It’s not Star Wars; it’s brain surgery.

Now, select brain tumor patients in the Peoria area have a minimally invasive, efficient way to receive a diagnosis and get their tumor removed.

NeuroBlate LITT (Laser Interstitial Thermal Therapy)

"NeuroBlate is a means to treat tumors with thermal energy,” says Andrew Tsung, MD, the vice president of OSF HealthCare Illinois Neurological Institute. “It's a laser, which is how the energy is administered, through very small probes the size of a wire. It's done through a very small incision, about the size of the width of a dime. Through that incision we're able to insert the small wire directly to the target. Then we're able to ablate, or get rid of, that tumor and at the same time obtain a biopsy specimen to confirm what we're treating."

How does NeuroBlate work?

"It is thermal energy delivered through a laser beam. We can either fire at the end of a laser, as one would think of laser gun, or we can side fire it and rotate the wire," Dr. Tsung says. "So, it's shooting out from the side, kind of like a lighthouse. You spin the lighthouse around as you pull the probe back. You're able to create shapes as you withdraw from the target." 

Even very sick patients can undergo this treatment because of the technology’s minimally invasive nature.

"We insert it to a target. By taking temperature measurements through the MRI machine and calculations, we're able to control the radius, or the spread of that current through the tumor and stop it at the three-dimensional boundary between where the tumor ends and the brain starts,” Dr. Tsung says.

Eligible patients for NeuroBlate

NeuroBlate, offered at OSF HealthCare in Peoria, Illinois, through Monteris, a neurosurgical technology company, has been recognized as a viable treatment for brain tumors. Roughly a handful of patients have received the treatment at OSF, with more coming down the pipeline soon, Dr. Tsung says.

Potential patients for NeuroBlate could have brain tumors, Glioblastoma (cancerous brain tumor), high-grade glioma, low-grade glioma (growing tumors), or metastatic brain cancer, also known as secondary brain tumors. The size of the tumor matters. NeuroBlate is effective on tumors three centimeters or less. Epilepsy patients can also benefit from this treatment. 

NeuroBlate decreases recovery time drastically

"The patients oftentimes will not require any pain medication following brain surgery, which is quite astonishing,” Dr. Tsung says. “When you make such a small incision, there's minimal disruption to the tissues. The brain itself does not have any pain sensors. That prevents us from using any pain medication. The recovery is quite fast. In patient cases we've done so far, the first patient used no pain medications and was ready to go home by 8 a.m. the next morning." 

OSF HealthCare Saint Francis Medical Center is the only medical center in the Peoria region that offers NeuroBlate.

From the patient arriving to undergoing the surgery and then leaving, the whole process only took 16 hours. Most brain surgery patients are in the hospital for at least two nights and then recover with weight restrictions (in terms of lifting). All of this is avoided when using NeuroBlate. Setup takes three to five hours, but treatment time for he patient is three or less minutes. 

For more information on NeuroBlate and other neurological services, learn more about OSF INI on the OSF website.

Video Interview Clips

NeuroBlate in use (GRAPHIC WARNING)

NeuroBlate B-Roll

"It can present in a variety of ways like vision loss, double vision, weakness, or numbness on one side or both sides of the body,” says Tiffani Franada, DO, a neurologist with the OSF HealthCare Illinois Neurological Institute (INI) who specializes in the autoimmune disease.

"Typically (multiple sclerosis) presents in young patients between 20 and 50 years of age. It's more common in women than men," Dr. Franada says. These events are called attacks or relapses, and they last a few weeks and then they get better. Patients can go awhile without anything, and then they can get other attacks down the line."

The OSF HealthCare Illinois Neurological Institute has launched a clinical trial for patients with nonrelapsing secondary progressive MS (nrSPMS). Dr. Franada and her team are looking for further preventive treatments. The trial, sponsored by Sanofi, uses an antibody called frexalimab, to see if it delays the progression in those enrolled.

"It's a disease state with no current treatment options available,” Dr. Franada adds. "We are actively enrolling right now. The age range is between 18-60 years of age for patients with secondary progressive MS that's not active. This is different than the relapsing remitting phase, which is the most common. This comes after that phase.”

While some patients currently in the OSF INI clinic are candidates for the clinical trial, Dr. Franada and her team are looking to include patients outside the clinic as well.

People interested in the clinical trial can call OSF INI at (309) 624-4000 to learn more information.

