Dr. DelBello’s Goal: Stopping Mental Illness before It Tragically Unfurls
Melissa DelBello, MD, Professor of Psychiatry and Pediatrics and Co-Director of the Division of Bipolar Disorders Research at UC. Photo by Cindy Starr / Mayfield Clinic. In a nightmare of déjà vu, a young adult inflicts a paroxysm of violence upon society. In this latest example in Aurora, Colo., a 24-year-old man kills 12 people in a crowded movie theater and shoots dozens more, leaving behind a booby-trapped apartment in an effort to create additional victims. Compounding the senselessness of the tragedy is our realization that the suspect was once a high-functioning graduate student of neuroscience with a world of promise ahead of him. In the week that followed the July 20 shooting, specialists with the Mood Disorders Center at the University of Cincinnati Neuroscience Institute, a component of UC Health, have provided media interviews to help the public grapple with questions about how such a tragedy could occur and how future tragedies might be prevented. Melissa DelBello, MD, Professor of Psychiatry and Pediatrics and Co-Director of the Division of Bipolar Disorders Research in UC’s Department of Psychiatry and Behavioral Neuroscience, took time out of her schedule to discuss recognition and prevention of serious mental illness. Question: Many of the perpetrators of mass violence are young individuals who seemed normal earlier in their lives. What has happened in these cases? Dr. DelBello: Late adolescence and early adulthood is the most common period of onset of psychiatric disorders, specifically psychotic and mood disorders. There are multiple stressors that exist in life during this period, including going off to college and making important career and personal life decisions. These are all big stressors. There is also the potential for substance use, since this is the most common period for exposure to alcohol and drugs. Finally, genetics and neurodevelopment are biological aspects that contribute to the onset of these illnesses. We think that you have to have the “right” genes, in combination with these stressors, to develop these brain-based illnesses. Question: What specifically is happening during adolescence that makes the brain vulnerable to psychosis and other mood disorders? Dr. DelBello: From puberty up to age 25, there is rapid development in the prefrontal cortex, the large and newest part of human brain that lies just behind the forehead and is responsible for cognitive analysis, abstract thought and regulation of emotion. The prefrontal cortex is establishing connections with other areas of the brain and then fine-tuning and developing them into the important connections. This process continues throughout late adolescence and early adulthood. An abnormal environment, or stressor, or the wrong genetics, or a combination of those factors can contribute to abnormal brain development and eventually the onset of these disorders. Question: Should we be paying more careful attention to young people during this critical phase of their lives? Dr. DelBello: This is a time for people to be watching. This includes family, friends, co-workers, roommates. Signs to look for are a change in behavior, sleep patterns, appetite or interests; an inability to perform as well as the person previously did; signs of functional impairment or impaired logic or thinking; evidence that a person is starting to use drugs or alcohol; signs that the person is withdrawing or isolating himself from friends. Those are all warning signs that an individual is not functioning as well as he or she used to. Question: How well can the system intervene if someone is deteriorating? Dr. DelBello: Many times people will hide the information from their families, particularly if they’re not living with their family and are away at school, where people don’t know them that well. We obviously don’t know the specifics about what happened in Aurora, Colorado, but obviously there is some speculation that there was a new interest in weapons and guns. And I don’t know whether that pre-existed. New interests or different interests should raise red flags. But sometimes people hide the symptoms well. Question: Does the brain actually deteriorate during mental illness? Are cells dying? Dr. DelBello: “There are two different processes in the brain: neuro-development and neuro-degeneration. We think that these disorders develop because of a neurodevelopmental abnormality, so initially the brain doesn’t develop as most developing brains do. This is followed by a secondary phase: a progression of abnormalities in different brain regions. Whether this is a result of the illness itself or confounding factors such as medications, drugs, alcohol, stressors, other illnesses that develop, we don’t really know. Question: Is there anything you personally took away from the latest tragedy? A