stroke

6 ways to prevent a stroke

When it comes to preventing a stroke, simple lifestyle changes can make all the difference.

Strokes occur when blood vessels that carry oxygen and nutrients to the brain burst or are blocked by a clot. When that happens, brain cells begin to die, affecting a person’s memory and ability to control muscles.

Stroke is the fifth-leading cause of death in the U.S. and in Kentucky, but there’s good news: Nearly 80 percent of all strokes are preventable.

In celebration of American Stroke Month, we’ve put together a list of things you can do to live a healthier lifestyle and better your chances of avoiding a stroke.

1. Get moving.

Regular physical activity will help lower your cholesterol and blood pressure, two of the biggest risk factors for stroke. Aim for 30 minutes of moderate activity five times a week. Something as simple as a brisk walk or bike ride with a friend will work wonders for your overall health.

2. Stop smoking.

Smokers are twice as likely to experience a stroke as nonsmokers. That’s because smoking thickens blood and increases the likelihood of clots. If you’re struggling to quit smoking, ask your doctor for help. And check out our blog with tips and resources that can help you or someone you know start on the path toward success.

3. Eat your vegetables.

And beans, whole grains and nuts, too – all of which are staples of a healthy diet. Improving your diet will help lower your cholesterol and blood pressure and help you maintain a healthy weight. Check out our guide for kick-starting a healthy diet.

4. Drink less.

Alcohol can increase blood pressure and the risk of stroke. Moderation is the key: For men, no more than two drinks a day, and for women, no more than one.

5. Learn about Afib.

Atrial fibrillation, also known as Afib, is a type of irregular heartbeat. If left untreated, Afib can cause blood clots in the heart that can move to the brain and cause a stroke. Talk to your doctor about Afib if you experience symptoms such as heart palpitations or shortness of breath. Learn more about the UK Gill Heart & Vascular Institute’s Heart Rhythm Program and listen to a podcast with our Afib specialist, Dr. Ted Wright.

6. Understand the things you can’t control.

Although improving your diet, ramping up your activity and living a healthy lifestyle can all decrease your risk for stroke, there are some risk factors you cannot control. Things like age, gender and race all play a role in stroke risk, and even though you can’t change those factors, it’s important to understand if you’re more susceptible.

Click the icon below to see our Stroke Quick Facts inforgraphic.

Stroke quick facts infographic from UK HealthCare


Next steps:

  • At the UK Comprehensive Stroke Center, we offer treatment, prevention and rehabilitation services for stroke patients. Learn more about our program.
  • Dr. Gretchen Wells, director of UK’s Women’s Heart Health Program, writes about why knowing your family health history can help you understand your own risk of disease. Read her blog.

 

Bruce Smith

Facing permanent brain damage, patient turns to UK for unlikely answer: a liver transplant

In 2011, Bruce Smith sat in his office preparing to make handouts for a meeting, like any other normal work day. But when he sat in front of his computer, he suddenly realized something frightening: He’d lost all understanding of how to use the machine. Bewildered at the sudden lapse in cognition, he said his coworkers thought he was joking around.

“I finally said, ‘I’m serious!'” Smith said. “‘There’s something going on here.'”

That moment was the first of many “lapses” to come. Smith was a diabetic, and his doctors initially thought his mental fog episodes were due to low blood sugar. When that was ruled out, they suspected he might be suffering from a series of mini-strokes.

“It was like I was taking a trip but never leaving the farm, you know?” said Smith, who is from Belfry, Ky. “I was awake but always taking naps.”

It wasn’t until Smith was referred to UK HealthCare that he got a diagnosis: hepatic encephalopathy, a term used to describe the mental fog that accompanies severe liver failure and a common occurrence in patients in need of a transplant. The liver’s job is to filter toxins from the body, and when it fails, the toxins accumulate in the bloodstream and wreak havoc elsewhere.

The team at UK determined that Smith’s liver was failing due to non-alcoholic cirrhosis. Although neither of his parents had the disease, one may have been a carrier and passed the gene down to Smith.

After getting a second opinion from the Cleveland Clinic confirming the diagnosis, Smith opted to remain at UK to be listed for a transplant. Liver transplant patients are assessed with a score known as the Model for End-stage Liver Disease, or MELD, which measures the amount of toxins in the blood and determines the patient’s position on the transplant waiting list. The higher the MELD score, the greater the severity of the disease and need for transplant.

