Swedish Neuroscience Institute A force for clinical excellence, innovative research and quality medical education

2016 ANNUAL REPORT The Swedish Neuroscience Institute

In calendar year 2015, patients from 43 out of 50 states and the District of Columbia turned to the Swedish Neuroscience Institute (SNI) for medical care. Additionally, patients came to SNI from many places outside the United States, including countries such as Canada, England, Germany, Scotland, Spain and Sweden. In the first half of 2016, patients from an additional three states made SNI their source for care, reinforcing that SNI has become a national — and international — destination for neurological and neurosurgical care. To support increasing demand, especially from throughout Washington and the Greater Puget Sound Area, SNI offers care in multiple locations and further expands access through its TeleHealth programs.

WASHINGTON MAINE MONTANA NORTH DAKOTA MINNESOTA VERMONT

OREGON NEW HAMPSHIRE WISCONSIN NEW MASSACHUSETTS IDAHO SOUTH DAKOTA YORK MICHIGAN RHODE ISLAND WYOMING CONNECTICUT

IOWA PENNSYLVANIA NEBRASKA NEW JERSEY NEVADA OHIO INDIANA DELAWARE ILLINOIS UTAH MARYLAND COLORADO WEST WASHINGTON, D.C. VIRGINIA VIRGINIA CALIFORNIA KANSAS MISSOURI KENTUCKY NORTH CAROLINA TENNESSEE OKLAHOMA SOUTH ARIZONA NEW MEXICO ARKANSAS CAROLINA

GEORGIA ALABAMA

TEXAS MISSISSIPPI FLORIDA LOUISIANA

ALASKA

HAWAII NUMBER OF SNI PATIENTS

1-49 patients* 50-99 patients 100-499 patients 500+ patients

*In 2015, patients from British Columbia and Ontario, Canada, as well as England, Germany, Scotland, Spain, Sweden and many other countries came to the Swedish Neuroscience Institute for care. the Pacific Northwest that do not have local neuroscience resources. Currently SNI offers TeleNeurology, TeleMovement Disorders and TeleStroke programs in multiple locations. SNI also sends specialists to communities in Alaska, including a neurosurgery fellowship rotation at the Alaska Native Medical Center in Anchorage, a Level II trauma center. The neurosurgery fellows and attending physicians provide coverage for the medical center 24 hours a day throughout the year. Employing Expertise The number of specialists on staff at SNI is another measure of its growth during Johnny B. Delashaw, M.D., chairman of Neurosurgery; and Todd J. Czartoski, M.D., chairman of Neurology the last several years. For example, and executive medical director of TeleHealth. since 2013 the number of SNI-employed neurologists has grown from 27 to 64, an increase of 137 percent. The medical The Swedish Neuroscience Institute staff includes a team of five neuroin- tensivists, with plans to add several Being a force in the field of neuroscience is not only an inspirational goal for more. State-of-the-art facilities, a robust the Swedish Neuroscience Institute (SNI), it is the foundational approach education program and forward-thinking to how we deliver care, create research opportunities and educate current clinical research attract medical staff and future neuroscience specialists. It is what guides our medical and to SNI. The fundamental focus on quality administrative staff every day. outcomes through extraordinary patient-centered care keeps them here. What began in 2004 at Swedish Cherry Hill in Seattle, Wash., as a vision to greatly improve access to comprehensive neurology and neurosurgery Setting the Benchmark services in the Pacific Northwest, quickly gained momentum. Today SNI is Whether evaluating new technologies, a world-class organization and a respected resource for clinical excellence, such as the Hybrid Assistive Limb (HAL®) a center for innovative research and a chosen destination for exceptional device, expanding the use of focused subspecialty and continuing medical education. ultrasound or building new operating- room capability, SNI is determined to be at the forefront of facility, technology and therapy innovations. It is about creating Expanding Access date state-of-the-art technology and to an environment that allows personalized provide highly sophisticated procedures care to flourish, clinical research to During the last 12 years, SNI has greatly at Swedish’s Cherry Hill or Issaquah expanded its reach. The SNI network of thrive and optimal outcomes to become campuses, other services are more easily the standard by which other programs community partners in the Greater Puget distributed throughout the network. Sound Area allows neurologists and assess themselves. At the Swedish Offering patients this kind convenience is Neuroscience Institute, being a force neurosurgeons to offer patients care one of the hallmarks of SNI’s patient- closer to where they live. As a result, in clinical excellence, innovative research centered care and it is instrumental in and quality medical education is an many patients who are scheduled for the 33 percent growth in the number of procedures at SNI in Seattle are able aspiration, a tradition and a catalyst for patients SNI cared for between January the future. to locally receive their pre-procedure 2014 and December 2015. evaluations and post-procedure follow- up care. As Swedish’s affiliation with SNI’s network of care also extends to percent growth in Providence Health Services continues to more remote areas within Washington, patient volume from mature, SNI’s population-based approach as well as locations outside the state. January 2014 through SNI’s telemedicine network continues to 33 to the delivery of care continues to grow. December 2015 While it is most appropriate to consoli- expand to serve communities throughout

www.swedish.org/SNI 1 Todd J. Czartoski, M.D., chairman of Neurology and executive medical director of TeleHealth; Genevieve Smith, ARNP; and Steven Deem, M.D., medical director of Neurocritical Care.

percent growth in Neurology neurology medical 137 staff since 2013 During the last two years, the Neurology program at the Swedish Neuroscience Institute (SNI) has grown significantly to meet the needs of the community. The neurology medical staff has seen 137 percent growth, from 27 SNI-employed neurologists in 2013 to the current 64. SNI added new community partners, such as Puget Sound Neurology in Edmonds and Providence Regional Medical Center in Everett, and distributed services to two additional Swedish locations — Redmond and Ballard. This growth has made Swedish neurology services accessible to many more patients, and has also allowed for the expansion of the breadth and scope of available care. Approaching neurology services from a population-based perspective, SNI channels its growth to address both an aging population and the significant overall population growth in the Greater Puget Sound Area. Neuromuscular medicine, including a new ALS Clinic, neuro-endocrinology and neuro- ophthalmology have all been part of this focus on community needs. Research is an integral part the Neurology program at SNI. Many neurologists at SNI participate in both investigator-initiated and sponsored drug and device trials, as well as basic science studies that may lead to earlier diagnosis and treatment of neurological diseases.

2 Swedish Neuroscience Institute Neuromuscular team members Michael A. Elliott, M.D.; Eric P. Gierke, M.D.; and Ali Aamer Habib, M.D. Kevin C. J. Yuen, M.D., MBChB, FRCP.

Neuromuscular Medicine nutrition, speech therapy, and occupa- Neuro-Endocrinology tional and respiratory therapy, as well During the last year, SNI initiated a new as a social worker and a representative of Neuro-endocrinology is an important focus in neuromuscular medicine to the local chapter of the ALS Association. and integral subspecialty within SNI. address the unmet needs of patients Consultation with a genetic counselor Working closely with neurology, with disorders of the peripheral nervous is also available for patients and their neuro-oncology and neurosurgery, system, such as peripheral neuropathy, families with familial ALS. Following neuro-endocrinologists add another myasthenia gravis, ALS, carpel tunnel the appointment, the team meets to layer of expertise to the comprehensive syndrome and other neuromuscular discuss the evaluation and a summary evaluation of disorders of the nervous diseases. With SNI’s dedicated expertise, letter outlining the plan of care is sent system. This new partnership recognizes access has improved and patients in the to the patient. The clinic’s mission is the importance of the interaction between Pacific Northwest are getting the care to preserve quality of life, improve the pituitary, hypothalamus and the they need in a timely manner. function and preserve the ability to enjoy brain on hormonal regulation that may independent living as long as possible. affect many aspects of human metab- olism (e.g., weight regulation, diabetes ALS is a complex disease. It is critical The ALS Clinic at Swedish under mellitus, osteoporosis), quality of life to conduct research to find a cure, to and cardiovascular risk. For example, Dr. Elliott’s leadership is as identify ways to diagnose and treat ALS, a patient with non-specific headache comprehensive as a clinic can be. and to develop devices that give patients symptoms, or memory, focus or sleep We invest three hours every three the freedom they need. Currently, SNI’s issues may first see a neurologist, but a months and everything that impacts ALS experts are working with Microsoft’s referral to a neuro-endocrinologist could my life as a person living with Enable Team to develop an eye-gaze- identify an incidental pituitary tumor as driven wheelchair — a unique opportunity ALS is addressed. — Patient Neil C. the underlying cause. due to the proximity of Microsoft and SNI. Other studies that are under way include a biomarker study to assist with Dr. Yuen has given my life back. I Three neurologists and two physiatrists diagnosis, a therapeutic drug study are the foundation for a new ALS Clinic designed to test efficacy on disease was completely debilitated by at SNI. However, in a three-hour initial progression, and a bioregistry to be acromegaly and he has brought appointment at the clinic patients receive used for future anatomic and basic me to a place where I can function a comprehensive, multidisciplinary science research. and live a full life. His care has evaluation by a team that also includes been life-changing. — Patient Judy specialists from nursing, palliative care,

Continued on next page.

www.swedish.org/SNI 3 Another example of patients with Neuro-Ophthalmology in Bellevue, Wash., further expands incidentally discovered pituitary tumors access to care and offers patients the Building on a long-standing relationship, are those with traumatic head injury and added convenience of receiving care the largest neuro-ophthalmology practice subarachnoid hemorrhage who have closer to their homes or places of work. in the region was fully integrated into SNI first been referred to a neurologist. in 2015 with four fellowship-trained The neuro-ophthalmologists are also These patients require a neuro-endocri- neuro-ophthalmologists moving into involved in clinical research. Most notably, nology referral for further evaluation to new clinical space on the Swedish the neuro-ophthalmology team has been develop future treatment plans that may Cherry Hill campus. Through a shared a long-term participant in the Idiopathic include surveillance and conservative electronic health record (Epic), the neuro- Intracranial Hypertension Treatment Trial long-term monitoring, or the possibility of ophthalmologists are able to effectively (IIHTT), sponsored by the National Eye pituitary surgery and/or cranial irradiation. coordinate care with other neuroscience Institute of the National Institutes of Neuro-endocrinologists are also actively specialists throughout SNI. Health. The IIHTT is the largest prospec- involved in clinical research. Presently tive study of IIH, testing whether diet/ The clinic’s location, next to the Balance they are conducting several large studies weight loss work as well as combining Center and in the same building as the in collaboration with both national and diet/weight loss with acetazolamide. The Swedish Multiple Sclerosis Center, international pituitary centers, and are study, which was completed in 2015, makes it extremely convenient for also planning and submitting for approval proved what neuro-ophthalmologists patients with balance or movement several additional investigator-initiated believed — using acetazolamide in disorders or MS to be evaluated and studies. conjunction with diet and weight loss is receive care for related eye conditions. safe and effective. Looking forward, the The neuro-ophthalmologists have neuro-ophthalmology team is working provided an MS Eye Clinic for many on additional studies, including an years. The clinic is dedicated to common international trial of a novel experimental visual symptoms associated with MS, therapy using intravitreal injections to such as double or unsteady vision, and treat acute monocular blindness from visual symptoms due to optic nerve or non-arteritic anterior ischemic optic- brain visual pathway disease. A satellite neuropathy (NA-AION). neuro-ophthalmology clinic located

Eugene F. May, M.D.; and Steven R. Hamilton, M.D.

