Busch RM, Janigro D, Dougherty M, Tilelli CQ, 

Lineweaver TT, Naugle RI, Diaz-Arrastia R, Najm IM. APOE 

epsilon4 is associated with postictal confusion in patients with 

medically refractory temporal lobe epilepsy. Epilepsy Res. 2008 

Oct;81(2-3):220-224. 

Dutton C, Foldvary-Schaefer N. Contraception in women with 

epilepsy: pharmacokinetic interactions, contraceptive options, 

and management. Int Rev Neurobiol. 2008;83:113-134. 


Research 45 

Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution 

of obstructive sleep apnea with epilepsy surgery? Expanding 

the relationship between sleep and epilepsy. Epilepsia. 2008 

Aug;49(8):1457-1459. 

Jehi L, Najm IM. Sudden unexpected death in epilepsy: impact, 

mechanisms, and prevention. Cleve Clin J Med. 2008 Mar;75 

Suppl 2:S66-S70. 

Kim H, Piao Z, Liu P, Bingaman W, Diehl B. Secondary white 

matter degeneration of the corpus callosum in patients with 

intractable temporal lobe epilepsy: a diffusion tensor imaging 

study. Epilepsy Res. 2008 Oct;81(2-3):136-142. 

Lachhwani DK, Loddenkemper T, Holland KD, Kotagal 

P, Mascha E, Bingaman W, Wyllie E. Discontinuation of 

medications after successful epilepsy surgery in children. Pediatr 

Neurol. 2008 May;38(5):340-344. 

Mani J, Diehl B, Piao Z, Schuele SS, Lapresto E, Liu P, Nair DR, 

Dinner DS, Luders HO. Evidence for a basal temporal visual 

language center: cortical stimulation producing pure alexia. 

Neurology. 2008 Nov 11;71(20):1621-1627. 

Zotev VS, Matlashov AN, Volegov PL, Savukov IM, Espy MA, 

Mosher JC, Gomez JJ, Kraus RH Jr. Microtesla MRI of the 

human brain combined with MEG. J Magn Reson. 2008 

Sep;194(1):115-120. 


Cardona AE, Sasse ME, Liu L, Cardona SM, Mizutani M, 

Savarin C, Hu T, Ransohoff RM. Scavenging roles of chemokine 

receptors: chemokine receptor deficiency is associated with 

increased levels of ligand in circulation and tissues. Blood. 2008 

Jul 15;112(2):256-263. 

Chang A, Smith MC, Yin X, Fox RJ, Staugaitis SM, Trapp BD. 

Neurogenesis in the chronic lesions of multiple sclerosis. Brain. 

2008 Sep;131(Pt 9):2366-2375. 

Cohen JA, Calabresi PA, Chakraborty S, Edwards KR, 

Eickenhorst T, Felton WL III, Fisher E, Fox RJ, Goodman AD, 

Hara-Cleaver C, Hutton GJ, Imrey PB, Ivancic DM, Mandell 

BF, Perryman JE, Scott TF, Skaramagas TT, Zhang H. Avonex 

combination trial in relapsing-remitting MS: rationale, design 

and baseline data. Mult Scler. 2008 Apr;14(3):370-382. 

Fisher E, Lee JC, Nakamura K, Rudick RA. Gray matter atrophy 

in multiple sclerosis: a longitudinal study. Ann Neurol. 2008 

Sep;64(3):255-265.

46 Research 

Fox RJ, McColl RW, Lee JC, Frohman T, Sakaie K, Frohman 

E. A preliminary validation study of diffusion tensor imaging 

as a measure of functional brain injury. Arch Neurol. 2008 

Sep;65(9):1179-1184. 

Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, 

Phillips MD. Resting state sensorimotor functional connectivity 

in multiple sclerosis inversely correlates with transcallosal 

motor pathway transverse diffusivity. Hum Brain Mapp. 2008 

Jul;29(7):818-827. 

Moll NM, Rietsch AM, Ransohoff AJ, Cossoy MB, Huang D, 

Eichler FS, Trapp BD, Ransohoff RM. Cortical demyelination in 

PML and MS: similarities and differences. Neurology. 2008 Jan 

29;70(5):336-343. 

Sutliff MH, Naft JM, Stough DK, Lee JC, Arrigain SS, Bethoux 

FA. Efficacy and safety of a hip flexion assist orthosis in 

ambulatory multiple sclerosis patients. Arch Phys Med Rehabil. 

2008 Aug;89(8):1611-1617. 

Trapp BD, Nave KA. Multiple sclerosis: an immune or 

neurodegenerative disorder? Annu Rev Neurosci. 2008;31:247- 

269. 

Young EA, Fowler CD, Kidd GJ, Chang A, Rudick R, Fisher 

E, Trapp BD. Imaging correlates of decreased axonal Na+/K+ 

ATPase in chronic multiple sclerosis lesions. Ann Neurol. 2008 

Apr;63(4):428-435. 


Ash LM, Modic MT, Obuchowski NA, Ross JS, Brant-Zawadzki 

MN, Grooff PN. Effects of diagnostic information, per se, on 

patient outcomes in acute radiculopathy and low back pain. 

AJNR Am J Neuroradiol. 2008 Jun;29(6):1098-1103. 

Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears 

J, Traboulsi EI. Pituitary stalk duplication in association with 

moya moya disease and bilateral morning glory disc anomaly — 

broadening the clinical spectrum of midline defects. J Neurol. 

2008 Jun;255(6):885-890. 

Lowe MJ, Beall EB, Sakaie KE, Koenig KA, Stone L, Marrie RA, 

Phillips MD. Resting state sensorimotor functional connectivity 

in multiple sclerosis inversely correlates with transcallosal 

motor pathway transverse diffusivity. Hum Brain Mapp. 2008 

Jul;29(7):818-827. 

Masaryk T, Kolonick R, Painter T, Weinreb DB. The economic 

and clinical benefits of portable head/neck CT imaging 

in the intensive care unit. Radiol Manage. 2008 Mar- 

Apr;30(2):50-54. 

Phillips MD. Functional faults: fMRI in MS. Neurology. 2008 

Jan 22;70(4):248-249. 