Making the case for a transplant

Smith’s MELD score remained relatively stable for the next four years. However, his mental function continued to decline. As Smith’s symptoms worsened, his doctors at UK referred him to neurologists at the Kentucky Neuroscience Institute, where they diagnosed him with a much more serious condition.

“Bruce started out with hepatic encephalopathy, but then developed hepatocerebral degeneration, an extremely rare form of brain injury,” said Dr. Malay Shah, director of the liver transplant program at UK. “The exact cause of this disease is unknown, but liver transplant is the only cure.”

Many symptoms of hepatocerebral degeneration closely resemble those of Parkinson’s disease. In Smith’s case, he had trouble with speech, gait ataxia (uncoordinated movement and problems with balance) and ever-worsening dementia. Smith says he was essentially home-bound. He was unable to return to work, often couldn’t go to church and avoided going out for fear of experiencing an episode.

“I was asking, ‘Why me, Lord?'” he said. “‘What’s going on?'”

Although Smith’s liver toxicity remained stable – thus keeping his MELD score lower than necessary to receive a transplant – Shah said he knew he needed to push harder for Smith to be transplanted as soon as possible. He wrote a letter of appeal to the United Network for Organ Sharing (UNOS), a nonprofit organization that manages the nation’s organ transplant system, making the case for the severity of Smith’s situation.

“I appealed to UNOS to make Bruce’s MELD score higher than his lab values would suggest because hepatocerebral degeneration needs to be treated with a liver transplant,” Shah said. “Without an expeditious transplant, this disorder becomes permanent and irreversible. At that point, a transplant would be contraindicated because of the permanent neurologic damage from the disease.”

Shah’s appeal was successful, and on Sept. 27, 2015, Smith got a call from UK just as he was arriving home from church. He and his wife packed up and headed to Lexington to prep for surgery.

“I had all this happiness, excitement,” Smith said. “But also the fright of undergoing a major surgery.”

At 2 a.m. the next morning, Smith received his new liver – and a new lease on life. Since his transplant, things have improved drastically. He recovered fully from the surgery, and he underwent physical and occupational therapy to build back his strength and improve some of the basic skills he’d lost during his illness.

“I had to relearn how to write straight,” Smith said. “I had to use a ruler to sign paperwork.”

Becoming an organ donor advocate

As a surgeon who sees firsthand what a difference a transplant can make in the lives of his patients, Shah is passionate about raising awareness for organ donation. He notes that part of his job is making sure patients understand the gift they’ve been given.

“Our patients rely on the generosity of others to have a second chance in life,” Shah said. “And that’s exactly what I impart on my patients prior to transplant – that they and I literally owe it to the donor and their family to do the very best we can to take care of that generous gift.”

One way Smith is using his gift is by educating others on his personal experience. He is now a member and ambassador for Kentucky Organ Donor Affiliates (KODA), the organization that runs the Kentucky Organ Donor Registry, educates the public on organ donation and honors those who have given the gift of life. He was recently featured on a billboard for KODA in Eastern Kentucky and says sharing his story is one thing he can do to honor his donor.

“What a selfless decision that person, or their family, made,” Smith said. “This is my way of giving back. Hopefully, it will get folks interested in becoming a donor and ultimately making a difference in someone else’s life.”

“Bruce is a wonderful patient and a great donor advocate for KODA,” Shah said. “It’s nice to see folks like him work with the organ bank to help educate others in their respective communities about how organ donation can help their neighbors.”

Although he is unable to work, Smith has returned to an active lifestyle that includes walking, performing and creating. He plays guitar as a hobby and gives lessons to those in his community. He has a small workshop behind his house, where he dabbles in woodworking and metalworking. None of these things would have been possible without the transplant he received a little less than two years ago.

But perhaps most importantly, he says, he lived to be able to hold his first grandchild, born just over a month ago, with a second grandchild coming next month.

“You push through death’s doors and go through what I’ve been through,” Smith said, describing his thoughts when he first held his grandchild, “and I just thank God that I’m alive to hold this little thing.”

Smith holding his newborn granddaughter -- his first.

Smith holding his newborn granddaughter.


Next steps:

UK student celebrates graduation one year after suffering strokes

Allison Couri graduated from UK May 5, but hers was more than the ordinary triumph over class loads and term papers. With the help of stroke experts at the Kentucky Neuroscience Institute, the Peoria, Ill.-native triumphed over health problems few 20-somethings face.

