research faculty members are also studying the underlying mechanisms that cause TS. The largest Level Four epilepsy center in the nation — Treats 6,700+ patients and performs 60 to 80 surgical procedures annually PAGE 22 NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 NYU Langone’s surgeons have an essential partner in the OR with them: the Medical Center’s Neurophysiology Division, which closely monitors the neurological status of patients during any operations that carry risk of neurologic complication. The approach is generally employed for neurosurgical spine, brain tumor, and cerebrovascular procedures, as well as selected operations done by orthopaedic surgeons, otolaryngologists, and other surgical specialties. During such procedures, PhD-level technicians continuously measure the function of descending and ascending nerve pathways, while supervising neurologists oversee the data stream in real time. If any nerve signals weaken, this is reported immediately to the attending surgeon, who then adjusts the surgical approach to avoid harming the affected nerves. “For example, we’ll typically monitor procedures to repair congenital hip problems that involve elongating the leg,” says Aleksandar Beric, MD, director of neurophysiology at NYU Langone’s Hospital for Joint Diseases, “since this carries risk of nerve damage and possible foot drop.” The most recent innovation involves a proposed clinical research project that will quantify the neuromuscular blockade during spine surgery, to ensure the blockade is completely reversed following the procedure. The division’s outstanding staff and cutting-edge protocols are a key factor in NYU Langone’s number 1 national ranking by University HealthSystem Consortium (UHC®) for quality and safety in craniotomy procedures. Its other focus involves assisting fellow neurologists in the clinical diagnosis of neuropathies, back pain, and neuromuscular conditions such as myasthenia gravis and Guillain-Barre syndrome, through the use of nerve conduction testing, electromyography (EMG), and evoked potential measurements. “We have the full spectrum of the latest diagnostic technology available 24 hours a day, including single-fiber EMGs,” says Dr. Beric. “Two hours with a patient is usually sufficient time to diagnose any condition, even in its earliest stages.” Monitoring Neurosurgical Procedures, Evaluating Nerve Function NEUROPHYSIOLOGY Much of the diagnosis, treatment, and research that takes place across NYU Langone’s Departments of Neurology and Neurosurgery would not be possible without the Medical Center’s large team of neuropsychologists. Using the latest modalities, they can precisely evaluate a patient’s cognitive status to inform the diagnosis for many neurologic conditions, and can also provide targeted cognitive therapy where appropriate. Neuropsychology services are integrated seamlessly as part of numerous NYU Langone programs, including: Testing before and after epilepsy or brain tumor surgery, to map localized function in areas around the surgical test site and to assess effects on cognitive function postsurgically Assessment of cognitive and behavioral disorders related to epilepsy and neurodegenerative diseases such as MS and Parkinson’s disease Evaluation of cognitive function as part of diagnostic workups for memory disorders such as AD and other age-related dementia, and for traumatic brain injury or concussion Assessment of language, learning, and attention deficits in children Measurement of cognitive status in response to standard or experimental treatments for cognitive-related neurological conditions Cognitive remediation therapy for patients whose cognitive abilities have been impacted by neurologic disease or brain trauma In cases where either a neurologic disease or its treatment affects mood or behavior—a common occurrence in epilepsy and neurodegenerative conditions such as MS, Parkinson’s, and Alzheimer’s—the Medical Center’s Neuropsychiatry Division may also be called to make an evaluation and provide psychopharmacologic treatment where appropriate. Measuring and Treating Cognition and Mood NEUROPSYCHOLOGY/NEUROPSYCHIATRY Accredited neurophysiology lab staffed by more than a dozen electromyographers NYU LANGONE MEDICAL CENTER / NEUROLOGY AND NEUROSURGERY / 2014 PAGE 23 CLINICAL CARE There are currently 12 FDA-approved drugs for reducing activity and disease progression in MS—more than double the number that existed just a decade ago—and more are in the pipeline. As a major clinical trial site for medicines in the advanced stages of testing, the MS Comprehensive Care Center is at the forefront of this progress. What sets its clinicians apart, however, is their expertise at optimizing the benefits of the drugs already available, including, in several instances, recalibrating how they’re administered. Natalizumab (Tysabri®) is considered the most effective medication at stopping MS relapses, but it has traditionally been reserved for the most severe cases, due to a potentially fatal side effect—progressive multifocal leukoencephalopathy (PML)—which may affect as many as 1 in 100 Tysabri® users with multiple risk factors. By analyzing the drug’s pharmacokinetics, NYU Langone researchers concluded it could be equally