4 Swedish Neuroscience Institute evaluated, and to work collaboratively with primary-care providers to help reduce the risk of falls in their patients. The one-stop/one-day process was designed to be quantitative and evidence based. It brings together otolaryngologists, audiologists, vestibular technicians and physical therapists to evaluate the patient for inner ear inflammation or vertigo, which may affect the patient’s balance and ability to walk. As part of the SNI, the centers medical staff can easily arrange additional consultations and services as needed. Opening the Balance Center has led to opportunities for related research studies, including a study of diagnostic specificity and sensitivity of various vestibular evoked myogenic potentials Judith A. White, M.D., Ph.D. (ocular and cervical), which is part of the center’s diagnostic assessment. As the center continues to grow and evolve, the medical staff will explore additional Balance Center research opportunities. The Balance Center at the Swedish Neuroscience Institute (SNI) is a recent According to the CDC, more than 2.5 addition to the programs and services offered patients throughout the Pacific million older adults seek emergency Northwest. Under the leadership of Judith White, M.D., Ph.D., who came to medical care each year for a fall and Swedish after establishing balance centers first at Lahey Hospital & Medical more than 700,000 are hospitalized Center in Burlington, Mass., and then at Cleveland Clinic in Ohio, SNI opened because of a fall injury (typically to the head or hip). While still in its infancy, the its balance center to address a growing concern — especially for individuals Balance Center at SNI is implementing 65 years and older. best practices that will allow it to take its place on the leading edge of reducing injuries and deaths due to falls. Statistics from the Centers for Disease hospitalizations in 2010 and the third Control and Prevention (CDC) that show leading cause of injury-related deaths a marked increase in the death rate from in the state. Older adults accounted for unintentional falls in adults 65 years and two thirds of those hospitalizations and older (from less than 42,000 in 2004 to 83 percent of the deaths. Therefore, fall nearly 58,000 in 2013) give substance to prevention has become both a national the CDC’s designation of fall prevention and a statewide priority. as one of its priorities. According to the Falls are the leading cause of fractures, Washington Department of Health, falls trauma hospitalization and death due to were the leading cause of injury-related injury. The CDC estimates that one out of three older adults will fall each year, My dizziness was a frightening but fewer than half of those individuals experience. Dr. White was incredibly will tell a doctor due to embarrassment or the fear of losing their independence. responsive and when it was done SNI and Dr. White established the — no more dizziness. I was Hannah Hansen, vestibular technician. comprehensive, multidisciplinary center extremely pleased with Dr. White to provide a safe, non-threatening place and the Swedish Balance Center. for older adults, especially those who — Patient Peggy have had one or more prior falls, to be

www.swedish.org/SNI 5 James D. Bowen, M.D. Pavle Repovic, M.D., Ph.D.

Multiple Sclerosis The National Multiple Sclerosis Society estimates that 400,000 people in the United States and 2.3 million people worldwide are living with MS. With the U.S. prevalence rate twice as high in northern states than in southern states, and the Pacific Northwest having one of the highest rates of MS, it is quite logical that the Swedish Neuroscience Institute (SNI) would have a robust MS program.

Physical, Emotional and The center has a dedicated MS reha- bilitation physician — one of only seven Community Wellness in the country. Due to increased patient The Swedish MS Center is much more volumes, the center added a staff than just a center to diagnose and treat member who provides hand treatments MS patients. It is the single most and equipment evaluations, and also comprehensive program in the country fills the role of MS adventure guide. This and is recognized as a national leader position is truly unique. The sole respon- in its approach. The foundation of SNI’s sibility of the guide is to get patients MS program is effectively blending with MS back into life’s activities. MS compassionate clinical care with predominantly affects young adults who services that support the physical and are in their prime, active years. Helping emotional challenges of living with MS. patients reintroduce activities into their The center — and a staff that is never lives is both physically and mentally satisfied with the status quo — has important to their continued progress. been setting the benchmark for other A “Sip, Eat and Relax” tour of a Seattle MS programs since it first opened. neighborhood, indoor rock climbing,

6 Swedish Neuroscience Institute Dr. Bowen with a patient on the outdoor therapy terrace, where patients practice walking on ramps, steps and a variety of surfaces, such as concrete sidewalks, artificial turf and gravel.

Barbara J. Severson, ARNP, MSN.

The center offers a broad range of optica, BOTOX® for treating spasticity, a I love the doctors and the support services, including five support groups, combination of fingolimod and glatiramer I get from having everything in one two Pilates and two yoga classes, music acetate for patients with relapsing- therapy, a reading group and a gym that remitting MS, and siponimod (BAF312) center — wellness, advocacy and patients can use for free. Most recently, for patients with secondary progressive medical care. It’s wonderful to have the center added weekly “Get Your Music MS. Researchers are also investigating a place where there is a feeling of Back” lessons for guitar, keyboard and whether autologous stem cell transplan- community and a shared purpose. drums, and a book club. Most notably, tation in combination with high-dose I feel like we have a ‘voice’ here the center hosts an annual art show as immunosuppressive therapy may be and I know that I get the best care a way of raising public awareness of effective in treating patients with poor possible. – Anonymous Patient MS and to showcase the artwork of prognosis MS. individuals in the Pacific Northwest who MS touches every part of a patient’s life. have been touched by this disease. The MS Center is setting the standard adaptive cycling, river rafting and art There are currently 14 drugs that the for programs around the world by projects help patients overcome both the U.S. Food & Drug Administration (FDA) effectively combining evidence- and physical and mental challenges of living has approved as disease modifying research-based medical care with well- with MS while socializing with others. therapies for MS, with one more ness, fitness, education and support to expected to achieve FDA approval in address the whole person and his or her The facility and the approach to patient 2016. Physicians at the MS Center have specific needs. This holistic approach to care are what make the center unique. been involved with approximately two- MS is making a difference for patients In 2015, there were nearly 8,100 thirds of the studies for drugs that are and their families. diagnostic, treatment and/or support currently on the market and are partic- visits at the center — a 66 percent ipating in more than two dozen clinical increase over 2013. Another 1,088 percent increase in research studies on new drugs that MS-related visits were provided at other patient visits, at the MS hold promise for future treatment. For clinics throughout Swedish in 2015. In 66 Center 2013 to 2015 example, MS specialists are studying 2016, the MS Center is on track to have eculizumab for relapsing neuromyelitis close to 9,000 visits.

www.swedish.org/SNI 7 Marcio A. Sotero de Menezes, M.D.; and Michael J. Doherty, M.D.

Epilepsy and Neurophysiology Epilepsy care at the Swedish Neuroscience Institute (SNI) is a true testament to continuity of care. Patients who begin their epilepsy care as children at SNI are able to seamlessly transition into adult care. Demand for services has led to the hiring of several additional pediatric and adult epiletologists, specialized nurse practitioners and additional neurophysiology staff, the acquisition of new technology and the expansion of SNI’s inpatient adult and pediatric monitoring capability. In 2014 and 2015, the pediatric epilepsy specialists at SNI focused additional resources on becoming a regional resource for two forms of genetic epilepsy, tuberous sclerosis and Dravet syndrome. Tuberous sclerosis is a multi-organ medical condition that requires close collaboration among multiple specialties, including nephrology, neurology, transplantation, ophthalmology, neurosurgery and adult epilepsy, all of which are available at Swedish. Dravet syndrome, one of the results of an SCN1A mutation, is a rare form of intractable epilepsy that is severely debilitating and places young children at increased risk of sudden death.

8 Swedish Neuroscience Institute While the majority of patients with epilepsy can be successfully treated with medication, nearly one-third require surgery. Swedish continues to be the primary referral site and only center in the Pacific Northwest actively implanting the RNS® System by NeuroPace, a device that monitors and treats epilepsy in adults ages 18 and older. Additionally, SNI added laser interstitial thermal therapy (LIT) as a minimally-invasive ablative approach to treating epilepsy and StereoEEG as a companion to LIT to diagnose where seizures are originating in patients with focal epilepsy. For a great majority of medically refractory epilepsy patients, these procedures are curative. The Clinical Neurophysiology (CNP) Lab, which experienced record growth in 2015, is one of only a handful of labs in the western United States to be Jehuda P. Sepkuty, M.D. accredited by the American Board of Registration of Electroencepholographic and Evoked Potential Technologists. In addition to beginning the Dravet percent volume The lab provides advanced electrodiag- syndrome clinic, the pediatric epilepsy nostic services for the Epilepsy Center, increase in intraoper- specialists also began two new drug ative monitoring from including eight adult and six pediatric 23 studies that may hold some promise epilepsy monitoring beds and long- 2014 to 2015 for these young patients. One study is term monitoring in the neonatal and testing synthetic CBD, which doesn’t pediatric intensive care units, as well percent volume cause psychosis, to control seizures in as intraoperative monitoring to protect increase in long-term children with Dravet syndrome. The central and peripheral nervous systems epilepsy monitoring other study is testing the safety and during surgery. 18 efficacy of fenfluramine, a seizure- from 2014 to 2015 controlling agent that has a unique mechanism of action mediated by the serotonin receptors. It has been shown to be effective in open label studies in Belgium for more than five years. The National Association of Epilepsy Centers has accredited the Swedish Epilepsy Center as a level IV program, acknowledging the center’s national reputation for medical and surgical treatment of seizure disorders. It is the designated referral center for complex epilepsy surgeries for NAEC level III affiliates at Providence Portland and Providence Spokane.

www.swedish.org/SNI 9 Ryder P. Gwinn, M.D., and medical assistant Puja Sharma.

Movement Disorders A synergy exists at the Swedish Neuroscience Institute (SNI) that benefits patients with chronic neurological conditions, such as those with various movement disorders. Medical therapies, minimally invasive procedures, surgical interventions and new non-incisal technologies give specialists the options they need to tailor treatment plans to patients’ specific needs. This type of coordinated approach to the diagnosis and treatment of patients is particularly important in a subspecialty like movement disorders that has seen volumes triple in less than three years.

In recent years several new symptomatic treatment of Parkinson’s for decades. At medication therapies have entered the same time, the FDA also approved clinical care for patients with Parkinson’s Duopa™, a gel formulation of carbidopa/ disease. For example, in early 2015 the levodopa. Duopa is continuously infused U.S. Food and Drug Administration (FDA) directly into the small intestine. Both approved RYTARY™, an extended-release of these new therapies are aimed at capsule form of carbidopa/levodopa, reducing disabling motor fluctuations which has been the mainstay medical that occur as Parkinson’s disease

10 Swedish Neuroscience Institute Ryder P. Gwinn, M.D., in front of the MRgFUS equipment, which the U.S. Food and Drug Administration Medical assistant Kimberly Fuqua and recently approved for the treatment of essential tremor. Swedish was the first in the Pacific Northwest to Rosalind Chuang, M.D. offer this ground-breaking treatment to patients with essential tremor.

progresses. In early 2016, the FDA ET affects more than 10 million people Focused ultrasound is a marriage of approved pimavanserin (Nuplazid™) for in the United States, and millions technologies. With the patient’s head psychosis associated with Parkinson’s worldwide. Focused ultrasound is an immobilized in a frame and water circu- Disease. It has a mechanism that is outpatient treatment option that offers lating through a cap to keep the brain unique from other available antipsychotic patients immediate improvement follow- cool, the neurosurgeon uses an MRI medications that are poorly tolerated by ing the procedure. Treatment requires a scanner intraoperatively to focus up to a most patients with Parkinson’s disease. single session with no anesthesia, which thousand ultrasound waves of energy to It now gives patients a safer treatment allows patients to quickly return to their ablate tissue deep inside the brain. The option for a symptom that has significant normal daily activities. imaging provides the necessary preci- impact on quality of life. sion to treat the targeted tissue while This new technology allows for the avoiding other important structures. Be- New technology in SNI’s operating suites, precise targeting of tissue to be treated. cause focused ultrasound is performed including intraoperative, high-resolution The U.S. Food and Drug Administration as an outpatient procedure, patients are CT scanning capability, has made deep (FDA) first approved focused ultrasound able to quickly return to normal activity. brain stimulation (DBS) a safer and more as a treatment for neuropathic pain and Alternative treatments are available for efficient process. Intraoperative imaging obsessive-compulsive disorder (OCD). patients who are not eligible for focused verifies probe placement as a possible In 2015, the technology was used at ultrasound. Swedish is the only hospital alternative to keeping the patient awake SNI as part of an early-stage clinical trial in the country that offers four therapies for testing. This may allow more patients examining the efficacy of using it to treat for ET: medication management, deep to have surgery performed while they patients with metastatic brain cancer, brain stimulation (DBS), GammaKnife® are asleep, while still achieving the best and also in clinical trials to treat patients and focused ultrasound. possible outcome. with essential tremor (ET) and Parkinson’s disease. Since then, the FDA has Focused ultrasound was also used in a Among the most promising advancements approved focused ultrasound as a clinical trial at SNI to treat patients with is SNI’s status as the first hospital in the treatment for patients with ET, and Parkinson’s. With additional research, Pacific Northwest to offer FDA-approved SNI was the first hospital in the Pacific focused ultrasound could be one of focused ultrasound treatment for medi- Northwest to offer this innovative the treatment options for various brain cation-refractory essential tremor (ET). new treatment. disorders.

www.swedish.org/SNI 11 W. Tom Kushner, D.O., and medical assistant Jeffrey Limos.

