SUBSPECIALTIES | Neurology

CHILD NEUROLOGY

Child Neurology is a sub-specialty of General Pediatrics which focuses on the care of children with disorders of both the central and peripheral nervous systems. Our department currently has two board certified child neurologists, Dr. Rosario Maria Riel-Romero and Dr. Sheila Asghar. Dr. Riel-Romero has a special interest and expertise in areas of pediatric epilepsy for patients with refractory seizures being considered for surgery, neurogenetic disorders, neurocutaneous disorders, neonatal neurology, pediatric neuromuscular disease, movement disorders such as tics, developmental disabilities, cerebral palsy among others. In addition, with our colleagues in the department, we offer an array of neurodiagnostic services.

This includes the following:

1. Intracranial EEG monitoring
2. Pediatric Epilepsy Surgery
3. Routine and video EEG
4. Visual Evoked Potentials
5. Neuroimaging studies including CT Scans, MRIs, MR Spectroscopy, PET scans and ictal SPECT
6. Pediatric Sleep Studies

Our goal is to work with our patients' primary care providers to diagnose and treat neurological problems with the most advanced and state of the art care available.
We offer the following services as well:

1. Eteplirsen for Duchenne Muscular Dystrophy
2. Nusinersen for Spinal Muscular Atrophy
3. ACTH Therapy for Infantile Spasms
4. Dysport injections for Spasticity
5. Intrathecal Baclofen Pump
    

CLINICAL NEUROPHYSIOLOGY

The clinical neurophysiology laboratory at LSU Health Shreveport will serve as the resident's "training grounds" in learning to interpret of electroencephalograms, nerve conduction studies/electromyograms and evoked potentials. Currently the laboratory performs about 1,000 EEG's, 400-500 EMG's and about 20-30 EP's each calendar year. Instruction in basic neurophysiology and anatomical substrates of EEG, EMG and EP's and the indications for performance of these tests will form the core curriculum leading proper interpretation of these clinical studies. The resident will learn to recognize normal EEG patterns in infants, children and adults as well as to recognize abnormal patterns and their clinical significance. In the EMG lab, the resident will learn the normal parameters of nerve conduction studies and needle electrode exam of infants, children and adults. The trainee will learn to recognize abnormal patterns of nerve conduction and EMG and to correlate findings with clinical conditions affecting the neuromuscular and peripheral nervous systems. The trainee will learn the principles and techniques in recording and interpreting evoked potential studies.

This basic knowledge of clinical neurophysiology should be helpful in further diagnostic studies in sleep disorders and epilepsy and in intraoperative monitoring.

Our department performs routine EEG’s, nerve conduction studies, electromyographic studies and evoked potential testing (visual, auditory and somatosensory). Studies can be scheduled by calling (318) 626-1828.

EEG/EPILEPSY

Our Epilepsy Center is accredited at the highest level, a level 4 Epilepsy Center.  We are the only level 4 center in the Tri-State area. 

The diagnosis and treatment of epilepsy is a major interest of the LSU Health Shreveport Neurology department. A specialty clinic designed to meet the needs of patients with epilepsy meets once a week. This clinic is especially suited for management of the patient with seizures that are not fully controlled. While medical management of epilepsy and seizures is the rule for most patients, other treatments such as surgery, vagus nerve stimulation and special diets may have to be considered. Our epilepsy monitoring unit is helpful in identifying persons who may respond to surgical intervention. Long-term video and electroencephalographic (EEG) monitoring in our epilepsy monitoring unit is essential in the initial evaluation of those with intractable epilepsy. Monitoring is also helpful in identifying patients whose clinical symptoms may not be related to epilepsy.

Our neurology residents must be able to diagnose and care for patients with epilepsy, including those with complications and diagnostic uncertainties. Instruction in the interpretation of EEG recordings and various epileptic syndromes helps in the management of seizure disorders.
The resident also is expected to understand the epidemiology, genetics, classification, prognosis and treatment of epilepsy. The trainee is expected to manage conditions such as convulsive and non-convulsive status epilepticus and refractory epilepsy. Further instruction in the pharmacology of various anti-epileptic drugs will enable the resident to choose medications that are appropriate for the type of seizure that an individual patient has. Our hospital has excellent neuro-imaging facilities, including computerized tomography (CT), magnetic resonance imaging (MRI), positron emission imaging (PET) and single photon emission computerized tomography (SPECT). Our clinical neurophysiology laboratories offer routine EEG as well as long-term video/EEG monitoring.

We also emphasize consideration of the quality of life in the epileptic patient. Problems such as employment, educational opportunities, driving, gender issues and medication side-effects must all be considered in successful management of patients with epilepsy.

