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Neurology & Neurosurgery — Baylor St. Luke's Medical Center

Innovative health care in Houston, Texas

Baylor St. Luke’s Medical Center is an internationally recognized leader in research and clinical excellence that has given rise to breakthroughs in cardiovascular care, neuroscience, oncology, transplantation, and more. Our team’s efforts have led to the creation of many research programs and initiatives to develop advanced treatments found nowhere else in the world.

Our strong alliance with Baylor College of Medicine allows us to bring our patients a powerful network of care unlike any other. Our collaboration is focused on increasing access to care through a growing network of leading specialists and revolutionizing healthcare to save lives and improve the health of the communities we serve. 

Baylor St. Luke’s Medical Center is also the first hospital in Texas and the Southwest designated a Magnet® hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times.

Researchers find more accurate way to predict recurrence in aggressive meningiomas

Meningioma, the most common type of tumor affecting the central nervous system, is a brain tumor that is most often benign and treatable. But in up to 20% of patients, they can recur even after successfully being removed with surgery and radiation. Over time, these tumors can lead to serious complications like headaches and seizures, or become cancerous with poor clinical outcomes, especially in older patients who cannot tolerate multiple cranial surgeries and radiation.

Understanding the genomic makeup of these aggressive meningiomas in order to better predict whether they will return in treated patients has been the focus of a team of researchers including neurologists at Baylor College of Medicine.

A hallmark of aggressive meningiomas is their genomic instability. In 2016, the World Health Organization (WHO) added homozygous loss of cyclin-dependent kinase inhibitor 2A and/or B (CDKN2A, CDKN2B)—two tumor suppressor genes adjacent to one another on chromosome 9p21—to its aggressive meningioma classification.

In a study published last year in Acta Neuropathologica, researchers sought to clarify the prognostic value of CDKN2A/B loss. The researchers examined 776 tumors from four institutions in total, grading them using the WHO guidelines. They then used methylation and RNA profiling to classify the tumors as Meningioma Group (MenG) A (benign, merlin-intact), B (benign, merlin-deficient), or C (aggressive) and determined CDKN2A/B status from the methylation data. 

Although tumors with any loss of CDKN2A/B were more proliferative, less likely to be primary tumors, and more likely to recur, they appeared in all three WHO grades. Molecular classification, however, showed that CDKN2A/B losses were almost exclusive to Group C.

Researchers found that using an integrated molecular classification predicts outcomes much more reliably than the WHO grade. Their findings suggest that the most pragmatic course to predicting recurrence of aggressive meningiomas would be to first identify Group C tumors—50% of which will recur by 47 months—and then analyze CDKN2A/B status to refine the prognosis.

Exploring the frontier of space travel and human health: state-of-the-art review

Over the next decade, the US, Russia, Europe, Canada, Japan, China, and a host of commercial space companies will continue to push the boundaries of space travel.

Future missions to space are reaching ever further into the cosmos and requiring human space travelers to spend longer times than ever before beyond our earthly bonds. Preparations are well underway by governments and businesses for long-distance, long-duration space exploration, including interplanetary exploration by the 2030s. Space travel has also captured the imaginations of entrepreneurs and technologists as new frontiers for tourism, technological advancements, medical discoveries and more.

Space exploration carries with it a great deal of risk from both known (e.g., ionizing radiation, microgravity) and unknown risk factors. Yet, exploring the short- and long-term impact of space travel on human health is also a relatively new frontier. An urgent need exists for expanded research to determine the true extent of the current limitations of long-term space travel and to develop potential applications and countermeasures for deep space exploration and colonization.

Recently, researchers at Baylor College of Medicine’s Center for Space Medicine joined a team of scientists and clinicians from NASA, JPL and other medical centers in the US and Canada to review prior studies as well as unpublished data from NASA to explore the potential health challenges associated with space travel.

The state-of-the-art review includes summaries of impact data and studies on each individual organ system and medical screening prior to space travel. Researchers categorized the extraterrestrial environment into exogenous (e.g., space radiation and microgravity) and endogenous processes (e.g., alteration of humans' natural circadian rhythm and mental health due to confinement, isolation, immobilization, and lack of social interaction) and their various effects on human health.