Alberts JL, Voelcker-Rehage C, Hallahan K, Vitek M, Bamzai R, 

Vitek JL. Bilateral subthalamic stimulation impairs cognitivemotor 

performance in Parkinson’s disease patients. Brain. 2008 

Dec;131(Pt 12):3348-3360. 

Cooper SE, Kuncel AM, Wolgamuth BR, Rezai AR, Grill WM. 

A model predicting optimal parameters for deep brain 

stimulation in essential tremor. J Clin Neurophysiol. 2008 

Oct;25(5):265-273. 

Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. 

Impulsivity and risk-taking behavior in focal frontal lobe lesions. 

Neuropsychologia. 2008;46(1):213-223. 

Guo Y, Rubin JE, McIntyre CC, Vitek JL, Terman D. 

Thalamocortical relay fidelity varies across subthalamic nucleus 

deep brain stimulation protocols in a data-driven computational 

model. J Neurophysiol. 2008 Mar;99(3):1477-1492. 

Johnson MD, Miocinovic S, McIntyre CC, Vitek JL. Mechanisms 

and targets of deep brain stimulation in movement disorders. 

Neurotherapeutics. 2008 Apr;5(2):294-308. 

Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden 

D, Feinstein A. Epigenetics of personality traits: an illustrative 

study of identical twins discordant for risk-taking behavior. Twin 

Res Hum Genet. 2008 Feb;11(1):1-11. 

Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, 

Schurigyn T, Farag E. Perioperative events during deep brain 

stimulation: the experience at Cleveland Clinic. J Neurosurg 

Anesthesiol. 2008 Jan;20(1):36-40. 

Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis 

NM. Surgery for movement disorders. Neurosurgery. 2008 

Feb;62(Suppl 2):809-838. 

Voon V, Krack P, Lang AE, Lozano AM, Dujardin K, Schupbach 

M, D’Ambrosia J, Thobois S, Tamma F, Herzog J, Speelman JD, 

Samanta J, Kubu C, Rossignol H, Poon YY, Saint-Cyr JA, Ardouin 

C, Moro E. A multicentre study on suicide outcomes following 

subthalamic stimulation for Parkinson’s disease. Brain. 2008 

Oct;131(Pt 10):2720-2728. 

Xu W, Russo GS, Hashimoto T, Zhang J, Vitek JL. Subthalamic 

nucleus stimulation modulates thalamic neuronal activity. 

J Neurosci. 2008 Nov 12;28(46):11916-11924. 



Chahine LM, Patrick R, Tavee J. Complex regional pain 

syndrome after infliximab infusion. J Pain Symptom Manage. 

2008 Sep;36(3):e2-e4. 

Cheng G, Kaminski HJ, Gong B, Zhou L, Hatala D, Howell 

SJ, Zhou X, Mustari MJ. Monocular visual deprivation in 

macaque monkeys: a profile in the gene expression of lateral 

geniculate nucleus by laser capture microdissection. Mol Vis. 

2008;14:1401-1413. 

Holmes RO Jr, Tavee J. Vasospasm and stroke attributable 

to ephedra-free xenadrine: case report. Mil Med. 2008 

Jul;173(7):708-710. 

McClelland S III, Bethoux FA, Boulis NM, Sutliff MH, Stough 

DK, Schwetz KM, Gogol DM, Harrison M, Pioro EP. Intrathecal 

baclofen for spasticity-related pain in amyotrophic lateral 

sclerosis: efficacy and factors associated with pain relief. Muscle 

Nerve. 2008 Mar;37(3):396-398. 

Rini BI, Shook S. Is Guillain Barre syndrome likely in this 

patient? Oncology (Williston Park). 2008 Jan;22(1):70-71. 

Shook SJ, Mamsa H, Jen JC, Baloh RW, Zhou L. Novel mutation 

in KCNA1 causes episodic ataxia with paroxysmal dyspnea. 

Muscle Nerve. 2008 Mar;37(3):399-402. 

Sorenson EJ, Windbank AJ, Mandrekar JN, Bamlet WR, Appel 

SH, Armon C, Barkhaus PE, Bosch P, Boylan K, David WS, 

Feldman E, Glass J, Gutmann L, Katz J, King W, Luciano CA, 

McCluskey LF, Nash S, Newman DS, Pascuzzi RM, Pioro E, 

Sams LJ, Scelsa S, Simpson EP, Subramony SH, Tiryaki E, 

Thornton CA. Subcutaneous IGF-1 is not beneficial in 2-year 

ALS trial. Neurology. 2008 Nov 25;71(22):1770-1775. 

Tavee J, Morris H III. Severe postictal laryngospasm as a 

potential mechanism for sudden unexpected death in epilepsy: a 

near-miss in an EMU. Epilepsia.2008 Dec;49(12):2113-2117. 

Zhou L, Rafael-Fortney JA, Huang P, Zhao XS, Cheng G, Zhou 

X, Kaminski HJ, Liu L, Ransohoff RM. Haploinsufficiency of 

utrophin gene worsens skeletal muscle inflammation and fibrosis 

in mdx mice. J Neurol Sci. 2008 Jan 15;264(1-2):106-111. 


Bigal M, Sheftell F, Tepper S, Tepper D, Ho TW, Rapoport 

A. A randomized double-blind study comparing rizatriptan, 

dexamethasone, and the combination of both in the acute 

treatment of menstrually related migraine. Headache. 2008 

Oct;48(9):1286-1293. 


Research 47 

Cleves C, Tepper SJ. Sumatriptan/naproxen sodium 

combination for the treatment of migraine. Expert Rev Neurother. 

2008 Sep;8(9):1289-1297. 

Sun-Edelstein C, Tepper SJ, Shapiro RE. Drug-induced 

serotonin syndrome: a review. Expert Opin Drug Saf. 2008 

Sep;7(5):587-596. 

Syrjala KL, Abrams JR, Polissar NL, Hansberry J, Robison J, 

DuPen S, Stillman M, Fredrickson M, Rivkin S, Feldman E, 

Gralow J, Rieke JW, Raish RJ, Lee DJ, Cleeland CS, DuPen A. 

Patient training in cancer pain management using integrated 

print and video materials: a multisite randomized controlled trial. 

Pain. 2008 Mar;135(1-2):175-186. 

Tepper SJ, Stillman MJ. Clinical and preclinical rationale 

for CGRP-receptor antagonists in the treatment of migraine. 

