neurological institute - cleveland clinic...02 chairman’s letter 04 cleveland clinic neurological...

Neurological Institute

2011 Year in Review

02 Chairman’s Letter

04 Cleveland Clinic Neurological Institute Overview

22 Institute Review

26 Staff Directory

31 Resources for Physicians and Patients

On the cover The neuropsychological test, Trials B, is being administered to an athlete. The Trials B test, which is one of five Cleveland Clinic Concussion app modules, measures visual attention, task switching and working memory. With this app, the athlete’s complete data set is stored for detailed analysis and can be replayed by a treating physician should the athlete sustain a concussion.

Contents

Expert Neurological Care Throughout an Integrated Hospital System

The multidisciplinary Neurological Institute fosters collaboration among Cleveland Clinic medical,

surgical and research specialists to promote comprehensive, compassionate, patient-centered care.

In this review, we highlight recent achievements in the research, diagnosis and treatment of

neurological disorders. From our main campus to our regional hospitals and family health centers

to Florida and Nevada, we remain united by the goal of creating superior outcomes through

exceptional care.

Michael T. Modic, MD, FACR

Dear Colleagues,

When formed in 2006, the Neurological Institute had 11 disease-specific centers and fewer than 200 specialists.

In the intervening years, the institute has experienced significant growth. Currently, we have 16 centers and

more than 300 specialists. In 2011, we conducted some 220 clinical trials supported by more than $19.6 million

in neurologically based grants from government and industry.

2 Chairman’s Letter

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Cleveland Clinic Neurological Institute Year in Review 3


Chairman, Cleveland Clinic Neurological Institute

More important is the substance behind the

statistics. For example, our Lou Ruvo Center for

Brain Health did not exist in 2006. Today, this

center is engaged in diagnosis, treatment and

research on neurocognitive disorders at all stages

of life, from traumatic brain injuries that tend to

occur in youth to Alzheimer’s disease in the

later years. New clinics for movement disorder

patients and multiple sclerosis patients have

been established at the center’s Las Vegas site.

Here is a look at our most promising pursuits:

•Confronting concussion The Neurological

Institute’s Center for Spine Health, Center for

Brain Health, Department of Neurological Surgery

and Spine Research Laboratory, in conjunction

with the Lerner Research Institute and Cleveland

Clinic Sports Health, are among the entities most

heavily involved in an enterprise-wide investigation

of the traumatic euromechanics of concussion

and subconcussive injury.

•Expanding options for epilepsy patients

Epilepsy Center neurosurgeons are pioneering

image-guided robotic placement of stereotactic

depth electrodes, an approach that could

eventually supersede current surgical techniques

for invasive brain mapping.

•Saving lives after aneurysm Our Cerebrovascular

Center can now provide endovascular treatment

for large or giant wide-necked intracranial

aneurysms. The Pipeline® Embolization Device

fillsanunmetneed,offeringnewhopetoa

subset of aneurysm patients with very high

morbidity and mortality rates.

Our research section provides an overview of

notable laboratory-based and translational

investigations from neuroscientists in the

Lerner Research Institute and clinical studies

from their collaborators throughout the institute.

I appreciate this opportunity to update you on

our progress. Regardless of whether we have

partnered in the past, the Neurological Institute

stands ready to support you in delivering the

highest-quality care to your patients.

The institute is anchored by specialized, disease-

specific centers. Each center incorporates a

multidisciplinary approach to the diagnosis and

management of a particular disease or group of

diseases, combining the expertise of physicians

and allied health professionals to foster collabora-

tion and improve patient access.

The institute comprises four departments:

Neurology, Neurological Surgery, Psychiatry

and Psychology, and Physical Medicine and

Rehabilitation — that integrate resident training,

academics and research.

U.S.News & World Report’s “America’s Best

Hospitals” survey consistently ranks our neurology

and neurosurgery programs among the top 10 in

the nation. For us, 2011 was no exception. We

maintained the top ranking in Ohio for neurology/

neurosurgery, pediatric neurology/neurosurgery and

psychiatry. We are also ranked among the nation’s

top programs for rehabilitation.

Expert, Specialized Diagnosis

Neurological Institute physicians draw on advanced

diagnostic capabilities and experience. Our imaging

services include structural and functional MRI, CT,

PET, myelography, diagnostic cerebral/spinal angi-

ography, interventional neuroradiology, and carotid

and transcranial Doppler ultrasound. Since 2008,

more than 400 studies have been performed in our

magnetoencephalography (MEG) laboratory. Our

neuroimaging staff subspecializes in disease entities

such as epilepsy and cerebrovascular disease, ensuring

accurate, in-depth interpretations.

Cleveland Clinic Neurological Institute Overview

Overview4

The multidisciplinary Cleveland Clinic Neurological Institute includes more than 300 medical, surgical and

research specialists dedicated to the diagnosis, treatment and rehabilitation of adult and pediatric patients

with disorders of the brain and central nervous system.

Neurological Institute Centers

• Center for Behavioral Health

• Lou Ruvo Center for Brain Health

• Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center

• Cerebrovascular Center

• Cleveland Clinic at Home

• Epilepsy Center

• Mellen Center for Multiple Sclerosis Treatment and Research

• Center for Neuroimaging

• Neurological Center for Pain

• Center for Neurological Restoration

• Neuromuscular Center

• Center for Pediatric Neurology and Neurosurgery

• Department of Physical Medicine and Rehabilitation

• Center for Regional Neurosciences

• Sleep Disorders Center

• Center for Spine Health


Additional diagnostic tools are found in our epilepsy

monitoring units, sleep laboratories, neuropsycho-

logical testing facilities, electromyography laboratory

and cutaneous nerve laboratory.

The Latest Treatment Modalities

Patients find leading-edge treatment options at

the Neurological Institute, where we continue to

advance such innovations as deep brain stimulation,

laser interstitial thermal therapy for brain tumors,

epilepsy surgery, stereotactic spine radiosurgery,

endovascular treatment of cerebral aneurysms and

vascular malformations, and neuroendoscopy. Joint

Commission certification as a Primary Stroke Center

and accreditation by the American Academy of Sleep

Medicine are just two reflections of our commitment

to provide the most advanced, highest-quality care

to our patients.

Relevant Research

We conduct research directly related to conditions

experienced by our patients, including translational

research and clinical trials of drug and device inter-

ventions. In 2010, 219 clinical research projects

involving almost 2,500 patients were under way in

the Neurological Institute. Neurologically based

research grants and contract awards totaled nearly

$20 million.