A little more than a year ago, Couri, then 21, came to the UK HealthCare Emergency Department complaining of headaches and dizziness. A CT scan identified that she had a stroke, and she was admitted to the hospital and assisted by the stroke care experts at the Kentucky Neuroscience Institute. Couri suffered more strokes, leaving her with a gait, slurred speech and blurry vision. She was diagnosed with lupus, which can lead to a rare complication called inflammatory vasculitis a condition marked by inflamed blood vessels that can also cause strokes.

After chemotherapy to treat her lupus, rehabilitation to address the effects of the strokes, and with the help of her service dog, Magnolia, Couri was able to finish her studies at UK and graduate. She plans to pursue a law degree.


Next steps:

Sanders-Brown Center on Aging

Watch: 6 families coping with Alzheimer’s share their stories

Alzheimer’s doesn’t just affect the person with the disease; it affects their family and friends, too. A new video from the UK Sanders-Brown Center on Aging chronicles the emotional journey of the wives, sons, husbands and daughters whose loved ones have been diagnosed with Alzheimer’s.

Titled “Our Story,” the video debuted at the Sanders-Brown annual dinner celebration on April 13 and featured the stories of six families whose lives have been affected by Alzheimer’s disease. (Watch the video below!)

Our Story shows how Sanders-Brown helps patients and their family and friends cope with the financial, psychological and emotional impact of the disease – and how many of them are giving back by participating in research at Sanders-Brown.

“Kentucky is so fortunate to have [Sanders-Brown] right in its backyard,” said Jon Vaughn, chairman of the Sanders-Brown Center on Aging Foundation. “It seemed right to focus on the Sanders-Brown research, education and clinical programs, and its profound impact on the people who suffer in Kentucky and beyond.”

About 70,000 Kentuckians suffer from the disease, and someone new is diagnosed with Alzheimer’s every 66 seconds. Linda Van Eldik, PhD, director of the Sanders-Brown, reminded those in attendance that while there is currently no cure for Alzheimer’s disease, Sanders-Brown is a world leader in efforts to find ways to slow down the disease process or cure it altogether.

In the end, however, Sanders-Brown’s mission isn’t just about numbers, test tubes or microscopes.

“It’s about patients and their families,” she said.

Watch “Our Story” below.


Next steps:

Dr. Craig van Horne, director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute, spoke about his aspirations and hidden talents.

Watch: 5 questions with neurosurgeon Dr. Craig van Horne

Neurosurgeon Dr. Craig van Horne came to Kentucky from Boston to pursue an idea: Could peripheral nerve tissue implanted in the brain reduce the symptoms of Parkinson’s disease?

Van Horne is the director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute. He focuses his research on cellular and surgical therapies for Parkinson’s disease.

Deep brain stimulation, or DBS, is a surgical procedure that uses electrodes to stimulate areas of the brain, effectively overriding the damaged nerve’s electrical impulses and reducing many of the symptoms related to Parkinson’s disease. Van Horne is testing an experimental procedure called DBS Plus, which uses a patient’s own peripheral nerve tissue to prompt nerve regeneration and slow the disease process.

Van Horne says the teamwork and support at UK HealthCare – plus a healthy dose of Kentucky hospitality – fostered the atmosphere he needed to bring DBS Plus to fruition. (And having a lucky cap doesn’t hurt.)

Watch this episode of “Five Questions” to learn more about Dr. van Horne’s aspirations and secret talents.


Next steps:

The American Heart Association have promoted a simple, effective way to identify stroke. But the work of one UK resident could make it even better.

UK neurology resident proposes new way to identify stroke

Organizations like the American Heart Association have promoted the FAST concept to help people recognize the symptoms of stroke. FAST is a mnemonic that stands for facial drooping, arm weakness, speech difficulties and time. It’s used to help people understand the symptoms of a stroke and remind them to act quickly in seeking treatment because strokes can be debilitating or even deadly.

However, a study published in a recent issue of Stroke and authored by a resident physician at UK HealthCare might signal a change in how laypeople understand stroke symptoms and how first responders assess possible strokes.

