Alberto Espay, MD, MSc, a rising global star, is Symposium Director for an international educational event for clinicians on May 15. Photo by Cindy Starr / Mayfield Clinic.

In Dr. Alberto Espay’s hands, good ideas just keep getting better. A specialist at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health, Dr. Espay has elevated an educational concept called Movement Disorders Video Rounds from an institutional event to one that is regional, national and now international. On May 15, clinical experts from six countries will arrive in Cincinnati for the first Unusual Movement Disorders Marathon Symposium. For established neurologists and those in training, the symposium will distill into five hours lessons that normally might take a lifetime to learn.

During the symposium, which is targeted to clinicians, 12 professors will each present one of the most challenging cases of their careers. A group of three internationally known specialists with no prior knowledge of the cases will then discuss them and – theoretically – will arrive at the correct diagnoses and optimal treatment plans. Those in the audience will have a rare educational opportunity to experience dialogues about cases that they might see but not recognize as distinct diseases.

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Dr. Espay, Symposium Director and a rising star internationally, describes his speakers as “a collective brain trust” that will present challenging cases “in a format that would be most instructive and deliver the highest yield of clinical pearls to trainees, physicians in our community, and neurologists interested in movement disorders.”

The cases themselves, Dr. Espay said, provided lasting lessons for the professors entrusted in presenting them. “The road to diagnosis and treatment was bumpy, but the bumps themselves represented educational opportunities for these professors that they feel are worth disseminating.”

“We will also learn how an expert addresses a complex situation that may take months or even years for someone else in the community. Our international experts are naive to these cases. The gift to the audience is seeing these experts digest in real time a set of complex information in a manner that leads to a focused work-up, a final diagnosis and, of course, appropriate treatment.”

At the end of each discussion, the original presenter will describe his or her own findings and share his own lessons learned.

Each case presentation will include video, because the visual component is vital in the diagnosis of movement disorders. A sampling of presentations include: “A Young Woman with a Long History of Shaking,” “Losing the Mind and then Gaining it Back,” and “The Man who Couldn’t Refrain from Coughing.”

Dr. Espay, Associate Professor of Neurology at UC and the Gardner Center’s Director of Clinical Research, began bi-monthly video rounds at UC seven years ago, building on an idea that had been used, and then discontinued, by the American Academy of Neurology.  The concept became popular among UC neurologists, fellows and residents and soon grew into a friendly TriState, then TetraState, Video Rounds competition. A national video rounds lecture, led by Dr. Espay and two colleagues, was sold out at the recent American Academy of Neurology Annual Meeting.

“We gave our own flavor to this concept, making it not just a challenge but an opportunity to say, ‘What lessons can I take away from this and apply in my practice?’“ Dr. Espay said. “We infused video rounds back into the Academy this year with an overhauled, educationally enhanced Unusual Movement Disorders Symposium.”

Speakers at the Cincinnati symposium, to be held at the Cincinnati Club downtown, will come from throughout the United States as well as Canada, Mexico, the United Kingdom, Italy and Brazil. The expert case discussants are Anthony Lang, MD, of the University of Toronto; Joseph Jankovic, MD, of Baylor College of Medicine in Houston; and Kapil Sethi, MD, of the Medical College of Georgia in Augusta.

The international Movement Disorders Society has endorsed the symposium and is so interested in the concept that it has asked Dr. Espay whether he would consider moving the event from Cincinnati and holding it twice a year, once on each coast. To this particular question, Dr. Espay does not yet have an answer.

– Cindy Starr

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March is Essential Tremor Awareness Month, and everyone at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders sends a vote of confidence and a word of encouragement to the more than 2,000 Gardner Center patients who are affected by this progressive neurological condition.

The Gardner Center is a center of excellence at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health.

Essential tremor is a movement disorder that is also known as familial tremor, benign essential tremor or hereditary tremor. It causes a rhythmic trembling of the hands, head, voice, legs or trunk and can make everyday activities, such as eating, drinking, dressing and writing difficult.

Although it does not garner as much media attention as Parkinson’s disease, it is at least three to four times as common as Parkinson’s, affecting an estimated 3.9 to 14 percent of all elderly individuals. Katharine Hepburn is the most famous American to have coped with the condition.

Although essential tremor has no definitive cure, up to two-thirds of patients have such mild symptoms that they do not require treatment. For the other third, treatment can involve medication and, in severe cases, surgery.

