2010 Neurological Institute Outcomes - Cleveland Clinic

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152 Innovations Lou Ruvo Center for Brain Health Building an Innovative Network to Improve Alzheimer’s Disease Care Cleveland Clinic Lou Ruvo Center for Brain Health is building an innovative network to advance patient care through discovery of new therapies for Alzheimer’s disease and other neurocognitive disorders. The network concept takes advantage of the multisite distribution of Cleveland Clinic. The institution has expanded to Nevada and Florida, creating the opportunity to conduct research at all these sites within the Cleveland Clinic framework, with one leadership, one set of operational guidelines, the same data collection approaches and one institutional review board for research approval. The center is capitalizing on this infrastructure to establish a clinical trials network that can more rapidly advance the development of new therapies for Alzheimer’s disease and other disorders of cognition. This approach is unique. The Lou Ruvo Center for Brain Health clinical trials network will position the center as a leader in advancing new therapies, developing new biomarkers and initiating novel programs for patients and caregivers. This program will serve as a model for how healthcare systems can embrace clinical trials, empowering patients to help defeat the diseases from which they suffer and helping to solve the problem of slow trial recruitment and slow emergence of new therapies. Outcomes 2010
Center for Neuroimaging Introducing a Hyperacute Stroke MRI Protocol Our “brain attack” program typically relies on noncontrast computed tomography (CT) of the head, CT angiography (CTA) and CT perfusion (CTP) studies to evaluate for a central ischemic core and a surrounding ischemic penumbra, the latter of which is potentially salvageable through aggressive intravenous and/or intra-arterial intervention. While the distinction between these two regions generally relies, in part, on the CTP study, a host of patient and technical factors makes this exam potentially unreliable. We recently introduced magnetic resonance imaging (MRI) into a hyperacute stroke protocol in an effort to make more informed decisions for therapy and extend the therapeutic window for acute stroke patients. While this strategy places additional logistical and safety demands on the acute workup of these patients, the benefits in patient management seem to outweigh the disadvantages. In view of the success on our main campus, this MRI protocol will shortly be exported to Lakewood and Hillcrest hospitals within our Cleveland Clinic health system. Developing an Electronic MR Safety Screening Tool Safety demands a careful screening process for patients prior to any MRI exam. Historically, this meant that each patient was required to complete an extensive paper questionnaire. We initiated a pilot project in the Neurological ICU, in which an electronic version was created for the electronic medical record. Preliminary data demonstrate significant reductions in the time intervals from the placement of the MRI order to exam completion and final report. Shortly, this form will be completed by all Neurological Institute inpatients upon admission, and it will travel with them across inpatient and outpatient venues. Neurological Institute Improving Methods of Mapping White Matter Tracts for Surgical Planning Tractography is an advanced application of MR diffusion imaging to map the course of white matter tracts in the brain for surgical planning purposes, most commonly for tumor and epilepsy surgery. While the application performs reasonably well with larger tracts in normal volunteers, results can be quite variable, hence unreliable, in patients with a number of central nervous system disorders. Our physicists developed a probabilistic method to detect the course of eloquent and non-eloquent white matter tracts in the brain, even in the presence of central nervous system disease states that cause lesions in the brain’s white matter, as seen in the figure below. This same group developed a means for quantifying the connectivity or strength of the white matter connections between different areas in the brain. Previously introduced methods for this assessment have been limited by a strong bias that depends on the distance between different structures. The newly introduced normalization procedure permits the assessment of connections between neighboring subcortical regions, which is independent of the conventional biases. 153
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Neurological Institute 2010 Outcome
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2 Dear Colleague: It is my great pl
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4 Chairman’s Letter Dear Colleagu
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Chairman Letter Institute Overview
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8 Institute Overview Relevant Resea
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10 Institute Overview 2010 Statisti
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Institute Overview Admissions 15,49
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14 Outcomes Overview Recognizing th
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16 Brain Tumors The Rose Ella Burkh
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18 Brain Tumors Brain Biopsy Brain
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20 Brain Tumors Supratentorial Cran
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22 Brain Tumors Infratentorial Cran
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24 Brain Tumors Infratentorial Cran
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26 Brain Tumors Pituitary Surgery P
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28 Brain Tumors Stereotactic Radios
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30 Brain Tumors Stereotactic Radios
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32 Brain Tumors Glioblastoma Multif
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34 Cerebrovascular Disease Inpatien
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36 Cerebrovascular Disease Change i
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38 Cerebrovascular Disease Hemorrha
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40 Cerebrovascular Disease Intracer
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42 Cognitive Disorders Depressive s
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44 Epilepsy Seizure Frequency in Me
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46 Epilepsy Seizure Outcomes Follow
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48 Epilepsy Frontal lobe resection
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50 Epilepsy Long-Term Seizure Freed
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52 Epilepsy Epilepsy Outcomes Beyon
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54 Epilepsy Adult Epilepsy: Effect
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56 Epilepsy Adult Epilepsy: Effect
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58 Epilepsy Change in Driving Statu
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60 Epilepsy Pediatric Epilepsy: Eff
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62 Epilepsy Pediatric Epilepsy: Eff
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64 Movement Disorders Change in Mot
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66 Multiple Sclerosis Mellen Center
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68 Multiple Sclerosis MS-Related Di
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70 Multiple Sclerosis Establishing
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72 Multiple Sclerosis Lower Extremi
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Multiple Sclerosis Treatment with N
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Multiple Sclerosis Walking Times be
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78 Multiple Sclerosis Distribution
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80 Multiple Sclerosis Spasticity be
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82 Neuromuscular Disorders Quality
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84 Pain / Headache Infusion Therapy
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86 Pain / Headache Depression, Anxi
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Pain / Headache Cleveland Clinic Ch
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Pain / Headache Anxiety before and
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Pain / Headache CPRP Outcomes in Mu
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94 Pain / Headache CPRP Outcomes in
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Pain / Headache Anxiety before and
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Pediatric Neurological / Neurosurgi
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100 Pediatric Neurological / Neuros
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Page 140 and 141: 138 Selected Publications “The Ne
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Page 180 and 181: 178 About Cleveland Clinic Overview
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2010 Neurological Institute Outcomes - Cleveland Clinic

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