Identifying areas for improvement

Dr. Sushanth Aroor, a fourth year neurology resident at UK, was inspired by a conversation with Dr. Larry B. Goldstein, co-director of the Kentucky Neuroscience Institute and Aroor’s mentor, to explore how many strokes were initially missed because the FAST mnemonic didn’t apply to them.

“Dr. Goldstein’s idea to look at FAST, which was prompted by a conversation he had with a medical reporter, was something that made a lot of sense to me as I would very often see patients presenting with strokes that were FAST negative,” Aroor said.

Aroor began by identifying all patients admitted at UK in 2014 who were ultimately diagnosed with stroke and then determined how many of those patients initially presented with the FAST symptoms.

“Of the 736 people included in the study, slightly more than 14 percent did not have FAST symptoms but were ultimately diagnosed with a stroke,” he said.

Aroor then tried to quantify additional presenting symptoms for these non-FAST stroke patients and identified two prevalent symptoms: problems with balance (42 percent) and sudden onset of visual problems (40 percent). This led to a modification of the FAST mnemonic to BE-FAST (B for balance and E for eyes).

BE-FAST could change public policy

“We were able to demonstrate that by adding these two symptoms to the FAST mnemonic, the proportion of stroke patients not initially identified was reduced to 4.4 percent,” Aroor said. “Focusing our education efforts on BE-FAST instead of FAST could help reduce the number of missed strokes, therefore improving access time to treatments that could reduce or eliminate disability.”

Goldstein says that Aroor’s study could signal an enormous change in public policy.

“This is potentially a big deal,” Goldstein said. “As Aroor’s study is replicated and fine-tuned prospectively, his work could ultimately change how hospitals and first responders identify potential stroke victims, and change how organizations like the American Heart Association shape their public education campaigns.”

Gaining national notoriety

Other centers – many of whom were looking for hard data to back up their hunch about BE-FAST – are already taking note of Aroor’s study.

“We had been looking to switch to BE-FAST for about six months now but had no evidence-based practice to actually be able to implement the change until this study,” said Angie Russell, RN, BSN, stroke nurse program coordinator for the Lahey Medical Center in Massachusetts.

But Aroor’s study in Stroke provided the data Russell needed to revise Lahey’s stroke alert in-house policy to include BE-FAST. He is now working with her medical practice council to implement BE-FAST at Lahey’s five satellite facilities.

Aroor, characteristically modest, is quite pleased with how his study has been received.

“It’s nice to know that a lot of people are looking at this study and wanting to change how they teach the public how to identify strokes,” he said.

Check out the video of Aroor speaking about the promise of his work:


Next steps:

There is no cure for Parkinson’s, a debilitating disease that affects movement. But Dr. Craig van Horne's work at UK HealthCare is showing promise.

Listen: Dr. Craig van Horne discusses promising Parkinson’s treatment

Parkinson’s disease is a long-term, progressive disorder of the nervous system that affects movement. There’s no cure for Parkinson’s, but UK neurosurgeon Dr. Craig van Horne‘s experimental treatment is showing promise in helping patients manage the symptoms of this disease.

Van Horne is the director of the Deep Brain Stimulator Center at the Kentucky Neuroscience Institute. He focuses his research on cellular and surgical therapies for Parkinson’s disease.

Deep brain stimulation, or DBS, is a surgical procedure that uses electrodes to stimulate areas of the brain, effectively overriding the damaged nerve’s electrical impulses and reducing many of the symptoms related to Parkinson’s disease. Dr. van Horne is testing an experimental procedure called DBS Plus, which uses a patient’s own peripheral nerve tissue to prompt nerve regeneration and slow the disease process.

Early data shows that DBS Plus has improved symptoms for some patients, and van Horne hopes it will become the new “standard of care” for treating Parkinson’s symptoms.

On this episode of the University of Kentucky’s podcast Behind the Blue, we sat down with Dr. van Horne to discuss DBS Plus, what this treatment may mean for Parkinson’s patients and how this research can impact other areas across the spectrum of healthcare.


Next steps:

Some patients who receive brain tumor radiation develop radiation necrosis, causing debilitating effects. But a new clinical trial could change that.

UK and Norton partner in first-ever clinical trial for radiation necrosis

Radiation saves countless lives, but in rare cases, it causes a debilitating complication. Around 3 to 5 percent of patients who receive radiation for brain tumors, or arteriovenous malformations (AVM), develop radiation necrosis.