Stroke and TeleStroke Stroke Follow-Up Care According to the National Stroke At the end of 2014, Swedish Cherry Hill received the American Heart Association’s Association, recurrent strokes account Stroke Gold-Plus Quality Achievement Award and was named to the association’s for about one quarter of the nearly Target: Stroke Honor Roll, recognizing the exceptional stroke care provided 800,000 strokes in the United States at the Swedish Neuroscience Institute (SNI). One year later, in November 2015, each year. The increased risk of another DNV-GL Healthcare, a national accrediting organization for acute care and critical stroke is particularly high during the year immediately following the original stroke. access hospitals, awarded SNI’s Cherry Hill stroke program its Comprehensive To address this risk, patients who receive Stroke Center Certification. The certification integrates requirements related to acute care for stroke at Swedish, as well the Centers for Medicare and Medicaid (CMS) Conditions of Participation for as referred patients from other hospitals, Hospitals, with the Guidelines of the Brain Attack Coalition and recommendations are scheduled for follow-up appointments of the American Heart Association and the American Stroke Association. at the Swedish Stroke Clinic. Working in partnership with the patient’s primary- This type of recognition underscores the success SNI has had in developing care provider, follow-up care focuses a stroke program that provides the highest quality of stroke care not only to on secondary stroke prevention through patients in the Seattle area, but also to communities throughout Western medication management and recom- Washington through onsite services and its TeleStroke Program. mendations for lifestyle changes. Some patients transition easily to a healthy life- The Washington Department of Health has designated Swedish Cherry Hill a style and receive most of their follow-up Level I Comprehensive Stroke Centers. Swedish Edmonds, Swedish First Hill care from their primary-care providers. and Swedish Issaquah are designated Level II centers, which acknowledges Patients with more complex medical their stroke-trained staff, clinical and administrative infrastructure and support issues and multiple co-morbidities, such as those recovering from arterial dis- programs for stroke patients. Swedish Ballard is a Level III stroke center, section, or diagnosed with moyamoya treating and evaluating acute stroke patients and admitting them to a Level I or fibromuscular dysplasia, may have or II hospital when necessary. long-term relationships with the Stroke Clinic. The goal, however, is to transition all stroke patients to long-term follow up in the primary-care setting.

12 Swedish Neuroscience Institute The Swedish Acute TeleStroke Network

Swedish Cherry Hill Providence Everett Hospital Island Hospital (Anacortes) (Everett) Jefferson Healthcare Skagit Valley Hospital (Port Townsend) (Mount Vernon) Kadlec Regional Medical Swedish Ballard Center (Richland) Swedish Edmonds Lake Chelan Community Swedish First Hill Hospital (Chelan) Swedish Issaquah Olympic Medical Center (Port Angeles) Swedish Mill Creek Swedish Redmond Walla Walla General Hospital (Walla Walla) Whidbey General Hospital (Coupeville)

One of SNI’s TeleStroke teams, including Todd J. Czartoski, M.D., chairman of Neurology and executive medical director of TeleHealth; and inpatient neurologists Thomas A. Deuel, M.D.; and Holly E. Hensley, M.D.

Door-to-Needle Time Results from multiple research studies emergency departments — one at published in 2015 supported the ap- Swedish Ballard and one in Issaquah — The stroke team continues to actively proach Swedish has been taking with has now grown to include all Swedish pursue new strategies that will further patients presenting at Cherry Hill with emergency departments, inpatient reduce its already low door-to-needle time acute ischemic stroke. For several years, units at Swedish Issaquah, Providence (DTN) — the time it takes to administer the team has administered alteplase, a Medical Center Everett and seven tissue plasminogen activator (tPA), a clot-busting medication, and also per- community hospital TeleStroke partners. potent clot buster, to stroke patients formed intra-arterial therapy using a stent SNI’s team of neurologists receives more upon arrival in the emergency depart- retrieval device to remove the clot. These ment. Since 2011, Swedish times have than 500 calls per month from various therapies are time sensitive. The use providers across the state of Washington. regularly been lower than the standards of alteplase for acute stroke has been set by The Joint Commission and the Providers have access to a neurologist endorsed by the American Heart Asso- 24 hours a day, seven days a week goals of the American Heart Association’s ciation up to four and one-half hours out Target: Stroke. For example, in 2015 the through the services provided by SNI. from the onset of stroke, while the use of These calls are not limited to stroke. The mean DTN time for the stroke team at intra-arterial therapy has been endorsed Swedish Cherry Hill was 39.9 minutes. neurologist can remotely review head up to six hours out from the onset of imaging films, including CT and MRI films, symptoms. Both of these therapies work 2015 Mean Door-To-Needle Time at any Swedish or TeleStroke partner site. by re-establishing blood flow in an artery He or she can also provide emergent in the brain that has a clot in it. Once video consultations with Swedish and blood flow is restored, the improvement partner sites, if needed, for patients in some patients can be dramatic. presenting with hyperacute stroke

symptoms who may be candidates for 2015 Mean Door-To-Needle39.9 Time minutes TeleStroke rescue therapies, such as a clot-busting medication and/or intra-arterial therapy. In 2007, SNI made a commitment to use technology to help Washington communities reduce door-to-needle times. What began with two Swedish

www.swedish.org/SNI 13 Jordan Steed, PA-C; Ryder P. Gwinn, M.D.; and Daniel Cavalcante, M.D.

Brain Tumors The Swedish Neuroscience Institute (SNI) and the Swedish Cancer Institute (SCI) have a close collaborative relationship when it comes to diagnosing and treating patients with benign or malignant brain tumors. Neurosurgery, with or without chemotherapy and radiation, remains the gold standard for treating accessible brain tumors. Many surgical procedures are done endoscopically with a much smaller incision than a traditional craniotomy, promoting a faster recovery. For tumors that are not easily accessible, SNI is fortunate to have available two stereotactic radiosurgery platforms, CyberKnife® and GammaKnife®, which allows neurosurgeons to select the best possible radiosurgery treatment for each individual patient.

14 Swedish Neuroscience Institute medical staff that includes neurosurgeons, neuro-oncologists, neuroradiation oncologists, neuropathologists, neurora- diologists, neuro-oncology nurses and a social worker is of immeasurable value to patients. Of equal importance is the on-site comprehensive brain-tumor research laboratory that allows neuropathologists to rapidly perform genetic analysis of brain tumors and provide critical information that helps The Ivy Center’s medical staff develop personalized treatment plans that will produce the best possible outcomes. The Ivy Center’s medical staff includes Charles Cobbs, M.D., the Gregory Foltz, M.D., endowed director of The Ben & Catherine Ivy Center for Advanced Brain Tumor Treatment, Tara Benkers, M.D., ID Coming medical director of neuro-oncology, and Charles S. Cobbs, M.D., Tara L. Benkers, M.D.; and Jerome J. Graber, M.D. Jerome Graber, M.D., a neuro-oncologist who recently came to SNI from Montefiore Medical Center in New York. Neurosurgeons at SNI have state-of- an advanced MRI-based neuroimaging There are many innovative research the-art operating suites with advanced technique to visualize the brain’s white projects under way at The Ivy Center, imaging, such as BrainLab Aero-i CT, matter tracts. The resulting 3D model is including several for patients with newly and computer-guided navigation called a “diffusion tensor” and provides diagnosed and recurrent glioblastoma equipment to provide the safest and a color-coded map that displays how multiforme (GBM), one of the most highest quality surgical procedures. the brain’s neurons are wired. Neuro- aggressive and deadliest forms of brain Additionally, a neurophysiologist is surgeons use this intraoperative tool as cancer. Since 2013, Dr. Benkers has available during any requested brain a direct roadmap when removing brain brought on nearly a dozen clinical or skull base surgery to provide intra- tumors and navigating around crucial trial therapies to expand access to operative neuromonitoring, which helps nerve fibers. Damage to these fibers can experimental therapies for patients in ensure surgeons are able to avoid neural lead to neurologic deficits, including pain, the Pacific Northwest who have been elements that control key functions. loss of sensation and even paralysis. diagnosed with GBM. Access to DTI can significantly improve surgical Most recently, SNI added diffusion tensor therapies that are not yet publicly accuracy during a brain tumor resection imaging (DTI) to its OR technology. DTI is available, including immunotherapies, and enables providers to customize their vaccine therapies, targeted therapies, surgical approach to minimize damage gene-based biologics and novel to healthy brain tissue. modified chemotherapeutics, is one of the benefits of receiving care at a The Ben & Catherine Ivy nationally recognized research institute. Center for Advanced Brain The Susan J. McGregor Viral Glioblastoma Tumor Treatment Immunotherapy Program is one of many examples at Swedish of philanthropy Since its opening in 2009, The Ben & advancing research. The program is Catherine Ivy Center for Advanced Brain based on research Dr. Cobbs began Tumor Treatment has taken its place more than 15 years ago. Working with among the premier brain tumor centers in the country. Having a collaborative Continued on next page. An image captured by DTI.

www.swedish.org/SNI 15 François Cloutier, M.D.; and Douglas D. Backous, M.D. Research associates Hwahyung Lee and Liping Chen, and Charles S. Cobbs, M.D.

Institute for Systems Biology (ISB) in them in the lab and using robotics to anonymized patient clinical information Seattle and Fred Hutchinson Cancer subject them to thousands of existing as a catalyst for innovative research Research Center, researchers are compounds can help determine which that will lead not only to a better under- leveraging new technologies to extract drugs or combination of drugs is most standing of GBM, but also to novel new proteins from tumors and to build a effective without subjecting the patient therapies that improve clinical outcomes tumor profile that would help identify to multiple courses of chemotherapy. and survival. proteins that all of the tumors share. The Ivy Glioblastoma Atlas Project (Ivy Another exciting research project is The goal is to produce a potent immu- GAP), which was conceived in 2006 evaluating the safety of the ExAblate notherapy vaccine that would target and launched in 2009 as a partnership Transcranial system for brain tumors. those specific proteins, thus killing the between The Ivy Center, Seattle’s Allen The system uses MRgFUS technology, proteins and the tumor. Institute for Brain Science and The Ben which combines MRI to visualize body In 2015, The Ivy Center began a high- & Catherine Ivy Foundation, is a major anatomy and monitor treatment in real thru-put cancer stem cell project — the research initiative focusing on mapping time with high-intensity focused ultra- first of its kind in the world to use a the gene activity in brain tumors. The sound to thermally ablate tissue inside patient’s own cancer stem cells to drive Ivy GAP is a foundational resource for the skull. therapy decisions. The project’s theory exploring the anatomic and genetic This noninvasive procedure is performed is based on the knowledge that cancer basis of glioblastoma at the cellular through the patient’s intact skull. stem cells are a subset of tumor cells and molecular levels. The intent of this and that GBM recurs if the cancer stem collaborative effort is to give researchers cells are not killed by chemotherapy or universal access to a massive amount radiation. Removing these cells, growing of tumor genomic information and

16 Swedish Neuroscience Institute Oded Goren, M.D.; and Stephen J. Monteith, M.D.

Cerebrovascular Cerebrovascular medicine is a rapidly changing neuroscience subspecialty. The acquisition of innovative new technologies and a commitment to education keeps the cerebrovascular team at the Swedish Neuroscience Institute (SNI) at the leading edge of clinical excellence. Cameron McDougall, M.D., medical director of cerebrovascular surgery for Western Washington and a nationally recognized neuro-interventional surgeon and educator, joined SNI in early 2016. McDougall and the center’s team of cerebrovascular surgeons, which includes Johnny Delashaw, M.D.; Yince Loh, M.D.; Stephen Monteith, M.D.; and Akshal Patel, M.D., along with their colleagues at Providence Regional Medical Center Everett, are a regional resource for complex open and endovascular neurological procedures, such as carotid endarterectomy, surgery to repair intracranial aneurysms and microvascular decompression for cranial neuropathies. The Cerebrovascular Center is one of the largest enrollment centers for many multicenter, national clinical trials, and is a respected center for continuing education and fellowship training opportunities. Continued on next page.

www.swedish.org/SNI 17 Stephen J. Monteith, M.D.

