---

Volume 14 2003-2004

Making the Rounds

Dr. David Walsh, new director of child neurology.

Dr. David Walsh joined the faculty in mid-September as associate professor of neurology and director of Child Neurology at Cardinal Glennon Children's Hospital (CGCH). He comes to Saint Louis University (SLU) from the Medical College of Wisconsin (MCW) in Milwaukee, where he was director of the pediatric neurology training program. Throughout his academic career, Dr. Walsh has been actively involved in the education of residents and medical students. During the 1980s, he was director of both the pediatric and pediatric neurology training programs at the University of Kansas (UK) as well as chairman of the residency committee in the pediatrics department.

For 14 years at MCW, Dr. Walsh served as a clinical preceptor for both medical students and residents. He has additional administrative experience from his six years as director of the division of pediatric neurology at UK and from interim stints heading the neurophysiology laboratory and comprehensive epilepsy program at the Children's Hospital of Wisconsin.

A 1973 graduate of the Medical University of South Carolina in Charleston, Dr. Walsh remained there for his pediatric and pediatric neurology residencies. In 1981, he finished a fellowship in neurophysiology at Harvard Medical School in Boston, Mass. While at MCW, he completed an inaugural fellowship offered in medical education.

Dr. Thomas Geller, who led child neurology for almost five years, is filing his final director's report for 2003-04 activities at CGCH. He notes that the child neurology residency program will have three full-time positions beginning in July 2005. Dr. Sean Goretzke began his first year this July, joining Dr. James Nelson, a second-year resident. Dr. Goretzke is a 1997 graduate of SLU School of Medicine. He trained in pediatrics at the Naval Medical Center in Portsmouth, Va., and has spent the last three years as a general pediatrician at the Naval Air Station in Brunswick, Maine. Dr. Nelson came in January 2003 after five years of private practice in the Springfield, Ill., area. He is a graduate of the University of Illinois College of Medicine in Chicago. He moved to Peoria, Ill., to pursue a pediatrics residency at the University of Illinois College of Medicine located there. Currently, Dr. Nelson is conducting a research project on post-lumbar headaches in children. Both he and Dr. Goretzke are board certified in pediatrics.

In other research news, Dr. Geller is principal investigator in a clinical trial studying the effects of the drug, topiramate, on children with absence epilepsy. CGCH is one of eight institutions nationwide participating. He and Dr. Mary Bertrand, co-investigator, expect to enroll at least five to six patients in this one-year program.

Forest Park Hospital (FPH) has been purchased by Argilla, a healthcare company, from the Tenet Healthcare Corporation. Discussing the sale, Dr. Laurence Kinsella, director of neurology at FPH, says that Argilla has been running hospitals for the last five to ten years. They own five other community hospitals located in cities across the country that are similar to FPH.

Dr. Kinsella is principal investigator in a clinical trial to determine the efficacy of the drug, midodrine, on patients with neurogenic orthostatic hypotension. Four patients, who have been studied in the autonomic laboratory, will be enrolled in the six-month trial. A new protocol has been started to improve neurological outcome in patients who have suffered cardiac arrest. Hypothermia blankets are being used to lower the body temperature to 32 to 34 degrees centigrade for 24 hours. The result is a 50-percent reduction in death and severe neurological injury. FPH now has two rotating neurology residents. One covers neurorehabilitation and stroke, while the other works in the outpatient clinic, performs EMGs and sees neurology consults. Dr. Richard Bucholz holds a neurosurgery clinic once a month and works with Dr. Aninda Acharya in implanting brain stimulators in patients with Parkinson's disease and other movement disorders.

The new neurology outpatient clinics at John Cochran Veterans Affairs Medical Center (JCVAMC), are functioning very well, says Dr. Francis Mithen, chief of the neurology service. Approximately 1,600 new patients and 3,500 follow-ups have been seen during its first year of operation. JCVAMC draws patients from Missouri as well as Illinois, Arkansas, Indiana and Kentucky because of the various closures and consolidations of healthcare facilities for veterans. In related news, the epilepsy clinic has expanded its service under Dr. Jayant Acharya's supervision. The multidisciplinary MS clinic organized three years ago by Dr. Florian Thomas has begun recruiting patients for clinical drug trials in which he is principal investigator.

Dr. Ghazala Hayat, medical director of the Clinical Neurophysiology Laboratory at SLU Hospital, reports that the laboratory performed 662 procedures from July through October 2004 as compared to 561 for the same period last year. This represents an 18-percent increase. Additionally, the electromyography equipment for nerve conduction studies will soon be updated. She also comments that preliminary steps are being taken to develop a sleep laboratory.

The clinical neurophysiology fellows for 2004-05 are Drs. Alireza Ahmadieh, Daniel Mattson and Ajitesh Rai. Dr. Ahmadieh completed his neurology residency at Upstate Medical University in Syracuse, N.Y. Dr. Mattson finished his at Harvard Medical School in Boston, Mass., and Dr. Rai at SLU. Drs. Ahmadieh and Rai are doing their fellowships with an emphasis on neuromuscular disease, while Dr. Mattson focuses on epilepsy.

In news of the Neuromuscular Service, Dr. Hayat, director, comments that the ALS clinic, now in its ninth year, is in the process of being certified by the Amyotrophic Lateral Sclerosis Association. The neuromuscular service is participating in a study for ALS to determine if the prognosis of a patient diagnosed with this disease is related to its recognition and the timing of EMG studies following initial symptoms. This retrospective study is looking at patients over the last eight years who have died or have deteriorated significantly. Patients who had a shorter interval between initial symptoms and first EMG studies did not fare as well as those where there was a longer interval.

Lastly, a botulinum toxin symposium is scheduled for early spring that will discuss its use in patients with dystonia, spasticity and pain related to headache and backache.
Dr. John Selhorst thanks Wanda Laden for her years of service.