Research Funding

Grant and contract research dollars funding neurological investigations in the Neurological Institute, Lerner Research Institute and other Cleveland Clinic collaborators totaled almost $20 million in 2010.

2010

New clinical research projects 75

Total active clinical research projects 219

Staff leading clinical research projects 61

New patients enrolled in clinical 715 research projects

Total patient enrollment in clinical 2,467 research projects

National Institutes of Health grants 105 and contracts*

Neurological grants and contracts 221 (non-NIH)*

* Includes collaborating investigators in Lerner Research Institute, Imaging Institute and other Cleveland Clinic collaborators.

Overview6

Convenient Care in the Community

We are committed to making access to the

most advanced care convenient for all patients.

Neurological Institute services are available at

Cleveland Clinic community hospitals and family

health centers throughout northeast Ohio, as well

as in Nevada and Florida. As a result, patients can

easily access specialists who treat the most complex

neurological conditions. This approach is predicated

on the notion that those we serve are entitled to a

uniformly high level of care, and location should

never be an issue. As a result, patients can easily

access specialists who treat the most complex

neurological conditions.

Key components in our regional network include:

• Cleveland Clinic Neurological Institute at Lake-

wood Hospital and Cleveland Clinic Neurological

Institute at Hillcrest Hospital, providing compre-

hensive services throughout the community

• Nearly 100 acute inpatient rehabilitation beds at

facilities across northeast Ohio

• A team of more than 650 specialty-trained thera-

pists at more than 45 locations offers physical

medicine and rehabilitation services

• Cleveland Clinic at Home, which brings in-home

and distance healthcare to individuals in an

expansive area encompassing 14 Ohio counties

and provides home infusion/pharmacy services

in eight states

Recognizing that caring for a patient doesn’t end upon discharge, Cleveland Clinic at Home provides follow-up care in the patient’s home.

Neurological Institute Volume, 2010

Patients

Total outpatient visits 154,944

Admissions 15,491

Inpatient days 98,808

Procedures

Surgical/interventional 8,230

Neuroimaging studies 98,276

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Integrated Nursing

Nurses in the Neurological Institute rank as respected

members of the care team. As such, they are

encouraged to offer their input to physicians and

administrators and to engage in problem solving

and process improvement. Patients benefit from this

integration through improved coordination of care

and commonly held provider goals.

Opportunities for further education and career

advancement are readily available to institute nurses.

Their participation is welcomed in all continuing edu-

cation programs, and those with at least two years’

experience in the institute can aspire to certification

in neuroscience nursing. These subspecialists staff

areas such as the Neurological Intensive Care Unit

and neurological stepdown units that treat the most

complex patients.

Each November, Cleveland Clinic’s “Innovations in

Neuroscience” conference convenes in Cleveland.

One of the goals of this meeting is to foster increased

provider collaboration between the attendees, com-

posed of nurses, physician assistants and medical

assistants.

Pioneering the Collection of Data and Outcomes

The Neurological Institute’s Knowledge Program©

has captured data from more than one million

self-administered patient questionnaires. One of the

world’s first interactive clinical patient databases,

the Knowledge Program is demonstrating its value

as it evolves, with collection and correlation of elec-

tronic information on patient health status, quality

of life and outcomes.

We are aggregating this patient-generated data with

information from other sources such as imaging

results and information collected during patient

encounters, to optimize clinical decision making,

quality improvement and research opportunities.

All these data are accessible to physicians through

an interface with the patient’s electronic medical

record. The Knowledge Program is proving to be

among our most constructive tools for delivering

individualized care to improve outcomes and quality

of life, in line with Cleveland Clinic’s guiding principle:

Patients First.

Meeting the complex medical needs of a patients with a wide range of rehabilitation needs demands a healthy partnership between physiatrists and rehabilitation nurses.


Left Jay Alberts, PhD, activates a balance app on the iPad2. The iPad2’s built-in gyroscope and accelerometer allow the device to measure position and movement of the athlete, which is then translated by the app to provide an objective measure of postural stability.

Cleveland Clinic Concussion Center: A Multidisciplinary Team Tackles a Massive Clinical Problem

Rapidly identifying concussion in athletes and expediting clinical intervention are crucial for optimizing safety

and timeliness of return to play. Conversely, objective analysis made quickly and accurately at the time of injury

can keep a player benched — and prevent a sometimes-fatal second impact. To that end, Cleveland Clinic is

developing better, faster, more accurate tools for diagnosing, preventing and managing concussions.

Gaming Technology with Diagnostic and

Management Potential

The gyroscope and accelerometers that make the

iPad®2 by Apple® such an agile video gaming instru-

ment also make it an excellent tool for analyzing the

multi-dimensional symptoms, both motor and cogni-

tive, of concussion at the time of injury and during

the return-to-play decision-making phase.

Research led by Jay Alberts, PhD, is being conducted

on Cleveland-area high school and college athletes

using an iPad2 that is attached to the body, and a

proprietary app that collects position and time series

data along with linear and angular acceleration data

as clinical tests are performed. The data are then

analyzedtoobjectivelyquantifyspecificchangesin

cognitive and motor functioning and any declines

in balance and postural (in)stability. This technology

represents a fundamental change in the level of

objectivity and the comprehensive nature of assessing

athletes following concussions, and has potential to

become an affordable, point-of-care tool for schools

and sports organizations to use in the baseline testing

and post-injury management of concussion.

Better Helmets, Better Protection

Football helmet testing has shown that in certain

instances, pre-World War II-era leather helmets

performed on par or better than some helmets cur-

rently used in high school, college and professional

football. Similar studies demonstrate that padding

did not always appreciably reduce risk of head and

neck trauma. Through a $100,000 grant from the

National Football League Charities, Cleveland Clinic

Concussion Center researchers are studying the role

of the neck in mitigating head trauma, and its role in

concussion in young athletes. Tests are also being

conducted to benchmark protective headgear. To this

end, Adam Bartsch, PhD, and colleagues have devel-

oped the Cleveland Clinic Intelligent Mouthguard.

Clevleand Clinic Neurological Institute12

The Intelligent Mouthguard collects head impact data,

and measures linear and rotational head movement in

real time. The data is then compared with post-game

neurological and motor test results, and used to drive

acomputer-basedfiniteelementbrainmodelthat

helps diagnose and pinpoint head injuries.

It is expected that the Intelligent Mouthguard will

provide data that captures all concussions, including

those currently undiagnosed, as well as offer insight

intosaferhelmetsdesignedspecificallyforayoung

athlete’s physiology, replacing the current “little

adult” helmets.

