The University of Toledo

The Center for Neurological Health

The Center for Neurological Health is an interdisciplinary, comprehensive program with two major areas of clinical, research and educational emphasis: neurological disorders of aging and neurological disorders affecting women. Through this unique approach, we specialize in the diagnosis and management of numerous disorders including stroke, epilepsy, multiple sclerosis, migraines, neuropathies, Parkinson's disease and dementia.

The mission of the Center for Neurological Health is: 1) To provide neurological evaluation and continuing care for persons with conditions of the nervous system. 2) To coordinate the services of physicians, nurses, social workers, psychologists and therapists in order to provide a multi-disciplinary approach to complicated and potentially disabling conditions. 3) To conduct clinical trials of new treatments for neurological conditions. 4) To conduct original basic and clinical science investigations into neurological diseases. 5) To provide education on neurological disorders to students, residents, healthcare providers, and the lay public.


The Parkinson's Disease and Movement Disorder Program (PDMDP):
Directed by neurologist Lawrence Elmer, MD, PhD, this program provides expert evaluation and care for persons with Parkinson's disease, Huntington's disease, other neurodegenerative disorders, and various neurological disorders affecting normal movement or creating abnormal movements. The Parkinson's Disease and Movement Disorder Program (PDMDP), established in 1998, has one of the more active clinical research programs in the country. In addition to standard and innovative medication protocols, patients are evaluated for neurosurgical procedures, including deep brain stimulation for Parkinson's disease and tremor. The faculty travel throughout the region educating and assisting Parkinson's support group members. The PDMDP, in conjunction with other programs in Ohio and Michigan, also conducts successful annual educational conferences for patients and caregivers.  Affiliated with this clinic are physicians Krishe Menezes MD, Selena Nicholas-Bublick MD, nurse practitioner Mary (Molly) Scott, coordinators Kathy Davis, RN, Kimberly Cole, RN, FNP, Stephanie Wilson, RN, MSN, social workers Kristen Schuchmann and Lisa Keaton, research administrator Julia Spears, patient coordinator Debra O'Connell, and patient assistance coordinator Kathy Pawloski.

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The Stroke Program:
The Stroke Program is unique within the region, both in regards to our commitment to providing state-of-the-art care and our level of expertise. Established in 1995 to provide emergent evaluation and inpatient care to persons suffering from acute stroke and transient ischemic attacks, we have been the region’s leader in the use of tPA therapy. Through our research protocols we have also been able to offer our patients to participate in important clinical trials studying cutting edge therapies. UTMC is the first Joint Commission-designated Primary Stroke Center in Northwest Ohio having received the designation in March 2005. Lead by Vascular Neurologist, Dr. Gretchen Tietjen, the Acute Stroke Team includes the Neurology faculty and residents, and Andrea Korsnack, RN., with assistance from our colleagues in Emergency Medicine, Neurosurgery, Vascular Surgery, and Neuroradiology. The Department directs the UTMC Stroke Unit, and organizes and maintains the UTMC Stroke registry through the American Heart Association (AHA) Get with the Guidelines Program, which began in January 2003. In 2010, for the 5th consecutive year,  the UTMC Primary Stroke Center received the Performance Award from the American Stroke Association Get With The Guidelines Council for excellence in stroke treatment with achievement of >85% compliance across all nationally-determined indicators. We join only 5 other programs nationwide who have received the award for 5 consecutive years. In 2010 Dr. Tietjen was also awarded the “Stroke Innovation Award” from the AHA scientific journal Stroke for her research on migraine as a stroke risk factor.

 

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The Comprehensive Epilepsy Program:
The Comprehensive Epilepsy Program provides state-of-the-art medical and surgical care for a large number of patients with epilepsy, with specialized services for the elderly, women with epilepsy and those with mental or physical disabilities. The incidence and prevalence of epilepsy increase dramatically in the elderly population, necessitating a multidisciplinary approach to deal with complex medical and social issues including drug interactions, the effects of anticonvulsants on bone density, and whether elderly patients with epilepsy should live alone. The program is directed by Imran I. Ali, MD, a board certified epileptologist who is also the director of the UT Clinical Neurophysiology Laboratory.  In addition to patient care, the Comprehensive Epilepsy Program also supports a strong research component including experimental drug trials in addition to clinical and laboratory research programs. Clinical research interests include studies on the morbidity and mortality of status epilepticus in the elderly, vascular risk factors in epilepsy, and bone loss with antiepileptic drug use. Dr. Ali served on a task force identifying risk factors for bone loss, osteopenia and osteoporosis in patients treated with antiepileptic drugs, an important risk factor for morbidity in elderly patients.  There is also a strong emphasis on education, as our faculty have lectures on epilepsy and antiepileptic drugs to medical students, residents at all levels of training, as well as other allied health programs at UT and community-based education programs for the general public.