The review also explores ways of enabling new paradigms for protecting human health in space, as well as the use of emerging Artificial Intelligence based (AI) technology to propel future space health research.

Alzheimer’s Disease and Memory Disorders Center offers newly approved treatment to slow cognitive decline in Alzheimer’s patients

The Baylor Alzheimer’s Disease and Memory Disorders Center (ADMDC) now offers treatment to eligible patients of the first fully-FDA approved treatment for Alzheimer’s disease in more than a decade. 

Leqembi (lecanemab), approved in July 2023, is a monoclonal antibody that works by removing amyloid plaque from the brain. The ADMDC was a site for CLARITY, the pivotal trial that demonstrated efficacy of Leqembi, which is given as a bi-weekly infusion, in slowing cognitive decline in persons in the early stages of Alzheimer’s disease.

Dr. Melissa Yu, director of clinical operations for the ADMDC, was the site principal investigator. The ADMDC also participates in the AHEAD trial, which is evaluating whether the generic version of Leqembi will prevent cognitive decline in cognitively normal persons who already have evidence of Alzheimer’s pathology on a PET scan. 

ADMDC is also one of six clinical sites around the US for the U.S. POINTER trial. The landmark, two-year trial, sponsored by the Alzheimer’s Association, is testing whether a multi-modal lifestyle intervention targeting diet, physical activity and social engagement will delay the onset of cognitive impairment in older adults with sub-optimally controlled cardiovascular risk factors. In partnership with the Kelsey Research Foundation, the ADMDC enrolled 455 persons (of a total 2,000 participants ages 60-79) from the greater Houston area into the U.S. POINTER trial. Final results of the trial are expected in late 2024.

The ADMDC offers a number of other Alzheimer’s disease prevention and treatment trials that are open to patients of the Center and the community at large.

Melissa Yu, MD

Leading Gulf Region in performing promising new treatment for preventing stroke in high-risk patients

A new treatment for treating and preventing stroke in people who are at the highest risk of having one—namely, those with carotid artery disease—is showing promise for preventing stroke in all eligible patients.

Baylor St. Luke’s Medical Center and Baylor Medicine neurosurgeon Dr. Omar Tanweer are leaders in the Gulf Coast area for offering and performing transcarotid artery revascularization (TCAR), a procedure that is quickly gaining popularity among physicians for treating strokes caused by carotid artery disease. Also known as carotid stenosis, the condition is defined as the narrowing of the artery in the neck and is often caused by high blood pressure.

While carotid stenosis can be managed by medications and lifestyle changes, surgical intervention is sometimes required to reduce the risk of stroke. Carotid endarterectomy (CEA) has traditionally been the treatment of choice for many physicians. Additionally, transfemoral carotid artery stenting (TF-CAS) may be prescribed for select patients with certain risk factors.

TCAR is one more option that permits patients with a high risk of stroke to receive the safest, most effective personalized treatment options.

During the TCAR procedure, blood flow is temporarily directed away from the brain using a tube inserted into the carotid artery. This allows the surgeon to filter the blood of plaque and other dangerous debris and decrease the chances of a stroke.

Compared to CEA,TCAR requires a smaller incision on the neck, reducing the chance of nerve injury and leaving behind a smaller scar. With the right patient selection, TCAR may also have lower risks of stroke compared to TF-CAS.

A new method of deep brain stimulation lessens motor impairment in Parkinson’s patients

Researchers at Baylor College of Medicine are investigating the effectiveness of higher-frequency deep brain stimulation (DBS) in controlling tremors and other disabling motor signs in patients with Parkinson’s disease.

Working with University of Houston biomedical engineer Nuri Ince, Ashwin Viswanathan, MD, and Sameer Sheth, MD, Ph.D., at Baylor College of Medicine have found that electrical stimulation of the brain at higher frequencies (>100 Hz) can immediately control the physical symptoms associated with the disease.