A two-year, $300,000 NIH National Institute for

Neurological Disorders grant to the laboratory of

Damir Janigro, PhD, and Nicola Marchi, PhD, will

allow further development of a diagnostic and prog-

nostic tool for “silent concussion” in sports.

Acute, traumatic brain injury is not always immediately

evident. The current standard is to perform CT or

MRI scans, which cost many thousands of dollars

and expose the patient to often-unnecessary doses

of radiation or contrast agents.

Realizing that brain damage is often preceded by an

abnormal blood-brain barrier disruption, a Cleveland

Clinic Lerner Research Institute team led by Dr.

Janigro and Dr. Marchi is developing a blood test that

reveals the status of the blood-brain barrier within a

few minutes. When administered within four hours

of injury, testing for the presence of S100B protein

accurately predicts which patients will need a CT or

MRI and will show a traumatic abnormality on such

a scan. The test to determine blood-brain barrier

damageisthefirstofitskindanditsuseisgaining

momentum in trauma centers across the world.

10

LEAKY

BBB

(Head

Trauma)

BLOOD BRAIN

S100B

LEAKY

BBB


The research team is further studying whether the

testisusefulfordeterminingaplayer’sfitnessto

returntothefield,creatingthepossibilitythata

portable test for S100B protein could be developed

foruseonthesidelinesofathleticfields,aswellas

emergency rooms.

Researchers at Cleveland Clinic recognize that

concussions, including mild traumatic brain injury

(mTBI), are due to many factors and that a multi-

modal approach is needed for an accurate diagnosis,

evaluation and treatment along the entire concussion

care path continuum. Our research teams are using

a multidisciplinary approach to harness the syner-

gistic power of state-of-art sensors, the ease of use

and reliability of personal computers, as well as the

quantitative and reproducible information of diag-

nostic blood tests. The goal is to produce a digital

footprint of individual brain health history to allow for

an informed decision-making process by patients,

their families and physicians.

Facing page, left and center Impacts conducted with leather and modern helmets showed that the leather helmet impact dosage was on par with modern “varsity” helmets.

Facing page, right S100B protein is normally present in the brain and not in blood. S100B is readily released in blood upon blood-brain barrier damage and can be measured using an ELISA assay. Drs. Janigro and Marchi’s recent data have shown that S100B elevation occurs in the blood of players who have sustained significant head hits.

Above The Intelligent Mouthguard head impact dosimeter has gone through several laboratory prototypes and is now being used to collect human data.

13Cleveland Clinic Neurological Institute Year in Review

Left One of the leading specialists in the nation, Brian Appleby, MD, has recently joined Cleveland Clinic Neurological Institute, to care for Alzheimer’s patients and lead research into what is currently a fatal disease.

Focusing on Brain Health

Cleveland Clinic’s Lou Ruvo Center for Brain Health is at the heart of an innovative network for advancing new

therapies for Alzheimer’s disease and other neurocognitive disorders.

The center’s unique model of collaboration connects

Cleveland Clinic’s main campus with Lakewood

Hospital, a community hospital on Cleveland’s west

side, Cleveland Clinic Lou Ruvo Center for Brain

Health in Las Vegas, Reno and Elko, Nevada, and

Cleveland Clinic Florida. Research is conducted

under one leadership, one set of operational guide-

lines, with standardized data collection approaches

and a single institutional review board for research

approval. This infrastructure may become a model

for how healthcare systems embrace clinical trials,

speeding the emergence of new therapies.

Current initiatives include:

•Alandmarkstudywithprofessionalfighterstohelp

determine whether MR imaging of the brain, along

with other tests, can detect subtle changes in brain

health that correlate with impaired thinking and

functioning. This research may result in better ways

to prevent permanent brain injury.

• The two-year study to evaluate the safety and toler-

ability of a vaccine for mild to moderate Alzheimer’s

disease. This experimental immunotherapy (ACC-001)

is given in six intramuscular injections over the

24-month period to investigate whether it may alter

the course of memory decline in patients with pro-

dromal Alzheimer’s disease.

• A pilot descriptive study of a blood test for detecting

Alzheimer’s disease, will assess the performance

of AclarusDx™ in newly diagnosed patients suffering

from memory impairment.

Expanding Services

In Las Vegas, Lou Ruvo Center for Brain Health has

expanded services to now provide diagnosis and medi-

cal management of movement disorders and multiple

sclerosis. Rehabilitative resources, including physical,

occupational and cognitive therapy, are also available.

In Cleveland, Lou Ruvo Center for Brain Health

has added expertise in Prion diseases, such as

Creutzfeldt-Jakob disease, which are the most

common cause of rapidly progressive dementias.


Advanced Treatment for Aneurysms — Embolization That Preserves Vessel Integrity

New technology is revolutionizing treatment for large or wideneck intracranial aneurysms. Once treatable only

with open surgery and clipping, endovascular procedures or palliative care, these aneurysms can now be

addressed with a minimally invasive procedure.

In April 2011, the U.S. Food and Drug Administration

approved the Pipeline™ Embolization Device (PED), a

flexible,fine-meshstentthatprovidescompleteand

lastingembolizationbyreducingbloodflowtothe

aneurysm while reinforcing the vessel wall. Cleveland

ClinicisoneofthefirstinstitutionsintheU.S.to

perform this type of embolization.

The PED has many advantages over its predecessors.

Its tubular mesh of cobalt chromium and platinum

tungsten is woven so tightly that it can divert 85

percentofbloodflowpasttheaneurysm.Thisallows

the blood remaining in the aneurysm to clot and

closeitoff.ThefineweavemakesthePEDmore

flexiblethanpreviousstents,anditcanbethreaded

through torturous vessel paths. Multiple PEDs can be

telescoped, one through another, when extra length

is required. Finally, the PED forms a scaffold upon

which endothelial cells can grow. As the blood vessel

heals, it grows over the mesh, further reinforcing the

vessel wall.

PEDs incur fewer risks and provide better outcomes

for large-aneurysm patients than conventional treat-

ments. International success rates have been nothing

short of remarkable, with 90 to 95 percent of aneu-

rysms treated with PEDs being completely resolved

and non-recurrent. PEDs effectively reduce mortality

and improve outcomes through rapid sharing of best

practices and expert consultation when time means

the most.

Left Neurosurgeon Shaye Moskowitz, MD, PhD, performs surgery on a patient with a large proximal carotid artery aneurysm by using the Pipeline Embolization Device’s tubular mesh of cobalt chromium and platinum tungsten.

Above Approximately 300,000 brain aneurysms rupture each year, and less than 1 percent of the 300,000 are large proximal carotid artery aneurysms, as shown here.


Left A newly diagnosed Parkinson’s disease patient undergoes a comprehensive baseline evaluation with Hubert Fernandez, MD.