Headache. 2008 Sep;48(8):1259-1268. 

Tepper SJ, Zatochill M, Szeto M, Sheftell F, Tepper DE, Bigal 

M. Development of a simple menstrual migraine screening tool 

for obstetric and gynecology clinics: the menstrual migraine 

assessment tool. Headache. 2008 Nov;48(10):1419-1425. 

Center for Pediatric Neurology and Neurosurgery 

Bedaiwy MA, Fathalla MM, Shaaban OM, Ragab MH, Elbaba S, 

Luciano M, El-Nashar SA, Falcone T. Reproductive implications 

of endoscopic third ventriculostomy for the treatment of 

hydrocephalus. Eur J Obstet Gynecol Reprod Biol. 2008 

Sep;140(1):55-60. 

Chappelow AV, Reid J, Parikh S, Traboulsi EI. Aicardi syndrome 

in a genotypic male. Ophthalmic Genet. 2008 Dec;29(4):181- 

183. 

Factora R, Luciano M. When to consider normal pressure 

hydrocephalus in the patient with gait disturbance. Geriatrics. 

2008 Feb;63(2):32-37. 

Fong J, Wu G, Wyllie E, Gupta A. Interictal hypermetabolic 

subcortical band on brain FDG-PET in doublecortin mutation. 

Neurology. 2008 Aug 12;71(7):535. 

Haas RH, Parikh S, Falk MJ, Saneto RP, Wolf NI, Darin N, 

Wong LJ, Cohen BH, Naviaux RK. The in-depth evaluation 

of suspected mitochondrial disease. Mol Genet Metab. 2008 

May;94(1):16-37. 

Loddenkemper T, Alexopoulos AV, Kotagal P, Moosa A, 

Lachhwani DK, Gupta A, Bingaman W, Wyllie E. Epilepsy

48 Research 

surgery in epidermal nevus syndrome variant with 

hemimegalencephaly and intractable seizures. J Neurol. 2008 

Nov;255(11):1829-1831. 

Loddenkemper T, Friedman NR, Ruggieri PM, Marcotty A, Sears 

J, Traboulsi EI. Pituitary stalk duplication in association with 

moya moya disease and bilateral morning glory disc anomaly — 

broadening the clinical spectrum of midline defects. J Neurol. 

2008 Jun;255(6):885-890. 

Parikh S, Cohen BH, Gupta A, Lachhwani DK, Wyllie E, Kotagal 

P. Metabolic testing in the pediatric epilepsy unit. Pediatr 

Neurol. 2008 Mar;38(3):191-195. 

Weissman JR, Kelley RI, Bauman ML, Cohen BH, Murray KF, 

Mitchell RL, Kern RL, Natowicz MR. Mitochondrial disease in 

autism spectrum disorder patients: a cohort analysis. PLoS ONE. 

2008;3(11):e3815. 


Busch RM, Chapin JS, Umashankar G, Diehl B, Harvey D, 

Naugle RI, Nair D, Najm IM. Poor presurgical performance on 

both verbal and visual memory measures is associated with low 

risk for memory decline following left temporal lobectomy for 

intractable epilepsy. Epileptic Disord. 2008 Sep;10(3):199- 

205. 

Coffman KL. The debate about marijuana usage in transplant 

candidates: recent medical evidence on marijuana health effects. 

Curr Opin Organ Transplant. 2008 Apr;13(2):189-195. 

Falcone T, Carlton E, Janigro D, Simon B, Franco K. 

Self-harm during first-episode psychosis. Br J Psychiatry. 2008 

Aug;193(2):167. 

Floden D, Alexander MP, Kubu CS, Katz D, Stuss DT. 

Impulsivity and risk-taking behavior in focal frontal lobe lesions. 

Neuropsychologia. 2008;46(1):213-223. 

Heinberg LJ, Coughlin JW, Pinto AM, Haug N, Brode C, Guarda 

AS. Validation and predictive utility of the Sociocultural Attitudes 

Toward Appearance Questionnaire for Eating Disorders (SATAQ- 

ED): internalization of sociocultural ideals predicts weight gain. 

Body Image. 2008 Sep;5(3):279-290. 

Kaminsky Z, Petronis A, Wang SC, Levine B, Ghaffar O, Floden 

D, Feinstein A. Epigenetics of personality traits: an illustrative 

study of identical twins discordant for risk-taking behavior. Twin 

Res Hum Genet. 2008 Feb;11(1):1-11. 

McKee MG. Biofeedback: an overview in the context of heartbrain 

medicine. Cleve Clin J Med. 2008 Mar;75 


Muzina DJ. Depression and anxiety: distinguishing unipolar 

and bipolar disorders. Ann Clin Psychiatry. 2008 Dec;20 


Pandya M, Kubu CS, Giroux ML. Parkinson disease: not just a 

movement disorder. Cleve Clin J Med. 2008 Dec;75(12):856- 

864. 

Tesar GE. Whither hospital and academic psychiatry? Psychiatr 

Clin North Am. 2008 Mar;31(1):27-42. 

Tetzlaff JE, Collins GB. Reentry of anesthesiology residents after 

treatment of chemical dependency — is it rational? J Clin Anesth. 

2008 Aug;20(5):325-327. 


Aboussouan LS, Lattin CD, Kline JL. Determinants of long-term 

mortality after prolonged mechanical ventilation. Lung. 2008 

Sep;186(5):299-306. 

Foldvary-Schaefer N, Stephenson L, Bingaman W. Resolution 

of obstructive sleep apnea with epilepsy surgery? Expanding 

the relationship between sleep and epilepsy. Epilepsia. 2008 

Aug;49(8):1457-1459. 

Gugliotti D, Grant P, Jaber W, Aboussouan L, Bae C, Sessler 

D, Scahuer P, Kaw R. Challenges in cardiac risk assessment in 

bariatric surgery patients. Obes Surg. 2008 Jan;18(1):129-133. 

Kaw R, Aboussouan L, Auckley D, Bae C, Gugliotti D, Grant P, 

Jaber W, Schauer P, Sessler D. Challenges in pulmonary risk 

assessment and perioperative management in bariatric surgery 

patients. Obes Surg. 2008 Jan;18(1):134-138. 

Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender 

and age on REM-related sleep-disordered breathing. Sleep 

Breath. 2008 Aug;12(3):259-264. 