Multiple Sclerosis treatment options

There are 20 disease-modifying therapies to prevent disease activity in MS, Dr. Franada says. “Some treatments are given by IV, some are given by mouth, and some are given as at-home injections. It just depends on what is right for that individual."

Dr. Franada says if someone has an MS attack, the team wants to know about it right away. Adding that treatment of MS is more effective when it’s started early.

"There are some acute treatments that can be given, typically in the hospital. But prevention is a mainstay of our treatment course for patients.”  

Prevention tips

"Getting good sleep at night (is important), about eight hours. Getting regular exercise, about 30 minutes 5 days per week. In fact, exercise helps increase levels of BDNF, which is one of the hormones in our body that helps with neurological repair, called remyelination," Dr. Franada says. "The problem in MS is stripping away the covering of the nerve, demyelination, so exercise helps the reparative process. We don't know what the best diet for MS is, but I usually encourage my patients to focus on a Mediterranean diet, which is heart healthy." 

Knowing family history is also important to assess your risk factor of getting the disease.

"The risk for developing MS is a combination of genetics and environment, it's not just one. If you have a family member who lives with an autoimmune disease, or MS, it does slightly increase your risk for developing the disease,” Dr. Franada says.

Hydration is paramount, as is stress reduction. “Exercise is a great way to manage stress.”

"Your brain sits in a pool of fluid, so we want to hydrate as much as possible," Dr. Franada says. 

If you know a family member has MS, there are things you can do to lessen your risk.

"That includes Vitamin D supplementation. If you're low in Vitamin D, it’s critical to supplement that to a normal level. Also, smoking cessation. If you're a smoker, we advise you to quit. But this is incredibly important for patients with MS, because smokers are more likely to develop the disease,” Dr. Franada says.

National recognition of the disease has gone up, Dr. Franada says, which drives more patients to the OSF Illinois Neurological Institute. 

While there is no cure for MS, there are treatment options available to help with day-to-day symptoms (fatigue, pain and cognitive issues).

For more information on OSF HealthCare Illinois Neurological Institute, visit the OSF HealthCare website.

Video Interview Clips

Actress Christina Applegate is back in the news about her struggle with multiple sclerosis (MS). After staying out the public eye since her diagnosis, Applegate got a standing ovation at this week's Emmy Awards.

Earlier, the actress said she wished she paid more attention to early symptoms such as balance issues a few years ago.

MS is a disease that impacts the brain, spinal cord and optic nerves, which make up the central nervous system and controls everything we do, according to the National Multiple Sclerosis Society (NMSS).

The exact cause is unknown, but genetics can be a factor. Symptoms are unpredictable but include numbness, tingling, mood changes, memory problems, pain, fatigue, and loss of vision. According to medical experts, MS presents differently with each patient and symptoms may be temporary or long-lasting. There is no cure for MS, but symptoms are treatable with medication and stress management.

“Usually, when it first presents MS is characterized by a relapse," says Dr. Tiffani Franada, a neurologist with OSF HealthCare.  "So it may be new symptoms that last for days at a time, and it can affect vision so patients could have a loss of vision. It could cause numbness on one side or both sides of the body, weakness on one side or both sides of the body and include really terrible balance episodes. These events usually lasts longer than a day. If patients are having those symptoms they need to seek care and talk to their primary care doctor and get referred potentially to a neurologist.”

MS can impact mobility, balance, energy level and cognition (how we learn and understand). Symptoms can worsen due to stressors such as lack of sleep, emotional stress or an infection. But experts agree that it can be difficult to diagnose MS since these symptoms are also consistent with other issues such as seasonal affective disorder, PMS and thyroid dysfunction.

According to the NMSS, there are more than one million people living with MS in the United States. Most people are diagnosed between the ages of 20 and 50, but MS can develop in young children and older adults.

A diagnosis, says Dr. Franada, can be overwhelming, especially among younger patients.

“A lot of patients who are diagnosed are diagnosed young within their working years and that can be very difficult, and a lot of patients are women," she says. "People are affected with MS at a rate of three to one female to male – many of these women are in their careers and might be considering starting families. There’s a lot to put into that, considering how that will affect their day-to-day life.”