Landmark Search for Parkinson’s Disease Biomarkers Begins

Without any indicators for disease progression, called “biomarkers,” discovering agents that can slow down

orcureuniversallyprogressiveillnessessuchParkinson’sdiseasecanbechallenging.However,findingthe

biomarkers of a disease requires study of a large population over time, and comparisons with healthy control

subjects and patient subtypes.

Hubert Fernandez, MD, Section Head of Movement

Disorders at Cleveland Clinic’s Center for Neurological

Restoration, has begun a clinical study sponsored

by the Michael J. Fox Foundation for Parkinson’s

Research, one of two dozen clinical trials being

offered at the center to patients with movement

disorders. This landmark study is a global effort,

with 16 hospitals participating in the United States

and a few centers Europe. Called the Parkinson’s

Progression Markers Initiative (PPMI), the study

seeks to identify biomarkers for Parkinson’s disease

(PD) progression through imaging, clinical and

biologic tests.

After a comprehensive baseline evaluation, participant

subsetsaredefinedbybaselineassessments,progres-

sion milestones and/or rate of change. All participants

with PD and controls will be repeat-tested every three

tosixmonthsforfiveyears.Allstudyvolunteersundergo

motor, neuropsychiatric and cognitive testing, and

donateblood,urine,DNAandcerebrospinalfluidfor

analysis. Participants with PD must be two years or

less from diagnosis at the time of screening in order

toparticipate.Controlvolunteersshouldnotbefirst-

degree relatives of someone with PD.

Themainobjectiveofthislandmarkstudyistofindany

clinical, imaging and/or laboratory indicators, among

Parkinson’s patients but not in the healthy volunteers,

that can reliably track and predict disease progression.

This study is the largest study of its kind ever to be

undertaken, both in population size (400 subjects)

andlengthofobservation(fiveyears).Thiswillaid

researchers in developing earlier, faster methods of

intervention that may prevent symptoms from ever

becoming full-blown — something that no current

therapy is able to do.


Pre-Surgery Post-Surgery – Day 1 Post-Surgery – Day 13 Post-Surgery – Day 180

AutoLITT Emerges as Leading-Edge Alternative to Brain Tumor Resection

Somebraintumorsthatwereonceconsideredinoperablecannowbereachedbyfiberopticlaserinahighly

targeted, minimally invasive procedure that may offer new hope for improving patients’ quality and length of life.

Cleveland Clinic’s Rose Ella Burkhardt Brain Tumor

Centerwasoneofthefirstmedicalcentersinthe

U.S. to acquire AutoLITT® (Laser Interstitial Thermal

Therapy). It also is one of only three that have an

AutoLITT unit integrated with an intraoperative MRI

suite. To date, more AutoLITT procedures have been

performed in Cleveland Clinic’s IMRIS Neuro™ suite

than at all of the other centers combined.

AutoLITT destroys tumor cells with laser-generated

heat. Though laser ablation of tumors is not a new

technique, AutoLITT’s ability to match the shape

of the coagulation to the shape of the tumor using

its guidance and imaging systems is considered

novel. Because Cleveland Clinic’s unit is embedded,

patients do not have to be transported to a diagnostic

MRI when imaging is needed. Rather, the MRI is

located in the operating suite — improving patient

safety and reducing procedure time.

The AutoLITT system, developed by Monteris

Medical Inc., allows the surgeon to steer and monitor

a MRI-guided laser probe that ablates tumor tissue

while limiting risk to surrounding healthy tissue.

The technique is minimally invasive, and the high-

precision movements of the laser literally “cook”

the tumor, eliminating the need for open surgery.

The laser heats the tumor tissue to 160 degrees

Fahrenheit in one direction, while simultaneously

cooling in the other to prevent charring and help steer

the heating process. The MRI continually refreshes

images of the laser’s progress throughout, mapping

the heat inside the tumor every seven seconds.

Hospitalization after AutoLITT treatment is typically

half that of conventional surgery (one or two days).

Further, repeat procedures may be performed, help-

ing some patients avoid the risks of open surgery and

enablingtreatmentfordifficult-to-reachtumorsthat

might otherwise be deemed inoperable.

.

Left and Above Results following AutoLITT procedure and changes in T1W over time are comparable to standard surgical procedure for non-surgical lesions.

Targeting Epileptic Activity with Magnetoencephalography (MEG)

Determining whether a patient with epilepsy may be best treated with surgery requires highly-precise record-

ing of electrical activity in the brain that helps determine which areas are functioning normally and which

may be resected.

Magnetoencephalography (MEG) represents the lead-

ing edge of technology for recording electrical activity

in the brain. In epilepsy, MEG shows the propagation

of activity from one brain region over a few millisec-

onds, or during seizure onset. Currently, ictal MEGs

account for approximately 15 percent of MEG scans

performed at Cleveland Clinic’s Epilepsy Center. MEG

results are then combined with anatomic images

from MRI and reconstructed in 3-D to show areas of

activity with pinpoint accuracy.

MEG can localize epileptic activity with higher

accuracy than any other noninvasive modality can,

without the blurring and smearing that affect EEG

results. The more-than 300 sensors embedded in

the MEG helmet produce a high-resolution picture,

and the unit’s instrumentation is unaffected by

interference from the skull or scalp. When MEG is

combined with high-resolution anatomic images from

MRI,neuronalactivitycanbelocalizedtospecific

sub-lobararea,usuallytoaspecificgyrusorsulcus.

With its high spatial and temporal resolution, MEG

is an excellent tool for noninvasive analysis and

visualization of epileptic activity in patients whose

seizures cannot be fully controlled with medications.

Ultimately, MEG can determine whether a patient

with intractable epilepsy is a surgical candidate. If

the patient must undergo intracranial recording with

subdural or stereoelectroencephalographic (SEEG)

electrodes before surgical resection, MEG can guide

electrode placement to ensure coverage of all possible

epileptogenic regions.

The MEG scan is noninvasive, painless and safe for

all ages, with no injections, radioactivity or strong

magneticfields.


Left Parents are allowed to accompany their child into the MEG testing room, a practice that can calm and comfort pediatric patients.

Above Specialized display software shows the location of epileptic activity as determined by MEG, together with areas of normal function from fMRI, to determine placement of subdural grid electrodes (also shown) on a 3-D anatomical MRI.

