D I R E C T O R Y Main Office Located At: RIVERWALK 354 Merrimack Street Lawrence, MA

Transcription

1 D I R E C T O R Y Main Office Located At: RIVERWALK 354 Merrimack Street Lawrence, MA

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3 Table of Contents Answering Your Needs Programs and Services Welcome Medical and Professional Staff Division of Neurosurgery Division of Orthopaedic Spine Surgery Division of Neurology Division of Physical Medicine and Rehabilitation.. 25 Division of Rheumatology Division of Pain Medicine Division of Neuro-Behavioral Medicine Scheduling an Appointment Prescription Refills HMO and Insurance Coverage Affiliated Organizations Northeast Rehabilitation Health Network Page New England Epilepsy Institute at Lawrence General Hospital New England PET Imaging System Think First Resources Index of Professional Staff Office Locations and Map

4 Answering Your Needs Answering Your Needs We're specialists who have combined our professional training and talents to bring you the most advanced combination of neurosurgical, orthopaedic spine, neurological, rheumatologic, rehabilitation, pain medicine, psychiatric and psychological services available in this area. Our advanced clinical expertise is conveniently located in the Merrimack Valley and Southern New Hampshire. We use a coordinated medical approach and give our patients and their families the unique caring that reflects our concern for our patients' needs from diagnosis to rehabilitation. Working as a team, our staff joins their resources and experience to provide quality treatment. Our goal is to help each of our patients reach his or her fullest potential. Offering Quality Care High level professional training and experience Continuity of care from the physician's office and hospital to your home Full range of neurosurgical, orthopaedic spine, neurological, rheumatologic, rehabilitation, pain medicine and mental health services Convenient suburban locations 24-hour coverage by our team of physicians Consultation between staff for coordinated patient benefit 2 Helping with Programs and Services for: Acute and Chronic Pain Program Adult Attention Deficit Disorders Brain Hemorrhage Brain Tumor Concussion Depression, Panic and Anxiety Dizziness/Vertigo Epilepsy Geriatric Psychiatry Headaches and Facial Pain Independent Medical Evaluation Individual and Family Counseling Relating to Illness or Trauma Industrial Accident Injury Related Problems of Brain, Spine and Nerves Memory Problems, Alzheimer's Disease and Other Dementias Minimally Invasive Surgery for Spinal Disorders Multiple Sclerosis Neck and Back Pain /Sciatica and Arm Pain Parkinson's Disease Rheumatoid Arthritis and other related disorders Scoliosis Sleep/Wake Disorders Spina Bifida Spinal Deformity Stroke/Shock/Sudden Visual Loss Walking Problems and Unsteadiness Weakness and Numbness of Limbs

5 Programs and Services Our Services Neurological Surgery Orthopaedic Spine Surgery Neurology Pediatric Neurology Neuro-Oncology Rehabilitative Neurology Epileptology Vascular Neurology Movement Disorders Clinic Physical Medicine & Rehabilitation Rheumatology Pain Medicine/Acute and Chronic Pain Biological Psychiatry & Psychopharmacology Psychology Diagnostic Services EEG EMG and Nerve Conduction Studies Electronystagmography (ENG) Testing Evoked Response Testing Myelography X-ray Services PET/CT (Positron Emission Tomography) Neuropsychological Screening For Appointment or Information Call: (978)

6 Welcome Welcome to New England Neurological Associates We hope you find this Directory to be a useful guide to the highly trained professionals of New England Neurological Associates and the extensive capabilities we offer. Since our founding in 1969, New England Neurological Associates has grown steadily to meet the changing medical needs of the communities we serve. Today our staff includes neurosurgeons, orthopaedic spine surgeons, neurologists in a number of subspecialties, physiatrists (physician specialists in rehabilitation medicine), pain management physicians, psychiatrists, psychologists, and various support personnel. Our physicians work in a multidisciplinary environment that encourages communication and collaboration between specialists, helping to ensure optimal outcomes for each patient. We strive for excellence in creating an environment where patients feel comfortable and confident that their needs will be addressed. For over four decades we have strived to provide university-level care in a community setting, offering the most advanced technology and services, close to home. Please look through this booklet to discover more about our full spectrum of capabilities. We encourage you to call our Patient Service Representative with comments or questions at (978) Sincerely, Joan T. Faucher Administrator/CEO New England Neurological Associates, P.C. 4

7 Medical & Professional Staff To help our patients understand the services by the professionals at New England Neurological Associates, we have included a listing of the wide range of coordinated services available and the role they may serve in your lives. We are proud to provide care and treatment at many of the well-equipped, modern community hospitals in the area. Division of Neurological Surgery Howard M. Gardner, M.D., F.A.C.S. Founder/Medical Director Peter J. Grillo, M.D., F.A.C.S. William P. McCann, M.D., F.A.C.S. Bruce R. Cook, M.D., F.A.C.S. Henry Ty, M.D., F.A.C.S. K. Sadashiva Karanth, M.D. Katharine Cronk, M.D., Ph.D. Brooke D. Storey, PA-C David R. Novicki, PA-C Division of Orthopaedic Spine Surgery Joseph K. Weistroffer, M.D. Division of Neurology Neurology Jonathan S. Moray, M.D. Neuro-Oncology Vladan P. Milosavljevic, M.D. Neurology/Epileptology Jonathan Ross, M.D. Arya Farahmand, M.D. Lanny Y. Xue, M.D., Ph.D. Neurology/Neuromuscular Disorders Richard S. Finkelman, M.D. Jennifer A. Grillo, M.D. Min Zhu, M.D., Ph.D Neurology/Vascular Neurology Andreas P. Schoeck, M.D. Jason C. Viereck, M.D., Ph.D. Gioacchino G. Curiale, M.D. Neurology/Movement Disorders Shabbir A. Abbasi, M.D., MRCP (UK) Pediatric Neurology Myrta I. Otero, M.D. Division Of Physical Medicine & Rehabilitation Physiatry Elizardo P. Carandang, M.D. Srirangam R. Padmanabhan, M.D. Scott Masterson, M.D. Thomas Cody, M.D. Physiatry/Internal Medicine Jon Mazur, M.D., MPH Division of Rheumatology Rheumatology Maosong Qi, M.D. Division of Pain Medicine Anesthesiology Jeffrey Norton, M.D. Michael C. Connelly, M.D. Richard R. Riccardi, M.D. Karine N. Ngoie, PA-C Division of Neuro-Behavioral Medicine Rehabilitative Neurology James A. Whitlock, Jr., M.D. Psychiatry Marc M. Sadowsky, M.D. Psychology Robert A. Moverman, Ph.D. 5

