Uncovering the Mystery of Alzheimer's Disease
When it's more Than a Headache
Managing Migraine Headaches
Breakthrough Tremor Control Therapy Improves Quality of Life
Five-and-a-half years ago, at age 57, Stuart Awbrey was cruising along in his job as editor of a weekly trade publication for the legal profession. Prior to that, he and his wife, Bev, owned and edited a suburban weekly newspaper.
"I had been experiencing some job-related stress," recalls Stuart, "but I assumed that my reactions to these demands were just part of the job. Imagine my surprise when Bev suggested to me one day that I undergo testing for my brain. Sure, I may have forgotten to send in a few checks, and perhaps I was having difficulty figuring out tips in restaurants, but I assumed that was just part of getting older."
What Stuart did not know was that Bev had been worried about him for about six months.
She had noticed that her husband was slowing down and having trouble processing information. A few times Stuart had sped onto a major highway without checking oncoming traffic and nearly caused a terrible accident. He began to ask directions to places previously familiar to him. All of these behaviors caused Bev to be concerned.
After several hours of psychological and neurological testing, Stuart was told that he had some mild to moderate cognitive deficits that were likely linked to Alzheimer's. He was advised to stop working and operating an automobile, for his own and others' safety.
"Knowing that I had a disease that would slowly kill me, I began to think of Alzheimer's as the silent bullet or my adversary," says Stuart. "I started to develop a plan about how I would meet this adversary, and I vowed that it would not be sitting down."
Just a few years ago, there seemed little hope of stopping Alzheimer's, a progressive, degenerative brain disease that has robbed the minds, memories and active lives of approximately four million Americans. With the aging of the U.S. population, experts warn that unless researchers discover how to prevent it, some seven percent of those over 65 might develop Alzheimer's by the year 2020 and that figure could rise as high as 15 percent by 2050.
Stuart and Bev consulted David P. Saur, M.D., a neurologist with the Atlantic Health System Neuroscience Institute, after learning about Dr. Saur's involvement in clinical research for new investigational drugs for treating Alzheimer's disease.
At the time Stuart visited Dr. Saur, only one drug was available to treat the symptoms of Alzheimer's. However, Dr. Saur was directing a clinical trial for a new drug designed to slow the progression of the disease, and he felt that Stuart was a perfect candidate to participate in the national study.
Being diagnosed in the early stages of Alzheimer's and receiving the new medication has helped Stuart to accomplish many of the important goals he had set for the rest of his life. He has published a book, spends quality time with his family, travels, and has taken some courses. Since he no longer drives, he rides his bicycle and walks frequently. Stuart also continues to play tennis on a weekly basis.
Stuart's family believes that he may not have been able to do those things as well without access to the leading edge treatment he has received from Dr. Saur.
"It does appear that the medication has been beneficial in slowing the progression of the disease," observes Dr. Saur. "We are very optimistic about the research we are currently conducting at the Neuroscience Institute. Should this new drug continue to prove effective, it will give hope to millions of Alzheimer's patients and their caregivers. Within the next decade, we're hopeful that Alzheimer's will become a manageable chronic illness, much like diabetes or asthma. In so many ways, Stuart has been a real inspiration to all of us."
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For most people, a throbbing pain in the head signals the onset of a bad headache or migraine. For others, it may mean something far worse.
For 18 years, Debbie Gianos worked as a neonatal intensive care nurse at Atlantic Health System's Overlook Hospital. At work and at home, the 41-year-old wife and mother of three had always been on the giving rather than on the receiving side of care - until one day, when she found herself clinging to life at the very hospital at which she worked.
Following an afternoon Tae Kwon Do class, Debbie began to experience an excruciating headache while driving to pick up her son from school. She was in extreme pain and barely able to focus on the road, but she managed to retrieve her son and drop him off at a dentist appointment. As she later proceeded through her neighborhood to pick up her other son for his dentist appointment, she was, unknowingly, driving up onto her neighbors' lawns and sideswiping mailboxes. Fortunately, Debbie's neighbors noticed her erratic driving and, after helping her out of the car, phoned her husband at work.
