Department of Neurology
Room 1400 • Phone: 419.383.3760 • utmc.webmaster@utoledo.edu
The Center for Neurological Disorders
The Center for Neurological Disorders is an interdisciplinary, comprehensive program with two major areas of clinical, research and educational emphasis: neurological disorders of aging and neurological disorders affecting women. Through this unique approach, we specialize in the diagnosis and management of numerous disorders including stroke, epilepsy, multiple sclerosis, migraines, neuropathies, Parkinson's disease and dementia.
The mission of the Center for Neurological Disorders is: 1) To provide neurological evaluation and continuing care for persons with conditions of the nervous system. 2) To coordinate the services of physicians, nurses, social workers, psychologists and therapists in order to provide a multi-disciplinary approach to complicated and potentially disabling conditions. 3) To conduct clinical trials of new treatments for neurological conditions. 4) To conduct original basic and clinical science investigations into neurological diseases. 5) To provide education on neurological disorders to students, residents, healthcare providers, and the lay public.
The Parkinson's Disease and Movement Disorder Program (PDMDP):
This program provides expert evaluation and care for persons with Parkinson's disease and other neurodegenerative disorders. This program was established in 1998, and has one of the more active clinical research programs in the country. In addition to standard and innovative medication protocols, patients are evaluated for neurosurgical procedures, including deep brain stimulation for Parkinson's disease and tremor.
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The Stroke Program:
This program was first established in 1994 to provide emergent evaluation and inpatient care to persons suffering from acute stroke and transient ischemic attacks. In addition to providing tPA therapy and subsequent critical care, the stroke team also evaluates persons for experimental neuroprotective medications and preventive medication regimens.
The acute stroke team consists of Dr. Tietjen (stroke neurologist), Andrea Korsnack, RN, assistance from Dr. Azedine Medhkour (neurosurgeon), Dr. Mounir Nazzal (vascular surgeon), and Dr. Lee Woldenberg (radiologist). Dr. Lawrence Horn, a physiatrist with expertise in traumatic brain injury and post-stroke rehabilitation, coordinates care for stroke survivors after acute hospitalization. The Stroke Program also provides continuing care in the outpatient setting, experimental protocols for stroke prevention, and new patient consultation for persons with TIAs, prior stroke and asymptomatic cerebrovascular disease.
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The Comprehensive Epilepsy Program
This program provides medical and surgical care for a large number of patients with epilepsy, with specialized services for the elderly, women with epilepsy and those with mental or physical disabilities. The incidence and prevalence of epilepsy increase dramatically in the elderly population, necessitating a multidisciplinary approach to deal with complex medical and social issues including drug interactions, the effects of anticonvulsants on bone density, and whether elderly patients with epilepsy should live alone. The program is directed by Imran I. Ali, MD, a board certified epileptologist who is also the director of the UT Clinical Neurophysiology Laboratory, the only accredited EEG laboratory in northwest Ohio. The program includes as Associate Director L. John Greenfield, MD, who is also board certified in EEG and epilepsy, neuropsychologist John McSweeny, PhD, neuroradiologist Lee Woldenberg, MD, neurosurgeon Azedine Medhkour, MD, and nurse coordinator Andrea Korsnack RN, BSN.
In addition to patient care, the Comprehensive Epilepsy Program also supports a strong research component including experimental drug trials in addition to clinical and laboratory research programs. Clinical research interests include studies on the morbidity and mortality of status epilepticus in the elderly, new uses of functional neuroimaging, vascular risk factors in epilepsy, and bone loss with antiepileptic drug use. Dr. Ali recently served on a task force identifying risk factors for bone loss, osteopenia and osteoporosis in patients treated with antiepileptic drugs, an important risk factor for morbidity in elderly patients. Dr. Greenfield directs a basic science laboratory studying the regulation of sensitivity to antiepileptic drugs and the cellular mechanisms underlying epilepsy and myoclonus. There is also a strong emphasis on education, as Drs. Ali and Greenfield have assumed responsibility for lectures on epilepsy and antiepileptic drugs to medical students and residents at all levels of training, as well as other allied health programs at UT and community-based education programs for the general public.
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The Multiple Sclerosis Program:
This program seeks to provide comprehensive care of patients with multiple sclerosis in order to provide the best possible quality of life. One of the initial responsibilities of their clinic is the evaluation and treatment of patients in whom multiple sclerosis is suspected. In addition, the UT Multidisciplinary MS Clinic meets once each month for comprehensive evaluation and treatment of patients with multiple sclerosis.
The Multidisciplinary MS Clinic is able to address a wide array of problems and is staffed by Drs. Koffman and Myers, neuropsychiatrist Mark Wright, MD, and a neuro-ophthalmologist Thomas Mehelas, MD. Additional access to subspecialties such as physical and occupational therapy, and urology is available through referral. The clinic is able to utilize neuroimaging modalities (MRI), lumbar puncture, and evoked potentials to aid in diagnosis. Symptomatic and/or immunomodulatory medications are used as appropriate to help treat this chronic disorder. New investigations at both basic science and clinical trials are underway.
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The Headache Treatment and Research Program:
This program offers opportunities for persons to participate in research protocols regarding the causes and consequences of headache, and studies for more effective therapies. The faculty and staff believe that with an understanding of the causes and treatments of headache, patients are able to partner with their doctor and better manage this debilitating condition. On a biweekly basis, there is a Headache School seminar for headache sufferers and their families, providing an informal forum for instruction, answering of questions and provision of additional educational resources.
The faculty lead courses on various aspects of headache at regional and nationally sponsored symposia, and instruct residents and medical students on the Health Science campus. The Neurologists are fellowship-trained and have expertise in the latest advances in headache treatment. The initial visit is used to take a careful history and perform a detailed neurological examination. Health issues, such as depression and anxiety, which impact on headache are also discussed. Together, the patient and physician devise an individualized plan-of-care for headache prevention and acute treatment, which may involve medication, dietary management, and complementary therapies, such as biofeedback. The Program also offers Botox therapy for migraine, and referral to neurosurgeons with expertise in the surgical treatment of refractory cluster headache.
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The Nerve and Muscle Program:
This program provides clinical, electrodiagnostic, and muscle biopsy evaluation of persons with symptoms of diffuse or focal weakness, numbness, or pain. The Division of Neurosurgery can provide nerve biopsy service when necessary. Diseases such as ALS (Lou Gehrig's disease), polyneuropathies, post-herpetic neuralgia, and some myopathies tend to occur more commonly in geriatric populations. The full range of available services includes; medical, physical, and occupational therapy, respiratory and nutritional care, orthotics, social work, and medical and rehabilitation supplies. T
he Neuromuscular Division provides chemodenervation therapy for various movement disorders. Botulinum toxin therapy is available for focal dystonias, such as spasmodic torticollis, blepharospasm, and writer's cramp and also for disorders such as hemifacial spasm. Patients who do not respond to botulinum toxin or who become resistant to it, receive injections of phenol. Chemo denervation is performed under EMG guidance, ensuring that the most active muscles are injected.