8 Division of Neurosurgery Our neurosurgeons work closely with our neurologists, physiatrists and pain specialists to provide comprehensive care for patients with conditions that affect the brain, spine and peripheral nerves. Our expertise in the diagnosis and treatment of neurosurgical diseases is available right here in the Merrimack Valley. We perform surgeries at the Lawrence General Hospital, Holy Family Hospital, Lowell General Hospital, and Lowell General Saints Campus. We coordinate with primary care physicians and specialists such as oncologists, radiation oncologists, endocrinologists, rheumatologists and other surgeons to help patients who choose to have their neurosurgical care locally. In cases wherein local resources become inadequate, patients are referred to tertiary care centers. We rely on the best available imaging technology such as functional MRI, tractography, spectroscopy, and PET/CT scans, to facilitate diagnosis. We use the Brainlab image-guidance system to accurately localize brain tumors. Electrophysiologic monitoring during surgery, such as SSEP, MEP, and EMG, is available to ensure the best possible surgical outcome. We understand that the decision to undergo surgery may be difficult. We welcome patients who are seeking another opinion regarding surgical treatment. We will thoroughly review the treatment options that may be considered for each patient. The following are some of the surgeries that we perform: Biopsy of the brain, nerve, muscle or bone of the spine Carpal tunnel release Cervical disc arthroplasty Cervical laminoplasty Cervical fusion, anterior or posterior approach Cingulotomy Craniotomy for clipping of aneurysm Craniotomy for evacuation of brain bleed Craniotomy for resection of brain tumor Implantation of deep brain stimulator Implantation of intrathecal pump (morphine or baclofen) Implantation of spinal cord stimulator Implantation of vagus nerve stimulator Kyphoplasty Laminectomy for stenosis or spine tumors Lumbar fusion, ALIF, DLIF, TLIF, PLIF Lumbar interspinous decompression with X-stop Microdiscectomy, cervical (anterior or posterior), thoracic or lumbar Minimally Invasive Spine Surgery Minimally Invasive Sacroiliac Joint Fusion Microvascular decompression for trigeminal neuralgia Occipitocervical fusion Odontoid screw fixation Percutaneous trigeminal rhizotomy Posterior fossa decompression for Chiari malformation Stereotactic Radiosurgery Transsphenoidal pituitary surgery Ulnar nerve decompression Ventriculoperitoneal shunt 6

9 Division of Neurosurgery Some of Our Services Treatment of Brain Disorders The neurologists and neurosurgeons of NENA work in a cooperative effort to diagnose and treat patients who may present with a variety of brain disorders, including brain tumors, blood vessel disorders, Chiari malformation, hydrocephalus, and those caused by trauma and infection. We also perform surgeries to treat movement disorders, seizure disorders and trigeminal neuralgia. Brain Tumors. We have extensive experience in the evaluation and treatment of brain tumors. Surgery may involve brain biopsy, partial or total removal of the tumors. During surgery, we utilize a computerized neuronavigation system to accurately localize the tumor. This allows for small incisions and minimal manipulation of the brain. Functional MRI that localizes the areas of the brain responsible for speech and movement, and tractography that identifies the interconnections of the fibers in the brain, are available when needed to minimize the risks of tumor removal. MRI spectroscopy can measure the chemical makeup of brain tumors and help differentiate these from stroke, demyelinating disease, radiation necrosis or infection. The collaboration between our neurosurgeons and the local oncologists and radiation oncologists ensures the best possible care for our patients with brain tumors. In certain patients with malignant brain tumors, radioactive seeds are implanted at the time of surgery to improve the delivery of radiation and the local control of the tumor. Post-operative radiation and chemotherapy are available locally. We treat a variety of tumors including meningioma, glioblastoma multiforme, lymphoma, metastasis, vestibular schwannoma, astrocytoma, oligodendroglioma, colloid cyst, craniopharyngioma, pituitary tumors and ependymoma. Blood Vessel Disorders. We treat patients who have disorders of the blood vessels in the brain. They may present with bleeding in the brain or seizures. Experts in stroke management and surgical intervention are available locally to help these patients, aided by a full complement of tests, including CT, MRI and angiography. An abnormal outpouching of the artery called an aneurysm may require emergent surgery if it ruptures. Congenital abnormality of the blood vessels called arteriovenous malformation (AVM) may require surgical resection. Inaccessible AVM's may be treated with radiosurgery. Chiari Malformation. Chiari malformation is a condition wherein part of the cerebellum descends through the opening of the skull. This may be associated with hydrocephalus or syringomyelia. Patients may present with headache, neck pain, or unsteadiness. Symptomatic patients usually benefit from removal of part of the skull in the back of the head and suturing of a synthetic membrane over the cerebellum. Functional Neurosurgery for Movement Disorders. We work with neurologists to evaluate and treat patients with Parkinson's Disease, essential tremor, multiple sclerosis and other movement disorders. Treatment options include medications, Botox, and deep brain stimulation (DBS). We have been performing functional neurosurgery since This involves the alteration of brain functions by means of electrical stimulation or lesioning of a specific area of the brain. Implantation of the deep brain stimulator electrode is guided by high resolution MRI that localizes brain targets and refined using sophisticated electrode brain mapping to ensure the highest likelihood of success. 7