A treatment plan includes a comprehensive approach created by a care team that includes a neurologist, therapists, nurses trained in MS and a social worker. Since there is no cure, doctors can prescribe drugs that may slow the course of the disease, prevent or treat attacks, help manage stress and ease symptoms. Physical therapy may help patients with strength and balance issues, and help manage pain and fatigue. Regular exercise can help boost energy levels and improve stress and anxiety.

Dr. Franada stresses that all is not lost when it comes to an MS diagnosis. Medical advancements have come a long way and that’s why she treats her patients with hope and positivity.

“I think that we should all be very hopeful," she says. "The world of MS has changed precipitously in the past 30 years. The first treatment for this disease came in 1993 and since then, we have 20 different treatment options for this disease so we've really come a long way. If we diagnose patients early, we really can treat their symptoms and help to get them on a productive path to hopefully ever prevent any further disease activity.”

When celebrities like Christina Applegate come forward, Dr. Franada says it gives hope to other people going through a similar experience. Recently, Applegate made her first appearance since announcing her diagnosis, when she received a star on the Hollywood Walk of Fame with help from a walking cane.

“I think it's empowering and we definitely want to get the word out," says Dr. Franada. "We want patients to seek care, we want them to be in our clinic, we want to be able to help them to diagnose the condition, but also to understand that it is okay to use an assist device for walking. We much rather them be safe than sorry.”

For more information on MS and clinic options, visit OSF HealthCare. 


 

Interview Clips 

Actor Chris Hemsworth recently made headlines when he announced that he’s taking time off from acting after undergoing testing that resulted in an alarming discovery: he has a greater risk of developing Alzheimer's disease at some point in his lifetime.

The 39-year-old Hemsworth made the discovery after undergoing tests as part of his documentary series Limitless, where Hemsworth tests his body and searches for ways to live longer.

While having a predisposition for Alzheimer’s is not a diagnosis, it can help someone take the appropriate preventative measures. Hemsworth has said he is going to spend time focusing on stress and sleep management, nutrition and fitness.

According to the Alzheimer’s Association, Alzheimer’s is the most common cause of dementia, making up 60-80% of dementia cases. Dementia is not a normal part of aging, and is caused by damage to brain cells that can lead to memory problems, confusion and communication issues.

“With dementia, it's a short term, memory-deficit, but usually long term is intact," said Andrea Shewalter, a nurse practitioner with OSF HealthCare Illinois Neurological Institute (INI). "People will forget what they ate for breakfast that day and they may forget having a specific conversation with a family member that morning or the day before, but they'll be able to tell you what they did 25 years ago and be able to reminisce with stories like that.”

Typically it’s a loved one who notices the initial troubling signs of dementia such as memory loss, problem-solving difficulties or issues with daily tasks such as paying bills, taking medication or preparing meals, so it’s the patients who are accompanied by family members to an appointment who are most likely exhibiting the greatest symptoms of dementia.

Shewalter adds that anyone is a candidate for testing. And if you have a loved one who has been diagnosed with dementia you do not need to wait to develop symptoms to look into testing options for yourself.

“When patients come in we refer them for a neuro psychological evaluation, where the psychologist reviews the 12 different domains of the brain through different systems and assessments," she says. "And they can come up with a potential diagnosis and are able to tell us what part of the brain is having a deficit or what deficit of the brain is occurring.”

But arriving at a dementia diagnosis isn’t always easy. Physicians have to recognize a pattern of loss of skills and function and determine what a person is still able to do. And it usually takes more than one test to come up with the diagnosis. Tests include cognitive and neuropsychological tests, neurological evaluation, brain scans, lab tests and sometimes psychiatric evaluation.

“I would refer anyone for neuropsychological testing, where they can help determine what areas of the brain are being affected," says Shewalter. "And then we usually send the patient for imaging to make sure that there's nothing from a pathological standpoint that's going on in the brain. Is there a brain tumor? Is there Lyme’s disease? Is there some sort of disease that is affecting this? We can also look at the structures of the brain to be able to tell if there a lot of shrinkage for their age. Is the brain compensating due to the atrophy or the shrinkage of the brain?”

In the early stages of dementia, Shewalter has several recommendations for patients to remain as independent as possible, including doing crossword puzzles, playing cards and crafting – anything that involves hand and eye coordination.

She also encourages socialization – getting out in the public and being around people as much as possible. While there is no conclusive evidence, there is still benefit to taking care of yourself as much as possible. That includes a healthy brain diet and a high intensity exercise program of 150 minutes each week. Finally, get your financial affairs and power of attorney in order, especially if memory loss progresses to the point where you can’t make decisions for yourself.

