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Neurological Institute

2010 Annual Report

02 Chairman’s Letter

04 Cleveland Clinic Neurological Institute Overview

08 Research and Clinical Highlights

24 Institute Review

36 Staff Achievements

38 Services for Physicians and Patients

On the cover: The evolution of the football helmet is traced in Cleveland Clinic’s Spine Research Laboratory. From the days of leather to contemporary plastic, helmet design has progressed over the decades, and the process is accelerating as researchers and clinicians seek to better protect athletes from head, neck and spine trauma.

Contents

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Expert Neurological Care throughout an Integrated Hospital System

In almost five years of existence, the multidisciplinary Neurological Institute has matured to foster

collaboration among Cleveland Clinic neuroscientists who are united not only by shared interests, but

also by a commitment to provide comprehensive, patient-centered care. In this report, we document

the myriad ways we are meeting this challenge in venues across the enterprise – from our main

campus to our regional hospitals and family health centers to our remote locations – with a common

goal of driving superior patient outcomes and delivering exceptional value.

Michael T. Modic, MD, FACR

Dear Colleagues,

As the incidence of neurological disorders increases, so, too, does the public’s awareness of their

prevalence, causes and devastating consequences. The most recent example is traumatic brain

injury, which has ignited a vigorous dialogue likely to influence the care of every athlete who

sustains a concussion, as well as returning military personnel with blast-related brain injuries.

2 Chairman’s Letter

This issue runs deep, extending beyond professional

football’s Sunday afternoon hit parade to the often-

overlooked and overshadowed accidents that occur

on playgrounds and in amateur athletic venues across

America in the course of everyday life.

At Cleveland Clinic, clinicians and researchers in the

Neurological Institute, Orthopaedic & Rheumatologic

Institute, Lerner Research Institute and Children’s

Hospital are collaborating across the enterprise to

better understand and respond to concussive injuries.

This inter-institutional cooperation characterizes our

entire hospital system’s approach to dealing with

medical disorders in a multidisciplinary fashion.

Following are additional areas of topical interest and

progress/success:

• Cleveland Clinic physicians have joined together

to develop care paths incorporating standardized,

evidence-based encounters with embedded

outcomes and quality measures over the longitudi-

nal course of patient care. Under the leadership of

Irene Katzan, MD, MS, Director of Enterprise Stroke

Systems, we structured a stroke care path and

established comprehensive stroke centers at our

main campus and two regional hospitals. With the

integration of the Department of Physical Medicine

and Rehabilitation and Cleveland Clinic at Home,

we are now one multidisciplinary institute aligned to

apply standard care protocols across all venues for

stroke and other brain dysfunction patients requiring

post-acute care.

• Teamwork within and between the Neurological

and Imaging institutes is supporting the ongoing

development of Cleveland Clinic Lou Ruvo Center for

Brain Health, co-located in Cleveland and Nevada.

Technology bridges geography, enabling secure

digital transfer of patient images to subspecialty-

trained radiologists throughout our system, who

interpret brain exams performed at remote sites.

Last May, this center marked the grand opening

of its Las Vegas facility, an architectural landmark

designed with the needs of patients and caregivers

uppermost in mind. Concurrently, we invested to

significantly strengthen our brain health staff and

physical resources in Cleveland and prepared to

build out the program at Cleveland Clinic Florida.

Multiple access points are consistent with our strate-

gic response to the projected growth in the volume

of patients with neurocognitive disorders.

• Design of our new interventional MRI suite was

another collaborative effort of the Neurological

and Imaging institutes. This technology provides

intraoperative guidance for the most exacting

neurosurgical procedures, including laser ablation

of tumors, cranial biopsies, and placement of deep

brain stimulators and stereotactic EEG electrodes.

• Complementary skill sets in the Neurological

Institute and Cleveland Clinic’s Sydell and Arnold

Miller Family Heart & Vascular Institute are the

foundation of a partnership that created the Center

for Syncope and Autonomic Disorders. This

innovative treatment model, headed by a neurologist

and a cardiologist, provides complete care for

patients with autonomic nervous system disorders,

including safe, noninvasive testing.

• Our neurological nursing staff is actively involved with

interdepartmental teams seeking to effect meaningful

change in the priority area of patient satisfaction.

Nurses have availed themselves of educational

opportunities in pain management, in the belief that

those who become adept at assessing and managing

pain and setting expectations of pain relief will

significantly enhance the patient experience.

These and other initiatives described in these pages

reflect the continuing evolution of the Neurological

Institute. We appreciate the opportunity to report

on our progress and we welcome your comments.

Michael T. Modic, MD, FACR

Chairman, Cleveland Clinic Neurological Institute

Cleveland Clinic Neurological Institute Annual Report 3

Cleveland Clinic Neurological Institute Overview

The institute is anchored by specialized, disease-

specific centers. Each center incorporates the

expertise of physicians and allied health professionals

from all medical and surgical specialties related to

the diagnosis and management of that disease or

group of diseases, thus fostering collaboration and

improved patient access.

The institute also comprises four departments –

Neurology, Neurological Surgery, Psychiatry and

Psychology, and Physical Medicine and Rehabilitation

– that integrate resident training, academics

and research. The latter department, formerly

the Rehabilitation Institute, was merged into the

Neurological Institute in 2009. Its addition, and

the subsequent formation of Cleveland Clinic

at Home, enables seamless delivery of a continuum

of healthcare services from hospital to home.

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

Hospitals” survey has consistently ranked our

neurology and neurosurgery programs among the

top 10 in the nation. We also hold top rankings in

Ohio for neurology, neurosurgery, pediatric

neurology/neurosurgery and psychiatry.

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

angiography, interventional neuroradiology, and

carotid and transcranial Doppler ultrasound. Our

neuroimaging staff subspecializes in disease enti-

ties such as epilepsy and cerebrovascular disease,

ensuring accurate, in-depth interpretations.

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 central nervous system.

Neurological Institute Centers

• Center for Behavioral Health

• Lou Ruvo Center for Brain Health

• 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

• Center for Regional Neurosciences

• Sleep Disorders Center

• Center for Spine Health


Additional diagnostic tools are found in our epilepsy

monitoring units, sleep laboratories, neuropsychologi-

cal testing facilities, electromyography laboratory,

autonomic 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 mal-

formations, and neuroendoscopy. Joint Commission

certification as a Primary Stroke Center and accredita-

tion 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 2009, more than 220 clinical research

trials involving almost 1,800 patients were under

way in the Neurological Institute. Neurologically

based research grants and contract awards totaled

more than $21 million.