“There are two first-line oral treatments for essential tremor,” explains Alberto Espay, MD, a UC Health neurologist and movement disorders specialist at the Gardner Center. “One is an anti-epileptic drug called Primidone. And the other is an anti-hypertensive drug called Propranolol.

“It is an interesting situation in that you have two drugs that were really not designed for essential tremor but were given to patients for either epilepsy or hypertension. In the process, doctors discovered that patients who also happened to have essential tremor reported that their tremor improved while they were taking the drug. And that’s how we serendipitously have our two best drugs for essential tremor.”

Symptoms progress slowly for most patients with essential tremor, but over time tremors can become severe. At the Gardner Center, those patients have the option of undergoing surgery, which is performed by neurosurgeons George Mandybur, MD, and Ellen Air, MD, PhD.

Surgery targets the thalamus, the part of the brain that is overactive in patients with essential tremor. The most commonly performed surgical procedure is deep brain stimulation (DBS) surgery. During DBS tiny electrodes are implanted in a small part of the thalamus and connected to a programmable, battery-powered device that creates electric pulses. The device, which resembles a heart pacemaker, is implanted beneath the collar bone. The electrodes deliver a low-intensity current that continually pulses through the thalamus, neutralizing it without damaging it.

In a less commonly performed procedure, surgeons use an electrode to ablate (destroy) the overactive part of the thalamus.

Meanwhile, lifestyle changes may ease symptoms of essential tremor. Fredy J. Revilla, MD, Director of the Gardner Center and the James J. and Joan A. Gardner Family Chair, says that decreasing or eliminating the consumption of caffeine (e.g., coffee and caffeinated beverages) or other stimulants may reduce tremor, while hand and wrist exercises can promote hand stability. Although alcohol is known to reduce tremor, Dr. Revilla does not recommend alcohol consumption as a treatment because of the risk of alcohol dependence.

Essential tremor differs from Parkinson’s disease in some important ways. Whereas fewer than 10 percent of people with Parkinson’s disease have a family history of the disease, more than 50 percent of patients with essential tremor have a family history of their condition. While Parkinson’s usually starts on one side of the body and remains asymmetrical when progressing to the other side, essential tremor usually affects both sides from the beginning. And while the tremor in Parkinson’s is usually confined to the hands and, to a lesser extent, the legs, essential tremor predominantly affects the hands but can also affect the head, jaw and voice.

As many as 20 percent of patients with essential tremor may also go on to develop Parkinson’s disease, but researchers have not confirmed that essential tremor is a risk factor for Parkinson’s.

The Essential Tremor Support Group welcomes patients treated at the Gardner Center. The group shares information about new studies, medication, coping and helpful hints from 2 to 4 p.m. on the second Sunday of each month, except in May, when it meets on the third Sunday. Meetings are held at Sycamore/Kettering Hospital on Leiter Road in Miamisburg, Ohio, about one mile from I-75. Come to Dining Room 2 on the lower level. Meetings are free and open to anyone with essential tremor, as well as families, caregivers and friends. For more information, contact Arlene Rosen in Cincinnati at (513) 791-5546 or arlene.rosen@gmail.com or Norma Doherty in Dayton at (973) 433-0153 or normadoherty1824@gmail.com.

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– Cindy Starr

Judy Towne Jennings, PT, MA

The story of Dean Jennings, a former patient of Andrew Duker, MD, a UC Health neurologist, is told in a new book for caregivers, Living with Lewy Body Dementia, by Dean’s widow, Judy Towne Jennings, PT, MA , of Cincinnati. Dr. Duker, who treated Dean at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health, served as one of Ms. Jennings’s editors.

Although Lewy body dementia, or LBD, does not receive as much publicity or attention as Alzheimer’s disease or Parkinson’s, it is the third most common cause of dementia after Alzheimer’s and vascular dementia, accounting for 10 to 25 percent of cases, according to the Alzheimer’s Association.

The hallmark of the disease is the presence of Lewy bodies, normal proteins that become abnormally clumped together inside neurons, or brain cells. They are named after Dr. Frederick Lewy, the neurologist who discovered them while working in Dr. Alois Alzheimer’s laboratory and who first described them in 1912. Dr. Lewy discovered Lewy bodies in the brains of people with Parkinson’s disease.

Lewy body dementia is typically diagnosed via symptoms, medical history and a complete laboratory workup that can rule out other causes of cognitive problems. Brain imaging does not reveal changes until the patient is in advanced stages of the disease.