10 Division of Neurosurgery Treatment of Brain Disorders, continued Head Injuries. Head injuries are common and affect people of all ages. They are recognized as a major public health issue. Our surgeons evaluate and treat all kinds of head injuries, ranging from concussion to contusion, intracranial bleeds and skull fractures. Surgeries are also performed to relieve the compression on the brain caused by blood clots or brain swelling. We repair skull fractures and debride the brain if necessary. For those with severe brain injuries, we insert a monitoring device to help us treat the patient's condition more effectively. We work with a multispecialty team approach to maximize the chances of neurologic recovery for every patient with head injury. Comprehensive brain injury rehabilitation services are available locally. We also evaluate and treat sports related head injuries. We are available to recommend the timing of return to normal activities and sports after a head injury. Hydrocephalus. Accumulation of cerebrospinal fluid (CSF) in the brain may require a shunting procedure to divert the CSF and decrease the pressure within the brain. We use a variety of shunts including programmable shunts. We evaluate and treat patients who may have normal pressure hydrocephalus. These patients usually present with gait disturbance, urinary incontinence and dementia. Pituitary Surgery. We work with local endocrinologists to diagnose and treat pituitary tumors. Some of these tumors can be treated with medications. When surgery is indicated, we perform a transsphenoidal removal of these tumors using microsurgical and endoscopic tools, guided by intra-operative fluoroscopy or neuronavigation. Seizure Disorders. Patients who cannot tolerate anticonvulsants, respond poorly to them or have intractable seizures are sent by NENA epileptologists for implantation of a vagus nerve stimulator (VNS). This device is programmable to deliver electrical impulses to the left vagus nerve in the neck. This may reduce the frequency, intensity or duration of the seizures, and the patient's dependence on anticonvulsants. We implant the electrodes in the neck and the generator in the left side of the chest. The procedure is done under general anesthesia. The patient is usually discharged on the same day. The epileptologist programs the stimulator two weeks after the implantation. Stereotactic Radiosurgery. We work with local radiation oncologists to offer this treatment option to patients with brain tumor, AVM, or trigeminal neuralgia. A frame is attached to the patient's head and MRI and CT images are obtained. The target is then outlined in these images by using a computer. Radiation is delivered from a linear accelerator to the target with surgical precision, avoiding unnecessary damage to the surrounding healthy tissues. A frameless stereotactic radiosurgery system is also be available locally. This can be used to treat patients with spinal metastatic tumors. Trigeminal Neuralgia. Trigeminal neuralgia is a very painful condition affecting the face. This may be caused by tumors, multiple sclerosis, or blood vessels compressing the trigeminal nerve near the brainstem. In patients who cannot tolerate or fail to respond to medications, other treatment options may be considered. We perform percutaneous trigeminal rhizotomy using glycerol or a balloon catheter to destroy the painful nerve, microvascular decompression to relieve the pressure on the trigeminal nerve that is causing the pain, and radiosurgery to destroy the painful nerve. The treatment is individualized for each patient. 8

11 Division of Neurosurgery Comprehensive Spine Program The surgeons of the Divisions of Neurosurgery and Orthopaedic Spine Surgery work in close collaboration to evaluate, diagnose, and treat a variety of conditions relating to the spine. Back and Neck Pain. Painful symptoms of the neck and back are very common and may become debilitating. The majority of these symptoms will improve with physical therapy and pain management. Surgery is indicated if there is compression of the spinal cord or nerve roots that results in persistent pain, weakness, or numbness. The multi-disciplinary approach at NENA is invaluable in the evaluation of all possible causes of pain. MRI, CT, PET scans, myelography, and discography are available to facilitate the diagnosis. We work very closely with our neurologists, physiatrists (specialists in physical medicine and rehabilitation), rheumatologist, and pain medicine specialists to treat not only degenerative disc diseases, but also vascular, neoplastic and congenital diseases of the spine as well. Cervical, Thoracic, and Lumbar Disc Herniation. We are very experienced with the treatment of herniated discs that cause weakness, numbness or pain that is not relieved with pain management and physical therapy. The spine surgery commonly involves removal of areas of the bone (laminotomy) and parts of the disc that compress the nerves (discectomy). Patients who undergo discectomies often have very short hospital stays, and surgical incisions usually heal after a week. Many patients can be discharged on the day of their surgery. Complex Spine Surgery. We perform instrumented fusions using screws, rods, plates, or cages to treat conditions that require stabilization, such as rheumatoid arthritis, odontoid fractures, burst fractures, spondylolisthesis, and tumors that cause instability. The surgery is guided by fluoroscopy or frameless stereotactic technique. Patients generally require a few days of hospital stay following these complex surgeries. We also perform recently developed, less invasive techniques that use smaller incisions and minimal muscle dissection. These usually reduce post-operative pain and allow patients to return home sooner. Fractures. We treat all kinds of spine fractures. Stable fractures may be treated with kyphoplasty for pain control. Unstable fractures require implantation of screws, rods, plates, or cages. Kyphoplasty. Compression fractures in elderly patients with osteoporosis can be quite painful and debilitating even with pain medications. We have been performing kyphoplasty since In our experience, a majority of the patients undergoing kyphoplasty have significant pain relief and improvement in their quality of life. This procedure involves the insertion of balloon-tipped catheters into the fractured bone through small tubes inserted through the skin under fluoroscopic guidance. As the balloons are inflated, they create a cavity within the bone. After they are deflated and removed, bone cement is injected into the fractured bone to fill the cavity and stabilize the fracture. Minimally Invasive Spine Surgery. We always perform microdiscectomies using microscopes or loupes. The added magnification improves the quality of surgery. We also perform minimally invasive lumbar fusions that use smaller incisions and result in less post-operative pain, shorter hospital stay, and earlier return to normal activities for many patients. These techniques include anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF) and direct lateral interbody fusion (DLIF). 9