Whereas clipping has decreased in use, options gives additional flexibility in during a clipping procedure for an inserting platinum coils into intracranial determining the best option for each aneurysm, intraoperative angiography aneurysms has continued to increase patient. Which procedure is used that is performed while the patient is in frequency. During the last few years, depends on the location and size of still draped and under anesthesia can CV specialists at SNI have added a the aneurysm, whether it has ruptured show whether the aneurysm has been third procedure to their list of treatment and various patient considerations, successfully removed. This real-time options for patients with aneurysms — such as choice and suitability for a visibility allows the procedure to continue the Pipeline™ flow-diverting stent. The craniotomy versus an endovascular without interruption and avoids having flow diverter, which directs flow away procedure. The goal for the entire CV to bring the patient back into the OR from the aneurysm and back to the team, many of whom are dual trained and a second round of anesthesia. normal vessel lumen, becomes part of in open and endovascular techniques, With advanced technology and expertise, the circulatory system. In essence, it is to identify the most effective, but SNI is a compelling location for exceptional reinforces the blood vessel wall and lowest-risk treatment for each patient. professional education and fellowship slows blood flow in and out of the Intraoperative angiography capability in training. The one- and two-year fellow- aneurysm leading to its thrombosis. SNI’s hybrid operating suite is technology ships in cerebrovascular microsurgery The aneurysm eventually atrophies and that enhances patient safety during and/or neuro-endovascular treatment disappears because it is no longer being complex procedures. For example, provide comprehensive subspecialty fed by blood. Having three treatment training for neurosurgeons. Currently,

18 Swedish Neuroscience Institute Cameron G. McDougall, M.D. Akshal S. Patel, M.D.

three full-time fellows are gaining valuable experience in the diagnosis and management of a wide range of cerebrovascular disorders, including cerebral aneurysms, arteriovenous malformations (AVMs), vascular neoplasm and Moyamoya disease. Training includes open cerebrovascular surgery, diagnos- tic angiography and endovascular procedures, such as embolization, stenting, microvascular decompression and coiling. The Seattle Science Foundation (SSF), which is adjacent to SNI at Swedish Cherry Hill, provides a state-of-the-art bioskills and tele- education center to further enhance fellowship training. The SSF venue also supports SNI’s cerebrovascular continuing medical education courses, such as its Cranial Ultrasound Course and the annual Cerebrovascular Symposium and Merrill P. Spencer, M.D., Endowed Lectureship. The Spenser Lecture honors Johnny B. Delashaw, M.D., chairman of Neurosurgery. a physician, professor, researcher and stroke prevention pioneer who gained an international reputation for his groundbreaking work with Doppler ultrasound technology.

www.swedish.org/SNI 19 Rod J. Oskouian, M.D.; Akshal S. Patel, M.D.; and Jens R. Chapman, M.D.

Technology is a key factor in providing Spine high-quality spine care. Ultra-high-end intraoperative imaging and high mag- The pursuit of innovation, clinical excellence, meaningful research and quality nification visualization supports precise education is the foundation of the spine program at the Swedish Neuroscience implant localization. SNI surgeons are Institute (SNI). As a result of the affiliation between Swedish and Providence leaders in using the lateral surgical Health & Services and an aging U.S. population, there has been an approach, a minimally disruptive unprecedented increase in complex spine cases, including patients with procedure that employs sophisticated benign and metastatic tumors, spinal deformity, spinal cord injuries, infections nerve-monitoring technology to help and revision fusion surgeries. avoid the risk of vascular and/or neural injury when treating spinal deformities. Additionally, in collaboration with the Swedish Cancer Institute, access to To meet that demand, SNI’s spine both GammaKnife® and CyberKnife® percent increase in surgeons have made a commitment to stereotactic radiosurgery platforms gives SNI spine visits from provide emergent spine care around the surgeons treatment options for spine January 2014 to 35 clock. With state-of-the-art dedicated tumor care that limit radiation exposure December 2015 neuro operating suites, highly skilled and promote full recovery. surgeons and an exceptional nursing Very few hospitals have the expertise staff work side-by-side to ensure patients and available range of implant options, receive the safest, most compassionate both those approved by the U.S. Food care with a common goal — to alleviate and Drug Administration and those pain and restore independent function. currently under study. Grafts, artificial

20 Swedish Neuroscience Institute give fellows experience in all areas of spine care, including trauma, tumors, infection and degenerative conditions. Research is an integral part of the spine program at SNI. In addition to several retrospective studies of procedural outcomes to advance understanding and focus on improving safety and outcomes, the spine team participates in procedural and device studies, as well as studies involving surgical approaches and equipment that may help prevent permanent spinal cord damage and/or improve function where there is perma- nent damage. For example, the RISCIS multicenter study is evaluating the effect of riluzole on outcomes in patients with acute traumatic spinal cord injury. The team is also participating in a pilot study using Cyberdyne’s Hybrid Assistive Limb® (HAL®) with patients who have lost function in their lower extremities due to Swedish physical therapist Ziadee Cambiar with a patient using the HAL® motion-support exoskeleton. spinal cord injury. The study will assess how much using an exoskeleton can improve function. (See page 24 for more discs, fixation and stabilization devices, grand rounds series. These educational information about the HAL clinical trial.) and other motion preserving technologies opportunities have highly respected are mainstays of the treatment arsenal speakers from throughout the world. (See the Swedish Surgical Spine for SNI’s spine surgeons. Sessions are also available to physicians Program supplemental publication for worldwide via the highly sophisticated additional information about clinical, SNI was an early adopter of multimodal telecommunication facility at the Seattle educational and research spine pain management in an effort to combat Science Foundation and an online video programs at Swedish.) the potentially deleterious side effects archive. Annual specialized courses of opioids. This approach to managing include advanced approaches to spine pain following spine surgery is critical surgery, trauma management and spine to having patients participate in their tumor treatment, as well as the very recovery. Local pain management, popular ONE Spine Master’s Course including anesthetic strips, IV-pain med- and ONE Spine Residents and Fellows ication, ultra-long-duration anesthetic, Course. The ONE Spine courses bring pain medications and ice blankets create together orthopedic surgeons and a menu of options that keep the patient neurosurgeons to advance the art and comfortable, responsive and available science of modern spinal care. to participate in the recovery process, while also reducing the risk of blood The Complex and Minimally Invasive clots and lung and wound infections. Spine Fellowship, which began with just one fellow, now hosts five neurosurgery- Fellowship training and regional and and orthopedic-trained surgeons for a national professional programs are at year of intensive training in evaluating the heart of the surgical spine education and treating a broad spectrum of adult program. Complex spine cases and spinal disorders. As a high-volume, continuing medical education courses tertiary spine care center that focuses on are presented through spine case blending neurosurgical and orthopedic David A. Hanscom, M.D. conferences and the neuroscience spine services, SNI is well positioned to

www.swedish.org/SNI 21 The center’s audiology specialists focus on improving access for patients who need hearing loss evaluations, including basic audiologic testing, neurophysio- logic testing and vestibular testing, and providing assessments for hearing aids, assistive-listening and osseointegrated devices and cochlear implants. They are also centralizing pediatric services, such as diagnostic auditory and vestibular assessments, amplification, cochlear implantation and aural rehabilitation, and standardizing protocols and processes from the clinic to the operating room. Coordinating care among multiple providers, with attention to care quality and safety, is a major initiative that is currently under way. Clinicians at the center have a deep understanding of the challenges facing patients as they choose to pursue their ability to communicate with spoken Zachary N. Litvack, M.D. language. The goal is to provide an excellent experience for patients and their families — making that journey Neurotology and Skull Base Surgery seamless and streamlined. The center’s research program supports its goals by The Center for Hearing and Skull Base Surgery provides a comprehensive and focusing on optimizing hearing outcomes collaborative approach to hearing disorders and skull base surgery. Combining with implantable devices. the most advanced diagnostic and surgical techniques with leading-edge Plans are under way to provide cochlear technologies allows the center’s team to deliver the highest level of care for implant evaluations and programming those who live with hearing loss, deafness and chronic ear problems, and for at Swedish Issaquah. The intent is to patients with tumors and disorders of the skull base. provide the same excellent services that are now available at Swedish Cherry As recently as 2010, there were no employed neurotology or audiology Hill, but to make receiving that care specialists at Swedish. Today, the center’s neurotology/audiology staff includes more convenient for patients living east two board-certified neurotologists, Douglas D. Backous, M.D., and Sean O. of Seattle. McMenomey, M.D.; two physician assistants; and four audiologists, including the new director of the Hearing Implant Program, Alyson Mellish, AuD, CCC-A. The skull base surgical team comprises four neurosurgeons.

Neurotology and disorders, otosclerosis, chronic otitis media, acoustic neuromas, neurofi- Audiology Services bromatosis type-2 and inherited ear The center’s neurotology team diagnoses malformations. and treats patients of all ages, including In addition to his clinical responsibilities, newborns, from throughout the Pacific Dr. McMenomey is also a weekly host Northwest. Neurotology specialists of the popular Doctor Radio channel on at the center provide cochlear, auditory Sirius XM, taking questions from callers brainstem, middle ear and bone across North America who want advice integrating implantation, as well as about hearing loss and diseases related diagnosing and treating facial nerve Alyson Mellish, AuD, CCC-A; and Elizabeth to otolaryngology. Elkins, AuD, CCC-A.

22 Swedish Neuroscience Institute Sean O. McMenomey, M.D.

Johnny B. Delashaw, M.D.; and Douglas D. Backous, M.D. Japanese physicians attending JapanLab at the Seattle Science Foundation.

Additionally, the center’s audiology team Skull Base Surgery clinicians, audiologists and patients. The has built a truly collaborative relationship center hosts an annual ear and sinus with the otolaryngologist at SNI’s new A team of four physicians manages course (SOAR) and a bi-annual on-site Balance Center, working together to the high-volume demand for skull base JapanLab for 40 Japanese surgeons. help reduce the risk of falling for patients surgery at SNI. They diagnose and The week-long JapanLab is also trans- with balance issues related to inner-ear treat benign and malignant skull base mitted live and with no time delay to disorders. tumors using the latest techniques and about 15 locations in Japan. This annual technologies, including microsurgery hands-on learning, which benefits from As the Center for Hearing and Skull and stereotactic radiosurgery, to remove SSF’s exceptional Bio-Skills Lab and Base Surgery grows, and demand and the tumor while preserving the greatest technology capabilities, has gained complexity of cases increases, the team possible neurological function. While the in popularity over the years. Today, has focused on improving access for majority of skull base patients require Japanese surgeons are eager to attend all patients, and ensuring quality patient surgical treatment for tumors, the team JapanLab and to be part of the faculty. experiences and referring clinician is also skilled at surgically repairing communications. This is particularly spinal fluid leaks and fractures of the SNI’s one-year Skull Base Surgery important as the care-delivery model skull base, and treats cerebral aneurysms and Neurotology fellowships provides now includes satellite hearing implant and deep-seated infections of the skull fully trained neurosurgeons hands-on partnerships in Washington’s Tri-Cities base bone. training from some of the most knowl- region (Richland, Kennewick and Pasco), edgeable multi-disciplinary specialists in and in Anchorage and Fairbanks, the country. The fellowships include the Alaska. While neurotology and cochlear Education diagnosis, treatment and management implant surgery on patients from these Through a unique partnership with the of patients with skull base tumors or areas is still performed in Seattle, pre- Seattle Science Foundation (SSF), the neurotology disorders using the latest operative evaluations and post-operative providers at the Center for Hearing & techniques and technologies. follow-up care is provided by teams of Skull Base Surgery continue their deep audiologists and otolaryngologists in the commitment to offering professional respective regions. education for surgeons, primary-care

www.swedish.org/SNI 23 Other SNI studies hold great promise for future research, such as the phase I hIgM22 study (Acorda). While the primary outcome of this study is safety in repairing the damage from MS, its mechanism of action — promoting remyelination of axons damaged by the inflammatory activity of MS — could signal the potential for neurological repair, which will warrant further research. A particularly exciting new research direction at SNI is a pilot study for neuronally controlled rehabilitation of spinal-cord injury patients, and also some stroke and multiple sclerosis patients. This novel Japanese technology, called HAL® (Hybrid Assistive Limb®), uses an external motorized brace to move the limbs in a coordinated fashion. Research associate Hwahyung Lee and Charles S. Cobbs, M.D. The study will assess how well HAL picks up on nerve signals in the legs to strengthen weakened muscle groups, which could potentially help nerve Research and Innovation reorganization occur in a process called “neuroplasticity.” Cyberdyne designed The Swedish Neuroscience Institute (SNI) is rapidly becoming a recognized this technology with the intent of helping leader in leveraging innovation to advance clinical processes, improve outcomes patients get stronger on their own, with and redefine benchmarks. To do this not only takes clinical excellence, it takes improved function and less spasticity. a commitment to research that seeks new therapies and devices that can fill SNI is also involved in the search for gaps in patient care. Principal investigators at SNI are physicians first and treatments for underserved and/or researchers second. They recognize the needs of their patients and have orphan diseases, such as Dravet and been involved in leading-edge clinical research that has dramatically changed Cushing syndromes, and neuromyelitis the way some diseases are treated. optica. Orphan diseases seldom gain the same kind of notoriety that broader- based diseases, such as breast cancer or HIV, have achieved. This research is Today there are more than 25 physicians for progressive multiple sclerosis (MS). vital to finding new treatments for these at SNI involved in about 100 investigator- SNI physicians have teamed up with the rare diseases, and also to gaining a initiated and sponsored research Allen Institute in Seattle to collect and better understanding and finding better protocols with more than 1,000 research preserve human brain tissue for cortical ways to diagnose them. participants. Many of the studies are neuronal cell type classification. This collaborations with universities and tissue bank will provide valuable insight With a shared commitment to helping research institutes across the country. for research in brain tumors, epilepsy and patients at Swedish — and throughout possibly other neurological conditions. the world — researchers at SNI are For example, through the National Surgeons are participating in several seeking innovative new ways to improve Institutes of Health-funded NeuroNEXT multicenter studies, including a study the prevention, diagnosis and treatment consortium, SNI is conducting trials of of the efficacy and safety of riluzole to of neuroscience diseases. a vasopressin 1a receptor antagonist reverse acute spinal cord injury and a (SRC246) in irritable subjects with prospective study of Reverse Medical’s Huntington’s disease, as well as ibudilast Barrel® vascular reconstruction device.