Brendan Kelley, MD

“Individuals with Lewy body dementia can have difficulty in any of the cognitive domains, especially memory, visuospatial skills, and the ability to plan, anticipate and think abstractly,” says Brendan Kelley, MD, the Sandy and Bob Heimann Chair in Research and Education of Alzheimer’s in UC’s Department of Neurology and Medical Director of the UC Memory Disorders Center. “Other symptoms may include parkinsonism, visual hallucinations, fluctuations in attention and alertness during the day and sensitivity to temperature changes. Lewy body dementia also can be associated with sleep symptoms, such as acting out dreams at night.”

The diagnosis of Lewy body dementia, Ms. Jennings writes, “felt like a torpedo piercing my chest.”

Families facing this diagnosis receive the unwelcome news that Lewy body disease, unlike Parkinson’s, often involves a rapid, cognitive decline. How caregivers cope becomes an important part of the patient’s overall healthcare scenario.

Andrew Duker, MD

“Just as with Parkinson’s disease, every patient has his or her own version of Lewy body dementia, and each person will be affected differently by the disease,” Dr. Duker notes. “There will be good days and bad days, and with LBD the good and the bad can fluctuate even over hours within the same day. I advise caregivers to hold on to the good periods when they come and use them to help get through the bad periods.”

The hallucinations that frequently occur can be especially traumatic for family members. Dr. Duker advises patience when a loved one is hallucinating.  “Their brain is feeding them incorrect information, but to them what they are seeing is quite real,” he says. “If the hallucination is not frightening or threatening, choose your battles as to when or when not to try to explain what is real.  If the hallucinations are frightening to them, tell the doctor, as there are medications that can help.”

Dr. Duker strongly encourages caregivers to take respite time for themselves. “You cannot expect to care for your loved one 24 hours per day, seven days per week, without burning out.”

Dr. Kelley stresses that treating contributing factors, including underlying medical disorders, psychiatric conditions, and sleep issues, is essential. “Exercise and other physical activity may be helpful, and patients are encouraged to remain socially and cognitively active,” he says. “Because both cognitive changes and parkinsonism can increase the risk of falls in those with Lewy body disease, taking steps to reduce the risk of falling is vital.”

Ms. Jennings worked to maintain an “I-can attitude” for both her husband and herself. To help him navigate the household after his retirement from his work as an engineer, she writes that she “circled the start buttons on the dishwasher, labeled the stove burner and painted an arrow on the clothes dryer controls to help him visually see how to operate the appliances.”

She also made the days more precious by scheduling outings, watching sporting events that her husband enjoyed, encouraging him to resurrect old hobbies (including his high school band instrument) and listening to audio books. “I always had a vacation looming in the future to keep my sanity,” Ms. Jennings writes. “Mostly, I was trying to encourage Dean to keep moving … We found many ‘carrots’ that inspired both of us to get out of bed each morning and make the decision to celebrate life.”

– Cindy Starr

Neurosurgeons Ellen Air, MD, PhD, left, and George Mandybur, MD, at the UC Medical Center.

CONTACT: Cindy Starr
(513) 558-3505
cindy.starr@uc.edu

For more than 15 years deep brain stimulation (DBS) surgery has been an important treatment option for people with Parkinson’s disease, a disorder of the nervous system caused by a lack of dopamine in the brain. Although the treatment is approved by the FDA for patients who no longer respond to medication and who typically have suffered symptoms of the disease for 10 or more years, a new European study published this month in the New England Journal of Medicine is causing doctors to ask whether the procedure should be offered earlier in the disease process.

“This new study gives scientific support to the notion that patients may experience the largest amount of benefit from deep brain stimulation surgery if they have the procedure earlier rather than later,” says Fredy J. Revilla, MD, Associate Professor of Neurology and Director of the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health.

“In our own experience here at UC we have too many patients with Parkinson’s disease who want to have the surgical procedure but no longer qualify for it because of the presence of cognitive impairment or other comorbidities that occur with longer duration of disease. In other words, we waited too long. A very careful selection process to determine who is a candidate for surgery is still warranted, but more patients with Parkinson’s disease should be able to access this therapy, based on these recent findings.”

In a typical treatment scenario, a patient has lost 50 percent of his or her dopamine-producing neurons when symptoms first appear and a diagnosis is made. The typical patient is then treated with medications for 10 to 14 years.