12 Division of Neurosurgery Comprehensive Spine Program, continued Outpatient, Same-Day Disc Surgery. The length of stay in the hospital following a surgical procedure is determined primarily by the patient's need for nursing care and pain management. With this in mind, NENA has developed a protocol to minimize post-operative pain and to assure a smooth post-operative course and the possibility of early discharge from the hospital. Utilizing this approach, the majority of laminectomy patients are able to leave the hospital on the day of their operation. Our model incorporates several aspects of patient care: (1) patient education about pain during the pre-operative visit with the neurosurgeon; (2) preemptive pain control with the use of long-acting anesthetic and anti-inflammatory medications during the operation; (3) nursing protocols that provide detailed plans for the patients' post-operative course on an hourly basis; (4) follow-up by the nurse treating the patient on the morning after discharge and by the surgeon when needed. There has been no increase in the complications associated with same-day disc surgery. In fact, early mobilization and pain control have allowed many patients to return to work and full activity sooner. Spinal Stenosis. The narrowing of the spinal canal caused by a combination of joint enlargement, thickening of the ligaments and bone, and disc degeneration may worsen with age and compress the spinal cord or nerves in the spinal canal. Surgery is done to relieve this compression. We perform laminectomies, laminoplasties, or vertebrectomies to decompress the spinal cord and nerve roots. Spondylolisthesis, Scoliosis, and Kyphosis. Patients with misalignment of the spine and instability may benefit from spinal fusion. Some of these patients have long-standing spondylolisthesis, a situation in which one vertebra slips onto the next, which results in progressive nerve root compression. If symptoms do not improve with pain management or physical therapy, complex spine surgery with implantation of screws and rods may be considered. Our experience has shown significant improvement of pain and return to normal activities in a majority of patients. Hospital stays of a few days are needed to control post-operative pain. NENA specialists also treat spinal deformities such as scoliosis (abnormal spine curvature when looking from the front), and kyphosis (abnormal spine curvature when looking from the side). Tethered Cord. Spinal cord tethering is a congenital condition that may present in adults. Patients may complain of back pain, leg pain or weakness, balance problems, progressive scoliosis, and bladder or bowel incontinence. MRI of the lumbar spine will show the spinal cord in an unusually low position. We treat this condition with lumbar laminectomy and cutting of the structure that is pulling down the spinal cord. Peripheral Nerve Surgery We perform surgeries that relieve the symptoms caused by the compression of the nerves in the wrist (carpal tunnel syndrome) or elbow (ulnar neuropathy). Patients usually present with pain, numbness, weakness or muscle atrophy. NENA neurologists confirm the diagnosis with EMG. These surgeries are done under local anesthesia with light sedation. Patients are discharged on the same day. We also remove tumors of the nerves such as neurofibromas and schwannomas. 10

13 Division of Neurosurgery Surgery for Pain and Spasticity We understand how pain can adversely affect the quality of life of many patients. We perform many surgeries to alleviate pain arising from a variety of causes. In addition to the spine surgeries, we also perform procedures that help control the pain in cancer patients and those with neuropathic pain. We coordinate with the oncologists and pain specialists to offer the best treatment options for these patients who have intractable pain. Cingulotomy involves the lesioning of the cingulate gyrus of the brain to diminish the unpleasant experience of pain. This is done with stereotactic guidance similar to DBS electrode placement. This procedure may benefit some cancer patients with severe pain that is not relieved by medications. For patients with complex regional pain syndrome or neuropathic pain that is not responsive to medications, spinal cord stimulation may provide sufficient pain relief to allow them to return to normal activities. We work with NENA pain specialists who evaluate potential patients and insert a trial electrode into the epidural space of the spinal canal. The electrode is connected to a generator that sends electrical impulses to stimulate the spinal cord. In patients who obtain good pain relief during the trial, we insert a permanent lead and generator. Patients usually go home on the same day. The stimulator is programmed two weeks after implantation. We work with the neurologists and physiatrists to care for patients who present with severe spasticity of the arms or legs caused by spinal cord injury or stroke. The spasticity may become quite painful or may hinder rehabilitation. Baclofen injected into the spinal canal may result in better control of the spasticity than oral medications. In patients who respond well to the intrathecal baclofen injection, we insert a catheter into the spinal canal and connect it to a programmable pump that is implanted under the skin. The procedure is done under general anesthesia. Patients are usually discharged on the same day. Botox injections are also available in the treatment of various forms of spasticity and rigidity, and dystonias. 11

14 Division of Neurosurgery Howard M. Gardner, M.D., F.A.C.S.* Founder/Medical Director College: Williams College, Williamstown, MA Medical School: University of Virginia Medical School, Charlottesville, VA Internship: New England Medical Center, Boston, MA Residency: New England Medical Center, Boston, MA/Surgery; The Neurological Institute of Columbia Presbyterian Medical Center, New York, NY/Neurosurgery Teaching Appointments: Assistant Clinical Professor of Neurosurgery, Tufts University School of Medicine, Boston, MA American Board of Neurological Surgery *Fellow American College of Surgeons Peter J. Grillo, M.D., F.A.C.S.* College: Yale University, New Haven, CT Medical School: Harvard Medical School, Cambridge, MA Internship: University of Kansas Medical Center, Kansas City, KS Residency: Boston City Hospital, Boston MA/ Surgery; New York Hospital-Cornell Medical Center, New York, NY/ Neurosurgery American Board of Neurological Surgery *Fellow American College of Surgeons William P. McCann, M.D., F.A.C.S.* College: Merrimack College, No. Andover, MA Medical School: Georgetown University School of Medicine, Washington, DC Internship: New York Hospital-Cornell Medical Center, New York, NY, Surgery Residency: New York Hospital-Cornell Medical Center, New York, NY/Surgery; Montreal Neurological Institute, McGill University, Montreal/Neurosurgery American Board of Neurological Surgery *Fellow American College of Surgeons Bruce R. Cook, M.D., F.A.C.S.* College: Muhlenberg College, Allentown, PA Medical School: George Washington University, Washington, DC Internship: University of Pittsburgh, Pittsburgh, PA/Surgery Residency: University of Pittsburgh, Pittsburgh, PA/Neurosurgery American Board of Neurological Surgery *Fellow American College of Surgeons 12