Malow BA, Foldvary-Schaefer N, Vaughn BV, Selwa LM, Chervin 

RD, Weatherwax KJ, Wang L, Song Y. Treating obstructive sleep 

apnea in adults with epilepsy: a randomized pilot trial. Neurology. 

2008 Aug 19;71(8):572-577. 

Minai OA, Malik N, Foldvary N, Bair N, Golish JA. Prevalence 

and characteristics of restless legs syndrome in patients with 

pulmonary hypertension. J Heart Lung Transplant. 2008 

Mar;27(3):335-340. 


Selwa LM, Marzec ML, Chervin RD, Weatherwax KJ, Vaughn BV, 

Foldvary-Schaefer N, Wang L, Song Y, Malow BA. Sleep staging 

and respiratory events in refractory epilepsy patients: is there a 

first night effect? Epilepsia. 2008 Dec;49(12):2063-2068. 


Foley KT, Mroz TE, Arnold PM, Chandler HC Jr, Dixon RA, 

Girasole GJ, Renkens KL Jr, Riew KD, Sasso RC, Smith RC, 

Tung H, Wecht DA, Whiting DM. Randomized, prospective, 

and controlled clinical trial of pulsed electromagnetic 

field stimulation for cervical fusion. Spine J. 2008 May- 

Jun;8(3):436-442. 

Mroz TE, Joyce MJ, Steinmetz MP, Lieberman IH, Wang JC. 

Musculoskeletal allograft risks and recalls in the United States. 

J Am Acad Orthop Surg. 2008 Oct;16(10):559-565. 

Mroz TE, Yamashita T, Davros WJ, Lieberman IH. Radiation 

exposure to the surgeon and the patient during kyphoplasty. 

J Spinal Disord Tech. 2008 Apr;21(2):96-100. 

Schofferman J, Mazanec D. Evidence-informed management of 

chronic low back pain with opioid analgesics. Spine J. 2008 Jan- 

Feb;8(1):185-194. 

Steinmetz MP, Patel R, Traynelis V, Resnick DK, Anderson PA. 

Cervical disc arthroplasty compared with fusion in a workers’ 

compensation population. Neurosurgery. 2008 Oct;63(4):741- 

747. 

Steinmetz MP, Rajpal S, Trost G. Segmental spinal 

instrumentation in the management of scoliosis. Neurosurgery. 

2008 Sep;63(3 Suppl):131-138. 

Studer RK, Gilbertson LG, Georgescu H, Sowa G, Vo N, Kang JD. 

p38 MAPK inhibition modulates rabbit nucleus pulposus cell 

response to IL-1. J Orthop Res. 2008 Jul;26(7):991-998. 

Vadala G, Studer RK, Sowa G, Spiezia F, Iucu C, Denaro 

V, Gilbertson LG, Kang JD. Coculture of bone marrow 

mesenchymal stem cells and nucleus pulposus cells modulate 

gene expression profile without cell fusion. Spine. 2008 Apr 

15;33(8):870-876. 

Vadala G, Sobajima S, Lee JY, Huard J, Denaro V, Kang JD, 

Gilbertson LG. In vitro interaction between muscle-derived stem 

cells and nucleus pulposus cells. Spine J. 2008 Sep;8(5):804- 

809. 


Research 49 

Watters WC III, Baisden J, Gilbert TJ, Kreiner S, Resnick DK, 

Bono CM, Ghiselli G, Heggeness MH, Mazanec DJ, O’Neill C, 

Reitman CA, Shaffer WO, Summers JT, Toton JF. Degenerative 

lumbar spinal stenosis: an evidence-based clinical guideline 

for the diagnosis and treatment of degenerative lumbar spinal 

stenosis. Spine J. 2008 Mar-Apr;8(2):305-310. 

Neurosurgical Anesthesiology 

Bala E, Sessler DI, Nair DR, McLain R, Dalton JE, Farag E. 

Motor and somatosensory evoked potentials are well maintained 

in patients given dexmedetomidine during spine surgery. 

Anesthesiology. 2008 Sep;109(3):417-425. 

Cata JP, Noguera EM, Parke E, Ebrahim Z, Kurz A, Kalfas I, 

Mascha E, Farag E. Patient-controlled epidural analgesia (PCEA) 

for postoperative pain control after lumbar spine surgery. 

J Neurosurg Anesthesiol. 2008 Oct;20(4):256-260. 

Elkassabany NM, Bhatia J, Deogaonkar A, Barnett GH, Lotto 

M, Maurtua M, Ebrahim Z, Schubert A, Ference S, Farag E. 

Perioperative complications of blood brain barrier disruption 

under general anesthesia: a retrospective review. J Neurosurg 


Khatib R, Ebrahim Z, Rezai A, Cata JP, Boulis NM, Doyle DJ, 

Schurigyn T, Farag E. Perioperative events during deep brain 

stimulation: the experience at Cleveland Clinic. J Neurosurg 


Maurtua MA, Deogaonkar A, Bakri MH, Mascha E, Na J, Foss 

J, Sessler DI, Lotto M, Ebrahim Z, Schubert A. Dosing of 

remifentanil to prevent movement during craniotomy in the 

absence of neuromuscular blockade. J Neurosurg Anesthesiol. 

2008 Oct;20(4):221-225.

Education 

Neurological Institute physicians direct the core neuroscience 

curriculum for approximately 120 medical students annually at 

Cleveland Clinic Lerner College of Medicine. They also share 

valuable information with the public on the latest neurological 

advances. 

This commitment to education was expressed in new forms in 

2008, including presentation of the first Neurological Institute 

Research Day. 

Medical Professionals 

Continuing Medical Education 

The Center for Continuing Education is responsible for one 

of the world’s largest, most diverse CME programs. In 2008, 

more than 15,000 professionals participated in more than 

250 Neurological Institute-sponsored CME programs, rang- 

ing from weekly grand rounds in six departments to multi-day 

international symposia, regional programs, association meetings, 

guest lectures and training courses. 

The center’s efforts to expand CME opportunities through non- 

traditional learning were highly successful in 2008, when 

2,087 certificates were issued for completion of online neuro- 

logical courses. The number represents a 60 percent increase 

over 2007. 