Institute Review22

Identifying Potential Origins of Cognitive

Dysfunction in Multiple Sclerosis

In 2011, a cross-institutional collaborative team at

Cleveland Clinic led by Bruce Trapp, PhD, published

itsfindingsinAnnals of Neurology. Their study,

conducted on postmortem hippocampi from the

brains of individuals with Multiple Sclerosis (MS),

established that the loss of myelin common in MS

leadstoalterationsingenesinvolvedinspecific

neuronal functions, and that demyelination also

alters mRNA that encodes for neuronal proteins

involved in synaptic integrity and memory function.

The consequence of these alterations is a disruption of

maintenance functions and the number of hippocampal

synapses. Conclusions drawn from the study include

development of new targets for therapies that may

restore balance and preserve if not improve memory

and cognitive functions. Additionally, noninvasive

imaging modalities that can distinguish myelinated

from demyelinated hippocampi at early stages of

disease may allow therapeutic intervention when it

is most likely to be most effective.

Targeting Alzheimer’s Disease with Immunotherapy

Due to the aging of the U.S. population, the incidence

of Alzheimer’s disease (AD) is expected to rise dramati-

cally in the coming decades. Cleveland Clinic Lou

Ruvo Center for Brain Health is building a comprehensive

AD trial program that connects centers in Cleveland,

Las Vegas and Florida. AD is characterized by the

abnormal accumulation of amyloid plaques in the

brain, thus becoming a major therapeutic target.

Currently, 11 trials are under way, evaluating various

AD therapeutic agents, with four trials involving active

and passive beta-amyloid protein immunotherapy. Two

are focused on patients in the prodromal phase of AD

when treatment can have a greater impact on disease

progression. If the treatments evaluated in the trials

show convincing results, they will be submitted for

FDA approval. Additionally, the number of trials

currently under way underscores the continued need

for recruitment of participants.

Coronal MR image showing shrinkage of the hippocampus consistent with Alzheimer’s disease.

Research and Innovation

Cleveland Clinic’s Neurological Institute conducts a robust research program that fosters a culture of innovation

and collaboration. Physician investigators and scientists pursue laboratory-based research whose findings

are applied to improve patient care. In 2010, we were awarded more nearly $20 million in neurologically

based research grants and contracts.

Biomechanical Testing Rises to a New Level

To understand spinal disorders, it is often helpful

to compare the biomechanical behavior of motion

segments of a normal, intact spine to those of

diseased spines affected by degeneration, surgical

decompression or spinal instrumentation. Sophisticated

programming and feedback systems now allow us

to robotically apply load-controlled methodologies in

circumstances where spinal rigidity may be high, yet

still provide displacement-controlled limits that

prevent damage and disruption of adjacent, more

fragile segments. This “hybrid” control allows robotic

testing to more closely simulate the complex coupled

motions of the actual human spine in real life.

On top of this, the robot’s ability to simultaneously

apply rotational, axial and shear loads allows a more

sophisticated level of testing than possible before.

Early results in studies at the Cleveland Clinic Spine

Research Laboratory at Lutheran Hospital have

shown that robotic systems are versatile, sensitive

and adaptable to a wide variety of spinal segments

and testing arrays. Studies are currently under way

onlumbarfixation,cervicalmechanicsandmotion

preserving implants.

Novel Technology

A recent acquisition provides Cleveland Clinic with

one of only a handful of 3-D electron microscopy

(3-D EM) machines in the world. The equipment is

capable of analyzing the 3-D relationship of cells in

the highest detail, representing a major advance over

2-D electron microscopy, on the level of taking a

snapshot of cells vs. an animated roller-coaster ride

through them. Potential applications include the

study of memory, synapses between cells, and the

neural mechanisms of learning. Currently, in vivo and

in vitro assays in remyelination, synapse organization

and mitochondria are under way.


Robo-mechanical testing in action, with infrared motion-tracking markers shown during a lumbar spine test.

24 Institute Review

Integrating World-Class Care Nationwide

Cleveland Clinic’s Neurological Institute has locations throughout Northeast Ohio and in Florida and Nevada,

making it easier for patients to access specialists who treat the most complex neurological conditions.

The Center for Regional Neurosciences combines physicians and other healthcare providers in neurology,

neurosurgery, neuroradiology and behavioral health, who see adult and pediatric patients at Cleveland Clinic

locations throughout Northeast Ohio and beyond. Regional facilities extend advanced treatments, technolo-

gies and the expertise of Cleveland Clinic into surrounding communities, making it easier for patients to

access specialists who treat the most complex neurological conditions.

Better Access to Clinical Trials

Clinical trials linking sites in Cleveland, Florida

and Nevada allow more patients access to clinical

advances in treatment for movement disorders,

Alzheimer’s disease and dementia, from specialty

programs highly ranked by U.S.News & World Report.

Expanding Services, Improving Outcomes

The Lou Ruvo Center for Brain Health diagnoses,

treats and researches Alzheimer’s disease and other

neurocognitive disorders from locations in Cleveland

and Lakewood, Ohio; Las Vegas, Reno and Elko,

Nevada; and Florida. Diagnostic tests performed at our

regional facilities and other Cleveland Clinic sites can

be digitally transferred to Cleveland for interpretation

by one of the world’s leading neuroimaging centers.

The Cleveland Clinic Lou Ruvo Center for Brain

Health in Las Vegas collaborates with the Cleveland

Clinic Mellen Center for Multiple Sclerosis Treatment

and Research in Cleveland on diagnosis, treatment

and research of MS. Staff in Las Vegas also collabo-

rate with Cleveland Clinic’s Center for Neurological

Restoration on the treatment of movement disorders,

participating in patient management conferences to

helpdeterminewhichpatientswillbenefitthemost

from surgical treatment.

At Cleveland Clinic Florida, epileptologists diagnose

patients in a dedicated four-bed adult epilepsy

monitoring unit and collaborate with their colleagues

in Cleveland when surgical treatment is recommended.

Programs for brain tumor treatment, Alzheimer’s

disease and dementia are similarly linked.