In June 2010, the institute announced an alliance

with Numoda Corporation to accelerate the process

by which neuroscience research discoveries are

moved from the laboratory to the patient.

Research Funding

Grant and contract research dollars funding neurological investigations in the Neurological Institute, Lerner Research Institute and Department of Neuroradiology totaled almost $21.5 million in 2009, a 20 percent increase over funding of more than $17.9 million in 2008:

2009

New clinical research projects 80

Total active clinical research projects 228

Staff leading clinical research projects 67

New patients enrolled in 420 clinical research projects

Total patient enrollment in 1,768 clinical research projects

National Institutes of Health grants 117 and contracts*

Neurological grants and contracts (non-NIH)* 208

2008

New clinical research projects 42

Total active clinical research projects 139

Staff leading clinical research projects 50

New patients enrolled in 772 clinical research projects

Total patient enrollment in 1,690 clinical research projects

National Institutes of Health grants 91 and contracts*

Neurological grants and contracts (non-NIH)* 167

* Includes collaborating investigators in Lerner Research Institute and Imaging Institute.

Overview6

Convenient Care in the Community

We are committed to making access to world-

class care convenient for all patients. Neurological

Institute services are available at Cleveland Clinic

health system regional hospitals and family health

centers throughout northeast Ohio. 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.

Key components in our regional network include:

• Cleveland Clinic Neurological Institute at Lakewood

Hospital, which provides comprehensive services

to Cleveland’s West Side and western suburbs

• More than 100 acute inpatient rehabilitation

beds at facilities across northeast Ohio

• More than 45 inpatient and outpatient sites, where

675-plus physical and occupational therapists

offer 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

Neurological Institute Volume, 2009

Patients

Total outpatient visits 143,401

Admissions 17,060

Inpatient days 113,895

Procedures

Surgical/interventional 8,016

Neuroimaging studies 63,514

Cleveland Clinic is a HomeCare Elite™ home health provider, a prestigious designation for Medicare-certified agencies ranked as top performers in delivery of quality care.


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 advance-

ment are readily available to institute nurses. Their

participation is welcomed in all continuing education

programs, and those with at least two years’ experience

in the institute can aspire to certification in neurosci-

ence 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.

This meeting, originally limited to nurses, broadened

its reach in 2009 to include physician assistants and

medical assistants as organizers continued to work

toward increased provider collaboration.

Pioneering the Collection of Data and Outcomes

Now in its third year, the Neurological Institute’s

Knowledge Program© has captured data from more

than 1 million self-administered patient question-

naires. One of the world’s first interactive clinical

patient databases, the Knowledge Program is dem-

onstrating its value as it evolves, with collection

and correlation of electronic 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 qual-

ity of life, in line with Cleveland Clinic’s guiding

principle: Patients First.

Neurological Institute nurses are encouraged to offer their input and to subspecialize in neuroscience nursing, which qualifies them to care for the most complex patients.

Research and Clinical Highlights8


Investigating the Effects of Head Trauma in Athletes

Researchers from the Center for Spine Health’s

Spine Research Laboratory, the Orthopaedic &

Rheumatologic Institute’s Center for Sports Health

and Lerner Research Institute are collaborating to

address an issue that has seized public and media

attention: the damage caused by concussion and

other sports-related head and neck injuries.

A teammate in this initiative is Rawlings, well-known

manufacturer and retailer of athletic equipment and

apparel. Rawlings has donated $250,000 in cash

and equipment in support of efforts to assess and

improve the protective properties of helmets and other

sports apparatus. With this gift, the company acquired

naming rights to the Lutheran Hospital-based Spine

Research Lab.

A team led by Edward Benzel, MD, will measure the

equipment’s ability to minimize the impact of single

and multiple blows to the heads of athletes and seek

to assess the extent of brain injury, with a goal of

reducing injury through better, safer helmet design

for football and baseball players.

In another project to promote safety at all levels of

competition, the Spine Research Laboratory has devel-

oped an “intelligent mouthguard” that measures head

impact dynamics in contact sports such as football

and boxing.

The mouthguard is equipped with linear and angular

micro-electro-mechanical systems (MEMS) sensors

to compute head orientation, position, velocity and

acceleration of impact in real time. With Bluetooth®

technology, these calculations are wirelessly transmit-

ted to a computer on the sideline or at ringside. The

resulting data can be correlated with post-competition

neurologic outcomes to better understand the effects

of head impact on brain health.

In the near term, the mouthguard is expected to

assist in design of safer helmets and protective

sports equipment, thus reducing the incidence of

traumatic brain injury in athletes. Ultimately, the

system will include built-in analytic capabilities to

facilitate rapid diagnosis of injury.

As this research expands to include an increasing

number of Cleveland Clinic collaborators across the

enterprise, a clinically focused Concussion Group is

meeting to plan an integrated approach to treating

these patients. The Neurological Institute is actively

involved in both research-based and clinical initiatives.

Left: Researchers use regulated head forms to measure the impact of head trauma in athletes. A cross-institutional approach to this research has helped position Cleveland Clinic as a leader in several ongoing studies to improve prevention, diagnosis and treatment of concussion.


Improving Safety, Precision with Image-Guided Robotic Epilepsy Surgery

Epilepsy is among the most common adult brain

disorders: Approximately 3 million people in the

United States are affected and 200,000 new cases

are diagnosed annually. For some patients with

medically refractory focal epilepsy, surgery offers

the prospect of seizure freedom and a better quality

of life. With the addition of image-guided robotics,

Cleveland Clinic neurosurgeons have added a new

tool to their arsenal for defining the brain area where

selected patients’ seizures originate, in preparation

for its removal.

In these patients, characterization of the epileptic

area(s) requires invasive brain-mapping techniques.

At Cleveland Clinic Epilepsy Center, subdural grids and

strips or stereotactically placed depth electrodes are

used for invasive brain mapping. The latter method,

known as stereoelectroencephalography (SEEG),

was popularized in the U.S. by Epilepsy Center surgeon

Jorge Gonzalez-Martinez, MD, PhD, who performed

the first SEEG surgery in March 2009. Since then,

more than 75 patients have been implanted with

specialized intracranial SEEG electrodes, a less invasive

and more exacting approach than the alternatives.