Graduate Medical Education 

Education 51 

The Neurological Institute collaborates with Cleveland Clinic’s Center for Continuing Education to offer a highly 

regarded series of continuing medical education (CME) programs to physicians and other healthcare professionals. In 

addition, the institute provides extensive graduate medical education opportunities, training some 170 clinical and 

research fellows and residents annually and hosting approximately 70 international and national physician-observers 

each year. 

The Neurological Institute offers approximately 30 accredited 

and non-accredited training programs providing physician 

education and research opportunities in neurology, neurosur- 

gery, psychiatry and psychology. Residents and fellows work side 

by side with some of the world’s most renowned experts in the 

neurosciences. 

Core residency programs accredited by the Accreditation Council 

for Graduate Medical Education (ACGME) encompass adult 

neurology, child neurology, neurosurgery, adult psychiatry, and 

child and adolescent psychiatry. ACGME-accredited subspecialty 

fellowships and non-accredited fellowships are also available. 

Research fellowships are offered for MDs and PhDs interested in 

clinician/scientist careers. 

Neurological Institute Research Day 

In 2008, the Neurological Institute inaugurated Research Day, 

a forum showcasing the projects of medical students, residents, 

and clinical, research and post-doctoral fellows. Participants 

made 74 poster and platform presentations and competed for 

recognition awards at the event, which was judged by an interdis- 

ciplinary team of Neurological Institute staff members. 

Left: Residents review anatomy in the Spine Research Laboratory. The Neurological Institute offers almost 30 training programs in neurology, neurosurgery, 

psychiatry and psychology, enabling residents and fellows to learn from some of the world’s most renowned experts in the neurosciences.

52 Education 

The first Neurological Institute Research Day, showcasing the work of 

medical students, residents and clinical fellows. 

For the presenters, Research Day was an opportunity to share 

their work and obtain helpful feedback, hone their writing and 

presentation skills, find new resources and collaborators, and 

earn recognition from mentors and peers. Participant Adrian 

Zachary, DO, MPH, alluded to a “feeling of honor presenting 

research.” 

For the physician-judges, Research Day reinforced “an understanding 

of our excellence,” in the words of Edward Benzel, 

MD. The event also inspired appreciation of and respect for the 

presenters and their work. Chief Resident Joyce Lee, MD, spoke 

for many when she remarked on “the amount of research generated 

by the residents in the NI — as busy as they are, they still 

manage to find the time to generate amazing research studies 

and papers.” 

Twelve presenters received awards for their work. Leopoldo 

Pozuelo, MD, was honored as the Neurological Institute 

Cleveland Clinic Lerner College of Medicine Teacher of the Year. 

Ultimately, the experience fostered a sense of community within 

the institute and exposed participants to methodologies that 

specialty areas outside their own apply to answer research ques- 

tions. Attendees commented on the general enthusiasm and the 

opportunity to communicate across departments. The strongest 

testimonials came from presenters who said they looked forward 

to taking part in Research Day 2009. 

Patients and the Public 

Through a range of communication channels, Neurological Insti- 

tute physicians and allied health professionals connect with the 

community, sharing information on specific neurological condi- 

tions, answering common questions, and helping patients and 

family members cope with challenging diagnoses and diseases. 

Among the most popular forums are: 

• Health Talks, which are free educational seminars at Cleveland 

Clinic’s main campus and Cleveland Clinic family health cen- 

ters throughout northeast Ohio. Recent sessions have focused 

on management of pituitary disorders, Parkinson’s disease and 

wellness, and treatment options for chronic back pain. 

• Live web chats with physicians who discuss a variety of neuro- 

logical disorders, diagnoses and therapeutic options. Topics 

have included medical management of back pain, pediatric 

brain tumor, neurofibromatosis, multiple sclerosis, sleep disor- 

ders, adult scoliosis and memory loss. 

• Gatherings that forge lasting bonds, such as the Pediatric Epi- 

lepsy Support Group’s second biennial reunion for children 

who underwent epilepsy surgery at Cleveland Clinic and their 

families. The two-day event in August 2008 drew 280 attend- 

ees from as far away as Ireland and South Africa. Educational 

as well as social, the reunion featured physician-led sessions for 

patients’ caregivers that focused on life after epilepsy surgery. 


The Pediatric Epilepsy Support Group offers families of children with epilepsy a forum for education, discussion and camaraderie. 

Music and the Brain 

Can music speed the healing process? Should musicians and 

neuroscientists collaborate on healing techniques? Questions 

like these were addressed during “Music and the Brain,” three 

public programs presented jointly by the Neurological Institute 

and the Arts and Medicine Institute, in partnership with the U.S. 

Department of Health and Human Services and The Cleveland 

Orchestra. The innovative series began at Cleveland Clinic and 

unfolded on an international stage, drawing a total of more than 

500 participants: 

• Cleveland Clinic’s “Doctor-Patient Music Connection,” 

which aims to improve medical care by raising the level of the 

physician-patient relationship through the performing arts, 

presented a piano and chamber music recital performed by 

physicians and patients. A reception followed the event, which 

was designed primarily for patients and their families. 


Education 53 

• Two days later, a concert-symposium on “neuromusic” 

explored the relationship between music and the physiological 

and pathological processes in the nervous system. Co-directed 

by Kamal Chémali, MD, and Neil Cherian, MD, the daylong 

event featured lectures by nationally recognized experts, 

including Neurological Institute physicians. The session, 

offered for CME credit, attracted medical professionals as well 

as musicians. The day concluded with a panel discussion and 

piano recital at the Cleveland Institute of Music. 

• Cleveland Clinic and The Cleveland Orchestra joined forces 

for a symposium at the Salzburg Festival in Austria, where a 

panel of international experts examined new understanding 

about the intersection of music and neuroscience, the effect of 

music on health and the brain’s impact on musical ability. The 

program launched a collaboration between two world leaders 

in medicine and music.

New Staff 

Due to its clinical expertise, academic achievement and 

research capabilities, the Neurological Institute has earned an 

international reputation, and continues to attract elite clinicians 

and scientists who aspire to be affiliated with one of the world’s 

premier medical centers. 