15 Division of Neurosurgery Henry Ty, M.D., F.A.C.S.* College: University of the Philippines, Quezon City, Philippines Medical School: University of the Philippines College of Medicine, Manila, Philippines Internship: Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA/Surgery Residency: Philippine General Hospital, University of the Philippines, Manila, Philippines/Neurosurgery Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA/Neurosurgery American Board of Neurological Surgery American Board of Spine Surgery *Fellow American College of Surgeons K. Sadashiva Karanth, M.D., M.S., F.R.C.S. Medical School: Kasturba Medical College, Mangalore, India Mangalore University, Mangalore, India, MS in General Surgery Residency: University of Illinois College of Medicine, Peoria, IL / Neurological Surgery Fellowships: Fellow / Royal London Hospital / London, UK, Neurosurgery Fellow / Neurological Surgery / University of Iowa Hospital Iowa City, IA Board Eligible, American Board of Neurological Surgery Katharine Cronk, M.D., Ph.D. College: Columbia University, New York, NY Medical School: Columbia University College of Physicians and Surgeons, New York, NY Post-Doctoral Fellowship: Columbia University, New York, NY / Brain Tumor Center Post Graduate Training: Ph.D. Albany Medical College, Albany, NY / Center for Neuropharmacology and Neuroscience Residency: Barrow Neurological Institute, Phoenix AZ / Neurosurgery Fellowships: Barrow Neurological Institute, Phoenix, AZ / Advanced and Complex Spinal Techniques AANS Research Fellowship, Arizona State University Department of Biomedical Engineering / Barrow Neurological Institute, Phoenix AZ American Board of Neurological Surgery, Board Eligible 13

16 Division of Neurosurgery Brooke D. Storey, PA-C College: University of Colorado, Denver, CO / Bachelor of Science Medical Training: University of New England, Portland ME / Master of Science - Physician Assistant National Commission on Certification of Physician Assistants David R. Novicki, PA-C College: Mercyhurst College, Erie, PA / Bachelor of Arts National Commission on Certification of Physician Assistants Medical Training: Mercyhurst College, Erie, PA / Licensed Practical Nurse. Philadelphia University, Philadelphia, PA / Master of Science - Physician Assistant 14

17 Division of Orthopaedic Spine Surgery The New England Neurological Associates (NENA) Division of Orthopaedic Spine Surgery focuses upon the comprehensive evaluation and treatment of conditions afflicting the cervical, thoracic, and lumbar spine, in all age groups, from infant to senior citizen. Our approach is to consider surgical intervention only after nonoperative approaches have been thoroughly investigated. If surgery is pursued, a variety of techniques are available, ranging from minimally invasive to complex reconstructive spine surgery. We specialize in the evaluation and treatment of such bony, structural issues as stenosis (choking of the nerves), scoliosis (abnormal spine curvature when looking from the front), kyphosis (abnormal spine curvature when looking from the side) and spondylolisthesis (one vertebrae slipping on the next). Led by a Board Certified, Fellowship-trained orthopaedic spine surgeon with particular expertise and experience in the evaluation, care, and treatment of spinal deformities, the Division treats a number of conditions, including: Disc herniations. Stenosis (neurogenic claudication and myelopathy) Scoliosis (idiopathic, degenerative, neuromuscular, congenital and post-traumatic) Spondylolisthesis (degenerative, isthmic and congenital) Spinal trauma to include fractures (compression and osteoporotic) Spinal tumors (primary bone cancer and metastatic cancer) Spinal infections Kyphosis (Scheuermann's and congenital) Cauda equina syndrome Degenerative conditions Spinal sports injuries Cervical procedures performed include anterior discectomy/fusion, laminoplasty and posterior decompression/fusion. Lumbar procedures performed include conventional open microdiscectomy, decompression, fusion and deformity correcting osteotomy as well as minimally invasive discectomy, decompression and fusion (transforaminal and direct/extreme lateral interbody techniques). When appropriate, motion-sparing spinal surgical techniques may be employed. In these select cases, artificial spinal disc replacement may be considered. The surgeons of the Divisions of Orthopaedic Spine Surgery and Neurosurgery work in close collaboration to evaluate, diagnose, and treat a variety of conditions relating to the spine. 15

18 Division of Orthopaedic Spine Surgery Joseph K. Weistroffer, M.D College: United States Naval Academy, Annapolis, MD. Medical School: Uniformed Services University of the Health Sciences, Bethesda, MD Internship: National Naval Medical Center; Bethesda, MD Residency: Naval Medical Center, San Diego, CA / Orthopaedic Surgery Fellowship: Twin Cities Spine Center, Minneapolis, MN/ Spine Surgery American Board of Orthopaedic Surgery 16

