Some health emergencies stem from lifestyle choices, while others have genetic roots. Stroke, which represents the fourth-leading cause of death in the United States, can be either, both or, more frighteningly, a completely random event. This is perhaps why a locally based initiative known as Stroke Alert has become so essential.
Building on the pervasiveness of Stroke Awareness Month (May), George C. Newman, M.D., Ph.D., created Stroke Alert—held this year on May 7. Stroke Alert began in Wisconsin in 2004 and has since grown to include partners in 32 states—more than half way toward Dr. Newman’s goal of creating a truly national event. Dr. Newman’s aim is to spread the word about not only how quickly and unexpectedly this neurological event can occur but also help the public understand that “time is brain,” meaning the quicker one seeks treatment, the better the outcome.
“There was a study done in Cincinnati and Los Angles of 600 calls to first responders, and only one was made by the stroke victim,” says Dr. Newman, chairman of neurosensory sciences and head of the stroke program at Einstein Medical Center Philadelphia in North Philadelphia. “It’s about educating the entire population, not just the stroke-prone person. The patient usually tries to talk the other person out of calling. Don’t stall, make the call.”
Stroke can be described as “a brain attack”—either ischemic (clotting) or hemorrhagic (bleeding) that disrupts the flow of oxygen to the brain. In the United States, stroke kills more than 133,000 people each year, and it is also a primary cause of long-term disability in adults, according to the National Stroke Association. Stroke can happen to anyone at any time, regardless of race, sex or age, though approximately 55,000 more women than men suffer a stroke each year.
There is some good news in regard to stroke. From 1998 to 2008, the annual stroke death rate fell approximately 35 percent, and the actual number of deaths fell by 19 percent. Furthermore, an estimated 7 million Americans over the age of 20—and counting—have survived stroke, and many return to decent function and a good quality of life after the event, thanks in part to initiatives such as Stroke Alert.
Any sudden changes—numbness or weakness on one side of the face or facial drooping; numbness or weakness in an arm or leg, especially on one side of the body; confusion, trouble speaking or understanding speech; trouble with vision in one or both eyes; trouble walking, dizziness, loss of balance or coordination; or severe headache with no attributable cause—should prompt a trip to the ER, Dr. Newman suggests, because “nothing good happens suddenly.”
“There are two groups of things to consider when it comes to stroke prevention,” he says. “One group consists of things you have within your control—not smoking, exercising regularly, eating a healthy diet (including foods rich with omega-3 fatty acids, such as salmon and walnuts, and avoiding fried foods), drinking six glasses of red wine per week—and for the other group you need help, with control of blood pressure, blood sugar and cholesterol. … My passion is treating stroke, but I would rather prevent than treat any day.”
Of stroke sufferers, nearly 50 percent return to their regular activities after effective treatment, while one-third make improvements over the course of six months to two years. Those in the remaining one-sixth either perish or are severely disabled, according to Dr. Newman. The use of revolutionary clot-busting drug t-PA (short for tissue plasminogen activator) has increased exponentially since 2011, he says. As a result, it has contributed greatly toward the number of ischemic-stroke survivors who successfully recover, especially when the drug is administered within three hours of the event.
“Last year we gave twice as much t-PA as the year before,” he says. “It’s the main reason we started Stroke Alert. This has the potential to reverse a condition that is the leading cause of disability in adults and the second-leading cause of disability in children, so the education campaign has been very satisfying.”
‘An Explosion of Understanding’
Everyone knows someone who has been affected by some form of cancer. Now, it seems, another health crisis—this one with neurological ties—has arisen to touch the lives of nearly every person in America: autism.
With the worlds of science and medicine uncovering something new about the brain every month, autism has become one of the most deeply analyzed aspects of neurology. Although a cure for the disorder has been elusive, physicians suggest “a broadening and rethinking of the definition” is leading to a deeper understanding, which is slowly opening new doors for treatment.
“There is a rising incidence [of autism], and we need to understand better the different biological subtypes, which will help understand more about the disorder itself,” says Mark Mintz, M.D., president, founder and CEO of The Center for Neurological and Neurodevelopmental Health, which recently opened a location in King of Prussia, to join several in New Jersey. “There is better awareness of the disorder, which means we are diagnosing more cases earlier, but it still seems to be on the rise.
“It’s an ongoing process,” he continues. “There has been an explosion of understanding of neurobiology, and an explosion in the area of genetics. Other technologies, like imaging of the brain and brainwave encephalography, has helped us learn more autism and ADHD. … We’re not at the level of understanding that we are with something like cancer, but we have much greater understanding, and we can access all this information noninvasively.”