Cleveland ClinicChagrin Falls

Cleveland ClinicStrongsville

Cleveland ClinicBrunswick

Cleveland ClinicWestlake

Cleveland ClinicLorain

Cleveland Clinic

Children’sHospital,Shaker

Cleveland ClinicElyria Cleveland Clinic

Broadview Heights Cleveland ClinicTwinsburg

Cleveland Clinic Avon

Lake Erie

Cleveland ClinicWooster

Cleveland ClinicBeachwood

Cleveland Clinic Solon

Cleveland ClinicWilloughby Hills

LORAIN COUNTY

CUYAHOGA COUNTY

SUMMIT COUNTY

MEDINACOUNTY

LAKE COUNTY

GEAUGACOUNTY

(WAYNE COUNTY)

Cleveland ClinicLakewoodCleveland

ClinicAvon Lake

Stephanie Tubbs Jones Health Center

WESTON

Cleveland ClinicFlorida

LAS VEGAS

ELKO

RENO

Cleveland Clinic Lou Ruvo Center for Brain Health

PORTAGECOUNTY

EuclidHospital

Hillcrest Hospital

Lutheran Hospital

Lakewood Hospital

Fairview Hospital

South Pointe Hospital

Medina Hospital

Marymount Hospital

Cleveland ClinicIndependence

26

Staff

Staff

NEUROLOGICAL INSTITUTE CHAIRMEN

Michael T. Modic, MD, FACR Chairman, Neurological Institute

William Bingaman, MD Vice Chairman, Clinical Areas, Neurological Institute

Richard Rudick, MD Vice Chairman, Research and Development, Neurological Institute

Edward Benzel, MD Chairman, Department of Neurological Surgery

Frederick Frost, MD Chairman, Department of Physical Medicine and Rehabilitation

Kerry Levin, MD Chairman, Department of Neurology

Donald A. Malone Jr., MD Chairman, Department of Psychiatry and Psychology Director, Center for Behavioral Health

Thomas Masaryk, MD Chairman, Department of Diagnostic Radiology

Bruce Trapp, PhD Chairman, Department of Neurosciences, Lerner Research Institute

STAFF

Lou Ruvo Center for Brain Health

Jeffrey Cummings, MD, ScD Director, Lou Ruvo Center for Brain Health

Brian Appleby, MD

Sarah Banks, PhD

Charles Bernick, MD

Aaron Bonner-Jackson, PhD

Gabriel Leger, MD

Donna Munic-Miller, PhD

Richard Naugle, PhD

Michael Parsons, PhD

Jagan Pillai, MD

Alexander Rae-Grant, MD, FRCP (C)

Stephen Rao, PhD, ABPP-CN Director, Schey Foundation Center for Advanced Cognitive Function

Babak Tousi, MD

Patrick Sweeney, MD

Ryan Walsh, MD, PhD

Timothy West, MD

Dylan Wint, MD

Xue (Kate) Zhong, MD, MSc

Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center

Gene Barnett, MD, MBA, FACS Director, Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center

Manmeet Ahluwalia, MD

Toomas Anton, MD

Lilyana Angelov, MD, FRCS(C)

Samuel Chao, MD

Kambiz Kamian, MD

Joung Lee, MD

Erin Murphy, MD


David Peereboom, MD

Violette Recinos, MD

Jeremy Rich, MD

Steven Rosefeld, MD, PhD

Glen Stevens, DO, PhD

John Suh, MD

Tanya Tekautz, MD

Jose Valerio, MD

Michael Vogelbaum, MD, PhD, FACS

Robert Weil, MD

Jennifer Yue, MD

Cerebrovascular Center

Peter Rasmussen, MD Director, Cerebrovascular Center

Dhimant Dani, MD

Stefan Dupont, MD

Neil Friedman, MBChB

Joao Gomes, MD

Ferdinand Hui, MD

M. Shazam Hussain, MD, FRCPC

Irene Katzan, MD, MS

John Lee, MD

Mei Lu, MD, PhD

Gwendolyn Lynch, MD

Edward Manno, MD

Thomas Masaryk, MD

Laurie McWilliams, MD

Shaye Moskowitz, MD, PhD

J. Javier Provencio, MD, FCCM

Susan Samuel, MD

Gabor Toth, MD

Ken Uchino, MD

Cleveland Clinic at Home

Steven Landers, MD, MPH Director, Cleveland Clinic at Home

Mohammed Ahmed Khan, MD

Young Doo Chang, MD

Mona Gupta, MD


Anu Shrestha, MD

Ethel Smith, MD

Epilepsy Center

Imad Najm, MD Director, Epilepsy Center

Andreas Alexopoulos, MD, MPH

Jocelyn Bautista, MD

William Bingaman, MD

Juan Bulacio, MD

Richard Burgess, MD, PhD

Robyn Busch, PhD

Tatiana Falcone, MD

Nancy Foldvary-Schaefer, DO, MS

Paul Ford, PhD

Joanna Fong, MD

Jorge Gonzalez-Martinez, MD, PhD

Ajay Gupta, MD

Stephen Hantus, MD

Jennifer Haut, PhD, ABPP-CN

Lara Jehi, MD

Stephen E. Jones, MD, PhD

Patricia Klaas, PhD

Prakash Kotagal, MD

Deepak Lachhwani, MBBS, MD

John Mosher, PhD

Dileep Nair, MD

Richard Naugle, PhD

Silvia Neme-Mercante, MD

Paul Ruggieri, MD

Norman So, MD

Andrey Stojic, MD, PhD

George E. Tesar, MD

Guiyan Wu, MD

Elaine Wyllie, MD

Zhong Ying, MD, PhD

Neurological Center for Pain

Edward Covington, MD Director, Neurological Center for Pain

Cynthia Bamford, MD

Neil Cherian, MD

Kelly Huffman, PhD

Steven Krause, PhD, MBA

Jennifer Kriegler, MD

Jahangir Maleki, MD, PhD

Manu Mathews, MD

MaryAnn Mays, MD

Judith Scheman, PhD

Mark Stillman, MD

Giries W. Sweis, PsyD

Deborah Tepper, MD

Stewart Tepper, MD

Mellen Center for Multiple Sclerosis Treatment and Research

Richard Rudick, MD Director, Mellen Center for Multiple Sclerosis Treatment and Research

Robert Bermel, MD

Francois Bethoux, MD

Adrienne Boissy, MD

Jeffrey Cohen, MD

Devon Conway, MD

Robert Fox, MD

Keith McKee, MD

Deborah Miller, PhD

Alexander Rae-Grant, MD, FRCP (C)