The Souers Stroke Institute (SSI) will be participating in the Phase I Study of Intravenous Thrombolysis Plus Hypothermia for Acute Ischemic Stroke in collaboration with the University of California-San Diego, announces Dr. Salvador Cruz-Flores, director. The multicenter project will study the effects of administering TPA, inducing hypothermia or a combination of both given within six hours of onset of stroke to improve the outcome in patients meeting certain criteria. This study is sponsored by the National Institutes of Health (NIH), and Dr. Cruz-Flores is the principal investigator. He expects that SSI will enroll five patients over the next two years.

Other ongoing clinical trials include AbESTTII, a multicenter, multinational study, to determine the efficacy of the drug, Abciximab, in acute ischemic stroke when it is given intravenously within six hours of onset to patients with mild to moderate deficit. Dr. Cruz-Flores is the principal investigator of this study funded by Eli Lilly and Company. In the trial's first year, one patient has been identified. He projects that four to five more will be found over the next year and a half. Another trial, PROFESS, is testing the effectiveness of two different combinations of anti-platelet agents in preventing a second ischemic stroke. An acronym for prevention regimen for effectively avoiding second strokes, PROFESS is a randomized, multicenter, multinational study that is determining which combination, aspirin and dipyridamole or clopidogrel and aspirin, yields better results. At the study's one-year mark, eight patients have been enrolled with a projection of adding one to two more patients a month over the next two years. Dr. Aninda Acharya is the principal investigator.

Several other projects supervised by Dr. Cruz-Flores involve West Nile virus encephalitis and herpes encephalitis. The West Nile virus study is not as active this year as last because of the decrease in patients in the St. Louis area diagnosed with this virus. Sponsored by the National Institute of Allergy and Infectious Disease (NIAID) and called CASG (Collaborative Antiviral Study Group), this program is being conducted in partnership with the University of Alabama in Birmingham (UAB). A grant to UAB was given to look at viral diseases and their effect on the nervous system. One study follows the natural history of West Nile virus encephalitis in untreated patients. Another studies the effect of OMR-Ig, an immunoglobulin produced by an Israeli pharmaceutical company, on patients in this country with West Nile virus encephalitis. The serum comes from Israelis, who typically have a higher titer of antibodies against West Nile virus than Americans because of the presence of this virus in Israel for many years. Patients in this trial have the option of receiving OMR-Ig or being left untreated. A third study is evaluating the effectiveness of the medication, valacyclovir, in reducing the recurrence of herpes encephalitis. Patients participating in this blind clinical trial are being given either valacyclovir or a placebo orally for three months following a standard two-week course of intravenous acyclovir.

Additionally, for the last two years, SSI has participated in the NIH-funded study, Secondary Prevention of Small Subcortical Strokes, which is evaluating various means to lower the rate of recurrence of small vessel strokes. The supposition is that the accumulative effect of these strokes impairs cognition and evolves into vascular dementia. To date, 12 patients have been enrolled with the expectation of adding one to two a month over the next two years, says Dr. Cruz-Flores, principal investigator.

Dr. Acharya has recently undertaken a stroke clinical core project for SSI based upon a registry of patients admitted to Saint Louis University Hospital and Forest Park Hospital with stroke. The purpose of this registry is to compile demographical information about the patients, the types of stroke and degrees of disability, so that SSI can better care for the patients they see.

Dr. Edward Hogan, director of the Greater Midwest Epilepsy Treatment Center, reports that this has been a year of publishing the results of clinical research. Articles in two journals feature data gathered on 32 patients with temporal lobe epilepsy evaluated in the monitoring unit from 1997-2002. Dr. Hogan developed a technique for determining the site within the brain where seizures originate and a method for predicting what other areas of the brain would likely be affected. Patients in the monitoring unit were given radio-ligand intravenously while they were experiencing seizures to see where there was increased blood flow within their brains. The theory was that these sites of increased blood flow reflected the excessive electrical activity of a seizure focus. The blood flow changes were recorded and averaged to help determine patterns of involvement in other parts of the brain, such as the basal ganglia and insula. In Nuclear Medicine Communications, Dr. Hogan demonstrates how the blood flow changes were averaged, and a soon-to-be published article in the Journal of Nuclear Medicine will show the different patterns of brain involvement related to temporal lobe epilepsy.

The August 2004 issue of Brain profiled eight years of research that Dr. Hogan has conducted to compare the hippocampus in healthy subjects to those with temporal lobe epilepsy. Thinking digitally, he devised a template of a MRI-scanned normal hippocampus and superimposed it over that of a patient with epilepsy to determine the differences. This was accomplished in 30 patients. What was discovered is that the deformation of hippocampi is clearly delineated by this digital brain mapping technique and exceeds information previously gained from surgically removed specimens.

Rebecca Grubb of the Neurology Support Staff has been named a SLUStar. She is one of five university employees selected for exemplifying a commitment to Ignatian ideals by living Saint Louis University's guiding principles of conscience, commitment, competence, compassion and community. Rebecca is a medical secretary in the epilepsy section.

In the administrative offices, members, Mary Sommers and Melissa Beckman, have changed positions. In addition to her new duties as receptionist, Mary is medical secretary to Drs. Ling Xu and Aninda Acharya. Melissa now serves Drs. Ghazala Hayat, Florian Thomas and Robert Woolsey as their medical secretary. In the clinic, the Department welcomes three new staffers. Rita Walter has been hired as clinic manager, Everal Oldham as licensed practical nurse, and Angela Bertagnolli as senior patient coordinator.

Wanda Laden, who worked as a licensed practical nurse in the neurology clinic for 11 years before her retirement, was recognized at the annual Department gathering in June.