Dr. Alma Bicknese settling into her laboratory at Pediatric Research Institute.

Dr. Alma Bicknese has joined the Department faculty in the Child Neurology Section. With support from her National Institutes of Health grant, Dr. Bicknese is continuing her research on the development of synaptic circuits in the cerebellar system. A greater understanding of this process could play a key role in treating patients with brain injury. Their recovery is directly related to the rewiring of neural circuits in the brain. Dr. Suresh Kotagal, director, says Dr. Bicknese divides her time between her laboratory in the Pediatric Research Institute and the child neurology service in the nearby Cardinal Glennon Children's Hospital. She also covers the outreach clinic at St. Joseph Health Center in St. Charles. Dr. Bicknese comes to Saint Louis University from State University of New York at Stony Brook, where she was assistant professor of neurology and pediatrics. During her affiliation with Washington University from 1985-92, Dr. Bicknese trained in pediatrics and neurology, conducted research in developmental neurology and served as an instructor. She received her degree in medicine from the University of Illinois in Urbana. In another outreach endeavor, Dr. Glen Fenton (R-91) is seeing child neurology patients at Hannibal Regional Hospital in Hannibal, Mo., at the invitation of Dr. Brett Hosley (R-92), who is in private practice there. Dr. Kotagal mentions that other such activities are being planned to broaden the referral base. He also proudly notes that initiating continuous quality control measures in the outpatient clinics has yielded an over 90 percent rate of patient satisfaction.

From the Neurology Service at John Cochran Veterans Affairs Medical Center (JCVAMC), Dr. Frank Mithen, chief, reports that Dr. Salvador Cruz-Flores (R-96, F-97) has established a stroke program for clinical management, research and prevention. According to Dr. Mithen, stroke is the most common admitting diagnosis at JCVAMC. A clinic will soon open for patients with multiple sclerosis, and will be supervised by Dr. Florian Thomas. The other specialty clinics in Parkinson disease, neuromus-cular disorders and epilepsy continue to run smoothly. In conjunction with Saint Louis University, JCVAMC now has fellows in epilepsy and clinical neurophysiology doing diagnostic procedures and seeing patients. In news of the Souers Stroke Institute (SSI), Dr. Daryl Thompson, director, is pleased that Dr. Cruz-Flores is now on the Department's faculty and running the stroke program at JCVAMC. The potential for cooperation and collaboration with the VA, he says, will make SSI all the stronger. It increases the number of patients screened and opens the possibility for joint clinical research studies. Eve Holzemer has been hired as the institute's nurse practitioner and coordinator of clinical research studies. Dr. Thompson notes that she has been a wonderful ambassador in caring for patients, representing SSI at national meetings for experimental drug trials, and speaking to groups about stroke. In updating the status of trials in which SSI has participated, Dr. Thompson reports that the latest results of the North American Symptomatic Carotid Endarterectomy Trial (NASCET) show that patients with more than 50 percent stenosis of the carotid artery fared better with surgical treatment as compared to those given aspirin alone. He adds that patients exhibiting lesser grades of stenosis had a favorable outcome with surgery because of fewer health issues and a selected surgeon with a high success rate for this procedure. The Pro-urokinase Acute Cerebral Thromboembolism (PROACT) trial has been completed, and the outcome is pending. With the sale of Saint Louis University Hospital, Dr. Thompson comments that SSI is determining its new role as a provider of tertiary care in a network of regional hospitals owned by Tenet. He concludes by saying SSI is planning a basic science section to complement its clinical research.

The SSI's Cerebrovascular Laboratory has recently acquired an updated transcranial Doppler machine that records the sound as well as the visual image of blood flow through the arteries. Dr. Christina Burch, director, also says that the laboratory has developed the expertise in ultrasound to examine the blood vessels in the eye. This is particularly helpful in monitoring retinal deterioration in patients with diabetes or hypertension. Additionally, the laboratory is using ultrasound of the temporal artery as a non-invasive procedure to rule out temporal arteritis.

The SSI's PremierCare Neurorehabilitation Unit received three-year accreditation from CARF, the rehabilitation accreditation commission. This represents the unit's third consecutive highest-level award for comprehensive rehabilitation since its inception in 1989 at Bethesda General Hospital. The acute inpatient program also received a new accreditation in brain injury rehabilitation. In further news, Dr. Burch, medical director, notes that a subacute neurorehabilitation service will soon open on the hospital's first floor for patients who are too ill to do more than an hour and half of rehabilitation a day. The bridge program begun last year to smooth the transition from hospital to home for patients not needing extended care is working well. Dr. Burch also serves as medical director for regional outpatient facilities called Premier Place, where patients with head injury can continue to recover beyond acute rehab. The facilities concentrate on improved mobility, cognitive ability as well as job-oriented and life skills. With the purchase of CASE IV, the Clinical Neurophysiology Laboratory is now performing quantitative sensory testing. The equipment's ability to evaluate all the sensory modalities is helpful, explains Dr. Ghazala Hayat, medical director, in objectively measuring subjective symptoms, such as pain, temperature and tingling. Patients with sensory complaints who have hereditary neuropathies, nutritional deficiencies and occult malignancies are among those who have benefited. This testing will also be used over the next three years by the laboratory to follow a group of patients in a multi-center trial evaluating the effectiveness of a nerve growth factor in treating diabetic polyneuropathy. The clinical neurophysiology fellows for 1998-99 are Drs. Brandon Chandos and Bashir Yousufazi, who completed their neurology residencies, respectively, at the University of Washington in Seattle and Temple University in Philadelphia, Pa. Following his residency, Dr. Chandos was in private practice for nearly two years at the Center for Neurology and Rehabilitation in Phoenix, Ariz.

The Greater Midwest Epilepsy Treatment Center has begun a fellowship program announces Dr. Edward Hogan, director. The first two fellows are Drs. Mary Bertrand and Ghulam Khaleel. Dr. Bertrand finished her residency in child neurology at Saint Louis University, and Dr. Khaleel completed his in adult neurology at Vanderbilt University in Nashville, Tenn.

According to Dr. Hogan, the clinical service has grown enough to keep two fellows busy, and funding was available. They will also rotate at JCVAMC where there is an epilepsy clinic. He is working with the Department's child neurologists at Cardinal Glennon Children's Hospital in a team effort to further develop the epilepsy service there. Over the last two years, Dr. Hogan, the clinical service has grown enough to keep two fellows busy, and funding was available. They will also rotate at JCVAMC where there is an epilepsy clinic. He is working with the Department's child neurologists at Cardinal Glennon Children's Hospital in a team effort to further develop the epilepsy service there. Over the last two years, Dr. Hogan says that approximately 50 patients have undergone an ictal SPECT scan of the brain to help pinpoint the origin of their seizures. As a result, many of these patients have had their epilepsy treated surgically with success.

In related news, Dr. Bassam Assaf continues to develop his clinical research in three-dimensional identification of epileptic foci with dipole electrode electroencephalography and a novel software program known as CURRY. The epilepsy unit in Saint Louis University Hospital will soon expand to three full-time monitoring beds. Approximately 150 patients are evaluated a year. Their stays vary from a few days to a week, depending how long it takes to record a seizure in progress.

In the Department's Administrative Office, Pamela Boyd has joined the staff as billing coordinator.