Medicine’s New Frontier: Neuroscience Tackles Some of the Most Delicate Cases in Healthcare

More intricate than the most complicated computer, the human brain and nervous system remain shrouded in mystery, an endless source of wonder. Every day brings new discoveries in neuroscience, deepening our understanding of how they work — and what doctors can do when they don’t.

Michael McDermott, M.D., chief medical executive at Miami Neuroscience Institute.

Michael McDermott, M.D., fell in love with the exquisite complexity of neuroscience when he was in medical school. Something about the brain’s remarkable symmetry captured his interest in a way no other part of the body did. Almost 40 years later, that fascination persists. A world-renown neurosurgeon and researcher, Dr. McDermott recently became the new chief medical executive of Miami Neuroscience Institute, part of Baptist Health South Florida.

“The brain is the crown jewelof human creation,” he says, quoting one of his mentors, famed neurosurgeonAlbert Rhoton Jr. “That is how he would start every lecture. It is the basis ofeverything.”

Even though Dr. McDermott hasparticipated in and witnessed countless technical advances, the medicalbreakthroughs on the horizon almost boggle the mind.  “We’re on the upswing part of the curve,” hesays. “The next 10 years are going to be very exciting.”

Progress in imaging,biosensor devices, wireless data transmission and signal processing algorithmshave resulted in startling developments in neuroscience, such as technologythat bypasses the eyes to allow blind people to “see,” or brain sensors thatcan translate thoughts into movement, helping amputees send mental messages torobotic limbs. It also is resulting in new treatments for diseases that once wereconsidered uncurable.

“The biggest advances arerelated to computer systems — their application to treatment and their use tounderstand neurological conditions,” says Dr. McDermott, who specializes inbrain tumors. “One can only imagine how far technology will take us.”

Miami NeuroscienceInstitute

On this new medical frontier is Miami Neuroscience Institute. It offers comprehensive treatment for neurological conditions affecting the brain, spinal cord and peripheral nervous system. Highly specialized experts address a wide range of problems from brain tumors to back pain, movement disorders and seizures to strokes and life-threatening aneurysms.

The complexity of the brainand nervous system — which act as “mission control” for the whole body — meansthe Institute often collaborates with experts from Miami Cancer Institute,Miami Cardiac & Vascular Institute and Miami Orthopedics & SportsMedicine Institute.

From minimally invasiveprocedures to complex brain and spine surgery, it provides care at all theBaptist Health hospitals. The exceptions are Boca Raton Regional Hospital,which already was home to the renowned Marcus Neuroscience Institute when itjoined Baptist Health last year, and Bethesda Hospital East and BethesdaHospital West, which also had an established neuroscience program.

Baptist Health’s neuroscienceinstitutes attract patients from far beyond South Florida.

For example, Robert Hall, a resident of St. John, Antigua in the Caribbean, sought emergency treatment through Baptist Health International after a severe seizure brought to light adangerous condition. Lacking a sophisticated treatment facility at home, his doctor on the island urged him to go to Baptist Health after discovering Mr.Hall had a rare arteriovenous malformation, an often-fatal tangle of abnormal blood vessels in the brain.

In a delicate surgery, themass was removed by Vitaly Siomin, M.D., medical director of the brain tumor program at Miami NeuroscienceInstitute. “The care I received there was top-notch, and if not for them, Iwouldn’t be here talking with you today,” Mr. Hall says.

In addition to increasinglysophisticated technology, the advancement of neuroscience is pushed forward bythe continuous evolution of surgical and treatment techniques. Physicians stayat the forefront of their fields through constant training, research andinnovation.

That means they are ready topivot when new treatment options can benefit patients. For example, endovascularsurgeons Italo Linfante, M.D., and Guilherme Dabus, M.D., were the first in Florida to treat a woman’slife-threatening brain aneurysm using a new generation of smart stents approvedby the FDA only weeks earlier. They also were the first in South Florida to usethe Woven EndoBridge, a self-expanding mesh ball of nickel titanium that chokes offwide-neck aneurysms after being snaked to the brain through a blood vessel inthe groin or wrist.

“We are finding new ways totreat unruptured aneurysms,” says Dr. Linfante, medical director of endovascularsurgery at Miami Neuroscience Institute and Miami Cardiac & VascularInstitute. “We have many new tools in our toolbox, and the technology is expandingmore and more.”

That means the prognosis forpatients keeps improving.

“It’s a game changer. Some ofthese aneurysms could not be treated a few years ago. And when they weretreated, the complication rates were very high,” says Dr. Dabus, director ofthe Neuroradiology Fellowship Program. “Being able to offer this kind of treatment here can be life-changingfor our patients.”