DBS has been the most important therapeutic advancement of the last several decades in the treatment of Parkinson’s disease, a progressive nervous system disorder that affects movement in 10 million people worldwide. With DBS, electrodes are surgically implanted in the deep brain to deliver the electrical pulses. However, finding the correct frequency has been time-consuming and imprecise, often requiring months to implant the devices and test them on the patient.

The research team found that higher-frequency stimulation (130-180 Hz), however, induces high-frequency oscillations (~300 Hz, HFO) similar to those observed with pharmacological treatment. Their method may speed up the time it takes to program the devices to the correct frequencies to an almost immediate response. DBS at higher frequencies promises to be an effective alternative to drug therapy and can be personalized to each patient.

Brain implant gives epilepsy patients fewer seizures, new lease on life

A small device implanted in the brains of people with epilepsy can help them when other medications fail to reduce seizure frequency or severity.

The device, called the NeuroPace® RNS® System, has been used for the past decade to treat seizures that are not well controlled with antiepileptic drugs. Approved by the FDA in 2010, the device, once implanted, monitors the brain’s electrical activity, detects abnormalities indicative of seizure onset, and emits small electrical pulses to normalize brain activity and prevent the seizure from occurring.

Baylor St. Luke’s Medical Center has treated patients with epilepsy and partial-onset seizures (POS) with the NeuroPace® RNS® System since 2014. Having participated in the NeuroPace clinical trial, St. Luke’s Health is also the most experienced hospital system in the Houston area with this technology. It remains the only device that monitors and responds to brain activity to prevent seizures before they start.

Overall, patients with the implant experience a significant reduction in seizures and an improved quality of life, both physically and mentally, along with improved cognitive functioning. The device works best in someone whose seizures are in one location in the brain. And while patients with the implant may still need medication, they typically need lesser doses.

The longer the device stays in, the better it gets at recognizing and controlling seizures.

“It’s a smart device that’s actually learning about the brain activity, and over time, we are fine-tuning the detection so that it can be very sensitive and also discriminatory from the normal brain activity,” said Dr. Alica M. Goldman, MD, PhD, MS, Professor of Neurology, Baylor College of Medicine.

Multiple Sclerosis Clinic involved in important study of hematopoietic stem cell transplantation

Multiple sclerosis (MS) is a neuroimmunologic disease that affects approximately 1 million Americans. MS an autoimmune disease in which the body’s own immune system attacks parts of the central nervous system.  The disease most commonly occurs as intermittent attacks of neurologic disability (relapses) followed by periods of recovery (remission).  This relapsing-remitting form of MS may eventually evolve into a progressive form of disease referred to as secondary progressive MS.  There has been great progress in MS therapeutics over the past 3 decades to the point that we now have over 20 medications available to treat MS. These disease modifying treatments (DMTs) have led to significant decrease in the frequency of relapse and in the progression of disability in MS patients.  However, there remains no cure for MS and some MS patients will continue to have relapses and progression despite the use of high-efficacy DMTs.

Despite therapeutic advancements over the past several decades, there remains a need for better medications and approaches to treat MS.  Clinical researchers at Baylor College of Medicine’s Maxine Mesinger Multiple Sclerosis Comprehensive Care Center have been involved with research into the use of hematopoietic stem cell transplantation (HSCT) for MS for over 20 years.  HSCT involves the harvesting of a patient’s own blood-based stem cells, followed by the administration of strong immunosuppressive medications to maximally suppress the immune system.  Once the patient’s immune system is maximally suppressed, the previously harvested stem cells are infused (transplanted), with the idea that they will help populate a new immune system with less propensity to attack the nervous system.

Dr George Hutton led a group at Baylor investigating HSCT in the HALT-MS trial, a multicenter trial funded by the NIH.  This landmark trial was published in Neurology in 2017.  In the HALT-MS trial, a group of highly-active MS patients underwent the HSCT procedure and were followed closely for 5 years.  The trial showed that event-free survival was 69% at 5 years.  This outcome means that 69% of the patients were free of clinical relapse, clinical progression, or change on MRI 5 years after HSCT, without the need for any interval DMT.