24 Swedish Neuroscience Institute Swedish Neuroscience Institute Research Studies (As of September 2016)

Brain Tumor Extension: A continuation protocol for patients Pharmacokinetics and pharmacodynamics of different A071101 heat shock protein vaccine, rGBM: A Phase previously enrolled in a study of Toca 511 (Principal dosing regimens of pegvisomant administration and II randomized trial comparing the efficacy of heat Investigator: Cobbs) its effects on of GH/IGF axis-related biomarkers, insu- shock protein-peptide complex-96 (HSPPC-96) (NSC Gene transfer: A Phase 1 ascending dose trial of lin sensitivity, ß-cell function, and postload glucose #725085, Alliance IND #15380) vaccine given with the safety and tolerability of Toca 511 (Principal tolerance in humans (Principal Investigator: Yuen) bevacizumab vs. bevacizumab alone in the treatment Investigator: Cobbs) QoL Acromegaly: Effects of growth hormone receptor of surgically resectable recurrent glioblastoma multi- Glioblastoma: A randomized Phase 2 single-blind antagonism and somatostatin analog administration forme (Principal Investigator: Graber) study of temozolomide plus radiation therapy on quality of life (Principal Investigator: Yuen) A071401 Meningioma: Phase II Trial of SMO/AKT/NF2 combined with nivolumab or placebo in newly REAL-1 growth hormone: A multicenter, multinational, inhibitors in progressive meningiomas with SMO/AKT/ diagnosed adult subjects with MGMT-Methylated randomized, parallel-group, placebo-controlled (dou- NF2 mutations (Principal Investigators: Graber) (tumor O-6-methylguanine DNA methyltransferase) ble blind) and active-controlled (open) trial to compare A221101 Armodafinil for fatigue: A Phase III ran- glioblastoma (Principal Investigator: Benkers) the efficacy and safety of once weekly dosing of domized, double-blind, placebo-controlled study Glioblastoma: A randomized phase 3 open-label NNC0195-0092 with once weekly dosing of placebo of armodafinil (nuvigil) to reduce cancer-related study of nivolumab vs temozolomide each in and daily Norditropin FlexPro in adults with growth fatigue in patients with high grade glioma (Principal combination with radiation therapy in newly hormone deficiency (Principal Investigator: Yuen) Investigator: Graber) diagnosed adult subjects with unmethylated MGMT SOM Roll-over 2412 Signifor: An open-label, A221208 BeST trial, brain mets: Randomized (tumor O-6-methylguanine DNA methyltransferase) multicenter pasireotide roll-over protocol for patients Phase II study: Corticosteroids + bevacizumab vs. glioblastoma (Principal Investigator: Benkers) who have completed a previous Novartis-sponsored corticosteroids + placebo (BeST) for radionecrosis ICT-107: Study of immunotherapy in newly diagnosed pasireotide study and are judged by the investigator after radiosurgery for brain metastases (Principal glioblastoma: A phase III randomized double-blind, to benefit from continued pasireotide treatment Investigator: Graber) controlled study of ICT-107 with maintenance te- (Principal Investigator: Yuen) Act IV: An international, randomized, double-blind, mozolomide (TMA) in newly diagnosed glioblastoma TV-1106 Growth Hormone: A phase 3 multicenter, controlled study of rindopepimut/GM-CSF with adju- following resection and concomitant TMZ chemora- randomized, open-label, comparator-controlled vant temozolomide in patients with newly diagnosed, diotherapy (Principal Investigator: Benkers) study to assess safety and tolerability of weekly surgically resected, EGFRvIII-positive glioblastoma REACT: A Phase II study of rindopepimut/GM-CSF in TV-1106 compared to daily rhGH (Genotropin) in (Principal Investigator: Henson) patients with relapsed EGFRvIII-positive glioblastoma adults with growth hormone deficiency (Principal Investigator: Yuen) A Phase 0/1 Study of Combination Drug Therapy for (Principal Investigator: Benkers) Glioblastoma Based on Personalized Cancer Stem VB-111: A phase 3 randomized controlled double- VITAL study Adult Growth Hormone: An open-label, Cell (CSC) High-Throughput Drug Screening (HTS) arm open-label multi-center study of VB-111 dose-finding, international Phase 2 study with once (Principal Investigator: Cobbs) combined with bevacizumab versus bevacizumab monthly subcutaneous VRS-317 in adult growth hormone deficiency (Principal Investigator: Yuen) Archer TPI 287 17: Phase 1/2 dose-escalation study monotherapy in patients with recurrent glioblastoma of TPI 287 in combination with bevacizumab followed (Principal Investigator: Benkers) Epilepsy by randomized study of the maximum tolerated A multicenter, randomized, double-blind, parallel dose of TPI 287 in combination with bevacizumab Endocrine Acrostudy: A multicenter, post-marketing surveillance group, placebo-controlled trial of two fixed doses of versus bevacizumab alone in adults with recurrent study of pegvisomant therapy in patients with acro- ZX008 (fenfluramine hydrochloride) oral solution as glioblastoma (Principal Investigator: Benkers) megaly (Principal Investigator: Yuen) an adjunctive therapy in children and young adults Archer TPI 287 18: Phase 2 dose-escalation study with Dravet syndrome (Principal Investigator: Sotero) AEZS Growth Hormone Study (Ergomed): Confirmatory of TPI 287 in combination with bevacizumab in adults validation of oral macimorelin as a growth hormone Compassionate Use of Stiripentol in Dravet with recurrent or progressive glioblastoma following (GH) stimulation test (ST) for the diagnosis of adult Syndrome (Principal Investigator: Sotero) bevacizumab alone (Principal Investigator: Benkers) growth hormone deficiency (AGHD) in comparison with Gwinn Allen Brain Tumor Collection: Human brain BMS CA209-143: A randomized Phase IIB open the insulin tolerance test (Principal Investigator: Yuen) tissue collection and preservation for cortical neuronal label study of nivolumab or nivolumab in combina- COR-003 Cushing’s: An open-label study to assess cell type classification (Principal Investigator: Gwinn) tion with ipilimumab versus bevacizumab in adult the safety and efficacy of COR-003 (2S, 4RKeto- Mesial Temporal Lobe Sclerosis: Pathological- subjects with recurrent glioblastoma (Principal conazole) in the treatment of endogenous Cushing’s Radiological Correlation in Patients with Presumed Investigator: Benkers) syndrome (Principal Investigator: Yuen) Mesial Temporal Lobe Sclerosis (Principal BT002: Evaluate the safety of MRI-guided focused Growth Hormone Defficiency (GHD): A phase 3, Investigator: Sotero) ultrasound thermal ablation of brain tumors multicenter study designed to evaluate the efficacy Nicotine Use in Patients with Epilepsy (Principal performed through intact human skull using the and safety of a long acting high product (MOD-4023) Investigator: Doherty) ExAblate transcranial system. (Principal Investigators: in adult subjects with growth hormone deficiency Monteith/Cobbs) PACES Collaborative Study: Prevention Research (Principal Investigator: Yuen) Network’s Managing Epilepsy Well Network PACES Cobbs Allen Brain Tumor Collection: Human brain Growth Hormone Extension: An open-label, long- Replication, Extension and Dissemination (Principal tissue collection and preservation for cortical neuronal term extension study of the safety and efficacy Investigator: Caylor) cell type classification (Principal Investigator: Cobbs) of somavaratan (VRS-317) in adults with growth RNS Long-Term Treatment: Responsive neurostimu- DC-Vax: A Phase II clinical trial evaluating DCVax®- hormone deficiency (Principal Investigator: Yuen) lator system long-term treatment clinical investigation brain, autologous dendritic cells pulsed with tumor Hyperglycemia B2219: A multicenter, randomized, (Principal Investigator: Gwinn) lysate antigen for the treatment of glioblastoma open-label, Phase IV study to investigate the multiforme (Principal Investigator: Cobbs) RNS System Post-Approval Study in Epilepsy management of pasireotide-induced hyperglycemia (Principal Investigator: Gwinn) DCVax Expanded Access: An expanded access with incretin based therapy or insulin in adult protocol for the treatment of glioblastoma multiforme patients with Cushing’s disease or acromegaly Tissue Bank: Tissue procurement and repository in patients with already manufactured DCVax®-L, (Principal Investigator: Yuen) protocol for future cerebrovascular studies autologous dendritic cells pulsed with tumor lysate (Principal Investigator: Gwinn) ISIS-GCCR: ISIS’s investigational product, ISIS-GC- antigen who have screen-failed protocol 020221 CRRx, is a second-generation 2’ methoxyethyl chime- (Principal Investigator: Cobbs) Movement Disorders ric antisense oligonucleotide (ASO) designed to inhibit CD FLEX: An open-label, non-inferiority study EF-14: A prospective, multi-center trial of NovoTTF- glucocorticoid receptor (GCCR) production (Principal evaluating the efficacy and safety of two injection 100A together with temozolomide compared to Investigator: Broyles) schedules of Xeomin® (incobotulinumtoxinA) [short temozolomide alone in patients with newly diagnosed Novartis SOM230B2410 Cushing’s observational: flex vs. long flex] in subjects with cervical dystonia glioblastoma (Principal Investigator: Benkers) Non-interventional study for the generation of long with < 10 weeks of benefit from onabotulinumtoxinA EORTC Protocol: ABT 414 alone or ABT 414 plus term safety and efficacy data of pasireotide s.c. in treatment (Principal Investigator: Witt) temozolomide versus lomustine or temozolomide patients with Cushing’s disease (Post-Authorization for recurrent glioblastoma: a randomized phase II Safety Study) (Principal Investigator: Yuen) study of the EORTC Brain Tumor Group (Principal Investigator: Benkers) www.swedish.org/SNI 25 Genentech OL OCR PPMS: An open-label, multi- center, expanded access program for ocrelizumab in patients with primary progressive MS (Principal Investigator: Bowen) HEORMS Retrospective Study (Principal Investigator: Repovic) Ibudilast: A randomized, double-blind, placebo- controlled study to evaluate the safety, tolerability and activity of ibudilast (MN-166) in subjects with progressive MS (Principal Investigator: Repovic) LAND Life after MS Diagnosis: A biopsychosocial assessment of symptom trajectory (Principal Investigator: Qian) Stephen J. Monteith, M.D., in the control room of the focused ultrasound suite. Lemtrada OBS14379: A prospective observational cohort study in adult patients with relapsing MS to ET-03: A prospective, randomized, double-blinded, acetate 20 mg administered subcutaneously once assess patient safety during and after Lemtrada® sham-stimulation controlled, non-significant risk, daily in patients with relapsing-remitting MS (Principal (alemtuzumab) infusions of the first treatment course pivotal study to assess the safety and effectiveness of Investigator: Qian) (Principal Investigator: Repovic) the Cala ONE device to aid in the symptomatic relief Autologous stem cell transplant – HALT MS: A Phase II MPF mapping: Quantitative imaging of white and gray of hand tremors in adult essential tremor subjects study of high-dose immunosuppressive therapy using matter demyelination in MS using macromolecular (Principal Investigator: Gwinn) carmustine etopside cytarabine and melphalan (BEAM) proton fraction mapping (Principal Investigator: Bowen) Focused Ultrasound for ET: A continued access + thymoglobulin, and autologous CD34 + hematopoi- MS CHORDS: An open-label study to evaluate the study to evaluate the effectiveness and safety etic stem cell transplantation for the treatment of poor effectiveness and safety of ocrelizumab in patients of ExAblate transcranial MRgFUS thalamotomy prognosis MS (Principal Investigator: Bowen) with relapsing remitting multiple sclerosis who have treatment of medication refractory essential tremor BAF 312 AMS04: Mechanistic studies of Phase had a suboptimal response to an adequate course of subjects (Principal Investigator: Gwinn) III trial with BAF312 in secondary progressive MS disease-modifying treatment (Principal Investigator: Focused Ultrasound for ET: Pivotal Study of MRg- (Principal Investigator: Bowen) Repovic) FUS thalamotomy for essential tremor (Principal BAF312-2304 EXPAND: A multicenter, randomized, MS Exacerbations: PT in acute motor MS Investigator: Gwinn) double-blind, parallel-group, placebo-controlled vari- exacerbations (Principal Investigator: Mayadev) NN105 – Huntington’s: An exploratory Phase II study able treatment duration study evaluating the efficacy MS Imaging: Cross-sectional analysis of DTI and to determine tolerability, safety and activity of a novel and safety of siponimod (BAF312) in patients with sec- clinical parameters in MS (Principal Investigator: vasopressin 1a receptor antagonist (SRX246) in ondary progressive MS (Principal Investigator: Bowen) McCullough) irritable subjects with Huntington’s disease (Principal BAF extension: A dose-blind extension study to the MS Transplant: The effect of allogeneic hematopoietic Investigator: Chuang) CBAF312A2201 study to evaluate long-term safety, cell transplantation on the activity and progression of Parkinson’s: An open-label, phase 3 study examining tolerability and efficacy of BAF312 given orally once MS (Principal Investigator: Bowen) the long-term safety, tolerability and efficacy of APL- daily in patients with relapsing MS (Principal Investi- 130277 in levodopa responsive patients with gator: Bowen) NeuroNEXT: Clinical research sites for the Network of Excellence in Neuroscience Clinical Trials (Principal Parkinson’s disease complicated by motor fluctuations Biogen 201 anti-LINGO: A randomized, double- Investigator: Bowen) (“OFF” episodes) (Principal Investigator: Ro) blind, placebo-controlled, parallel-group, dose- PD001: A feasibility study to evaluate safety and initial ranging study to assess the efficacy, safety, tolerabil- OMB PPMS: A randomized, double-blind, double- effectiveness of ExAblate transcranial MR-guided ity and pharmacokinetics of BIIB033 in subjects with dummy, parallel-group study comparing the efficacy focused ultrasound for unilateral thalamotomy in the relapsing forms of MS when used concurrently with and safety of ofatumumab versus teriflunomide in treatment of medication-refractory tremor dominant avonex (Principal Investigator: Qian) patients with relapsing MS (Principal Investigator: Repovic) idiopathic Parkinson’s disease (Principal Investigator: Biogen 303: A dose-blind, multicenter, extension study Gwinn) to determine the long-term safety and efficacy of two OPERA: A randomized, double-blind, double- doses of BG00012 monotherapy in subjects with dummy, parallel-group study to evaluate the Multiple Sclerosis efficacy and safety of ocrelizumab in comparison to ACTH Fatigue study: The effect of ACTH (Acthar relapsing-remitting MS (Principal Investigator: Bowen) interferon beta-1a (Rebif®) in patients with relapsing Gel) on measures of fatigue in patients with relapsing Biogen MITIGATE: A multicenter, double-blind, MS (Principal Investigator: Repovic) MS (Principal Investigator: Bowen) placebo-controlled study of montelukast on gastro- Opexa 2012-00 SPMS: A Phase 2 double-blind, pla- ADPR Subaward (Principal Investigator: Bowen) intestinal tolerability in patients with relapsing forms of MS receiving tecfidera delayed release capsules cebo-controlled multicenter study to evaluate the effi- Alexion NMO 301: A randomized, double-blind, (Principal Investigator: Bowen) cacy and safety of Tovaxin® in subjects with secondary placebo-controlled trial to evaluate the safety and progressive MS (Principal Investigator: Bowen) efficacy of eculizumab in patients with relapsing neuro- CARE-MS extension: An extension protocol for MS Oratorio (Ocrelizumab in PPMS): A Phase III, mul- myelitis optica (Principal Investigator: Repovic) patients who participated in Genzyme-sponsored studies of alemtuzumab. ticenter, randomized, parallel-group, double-blind, Alexion NMO 302 extension: A Phase III, open-label, placebo controlled study to evaluate the efficacy CFTY720D2306E1: Open-label, single-arm extension extension trial of ECU-NMO-301 to evaluate the safety and safety of ocrelizumab in adults with primary study to the double-blind, randomized, multicenter, and efficacy of eculizumab in patients with relapsing progressive MS (Principal Investigator: Bowen) neuromyelitis optica (Principal Investigator: Repovic) placebo-controlled, parallel-group study comparing the efficacy and safety of 0.5 mg FTY720 administered Passage FTY2403: Long-term, prospective, multi- A Phase 3 open-label study to evaluate the long-term orally once daily versus placebo in patients with prima- national, parallel-cohort study monitoring safety in pa- safety and tolerability of ALKS 8700 in adults with ry progressive MS (Principal Investigator: Bowen) tients with MS newly started on fingolimod once daily relapsing remitting MS (Principal Investigator: Bowen) or treated with another approved disease-modifying CIRCLES: Collaborative International Research in therapy (Principal Investigator: Bowen) ARISE: A multicenter, randomized, double-blind Clinical and Longitudinal Experience for Neuromyelitis assessment of tecfidera in extending the time to Optica Studies (Principal Investigator: Repovic) Quantitative imaging MS spine sub study subaward a first attack in radiologically isolated syndrome (Principal Investigator: Bowen) (Principal Investigator: Repovic) CONCERTO: A multinational, multicenter, randomized, double-blind, parallel-group, placebo-controlled study REALIZE: A retrospective, multicenter, observational ASPIRE: An international, multicenter, prospective followed by an active treatment period, to evaluate study to assess the effect of Tecfidera® delayed- observational study to determine patterns of utilization the efficacy, safety and tolerability of two doses of oral release capsules on lymphocyte subsets in subjects of BOTOX for the treatment of spasticity and to assess administration of laquinimod (0.6 mg/day or 1.2 mg/ with relapsing forms of MS the product effectiveness (Principal Investigator: day) in subjects with relapsing-remitting MS (Principal REVEAL: A multicenter, randomized, open-label study Mayadev) Investigator: Qian) to assess the impact of natalizumab versus fingolimod ASSESS – Gilenya & glatiramir acetate: A 12-month, FTY Gilenya Long-term: A single arm, open-label, on central nervous system tissue damage and recov- randomized, rater- and dose-blind study to compare multicenter study evaluating the long-term safety, ery in active relapsing-remitting MS subjects (Principal the efficacy and safety of fingolimod 0.25 mg and tolerability and efficacy of 0.5 mg fingolimod Investigator: Qian) 0.5 mg administered orally once daily with glatiramer (FTY720) administered orally once daily inpatients with MS (Principal Investigator: Bowen)