In 2008, the following professionals joined the Neurological 

Institute staff: 

Lou Ruvo Center for Brain Health 

Randolph B. Schiffer, MD, neurologist/psychiatrist, Director 


Rishi Gupta, MD, vascular and interventional neurologist 

Ferdinand Hui, MD, interventional neuroradiologist 

Shaye Moskowitz, MD, PhD, endovascular neurosurgeon 


Juan Bulacio, MD, clinical neurophysiologist 

Jorge Gonzalez-Martinez, MD, PhD, neurosurgeon 

Stephen Hantus, MD, epileptologist 

John Mosher, PhD, neuroscientist, Section Head 

of the magnetoencephalography program 

Diosely Silveira, MD, PhD, epileptologist 


Lerner Research Institute 

New Staff 55 

The lifeblood of any organization is its people. Cleveland Clinic Neurological Institute includes more than 250 

medical, surgical and research specialists dedicated to the diagnosis, treatment and understanding of all neurological 

conditions affecting adult and pediatric patients. 

James Kaltenbach, PhD, neuroscientist, Department of 

Neurosciences and Cleveland Clinic Head and Neck Institute 

Jeremy Rich, MD, neurologist, Chairman of the Department 

of Stem Cell Biology and Regenerative Medicine 


Deborah Tepper, MD, internist 

Stewart Tepper, MD, neurologist 


Anwar Ahmed, MD, neurologist 


Sheila Rubin, MD, neurologist 

Jennifer Ui, MD, neurologist 

Joseph Zayat, MD, neurologist 


Sally Ibrahim, MD, sleep specialist 


Tagreed Khalaf, MD, medical spine specialist 


Joseph Austerman, DO, psychiatrist 

Left: Sally Ibrahim, MD, sees both adult and pediatric patients with sleep disorders. Reflecting the scope of the Sleep Disorders Center’s 

capabilities, she treats a wide range of conditions, including sleep apnea, disorders of excessive daytime sleepiness, circadian rhythm 

disorders, restless legs syndrome and parasomnias.

56 Neurological Institute 

Staff 

Neurological Institute Chairmen 


Chairman, Neurological Institute 


Vice Chairman, Clinical Areas, 

Neurological Institute 

Richard Rudick, MD 

Vice Chairman, Research and 

Development, Neurological Institute 

Edward Benzel, MD 

Chairman, Department of 

Neurological Surgery 

Kerry Levin, MD 

Chairman, Department of Neurology 

Vernon Lin, MD, PhD 


Physical Medicine and Rehabilitation 

Thomas Masaryk, MD 


Diagnostic Radiology 

George E. Tesar, MD 


Psychiatry and Psychology 

Bruce Trapp, PhD 


Neurosciences, Lerner Research Institute 

Lou Ruvo Center for Brain Health 

Randolph B. Schiffer, MD 

Director, Lou Ruvo Center for 

Brain Health 

Charles Bernick, MD 

Cynthia S. Kubu, PhD, ABPP-CN 

Richard Naugle, PhD 

Michael Parsons, PhD 

Alexander Rae-Grant, MD, FRCP (C) 

Stephen Rao, PhD 

Director, Schey Foundation Center for 

Advanced Cognitive Function 

Patrick Sweeney, MD 

Janice Zimbelman, PT, PhD 


Gene Barnett, MD, FACS 

Director, Brain Tumor and 

Neuro-Oncology Center 

Manmeet Ahluwalia, MD 

Lilyana Angelov, MD, FRCS(C) 

Samuel Chao, MD 

Bruce H. Cohen, MD 

Joung Lee, MD 

David Peereboom, MD 

Jeremy Rich, MD 

Burak Sade, MD 

Glen Stevens, DO, PhD 

John Suh, MD 


Michael Vogelbaum, MD, PhD 

Robert Weil, MD 


Peter Rasmussen, MD 

Director, Cerebrovascular Center 

Neil Friedman, MBChB 

James Gebel, MD 

Rishi Gupta, MD 

Ferdinand Hui, MD 

Irene Katzan, MD, MS 

Gwendolyn Lynch, MD 

Edward Manno, MD 


Shaye Moskowitz, MD, PhD 

J. Javier Provencio, MD, FCCM 

Vivek Sabharwal, MD 

Ken Uchino, MD 


Imad Najm, MD 

Director, Epilepsy Center 

Andreas Alexopoulos, MD, MPH 

Jocelyn Bautista, MD 


Juan Bulacio, MD 

Richard Burgess, MD, PhD 

Robyn Busch, PhD 

Jessica Chapin, PhD 

Tatiana Falcone, MD 

Nancy Foldvary-Schaefer, DO 

Paul Ford, PhD 

Jorge Gonzalez-Martinez, MD, PhD 

Ajay Gupta, MD 

Stephen Hantus, MD 

Jennifer Haut, PhD, ABPP-CN 

Lara Jehi, MD 


Patricia Klaas, PhD 

Prakash Kotagal, MD 

Deepak Lachhwani, MBBS, MD 

John Mosher, PhD 

Dileep Nair, MD 


Paul Ruggieri, MD 

Diosely Silveira, MD, PhD 

Norman So, MD 

Andrey Stojic, MD, PhD 


Ingrid Tuxhorn, MD 

Elaine Wyllie, MD 

Mellen Center for Multiple Sclerosis 

Treatment and Research 

Richard Rudick, MD 

Director, Mellen Center for Multiple 

Sclerosis Treatment and Research 

Robert Bermel, MD 

Francois Bethoux, MD 

Adrienne Boissy, MD 

Jeffrey Cohen, MD 

Robert Fox, MD 

Keith McKee, MD 

Deborah Miller, PhD 

Alexander Rae-Grant, MD, FRCP (C) 

