LEXINGTON Neurologists have much hope to offer patients with chronic neurological conditions by using new and aggressive therapies that significantly improve quality of life, according to Gregory Anderson, MD, and Nicole Everman, MD, neurologists with KentuckyOne Health Neurology Associates. They want healthcare providers to know that the days of the “conservative” neurologist with little to offer these patients are over. While these chronic neurological conditions cannot be cured, new treatments can enable patients to lead productive lives.
Leadership, Passion, and Complexity
Anderson graduated from Mayo Medical School and completed his neurology residency and a fellowship in neurophysiology there. He has spent 30 years in central Kentucky with Associates in Neurology (AIN), which joined the KentuckyOne Health network to become KentuckyOne Health Neurology Associates.
In addition to his general neurology practice, Anderson serves as medical director for the independent AIN clinical research division. Anderson, a certified principal investigator, describes his passion for research, saying, “Clinical research keeps us on the cutting-edge of the newest treatment options for our patients.”
His most recent personal goal is physician leadership. “About four years ago, I recognized the need for physician involvement in the transformation of healthcare currently occurring in the United States,” Anderson says. He is on the board of directors for the KentuckyOne Health medical group and serves as physician market leader for the eastern half of Kentucky. “Clinicians need to drive quality of care and patient satisfaction and be involved in making wise decisions about managing healthcare populations,” notes Anderson.
Everman, a Kentucky native who completed medical school and residency at the University of Kentucky, joined Kentucky One Health Neurology Associates full time in 2015 to help meet the needs of this busy neurology practice. Everman enjoys the challenges of complex neurology cases, describing her role as being part “detective and investigator.”
Offering New Hope to MS Patients
“Tremendous advances have been made in the treatment of multiple sclerosis (MS) over the past five years. The number of medications has risen from four to 12,” notes Everman. MS is an auto-immune disorder that causes demyelization of the nerve fiber sheaths and is characterized by relapse and remission. Symptoms include optic neuritis, new onset weakness, imbalance, and double vision.
Anderson notes the importance of early referral and diagnosis, stating, “The goal is to identify and treat early and switch to another medication when a drug begins to fail.” He describes the recent FDA approval of Lemtrada, a monoclonal antibody, as a “game changer” in the treatment of MS. He adds that Associates in Neurology research center was involved in the clinical trials of this drug for 12 years before approval and was the second highest enrolling site in the US.
KentuckyOne Neurology Associates is the only certified multidisciplinary MS center in Kentucky and treats the “whole” patient by using a wellness approach to complement drug therapy. Diet, exercise, cognitive rehab, physical, speech and occupational therapy, and a nurse navigator, Nancy Heckler RN, support patients throughout treatment. KentuckyOne Health, in association with the YMCA, provides access to yoga, tai chi, water therapy, and special equipment for MS and other neurology patients. Anderson envisions this healthcare model being used more globally for treating chronic neurologic diseases.
Migraines and Parkinson’s Disease
According to Everman, many migraine sufferers are reaping the benefits of successful treatment for this debilitating condition that affects over 45 million people. Migraines occur three times more frequently in the female population due to hormonal effects. Symptoms include pounding, pulsating, often one-sided headaches that don’t respond to conventional headache medications. Migraines can be chronic or episodic and often have environmental triggers. Treatments include anti-epileptics, beta blockers, calcium channel blockers, tricyclic anti-depressants, and Botox® therapy. Everman notes that Botox therapy, delivered by multiple small injections around the head every three months, has been very successful in treating chronic migraines.
Parkinson’s disease, characterized by resting tremors, gait changes, and stiffness on one side of the body, occurs in 1/200 people over age 60, more predominately in males. Everman notes that treatment is aimed at replacing dopamine, as more than 50 percent of dopamine stores are gone in these patients. Medications include carbidopa levodopa and dopamine antagonists but tend to wear off quickly. She states that more research is needed to find ways to get and keep dopamine in the brain. Deep brain stimulation is also a treatment option for this neuro-degenerative disease that has a higher prevalence in farmers, dry cleaners, and artists due to chemical exposure.
The “Win-Win” of Clinical Trials
Anderson describes his role in Associates in Neurology clinical research center by using a sports analogy. He is the “player-coach” of a team of support staff at the research center. “We do a lot of clinical trials for new drugs, and it’s a win-win for our patients and practice,” states Anderson. “Patients get additional care and attention; many of the costs are covered by the sponsoring drug company; patients get long term follow-up for safety and efficacy of treatment; and they have access to the newest treatments.”
Anderson and Everman expect the neurology field to grow due to the aging population. Challenges will include a projected shortage of neurologists and expense/insurance coverage for new treatments. These two physicians are committed to getting their Kentucky patients the best therapies on the market as quickly as possible and to improving the quality of life for their patients with chronic neurological disorders.
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