Richard M. Ransohoff, MD

Mary Rensel, MD

Lael Stone, MD

Amy Sullivan, PsyD

Timothy West, MD

Center for Neuroimaging

Thomas Masaryk, MD Director, Center for Neuroimaging

Paul Ruggieri, MD Head, Section of Neuroimaging

Manzoor Ahmed, MD

Todd M. Emch, MD

Stephen E. Jones, MD, PhD

Daniel Lockwood, MD

Mark Lowe, PhD

Parvez Masood, MD


Doksu Moon, MD

Micheal Phillips, MD

Alison Smith, MD

Todd Stultz, DDS, MD

Andrew Tievsky, MD

Center for Neurological Restoration

Andre Machado, MD, PhD Director, Center for Neurological Restoration

Anwar Ahmed, MD

Jay Alberts, PhD

Scott Cooper, MD, PhD

Milind Deogaonkar, MD

Hubert Fernandez, MD

Darlene Floden, PhD, ABPP-CN

John Gale, PhD

Michal Gostkowski, DO

Ilia Itin, MD

Cynthia S. Kubu, PhD, ABPP-CN

Richard Lederman, MD, PhD

Donald A. Malone Jr., MD

Cameron McIntyre, PhD

Mayur Pandya, DO

Ela B. Plow, PhD, PT

Joseph Rudolph, MD

Patrick Sweeney, MD

Ryan Walsh, MD, PhD

28 Staff

Neuromuscular Center

Kerry Levin, MD Director, Neuromuscular Center


Aamir Hussain, MD

ZulfiqarHussain,MD

Rebecca Kuenzler, MD

Mei Lu, MD, PhD

Erik Pioro, MD, PhD

David Polston, MD

Robert Shields Jr., MD

Steven Shook, MD

Jinny Tavee, MD

Nimish Thakore, MD

Center for Pediatric Neurology and Neurosurgery

Elaine Wyllie, MD Director, Center for Pediatric Neurology

Mark Luciano, MD, PhD Director, Center for Pediatric Neurosurgery

Stephen Dombrowski, PhD

Gerald Erenberg, MD


Debabrata Ghosh, MD, DM

Gary Hsich, MD

Irwin Jacobs, MD

Kambiz Kamian, MD

Sudeshna Mitra, MD

Manikum Moodley, MBChB, FCP, FRCP

Sumit Parikh, MD

Violette Recinos, MD

A. David Rothner, MD

Tanya Tekautz, MD

Center for Behavioral Health

Donald A. Malone Jr., MD Chairman, Department of Psychiatry and Psychology Director, Center for Behavioral Health

Susan Albers-Bowling, PsyD

Kathleen Ashton, PhD

Joseph M. Austerman, DO

Joseph Baskin, MD

Scott Bea, PsyD

Minnie Bowers, MD

Dana Brendza, PsyD

Karen Broer, PhD

Robyn Busch, PhD

Kathy Coffman, MD

Gregory Collins, MD

Edward Covington, MD

Roman Dale, MD

Beth Dixon, PsyD

Judy Dodds, PhD

Jung Jin El-Mallawany, MD

Tatiana Falcone, MD

Lara Feldman, DO

Darlene Floden, PhD

Kathleen Franco, MD

Margo Funk, MD

John P. Glazer, MD

Lilian Gonsalves, MD

J. Robert Gribble, PhD

Jennifer Haut, PhD, ABPP-CN

Leslie Heinberg, PhD

Kelly Huffman, PhD

Karen Jacobs, DO

Joseph W. Janesz, PhD, LICDC

Amir Jassani, PhD

Jason Jerry, MD

Regina Josell, PsyD

Elias Khawam, MD

Patricia Klaas, PhD

Olga Kostenko, MD

Steven Krause, PhD, MBA

Cynthia S. Kubu, PhD, ABPP-CN

Manu Mathews, MD

Michael McKee, PhD

Gene Morris, PhD

Kathryn Muzina, MD

Richard Naugle, PhD

Mayur Pandya, DO


Leo Pozuelo, MD

Kathleen Quinn, MD

Ted Raddell, PhD

Robert T. Rowney, D.O.