Richard M. Ransohoff, MD 

Mary Rensel, MD 

Lael Stone, MD 



Director, Center for Neuroimaging 

Manzoor Ahmed, MD 

Todd M. Emch, MD 

Stephen E. Jones, MD, PhD 

Mark Lowe, PhD 


Parvez Masood, MD 


Doksu Moon, MD 

Micheal Phillips, MD 

Paul Ruggieri, MD 

Alison Smith, MD 

Todd Stultz, DDS, MD 

Andrew Tievsky, MD 


Andre Machado, MD, PhD 

Director, Center for Neurological 

Restoration 

Anwar Ahmed, MD 

Jay Alberts, PhD 

Scott Cooper, MD, PhD 

Milind Deogaonkar, MD 

Darlene Floden, PhD 

Ilia Itin, MD 


Richard Lederman, MD, PhD 

Donald A. Malone Jr., MD 

Cameron McIntyre, PhD 

Mayur Pandya, DO 



Center for Pediatric Neurology and 

Neurosurgery 

Elaine Wyllie, MD 

Director, Center for Pediatric Neurology 

Mark Luciano, MD, PhD 

Director, Center for Pediatric 

Neurosurgery 

Bruce H. Cohen, MD 

Xiao Di, MD, PhD 

Stephen Dombrowski, PhD 

Gerald Erenberg, MD 

Neurological Institute 57 


Debabrata Ghosh, MD, DM 

Gary Hsich, MD 

Irwin Jacobs, MD 

Sudeshna Mitra, MD 

Manikum Moodley, MD 

Sumit Parikh, MD 

A. David Rothner, MD 



Edward Covington, MD 

Director, Neurological Center for Pain 

Cynthia Bamford, MD 

Neil Cherian, MD 

Steven Krause, PhD, MBA 

Jennifer Kriegler, MD 

Robert Kunkel, MD 

Jahangir Maleki, MD, PhD 

MaryAnn Mays, MD 

Judith Scheman, PhD 

Mark Stillman, MD 

Deborah Tepper, MD 

Stewart Tepper, MD 



Director, Neuromuscular Center 

Mohammad Alsharabati, MD 

Kamal Chémali, MD 


Rebecca Kuenzler, MD 


Erik Pioro, MD, PhD 

David Polston, MD 

Robert Shields Jr., MD 

Steven Shook, MD 

Jinny Tavee, MD 

Lan Zhou, MD, PhD

58 Neurological Institute 

General Adult Neurology 


Chairman, Department of Neurology 

Thomas E. Gretter, MD 



Department of Physical Medicine 

and Rehabilitation 

Vernon Lin, MD, PhD 

Chairman, Department of Physical 

Medicine and Rehabilitation 

Michael Felver, MD 

Medical Director, Center for 

Rehabilitation and Subacute Services 

Steven Landers, MD, MPH 

Medical Director, Home Care Services 

Raghavendra Allareddy, MD 

Frederick Frost, MD 

Sepideh Haghpanah, MD 

Juliet Hou, MD 

Lynn Jedlicka, MD 

Anantha Reddy, MD 

Kalyani Shah, MD 

Deborah Venesy, MD 



Chairman, Department of Psychiatry 

and Psychology 

Donald A. Malone Jr., MD 

Director, Center for Behavioral Health 

Susan Albers-Bowling, PsyD 

Kathleen Ashton, PhD 

Joseph M. Austerman, DO 

Scott Bea, PsyD 

Dana Brendza, PsyD 

Karen Broer, PhD 

Robyn Busch, PhD 

Jessica Chapin, PhD 

Kathy Coffman, MD 

Gregory Collins, MD 

Edward Covington, MD 

Roman Dale, MD 

Beth Dixon, PsyD 

Judy Dodds, PhD 

Tatiana Falcone, MD 

Darlene Floden, PhD 

Kathleen Franco, MD 

John P. Glazer, MD 

Lilian Gonsalves, MD 

J. Robert Gribble, PhD 

Jennifer Haut, PhD, ABPP-CN 

Leslie Heinberg, PhD 

Karen Jacobs, DO 

Joseph W. Janesz, PhD, LICDC 

Regina Josell, PsyD 

Elias Khawan, MD 

Patricia Klaas, PhD 

Steven Krause, PhD, MBA 


Michael McKee, PhD 

Gene Morris, PhD 

David J. Muzina, MD 


Mayur Pandya, DO 

Michael Parsons, PhD 

Leo Pozuelo, MD 

Kathleen Quinn, MD 

Ted Raddell, PhD 


Isabel Schuermeyer, MD 

Jean Simmons, PhD 

Barry Simon, DO 

Catherine Stenroos, PhD 

David Streem, MD 

Adele Viguera, MD 

John Vitkus, PhD 

Cynthia White, PsyD 

Amy Windover, PhD 


Stephen Samples, MD 

Director, Center for Regional Neurology 

Mohammad Alsharabati, MD 

A. Romeo Craciun, MD 

Director, Stroke Center, 

Marymount Hospital 

James Gebel, MD 

Sheila Rubin, MD 

Roderick Spears, MD 

Andrey Stojic, MD, PhD 

Diana Tanase, MD 

Jennifer Ui, MD 

Joseph Zayat, MD 

Center for Regional Neurological Surgery 

Michael Mervart, MD 

Director, Center for Regional 

Neurological Surgery 

Samuel Borsellino, MD 

Roseanna Lechner, MD 

Samuel Tobias, MD 

Right: Epilepsy Center Director Imad Najm, MD, right, confers with William Bingaman, MD, Vice Chairman, Clinical Areas, Neurological Institute, at a 

patient management conference. These sessions bring center staff together to discuss patients suitable for epilepsy surgery. 



Nancy Foldvary-Schaefer, DO 

Director, Sleep Disorders Center 

Loutfi Aboussouan, MD 

Kathleen Ashton, PhD 

Charles Bae, MD 

A. Romeo Craciun, MD 

Michelle Drerup, PsyD 

Sally Ibrahim, MD 

Alan Kominsky, MD 

Jyoti Krishna, MD 

William Novak, MD 

Carlos Rodriguez, MD 


Gordon Bell, MD 

Director, Center for Spine Health 

Edward Benzel, MD 

Edwin Capulong, MD 

Russell DeMicco, DO 

Lars Gilbertson, PhD 

Augusto Hsia Jr., MD 

Serkan Inceoglu, PhD 

Iain Kalfas, MD 

Tagreed Khalaf, MD 

Ajit Krishnaney, MD 

Daniel Mazanec, MD 

Robert McLain, MD 

Thomas Mroz, MD 

R. Douglas Orr, MD 


Richard Schlenk, MD 

Michael Steinmetz, MD 

Santhosh Thomas, DO, MBA 

Left: Neurologists work side by side with neurosurgeons, behavioral health specialists and researchers in the Neurological Institute, providing 

the highest-quality care for patients and an enhanced educational experience for physicians in training. 