26 Swedish Neuroscience Institute rHIgM22-MS-1033: A double-blind, placebo-con- Neuroform® Microdelivery Stent system HDE: Stand-Alone Cervical Fusion Cage Systems: trolled, single ascending dose intravenous infusion Boston Scientific Target Neuroform® Microdelivery Long-term results and complications (Principal study of rHIgM22 in subjects with MS immediately Stent System (Principal Investigator: Eskridge) Investigator: Page) following a relapse (Principal Investigator: Bowen) RELIEF: Prospective, multicenter, global registry to Structured Spine Care: Prospective review of Roche VELOCE Vaccine response study: A phase compile characteristics of real-world clinical outcomes Structured Spine Care Program for surgical and IIIb, multicenter, randomized, parallel-group, open- for Boston Scientific commercially approved non-surgical spine patients (Principal Investigator: label study to evaluate the effects of ocrelizumab on neurostimulation systems for pain in routine clinical Hanscom) immune responses in patients with relapsing forms of practice when used according to the applicable Unplanned Reoperation after Intradural Spinal MS (Principal Investigator: Bowen) directions for use (Principal Investigator: Gwinn/David) Tumor Resection (Principal Investigator: Oskouian) STRATIFY-2: JCV antibody program in patients with Transspher: Prospective multicenter cohort study relapsing MS receiving or considering treatment with comparing extent of tumor resection between micro- Stroke tysabri (Principal Investigator: Bowen) scopic transsphenoidal surgery and fully endoscopic BIPI Stroke: Randomized, double-blind, evaluation in secondary stroke prevention comparing the efficacy TOPAZ: A long-term follow-up study for MS patients transsphenoidal surgery for nonfunctioning pituitary adenomas (Principal Investigator: Delashaw) and safety of the oral thrombin inhibitor dabigatran who have completed the alemtuzumab Extension etexilate (110 mg or 150 mg, oral bid) versus ™ Study (CAMMS03409) (Principal Voyager: A feasibility study of the Nativis Voyager acetylsalicylic acid (100 mg oral qd) in patients with Investigator: Bowen) system in patients with recurrent GBM (Principal embolic stroke of undetermined source (RESPECT Vitamin D: A randomized controlled trial of vitamin D Investigator: Cobbs) ESUS) (Principal Investigator: Smith) ™ ™ in MS (Principal Investigator: Qian) Wingspan Stent: Wingspan Stent System with The Flow Redirectional Endoluminal Device Stent Sys- ™ Gateway PTA Balloon Catheter (Principal tem Trial (FRED Trial) (Principal Investigator: McDougall) Neurology Investigator: Eskridge) Eye-gaze wheel chair pilot study. This is a pilot study Imaging Collaterals in Acute Stroke (iCAS) study designed to assess the feasibility and initial safety of Psychiatry to determine if non-contrast arterial spin label MR use of an eye-gaze controlled power wheelchair in RECLAIM — HDE: Bilateral stimulation of the imaging can help characterize collateral Pipeline in subjects with amyotrophic lateral sclerosis (ALS) who anterior limb of the internal capsule, AIC, as an patients presenting with acute large vessel arterial are wheelchair dependent. (Principal Investigator: Elliott) adjunct to medications and as an alternative to an- stroke and whether it can identify which patients Iron Horse ALS Biomarker: A study to evaluate the terior capsulotomy for treatment of chronic, severe who are ineligible for intravenous tissue plasminogen sensitivity, specificity and overall accuracy of an amy- treatment-resistant OCD in adult patients who have activator (iv tPA) therapy or have failed iv tPA therapy otrophic lateral sclerosis diagnostic test developed by failed at least three selective serotonin re-uptake are most likely to benefit from an endovascular clot Iron Horse Diagnostics (Principal Investigator: Elliott) inhibitors (Principal Investigator: Melman) removal procedure; and a direct comparison with current state-of-the-art for clinical perfusion imaging, NN103 – Myasthenia Gravis: Multicenter, random- Spine bolus contrast dynamic susceptibility contrast. ® ® ized, double-blind, placebo-controlled Phase II clinical BoneBac : Spinal fusion with local BoneBac auto- (Principal Investigator: Keogh) trial evaluating the safety and steroid-sparing effect of graft: preliminary clinical results and cost analysis rituximab in MG. (Principal Investigator: Gierke) (Principal Investigator: Page) PRISMS: A Phase IIIB, double-blind, multicenter study to evaluate the efficacy and safety of alteplase in pa- Coflex Spine Device: A 2 and 5 year comparative tients with mild stroke. (Principal Investigator: Stayman) evaluation of clinical outcomes in the treatment of degenerative spinal stenosis with concomitant Retrospective chart review study in Telemedicine — Is it low back pain by decompression with and without a safe and effective method for performing acute medi- additional stabilization using the Coflex Interlaminar cal hospital admissions? (Principal Investigator: Gude) Technology for FDA Real Conditions of Use study SOCRATES: A randomized, double-blind, multinational (Principal Investigator: Oskouian) study to prevent major vascular events with ticagrelor DuraSeal™ Exact Spine Sealant System Post-Approval compared to aspirin (ASA) in patients with acute isch- Study Protocol (Principal Investigator: Oskouian) aemic stroke or TIA (Principal Investigator: Menon) HAL® Exoskeleton: Use of an exoskeleton in STRATIS: Systematic Evaluation of Patients Treated neuromuscular-locomotion-impaired patients in with Neurothrombectomy Devices for Acute Ischemic rehabilitation therapy to improve function and societal Stroke Registry (Principal Investigator: Monteith) contribution (Principal Investigator: Chapman) Translational Brain Tumor I-Spondi: An assessment of outcomes of surgical GBM Biomarkers: Glioblastoma Biomarker Database treatment of isthmic spondylolistheses (Principal (Principal Investigator: Cobbs) Investigator: Chapman) NIH TCGA: The Cancer Genome Atlas (Principal Lateral Spine Interbody Fusion: Long-term results Investigator: Cobbs) Cyberdyne’s Hybrid Assistive Limb® (HAL®), which and complications (Principal Investigator: Page) The Ivy Glioblastoma Atlas Project: A multi-site initia- is being used in a clinical trial at SNI. Neurologically controlled intrinsic neuromuscular tive to create a web-based resource for glioblastoma feedback therapy in the treatment of incomplete research (Principal Investigator: Cobbs) Neuro-ophthalmology spinal cord disease: A pilot study using the HAL® NAION: A phase 2/3, randomized, double-masked, system (Principal Investigator: Chapman) R01 SMC Prime: The role of cidofovir and structural sham-controlled trial of QPI-1007 delivered by single analogs as adjuvant therapy for GBM (Principal or multi-dose intravitreal injection(s) to subjects with Osteocel — Retrospective Chart Review: Osteocel Investigator: Cobbs) bone grafting results in spinal fusions: Long-term acute nonarteritic anterior ischemic optic neuropathy R01 CPMC Transfer Grant: Cytomegalovirus gene (Principal Investigator: Hamilton) review of outcomes and complications (Principal Investigator: Page) expression and strain variability in glioma pathogen- esis (Principal Investigator: Cobbs) Neurosurgery RISCIS: A multicenter, randomized, placebo- Barrel Study — Aneurysm: Prospective, multicenter, controlled, double-blind, trial of efficacy and safety ™ Other single-arm study of the Reverse Medical Barrel vas- of riluzole in acute spinal cord injury (Principal DBS for Dystonia (Principal Investigators: Nora/Gwinn) cular reconstruction device for adjunctive treatment Investigator: Chapman) to embolic coils for wide-neck, intracranial, bifur- DBS for OCD (Principal Investigators: Nora/Gwinn) cating/branching aneurysms of middle cerebral and SNI Frailty Index Study: A prospective evaluation IVAC: A single-blind, randomized, controlled trial to basilar arteries (Principal Investigator: Monteith) of the influence of patient frailty and their eventual determine the effect of intravenous acetaminophen disposition (Principal Investigator: Chapman) Enterprise HDE: Enterprise Vascular Reconstruction administered at induction and emergence from crani- Device and Delivery System (Principal Investigator: Spinal Interbody Fusion Spinal Interbody Fusion: otomy (Principal Investigator: Lam) Monteith) Long-term results and complications (Principal PTSD-ADNI Study: Effects of traumatic brain injury Investigator: Page) LVIS HDE: MicroVention Low-profile Visualized and post-traumatic stress disorder on Alzheimer’s Intraluminal Support (LVIS®) or LVIS Jr. Humanitarian Stand-Alone Cage — Retrospective Chart Review: disease (AD) in veterans using ADNI (DoD-ADNI) Use Device (Principal Investigator: Monteith) Stand-alone cervical fusion cage systems: Long-term (Principal Investigator: Keogh) results and complications (Principal Investigator: Page) NANO Effectiveness and Safety of Small Aneurysm Tissue Bank – PAW (Principal Investigator: Repovic) Coiling Trial (Principal Investigator: Monteith) Stand-Alone Cage versus Conventional ACDF (Principal Investigator: Oskouian) www.swedish.org/SNI 27 Bio-Skills Lab at the Seattle Science Foundation.