wish that society could do something that is not currently doing? Dr. DelBello: What happened is incredibly tragic. I don’t know that all of the preventive strategies in the world would have stopped it. But if I had a wish it would be that more research is devoted to preventing these illnesses so that we could understand exactly how the combination of these risk factors and the interaction of genetics and abnormal brain development unfold. Being able to somehow intervene and slow down or prevent the onset of mental illness would be the ultimate goal. Question: Some if this research is ongoing right now at UC and Cincinnati Children’s Hospital Medical Center. Dr. DelBello: We are doing high-risk studies in children of parents with bipolar disorder, trying to look at the longitudinal course of these children in order to identify whether there are biological or clinical factors that predict who is going to go on to develop a mood disorder. This is part of a center grant from the National Institutes of Health. I’m involved in the high-risk study where we recruit young children, 8-20, who have at least one parent with bipolar disorder. They participate in a neuroimaging study, and then over time we ask them about their mood and function. Once they start developing symptoms, we follow them very closely and perform another neuroimaging scan to identify brain changes predictive of and associated with illness development. In another research study, we are treating children who develop
In Honor of His Patients, Dr. Revilla Sets His Sights on a Summit
In the background, Mt. Sajama. Foreground, photos of Dr. Revilla on the Peruvian mountain Chopicalqui nearly two decades ago. Movement disorders specialist Fredy J. Revilla, MD, won’t be able to attend the Sunflower Revolution bike ride and symposium this year. But he is hoping to send a big hello – and a hurrah! – from the summit of Mount Sajama, the highest mountain in Bolivia. Dr. Revilla hopes to reach the summit, 6,542 meters (21,463 feet) above sea level, on Sept. 7, the day before the Sunflower events. As Director of the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, a component of the University of Cincinnati Neuroscience Institute and UC Health, Dr. Revilla is dedicating his summit to his patients who struggle with Parkinson’s disease and Huntington’s disease. He is hoping to inspire people in the way that he has long been inspired by Davis Phinney, the Tour de France cyclist who co-founded the Sunflower Revolution, and he is inviting friends and supporters to acknowledge his effort by making a donation to the Gardner Center. Davis, who was diagnosed with Parkinson’s disease at age 40, has been a voice of hope for people with Parkinson’s with his message of “every victory counts” and his Victory Summit® symposia. Dr. Revilla said he hopes his climb will echo “everything that Davis has promoted: that you should live a whole life and that no matter what you have, go with what you have.” To make a gift in support of Dr. Revilla’s summit of Mt. Sajama, click here >> When asked whether you would like to designate your gift further, you may type in “Dr. Revilla’s Summit.” The timing of the Sunflower and Dr. Revilla’s climb of Mt. Sajama is a coincidence. “I had been a climber for many years in my 20′s and even into my 30′s,” said Dr. Revilla, pictured at right. “Now I’m 48, and when this opportunity came up I signed up immediately. I thought I would do it as my personal challenge and do fundraising for Parkinson’s and Huntington’s disease. I didn’t want to wait too long, because this might be my last shot at it.” Mt. Sajama will not be the highest mountain Dr. Revilla has climbed. The highest was Huascarán, which at 6,768 meters (22,205 feet) is the highest mountain in Peru. Dr. Revilla grew up in the shadow of the Andes mountains in Arequipa, Peru. Dr. Revilla will travel to Peru to give a talk in late August, then will fly to La Paz, Bolivia, where he and his climbing partner, Stephen Burrington of Cincinnati, will spend two weeks acclimatizing and climbing two lower peaks. We do not need to worry about Dr. Revilla’s safety, he assures us, because he and Mr. Burrington will be climbing with a guide who is intimately acquainted with the mountain and because they are going at the right time of year. “We’ll have crampons and ice axes and all that, but it’s not dangerous,” Dr. Revilla said. “It’s not like going up Mt. Everest.” Dr. Revilla has been training for months for the climb, kayaking, running, and going up and down stairs with a backpack filled with gallons of water. The final backpack weight will be 45 to 50 pounds. “Summiting a high mountain is like running a super marathon,” he said. “If you don’t make it, it’s because you didn’t train enough.” – Cindy Starr
Even Years after a Stroke, It’s Never Too Late to START