19 Division of Neurology A neurologist is a medical doctor who is highly trained to identify and treat various diseases of the nervous system such as headache, stroke, neck and back pain, dizziness, Parkinson's Disease, Alzheimer's Disease, multiple sclerosis, and epilepsy. After obtaining a complete neurological and medical history, the neurologist does a thorough neurological examination and then discusses the findings with the patient and family to advise whether any further diagnostic testing is necessary and/or what medical treatment is indicated. Some of Our Services Botox Treatment for Neurological Disorders The specialists of New England Neurological Associates employ Botox injections as a therapeutic tool in the treatment of a variety of neurological and ophthalmological disorders. Botox is a naturally derived product that acts to reduce unwanted muscle activity. Clinical applications of Botox therapy include treatment of: blepharospasm (involuntary eyelid closure); hemifacial spasm (involuntary twitches of the eyelids and facial muscles); movement disorders involving tremor; spasticity and rigidity; torticollis; intractable migraine and chronic headache; and dystonias. Epilepsy and Seizure Disorder Program Comprehensive, Multidisciplinary Evaluation Led by neurology specialists with advanced Fellowship training in epilepsy, New England Neurological Associates offers a comprehensive approach to the evaluation and treatment of patients suffering from epilepsy and other seizure disorders. A multidisciplinary approach offers a full range of sophisticated services and advanced technology, including neurological evaluations, electroencephalography (EEG), ambulatory EEG, and inpatient EEG with video monitoring, high resolution MRI, PET/CT scanning, and management of complicated intractable epilepsy with the latest pharmacological treatments available. 24 Hour Ambulatory Electroencephalographic (EEG) Monitoring Brain wave electrodes are attached to a portable recorder that is carried at home 24 hours a day to study the brain's electrical activity to aid in the diagnosis of seizures and other neurological conditions. Adult and Pediatric Overnight Inpatient Video Telemetry For those patients with poorly controlled seizures, the use of overnight inpatient video EEG telemetry is an integral part of evaluations. These studies are conducted at the New England Epilepsy Institute (NEEI), a joint project of New England Neurological Associates and Lawrence General Hospital. NEII offers the only computerized digital video EEG in the region. This system utilizes state-ofthe-art technology to record and analyze seizures captured by a combination of digital video and time-locked brainwave recording. This is critical to the understanding of the patient's seizure type, and leads to the optimal medical or surgical management of this very common and debilitating condition. 17

20 Division of Neurology Vagus Nerve Stimulation for Intractable Epilepsy Patients For difficult to control seizure disorders, NENA offers implantation of the vagus nerve stimulator (VNS). This device may be implanted in patients with epilepsy who respond poorly to, or have poor tolerance for, multiple anti-epileptic drugs (AEDs) and who are not surgical candidates. The stimulator is a programmable, implantable device that delivers intermittent electrical stimuli to the vagus nerve in the neck. This may lead to reduced frequency of seizures or seizures of lessened intensity or shorter duration, possibly leading to reduced dependence on AED regimens and improved mental awareness and energy. The stimulator device is implanted under the direction of a team consisting of the NENA neurologist/epileptologist and a NENA neurosurgeon. The procedure is usually done under general anesthesia, and the patient generally returns home the same day. Headache and Facial Pain The neurologists of New England Neurological Associates have extensive experience in treating various types of headache and facial pain, including: Migraine Tension type headache Cluster Headache Post-concussional headache Trigeminal Neuralgia Trigeminal neuralgia and other pain disorders are treated by a team that includes neurologists, pain management specialists, and neurosurgeons. The majority of patients respond to medication, but a full range of surgical options is available for patients who do not respond to medicine. The optimum treatment plan for each patient will be developed on an individual basis. Movement Disorders Program A group of dedicated neurologists and neurosurgeons is available to evaluate and treat patients with a number of movement disorders, including: Parkinson's Disease Essential tremor Ataxia Dystonia Myoclonus Spasticity After a thorough evaluation, an optimal treatment plan is developed to treat individual patient's needs. Treatment options include medications, Botox injections and, for appropriate patients, surgical options, such as implantation of a deep brain stimulator (DBS) that sends electrical impulses to specific parts of the brain. Implantation of the DBS is guided by high resolution MRI that localizes brain targets, and refined using sophisticated electrode brain mapping to ensure the highest likelihood of success. DBS can be beneficial for essential tremor, dystonia, and Parkinson's Disease. 18

21 Division of Neurology Multiple Sclerosis Multiple Sclerosis (MS) is the most common neurological disorder diagnosed in young adults, with most people experiencing first symptoms between the ages of 20 and 40. There are some 400,000 reported cases of MS in the United States. MS symptoms can vary from person to person, depending upon the area of the nervous system affected. In some persons, symptoms may be mild, such as limb numbness, or severe, such as loss of vision of paralysis. Some patients may experience initial symptoms for a short time period and then be symptom-free for an extended period of time, while others may experience a more steady progression of disease. Common symptoms of MS may include: balance and coordination problems; blurred or double vision; depression; vertigo; fatigue; spasticity; slurred speech; swallowing disorders; tremor, and; limb weakness. While there is no cure for MS, effective treatments exist that can help reduce the severity and frequency of attacks and help to manage the symptoms of MS. The diagnosis of MS is based upon medical history, a complete neurological examination, imaging studies such as MRI, evoked potentials, and lumbar puncture. Post-Concussional Program This program serves patients with intractable post-concussional symptoms such as headaches, neck pain, vertigo, behavioral changes and emotional or cognitive dysfunction. Neuromuscular Disorders Program The Division of Neurology includes several neurologists who are Fellowshiptrained in neuromuscular disorders and electrodiagnostic testing. NENA neurologists have extensive experience in the initial evaluation, treatment, and monitoring of patients with a variety of neuromuscular disorders, including: Cervical and lumbar radiculopathies Diabetic polyneuropathy and neuropathy from other causes Carpal tunnel syndrome, ulnar neuropathy, and other mononeuropathies Myopathy and muscular dystrophy Neuromuscular junction disorders, such as myasthenia gravis Amyotrophic Lateral Sclerosis (ALS) Electrodiagnostic Testing. Needle electromyography (EMG) and nerve conduction studies (NCS) studies play a key role in the evaluation of patients with a wide variety of neuromuscular disorders. Through mild electrical stimuli, these tests measures the electrical activity in muscles and the functioning of nerves for the diagnosis of various disorders of the nerves, muscles, and spinal cord. 19