Radiation necrosis causes headaches, nausea and vomiting, cognitive problems, and neural dysfunction. Although a variety of medications has been used to manage symptoms, there is no approved cure. But a joint clinical trial at Norton Brownsboro Hospital in Louisville and UK HealthCare could change that.

The first trial of its kind that treats the brain directly

Led by Dr. Shervin Dashti and Dr. Tom Yao from the Norton Neuroscience Institute and Dr. Justin Fraser at UK HealthCare, the trial is the first in the world to deliver a dose of a cancer drug directly to the brain. This allows a larger amount of the drug to reach the brain, making treatment more effective.

Dashti has seen the effects of radiation necrosis on patients who have already experienced the trauma of brain cancer or AVM. In addition to the symptoms caused by the condition itself, patients suffer from side effects of steroids used to manage it: insomnia, mood changes and weight gain.

“There was nothing that worked for treating it, and people were devastated,” he said. “What we’re doing now is something completely different, and I think it has a chance to really change the way we treat this.”

More than three years ago, Dashti developed this treatment when two young patients were in desperate need. Only 12 and 13, both girls had developed radiation necrosis and were experiencing severe side effects from steroids. They had disabling headaches, gained 50 to 60 pounds each, missed significant amounts of school or withdrew entirely. One patient experienced focal seizures in her arm and leg; the other patient was hospitalized for fluid overload.

With no other treatment available, Dashti and Yao spoke to the first patient and her family about trying a low dose of Avastin directly to the brain. They agreed, and within 12 hours of the procedure, her headaches were gone. Brain scans over several months showed continuous improvement, her arm and leg had strengthened so she could walk without help, and she returned to school.

Jade Cain, now 16, was the second patient. She was 11 when the AVM was diagnosed and 13 when she met Dashti. According to her mother, Desiree Fischer, 75 percent of her brain was swollen by that time, and she was so depressed she didn’t want to leave the house.

“We’d been doing three or four months of steroids, and she ended up on all other kinds of other medications, too, because she developed thrush. So that’s what led us to this procedure. She spent a week in the children’s hospital because she was in fluid overload. She couldn’t do any more steroids because that was going to kill her.”

Fortunately, the treatment worked just as well for Cain. Her headaches went away, she was off steroids within four weeks, and she returned to school.

She had a final angiogram of her brain in March 2016, and everything was normal.

“It the most amazing, complete response after one treatment, and the imaging response was unbelievable. It was a miraculous recovery for both of them,” Dashti said.

Partnering with UK HealthCare

The success of these two patients motivated Dashti to start a clinical trial. He asked Fraser, director of cerebrovascular surgery and surgical director of the comprehensive stroke center at UK’s Kentucky Neuroscience Institute, to join them.

“We’re in this position of facing an uncommon complication of a treatment that is becoming more commonly used, and we don’t have a great way to fix it,” Fraser said. “What’s special about our procedure is that patients get the drug once, directly to the brain, as opposed to a complete course of the drug that can cause serious side effects.”

The trial is supported by both institutions and has received expert project management support from the UK Center for Clinical and Translational Science.

Showing gratitude and support

Cain’s family has raised more than $20,000 for the Children’s Hospital Foundation. At the decision of Cain and her mother, these funds are directed specifically to support research on radiation necrosis.

“From the steroid use, my child who weighed 105 pounds went up to 160 pounds in one month. Had this treatment already been approved, we could have omitted all that. She battled to get the weight off and to overcome poor body self-image,” Fischer said. “I wish it had been approved way before. And I hate that my child is the one who had to go through it, but I tell her, ‘You have no idea what you’ve done – you’ve paved the way so other people hopefully won’t have go through what you went through.’”

If you are interested in learning about participating in this study, please contact Elodie Elayi at elodie.elayi@uky.edu, or review the study information at ClinicalTrials.gov.


Next steps:

  • UK’s Center for Drug and Alcohol Research has recently made progress on a treatment for those with opioid use disorder. Learn more.
  • Clinical research helps develop the treatments and medications of the future. Learn how you can help.

Experimental treatment at UK targets Parkinson’s disease symptoms

About 14 years ago, Bill Crawford noticed a persistent twitching in one of his fingers that was interfering with his rehearsal time as the music pastor at Porter Memorial Church.

“It was driving me crazy,” the 57-year-old Lexingtonian said.