Brett Kissela, MD, Professor of Neurology and Co-Director of the Stroke Recovery Center, in his office on the UC Academic Health Center campus. Known around the world for its pioneering work in the area of treatment and research into acute stroke, the UC Stroke Team is now making strides in what comes next: the emerging and enormously hopeful field of long-term recovery, rehabilitation and renewal. Nearly 200 stroke survivors from 10 states have benefited from sustained and intensive rehabilitation efforts through the Stroke Team Assessment and Recovery Treatment (START) Program, which celebrates its fourth birthday July 1 at UC Health’s Drake Center. “There’s a long-held conception that, following a stroke, a patient will improve spontaneously for about six months and then hit a plateau, beyond which further recovery is minimal or impossible,” says Brett Kissela, MD, Co-Director of Drake’s Stroke Recovery Center and a specialist at the Comprehensive Stroke Center at the UC Neuroscience Institute. “We now know that this is totally wrong. The easy phase may stop at six months, and there is a likelihood that a survivor will plateau a little bit at that time. But what we now know is that you can recover for years — maybe even decades — after your stroke. It’s just harder, and it’s not going to happen spontaneously.” The new realm of long-term recovery, Dr. Kissela says, “is the next great frontier in stroke.” Treatments for acute ischemic stroke (one caused by a blockage) involve rapid-fire diagnosis and the delivery of clot-busting medication within 3 to 4 ½ hours of the stroke’s onset. The UC Comprehensive Stroke Center also excels in surgical and endovascular treatments of ischemic and bleeding stroke, which can be used to open stubbornly clogged arteries, remove persistent clots or shut down bleeding aneurysms. Still, not all patients are helped by these acute treatments. Some never make it to the hospital in time for clot-dissolving medication to be an option. “The American Heart Association’s goal is to have 20 percent of (ischemic) stroke patients treated with acute stroke therapy by 2020,” Dr. Kissela says. “We’re not there, and the general consensus is that we’re not going to make it. Optimistically, we’re pushing 10 percent at this time. Published data says we’re closer to 5 percent, historically.” This means that 95 percent of people who have suffered a stroke fail to benefit from acute stroke therapy and, if they survive, are left to cope with the often-disabling after-effects of their stroke. These patients, Dr. Kissela says, experience a whirlwind of activity early in their recovery process: a three-day stay in the hospital, followed by a standard course of treatment at a rehabilitation center. After that, patients may receive therapy at home or in a nursing home. Or, as is often the case, they receive no additional therapy. Bringing survivors back into the fold This is where START kicks in: a life-affirming option for patients who have already completed standard treatments. “We have a lot of work to do in helping people who don’t get a reversal of their symptoms. And that’s what the stroke recovery clinic is about,” Dr. Kissela says. “When the six-month spontaneous recovery ends, people can feel abandoned or lost. So the idea is to bring them back into the fold and help them.” A new patient at START begins with a four-hour visit in which he or she sees a physical therapist, occupational therapist, speech therapist, neurologist and physiatrist (a specialist in physical medicine & rehabilitation). The patient also meets the research team and is screened for all ongoing post-stroke research studies, which often provide therapy at no cost. The patient’s caregiver, meanwhile, has an opportunity to see a neuro-psychologist, who can help the caregiver develop strategies for coping with day-to-day demands. After the visit, the team sits down as a group and develops a cohesive plan. “It’s the power of collaboration that we so often lack in healthcare,” says Dr. Kissela, who pioneered daily collaborative rounds on the neuro floor at University Hospital in 2008. Developing a one-year plan Privately insured patients who want long-term therapy following stroke are typically allotted a limited number of therapy visits a year, a resource that can be exhausted within a few months. The START program differs by spreading out formal therapeutic sessions over the course of an entire year and mixing in periods of at-home exercises and goal-setting, group therapy classes, exercise/wellness programs, and participation in clinical trials that include therapy. Some research studies include functional MRI, which is used to examine neuro-plasticity, a process in which healthy parts of the brain take over jobs once performed by areas that have been injured by stroke or trauma. “We take it in one-year blocks because of insurance,” Dr. Kissela says. “Some Medicare plans don’t have a limit, but even so, people need a variety of activities. Therapy is an intensive, interpersonal interaction, and sometimes patients need to have a break, see something new, do something new. We can facilitate that. By looking at it from 10,000 feet, we design a program that keeps the participants fresh.” Dr. Kissela’s co-director at the Stroke Recovery Program at Drake Center is Mark Goddard, MD, Professor and Chair of the Department of Physical Medicine & Rehabilitation at UC. Candidates for the START program include those who suffered a stroke years ago and are seeking a fuller recovery. For more information, contact Lucretia White, MBA, BSN, RN, at (513) 418-2549 or [email protected]. — Cindy Starr