22 Division of Neurology Stroke and Brain Attack Stroke is the 3rd leading cause of death in the United States, behind heart disease and cancer, and is a significant cause of disability. NENA neurologists work at the forefront of stroke evaluation and treatment, as well as in the prevention and care of secondary or recurrent stroke. New England Neurological Associates offers a multidisciplinary approach to individuals suffering from stroke. Our specialists treat numerous stroke conditions, including those from aneurysm, arteriovenous malformation, and brain attack. Our team includes specialists in carotid and vascular surgery as well as rehabilitation. Patients with stroke or transient ischemic attack (TIA) benefit from a treatment plan that is individually tailored to their needs, and that takes into account a number of factors, including the pathomechanism of the ischemic event, patient's age, gender, co-morbidities, as well as other variables. Brain Attack is another way of describing a stroke. A stroke, like a heart attack, is a medical emergency that requires immediate medical care. The symptoms of stroke may include weakness, numbness or paralysis - particularly on one side of the body - sudden blurred or decreased vision, speech difficulty, dizziness, or sudden and severe headache. Acute ischemic stroke is the result of a blood clot that blocks the flow of blood to the brain. If symptoms are recognized within three hours, clot-dissolving agents, such as TPA, may be used for eligible patients to reduce disability. Vascular Neurology Program. The NENA stroke team includes several neurologists with Fellowship training in Stroke, as well as sub-specialty Certification in Vascular Neurology. These specialists have worked closely with local hospitals in the development of protocols for use of TPA, the implementation of these protocols, and monitoring of TPA use over time. These efforts are aimed at ensuring the appropriate and timely use of TPA to help reduce the impact of stroke. Of the 700,000 or so strokes that occur annually in the United States, some 200,000 are secondary or recurrent strokes. The NENA vascular neurologists work with those who have suffered stroke in an effort to prevent recurrent attacks, often through the development of drug regimens suited to the individual patient's needs. 20

23 Division of Neurology Jonathan S. Moray, M.D. College: University of Pennsylvania, Philadelphia, PA Medical School: Mount Sinai School of Medicine, New York, NY Internship: Carney Hospital, Boston, MA Residency: Boston University Medical Center, Boston, MA/Neurology American Board of Psychiatry and Neurology in Neurology Richard S. Finkelman, M.D. College: Cornell University, Ithaca, NY Medical School: Medical College of Pennsylvania, Philadelphia, PA Internship: New Rochelle Hospital Medical Center, New Rochelle, NY Residency: Boston University Medical Center, Boston, MA/Neurology Fellowship: New England Medical Center, Boston, MA/Neuromuscular Disease Jennifer A. Grillo, M.D. College: Dartmouth College, Hanover, NH Medical School: Tufts University School of Medicine, Boston, MA Internship: Lahey Clinic Medical Center, Burlington, MA/Internal Medicine Residency: Tufts, New England Medical Center, Boston, MA/ Neurology Jonathan Ross, M.D. College: Royal College of Surgeons in Ireland, Dublin, Ireland Medical School: Royal College of Surgeons in Ireland, Dublin, Ireland Internship: Beaumont Hospital, Dublin Ireland and Boston City Hospital, Boston, MA/Medical Beaumont Hospital, Dublin Ireland/Surgical Boston City Hospital, Boston, MA/Medical Residency: Boston City Hospital, Boston, MA and Lahey Clinic, Burlington, MA/Neurology American Board of Psychiatry and Neurology in Neurology American Board of Electrodiagnostic Medicine Fellowship: Lahey Clinic Medical Center, Burlington, MA/Neurophysiology American Board of Psychiatry and Neurology in Neurology American Board of Electrodiagnostic Medicine Fellowship: Massachusetts General Hospital, Boston, MA/Epilepsy and EEG American Board of Psychiatry and Neurology in Neurology American Board of Psychiatry and Neurology, in Clinical Neurophysiology American Board of Clinical Neurophysiology, With Added Competency in Epilepsy Monitoring American Board of Psychiatry and Neurology in Epilepsy 21

24 Division of Neurology Shabbir A. Abbasi, M.D., MRCP (UK) College: D.J. Sindh Government Science College; Karachi, Pakistan Medical School: Dow Medical College, Karachi, Pakistan Internship: Civil Hospital, Karachi, Pakistan/Internal Medicine and General Surgery Residency: State University of New York, Syracuse, New York/ Neurology Fellowship: Mount Sinai Medical Center, New York, New York/Movement Disorders American Board of Psychiatry and Neurology in Neurology Vladan P. Milosavljevic, M.D. College: University of Belgrade School of Medicine Medical School: University of Belgrade School of Medicine Internship: Transitional Medicine, Dr. Dragisa Misovic Medical Center, Belgrade, Yugoslavia Wayne State University, Detroit, MI/Internal Medicine Residency: Mount Sinai School of Medicine, New York, NY/Neurology Fellowship: M.D. Anderson Cancer Center, Houston,Texas/Neuro-Oncology American Board of Psychiatry and Neurology in Neurology Arya Farahmand, M.D. College: Isfahan Medical Sciences University, Isfahan, Iran Medical School: Isfahan Medical Sciences University, Isfahan, Iran Internship: Frankford Hospital; Philadelphia, PA Residency: Boston University Medical Center, Boston, MA/Neurology Fellowship: Beth Israel Deaconess Medical Center, Boston, MA/Clinical Neurophysiology/ACGME Beth Israel Deaconess Medical Center, Boston, MA/Clinical Epilepsy American Board of Psychiatry and Neurology in Neurology Andreas P. Schoeck, M.D. College: University of Innsbruck Medical School, Innsbruck, Austria Medical School: University of Innsbruck Medical School, Innsbruck, Austria Internship: Faulkner Hospital, Tufts University Medical School, Boston, MA Residency: Boston University, Boston, MA / Neurology Fellowships: Boston University Medical Center, Boston, MA / Vascular Neurology (Stroke) Rhode Island Hospital, Brown University Medical School, Providence, RI / Neurophysiology American Board of Psychiatry and Neurology in Neurology American Board of Psychiatry and Neurology in Vascular Neurology 22