He’d noticed a few other things too, like weakness. He had mentioned it to his primary care physician, who ordered heart and lung function tests, but both were negative.

Finally, however, he was so weak that he could no longer ride his bike. “I just couldn’t seem to go,” he said.  So he made an appointment with a neurologist.

After a few minutes with Crawford, the neurologist asked him to return on Monday – and bring his wife, Lisa, with him.

On that dreadful day, the neurologist told Bill that he had Parkinson’s disease. At the time, Bill was just 44 years old.

“Obviously not what you want to hear,” he said. “But then I began to think of Michael J. Fox and all he had accomplished, and I thought I could do that too.”

Needing more than medicine

Eventually, though, the medicines that helped Bill control his Parkinson’s symptoms began to lose their effectiveness.

“There is no cure for Parkinson’s, and treatments we currently have at our disposal can only reduce symptoms,” explained Dr. John T. Slevin, a specialist at UK HealthCare’s Kentucky Neuroscience Institute, who began treating Crawford in 2006. “The disease progression inevitably overcomes the drugs’ capacity to alleviate the rigidity and tremor that are hallmarks of Parkinson’s.”

That meant that Crawford would go into what he called “full body charley horses” – sudden, painful involuntary spasms that left him paralyzed and lying on the floor for as much as 45 minutes.

“It was the pits,” Crawford said. Sometimes at the last minute he would be unable to conduct musical performances at church services, which was particularly disheartening. “I didn’t want to be a spectacle.”

It was then that Slevin suggested a treatment called deep brain stimulation, or DBS, and connected Crawford with UK HealthCare neurosurgeon Dr. Craig van Horne.

A new version of deep brain stimulation

Deep brain stimulation is a surgical procedure used to treat the problems associated with Parkinson’s disease. The procedure involves implanting electrodes into the brain that are connected to a small, pacemaker-like device implanted in the chest. These electrodes produce electrical signals that override the abnormal electrical impulses caused by the disease, which attacks and breaks down nerve cells in the brain.

The procedure isn’t suitable for everyone and requires thorough psychological testing and motion studies to ensure that a patient is ready for DBS.

“I wasn’t sure I would qualify,” Crawford said. “But I knew this was my last chance.”

Crawford considers it a blessing that he was, in fact, qualified to receive DBS. But then came an additional surprise: After further testing, van Horne told Crawford that he was qualified to participate in a study for a new version of DBS called “DBS Plus.”

The central nervous system – which comprises the brain and spinal cord – is unable to heal itself after injury or disease, van Horne said. However, peripheral nerves from the rest of the body are able to regenerate.

“Our study is designed to test whether taking a small part of peripheral nerve tissue and putting it in the brain would prompt healing in the areas of the central nervous system damaged by Parkinson’s,” he said.

This slideshow requires JavaScript.

With DBS Plus, van Horne and his team (Greg Gerhard, PhD, and George Quintero, PhD) take a small piece of nerve tissue from the patient’s ankle and implant it in their brain.

Because the tissue is from a patient’s own body there are no concerns about rejection, and because the experimental treatment is applied during a procedure that was declared safe and effective by U.S. Food and Drug Administration almost two decades ago, DBS Plus is considered relatively safe with only minimal additional risk.

A marked improvement

Nonetheless, van Horne is cautious about the process of enrolling patients in the study.

“It’s more ethical, in my opinion, to wait until after a patient qualifies for the basic DBS before I tell them about my study,” he said. “I don’t want patients to elect to do DBS just because they want DBS Plus.”

And van Horne says he was thrilled that Crawford qualified for the study.

“When I met Bill for the first time, he was lying paralyzed on the floor in the treatment room,” van Horne recalled. “It was a startling and heart-breaking sight.”

Crawford received DBS Plus in August 2015. His family can’t get over the dramatic changes in his mobility.

“I’m climbing ladders now, I can plan our church’s worship time, I can lead the services, I can still lead others in worship,” he said.

The charley horses have gone away, and Crawford now takes just one or two pills a day, down from 12 before the surgery. A before-and-after video of Crawford walking the halls outside van Horne’s office is astonishing.

Promising results

To date, 34 patients have participated in the DBS Plus study with encouraging results.  Of the 17 patients that are 12 months out from their procedure, 65 percent of them have shown a clinically important improvement in motor performance as a result of the graft.