During that time, medications can offer symptomatic relief from tremor, slowness of movement, stiffness, and walking problems, but cell loss continues unabated. There is at present no cure for the disease.

“For those who have Parkinson’s disease, medications to restore the needed balance of dopamine quickly become a way of life,” says Ellen Air, MD, PhD, Assistant Professor in UC’s Department of Neurosurgery and a neurosurgeon at the Gardner Center and Mayfield Clinic. “For most, these medications are very much a miracle, releasing the stiffness and calming tremors.

“Over time, however, the medications’ effect shortens, becomes less predictable, and leads to large swings in motor function. Daily life becomes a roller coaster, moving from extremes of slow and stiff movement to uncontrolled twisting movements and back, often over just a few short hours.”

George Mandybur, MD, performing DBS surgery at the UC Medical Center. Photo by Tonya Hines / Mayfield Clinic.

DBS surgery becomes an option in patients who experience benefits from dopamine-replacement medication but whose symptoms have become severe. The procedure involves implanting tiny electrodes deep inside the brain and connecting them to a programmable, battery-powered device that creates electric pulses. The device, which resembles a heart pacemaker, is implanted beneath the collar bone. Electrical impulses from the electrodes work by regulating or overriding faulty signals caused by the disease.

“Deep brain stimulation provides effective treatment of Parkinson’s disease for those experiencing these side effects of dopamine therapy,” Dr. Air says. “We generally wait to consider DBS until the disease and the medication side-effects are severe and are impairing the patient’s ability to work, socialize and enjoy life.”

Although that timetable is usually a decade or more, the FDA’s approval of DBS for medically refractory Parkinson’s disease does not specify a time course. “We have done surgery on patients within five years of diagnosis because of symptom severity,” says George Mandybur, MD, Associate Professor in the Department of Neurosurgery and Director of the NeuroRestorative Program at the UC Neuroscience Institute.

Doctors have tended to postpone surgery, Dr. Air says, because they want to confirm that the patient has Parkinson’s and not another condition that may mimic Parkinson’s in the early stages but that will not respond to DBS. Doctors also have lacked good evidence about the optimal timing of surgery.

The research by German and French researchers, led by Günther Deuschl, a professor at Christian-Albrechts-University in Kiel, Germany, and published Feb. 14 in the New England Journal of Medicine, provides new evidence that may alter the conventional wisdom of late surgical intervention. The German-French study, known as the EARLYSTIM trial, enrolled 251 patients who had been diagnosed with Parkinson’s disease an average of 7.5 years earlier and had not yet lost occupational and psycho-social function. The participants were randomized to one of two groups: one that received continued medical therapy, and another that received DBS surgery. Over two years of follow-up, those who underwent DBS showed a 26 percent improvement in quality of life compared with no improvements in patients treated with best medical therapy alone.

The study was partially funded by Medtronic, Inc., which makes DBS products.

The EARLYSTIM study’s results were not necessarily surprising. The safety and tolerability of DBS in early Parkinson’s disease has been studied for several years by David Charles, MD, the Chief Medical Officer of the Vanderbilt Neuroscience Institute who lectured about the topic at UC in 2008. Meanwhile, preliminary laboratory research performed at UC found that DBS halts the progression of dopamine-cell loss in animal models. That research grew out of an observation by physicians, including Dr. Mandybur, about patients who underwent DBS.

“We noticed that in some patients the disease did not seem to progress as rapidly after surgery as it did before the surgery,” says Dr. Mandybur, a neurosurgeon with the Gardner Center and Mayfield Clinic. As a result, he and others theorized that DBS not only alleviated symptoms, but also provided neuroprotection.

Dr. Air cautions that DBS is not a cure-all for Parkinson’s disease and that it only improves some symptoms. DBS does not improve the declines in memory and thinking that come with Parkinson’s.

The study reported surgical complications that were no higher than complications in previous studies of patients with more advanced disease, but it did suggest a higher rate of depression among those who underwent surgery. “This highlights the importance of both pre-operative screening for psychiatric disease and post-operative monitoring,” Dr. Air says.

Dr. Air notes that more study is needed before large-scale changes in practice can be recommended.  “However, this study pushes us to rethink when and for whom surgery is suited so that we can help those with Parkinson’s disease maximize their quality of life,” she says.