Meanwhile, at home and feeling cold and disoriented, Debbie decided to go upstairs and draw herself a hot bath. The last thing she remembers was lowering herself into the water, hoping for relief from her throbbing headache. When Debbie's husband arrived home a short while later, he found her submerged underwater in the tub, and, thankfully, was able to revive her. Local paramedics were called, and they transported Debbie to Overlook Hospital.
Upon arriving at Overlook's Emergency Department, a CAT scan revealed that a baseball-size tumor in the frontal lobe of Debbie's brain had ruptured. Within an hour, she was in the operating room, and for the next five hours, Debbie's fate rested in the skilled hands of Brian Beyerl, M.D., a neurosurgeon with the Atlantic Health System Neuroscience Institute.
Debbie is one of the roughly 15,000 patients treated each year for a meningioma - a tumor, commonly benign, arising from the thick membranes that surround and protect the brain. Most meningiomas grow slowly and may be without symptoms; however, as they grow, they may cause serious neurologic problems depending upon their location and size.
"Meningiomas are more likely to occur in women than in men," observes Dr. Beyerl, "and some studies suggest a link between female hormones and meningiomas. However, despite the future promise of hormonal therapy, surgery is the mainstay of treatment. For patients with meningiomas that are not surgically accessible or for those with medical problems that make anesthesia and surgery less tolerable, radiation therapy or stereotactic radiosurgery may be an option."
Following surgery, Debbie was treated in the Neuro-Enhanced Care Unit, where, the next day, tests confirmed that her tumor was benign. Two days later, she was home and beginning to feel like her old self. Weeks later, she returned to work.
Unfortunately, as is often the case with meningiomas, Debbie's tumor grew back a little more than a year after her emergency surgery. Soon, she was back in the operating room, where Dr. Beyerl removed a larger portion of the tissue surrounding the meningioma. Although the recovery from the second surgery was slower, Debbie is now resuming her normal routine.
"I wouldn't be here if it weren't for Dr. Beyerl," says Debbie. "I've learned, firsthand, that the brain is an extremely recuperative organ. To be on the safe side, I get regular MRIs of my brain, and, of course, I avoid my neighbors' mailboxes when I drive down the street."
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"I think I'm getting a migraine" is one phrase that most people have said at some point in their life, especially when dealing with a stressful situation. Fortunately, for some, this so-called migraine turns out to be a headache that soon disappears. But for 26 million Americans, the pain of a migraine headache is all too real.
Migraine headaches can strike anyone at any age, although they are most common in young women. A migraine is a neurologic disorder characterized by recurrent attacks of headache, with pain most often occurring on one side of the head, accompanied by other symptoms such as nausea, vomiting and sensitivity to light and sound. Typically, the onset of a migraine occurs after waking up in the morning. Routine activity or slight head movement frequently makes the pain worse. These episodes can last from several hours to several days and are often disabling.
Patricia Dragunas had been living with migraine headaches for years. After her twin boys were born, however, the headaches went from bad to worse.
"I was getting migraines several times a week," recalls Patricia. "I was nauseous, sensitive to sound and light and in severe pain every other day. I had two young boys to take care of, but I could barely function."
Although migraines are not curable, they are manageable with the proper medical care. Patricia had been taking numerous medications, including steroids and pain relievers, without much success. Because the migraines prevented her from enjoying an active, healthy lifestyle, she was also overweight and had high blood pressure.
Finally, in an attempt to relieve her suffering and regain control of her life, Patricia sought the help of Stuart W. Fox, M.D., a neurologist with the Atlantic Health System Neuroscience Institute.