Van Horne is quick to point out that the study needs to be tested on a larger sample size at many other medical centers around the country before it can be deemed a viable treatment. Furthermore, he cautions, while 12-month results are promising, it’s important to evaluate effectiveness over a longer term. But assuming all goes as well as it has so far, DBS Plus shows promise as a means of slowing down the disease process.

Van Horne and his team garner no financial benefit from DBS Plus, which adds just a fraction of cost to the DBS surgery that is already covered by most insurance plans.

“Our payback is the gratification we receive in seeing our patients do well,” van Horne said.

Crawford understands that DBS Plus isn’t a cure for his Parkinson’s, but is delighted to have a little more time to enjoy life.

“‘Feeling the beat’ is critical to my work as a musician, and my Parkinson’s had begun to take that away from me,” he said. “I couldn’t even snap my fingers with the music anymore.”

But as he woke up from the surgery, Crawford said he instinctively began to tap his fingers like a metronome. Two members of the team, Julie Gurwell, the physician assistant responsible for programming the DBS equipment, and Ann Hanley, a Parkinson’s patient who personally accompanies patients through their surgeries, were sitting with him, and they asked him what he was doing.

“I was too emotional to explain but I managed to say ‘I can feel the beat.’ And they high-fived each other,” Crawford remembered.

“I just knew God had answered my prayers.”

Media inquiries: Laura Dawahare, UK Public Relations, laura.dawahare@uky.edu.


Next steps:

  • The promising results of Dr. van Horne’s DBS Plus treatment were recently highlighted in the Louisville Courier-Journal. Read the story here.
  • Learn more about the UK Movement Disorders Clinic, which provides specialized treatment for patients with a range of conditions and diseases including Parkinson’s, dystonia and Huntington’s disease.
In Berlin this past fall, a multidisciplinary team of UK scientists presented research on traumatic brain injuries in equine sports.

UK presents protocol on traumatic brain injuries in equine sports

Equestrian sports contribute to the highest percentage of traumatic brain injuries (TBIs) in sports, based on findings in the National Trauma Databank. Multiple concussions and head trauma can have long-term consequences, including acute injuries and neurodegenerative diseases.

First-ever international protocol

Health providers, researchers and other professionals from UK who work in the area of traumatic brain injury developed and presented the Saddle Up Safely Concussion Assessment Tool and Return to Riding Protocol for Concussions in Equine Sports at the 5th International Consensus Conference on Concussion in Sports in Berlin, Germany, this past fall.

The conference was hosted and organized by Fédération Internationale de Football Association, International Ice Hockey Federation, International Olympic Committee, World Rugby, and Fédération Equestre Internationale and has evolved into the world’s most influential process for policy makers on concussions in sport.

UK’s multidisciplinary team

Representing UK at the conference were Dan Han, chief of UK Neuropsychology Service and director of Neurobehavioral Studies Division; Bill Gombeski, senior adviser at UK HealthCare;  Fernanda Camargo, associate extension professor at the UK College of Agriculture; and Carl Mattacola, professor in the Athletic Training Program at the UK College of Health Sciences. Also playing a major role in the development of the concussion tool but unable to attend the conference were Dr. Erika Erlandson, assistant professor of Physical Medicine & Rehabilitation at the UK College of Medicine, and Jill Stowe, director of Equine Programs at the UK College of Agriculture.

The multidisciplinary effort represented Saddle Up Safety, the Kentucky Neuroscience Institute, the Sports Medicine Research Institute, the Spinal Cord and Brain Injury Research Center, Physical Medicine & Rehabilitation, the Equine Program, and UK HealthCare.

The UK team identified key questions that needed to be addressed in advance, identified and reviewed relevant articles, and developed early recommendations which they presented to conference attendees.

A world leader in equestrian sports concussion protocol

“It was clear that in the area of equestrian sports concussion and return to riding protocol, that UK is one of the world leaders,” Gombeski said. “Individuals attending the conference from around the world discussed the work that the UK group shared and to learn more about using the concussion assessment tool and return to riding guidelines that members of the Saddle Up Safely program created.”

The Return to Riding Protocol for Equine Sport is the first of its kind for equine specific head injury. Presentations (5 in total) by the UK team members will be published in the May 2017 issue of the British Journal of Sports Medicine. The conference recommendations created this year will come out online in February.


Next steps: