October 23, 2020 by John Fernandez
Medicine’s New Frontier: Neuroscience Tackles Some of the Most Delicate Cases in Healthcare
More intricate than the most complicated computer, the human brain and nervous system remain shrouded in mystery, an endless source of wonder. Every day brings new discoveries in neuroscience, deepening our understanding of how they work — and what doctors can do when they don’t.
Michael McDermott, M.D., fell in love with the exquisite complexity of neuroscience when he was in medical school. Something about the brain’s remarkable symmetry captured his interest in a way no other part of the body did. Almost 40 years later, that fascination persists. A world-renown neurosurgeon and researcher, Dr. McDermott recently became the new chief medical executive of Miami Neuroscience Institute, part of Baptist Health South Florida.
“The brain is the crown jewel of human creation,” he says, quoting one of his mentors, famed neurosurgeon Albert Rhoton Jr. “That is how he would start every lecture. It is the basis of everything.”
Even though Dr. McDermott has participated in and witnessed countless technical advances, the medical breakthroughs on the horizon almost boggle the mind. “We’re on the upswing part of the curve,” he says. “The next 10 years are going to be very exciting.”
Progress in imaging, biosensor devices, wireless data transmission and signal processing algorithms have resulted in startling developments in neuroscience, such as technology that bypasses the eyes to allow blind people to “see,” or brain sensors that can translate thoughts into movement, helping amputees send mental messages to robotic limbs. It also is resulting in new treatments for diseases that once were considered uncurable.
“The biggest advances are related to computer systems — their application to treatment and their use to understand neurological conditions,” says Dr. McDermott, who specializes in brain tumors. “One can only imagine how far technology will take us.”
Miami Neuroscience Institute
On this new medical frontier is Miami Neuroscience Institute. It offers comprehensive treatment for neurological conditions affecting the brain, spinal cord and peripheral nervous system. Highly specialized experts address a wide range of problems from brain tumors to back pain, movement disorders and seizures to strokes and life-threatening aneurysms.
The complexity of the brain and nervous system — which act as “mission control” for the whole body — means the Institute often collaborates with experts from Miami Cancer Institute, Miami Cardiac & Vascular Institute and Miami Orthopedics & Sports Medicine Institute.
From minimally invasive procedures to complex brain and spine surgery, it provides care at all the Baptist Health hospitals. The exceptions are Boca Raton Regional Hospital, which already was home to the renowned Marcus Neuroscience Institute when it joined Baptist Health last year, and Bethesda Hospital East and Bethesda Hospital West, which also had an established neuroscience program.
Baptist Health’s neuroscience institutes attract patients from far beyond South Florida.
For example, Robert Hall, a resident of St. John, Antigua in the Caribbean, sought emergency treatment through Baptist Health International after a severe seizure brought to light a dangerous condition. Lacking a sophisticated treatment facility at home, his doctor on the island urged him to go to Baptist Health after discovering Mr. Hall had a rare arteriovenous malformation, an often-fatal tangle of abnormal blood vessels in the brain.
In a delicate surgery, the mass was removed by Vitaly Siomin, M.D., medical director of the brain tumor program at Miami Neuroscience Institute. “The care I received there was top-notch, and if not for them, I wouldn’t be here talking with you today,” Mr. Hall says.
In addition to increasingly sophisticated technology, the advancement of neuroscience is pushed forward by the continuous evolution of surgical and treatment techniques. Physicians stay at the forefront of their fields through constant training, research and innovation.
That means they are ready to pivot when new treatment options can benefit patients. For example, endovascular surgeons Italo Linfante, M.D., and Guilherme Dabus, M.D., were the first in Florida to treat a woman’s life-threatening brain aneurysm using a new generation of smart stents approved by the FDA only weeks earlier. They also were the first in South Florida to use the Woven EndoBridge, a self-expanding mesh ball of nickel titanium that chokes off wide-neck aneurysms after being snaked to the brain through a blood vessel in the groin or wrist.
“We are finding new ways to treat unruptured aneurysms,” says Dr. Linfante, medical director of endovascular surgery at Miami Neuroscience Institute and Miami Cardiac & Vascular Institute. “We have many new tools in our toolbox, and the technology is expanding more and more.”
That means the prognosis for patients keeps improving.
“It’s a game changer. Some of these aneurysms could not be treated a few years ago. And when they were treated, the complication rates were very high,” says Dr. Dabus, director of the Neuroradiology Fellowship Program. “Being able to offer this kind of treatment here can be life-changing for our patients.”
Minimally Invasive Innovative Technology
New technology and surgical approaches require a huge investment — not only financial, to be able to acquire new equipment, but by doctors who must devote time and energy to stay on the cutting edge.
Neurosurgeon Justin Sporer, M.D., has spent about two years to bring high-intensity focused ultrasound treatment, also known as HIFU, to Miami Neuroscience Institute to treat essential tremor, a progressive and debilitating condition that causes trembling. People with essential tremor have difficulty-writing, holding a cup of water or coffee without spilling, shaving and performing many other tasks.
Focused ultrasound technology is available in only a few neuroscience facilities in the United States and uses sound waves to reduce or eliminate the trembling. Described as incisionless brain surgery, it is performed while the patient is awake and involves no anesthesia, no cuts in the scalp and no burr holes through the skull to reach the brain.
The concept is similar to deep brain stimulation (DBS) treatment, which is also offered at Miami Neuroscience Institute for certain seizure and movement disorders. However, DBS, which relies on continual electrical pulses like a pacemaker, requires placement of wires in the brain. It is powered by batteries and a device that can be adjusted — a plus for certain patients.
“In both DBS and HIFU, the results can be nothing short of a miracle,” Dr. Sporrer says. “The effect is essentially instantaneous once treatment is delivered. It’s not uncommon to actually hear patients laugh as they are being treated because the effect is so dramatic.”
Communicating with First Responders
While the institutes take advantage of the most sophisticated technology, making new use of more common tools also can have a big impact. With something as simple as a cell phone, physicians are taking advantage of a software program with artificial intelligence to better synchronize stroke care and shave minutes off their response.
The communication system uses machine learning to analyze brain scans and notify the healthcare provider when patients need urgent attention. The software is being used at Baptist, Boca Raton Regional, Homestead, South Miami and West Kendall Baptist Hospital.
Institute doctors are also using iPads to connect with first responders from the Coral Gables Fire Department, the first agency in Miami-Dade County to establish a direct audio-video connection between transport vehicles and teams at Baptist Health’s emergency departments. Consulting about patients while en route saves time at the hospital for stroke or head trauma patients, helping determine if they need imaging, clot-busting drugs or life-saving surgery.
“The quicker they get the specific treatment they need, the better the outcome for the patient,” says Felipe De Los Rios, M.D., medical director of the stroke program at Miami Neuroscience Institute. “We have time-dependent treatments that can really change the outlook for someone with a stroke and prevent long-term disability.”
‘It’s Just the Tip of the iceberg’
Few cases illustrate the need for speed better than that of Gary Mace, a dive shop operator and boat captain in the Florida Keys. Mr. Mace was home alone about a year ago when he began experiencing symptoms of stroke. Barely able to speak, he called his wife, Brenda, and whispered, “Help me.”
She immediately hung up and dialed 911. Within minutes, an ambulance rushed him to Mariners Hospital, where he was picked up by helicopter and whisked to Baptist Hospital in Miami.
As the chopper approached, neurologist Dalia Lorenzo, M.D., was already mobilizing the hospital’s dedicated stroke response team. As a designated Comprehensive Stroke Center by the Joint Commission, which accredits U.S. healthcare organizations, Baptist Hospital has all the necessary resources to treat the most complex stroke cases.
Upon landing, Mr. Mace was rushed to the emergency room where, within 12 minutes of arrival, he received Tissue Plasminogen Activator (tPA). This powerful blood thinner can break up blood clots in the brain that cause a stroke, but it must be administered within about four hours of the onset of symptoms in order to be effective.
“Because we had such a good system in place, we were able to get him the treatment he needed to prevent any permanent disability,” Dr. Lorenzo said. Two days later. he walked out of the hospital and soon returned to work.
Mr. Mace, the owner of Conch Republic Divers in Tavernier, is still overwhelmed by all the things that were firmly in place for him to recover. “It really is a miracle,” he says. “I really appreciate everything that Baptist did for me – everybody was so professional and caring. Words can’t express my gratitude.”
Dr. McDermott is eager to see what comes next, especially as Miami Neuroscience Institute and Marcus Neuroscience Institute expand their programs. Baptist Health has demonstrated it has the vision and determination to bring even more advancements to South Florida, he says. “We’ve come a long way,” Dr. McDermott says, “but it’s just the tip of the iceberg.”