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CCM student Tyler Alessi, left, and CCM graduate Samina Aslam, perform during a celebration of the UC Medical Center’s new partnership with Cincinnati Opera in the hospital’s lobby. Photos by Cindy Starr / Mayfield Clinic.

The power of music, with all of its beauty and adjunct neurological benefits, swept through the lobby of the University of Cincinnati Medical Center (UCMC) on Wednesday as the hospital celebrated a new partnership with Cincinnati Opera. Among those enjoying the occasion – which included arias and Broadway tunes from four gifted young vocalists — were four specialists from the UC Neuroscience Institute who helped make it happen: Drs. Sid Khosla, Charles Kuntz, IV, John M. Tew, Jr., and Mario Zuccarello. The UC Neuroscience Institute is one of four institutes of the UC College of Medicine and UC Health.

It is perhaps no surprise that the four neuroscientists share a passion for opera, a neurological triumph blending sight, sound, language, voice and soul.

“Music involves the entire brain, or almost the entire brain,” said Dr. Khosla, Assistant Professor of Otolaryngology at UC and Director of the UC Health Voice and Swallowing Center.

In a 2009 interview with CNN, Dr. Wendy Magee, International Fellow in Music Therapy at London’s Institute of Neuropalliative Rehabilitation, described music as a “mega-vitamin for the brain” that could influence and improve motor function, communication and even cognition.

Voice specialist Sid Khosla, MD

As such, researchers have found that music, with its complex and widespread neural pathways, enables some individuals with neurological diseases or disorders to rise above limitations in specific parts of the brain. The act of singing employs pathways that are different from those used in speaking, for example, and people who stutter, have suffered a stroke, or suffer from spasmodic dystonia may benefit from music therapy, a type of task-specific training, Dr. Khosla said.

The movie, The King’s Speech, is an example where stuttering abates when music is playing in the background. “We have a lot of different theories about why we have task specificity as human beings, and they’re fascinating, but we don’t know for sure,” Dr. Khosla said. “The newer theories are evolving from brain imaging of the gray matter and the white matter tracts, which facilitate electrical connections between different parts of the brain.”

At UC Health Drake Center, rehabilitation therapists employ music in the treatment of stroke survivors who suffer from aphasia, a language impairment that makes communication difficult. “Often folks cannot speak fluently, but if you give them a familiar song, they can sing it well,” said Paige Thomas, PT-MSR, NCS, MHA, manager of outpatient physical therapy and occupational therapy. “It helps tap into those rote and automatic speech patterns.”

Alberto Espay, MD, a neurologist with the James J. and Joan A. Gardner Center for Parkinson’s Disease and Movement Disorders, says the rhythm and melody of music can replace some of the abnormal motor programs in the brains of patients with Parkinson’s disease “with more ‘harmonic,’ better sequenced programs.”

The best example of this, Dr. Espay said, is seen in patients who have problems with gait and who are at risk of suddenly freezing in place while walking. These patients can experience a restoration of gait with music, Dr. Espay said. “The type of music that works best will vary from person to person. The optimal music is something that resonates with the patient and has a beat that is contagious enough that it can be brought to mind during potentially freezing moments.”

Wednesday’s performers¹, current and former opera students from UC’s College-Conservatory of Music, performed a few selections that might do the trick, including the Toreador’s Song from Bizet’s Carmen², and the famous Brindisi drinking song from Verdi’s La Traviata.

Samina Aslam performs Puccini.

Other selections, including Puccini’s glorious “O mio babbino caro” from Gianni Schicchi, might play a healing role for patients with Alzheimer’s disease.

Cathy Crain, Chairman of the Cincinnati Opera Board of Trustees, who attended the UCMC event, shared a story about her own mother, who suffers from Alzheimer’s. “My mother raised us all to love music, particularly opera, and now, when it’s a little hard for her to focus on things, if we put an opera on, she will actually sit for two hours and listen,” Ms. Crain said. “And it is the most wonderful thing. In fact, I get chills thinking about it, because she sits there and smiles the whole time. The music brings a peace and joy to her that’s incredible to see. It’s worth everything to me.”

Ms. Thomas echoed that sentiment. “Everyone gets more excited and motivated when they hear a familiar song they enjoy,” she said. “That can be part of a social connection for folks. Music is one of the few things that pretty much everyone can participate in, either through humming, singing, dancing, tapping a foot, even when seated. We use music in our stroke and Parkinson’s wellness classes to help facilitate the mood of the class as well as give some rhythm to assist in movements.”