"There are many migraine medications available, so it is important to develop a drug therapy that is individualized for each patient," says Dr. Fox. Some medications, such as beta blockers or anti-seizure medications, are also used to treat other medical conditions but may be beneficial in controlling migraines. While some patients who experience frequent migraines take medication preventively, others take medication only at the time of an attack or to treat associated symptoms, such as nausea.
Over the course of several months, Dr. Fox weaned Patricia of the medications she had been taking, and he prescribed a new anti-seizure medication to reduce the frequency, intensity and duration of the migraine attacks.
"Dr. Fox turned my life around," says Patricia. "My migraines have stopped, I've lost 20 pounds and I'm now running three miles a day."
The 46-year-old mom has even tackled New York's famed Five Boro Bike Tour.
"I never would have thought my life could improve so much," observes Patricia. "My only regret is not visiting Dr. Fox sooner."
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For most of us, writing a letter or paying the bills is routine and uneventful. But for 69-year-old Jerry Tobackman, who suffers from severe hand tremors, such daily tasks can be sources of tremendous anxiety.
When medications failed to control his tremors, Mr. Tobackman learned about a breakthrough treatment called deep brain stimulation, or tremor control therapy, from Edward J. Zampella, M.D., a neurosurgeon at the Atlantic Health System Neuroscience Institute. Dr. Zampella is among the first neurosurgeons in the state to perform this state-of-the-art procedure that has produced dramatic results in tremor patients.
According to Dr. Zampella, deep brain stimulation works by using electric impulses to alter brain signals that cause tremors. This process occurs with the help of a special device, or electrode, that is implanted deep within the brain. When activated, the electrode stimulates the brain at very high frequencies and suppresses tremors. The patient can induce the stimulation as needed by holding a magnet over a small, battery-powered generator inserted in the upper chest.
"Sending electronic signals to the brain enables us to 'pace' or 'overdrive' the person out of a tremor," explains Dr. Zampella. "It works in much the same way as a pacemaker, which utilizes electrical pulses to control heart rate."
Tremors are often characterized by uncontrollable shaking, or rhythmic limb movements caused by muscle contractions. They are frequently associated with Parkinson's disease but are also common symptoms of essential tremor, another neurological disorder affecting approximately two million Americans. In many cases, tremors can be so extreme that they interfere with an individual's independence and quality of life.
Mr. Tobackman, a furniture salesman, has lived with essential tremor for the past 10 years. As his condition progressed, his tremors worsened, eventually becoming so pronounced that he was unable to write his own name. "At first, my hand would shake a little and I could disguise it," he says. "But for the past two years, the tremors were so bad that no one could read my handwriting.
Interestingly, the electrode is implanted in the brain while the patient is awake - though he or she does not experience any pain or discomfort. Physicians use stereotactic and imaging technology to target the precise location for the device. "Once the electrode is implanted, we place a cup of water in the patient's hand, and stimulate the brain interoperatively. If the electrode is in the proper position, the tremor (and the water splashing out of the cup) stops immediately," says Dr. Zampella. If the tremor does not stop, the electrode is repositioned.
The deep brain stimulator has several advantages over other treatments for tremor, including medication, which may produce side effects, and older surgical interventions, which destroy portions of the nervous system. "The greatest benefit of the deep brain stimulator is that if the patient or doctor is not satisfied with the surgical result, it is completely reversible," adds Dr. Zampella.
Since undergoing the procedure in March 1999, Mr. Tobackman's tremors have disappeared completely. His handwriting is "back to normal" and he has regained his independence. "I'm a different person," he says.
Functional/restorative neurosurgery, with devices/techniques like deep brain stimulation, is in the forefront of neurosurgery, says Dr. Zampella. "High tech" implantable devices can give relief of chronic pain to patients who had previously been considered "hopeless cases"; can treat seizures without the need for removal of brain tissue; and can relieve disabling spasms (via intraspinal drug infusion) in patients with cerebral palsy, multiple sclerosis and spinal cord injuries.
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