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Some Nerve

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Conversations between neurologist Lanny Edelsohn (left) and neurosurgeon Yakov Koyfman led to the creation of the Neuroscience and Surgery Institute 
of Delaware in Newark. Photograph by Pat Crowe IIWhat began as back pain and a little numbness in his toes gradually spread. By the time Stephen Storch Jr., then 22, arrived at the Neuroscience and Surgery Institute of Delaware eight weeks later, he could no longer walk unassisted.

Storch had not taken the problem seriously at first, thinking he could self-treat with rest and the application of heat. Earlier visits to other doctors had provided no answers. “I’ve always had back problems, and I thought it was a pinched nerve or something,” he says. “A tumor was the last thing I expected.”

But a tumor it was, and it was compressing his spinal cord. When Dr. Sung Ho Bae of Neurology Associates saw results of an MRI done at the institute that morning, he immediately walked Storch down the hall to see neurosurgeon Yakov Koyfman. In less then 18 hours, Storch was on an operating table at Christiana Hospital, and two days later he walked out on his own.

Storch’s experience provides a vivid example of the accelerated, one-stop care that patients receive at the Neuroscience and Surgery Institute of Delaware, a multi-disciplinary center that provides diagnostic testing, medical care and outpatient surgery for neurological conditions and engages in medical research, education and outreach.

The institute, located in the two original MBNA buildings just off Del. 273 in Newark, opened in several stages beginning in late 2004. By the time the institute held an open house a year ago, all the pieces had come together, and the original group of 26 doctors had grown to 100, half of whom practice there full time.

In addition to neurology and neurosurgery, specialties include neuropsychology, neuroradiology, pain management, otolaryngology (ear-nose-throat, or ENT), podiatry and physical therapy, and, in cooperation with Christiana Care, psychiatry, neuro-oncology, sleep medicine and vascular surgery. Sophisticated medical imaging (and immediate results) and an onsite outpatient surgery center allow a patient in many cases to receive all his required care in one place.

“We really try to be patient-centered so that patients can come and get things done quickly, efficiently, without having to run around to various sites,” says neurologist Lanny Edelsohn.

With four neurosurgeons, 14 neurologists and physicians representing nearly a dozen other neurological specialties onsite, the Neuroscience and Surgery Institute is the most comprehensive center for neurological care between Philadelphia and Baltimore. It draws patients from Delaware, Maryland, Pennsylvania and New Jersey.

The idea for the Neuroscience and Surgery Institute sprang from conversations between Edelsohn and Koyfman. Over the course of many years, they would commiserate frequently about the time-consuming process of testing and referrals and the barriers to communication between doctors.

When Edelsohn’s and Koyfman’s practice groups were both looking for new office space at the same time, they decided to put into action their dream of a neuroscience center that would cluster many neurological-related specialties. It took a couple of years to find the right facility at the right price and to convince the other physicians—all of them handpicked, Koyfman adds—that the expense and hassle of moving their practices would be worth it. Though the doctors work collaboratively, each practice group remains independent and owns or leases its space at the institute.

Before the practices came together, Koyfman says, the process of testing, consultations and referrals was slow and ineffective.

“Here, we get instantaneous action. If I see a patient in my office, and I want him to undergo a diagnostic injection, I would walk 10 steps and talk to [pain management specialists] Dr. Witherell or Dr. Downing, to say ‘Look, I have a patient. Here is his MRI, here is the CT scan, and here’s the patient. I think this is what I need. Can you see the patient right now and tell me if you agree and how to proceed?’ And that’s what happens.

“The same thing with neuropsychology,” Koyfman adds. “Before we all came together, we could not even imagine how much we would use neuropsychology, but now it’s absolutely routine. For certain diseases, we cannot work without neuropsychology. Evaluation of the cognitive function of the patient is a very serious task.”

The same sort of collaboration happens among all the disciplines at the institute. The mix of medical specialties, access to specialized equipment and a heterogeneous group of patients makes the institute an ideal place for clinical research as well. “Many people think that research studies are available only at large academic centers, but that’s not the case,” says Michael Paradise, RN, clinical research coordinator for Neurology Associates.