In September 2010, Dr. Gonzalez-Martinez performed

Cleveland Clinic’s first frameless, image-guided robotic

procedure for placement of depth electrodes to localize

the epileptic area(s). With robotic guidance, place-

ment is safer and more precise. The technique also

enhances opportunities to combine subdural grids

and stereotactically placed depth electrodes for the

most precise spatial mapping possible of superficial

and deep brain structures, with optimal three-

dimensional understanding of the epileptic neuronal

network and its relation to cortical brain function.

For medically intractable epilepsy patients who were not

considered to be surgical candidates in the past, these

advances open new diagnostic and treatment options.

Left: Neurosurgeon Jorge Gonzalez-Martinez, right, performs a SEEG procedure with the guidance of a robotic device, which makes placement of brain-mapping electrodes safer and more precise.


Pioneering High-Tech Models of Healthcare Delivery

In venues ranging from the Emergency Department

to the patient’s home, technology is enabling

the introduction of innovative new approaches

that integrate offsite capabilities in the treatment

of acute episodes and chronic diseases alike.

Broadened Access to Stroke Expertise

The Cerebrovascular Center’s Telestroke Network,

established in 2010, affords medical staffs at other

healthcare institutions immediate, round-the-clock

remote access to patient consultation services from

the multidisciplinary team of neurological specialists

at Cleveland Clinic. The network is enabled with

a mobile, two-way videoconference system and a

secure, dedicated link for digital transfer of relevant

imaging studies to facilitate real-time consults.

Remote consultations, utilized by Cleveland Clinic

community hospitals, can also benefit hospitals in

regions with a shortage of neurological specialists.

Support for In-Home Recovery

As a swelling population of older, chronically ill adults

challenges the nation’s healthcare system, Cleveland

Clinic at Home (formerly the Center for Home Care

and Community Rehabilitation) is collaborating with

the Sydell and Arnold Miller Family Heart & Vascular

Institute in a specialized program that joins distance

health monitoring with in-home rehabilitation and

nursing services.

Cleveland Clinic Heart Care at Home, launched in May

2010, uses advanced communications technology with

the capability to support patient assessment, teaching

and training. Recovering cardiac patients are linked

with a remote nurse via a transmitter, which they use

to securely send data on their health status. Using

wireless monitoring devices, patients collect readings

on such measures as weight, blood pressure and

cardiac rhythm. A nurse manager reviews the data

daily and calls patients who require follow-up or

clinical intervention.

Studies have demonstrated more rapid recovery

and earlier return to normal activities for patients

who recover in the comfort of home, rather than in

an institutional setting. Heart Care at Home is an

innovative response designed to restore patients to

maximum functionality and keep them in the com-

munity as long as possible.

Left: Cleveland Clinic Heart Care at Home patient Karen M. demonstrates the program’s home monitoring device. “I received counseling and teaching by phone that helped me make better choices,” she says. “I felt like I lost control of my health, and Heart Care at Home gave me back that control.”


Meeting the Challenge of the Impaired Brain

“Neurological disorders affect millions of people

around the world and represent a vast and growing

need for new and improved treatment options,” notes

Michael T. Modic, MD, FACR, who chairs Cleveland

Clinic Neurological Institute.

More than 5 million Americans are living with

Alzheimer’s disease. For those who suffer and those

who love them, Cleveland Clinic Lou Ruvo Center for

Brain Health pursues a dual mission to advance early

diagnosis, treatment and research of neurocognitive

disorders while providing intensive support and

education for patients’ caregivers.

The year 2010 marked rapid progress in the evolution

of the center, co-located in Ohio, Nevada and Florida.

In May, a grand opening celebration showcased the

center’s Las Vegas home, a striking $80 million facility

designed by Frank Gehry. In July, the center observed

its first anniversary of treating patients and welcomed a

new leadership team headed by Jeffrey L. Cummings,

MD, a world-renowned innovator in the research

of neurodegenerative disorders and an expert on

Alzheimer’s disease.

The center offers patients and families a continuum of

care, with outpatient services that include physician

evaluation, memory testing, neuroimaging, treatment

and caregiver support. Under Dr. Cummings’ direction,

a robust clinical trials program has been launched.

Left: A segmented image of the brain, used to measure brain volume and hippocampal volume changes in Alzheimer’s disease.

Above: Dramatic shapes and light-filled spaces distinguish Cleveland Clinic’s Lou Ruvo Center for Brain Health in Las Vegas. The facility is part of a comprehensive approach to the prevention, diagnosis and management of brain health disorders, with complementary services in Cleveland and in Weston, Florida.

17Cleveland Clinic Neurological Institute Annual Report

Implementing an Interventional MRI Suite

In April 2010, physicians in the Brain Tumor and

Neuro-Oncology Center performed the first neurosurgi-

cal procedure in Cleveland Clinic’s new intraoperative

MRI suite. The technologically advanced suite integrates

the expertise of the Imaging Institute and Neurological

Institute to improve clinical care.

The IMRIS Neuro™ suite opens the surgeon’s window

into the brain, providing high-quality images through-

out the course of neurosurgery and offering surgical

teams real-time guidance to any point within the brain.

The MRI machine is brought into the operating room

on a ceiling-mounted rail system in approximately

a minute when improved visualization is needed.

This technology is used primarily for brain tumor

surgery but is easily adaptable to any neurosurgical

procedure, providing dramatically improved guidance

and visualization of structures, which enhance patient

safety and reduce procedure time. Examples include

placement of stereotactic EEG electrodes, shunt

catheters and deep brain stimulators; cranial biopsies;

and laser ablation therapy for intracranial neoplasms.

Left: The interventional MRI suite can be used as a conventional operating room until image guidance is needed. At that point, the ceiling-suspended scanner can be moved into the operating room to image the patient. The scanner can be used for conven-tional diagnostic studies when not needed for interventional procedures.

Above: Images from the first intraoperative procedure performed in Cleveland Clinic’s interventional MRI suite. Figure 1: Preoperative tumor. Figure 2: Results of initial resection demonstrate residual tumor along anterior aspect of the operative bed during intraoperative MRI. In a standard procedure without intraoperative imaging, the patient would have been sent to the recovery room at this point. Figure 3: Intraoperative MRI provided a road map to remove the residual tumor, resulting in a more complete resection with no visible residual tumor.