The partnership between Cincinnati Opera and the UC Medical Center will result in 18 public performances over the next three years at the UC Medical Center for staff, visitors, patients and physicians. In return, UC Health will provide enhanced wellness and voice care, in the words of Opera Board President Bob Olson, “for our invaluable professional and amateur singers.”

Brian Gibler, MD, President and CEO of the UCMC, said the partnership was something to sing about. “Researchers have long studied the curative benefits of music and how it stimulates the brain,” he said. “We can all agree that music influences our lives in many ways and is considered to be the universal language. Joining medicine and music, this new duet between two longstanding institutions can provide a diverse healing environment for our patients and their families, in perfect harmony.”

Mr. Olson also announced that Cincinnati Opera and UCMC would once again team up on World Voice Day, a free public event scheduled for Saturday, April 20, at Music Hall. He also announced that the International Conference on Advances in Quantitative Laryngology, Voice and Speech Research will be held in the United States for the first time, with Cincinnati as the host city. Cincinnati Opera will host and provide entertainment for a celebration dinner at Music Hall on June 3.

–Cindy Starr

¹ CCM students Tyler Alessi, Reilly Nelson and James Onstad, and CCM graduate Samina Aslam.

² You can listen to a Metropolitan Opera radio broadcast of Carmen at 12:30 p.m. EST on Saturday, Feb. 23, 2013 (in Cincinnati on WGUC 90.9-FM).

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From left, Kelly Lyle, Fredy J. Revilla, MD, Beth Mitchell and George Mandybur, MD.Photo by Cindy Starr / Mayfield Clinic.

The first “Serve an Ace for Parkinson’s” event last Saturday at Five Seasons Sports Club in northern Cincinnati delivered almost everything it promised: camaraderie, lots of tennis, excellent food, enticing raffle prizes and even a few aces. The only thing missing (though not really missed) was the Australian Open tennis championship on the telly, which was bumped by popular demand in favor of the University of Cincinnati basketball game, which the Bearcats won.

As an added bonus, the event netted $2,500 for neurosurgery research at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease & Movement Disorders at the UC Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health. Those funds will be used to support the purchase of computer hardware and software that will be used in research aimed at improving the effectiveness of deep brain stimulation surgery for patients with Parkinson’s disease.

“This was an enjoyable first-time event and the first tennis event in the history of UCNI,” noted George Mandybur, MD, Associate Professor and Director of the Division of Functional and Stereotactic Neurosurgery at UC. “It was a great opportunity for members and friends of the Gardner Center to engage in team-building, nurture friendships, and raise money at the same time.”

The event, which drew 65 guests, built on the Gardner Center’s theme – “Move to Live, Live to Move” – by celebrating fitness and exercise as vehicles for maintaining optimal health. Research has shown that exercise improves motor symptoms, flexibility, strength, balance, gait, health-related quality of life and overall function in people with Parkinson’s disease.

Co-hosting the event with Dr. Mandybur was Fredy J. Revilla, MD, Director of the Gardner Center and the James J. and Joan A. Gardner Family Center Chair. Drs. Revilla and Mandybur wish to thank the following individuals for helping make the event possible:

• Brian Schubert, USPTA, Director of Junior Tennis at Five Seasons Sports Club, who oversaw the tennis portion of the event after already putting in a 10-hour day on the courts, and Tennis Professional Matt Kriener, USPTA
• Grand Slam patrons Mary & Gus McPhie and Jeanie & Andre Affatato
• Round-Robin patrons Mark Donley, Vinnie Fuggetta, and Cindy & John Cox
• Volunteers Kelly Lyle, Darlene Woosley, Cindy & Bill Starr, Sebastian Revilla and Ian Mandybur
• Patrick Shumrick, MHS, DPT, owner of the Center for Balance Physical Therapy, and vintner Tim Shumrick, of Tobin James, who donated a wine-tasting
• In-kind donors Kroger, Outback Steakhouse and Eastern Hills Indoor Tennis Club

The tennis event was organized as a non-competitive round-robin, divided into four brackets: Koalas, Kangaroos, Crocodiles and Kookaburras.

Most players mixed around, but one court in the Koalas bracket got its competitive traction and was soon serving up real aces for Parkinson’s. Ed Knapp, left, offered a sportsman’s smile after watching one of them — a big spin serve by John Khoury — whiz by out of reach.