Beyond the 275 Beltway, UC Health Telestroke Network Proves Its Value
Pamela Kimmel, RN, BSN, with a telestroke robot (nicknamed “Rosie”) in the NSICU at UC Health’s University Hospital. Photo by Cindy Starr / Mayfield Clinic. The new UC Health Telestroke Network has already paid dividends for patients at Dearborn County Hospital in Lawrenceburg, Ind. More than half a dozen patients at the hospital have been examined, via a telestroke robot, by members of the UC Stroke Team since the system was implemented April 30. The robots enable audio-video communications in real time between a patient and clinician at a distant site and a UC Stroke Team member (with laptop) wherever he or she is at the time. The Stroke Team physician can interview the patient and observe while the patient performs simple tasks, such as touching his or her nose or repeating words or phrases. The physician also will be able to confirm or rule out facial droop and will even be able to see the size of the patient’s pupils. None of the patients examined at Dearborn County via telestroke thus far has been given the potent clot-busting drug TPA, said Pamela Kimmel, RN, BSN, Telestroke Program Manager for the University of Cincinnati Neuroscience Institute. But on the very first night the system was in place, the robot changed a physician’s recommendation for treatment. “Based on his consultation over phone and what he was hearing, the physician felt that he most likely would have treated the patient with TPA,” Ms. Kimmel said. “But because he had the ability to actually examine the patient via the robot, he determined that the stroke was not severe enough to warrant the TPA.” Stroke is a leading cause of severe adult disability and the fourth leading cause of death in the United States. Time is precious when a stroke occurs, as brain cells lacking oxygen begin to die. People who have suffered an ischemic stroke — one caused by a blood clot — can reduce or eliminate their risk of death and disability through early treatment and the administration of the TPA within 3 to 4 ½-hours of the onset of the stroke’s first symptoms.* At the same time, this drug does carry a risk: a small minority of patients will experience bleeding in the brain. A patient who avoids unnecessary administration of TPA therefore avoids that risk. The telestroke program was launched at University Hospital in March 2012, with one robot placed in the Emergency Department and another in the Neuroscience Intensive Care Unit (NSICU). A third robot was placed at West Chester Hospital’s Emergency Department in May. “The Dearborn County staff has praised our doctors’ ability to beam in and examine their patients,” Ms. Kimmel said. “They view it as a simple and effective program, and we’ve had several situations that have proved its value.” “The stroke team physicians are experts in their field,” said Roger Howard, Director of Clinical Services and Facilities for Dearborn County Hospital. “By using this telemedicine system, the specialist is brought to the patient in a matter of minutes.” Working collaboratively, he added, the Dearborn County Hospital Emergency Department physician and the University Hospital Stroke Team physician can also determine whether the patient should remain at Dearborn County or be transferred to the UC Comprehensive Stroke Center for tertiary stroke care. In an unexpected benefit of the telestroke program, Ms. Kimmel said, Dearborn County physicians are consulting the UC Stroke Team more frequently than before. “They might have felt they were disturbing a busy physician in the past, but because we have this technology in their emergency room, they feel we definitely want them to call us about any patient who presents with a symptom that could be related to stroke.” Meanwhile, the UC Neuroscience Institute and University Hospital plan to continue expanding into rural and underserved areas. They will implement a telestroke system at Clinton Memorial Hospital in Wilmington, Ohio, in July and expect to be present in up to five additional hospitals during the next year. “UC Health has taken on this mission,” Ms. Kimmel said. “They’re going to use robot technology to take the level of expertise of our stroke physicians beyond the 275 beltway and out to the underserved areas of the various surrounding states.” – Cindy Starr