Figure 1 Figure 2 Figure 3


Investigating Neurorepair in MS through Stem Cell Transplantation

With a $2.75 million grant from the U.S. Department

of Defense and a $1 million grant from the National

Institutes of Health, Jeffrey Cohen, MD, is studying

mesenchymal stem cell (MSC) transplantation as

a potential neuroprotective treatment for multiple

sclerosis (MS). No formal trials of this therapy in

MS patients have been published.

The primary objective of this Phase I study, con-

ducted in collaboration with the National Center for

Regenerative Medicine and the Montreal Neurological

Institute, is to evaluate the safety and tolerability of

a single infusion of autologous MSC transplantation

in patients with relapsing forms of MS. These cells

have immunomodulatory actions that may be benefi-

cial. In addition, the ability of MSCs to replace neural

cells through transdifferentiation or, more likely, by

augmentation of intrinsic tissue repair mechanisms,

has focused substantial attention on transplantation

as an approach to neurorepair in MS.

Left: Figure denotes the characteristic morphology of mesenchymal stem cells in culture.

Above: Typical MRI findings in multiple sclerosis are shown here. In the MSC trial, routine and advanced MRI techniques will be used to monitor MS disease activity and changes in the extent of brain tissue damage.


Treating Chronic Central Pain with Deep Brain Stimulation

Andre Machado, MD, PhD, Director of Cleveland Clinic

Center for Neurological Restoration, received an NIH

New Innovator Award and a five-year, $1.5 million

grant to fund investigation of a novel approach

for managing patients with central thalamic pain

syndrome, a particularly severe form of pain.

In this pilot study, Dr. Machado will utilize deep brain

stimulation (DBS) of the ventral capsular/ventral

striatal (VC/VS) area, the goal being to modulate the

affective component in patients with refractory pain

and, consequently, to reduce pain-related disability.

This approach departs from the traditional practice

of intervening in the sensory-discriminative neural

pathways of pain transmission to produce analgesia.

The research marks the first use of DBS of the VC/

VS for management of central pain. It builds upon the

work of a multicenter collaborative, including Cleveland

Clinic, that has evaluated stimulation of the VC/VS

for treatment of disabling depression and obsessive-

compulsive disorders.

Left: Neurosurgeon Andre Machado, MD, PhD, performs deep brain stimulation (DBS). Dr. Machado, who directs the Center for Neurological Restoration, is investigating a new application of DBS for management of intractable thalamic pain syndrome, which has shown inconsistent response to other surgical approaches.


Exploring the Potential of Forced Exercise for Parkinson’s Patients

It was a surprising discovery that Jay Alberts, PhD,

made during a bicycle trip across Iowa: A patient with

Parkinson’s disease, pushed to pedal a tandem bike

at an accelerated rate, experienced improved motor

function even in her non-exercised upper extremi-

ties, which suggests the occurrence of neurochemical

changes with disease-modifying impact. This insight

led to research and to a place among the top 10

medical innovations of 2009. This prestigious list is

unveiled each year at the Cleveland Clinic Medical

Innovation Summit.

Micheal Phillips, MD, and Mark Lowe, PhD, have

examined brain function in Parkinson’s patients

involved in Dr. Alberts’ research. The fMRI scans

showed that, among subjects in the forced exercise

program vs. those who followed a voluntary exercise

regimen, exercise increased activation levels in the

cortical and subcortical areas of the brain. If ongo-

ing research confirms that forced exercise induces

beneficial neurochemical changes in Parkinson’s

disease, this intervention may help patients with

other neurodegenerative disorders as well.

T-SCOREPost-exercise Off-medication On-medication

Left: Jay Alberts, PhD, of the Department of Biomedical Engineering at Cleveland Clinic Lerner Research Institute and the Center for Neurological Restoration, talks with a participant exercising on a stationary bicycle as part of a laboratory study of the potential benefits of forced exercise for Parkinson’s disease patients.

Above: Cortical and subcortical activation maps across participants, showing that the pattern of neural activation following forced exercise is similar to the pattern with medication.

Institute Review24

Research and Innovation

Examining Treatment Success through Patients’ Eyes

With the only ethics award granted by the National

Institute of Neurological Disorders and Stroke through

the American Recovery and Reinvestment Act,

neuropsychologist Cynthia Kubu, PhD, and

bioethicist Paul Ford, PhD, are studying the ethics

of control and consent in deep brain stimulation

(DBS) for Parkinson’s disease.

Conventional wisdom holds that to patients, a

significant reduction in symptoms equates to

treatment success, but data hint that individual

perspectives may be more complex, incorporating

values, resumption of specific activities/goals, and

underlying cognitive and personality attributes. This

study focuses on defining a more patient-centered

metric than mere symptom-specific measures to

evaluate and better understand treatment success.

With a second grant awarded by the Greenwall

Foundation, Dr. Ford and Dr. Kubu are addressing

similar issues in a population of patients undergoing

epilepsy surgery. Findings from both studies may

have implications for the informed consent process

and for other neurosurgical populations.

Controlling Pseudobulbar Affect in ALS and MS Patients

Erik Pioro, MD, PhD, Director of the Section of

Amyotrophic Lateral Sclerosis (ALS) and Related

Disorders, and Jeffrey L. Cummings, MD, Director

of Cleveland Clinic Lou Ruvo Center for Brain Health,

co-authored a study reporting that an experimental

drug reduces involuntary bouts of laughing and/or

crying in ALS and multiple sclerosis (MS) patients.

“These outbursts are socially debilitating because they

are so unpredictable, are uncontrollable and can be

very embarrassing,” said Dr. Pioro, the lead author.

A 12-week, double-blind, placebo-controlled study

of 326 patients tested the effectiveness of dextro-

methorphan plus low-dose quinidine (DMq). The

drug reduced the frequency of uncontrolled out-

bursts, known as pseudobulbar affect, almost

50 percent. The study was featured in the June

2010 issue of Neurology Reviews and online in

Annals of Neurology. The drug, with the brand

name Nudexta™, was subsequently approved by

the Food and Drug Administration.

Postoperative X-ray shows bilateral deep brain stimulation leads and electrodes in a patient with Parkinson’s disease.


Reducing Procedure Time in Spine Surgery

Digital radiography is significantly faster than conven-

tional radiography (100 seconds vs. 823 seconds)

in localizing the cervical spine level during surgery,

according to a study by Michael Steinmetz, MD, and

colleagues that appeared in the December 2009 issue

of The Spine Journal.