Minimally InvasiveInnovative Technology

New technology and surgicalapproaches require a huge investment — not only financial, to be able toacquire new equipment, but by doctors who must devote time and energy to stayon the cutting edge.

Neurosurgeon Justin Sporer, M.D., has spent about two years to bring high-intensity focused ultrasound treatment, also known as HIFU, to Miami Neuroscience Institute to treat essential tremor, a progressive and debilitating condition that causes trembling. People with essential tremor have difficulty-writing, holding a cup of water or coffee without spilling, shaving and performing many other tasks.

Focused ultrasound technologyis available in only a few neuroscience facilities in the United States anduses sound waves to reduce or eliminate the trembling. Described asincisionless brain surgery, it is performed while the patient is awake andinvolves no anesthesia, no cuts in the scalp and no burr holes through theskull to reach the brain.

The concept is similar todeep brain stimulation (DBS) treatment, which is also offered at MiamiNeuroscience Institute for certain seizure and movement disorders. However,DBS, which relies on continual electrical pulses like a pacemaker, requiresplacement of wires in the brain. It is powered by batteries and a device thatcan be adjusted — a plus for certain patients.

“In both DBS and HIFU, theresults can be nothing short of a miracle,” Dr. Sporrer says. “The effect isessentially instantaneous once treatment is delivered. It’s not uncommon toactually hear patients laugh as they are being treated because the effect is sodramatic.”

Communicating with FirstResponders

While the institutes takeadvantage of the most sophisticated technology, making new use of more commontools also can have a big impact. With something as simple as a cell phone,physicians are taking advantage of a software program with artificial intelligence to better synchronize stroke care andshave minutes off their response.

The communication system usesmachine learning to analyze brain scans and notify the healthcare provider whenpatients need urgent attention. The software is being used at Baptist, Boca RatonRegional, Homestead, South Miami and West Kendall Baptist Hospital.

Institute doctors are also using iPads to connect withfirst responders from the CoralGables Fire Department, the first agency in Miami-Dade County to establish adirect audio-video connection between transport vehicles and teams at BaptistHealth’s emergency departments. Consulting about patients while en route savestime at the hospital for stroke or head trauma patients, helping determine ifthey need imaging, clot-busting drugs or life-saving surgery.

 “The quicker they get the specific treatmentthey need, the better the outcome for the patient,” says Felipe De Los Rios,M.D., medical director of the stroke program at Miami Neuroscience Institute.“We have time-dependent treatments that can really change the outlook forsomeone with a stroke and prevent long-term disability.”

‘It’s Just the Tip of theiceberg’

Few cases illustrate the needfor speed better than that of Gary Mace, a dive shop operator and boat captain inthe Florida Keys. Mr. Mace was homealone about a year ago when he began experiencing symptoms of stroke. Barelyable to speak, he called his wife, Brenda, and whispered, “Help me.”

She immediately hung up and dialed 911. Within minutes, an ambulance rushed him to Mariners Hospital, where he was picked up by helicopter and whisked to Baptist Hospital in Miami.

As the chopper approached, neurologist Dalia Lorenzo, M.D., was already mobilizing the hospital’s dedicated stroke response team. As a designated Comprehensive Stroke Center by the Joint Commission, which accredits U.S. healthcare organizations, Baptist Hospital has all the necessary resources to treat the most complex stroke cases.

Upon landing, Mr. Mace wasrushed to the emergency room where, within 12 minutes of arrival, he receivedTissue Plasminogen Activator (tPA). This powerful blood thinner can break upblood clots in the brain that cause a stroke, but it must be administeredwithin about four hours of the onset of symptoms in order to be effective.

“Because we had such a goodsystem in place, we were able to get him the treatment he needed to prevent anypermanent disability,” Dr. Lorenzo said. Two days later. he walked out of thehospital and soon returned to work.

Mr. Mace, the owner of ConchRepublic Divers in Tavernier, is still overwhelmed by all the things that werefirmly in place for him to recover. “It really is a miracle,” he says. “Ireally appreciate everything that Baptist did for me – everybody was soprofessional and caring. Words can’t express my gratitude.”

Dr. McDermott is eager to seewhat comes next, especially as Miami Neuroscience Institute and MarcusNeuroscience Institute expand their programs. Baptist Health has demonstratedit has the vision and determination to bring even more advancements to SouthFlorida, he says. “We’ve come a long way,” Dr. McDermott says, “but it’s justthe tip of the iceberg.”