Dr. Mintz suggests some “very effective treatments” for autism, beginning with early intervention—a combination of behavioral, educational and medical. With proper treatment, as many as 20 percent of young children diagnosed with a disorder along the autism spectrum will no longer manifest features as they get older. At the same time, there will be others who do not reach “normalcy” but attain a functional level that enables them to be gainfully employed, maintain relationships and otherwise enjoy a good quality of life. There is also a percentage of individuals who are diagnosed early will regress and lose skills and language, perhaps caused by abnormal electrical activity or metabolic issues. The many potential outcomes speak to autism’s surprising diversity.
“We have a good and continuing understanding of the many biological causes and bases for autism,” says Dr. Mintz. “It’s not one uniform cause; it’s heterogeneous. In the future, we have to define it more by biology rather than symptoms. If you look at cancer, which is a general term, you talk about individual types of cancers and you talk about treatment of specific cancers. Right now the different types of autism are all lumped together.
“It’s a varied disorder that depends on the biological subtype,” he continues. “Right now autism is a general term. One way to look at it is that it’s not autism but autisms, plural.”
In addition to advances in treatment and prevention of neurological disorders such as stroke and autism, there has also been some movement in the area of Alzheimer’s disease and other forms of dementia. For starters, maintaining brain health, through reasonable and rational exercise, eliminating stress and keeping the brain active, can delay and possibly prevent some forms of memory loss. Dr. Mintz suggests there has been some progress in preventing brain deterioration and even reversing it.
“HIV and cancer used to be a death sentence, but through research we understood more about how to provide treatments to control the virus or the cancer and control the adverse effects of each,” he says. “The best treatment for HIV and cancer is to prevent it. With lung cancer, for example, if you eliminate smoking it definitely reduces the risk. Likewise, with the brain, the more you learn about the brain and the more you preserve the health of the brain, you prevent the onset of certain diseases. The brain doesn’t live in isolation from the rest of the body.”
Dr. Newman, meanwhile, foresees tremendous changes occurring in the field of neurology in the next 10 to 20 years. He also sees “a greater interface” between neurology (dealing with disorders of the brain and nervous system) and psychology (the study of mental functions and behaviors)—the confluence of brain and mind—in terms of the discovery and treatment of certain disorders or diseases.
“This is what the president is talking about with brain mapping, looking into imaging connections,” he says, referring to President Obama’s April announcement of a $100-million research project aimed at overcoming neurological challenges such as autism, Alzheimer’s disease and epilepsy. “What brought me back to the field of stroke is new MRI technology where you can actually see a stroke in real time. This gives insight into the ‘black box,’ and you can pull the disease apart and see parts of brain further at risk for stroke.
“I think imaging will make dramatic advances, and there are active trials trying to prevent the progression of Alzheimer’s,” he continues. “Between [imaging technologies] and some blood tests and the analysis of chemicals of spinal fluid, I believe we will be able to recognize Alzheimer’s and other causes of dementia before they are symptomatic to make advances in prevention. If you can do that for Alzheimer’s, you can do that for schizophrenia and depression, because the same tools you are using for Alzheimer’s will be applicable to other major diseases that pose a huge hardship on families.”
Neurology Resource Guide
The Philadelphia area has a number of excellent medical centers and facilities devoted to the treatment of and support for neurology-specific conditions. Following are some of the region’s best.
Brain Balance Achievement Centers
Visit brainbalancecenters.com for multiple locations throughout the Philadelphia area.
The Center for Neurological and Neurodevelopmental Health
King of Prussia
610-337-1220 | thecnnh.org
Einstein Healthcare Network
Visit einstein.edu for multiple locations throughout the Philadelphia area.
Lankenau Medical Center/Main Line Health
866-CALL-MLH | mainlinehealth.org
610-296-4219 | 610-363-5002 | neurologyconsultants.net
Performance Spine & Sports Medicine
215-504-2223 | sportsmedicinenewtownpa.com
Sports Concussion Center of New Jersey
609-895-1076 | sccnj.com
St. Mary Medical Center
215-710-2000 | stmaryhealthcare.org
Temple University Health System/Temple Neurosciences Center
800-Temple-Med | neuro.templehealth.org
Brandywine Senior Living at Haverford Estates
610-527-1800 | brandycare.com
610-359-4400 | dunwoody.org