Of 18 patients undergoing single-level anterior cervical

discectomy and fusion with plate and allograft,

10 underwent cervical spine level localization with

conventional radiography and eight underwent

localization with digital imaging. The authors reported

that the latter technique decreased the cycle time for

data acquisition, provided accurate information and

increased operational efficiency, which may reduce

costs and improve patient safety.

Partnering to Bring Research Discoveries to Patients

In May 2009, the Neurological Institute finalized a joint

venture agreement with Numoda Corporation to collabo-

rate in providing physicians and researchers with

systems and tools to improve clinical research manage-

ment. Numoda’s integrated technology platforms offer

rapid data validation and analysis, helping to ensure

on-time, efficiently run projects for pharma, biotech,

medical device and diagnostic companies, and contract

research organizations. The combination of academic

medical center expertise and industry best practices is

expected to hasten development of novel therapies and

treatments for neurological disorders.

Spine surgeons are skilled in minimally invasive techniques and in the most complex procedures. Surgery may be indicated when nonoperative treatments fail.

26

Research and Innovation (continued)

Targeting Metabolism in Brain Tumors

Glioblastoma multiforme is among the most virulent

cancers; most patients succumb within 12 months.

With a $50,000 grant from the Musella Foundation

for Brain Tumor Research & Information, researchers

in the Brain Tumor and Neuro-Oncology Center will

investigate the link between metabolism of glucose

and an oncogene that is necessary for tumor growth

and survival.

This work is based on the theory that malignant

gliomas will stop spreading if they are deprived of the

ability to fuel themselves through glycolysis. The study

will also explore the mechanism by which normal

brain cells, in the absence of glucose, generate energy

from ketone bodies – an ability that some or most

fast-growing, invasive cancers appear to lack.

Tumor Board Cases

Both the Brain Tumor and Neuro-Oncology

Center and the Center for Spine Health

use a multidisciplinary team approach to

evaluate and treat patients with complex

brain or spine tumors. The volume of cases

has multiplied since these two groups

began meeting.

Brain Tumor Board

2010 cases (through mid-December): 1,554

Total number of cases since board’s inception in 2000: 17,019

Spine Tumor Board

2010 cases (through mid-December): 283


Institute Review


Enhanced Clinical Care

Sweating Out a Diagnosis

The Center for Syncope and Autonomic Disorders, a

collaborative effort of the Neuromuscular Center and

the Department of Cardiovascular Medicine, diagno-

ses and treats autonomic nervous system disorders.

Often, special testing is required to reach a diagnosis.

The newest offering is the thermoregulatory sweat

test, which employs a sweat-reactive powder and a

heating cabinet.

The powder is dusted on the patient’s body, and

the heat and humidity in the cabinet are adjusted to

raise the patient’s body temperature approximately

one degree Centigrade, which produces generalized

sweating. The resulting sweat patterns are helpful in

the diagnosis of a wide array of peripheral and central

autonomic and neurological disorders.

This sensitive test is part of a complete panel of

cardiovascular and sudomotor tests that the Center

for Syncope and Autonomic Disorders administers to

assess the full spectrum of autonomic disorders.

Healing the Mind in a Welcoming Space

Cleveland Clinic’s new child and adolescent inpatient

psychiatric unit at Fairview Hospital combines the best

of modern biomedical treatment with a commitment

to the concept that environment plays a vital role in

recovery from mental illness. The unit, which opened

in February 2010, looks and feels like a place for

recovery, not illness. Thirteen single-occupancy rooms

arc around a large, brightly lit space and look out

through expansive windows at woods and trails in the

neighboring valley.

The progressive design incorporates sophisticated

technologies, including multiple cameras, motion

detectors and an integrated security system, to ensure

the safety of patients and staff. The unit is led by

Barry Simon, DO, Medical Director of Inpatient

Services, Child and Adolescent Psychiatry.

The new child and adolescent inpatient psychiatric unit integrates a comfortable environment and a sophisticated security system.

The Center for Syncope and Autonomic Disorders often conducts special tests of the autonomic nervous system to assist in reaching an accurate clinical diagnosis.

28

Promoting Early Detection of Brain Metastases

Approximately one-quarter of all cancer patients

develop metastatic brain tumors in the course of their

illness when a primary cancer spreads to the brain.

To educate cancer patients on risk factors, symptoms

and available treatment options, the Brain Tumor

and Neuro-Oncology Center launched its B-AwareSM

initiative in 2010.

Under the auspices of the B-Aware campaign, the

center joined with Cleveland Clinic Taussig Cancer

Institute and the American Cancer Society to pre sent

a free informational program for patients, their

families and friends. In addition, the center created

educational materials to disseminate the message

that brain metastases are potentially life threatening

but treatable, and prompt diagnosis is critical.

Performing to a Higher Stroke Care Standard

The Cerebrovascular Center’s commitment to treating

stroke patients according to evidence-based guide-

lines was underscored in 2010 with the center’s

receipt of the American Heart Association/American

Stroke Association’s Get With The Guidelines®

– Stroke Gold Plus Performance Achievement Award.

The designation signifies full compliance with seven

stroke performance achievement indicators.

In addition, The Joint Commission recertified Cleveland

Clinic as a Primary Stroke Center. With regional

expansion and the development of a comprehensive

stroke care path, Cleveland Clinic hospital system now

has five Primary Stroke Centers offering patients in

northeast Ohio convenient access to top-quality care.

The Cerebrovascular Center has one of the highest

stroke-related patient volumes in North America and a

case severity index ranked among the top 2.2 percent

in the nation.

Cranial Radiosurgery Milestone

The Brain Tumor and Neuro-Oncology Center performed its 3,000th Gamma Knife® procedure in

January 2010, solidifying its reputation for technical leadership, experience and clinical expertise.

Cleveland Clinic Gamma Knife Center® opened in 1997, offering patients a nonsurgical treatment option

for certain malignant and noncancerous brain disorders, including brain metastases, pituitary tumors

and arteriovenous malformations.

Institute Review

Enhanced Clinical Care (continued)

A patient diagnosed with multiple brain metastases and treated with cranial radiosurgery.

Brain Tumor Board

2010 cases (through mid-August): 1,155


Spine Tumor Board

2010 cases (through mid-August): 218



Accelerating Epilepsy Diagnosis and Care

Cleveland Clinic Epilepsy Center, an international leader

in epilepsy diagnosis and treatment, expanded its

epilepsy monitoring units to improve patient access:

• Adult Epilepsy Monitoring Unit: from 10 to 14 beds

• Pediatric Epilepsy Monitoring Unit: from eight to nine

beds, plus the addition of a playroom for patients and

their siblings

The expansions enable patient consultations within

24 to 48 hours and expedited admission to the

appropriate monitoring unit to accurately diagnose

seizure problems and design the best possible

treatment plan.

Each year, the epilepsy team monitors more than

600 adults and 500 children. Both monitoring units

operate around the clock, staffed with dedicated

nursing and technical personnel and equipped with

the latest, most innovative technology.

Shaping a Supportive NeuroEthics Program

2010 saw the emergence of an active, viable

NeuroEthics program – a partnership between

the Neurological Institute and the Department of

Bioethics, with faculty from both areas. The program

was conceived to address the many ethical chal-

lenges posed for patients, families, caregivers,

researchers and clinicians by the rising incidence

of brain-based diseases and the attendant suffering.

The core faculty includes Paul Ford, PhD, Director;

Cynthia Kubu, PhD, Associate Director of

Neuroethics Research; and Adrienne Boissy, MD,

Associate Director of Clinical Neuroethics.

In its first full year, the program’s ambitious agenda

comprised:

• An inaugural distinguished neuroethics lecture,

delivered in June by Roberta Bondar, MD, nation-

ally recognized astronaut and neurologist

• A one-day symposium on the ethics of invasive

brain testing, presented in October through a

collaboration between the Epilepsy Center and

the Department of Bioethics

• A burgeoning research component, including two

ongoing grants with a combined budget of almost

$1 million (see details on page 24)

• Development of a robust ethics education program

In addition, the faculty provided continuing clinical

consultations. Ethicists participate in specialized patient

management conferences where difficult patient

selection and care issues are aired. They also are called

upon to consult on specific neurosurgical issues.

The Adult Epilepsy Monitoring Unit has undergone a significant expansion to expedite admission for diagnosis of seizure disorders.

30

Patient Experience

Creating a Calming Environment for Families

The task: Design a space to accommodate people

overwhelmed by grief, anxiety, exhaustion, relief

and a range of other powerful emotions as they

cope with a loved one’s health crisis. That responsi-

bility fell to patients and family members on the

Neurological Institute Patient Advisory Council,

working with a diverse Cleveland Clinic care team.

Led by Adrienne Boissy, MD, who chairs the

council, the team consulted with designers, the

Office of Patient Experience, IT and art curators on

appropriate carpeting, lighting, artwork and restroom

options to convey a sense of peace and hope to

patients’ families.

After nine months of collaboration, the Neuro-ICU

Family Comfort Area opened with a celebratory

ribbon-cutting. The comfort area, which seats

approximately 15 people, represents the vision and

partnership of patients, staff and employees. Not

content to rest on its laurels, the council went to work

on an admission brochure for neurological inpatients.

Celebrating the Defiance of Chronic Pain

Few chronic pain programs endure to mark three

decades of service to people who are emotionally and

physically devastated by pain. The Neurological Center

for Pain’s Chronic Pain Rehabilitation Program (CPRP)

is a rare exception. To commemorate its long legacy of

care, the CPRP invited all current and former patients

nationwide to attend an October 2009 reunion. Some

90 individuals turned out, many with family members,

to connect with other CPRP alumni and honor their

collective achievement in learning to manage their pain

and refusing to let it define them.

CPRP Program Director Judith Scheman, PhD,

welcomed the guests and former patients Penny Cowan

and Jim Ryser spoke of how they overcame their pain

and developed programs to help others. Edward

Covington, MD, Director of the Neurological Center for

Pain, was recognized for his dedication to the field.

Institute Review

The Neuro-ICU Family Comfort Area is an island of serenity for main campus visitors dealing with the severe illness of a loved one.

Brain Tumor Board

2010 cases (through mid-August): 1,155


Spine Tumor Board

2010 cases (through mid-August): 218



Binding a Community of Families Touched by Epilepsy

Cleveland Clinic’s Pediatric Epilepsy Support Group is

for families caring for children with difficult-to-control

epilepsy. Like a family itself, the group provides

a forum for parents facing tough decisions about

epilepsy surgery, invasive monitoring of seizures and

other procedures.

In August 2010, the group’s biennial reunion for

surgical patients and their families drew approximately

150 people from 15 states. While the children were

engaged in a full slate of activities – including a visit

from an animal trainer and his exotic friends and a

workshop for patients and their siblings – their parents

networked and attended educational sessions.

“I am very passionate about this group,” says leader

Deepak Lachhwani, MBBS, MD. “For families with a

child who has been a surgical patient, our reunion is

a wonderful and heartwarming occasion.”

Using Music to Ease Surgical Stress

As a surgical patient, Damir Janigro, PhD, had been

exposed to the din of the operating room. He won-

dered whether music could soothe neurosurgical

patients who must remain awake for long periods

during procedures such as deep brain stimulation. In

a study involving more than a dozen patients, most

with Parkinson’s disease, Dr. Janigro recorded the

subjects’ brain activity during surgery while different

types of music were played.

Listening to melodic music decreased the activity

of individual neurons in the deep brain, Dr. Janigro

reported, and relaxed some patients to the point of

sleep. The results suggest the right music can reduce

patient anxiety and possibly lower blood pressure,

which could mean less medication, quicker recovery

time and shorter hospital stays.Young epilepsy surgery patients and their siblings get acquainted with a tortoise at the 2010 Pediatric Epilepsy Support Group reunion.

32

Integrating World-Class Care Regionwide

The Neurological Institute’s Center for Regional Neurosciences combines physicians and other healthcare

providers in neurology, neurosurgery, neuroradiology and behavioral sciences, who see adult and pediatric

patients at Cleveland Clinic locations throughout northeast Ohio. Regional facilities extend advanced treat-

ments, technologies and the expertise of Cleveland Clinic into surrounding communities, making it easier for

patients to access specialists who treat the most complex neurological conditions.

Upgrading and Expanding to Optimize Outcomes

• Lakewood Hospital, a Cleveland Clinic hospital,

received a $1 million donation from Cleveland’s

Harold C. Schott Foundation to improve neurologi-

cal and geriatric services promoting brain health.

The donation funds The Harold C. Schott Pavilion

for Geriatric Neurological Health, providing patient

education and resources, allowing the hospital to

better care for patients with age-related neurologi-

cal disorders such as dementia and Parkinson’s

disease, and helping to establish Lakewood as

a hub for regional neurological care.

The hospital will partner with Cleveland Clinic Lou

Ruvo Center for Brain Health. Under the direction

of renowned researcher Jeffrey L. Cummings, MD,

the center is expanding its management of clinical

trials. Programming at Lakewood will focus on

enrolling patients in trials of new treatment options

for Alzheimer’s disease.

Cleveland Clinic Neurological Institute at Lakewood

Hospital opened in 2008, with a multidisciplinary

staff offering treatments for even the most complex

conditions at a convenient site for residents of

Cleveland’s West Side and western suburbs.

• Recent enhancements at Cleveland Clinic’s Hillcrest

Hospital illustrate the significance the Neurological

Institute attaches to regional integration. Among

the improvements was the installation of a state-of-

the-art, flat-panel-detector biplane angiography

suite. This equipment enables the performance of

therapeutic endovascular procedures and positions

Hillcrest to be a leader in the management of

acute ischemic stroke and complex cerebrovascular

conditions. Continued expansion of neurological

services at Hillcrest is likely.

• Cleveland Clinic Sleep Disorders Center extended

its presence to two additional community hospitals

in the Cleveland Clinic system: Medina and

Hillcrest hospitals. For patient comfort and

convenience, the Sleep Disorders Center offers

overnight sleep studies at nine regional locations,

including six hotels, where sleep studies are

performed for adults and children age 12 and older.

Consultations and sleep studies for patients of all

ages are performed at our main location at Fairhill.

Institute Review


Cleveland ClinicChagrin Falls

Cleveland ClinicTwinsburg

Cleveland ClinicStrongsville

Cleveland ClinicBrunswick

Cleveland ClinicWestlake

Cleveland ClinicLorain

Cleveland Clinic

Children’sHospital,Shaker

Cleveland ClinicElyria

Cleveland ClinicAvon Lake

Cleveland ClinicBroadview Heights

Lake Erie

Cleveland ClinicWooster

Cleveland ClinicBeachwood

Cleveland Clinic Solon

Cleveland ClinicWilloughby Hills

LORAIN COUNTY

CUYAHOGA COUNTY

SUMMIT COUNTYMEDINA COUNTY

LAKE COUNTY

PORTAGECOUNTY

GEAUGACOUNTY

(WAYNE COUNTY)

Cleveland ClinicLakewood

Cleveland Clinic Avon

EuclidHospital

Hillcrest Hospital

Huron Hospital

Lutheran Hospital

Lakewood Hospital

Fairview Hospital

South Pointe Hospital

Medina Hospital

Marymount Hospital

34

Education

Extending CME Opportunities

Cleveland Clinic’s Center for Continuing Education

is responsible for one of the world’s largest, most

diverse CME programs. In 2009 and 2010, more

than 30,000 professionals participated in more than

500 Neurological Institute-sponsored CME programs,

ranging from weekly Grand Rounds in six depart-

ments to multi-day international symposia, regional

programs, association meetings, guest lectures and

training courses. Among the highlights:

• 2010 Neurology Update – a Comprehensive Review

for the Clinician, which brought almost 200 neurolo-

gists, internists, family practice physicians and other

providers from 35 states to Washington, D.C.

• 2010 International Symposium on Long-Term

Control of Secondary Central Nervous System

Malignancies, which attracted almost 200 indi-

viduals from around the world to Cleveland. This

event, presented by the Neurological Institute and

Taussig Cancer Institute, marked the launch of

the B-AwareSM educational campaign for cancer

patients (see page 28).

• Endovascular Therapy for Supra-Aortic Disorders

symposium. This 2009 event, a new joint venture

with Beijing Tiantan Hospital, drew more than

300 attendees to Beijing. A second symposium,

A Focus on Acute Ischemic Stroke, took place in

October 2010 in Las Vegas, Nevada.

The Center for Continuing Education’s efforts to

expand CME opportunities through nontraditional

learning were highly successful. The number of

online certificates awarded rose to 10,422 in 2010,

from 5,995 the prior year. In 2008, 2,221 online

certificates were issued.

Health Care Quality Innovation Summit

Optimizing Value and Securing a Future of Innovation and Quality

May 11-13, 2011

InterContinental Hotel and Bank of America Conference Center, Cleveland, Ohio

This multidisciplinary conference on Cleveland Clinic’s main campus is dedicated to exploring novel strategies for improving the assess-ment and delivery of quality health care. The summit brings together the major stakeholders in this process, including physicians, nurses, patients, provider institutions, public and private payers, government agencies and more. In-depth discussions will focus on the shared and sometimes competing visions through which health care quality metrics can be used to advance outcomes.

Register today! ccfcme.org/Quality11

Institute Review


Observing a Tradition: NI Research Day

The annual Neurological Institute Research Day was

created to provide an opportunity for trainees in the

institute to present their research projects to the

Cleveland Clinic neuroscience community. Patterned

after national scientific meetings with poster and

platform sessions, the event is open to residents,

fellows, medical students, PhD students and

postdoctoral fellows conducting research in the

Neurological Institute and the Department of

Neurosciences of Lerner Research Institute. Each

year, 65 or more trainees present projects, many

of which go on to national presentation and peer-

reviewed publication.

Projects are evaluated by a panel of judges from

the departments of Neurology, Neurological Surgery,

and Psychiatry and Psychology. Awardees are selected

in a number of categories, based on scientific merit,

originality, quality and relevance of the projects.

Staff attendance is encouraged and CME credits

are provided. The day ends with a reception and

an awards ceremony.

Neurological Institute Research Day showcases the research projects of physicians in training. Staff physicians judge the work and confer awards for excellence.

Staff Achievements36

Staff Achievements

Milestone

• William Bingaman, MD, Vice Chairman, Clinical

Areas, Neurological Institute, performed his 1,000th

pediatric epilepsy surgery, a tremendous achieve-

ment for any neurosurgeon in his or her lifetime.

Cleveland Clinic is one of a few centers to perform

brain surgery on epileptic patients to improve their

quality of life. Cleveland Clinic Epilepsy Center leads

the country in surgical volume, with more than

350 surgeries in children and adults each year.

Grant Awards

• The National Multiple Sclerosis Society committed

almost $305,000 to a two-year study of “Patient

Decision-Making in Multiple Sclerosis,” led by

Robert Fox, MD. The study’s goal is to assess

risk tolerance and its role in patient decision

making in the treatment of MS.

• Stephen Rao, PhD, was awarded a five-year,

$2.1 million grant by the National Institute on

Aging to examine the value of task-activated

functional MRI (fMRI) in the identification and

prediction of disease course in populations at

risk for development of Alzheimer’s disease. fMRI

will also be used as an outcome measure in a

randomized, double-blind, placebo-controlled

clinical trial involving the rivastigmine (Exelon®)

patch in patients with the amnestic form of mild

cognitive impairment.

• Tatiana Falcone, MD, received a $791,622

federal grant to improve access, knowledge and

mental health resources for children with epilepsy.

The three-year grant will also support training in

the problems children with epilepsy face and how

to help them. Partners in the project include the

Epilepsy Association of Cleveland, the Cleveland

Metropolitan School District and the National

Alliance of Mental Illness Greater Cleveland.

• J. Javier Provencio, MD, FCCM, is one of

seven recipients nationwide of a 2010 research

grant from the Brain Aneurysm Foundation.

He received $20,000 for his project, “Timing

Neutrophil Inactivation to Prevent Vasospasm

in Murine Model.”

• Imad Najm, MD, received an $846,847

Department of Defense grant to study the

mechanisms of epilepsy development following

severe head injury. This grant will enable the

study of imaging and neurophysiologic predictors

of epilepsy development after traumatic brain

injury (TBI) and assessment of the effect

of deep brain stimulation on the treatment of

TBI-induced epilepsy.


Appointments

• Neurological Institute Chairman Michael T.

Modic, MD, FACR, was appointed to the newly

created post of Cleveland Clinic Chief Emerging

Business Officer. Dr. Modic works with executive

leadership to review emerging business strategy,

capitalize on strategic thinking and assess new

ideas to expand opportunities. He continues as

Chairman of the Neurological Institute and works

closely with other institutes to identify ways to

take advantage of existing opportunities.

• Donald A. Malone Jr., MD, was appointed

Chairman of the Department of Psychiatry and

Psychology. He also serves as Director of the

Center for Behavioral Health. Dr. Malone succeeds

George Tesar, MD, who held the department

chairmanship for 16 years and continues as

Director of the General Psychiatry Residency

Training Program.

• Robert Weil, MD, was named to fill the newly

created position of Director of Neurological Institute

Surgical Operations. His responsibilities include

improving operational efficiency and enhancing the

institute’s ability to achieve and maintain excellence

in patient care, safety, satisfaction and outcomes.

Recognition

• Steven Landers, MD, MPH, Director of Cleveland

Clinic at Home, was chosen 2009 Physician of

the Year by the National Association for Home

Care & Hospice.

• Richard Ransohoff, MD, was among five

healthcare professionals inducted in 2009 into

the National Multiple Sclerosis Society’s Volunteer

Hall of Fame.

• Tatiana Falcone, MD, was chosen by the

American Academy of Child and Adolescent

Psychiatry as a mentor for its summer 2010

medical student research training program. The

prestigious designation is limited to a small

number of academy members annually.

• A textbook authored by Edward Benzel, MD;

Michael Steinmetz, MD; and Imad Najm, MD,

received the Benjamin Franklin Silver Award

for 2010 in the professional/technical category.

Their text, “Anatomic Basis of Neurologic

Diagnosis,” was the only Thieme Publishers

award recipient. The competition attracted more

than 1,300 entries, which were judged for

editorial and design excellence.

• “The Kindness of Cleveland” was the title of

a February 2010 blog posting by Scott Simon

extolling the skill and wisdom of Edward Benzel,

MD, who performed cervical spine surgery on the

popular National Public Radio host. Dr. Benzel was

not the only one who earned Mr. Simon’s praise:

“From shuttle drivers to nurses and surgeons, the

staff at the Cleveland Clinic filled an anxious time

for our family with warmth, and even laughter.”

Mr. Simon returned to Cleveland Clinic in May

2010 to deliver the keynote address at the first

Patient Experience Summit.

Services for Physicians and Patients38

Stay Connected to Cleveland Clinic

Cleveland Clinic Information

Neurological Institute24/7 hospital transfers or physician consults

800.553.5056

Neurological Institute Contact Center

Centralized scheduling that allows patients to make appointments – including same-day appointments, if necessary – with any Neurological Institute physician at any location.

216.636.5860 or toll-free 866.588.2264

On the Web at clevelandclinic.org/neuroscience

Services for PhysiciansPhysician Directory View all Cleveland Clinic staff online at clevelandclinic.org/staff.

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

Critical Care Transport Worldwide Cleveland Clinic’s critical care transport team and fleet of mobile ICU vehicles, helicopters and fixed-wing aircraft serve critically ill and highly complex patients across the globe. 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 216.444.8302 or 800.553.5056.

Request for Medical Records 216.444.2640 or toll-free 800.225.2273, ext. 42640

Track Your Patient’s Care Online DrConnect offers referring physicians secure access to their patients’ treatment progress while at Cleveland Clinic. To establish a DrConnect account, visit clevelandclinic.org/drconnect or email [email protected].

Online Medical Second Opinions from Cleveland Clinic’s MyConsult are particularly valuable for patients who wish to avoid the time and expense of travel. Visit clevelandclinic.org/myconsult, email [email protected] or call 800.223.2273, ext. 43223.

Outcomes Data View the latest clinical Outcomes book from Cleveland Clinic Neurological Institute at clevelandclinic.org/quality/outcomes.

CME Opportunities: Live and Online Cleveland Clinic’s Center for Continuing Education’s website, ccfcme.com, offers convenient, complimentary learning opportunities, from a virtual textbook of medicine (Disease Management Project) and a medical newsfeed refreshed daily, to myCME, a system for physicians to manage their CME portfolios. Many live CME courses are hosted in Cleveland, an economical option for business travel.

Services for PatientsMedical Concierge Complimentary assistance for out-of-state patients and families, 800.223.2273, ext. 55580, or email [email protected]

Global Patient Services Complimentary assistance for national and international patients and families, 001.216.444.8184 or visit clevelandclinic.org/gps

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

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