course— as well as quality of care. Dr. Kondziolka’s group has instituted the world’s first prospective radiosurgery patient database. The new initiative includes a sophisticated tracking and analysis tool that captures data from every patient visit, including patient and referral demographics, disease features, radiosurgery treatment data, and follow-up. Says Dr. Kondziolka, “Our focus is on the evidencebased quality of care that’s driving today’s treatments. That’s how we become better.” 450+ Gamma Knife® procedures 1 of the 3 largest practices in the country and the largest in the New York City area Expanding use of radiosurgery to treat Parkinson’s disease, other movement disorders, and OCD NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 PAGE 17 CLINICAL CARE Building a Hub for Education, Research, and the Care of Concussion CONCUSSION CENTER In 2013, to address the lack of comprehensive treatment options in the New York area for concussions suffered by young athletes and others, NYU Langone took an important step, establishing a multidisciplinary Concussion Center. The center brings together NYU Langone’s neurology expertise—including adult and pediatric neurologists, neuropsychologists, neuroradiologists, and neuro-ophthalmologists—with neuro-rehabilitation and sports medicine specialists and other clinicians from across the Medical Center. “It’s a truly distinct program at the leading edge of concussion management and research,” says Steven L. Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of the Department of Neurology. To streamline access to all specialties and provide a single entry-point, the center maintains a phone number staffed by trained nurses who carefully review each caller’s symptoms and then promptly schedule an appointment with the appropriate specialist. The center also has a dedicated program manager—Mara F. Sproul, RN, MPA, CRRN, RN-BC, a highly experienced and seasoned registered nurse—who coordinates and oversees the patient journey across all specialties. Since concussion damage frequently doesn’t show up on MRI and CT scans, diagnoses are based on neuropsychological and neuro-ophthalmologic testing. In addition to avoiding high-risk activities, treatment may include cognitive remediation or occupational or vestibular rehabilitation, as well as medical management of symptoms such as post-concussion headache, sleep disorders, and psychiatric disturbances. Another primary focus of the center involves educating the community, including coaches, athletic trainers, and health professionals, about concussion symptoms, as well as the importance of immediately removing individuals with potential concussion from the field of play and seeking treatment for them. Recent events hosted by the center include a concussion workshop for lacrosse coaches and parents and an annual, daylong CME course for medical professionals on Concussion in Sports. The course covers current knowledge on the epidemiology and pathophysiology of concussion, advances in neuro-cognitive, neuroimaging, and neuro-ophthalmologic diagnostics, and the latest thinking on concussion rehabilitation, management, and safe return to play. The center has also initiated a concussion patient registry, and is conducting ongoing research aimed at refining sideline concussion diagnosis through screening tests such as the King-Devick Test® for eye movement, the Standardized Assessment of Concussion (SAC) cognition and memory scale, and the Balance Error Scoring System. “A composite (concussion) test and sequential testing are likely to be the screening paradigm of the future,” notes Dr. Galetta. To track brain healing and identify which concussion victims are at highest risk for ongoing problems, NYU Langone’s neurologic researchers are concurrently pursuing the development of concussion biomarkers through advanced technologies such as optical coherence tomography and brain imaging. 2014 Highlights — • Presented preliminary clinical research on the use of visual screens in the sideline diagnosis of concussion • Hosted first annual CME course on Concussion in Sports PAGE 18 NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 “Vision is involved in about half of the brain’s pathways,” says Laura J. Balcer, MD, vice chair of the Department of Neurology and professor of ophthalmology and neurology, “which means that we can learn a huge amount about the brain and the nervous system by studying how our eyes move, see, and process what they’re looking at.” Neuro-ophthalmology is among the fastest-growing fields of neurology for this very reason. And with three neurologically trained faculty members—Dr. Balcer; Steven L. Galetta, MD, the Philip K. Moskowitz, MD Professor and Chair of the Department of Neurology; and Janet C. Rucker, MD, the Bernard A. and Charlotte Marden Associate Professor of Neurology, who leads the Neuro-Ophthalmology Program as well as its fellowship training program—plus a fourth faculty member, Floyd A. Warren, MD, professor of neurology and ophthalmology, who brings an ophthalmologic background to the practice, the Medical Center’s Neuro-Ophthalmology Program is one of the largest and most experienced in the nation. A prime