New on the Neuro Floor: One-Stop Recovery
Ronald Warnick, MD, and University of Cincinnati Trustee Ginger Warner outside a new educational alcove that Mrs. Warner and her husband, David, helped to fund. Photo by Cindy Starr / Mayfield Clinic. A new kind of safety net is arriving at UC Health’s University Hospital and the University of Cincinnati Neuroscience Institute on May 1. It is patient-friendly, family-friendly and, for some, possibly life-saving as well. It has a fancy name — “acuity-adjustable unit” – but its goals are fairly straightforward. Instead of moving a recovering patient from room to room, and from one clinical team to another, the unit adjusts a single room and clinical team to the individual needs of the patient. In short, a room’s technologies change according to the acuteness, or severity, of the patient’s condition. As the patient recovers, higher-level monitoring equipment can be rolled away. “This concept originated in cardiovascular care, and the UC Neuroscience Institute is the first to implement it for neurosurgery,” said UC Brain Tumor Center Medical Director Ronald Warnick, MD, who proposed and championed the unit. “In the past, a patient might be in three or four different rooms within the hospital.” Acuity-adjustable units previously established for cardiovascular patients have reduced medical errors, falls and patient anxiety, Dr. Warnick said. “Hospitals with cardiovascular acuity-adjustable units have seen a drop of up to 90 percent in the number of transfers to new beds, a 70 percent reduction in medication errors and a 75 percent decrease in patient falls. We expect to see similarly significant benefits for our neurosurgical patients.” Dr. Warnick and other leaders of the Brain Tumor Center and UC Neuroscience Institute this week unveiled the spacious, soft-hued acuity-adjustable unit on the fourth floor of University Hospital. Donors and members of the Brain Tumor Center’s Community Advisory Board got the first peek. Those in attendance included Ginger Warner, a member of the UC Board of Trustees who, with her husband, David, provided significant funding for a private educational alcove located just outside the unit. The unit represents an important new addition at the UC Neuroscience Institute. It will primarily serve patients who are recovering from brain tumor surgery, but it will also serve patients who are recovering from procedures relating to cerebrovascular disease, epilepsy, Chiari malformation and other neurological disorders. Critically ill neurological patients, including those who have suffered a bleeding stroke or a traumatic brain injury, will continue to receive care in University Hospital’s state-of-the-art Neuroscience Intensive Care Unit. The acuity-adjustable unit includes 10 patient rooms, two of which are hard-wired to accommodate epilepsy patients who require continuous monitoring for seizures. Another patient room includes a mechanized lift to serve bariatric patients. Two rooms have negative air flow for patients requiring isolation. All rooms include a pull-out bed and are designed so that a family member can stay with his or her loved one around the clock. Also among the high-tech amenities is a purse-sized portable monitor, shown in the photo above by Heidi Salyer, RN, CNRN, Director of Nursing for Neuroscience. A patient who is ready for a walk down the hall can carry the device and continue to receive monitoring oversight. Ms. Salyer said that patients and families will participate not only in their loved one’s care but also in the shift change so that observations and instructions are conveyed clearly. Daily rounds will be collaborative, will be held at the bedside, and will include a nurse practitioner and social workers. Families who participate in their loved one’s recovery in this way will know how to continue that care when their loved one goes home, Ms. Salyer said. Kathy Beechem, Chair of the Brain Tumor Center’s Community Advisory Board said, “The new unit is based on the idea that you come here to recover. You never have to leave your room, and your family can stay.” – Cindy Starr
Alzheimer’s Expert Sees Promise in Research Aimed at Underlying Pathologies