25 Division of Neurology Lanny Y. Xue, M.D., Ph.D. College: Medical College of Qingdao University, Qingdao, China Residency: Albany Medical Center Hospitals, Albany, NY / Neurology Post-graduate Training: University of Fellowship: New York University Alberta; Edmonton Alberta, Canada/ Medical Center, New York, NY / Ph.D. Neurophysiology-EMG / Epilepsy-EEG Medical School: Medical College of Qingdao University, Qingdao, China Internship: Albany Medical Center Hospitals, Albany, NY / Internal Medicine American Board of Psychiatry and Neurology in Neurology American Board of Psychiatry and Neurology in Clinical Neurophysiology Jason C. Viereck, M.D., Ph.D. College: San Francisco State University; San Francisco, CA Medical School: St. Louis University School of Medicine, St. Louis, MO Internship: Brockton Hospital, Brockton, MA Residency: Boston Medical Center, Boston, MA / Neurology Fellowship: Boston Medical Center, Boston, MA / Stroke American Board of Psychiatry and Neurology in Neurology American Board of Psychiatry and Neurology in Vascular Neurology Min Zhu, M.D., Ph.D. College: Beijing University; Beijing, China Post-graduate Training: University of Rochester; Rochester, New York/ Ph.D. Medical School: Peking Union Medical College; Beijing, China Internship: Long Island College Hospital, State University of New York at Downstate, Brooklyn, N.Y. Residency: Albert Einstein College of Medicine, Bronx, NY/ Neurology Fellowship: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA/ Neurophysiology American Board of Psychiatry and Neurology in Neurology American Board of Psychiatry and Neurology in Clinical Neurophysiology 23

26 Division of Neurology Myrta I. Otero, M.D. College: University of Massachusetts, Amherst, MA Medical School: Universidad Autonoma de Guadalajara School of Medicine; Jalisco, Mexico Internship: Veteran's Affairs Medical Center, San Juan, Puerto Rico/ Internal Medicine Residency: San Juan City Hospital, San Juan Puerto Rico/ Pediatrics Fellowship: Floating Hospital at Tufts Medical Center, Boston, MA/ Child Neurology Fellowship: Dartmouth-Hitchcock Medical Center, Lebanon NH / Clinical Neurophysiology Board Eligible American Board of Pediatrics Board Eligible American Board of Psychiatry and Neurology in Neurology with Special Qualifications in Child Neurology Board Eligible American Board of Psychiatry and Neurology in Clinical Neurophysiology Gioacchino G. Curiale, M.D. College: Harvard University, Cambridge, MA Medical School: University of Massachusetts Medical School, Worcester, MA Internship: Yale University School of Medicine, New Haven, CT / Internal Medicine Residency: Yale School of Medicine, New Haven, CT / Neurology Fellowship: Harvard Medical School; Beth Israel Deaconess Medical Center, Boston MA / Vascular Neurology American Board of Psychiatry and Neurology in Neurology Board Eligible American Board of Psychiatry and Neurology in Vascular Neurology 24

27 Division of Physical Medicine and Rehabilitation A physiatrist is a physician specializing in managing the rehabilitation of patients with a variety of disorders, including neck and low back pain, stroke, head injury, spinal cord injury, amputations, and numerous neurological and musculoskeletal disorders. The focus of the specialty is functional enhancement. Rehabilitation physicians have completed advanced training in the medical specialty of Physical Medicine and Rehabilitation (PM & R). The physiatrist's primary goal is to organize a comprehensive rehabilitation program for patients in order to achieve maximum physical, social, psychological and vocational functioning. To achieve this goal, the doctor utilizes various health care professionals for therapeutic programs, various therapeutic and diagnostic techniques such as electrodiagnosis (electromyography and nerve conduction studies), nerve blocks, and use of special devices such as splints, braces, and artificial limbs. A treatment plan is developed that may focus solely on the patient working with a physical, occupational, or speech therapist, or in conjunction with another medical specialist. Our physiatrists work in a collaborative effort with other NENA specialists including neurologists, neurosurgeons, psychiatrist and psychologist, and pain medicine physicians to help meet patients' clinical needs and achieve optimal functional capacity. Clinical areas of New England Neurological Associates physiatrists include the following: Back, Neck, and other musculoskeletal disorders Sports-related injuries Various pain syndromes, including radiculopathy Cardiac rehabilitation and conditioning programs Amputations/Prosthetics/Orthotics Osteoporosis/arthritis Work-related injuries Stroke Spinal Cord Injury Multiple Sclerosis Brain injuries Independent Medical Evaluations A select number of our physicians have added expertise in the performance of Independent Medical Evaluations (IME's). An IME is a medico-legal examination frequently performed to assist in the management of complicated medical cases, especially those involving personal injury and worker's compensation. It is done at the request of a third party lawyer, insurer, case manager, or employer to answer specific questions relevant to diagnosis, prognosis, and treatment. Properly utilized, an IME can help guarantee an appropriate and speedy resolution in these particular cases. 25