Balaji Saravanan, MD

Judith Scheman, PhD

Isabel Schuermeyer, MD

Cynthia Seng, PhD

Jean Simmons, PhD

Barry Simon, DO

Catherine Stenroos, PhD

David Streem, MD

Amy Sullivan, PsyD

Giries Sweis, PsyD

George Tesar, MD

Mackenzie Varkula, DO

Adele Viguera, MD

John Vitkus, PhD

Cynthia White, PsyD

Molly Wimbiscus, MD

Amy Windover, PhD

Center for Regional Neurosciences

Stephen Samples, MD Director, Center for Regional Neurosciences

Jeremy Amps, MD

Kristin Appleby, MD

C. Daniel Ansiven, MD


Toomas Anton, MD

Eric Baron, DO

Samuel Borsellino, MD

A. Romeo Craciun, MD

Carrie Diulus, MD

Megan Donohue, MD

Atef Eltomey, MD

Joanna Fong, MD

Aamir Hussain, MD

Dulara Hussain, MD

ZulfiqarHussain,MD

Abdul Itani, MD

Kambiz Kamian, MD

Michael Mervart, MD

Sheila Rubin, MD

Teresa Ruch, MD

Joseph Rudolph, MD

Andrey Stojic, MD, PhD

Diana Tanase, MD, PhD

Nimish Thakore, MD

Samuel Tobias, MD

Jennifer Ui, MD

Ari Wilkenfeld, MD, PhD

Joseph Zayat, MD

Department of Physical Medicine and Rehabilitation

Frederick Frost, MD Chairman, Department of Physical Medicine and Rehabilitation

Richard Aguilera, MD

Jay Alberts, PhD

Raghavendra Allareddy, MD

Yin Fang, PhD

Michael Felver, MD

Juliet Hou, MD

Lynn Jedlicka MD

John Lee, MD

Yu-Shang Lee, PhD

Zong-Ming Li, PhD

Ching-Yi Lin, PhD

Vernon W. H. Lin, MD, PhD

Carey Miklavcic, DO


Matthew Plow, PhD

Anantha Reddy, MD

Michael Schaefer, MD

Patrick Schmitt, DO

Yana Schumatcher, MD

Dan Shamir, MD

Vlodek Siemionow, PhD

Maria Tsarouhas, DO

Weidong Xu, MD, MS

General Adult Neurology

Kerry Levin, MD Chairman, Department of Neurology

C. Daniel Ansevin, MD

Kristin Appleby, MD

Dina Boutros, MD

Thomas E. Gretter, MD

ZulfiqarHussain,MD

Richard Lederman, MD, PhD

Patrick Sweeney, MD

Diana Tanase, MD, PhD

Nimish Thakore, MD

Sleep Disorders Center

Nancy Foldvary-Schaefer, DO, MS Director, Sleep Disorders Center

LoutfiAboussouan,MD

Charles Bae, MD

A. Romeo Craciun, MD

Michelle Drerup, PsyD

Joanna Fong, MD

Sally Ibrahim, MD

Alan Kominsky, MD

Jyoti Krishna, MD

Omar Minai, MD

Douglas Moul, MD, MPH, FAASM

Silvia Neme-Mercante, MD

Margaret Richards, PhD, ABPP

Carlos Rodriguez, MD

Jessica Vensel-Rundo, MD, MS

Tina Waters, MD

Center for Spine Health

Gordon Bell, MD Director, Center for Spine Health

Edward Benzel, MD

William Bingaman, MD

Edwin Capulong, MD

Russell DeMicco, DO

Carrie Diulus, MD

Michael Eppig, MD

Augusto Hsia Jr., MD

Iain Kalfas, MD

Tagreed Khalaf, MD

Ajit Krishnaney, MD

E. Kano Mayer, MD

Daniel Mazanec, MD

Robert McLain, MD

Thomas Mroz, MD

R. Douglas Orr, MD

Judith Scheman, PhD

Richard Schlenk, MD

Santhosh Thomas, DO, MBA

Deborah Venesy, MD

Fredrick Wilson, DO

Adrian Zachary, DO, MPH

Staff30

Neuroanesthesiology

RafiAvitsian,MD Section Head, Neurosurgical Anesthesiology

Matvey Bobylev, MD

Zeyd Ebrahim, MD

Ehab Farag, MD, FRCA

SamuelIrefin,MD

Allen Keebler, DO

Paul Kempen, MD, PhD

Reem Khatib, MD

Mariel Manlapaz, MD

Marco Maurtua, MD

Stacy Ritzman, MD

Leif Saager, MD

David Traul, MD, PhD

Guangxiang Yu, MD

Lerner Research Institute Department of Neurosciences

Bruce Trapp, PhD Chairman, Department of Neurosciences, Lerner Research Institute

Cornelia Bergmann, PhD

Jianguo Cheng, MD, PhD

John Gale, PhD

James Kaltenbach, PhD

Hitoshi Komuro, PhD

Bruce Lamb, PhD

Yu-Shang Lee, PhD

Ching-Yi Lin, PhD

Yoav Littner, MD

Sanjay W. Pimplikar, PhD

Erik Pioro, MD, PhD

J. Javier Provencio, MD, FCCM

Richard M. Ransohoff, MD

Susan Staugaitis, MD, PhD

Michael Steinmetz, MD

Stephen Stohlman, PhD

Dawn Taylor, PhD

Riqiang Yan, PhD

Lan Zhou, MD, PhD

Lerner Research Institute Biomedical Engineering

Jay Alberts, PhD

Yin Fang, PhD

Elizabeth Fisher, PhD

Aaron Fleischman, PhD

Zong-Ming Li, PhD

Cameron McIntyre, PhD


Matthew Plow, PhD

Vlodek Siemionow, PhD

Weidong Xu, MD

Lerner Research Institute Cell Biology

Damir Janigro, PhD

Pathology and Laboratory Medicine Institute Anatomic Pathology

Richard Prayson, MD

Services for Physicians and Patients 31

Resources for Physicians

Physician DirectoryView all Cleveland Clinic staff online at clevelandclinic.org/staff.

Referring Physician CenterFor help with service-related issues, information about our clinical specialists and services, details about CME opportunities, and more, contact the Referring Physician Center at [email protected], or 216.448.0900 or 888.637.0568.

Track Your Patient’s Care OnlineDrConnect is a secure online service providing our physician colleagues with real-time informa-tion about the treatment their patients receive at Cleveland Clinic. To receive your next patient report electronically, establish a DrConnect account at clevelandclinic.org/drconnect.

Request Medical Records216.445.2547 or 800.223.2273, ext. 52547

Critical Care Transport WorldwideCleveland Clinic’s critical care transport teams and fleet of mobile ICU vehicles, helicopters and fixed-wing aircraft serve critically ill and highly complex patients across the globe. Transport is available for children and adults. To arrange a transfer for STEMI (ST elevated myocardial infarction), acute stroke, ICH (intracerebral hemorrhage), SAH (subarachnoid hemorrhage) or aortic syndromes, call 877.379.CODE (2633). For all other critical care transfers, call 216.448.7000 or 866.547.1467 or visit clevelandclinic.org/criticalcaretransport.

Outcomes DataView clinical Outcomes books from the Neurological Institute and other Cleveland Clinic institutes at clevelandclinic.org/quality/outcomes.

CME Opportunities: Live and OnlineCleveland Clinic’s Center for Continuing Education’s website offers convenient, complimentary learning opportunities, from patient simulations, webcasts and podcasts to a host of medical publications and a schedule of live CME courses. Physicians can manage CME credits using the myCME.com Web portal available 24/7. Visit ccfcme.org.

Resources for Patients

Medical Concierge For complimentary assistance for out-of-state patients and families, call 800.223.2273, ext. 55580, or email [email protected].

Global Patient ServicesFor complimentary assistance for national and international patients and families, call 001.216.444.8184 or visit clevelandclinic.org/gps.

MyChart®

Cleveland Clinic MyChart® is a secure, online personal healthcare management tool that connects patients to portions of their medical record at any time of day or night. Patients may view test results, renew prescriptions, review past appointments and request new ones. A new feature, Schedule My Appointment, allows patients to view their primary physician’s open schedule and make appointments online in real time. Patients may register for MyChart through their physician’s office or by going online to clevelandclinic.org/mychart.

Cleveland Clinic Information

Referrals

General Patient Referral

24/7 hospital transfers or physician consults: 800.553.5056

Patient Referrals to all Neurological Institute physicians

216.636.5860 or toll-free, 866.588.2264

On the Web at

clevelandclinic.org/neuroscience

Stay Connected to Cleveland Clinic

Services for Physicians and Patients38

The multidisciplinary Neurological Institute, one of 26 institutes at Cleveland Clinic, is internationally known for

superior diagnosis and treatment of neurological disorders ranging from the common to the most complex. More

than 300 specialists combine clinical expertise, academic achievement and innovative research to accelerate

transfer of investigational therapies unavailable elsewhere, for the benefit of adult and pediatric patients. The

institute is committed to improving outcomes while treating patients with compassion and respect.

Cleveland Clinic is a nonprofit, multispecialty academic medical center, consistently ranked among the top

hospitals in America by U.S.News & World Report. Founded in 1921, it is dedicated to providing quality

specialized care and includes an outpatient Clinic, a hospital with more than 1,300 staffed beds, an education

institute and a research institute.

Cleveland Clinic ©2011

ARt dIReCtIOn | desIgneR: Barbara Ludwig Coleman

MARketIng: Colleen Burke, sarah delly, Jennifer Lynch, Laura Vasile

PhOtOgRAPhY: don gerda, Willie McAllister, stephen travarca, scott goldsmith Photography, Russell Lee Photography

11-NEU-063

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Use your smartphone to connect to our medical professionals page and sign up to receive publications electronically from Cleveland Clinic’s Neurological Institute.

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