The same researchers are now enrolling for the BEAT-MS trial, a larger NIH-funded multicenter trial of HSCT vs. best-available treatment in highly-active MS.  This controlled comparison trial is necessary to better understand the benefit of HSCT in comparison to our best-available FDA approved DMT options.  This trial will be able to answer whether the risks and benefits of HSCT are favorable in comparison to the increasingly effective medications available to treat MS.

Brain Infection Diagnosed in Ecuador Treated at Baylor St. Luke’s Within 48 Hours

Patients all over the world can consult with specialists at Baylor St. Luke’s Medical Center, thanks to an international services program.

Francisco Laso, a mechanical engineer living in Quito, Ecuador, might not be alive today had he not obtained a virtual second opinion from noted Baylor St. Luke’s Neurosurgeon Ganesh Rao. Francisco underwent sinus surgery in his home country and developed a serious bacterial infection. After just one week, the infection spread to his brain. Francisco’s son is a physician, (pulmonologist) and referred him to Baylor St. Luke’s international medical ambassador in Ecuador, Dr. Nelson Maldonado, who facilitated a review with Dr. Rao, who is also the chairman of neurosurgery at Baylor College of Medicine. Dr. Rao remotely reviewed Francisco's MRI, recognized the urgency and scheduled surgery immediately. The patient flew from Quito to Houston that night and underwent an eight-hour surgery the next day.

“If the abscess continued to grow, it could really cause neurological problems, headaches, seizures, and it can disseminate throughout the brain and into the spinal fluid, which could be fatal,” Dr. Rao said. “Francisco flew to Houston on a moment's notice and our team got him to surgery quickly.”

Dr. Rao performed a craniotomy, opening the skull, exposing the brain to remove the abscess and ruling out the presence of other bacteria or organisms that might also need to be treated with antibiotics. He relied on a multidisciplinary team that included neurological, infectious disease and intensive care specialists.

Francisco tolerated the surgery well and recovered quickly with physical therapy. Six weeks afterward, he was back at work, living his life as if nothing happened. “My life is completely normal and I don't have any pain so I am very happy. I am perfect. Great. No problem!”

Baylor St. Luke's Medical Center is jointly owned by Baylor College of Medicine and St. Luke’s Health, part of CommonSpirit Health, which oversees the international program. Each year, it assists more than a thousand patients in 85 countries, by bridging cultural and language differences and providing personal support to ensure humankindness is delivered at every touchpoint according to Tania Matar, System Vice President of International Health Services, CommonSpirit.

“The international remote second opinion is a new program that CommonSpirit Health International launched in order to connect patients in other countries to our physicians. COVID taught us that the virtual world is reality. Our remote second opinion technology allows our specialists to review a patient’s diagnosis, lab tests, images and treatment and determine whether travel to Baylor St. Luke’s Medical Center is best for the patient,” Matar said.

Francisco was pleased with the efficiency of the international program. “There was not a lot of paperwork, and I was quickly taken into the intensive care unit once I arrived,” Francisco recalled. “I was really surprised with the agility with which the international team took care of me.”

Dr. Maldonado has seen the benefits of having access to Baylor St. Luke’s. His own mother relied on the international program for treatment of lymphoma. “It was lifesaving,” he said. “Here in Ecuador we do not have the genetic sequencing that was needed to identify the appropriate treatment. Without that genetic testing, she had less than a 20-percent chance of survival.” She is a three-year cancer survivor now, he explained.

Pituitary center at Baylor St. Luke’s

From the common to the most complex, our team of experts at Baylor Medicine Pituitary Center diagnose and treat patients with even the rarest pituitary disorders. As one of the top pituitary centers in the region, our team of experts provides prompt multidisciplinary consultations and timely surgical scheduling, with more than 90% of our patients requiring only one night of hospital stay after surgery. Our patients experience excellent postoperative care, very low complication rates, and outstanding outcomes and remission rates on par with or better than most of the other leading centers in the country.