Education Highly respected institutes, such as the Swedish Neuroscience Institute (SNI) share a common characteristic — they accept responsibility to advance the practice of medicine through knowledge sharing. This exchange of expertise drives innovation, improves the delivery of care and contributes to achieving exceptional clinical outcomes. SNI offers continuing medication education (CME) courses and neuroscience grand rounds for primary-care physicians and specialists, and also provides advanced training through five fellowship programs.

A close partnership with the Seattle allied health-care training. A 21-station Science Foundation (SSF), a non-profit Bio Skills Lab is outfitted with operating education and research organization room tables and lighting, which makes it located adjacent to SNI, enhances an ideal venue for hands-on workshops these educational opportunities. As a for surgical and endoscopic specialties. clinical education resource for SNI, SSF These sessions can be viewed remotely is unmatched. Its professional staff helps and are recorded for future viewing. SNI develop and administer didactic Demand for in-person attendance courses, hands-on practical labs, is often over-subscribed; however, clinical trial investigator meetings and teleconferencing and distance learning

28 Swedish Neuroscience Institute Thomas Schildhauer, M.D., a guest lecturer from Germany, at an SNI spine conference in the Bio-Skills Ruth Thiex, M.D., PhD, from the Cranial, Spine & Lab at the Seattle Science Foundation. Joint Clinic at Providence Regional Medical Center Everett, attending an SNI spine conference at the Seattle Science Foundation.

capabilities, access to an online video resection techniques and vagal nerve Advanced Brain Tumor Treatment. The archive, and SSF’s ability to facilitate live, stimulation, and also provides functional two one-year fellowships include hands- interactive feeds from SNI’s operating neurosurgery training. on training using the latest techniques suites to outside facilities, give SNI’s and technologies to diagnose, treat and Complex and Minimally Invasive worldwide audience easy access to this manage patients with skull base tumors Spine. This is a unique fellowship that quality knowledge sharing. or neurotology disorders. Skull base combines orthopedic and neurosurgical fellows have access to an anatomical Demand is also high for SNI’s fellowship spine training. As a high-volume tertiary laboratory where they can practice pro- training. More than 100 applications spine center, SNI offers fellows experience cedures before performing live surgeries. were received in 2015 for SNI’s five in trauma, tumors, infection, degenerative fellowships, which include: conditions and complex adult spinal deformity, as well as exposure to all Cerebrovascular Surgery/Endovascular. types of osteotomies. SNI offers neurosurgeons one- and two-year fellowships in cerebrovascular General Neurosurgery. Through microsurgery and/or neuro-endovascular one- and two-year fellowships, fellows treatment. The fellowships provide ex- receive additional hands-on training perience in the diagnosis and manage- in general and advanced tertiary-care ment of a wide range of cerebrovascular neurosurgery. This training includes the disorders, and in extracranial carotid diagnosis and management of a wide and vertebral artery disorders. variety of neurosurgical conditions using traditional and endovascular surgical Epilepsy and Functional. As one of procedures, as well as radiosurgery. the busiest centers for epilepsy and functional disorders in the country, SNI Skull Base and Neurotology. Fellows is a prime location for advanced training. receive training in association with the The fellowship teaches complete work- Swedish Hearing and Skull Base Surgery Teleconferencing capabilities give SNI a worldwide ups and evaluation for epilepsy surgery, Center, the Seattle Pituitary Center and audience for its professional courses. including grid and strip monitoring, The Ben and Catherine Ivy Center for

www.swedish.org/SNI 29 Special Thanks

The Ben & Catherine Ivy Foundation (Funded the Ivy Stem Cell Therapeutics Project)

David and Doreen Keyes (Funded SNI Focused Ultrasound)

Chris Hahn and Radmila Sarac (Endowed the medical directorship for the MS Center)

Mr. and Mrs. William H. Neukom (Contributed unrestricted funding to support the area of greatest need at SNI)

Linda Fleming and her faithful pup, Phoenix, are regular attendees at the Pilates class, one of Swedish’s many MS Wellness services funded through philanthropy.

lateral sclerosis (ALS or Lou Gehrig’s Funding Innovation through Philanthropy disease). It will also build a clinical trials platform to evaluate new technologies, As a not-for-profit health system, Swedish relies on the generosity of the such as Cyberdyne’s Hybrid Assistive community to enhance clinical excellence, to support the physical, emotional Limb (HAL®) suit. (See page 21 for more and mental needs of patients, and to advance medical care through research information about the HAL® research.) and the acquisition of state-of-the-art technology. A gift from the estate of Susan McGregor, Swedish is fortunate to have that type of commitment and support of a very who died of glioblastoma multiforme, generous community. is helping Charles Cobbs, M.D., the Gregory Foltz, M.D., endowed director of The Ben & Catherine Ivy Center for Advanced Brain Tumor Treatment at SNI, Philanthropic gifts from the community that would permanently fund several establish a partnership among The Ivy help the Swedish Neuroscience Institute supportive care services, including a Center, Institute for Systems Biology and (SNI) broaden the advanced, progressive social worker, vocational counselor, Fred Hutch (a cancer research center in treatment it provides for a wide range of program development coordinator, Seattle). The purpose of the research is brain, spine and central nervous system adventure guide and a neuropsychol- to leverage new technologies to identify conditions. In 2015, the community’s ogist. An endowment will ensure these proteins that all brain tumors share, so support of Swedish was greater than non-clinical services are available in eventually they can produce a vaccine ever before, with nearly $2.5 million perpetuity to enrich patients’ lives. (See that would target those specific proteins, donated specifically to benefit SNI. page 6 for more information about the thus killing the proteins and the tumor. MS Center’s programs.) (See page 15 for more information about For example, philanthropy helped open The Ivy Center.) the Multiple Sclerosis Center at Swedish Community support is also making it in 2012, the only one of its kind in the possible to build a paralysis research Gifts like these help SNI’s staff provide Pacific Northwest. Gifts to the center program. The Swedish Spinal Cord their patients comprehensive care and continue to help fund specialized services, Research Platform will create a 3-D support, while also pursuing research education and programs found only at human spinal cord atlas and develop a breakthroughs that may change the way Swedish. Looking forward, the Swedish registry and tissue bank that will spur patients with neurologic disorders are Medical Center Foundation is working research in paralysis associated with cared for in the future. with the center and members of the stroke, spinal cord injury and neurological community to create an endowment diseases, such as MS and amyotrophic

30 Swedish Neuroscience Institute Bibliography This bibliography features publications by Swedish Neuroscience Institute members (noted in bold) in 2015.