“We try to treat dementia as naturally as possible," adds Shewalter. "That's why we recommend the exercise, the increase in socialization, and the brain healthy diet, because it is what you make of it. If you just sit in a house and don't use your brain or challenge your brain and let the world go by, you often have generally worse outcomes than if you were to face this head on. Do the steps that we naturally recommend to decrease the rate at which your memory declines.”

In addition to taking preventative measures and staying active, having a support system in place early on is especially important for someone with any dementia diagnosis.

For more information about dementia testing, visit OSF HealthCare.

Interview Clips 

We have all heard the warnings when it comes to stroke: time lost is brain lost. Every minute a stroke goes untreated, the brain loses nearly two million brain cells it can never recover, and every hour of stroke is equivalent to losing over three and a half years’ worth of brain cells. 

While acting quickly during a stoke event is imperative, there are some medical advances that can help prevent a stroke from occurring in the first place especially in those with carotid artery disease.

Carotid artery disease occurs when fatty deposits, or plaques, clog the blood vessels that deliver blood to the brain and head (carotid arteries). These blockages dramatically increase the risk of stroke.

“It can lead to lightheadedness, or feelings of dizziness, or losing consciousness sometimes, but most importantly stroke,” says Dr. Sourabh Lahoti.

Dr. Lahoti is an interventional neurologist at the OSF Illinois Neurological Institute (OSF INI) in Peoria, Illinois. He says a procedure called carotid artery stenting has proven to alleviate the risk for patients with carotid artery disease.

During carotid artery stenting a small catheter is threaded through a blood vessel, eventually reaching the carotid artery. A balloon is inflated to dilate the narrowed segment of the artery and then a wire mesh stent is placed across the blockage. The stent will become a part of the artery wall as a part of the natural healing process, eventually strengthening it, widening it, and helping to prevent future blockages.

Carotid artery stenting is typically done by running the catheter through the femoral artery – a main artery in the groin. It is generally a successful procedure, but because the femoral artery is so large it takes time to close. Patients need to lie flat and still for hours post-procedure and are limited in activity in the days following to prevent complications. Unsuccessful closure can lead to serious bleeding issues.

Dr. Lahoti is the first surgeon in central Illinois to offer carotid artery stenting via the radial artery: something he calls a game changer.

“It is very exciting. And I'm glad to be in a time where the field of neuro interventional surgery is going through this phenomenal, and honestly revolutionary change, because it has completely changed the way we approach cerebrovascular diseases and the way we treat them,” says Dr. Lahoti.

With the minimally invasive radial approach, a small poke is made in a patient’s hand to gain access to the radial artery. The catheter is inserted, and a carotid artery stent is placed in the neck. According to Dr. Lahoti, the radial approach reduces the complications of bleeding, severe bruising and pain. 

“The biggest advantage is that after we are done, we don't have to stitch anything,” explains Dr. Lahoti. “We don't have to put in any device, and the artery in the wrist is much smaller than the one in the leg. And it's very easily accessible. So all we do is put a band across the wrist to save it from bleeding, and the band stays for a couple of hours, and then we are done.”

Carotid artery stenting via the radial artery requires no anesthesia, and the patient is able to get up and walk around following the procedure with no restrictions, other than lifting heavy weight with that arm for a few days.

Conversely, patients who receive a stent through the femoral artery are required to remain in bed for four to six hours after the procedure.

“As soon as we're done, patients can get up. They can walk. They can move around as if they didn't have any procedure at all.”

Not all patients qualify for carotid artery stenting – either through the radial artery or the groin – and some may be recommended for drug therapy or even a carotid endarterectomy, where a surgeon makes an incision on the side of the neck and surgically removes the plaque inside the artery.

Dr. Lahoti says each case is evaluated on an individual level, and the most important thing is getting the blockage addressed and reducing the risk for stroke.

Many people suffering from carotid artery disease don’t know they are affected. Dr. Lahoti suggests keeping up with yearly physicals with your primary care physician, and having open and honest conversations about lifestyle choices like smoking status, diet and activity levels.

For more information on carotid artery disease, its symptoms and treatments visit osfhealthcare.org.

Interview Clip - Dr. Sourabh Lahoti