Looking ahead at the Parkinson’s event schedule for friends, supporters and members of the Gardner Center team:

•    Feb. 9, 2013: Pedal for Parkinson’s
•    July 19, 2013: Putting for Parkinson’s
•    Aug. 4-5, 2013: Jerry Wuest-Pete Hershberger dinner and golf outing
•    Sept. 8, 2013: Sunflower Revolution Fitness Festival

George Mandybur, MD, left, and at right performing deep brain stimulation surgery at the UC Medical Center. Photos by Mayfield Clinic.

A new neurosurgical program at the University of Cincinnati Neuroscience Institute is helping restore function needed for everyday living in patients who have been plagued by chronic pain, facial pain, epilepsy and movement disorders.

“This much-needed program is helping restore patients back to a higher level of function,” says Program Director George Mandybur, MD. “In contrast to a rehabilitation program, in which the patient strives to get better by improving the condition of his or her body, our NeuroRestorative Program improves patients’ functionality by giving them something they cannot get with rehabilitation. This improvement comes in many forms, from decreased pain to eliminated tremors or seizures.”

Surgical changes can involve additions, such as the implantation of electrodes, spinal stimulators and pain pumps. Or, in the case of facial pain (trigeminal neuralgia) and epilepsy, surgical restoration can involve a subtraction, such as the numbing or severing of a nerve that is causing excruciating pain or the removal of an area of the brain that is causing seizures.

Ellen Air, MD, PhD

Dr. Mandybur is Associate Professor and Director of the Division of Functional and Stereotactic Neurosurgery at UC. Co-Director of the NeuroRestorative Program is Ellen Air, MD, PhD, Assistant Professor and Director of the Division of Epilepsy Surgery at UC.

Restorative procedures are varied, and many have been available for years.

•    Patients who have lost quality of life because of tremor may be given the chance to eat, drink and write again with the help of deep brain stimulation (DBS) surgery, which involves the implantation of a neurostimulator under the collarbone and electrodes deep within the brain. Patients with Parkinson’s disease who undergo DBS surgery often are able to decrease their medication and experience an improved quality of life.

•    Patients with temporal lobe epilepsy – epilepsy in the part of the brain just above the ear – may experience a complete reduction in their seizures if the source of their seizures (the seizure focus) can be surgically removed.

•    Patients who suffer chronic pain in the spine, or limbs (arms or legs) may benefit from implanted pain pumps or spinal stimulators that interrupt pain signals and prevent them from reaching the brain.

•    Patients with trigeminal neuralgia typically experience life-changing relief after surgical treatment for their searing facial pain, which occurs when the facial nerve is compressed by an artery, vein or tumor. The NeuroRestorative Program offers many different treatments for this facial pain, which can be tailored to the individual patient.

The NeuroRestorative team collaborates closely in an integrated, multidisciplinary fashion with specialists from the UC Epilepsy Center, the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, the Neurosensory Disorders Center and the Waddell Center for Multiple Sclerosis.

The team also works with the UC Health Pain Medicine Center, and it has been given the green light by UC’s Institutional Review Board (IRB) to offer DBS surgery as a treatment for people with obsessive-compulsive disorder.

“We’re the hub of a wheel,” Dr. Mandybur says. “We work with multiple groups. Our skills can be used to serve patients who are treated for mood disorders, movement disorders, epilepsy and pain. Sometimes you have a tool – such as DBS – that has many different applications.”

Research that benefits the Gardner Center as well as the NeuroRestorative Program will get a boost from a tennis round robin and wine-tasting event, “Serve an Ace for Parkinson’s,” to be held from 6 to 10 p.m. Saturday, Jan. 19, at Five Seasons Sports Club in Symmes Township. Proceeds from the fundraiser will support the purchase of computer hardware and software that will give the surgical team new capabilities.

“The computer upgrades will give us insight into what’s going on in the brain,” Dr. Mandybur says. “The new equipment will be used in research to improve the effectiveness of DBS in Parkinson’s disease.”

Dr. Mandybur, who is listed in the 2013 Best Doctors in America®, has seen his prominence rise internationally. In September he spoke at the First China Forum of Pain Medicine in Beijing and gave seven additional lectures and a demonstration lab during a 10-day tour of China. Dr. Mandybur’s tour lectures, which covered pain, epilepsy and movement disorders, were sponsored by Medtronic.

– Cindy Starr