Brendan Kelley, MD, left, and William Thies, PhD, prior to Dr. Thies’s guest lecture. Photo by Dan Davenport / UC Academic Health Center Communications Services. What does Alzheimer’s disease have in common with cardiovascular disease? More than you might think, says William Thies, PhD, Chief Medical and Scientific Officer of the Alzheimer’s Association. Dr. Thies made the comparison while discussing the future of Alzheimer’s research and drug development during a special “joint grand rounds” lecture hosted by the University of Cincinnati Department of Neurology and the Department of Psychiatry and Behavioral Neuroscience. Brendan Kelley, MD, Director of the Memory Disorders Center at the University of Cincinnati Neuroscience Institute, introduced Thies and noted that he hoped to make such joint grand rounds a regular occurrence. Dr. Thies said that while early Alzheimer’s drug trials focused — without long-term success — on treating symptoms, which include cognitive impairment and dementia, current research is focused on finding biomarkers and addressing the underlying pathology of Alzheimer’s. Dr. Thies invited attendees to look at the example of heart disease. “The first clinical description of myocardial infarction (heart attack) was that it was a very rare phenomenon. You virtually never saw it, and when you saw it you only saw it in really older people—over 50. That was in the 1700s, when there weren’t many people over 50. “So between the 1700s and the 1900s, when heart disease became an epidemic, we got lots of people over 50 and now all of a sudden there were lots of myocardial infarctions. “But as we began to understand the underlying pathology—high blood pressure, high serum lipids—and began to develop medications that really treated those underlying pathologies, we got to a point where we could avoid the catastrophic endpoint of the disease.” Dr. Thies said U.S. deaths from cardiovascular disease peaked in the mid-1950s, with the subsequent decrease linked to the advent of drugs that lowered blood pressure and serum lipids, plus enhanced knowledge of the benefits of adjustments in diet and physical activity. “Only a small portion of that (decrease) comes from actual treatment of myocardial infarction,” he said. “Most of this comes from the prevention of those catastrophic endpoints. “So I would suggest to you that what we will see in the near future is the development of medications that will interfere with the basic pathology of Alzheimer’s disease and in so doing prevent the eventual catastrophic outcome of dementia.” While in Cincinnati, Dr. Thies also spoke at an Alzheimer’s research update sponsored by the Alzheimer’s Association of Greater Cincinnati. About 5.4 million Americans are living with Alzheimer’s disease, according to the Alzheimer’s Association. It is the sixth-leading cause of death in the nation and has no known way of being prevented, cured or even slowed. –Keith Herrell
Ginny’s Story: Living with Glioblastoma
Greg and Ginny during one of her chemotherapy treatments. Photo by Cindy Starr / Mayfield Clinic. Greg tears up when he remembers one of his early visits to the UC Barrett Cancer Center with his wife, Ginny, newly diagnosed with a malignant brain tumor in July 2008. “I remember being on the elevator that summer,” he says. “We were going to and from Cincinnati and West Chester every day for something. We were constantly going someplace to see a doctor. And on the elevator there was a young guy with his wife. I think he had a brain tumor. And I spoke to him, and he told me, ‘You’re on a journey, and it’s not going to be over today.’” Indeed, for Greg and Ginny, a Dayton, Ohio, area couple who fell in love while working as deputy sheriffs, it has been a life-altering journey of hope, faith and a succession of the best treatments medical science can offer. Ginny was retired from the sheriff’s office and enjoying an active life with Greg and their two children when she was unexpectedly diagnosed with a grade 4 glioma, also known as glioblastoma multiforme. Since then she has persevered against difficult odds, her family, doctors and many friends supporting her every step of the way. Whereas the median life expectancy following diagnosis of glioblastoma is less than one year, Ginny is now approaching year four. Ginny’s story of survival includes a new glioblastoma vaccine. Ginny was one of the first patients enrolled in a national clinical trial that was available to patients at the Brain Tumor Center at the University of Cincinnati Neuroscience Institute, a multi-disciplinary center within UC Health. Christopher McPherson, MD, a neurosurgeon at the UC Brain Tumor Center, says, “Virginia’s long survival illustrates the importance of clinical trials and speaks to the huge potential that vaccination treatment has for creating a breakthrough in the treatment for glioblastoma. Every clinical trial not only has the potential to help future generations but also has the potential to provide each study participant with a new treatment that could be the breakthrough treatment for that patient.” Ginny’s symptoms began innocuously. “Looking back, she wasn’t herself the whole spring of that year,” Greg says. “In April, May and June, she constantly had headaches. I started noticing that she was asking the same questions over and over again.” At first the problem was attributed to the sinus infections and migraines to which Ginny was