The neurology epilepsy academic program has been built-up over last two decades. It has unconditionally supported the epilepsy care in this region assisted by local healthcare systems. Along with neurosurgeons Dr. Sun and Dr. Notarianni, the epilepsy surgery program has been certified as level IV center (NAEC), the highest level of epilepsy care nationwide. For pediatric epilepsy patient referral, please ask PCP or primary neurologist to contact at (318) 675-8182. or Fax request to (318) 675-7805. For adult epilepsy patient referral to Oschner, please ask PCP or primary neurologist to contact at (318) 675-4613, or Fax request to (318) 675-6382. For adult epilepsy patient referral to Tri-State Neurosurgery (Dr. Wilden's office, part of Willis-Knighton Physician Network), please ask PCP or primary neurologist to contact at (318) 675-8176, or Fax request to (318) 675-8186. For general question, please contact at (318) 675-2482, the neurology clinic.

The LSU Health Shreveport neurophysiology department operates Monday through Friday from 8:00 AM to 4:30 PM. The department offers routine EEG testing and long-term video monitoring on patients of all ages. Please contact Alena Stevens, R.EEG.T. at (318) 626-1833 or Fax request to (318) 626-3485.

HEADACHE

Dr. Debra Elliott Davis is board certified in Neurology and Headache Medicine. She manages chronic migraine and other primary headache disorders in an outpatient setting with inpatient treatment available when necessary. Patients also have the option of using our new Outpatient Infusion Center for IV therapies. Pharmacologic and non-pharmacologic state of the art therapeutic protocols are used in treating migraine, cluster headache and chronic daily headache, with emphasis on a non-opioid approach. Trigger point and Botox injections are utilized as well. Patients are encouraged to make lifestyle changes in order to achieve realistic goals and maximize activity and productivity for an improved quality of life.

MULTIPLE SCLEROSIS

Multiple sclerosis (or MS) is a chronic, often disabling disease that attacks the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. Symptoms may be mild, such as numbness in the limbs, or severe, such as paralysis or loss of vision. Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS).  The CNS is made up of the brain, spinal cord and optic nerves.  The progress, severity, and specific symptoms of MS are unpredictable and vary from one person to another. Today, new treatments and advances in research are giving new hope to people affected by the disease. 

Although there is still no cure for MS, effective strategies are available to modify the disease course, treat exacerbations (also called attacks, relapses, or flare-ups), manage symptoms, improve function and safety, and provide emotional support. In combination, these treatments enhance the quality of life for people living with MS.  Treatments for MS involve disease modifying therapies in the forms of oral medications, injectable medications and infusions. 
For more information please visit the National Multiple Sclerosis Society website at www.nationalmssociety.org

Types of Multiple Sclerosis (MS):

Relapsing-Remitting Multiple Sclerosis: People with this type of MS experience clearly defined attacks of worsening neurologic function. These attacks—which are called relapses, flare-ups, or exacerbations —are followed by partial or complete recovery periods (remissions), during which no disease progression occurs. Approximately 85% of people are initially diagnosed with relapsing-remitting MS.

Secondary Progressive Multiple Sclerosis: Following an initial period of relapsing-remitting MS, many people develop a secondary-progressive disease course in which the disease worsens more steadily, with or without occasional flare-ups, minor recoveries (remissions), or plateaus. Before the disease-modifying medications became available, approximately 50% of people with relapsing-remitting MS developed this form of the disease within 10 years. Long-term data are not yet available to determine if treatment significantly delays this transition.

Primary Progressive Multiple Sclerosis: This disease course is characterized by slowly worsening neurologic function from the beginning—with no distinct relapses or remissions. The rate of progression may vary over time, with occasional plateaus and temporary minor improvements. Approximately 10% of people are diagnosed with primary-progressive MS.

Progressive Relapsing Multiple Sclerosis: In this relatively rare course of MS (5%), people experience steadily worsening disease from the beginning, but with clear attacks of worsening neurologic function along the way. They may or may not experience some recovery following these relapses, but the disease continues to progress without remissions.

NEUROMUSCULAR DISEASE

The resident's exposure to neuromuscular disease and diseases of the peripheral nervous system will be, in part, through the local Muscular Dystrophy Association Clinic. This clinic currently meets weekly. Eight to twelve established and new patients are evaluated each week. Enrollment of patients includes not only those with muscular dystrophy but also patients with a variety of other conditions including other hereditary muscle diseases (congenital and mitochondrial myopathies), acquired neuromuscular problems (i.e. inflammatory myopathies), diseases of the neuromuscular junction, diseases of the motor neuron (ALS, spinal muscular atrophy), hereditary neuropathies and a number of other hereditary conditions (spinocerebellar ataxias). The resident will learn skills in performing the neuromuscular examination, in diagnosing and managing neuromuscular conditions, in genetic counseling of hereditary disorders and in utilizing allied health specialties (physical, occupational, speech/language therapy).

The resident will also receive instruction in the neuropathology of neuromuscular disease including indications for and interpretation of muscle and nerve biopsy.

The in-patient service and consultation service will also provide further experience in diagnosis and management of more acute neuromuscular diseases such as myasthenia/myasthenic crisis, Guillain-Barre syndrome, traumatic nerve and plexus injury, acute weakness in the critical care unit. The outpatient clinic service will provide exposure to a similar variety of subacute and chronic neuromuscular and peripheral nerve conditions.

Neurological Medical Ethics
Over the course of his/her training, the resident can expect to receive further instruction in neurological aspects of medical ethics. A case-based curriculum will likely be the format for this instruction. A few topics that will be considered include truth-telling, ethics of genetic testing and problems regarding persistent vegetative state, brain death and transplantation. There will be opportunities to participate in and interact with the hospital ethics committee, if desired.
 

OUR MISSION

To assist in motivating individuals with Parkinson's disease, to maximize strengths, minimize impediments, and to achieve and maintain full potential.

ABOUT PARKINSON'S DISEASE

Parkinson's disease is a common, progressive disorder in which loss of nerve cells in certain areas of the brain result in characteristic symptoms. The classic triad includes tremor (primarily with limb at rest), rigidity (stiffness), and bradykinesia (slowness). Difficulty with balance, stooped posture, and small steps can make walking difficult. Slurred speech and a soft voice are also symptoms of Parkinson's. However, every affected person is different. For example, some individuals have tremor but few additional symptoms. Others have no tremor.

Most people are well, not sick, with Parkinson's. The symptoms are treatable. The commonly used medications for this disorder can improve symptoms in many patients for a number of years. It is important that the individual with Parkinson's and those involved with their care know the proper indications and side effects of the medications. Exercise programs, physical, occupational, and speech therapy are also beneficial.

OBJECTIVES

1. Provide information and resources to individuals with Parkinson's disease, their families, caregivers, medical professionals involved in their treatment, and other interested people.
2. Provide educational and technical/administrative support to the local and regional PD support groups and facilitate the establishment of the satellite support groups in outlying communities.
3. Enhance public education and awareness of the disease and its problems.
4. Support Parkinson's disease basic science research (Eichler and Special Awards).
5. Advocacy for national funding of Parkinson's research.
    

STROKE

The Neurology residents who train within our Program will have the opportunity to see a large number of patients with various forms of stroke during their three year residency. Many of the stroke patients are admitted onto the Neurology Service and most of the rest are seen in consultation. There are a number of didactic presentations on the diagnostic evaluation and management of acute, subacute and chronic stroke. This includes a series of lectures on optimizing stroke prevention. There is outstanding neuroimaging available, when clinically appropriate, and this includes ready access to CT brain scan (with the availability of perfusion CT) for acute stroke, MRI including magnetic resonance spectroscopy as well as perfusion and diffusion-weighted imaging, along with formal instruction in the Department's Noninvasive Lab which includes color duplex scanning along with transcranial Doppler. The transcranial Doppler component is responsible for the reading of the transcranial Doppler studies of all patients with aneurysmal subarachnoid hemorrhage and Sickle Cell Disease at our medical center and from referring medical centers. It is expected that the Neurology residents will be quite comfortable with acute and chronic management of stroke by the time they complete their training. This is augmented by the neurorehabilitation rotation during the PGY-4 year. The Department of Neurology has an active Stroke Service which is involved in a number of stroke preventive and interventional studies. Residents are encouraged to participate in clinical trials in stroke as sub-investigators.

General:

• Medical Library Subject Portal
• Citrix
• Outlook Web Access
• LSUHSC-Shreveport SSL VPN Portal
• CED / Quarterly Safety Training (login is 7 digit employee ID and password is 8 digit birthday)
• MyEvaluations
• ECFMG
• LSBME
• Shreveport Medical Society
• Center for Brain Health

Associations:

• American Academy of Neurology
• American Headache Society (Professionals) | American Headache Society (Patients)
• American Stroke Association
• Child Neurology Society
• National Multiple Sclerosis Society
• Neurocritical Care Society
• American Parkinson Disease Association (APDA) 
• Parkinson's Disease Foundation (PDF) 
• National Parkinson Foundation (NPF) 
• National Family Caregivers Association (NFCA) 
• Parkinson's Action Network (PAN) 
• Young Onset Parkinson's Association 
• Michael J. Fox Foundation