Epilepsy Center of Excellence Brochure

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The Multiple Sclerosis Program:
The Multiple Sclerosis (MS) Program, co-directed by Boyd Koffman, MD, PhD, Department of Neurology and Mary Ann Myers, MD, Department of Physical Medicine and Rehabilitation, seeks to provide comprehensive care of patients with multiple sclerosis in order to provide the best possible quality of life. One of the initial responsibilities of their clinic is the evaluation and treatment of patients in whom multiple sclerosis is suspected. In addition, the UT Multidisciplinary MS Clinic meets once each month for comprehensive evaluation and treatment of patients with multiple sclerosis. The Multidisciplinary MS Clinic is able to address a wide array of problems and is staffed by Drs. Koffman and Myers, neuropsychiatrist Mark Wright, MD, and a neuro-ophthalmologist Thomas Mehelas, MD. Additional access to subspecialties such as physical and occupational therapy, and urology is available through referral. The clinic is able to utilize neuroimaging modalities (MRI), lumbar puncture, and evoked potentials to aid in diagnosis. Symptomatic and/or immunomodulatory medications are used as appropriate to help treat this chronic disorder. New investigations at both basic science and clinical trials are underway.

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The Headache Treatment and Research Program:
The faculty of The Headache Treatment and Research Program at the Medical College of Ohio are nationally recognized for their expertise in headache management, education, and research. Dr. Tietjen, Program Director, is certified in Headache Medicine, and works together with Dr. Vicki Ramsey- Williams, and two Nurse Practitioners, Christine Utley, CNP, and Kim Cole, CNP. The monthly multidisciplinary clinic for persons with refractory is coordinated by Christine Utley, CNP, and includes evaluation and treatment by Mr. David Kujawa, Physical Therapist,  and Lori Rokicki, PhD., Pain Psychologist. The Program offers opportunities for persons to participate in research protocols regarding the causes and consequences of headache, and studies for more effective therapies. In 2008 Dr. Tietjen received The Seymour Solomon Research Award and in 2010 The Pink Brain Research Award, both from the American Headache Society, for her work in endothelial dysfunction and the effects of childhood maltreatment on migraine and related pain disorders.

 

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The Nerve and Muscle Program:
Noor Pirzada, MD, Director of the UT EMG Laboratory, and Boyd Koffman, MD, PhD, provide clinical, electrodiagnostic, and muscle biopsy evaluation of persons with symptoms of diffuse or focal weakness, numbness, or pain. The Division of Neurosurgery can provide nerve biopsy service when necessary. Diseases such as ALS (Lou Gehrig's disease), polyneuropathies, post-herpetic neuralgia, and some myopathies tend to occur more commonly in geriatric populations. The full range of available services includes; medical, physical, and occupational therapy, respiratory and nutritional care, orthotics, social work, and medical and rehabilitation supplies. The Neuromuscular Division provides chemodenervation therapy for various movement disorders. Botulinum toxin therapy is available for focal dystonias, such as spasmodic torticollis, blepharospasm, and writer's cramp and also for disorders such as hemifacial spasm. Patients who do not respond to botulinum toxin or who become resistant to it, receive injections of phenol. Chemo denervation is performed under EMG guidance, ensuring that the most active muscles are injected. 

 

 

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The Vestibular and Balance Program:
The UTMC Vestibular and Balance Program (Director: Hongyan Li, MD, Ph.D) provides comprehensive services to patients with dizziness and balance problems. The program includes Dizziness and Balance Clinic for outpatient office visits and a Vestibular Laboratory for diagnostic neurophysiological testing. Our program is one of only three in the state led by a specialty trained neurologist, and the only one in Northwest Ohio. Patients with dizziness, vertigo, and impaired equilibrium are evaluated for the underlying neurological causes and then, after diagnosis, are directed to appropriate treatments. Dizziness and imbalance can be caused by both neurological and non-neurological conditions. When one suffers from those symptoms, he or she should receive a comprehensive evaluation as soon as possible because symptoms may be related to serious conditions, such as stroke, tumor, or infection, that can be life threatening should correct treatments were delayed. When the diagnosis is right and appropriate treatments are given, many neurological disorders, such as migraine and motion sickness, can be prevented and the some others, such as multiple sclerosis and neurodegenerative diseases, can be stabilized. Benign positional vertigo, one of the most common causes of positional vertigo, often resolves when special maneuvers have been applied. Many patients with irreversible causes for their symptoms may also benefit from participating specially designed physical therapies and exercises provided by specially trained therapists at our Vestibular and Balance Rehabilitation Service. Some patients may be also referred to other specialists, including otolaryngologists and cardiologists.