Fredrick Wilson, DO 

Adrian Zachary, DO, MPH 

Neuroanesthesiology 

Rafi Avitsian, MD 

Section Head, Neurosurgical and Spine 

Surgery Anesthesiology 

Section Head, Neuro-endovascular 

Anesthesiology 

Zeyd Ebrahim, MD 

O.R. Clinical Director 

Armin Schubert, MD 


General Anesthesiology 

Ehab Farag, MD, FRCA 

Paul Kempen, MD, PhD 

Jia Lin, MD, PhD 

Mariel Manlapaz, MD 

Marco Maurtua, MD 

Stacy Ritzman, MD 

Vivek Sabharwal, MD 

Gloria Walters, MD 


Department of Neurosciences 

Bruce Trapp, PhD 


Neurosciences, Lerner Research Institute 

Cornelia Bergmann, PhD 

Jianguo Cheng, MD, PhD 

James Kaltenbach, PhD 

Hitoshi Komuro, PhD 

Bruce Lamb, PhD 

Yu-Shang Lee, PhD 

Ching-Yi Lin, PhD 

Yoav Littner, MD 

Sanjay W. Pimplikar, PhD 

Erik Pioro, MD, PhD 

J. Javier Provencio, MD, FCCM 

Richard M. Ransohoff, MD 

Director, Neuroinflammation Research 

Center, Lerner Research Institute 

Susan Staugaitis, MD, PhD 

Michael Steinmetz, MD 

Stephen Stohlman, PhD 


Riqiang Yan, PhD 

Lan Zhou, MD, PhD 


Biomedical Engineering 

Jay Alberts, PhD 

Elizabeth Fisher, PhD 

Aaron Fleischman, PhD 

Cameron McIntyre, PhD 


Cell Biology 

Damir Janigro, PhD 

Pathology and Laboratory Medicine 

Institute Anatomic Pathology 

Richard Prayson, MD 

Neurological Institute 61

62 Cleveland Clinic Information 

Neurological Institute 

24/7 hospital transfers or physician consults 

800.553.5056 

Neurological Institute Contact Center 

Centralized scheduling that allows patients 

to make appointments with any Neurological 

Institute physician at any location 

216.636.5860 or toll-free 866.588.2264 

Web 

clevelandclinic.org/neuroscience 

Services for Physicians 

Physician Directory View all Cleveland Clinic staff online at clevelandclinic.org/staff. 

Physician Liaison Referring physicians have a direct and personal link to Cleveland Clinic 

with our Physician Liaison. For help with any interaction involving Cleveland Clinic, 

contact Physician Liaison Kate Kenny at clevelandclinic.org/ContactKate. 

Critical Care Transport Worldwide Cleveland Clinic’s critical care transport team serves 

critically ill and highly complex patients across the globe. The transport fleet comprises 

mobile ICU vehicles, helicopters and fixed-wing aircraft. The transport teams are staffed 

by physicians, critical care nurse practitioners, critical care nurses, paramedics and 

ancillary staff, and are customized to meet the needs of the patient. Critical care transport 

is available for children and adults. 

To arrange a transfer for acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid 

hemorrhage), STEMI (ST elevated myocardial infarction) or aortic syndromes, call 

877.379.CODE (2633). 

For all other critical care transfers, call 216.444.8302 or 800.553.5056. 

Track Your Patient’s Care Online Whether you are referring from near or far, DrConnect 

offers secure access to your patient’s treatment progress at Cleveland Clinic. To establish 

a DrConnect account, visit clevelandclinic.org/drconnect or email drconnect@ccf.org. 

Outcomes Data Available The latest Outcomes book from the Cleveland Clinic Neurological 

Institute is available. Our Outcomes books contain clinical outcomes data and 

information on volumes, innovations, research and publications. To view Outcomes books 

for many Cleveland Clinic institutes, visit clevelandclinic.org/quality. 

CME Opportunities Live and Online Cleveland Clinic’s Center for Continuing Education’s 

website, clevelandclinicmeded.com, offers convenient, complimentary learning opportunities, 

from webcasts and podcasts to a host of medical publications and a schedule of live 

CME courses. Many live CME courses are hosted in Cleveland, an economical option for 

business travel. Physicians can manage their CME credits by using the myCME Web 

Portal, available 24/7. 

Services for Patients 

Remote Consults Request a remote medical second opinion from Cleveland Clinic. 

MyConsult is particularly valuable for patients who wish to avoid the time and expense of 

travel. Visit clevelandclinic.org/myconsult, email eclevelandclinic@ccf.org or call 

800.223.2273, ext. 43223. 

Medical Concierge Complimentary assistance for out-of-state patients and families, 

800.223.2273, ext. 55580, or email medicalconcierge@ccf.org. 

Global Patient Services Complimentary assistance for national and international patients 

and families, 001.216.444.8184 or visit clevelandclinic.org/gps. 

Stay Connected to Cleveland Clinic 


The Neurological Institute is one of 26 institutes at Cleveland Clinic that group multiple 

specialties together to provide collaborative, patient-centered care. The institute is a 

leader in treating the most complex neurological disorders, advancing innovations such as 

deep brain stimulation, epilepsy surgery, stereotactic spine radiosurgery and blood-brain 

barrier disruption. Annually, our staff of more than 250 specialists serves 140,000 patients 

and performs 7,500 surgeries. Cleveland Clinic is a nonprofit multispecialty academic 

medical center, consistently ranked among the top hospitals in America by U.S.News & 

World Report. Founded in 1921, it is dedicated to providing quality specialized care and 

includes an outpatient clinic, a hospital with more than 1,000 staffed beds, an education 

institute and a research institute. 

Cleveland Clinic ©2009 

DESIGN: Chip Valleriano | EDITOR: Terry Pederson | MARKETING: Colleen Burke, Kim Kerver, Cathy Luck, Jennifer Lynch, Laura Vasile 

PHOTOGRAPHY: Ken Baehr, Al Fuchs, Don Gerda, Neil Lantzy, Russell Lee, Yu Kwan Lee, Willie McAllister, Tom Merce, Steve Travarca 

PRINT PRODUCTION: Paul Durrant 

Cert no. SW-COC-002546

The Cleveland Clinic Foundation 

9500 Euclid Avenue / AC311 

Cleveland, OH 44195 

08-NEU-062

Neurological Institute 2008 Annual Report - Cleveland Clinic

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