By Helen K. Kelley
The field of neuroscience is ever changing and expanding, with physicians and researchers working separately and together, using cutting-edge technologies and techniques to advance the understanding of the brain and nervous system.
Minimally Invasive Technologies Improve Cerebrovascular Treatments
Continuous advances in technology are making it possible to treat cerebrovascular disease, strokes and aneurysms with greater precision and effectiveness, according to Rishi Gupta, M.D., director of the Neurocritical Care Unit and Telestroke Network at WellStar Health System. One such treatment is a catheter-based approach for patients suffering from strokes.
â€œIn the past, a patient suffering from one of these conditions would receive thrombolytic therapy to break up or dissolve blood clots. Today, we have catheters that we can use to remove clots and treat brain blood vessel disorders,â€ he says.
Dr. Gupta says that new technologies have especially improved surgeonâ€™s capabilities to remove blood clots.
â€œThere has been a rapid evolution of technologies to allow physicians to safely and effectively remove blood clots from the brain. Less than five years ago, we were able to open arteries by removing clots about 50 percent of the time; now, we are able to open arteries about 95 percent of the time. That improvement is attributable to technology,â€ he says. â€œThe previous Merci device that is similar to a corkscrew has been replaced with retrievable stent-like devices â€“ the Trevo device and the Solitaire device â€“ that we can deploy to collapse and remove blood clots.â€
A new and exciting technology for the removal of brain hemorrhages is the Apollo aspiration catheter.
â€œIn the past, we had to open the patientâ€™s skull to remove a hemorrhage. Now, we can use the Apollo device to pass a catheter through a tiny hole drilled in the skull, reach the clot and initiate aspiration to remove the bleed,â€ he says. â€œThis technology allows us to access brain hemorrhages that previously could not be operated upon, and with only minimal disruption to the normal brain tissue.â€
According to Dr. Gupta, new and advanced treatments and techniques are quickly changing the way stroke patients receive care.
â€œStroke patients have more options today,â€ he says. â€œNow, by using approaches that are less invasive and with new technologies, we have been able to extend the window of time for treating these people. That allows us to do a lot more for them.â€
Targeted Therapies for Brain Tumors
â€œThe scope of neuro-oncology includes primary and metastatic cancers that affect the brain and the spine. The neuro-oncologistâ€™s â€˜bread and butterâ€™ is metastatic disease â€“ brain and spine metastases are 10 times more common than tumors that originate in the brain and spine,â€ says Erin Dunbar, M.D., director for neuro-oncology and one of the founding physicians of the Piedmont Brain Tumor Center. â€œFortunately, there are some extraordinarily promising tumor-directed therapies â€“ chemotherapies, radiations, surgeries and devices like tumor-treating shields â€“ that we are using today to improve both longevity and quality of life for patients with both primary and metastatic tumors of the brain and spine.â€
For example, in light of former President Jimmy Carterâ€™s recent diagnosis of melanoma that has metastasized to other parts of his body including his brain, Dr. Dunbar says that a targeted medicine approach, immunotherapy, is making huge strides in treatment.
â€œImmunotherapy is exciting and showing promise in treating melanoma and lung cancer, including their brain metastases,â€ she says. â€œAdditionally, it is being used to treat primary brain tumors like glioblastoma.â€
Dr. Dunbar says that there is currently an explosion of new medicines being applied to tumor-directed therapy, both in terms of delivery mechanisms and the benefits to and tolerability for the patient.
â€œThere are some amazing new medicines being applied to tumor-directed therapy, including vaccines that can harness [the] immune system and get it to fight the tumor. Traditional chemotherapy is only one tiny fraction of how we fight tumors with medicines now,â€ she says. â€œThese vaccines and other immune system fighters and new chemotherapies are often outpatient therapies that patients can live with.â€
One modality is a non-invasive device that the patient wears on his or her head. â€œ[Itâ€™s] a biologic energy field that is designed by a certified physician to deliver a low-dose treatment right to their brain tumor,â€ Dr. Dunbar says. â€œThe device is portable and empowers patients by giving them control of their therapy.â€
Traditional treatments for brain tumors continue to improve as well, according to Dr. Dunbar.
â€œThe technical components of radiation and surgery are becoming so precise that patients are receiving more effective therapy with fewer side effects than ever before,â€ she says. â€œThe improvements are completely changing the way people get their care.â€
Dr. Dunbar adds that the paradigm in oncology has evolved to a point where patients are benefiting from clinical trials and emerging technologies and therapies, at diagnosis and throughout their lifetimes. Patient-centered, multidisciplinary care teams are also essential to improvements in quality of life and longevity. And there have been advances in palliative care.
â€œNow we have board-certified palliative oncologists as well as providers in both palliative care and oncology specialties who are dedicated to aggressively preventing and managing complex symptoms,â€ she says.
Telemedicine Offers Hospitals 24/7 Access to Stroke Care
When it comes to stroke care, time is of the essence. Yet more and more hospitals are themselves without neurologists on staff, leaving them with a critical need for assistance in diagnosing and treating stroke patients.
Matthews Gwynn, M.D., and his partners at Atlanta Neurology, Drs. Keith Sanders, Jim Kiley and Lisa Johnston, saw that they could provide this much-needed service to hospitals in real-time via the Internet. Six years ago, they founded AcuteCare Telemedicine (ACT), which offers cost-effective solutions that deliver complete on-call coverage, improve patient outcomes, adhere to HIPAA/HITECH requirements and establish a sustainable financial model for patient care.
â€œWith the advent of high-speed Internet service, we saw the feasibility of treating emergency neurology patients through telemedicine in real time,â€ says Dr. Gwynn. â€œWe started out providing the service to one hospital and are now serving 25 hospitals in five states, and the demand is still high and growing.â€
Dr. Gwynn explains that ACTâ€™s physicians are available to consult with hospital personnel and see the patient who presents with stroke symptoms within just minutes of notification.
â€œWeâ€™re able to actually see the patient via a webcam with a high-definition camera on a wide flat screen. The camera can pan, tilt and zoom all around the room so that we are able to view the patient, turn and talk with his or her family members, view lab results and scans â€¦ exactly as if we were in the room,â€ he says. â€œThen we can determine if the patient is having a stroke or experiencing something else and make recommendations for how to treat them. Our note goes into the patientâ€™s chart immediately.â€
Through ACT, hospitals are able to access a network of experienced, board-certified clinicians who are able to communicate clearly with patients, doctors, nurses and pharmacists, at a fraction of the cost they would incur for having neurologists on staff. But more important, they are able to provide immediate diagnosis and treatment for patients who may be experiencing stroke.