prone. In June she went to the hospital with chest pains, but an EEG found her heart normal. Then her vision blurred, and she went to see her ophthalmologist, Gregory Bruchs, MD. “I told him I couldn’t see very well, and his eyes got big,” Ginny recalls. Detecting abnormal pressure in her both of her eyes, Dr. Bruchs conferred with his partner, Ronald Warwar, MD, then sent Ginny to Miami Valley Hospital South for an immediate brain scan. Before the day was over, Ginny was transported to UC Health’s University Hospital in Cincinnati in an ambulance, with Greg following behind in his car. Less than a week later, John M. Tew, Jr., MD, a neurosurgeon with the UC Brain Tumor Center, removed as much of the infiltrative tumor as he safely could. Additional treatments followed: multiple sessions at the Precision Radiotherapy Center in West Chester, Ohio, followed by the vaccine and chemotherapy. Ginny continues her treatment today under the care of Rekha Chaudhary, MD, a neuro-oncologist at the UC Brain Tumor, with bi-weekly 30-minute infusions of the chemotherapy drug bevacizumab (Avastin). The chemotherapy shuts off the spigot to a tumor’s growth by inhibiting the growth of the blood vessels that feed it. Ginny will continue to receive the chemotherapy infusions indefinitely. Dr. Chaudhary (pronounced CHOHD-ary) also believes the family’s attitude has made a difference. “They have a lot of gratitude in their life,” she says. “Brain tumors are immune system tumors, and keeping a positive attitude can make a difference.” Although not nearly as active as she used to be, the woman who lost her father when she was 9 and her mother when she was 16 has proved resilient. She enjoys going to her son’s basketball games and having lunch at the Rusty Bucket with her friends. And she is looking forward to attending her daughter’s golf tournaments in the fall. While Greg expresses thanks for Ginny’s doctors, the nursing staff and the entire UC Brain Tumor Center team, he and Ginny and their children draw strength from their faith. “It’s a large part of who we are,” Greg says. “Since the diagnosis in July of 2008, our faith in God has increased tremendously. We’ve always been devout Catholics, but we’ve never asked ‘why us’ even one time. We believe God has a plan. We don’t know what it is, but we trust in Him, and this gives us comfort.” — Cindy Starr
Dr. Mario Zuccarello is University Hospital’s MVP for 2012
Mario Zuccarello, MD, left, is presented with the Clinical MVP Award by Brian Gibler, MD, President and CEO of University Hospital. Photo by Cindy Starr / Mayfield Clinic. Today is Doctors’ Day nationwide, and at UC Health’s University Hospital, cerebrovascular specialist Mario Zuccarello, MD, is being honored with the Clinical MVP Award. Brian Gibler, MD, President and CEO of University Hospital, surprised Dr. Zuccarello with a private announcement of the award last week at a routine 7 a.m. meeting. Dr. Zuccarello, the Frank H. Mayfield Professor and Chairman of the Department of Neurosurgery, helps lead the Cerebrovascular Disease and Stroke Center at the UC Neuroscience Institute, a multi-disciplinary center within UC Health. Dr. Gibler said the Clinical MVP Award “is presented to the attending physician who has a highly productive clinical practice with good patient outcomes and high patient satisfaction. The award recognizes the physician, regardless of specialty, who makes a significant contribution to our inpatient, outpatient, and/or procedural volumes.” Dr. Zuccarello, a native of Italy, is in the prime of a career defined by consistent excellence in clinical care, research and education. He has published more than 175 peer-reviewed papers and 10 book chapters, has received more than $17 million in research funding, and has been named to Top Doctors in Cincinnati (2005-2012) and Best Doctors in America (2006-2011). He became head of the Department of Neurosurgery in 2010. Dr. Zuccarello chaired and brought Vasospasm 2011: The 11th International Conference on Neurovascular Events after Subarachnoid Hemorrhage to Cincinnati. He also played an integral role in the recovery of three young women whose recovery from life-threatening cerebrovascular events was widely publicized: pediatric resident Alison Delgado, MD, Xavier University basketball star Amber Gray, and American Heart Association advocate Christine Phan. “In addition to his responsibilities as Chairman of the Department of Neurosurgery and chairman of multiple committees in the UC Neuroscience Institute and the University Hospital, Dr. Zuccarello is one of the busiest surgeons at the University Hospital,” Dr. Gibler said. “Those who know Mario know that he is indefatigable, sincere, passionate, erudite, skilled and, above all, compassionate. It is for these reasons that I am happy to award him the Clinical MVP Award for 2012.” – Cindy Starr
Spotted in Boulder, Colorado!