During the past two years, Neurology Associates has participated in clinical studies of medications for epilepsy, Parkinson’s disease, Alzheimer’s disease, multiple sclerosis and neuropathic pain. The breadth of studies varies widely, from one recent study for an Alzheimer’s drug that involved only 150 patients nationwide to a just-finished study of a drug to prevent secondary strokes that involved 20,000 patients around the world. Other studies in the works include those for chronic migraines, seizure disorders and the Alzheimer’s drug Bapineuzumas, which in earlier studies showed some promise for causing remission.
 

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The Delaware Neurological Group is involved with two studies of surgical devices designed to eliminate the need for spinal fusion, thus preserving a greater range of movement for the patient. Both studies are confined to fewer than 25 sites in the country.

“Now that everything is in place with the institute’s space and personnel, we plan to expand in the research world,” says neurosurgery research coordinator Aaron Silverman. “Dr. Koyfman is out there looking for studies all the time. We want to be on the cutting edge of any research out there that will benefit our patients.”

The advanced medical imaging capabilities and onsite surgery center make it more likely that the institute will qualify for such studies. Neuroscience Imaging, for example, can perform not only X-rays, CT scans, and MRIs with and without contrast, but also delicate, highly specialized procedures such as spinal punctures and myelograms, which involve injections directly into the spine. The imaging center also can provide protocols that allow doctors to perform CyberKnife® Robotic Radiosurgery, a noninvasive tumor surgery that can sometimes be used in patients who have near-inoperable or surgically complex tumors.

Doctors at the surgery center, one of the largest in Delaware, will perform more than 8,000 procedures this year, a number that has been steadily increasing since the center opened. They range from minor procedures such as endoscopy and colonoscopy to ENT, vascular, and gynecological surgeries. But it is the neurosurgeries that are most complex.

“I am unaware of any surgery center that has quite as much neurosurgery and advanced neurosurgery procedures as we have,” says Dr. Fred Hyde, CEO of the surgery center. “The types of procedures done by Dr. Koyfman and others on an outpatient basis are really quite extraordinary. It is very sophisticated surgery, even some that is experimental, such as the artificial disk insertions.”

The institute has become a center for medical education as well. UD nursing practitioner students, as well as residents and interns from Thomas Jefferson and Christiana Care, rotate through the institute. Koyfman hopes soon to have in place a 12-month physician assistant fellowship in neuroscience—the only one in the country, he believes—that will prepare a licensed graduate physician assistant to practice in the neuroscience field.

The institute organizes frequent continuing medical education presentations at its own facility that are open to all area physicians and are accredited by the Medical Society of Delaware. In October it hosted the Delaware Neuroscience Symposium, which Edelsohn hopes to make an annual event.

As important as this outreach to the medical community is the institute’s commitment to patient outreach. The ARC of Delaware, Alzheimer’s Association, Autism Society, Bancroft Neurohealth and MS Society all use the facility free for meetings and patient outreach.

“Our biweekly meet-and-greets here at the Neuroscience Institute are a way for us to meet and interact with people with multiple sclerosis and let them know about our range of services,” says the MS Society’s Ginger Stein. “I have sat here myself with someone who just got a diagnosis, and I have hugged them and cried with them. We have connected people with sources of free medication and talked to family and friends about how to help someone with MS. It’s a value-added service that the institute provides its patients, and it has a subtle ripple effect all the way around.”

Despite all the research and collaboration, Koyfman says the institute has only “scratched the surface” of what is possible. He would like the institute to become involved in studies of long-term outcomes and in research on neurological conditions caused by trauma. He also hopes to add a second fellowship.

Edelsohn talks of adding more neurological sub-specialties, including a neuro-ophthalmologist. He would like to hire more people who have neurological handicaps. (Three current staff members do.)

“Everyone has an ability and can grow, if they are given the opportunity,” Edelsohn says, “and we want our patients and our staff to see that.” He wants to continue to develop the institute’s efforts at medical education and community outreach.

Most of all, he wants the public to have confidence that the Delaware community has this neuroscience expertise and that the institute will continue to develop and improve while remaining patient-centered.

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