Spotted! In Boulder, Colorado: From left, UCNI Friend Buck Niehoff, a member of the University of Cincinnati Board of Trustees; Tour de France Stagewinner and UCNI Friend Davis Phinney; and UCNI Clinical Director John M. Tew, MD. The three gentlemen had been inside spinning at the Boulder Center for Sports Medicine, each rider connected to wattage output and cardiac parameters. The photo was taken by the spinning instructor, 1984 Olympic gold-medal cyclist Connie Carpenter, Davis’s wife. What else were these gentlemen discussing? Stay tuned for more news about Davis Phinney and the Sunflower Revolution Symposium & Bike Ride! – Cindy Starr
Alzheimer’s Findings Suggest Future Restorative Treatment Interventions
Photo of Brendan Kelley, MD, by UC Academic Health Center Communications Services. By Brendan Kelley, MD Director, Memory Disorders Center Widespread media coverage of findings reported in Science (published online 2/9/2012) by researchers at Case Western Reserve University has renewed attention and interest in the development of compounds that address the pathological changes that cause Alzheimer’s disease. The two pathological hallmarks of Alzheimer’s disease involve abnormal processing of the proteins amyloid and tau. In people who have Alzheimer’s disease, the body’s normal processing of the protein amyloid is not functioning correctly, leading to accumulation of the amyloid protein in the brain. This appears to be related to impaired clearance (removal), although some research has also identified overproduction of the more reactive (“sticky”) subtypes of the amyloid protein as playing a role as well. The Case Western researchers reasoned that a molecule that might promote clearance of amyloid may have a beneficial effect in the disease pathogenesis. They used a mouse model of Alzheimer’s disease that has been genetically modified to produce amyloid pathology in the brain that resembles the changes seen in humans. They administered a compound, bexarotene, that interacts with a retinoid-X receptor (RXR), with the hypothesis that this would increase clearance of amyloid in these mice. Their study was positive, demonstrating changes in the levels of both free and aggregated amyloid in the mouse brains. This finding was seen both in young mice and older mice, suggesting the effect may translate to more chronically deposited amyloid (although it should be noted that “older mice” are 11 months old). Fascinatingly, the mice also exhibited behavioral changes when treated with the drug. There were improvements in a memory task, a fear-conditioning task following more chronic treatment. As featured in an article in the Wall Street Journal, treated mice appear to have exhibited behavioral changes related to nest building as well. Thus, both instrumental and complex behaviors appear to have been improved in those mice treated with bexarotene. These are exciting findings. The behavioral changes provide a persuasive suggestion that cognition in Alzheimer’s disease may be amenable to future restorative treatment interventions. The study illustrates a new potential therapeutic target (namely the RXRs), which will certainly spur further research and increase our understanding of the pathological causes of Alzheimer’s disease. The compound, bexarotene, will certainly merit further investigation. As we have seen previously, test results in mice do not always correlate to a similar effect in humans, and further study of dosing, safety and side effects will be required before a clinical trial using this compound in humans would be appropriate. Nonetheless, this important research finding will advance our understanding of Alzheimer’s disease, drawing us one step closer to identifying effective treatment strategies and ultimately a cure.