Audiology Klinger DR, White JA, Batjer HH. Race and Patel AS, Horton TG, Kalapos P, Cockroft KM. hemorrhage in cerebral Arteriovenous malformation. Onyx-HD 500 Embolization of a traumatic internal Anderson S, Parbery-Clark A, White-Schwoch T, World Neurosurg. 2015; 84(3):640-642. doi: carotid artery pseudoaneurysm after transsphenoidal Kraus N. Development of subcortical speech 101016/jwneu201505009. surgery. J Neuroimaging. 2015; 25(4):656-659. representation in human infants. J Acoust Soc Am. doi: 101111/jon12221. 2015; 137(6):3346-3355. doi: 101121/14921032. Manhas A, Nimjee SM, Agrawal A, Zhang J, Diaz O, Zomorodi AR, Smith T, Powers CJ, Sauvageau Payne R, Baccon J, Dossett J, Scollard D, Byler Cerebrovascular E, Klucznik RP, Ferrell A, Golshani K, Stieg PE, Britz D, Patel A, Harbaugh K. Pure neuritic leprosy GW. Comprehensive overview of contemporary presenting as ulnar nerve neuropathy: A case Crowley RW, Ducruet AF, Kalani MYS, Kim LJ, management strategies for cerebral Aneurysms. report of electrodiagnostic, radiographic, and Albuquerque FC, McDougall CG. Neurological World Neurosurg. 2015; 84(4):1147-1160 doi: histopathological findings. J Neurosurg. 2015; morbidity and mortality associated with the 101016/jwneu201505064 123(5):1238-1243. doi: 103171/20149jns142210. endovascular treatment of cerebral arteriovenous malformations before and during the onyx era. Maynard C, Longstreth WT, Nichol G, Hallstrom Reinard KA, Pabaney AH, Basheer A, Phillips J Neurosurg. 2015; 122(6):1492-1497. doi: A, Kudenchuk PJ, Rea T, Copass MK, Carlbom SB, Kole MK, Malik GM. Surgical management 103171/20152jns131368. D, Deem S, Olsufka M, Cobb LA, Kim F. Effect of giant intracranial arteriovenous malformations: of Prehospital induction of mild Hypothermia on A single center experience over 32 years. World Crowley RW and McDougall CG. Response. J 3-Month neurological status and 1-Year survival Neurosurg. 2015; 84(6):1765-1778. doi: 101016/ Neurosurg, 2015; 6:1491. among adults with cardiac arrest: Long-Term jwneu201507051. Ene CI, Xu D, Morton RP, Emerson S, Levitt MR, Follow-up of a Randomized, clinical trial. J Am Sahlein DH, Fouladvand M, Becske T, Saatci I, Barber J, Rostomily RC, Ghodke BV, Hallam DK, Heart Assoc. 2015 Mar 11; 4(3):e001693. doi: McDougall CG, Szikora I, Lanzino G, Moran CJ, Albuquerque FC, McDougall CG, Sekhar LN, 10.1161/JAHA.114. Woo HH, Lopes DK, Berez AL, Cher DJ, Siddiqui Ferreira M, Kim LJ, Chang SW. Safety and efficacy McDougall CG and Spetzler RF. Response. J AH, Levy EI, Albuquerque FC, Fiorella DJ, Berentei of Preoperative Embolization of Intracranial Neurosurg. 2015; 3:607-608. Z, Marosfoi M, Cekirge SH, Kallmes DF, Nelson Hemangioblastomas. Neurosurgery. 2015; 1. doi: PK. Neuroophthalmological outcomes associated 101227/neu0000000000001014. Monteith S. Commentary on Vertebral artery injury during routine posterior cervical exposure: with use of the pipeline Embolization device: Analysis Etminan N, Brown RD, Beseoglu K, Juvela S, Case reports and review of Literature. Global of the PUFS trial results. J Neurosurg. 2015; Raymond J, Morita A, Torner JC, Derdeyn CP, Spine J. 2015; 05(06):533-534. doi: 101055/ 123(4):897-905. doi: 103171/201412jns141777. Raabe A, Mocco J, Korja M, Abdulazim A, s-0035-1566292. Shi Z-S, Duckwiler GR, Jahan R, Tateshima S, Amin-Hanjani S, Al-Shahi Salman R, Barrow DL, Monteith SJ and Elias WJ. Response. Gonzalez NR, Szeder V, Saver JL, Kim D, Ali LK, Bederson J, Bonafe A, Dumont AS, Fiorella Starkman S, Vespa PM, Salamon N, Villablanca DJ, Gruber A, Hankey GJ, Hasan DM, Hoh BL, J Neurosurgery. 2015; 1:289-290. JP, Viñuela F, Feng L, Loh Y, Liebeskind DS. New Jabbour P, Kasuya H, Kelly ME, Kirkpatrick PJ, Moon K, Albuquerque FC, Levitt MR, Ahme, cerebral microbleeds after mechanical thrombec- Knuckey N, Koivisto T, Krings T, Lawton MT, AS, Kalani MYS, McDougall CG. The myth of tomy for large-vessel occlusion strokes. Medicine Marotta TR, Mayer SA, Mee E, Pereira VM, restenosis after carotid angioplasty and stenting. (Baltimore). 2015 Nov; 94(47):e2180. doi: Molyneux A, Morgan MK, Mori K, Murayama Y, J NeuroInterv Surg. 2015 Sep 18; pii: 10.1097/MD.0000000000002180. Nagahiro S, Nakayama N, Niemelä M, Ogilvy CS, neurintsurg-2015-011938. doi: 10.1136/ Pierot L, Rabinstein AA, Roos YBWEM, Rinne J, neurintsurg-2015-011938. [Epub ahead of print] Spetzler RF, McDougall CG, Zabramski JM, Albuquerque FC, Hills NK, Russin JJ, Partovi Rosenwasser RH, Ronkainen A, Schaller K, Seifert Moon K, Levitt MR, Almefty RO, Nakaji P, V, Solomon RA, Spears J, Steiger H-J, Vergouwen S, Nakaji P, Wallace RC. The barrow ruptured Albuquerque FC, Zabramski JM, McDougall CG, MDI, Wanke I, Wermer MJH, Wong GKC, Wong Aneurysm trial: 6-year results. J Neurosurg. 2015; Spetzler RF. Treatment of ruptured anterior 123(3):609-617. doi: 103171/20149jns141749. JH, Zipfel GJ, Connolly ES, Steinmetz H, Lanzino communicating artery Aneurysms. Neurosurgery. G, Pasqualin A, Rüfenacht D, Vajkoczy P, 2015; 77(4):566-571. doi: 101227/ Starke RM, Monteith SJ, Southerland AM, McDougall C, Hänggi D, LeRoux P, Rinkel GJE, neu0000000000000878. Crowley RW, Chalouhi N, Ding D, Hasan DM, Macdonald RL. The unruptured intracranial Dumont AS. Developments in neurovascular aneurysm treatment score. Neurology. 2015; Moon K, Levitt MR, Almefty RO, Nakaji P, diseases and treatments. Scientific World J. 2015; 85(10):881-889. doi: 101212/ Albuquerque FC, Zabramski JM, Wanebo JE, 1-2. doi: 101155/2015/608607 wnl0000000000001891. McDougall CG, Spetzler RF. Safety and efficacy of surgical resection of unruptured low-grade Togashi K, Joffe AM, Sekhar L, Kim L, Lam A, Lam AM and Kianpour D. Monitoring for Carotid arteriovenous malformations from the modern Yanez D, Broeckel-Elrod JA, Moore A, Deem S, Endarterectomy. Anesth Analg. 2015; 120(6): decade. Neurosurgery. 2015; 77(6):948-953. Khandelwal N, Souter MJ, Treggiari MM. 1186-1188. doi: 101213/ane0000000000000734. doi: 101227/neu0000000000000968. Randomized Pilot Trial of Intensive Management Zaidi HA, Kalani MYS, Spetzler RF, , of Blood Pressure or Volume Expansion in McDougall CG Moon K, Nakaji P, Albuquerque FC, McDougall Albuquerque FC. Multimodal treatment strategies Subarachnoid Hemorrhage (IMPROVES). CG, Spetzler RF. Modern paradigms for the treat- for complex pediatric cerebral arteriovenous Neurosurgery. 2015;76(2):125-135. doi:10.1227/ ment of ruptured anterior communicating artery neu.0000000000000592. fistulas: Contemporary case series at barrow Aneurysms. Neurosurgery. 2015; 62:177-179. neurological institute. J Neurosurg Pediatr. 2015; doi: 101227/neu0000000000000809. Van Wyck DW, Diaz JR, Loh Y. Magnetic 15(6):615-624. doi: 103171/201411peds14468. resonance imaging corticospinal tract Mooney MA, Kalani MYS, Nakaji P, Albuquerque Zaidi HA, Montoure A, Elhadi A, Nakaji P, hyperintensities in progressive supranuclear FC, McDougall CG, Spetzler RF, Zabramski JM. McDougall CG, Albuquerque FC, Spetzler RF, palsy. Neurohospitalist. 2015; Apr;5(2):89-90. Long-term patient outcomes after microsurgical doi: 10.1177/1941874414554302. Zabramski JM. Long-term functional outcomes treatment of blister-like aneurysms of the basilar and predictors of shunt-dependent Hydrocephalus artery. Neurosurgery. 2015; 11:387-393. doi: Williamson RW, Wilson DA, Abla AA, McDougall after treatment of ruptured Intracranial Aneurysms 101227/neu0000000000000866 CG, Nakaji P, Albuquerque FC, Spetzler RF. in the BRAT trial. Neurosurg. 2015; 76(5):608-615. 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Impact of obesity on of impact of standing long-cassette radiographs affects the back: Changes in regional cervical complications, infection, and patient-reported on surgical planning for lumbar pathology: sagittal alignment correlate to HRQOL improve- outcomes in adult spinal deformity surgery. J An international survey of spine surgeons. J ment in adult thoracolumbar deformity patients Neurosurg Spine. 2015; 23(5):656-664. doi: Neurosurg Spine. 2015; 23(5):581-588. doi: at 2-year follow-up. J Neurosurg Spine. 2015; 103171/20153spine14743. 103171/20151spine14833. 23(2):153-158. doi: 103171/201411spine1441. Soroceanu A, Diebo BG, Burton D, Smith JS, Moisi M, Page J, Paulson D, Oskouian RJ. Rajz G, Cohen JE, Harnof S, Knoller N, Goren O, Deviren V, Shaffrey C, Kim HJ, Mundis G, Ames Technical note – lateral approach to the lumbar Shoshan Y, Fraifeld S, Kaplan L, Itshayek E. C, Errico T, Bess S, Hostin R, Hart R, Schwab spine for the removal of Interbody cages. Spontaneous spinal epidural hematoma: The F, Lafage V. Radiographical and implant-related Cureus. 2015 May 11; 7(5):e268. doi: 10.7759/ importance of preoperative neurological status complications in adult spinal deformity surgery. cureus.268. eCollection 2015. and rapid intervention. J Clin Neurosci. 2015; Spine. 2015; 40(18):1414-1421. doi: 101097/ brs0000000000001020. Oner FC, Sadiqi S, Lehr AM, Dvorak MF, Aarabi 22(1):123-128. doi: 101016/jjocn201407003. B, Chapman JR, Fehlings MG, Kandziora F, Rhee JM, Chapman JR, Norvell DC, Smith J, Sherry Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Rajasekaran S, Vaccaro AR. Towards the NA, Riew KD. Radiological determination of postop- Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames development of an outcome instrument for erative cervical fusion. Spine. 2015; 40(13):974-991. CP. The impact of standing regional cervical spinal trauma. Spine. 2015; 40(2):e91-e96. doi: 101097/brs0000000000000940. Sagittal alignment on outcomes in posterior doi: 101097/brs0000000000000684. cervical fusion surgery. Neurosurgery. 2015; Saigal R, Clark AJ, Scheer JK, Smith JS, Bess S, 71(3):662-669. doi: 101227/neu0b013e31826100c9. Page J, Gahramanov S, Oskouian R, Moisi M. Mummaneni PV, McCarthy IM, Hart RA, Kebaish Bullet fragment of the lumbar spine: The decision KM, Klineberg EO, Deviren V, Schwab F, Shaffrey Tubbs S, Blouir MC, Singh R, Lachman N, is more important than the incision. Global Spine CI , Ames CP. Adult spinal deformity patients D’Antoni AV, Loukas M, Hattab E, Oskouian RJ. J. 2015; 05(06):523-526. doi: 101055/s-0035- recall fewer than 50% of the risks discussed in Relationship between regional atherosclerosis and 1566231. the informed consent process preoperatively adjacent spinal cord histology. Cureus. 2015 Sep 21; 7(9):e329. doi: 10.7759/cureus.329. Palumbo MA, Shah KN, Eberson CP, Hart RA, and the recall rate worsens significantly in the Daniels AH. Outrigger rod technique for supple- postoperative period. Spine. 2015; 40(14): Vavken P, Ganal-Antonio A, Quidde J, Shen F, mental support of posterior spinal arthrodesis. 1079-1085. doi: 101097/brs0000000000000964. Chapman J, Samartzis D. Fundamentals of Spine J. 2015; 15(6):1409-1414. doi: 101016/ Scheer JK, Fakurnejad S, Lau D, Daubs MD, clinical outcomes assessment for spinal disorders: jspinee201503004. Coe JD, Paonessa KJ, LaGrone MO, Amaral Clinical outcome instruments and applications. RA, Trobisch PD, Lee J-H, Fabris-Monterumici Global Spine J. 2015; 05(04):329-338. doi: Passias PG, Soroceanu A, Scheer J, Yang S, 101055/s-0034-1396046. Boniello A, Smith JS, Protopsaltis T, Kim HJ, D, Anand N, Cree AK, Hart RA, Hey LA, Ames Schwab F, Gupta M, Klineberg E, Mundis G, CP. Results of the 2014 SRS survey on PJK/ Vavken P, Ganal-Antonio A, Shen F, Chapman J, Lafage R, Hart R, Shaffrey C, Lafage V, Ames PJF. Spine. 2015; 40(11):829-840. doi: 101097/ Samartzis D. Fundamentals of clinical outcomes C. Magnitude of preoperative cervical lordotic brs0000000000000897. assessment for spinal disorders: Study designs, compensation and C2–T3 angle are correlated Scheer JK, Mundis GM, Klineberg E, Hart RA, methodologies, and analyses. Global Spine J. to increased risk of postoperative sagittal spinal Deviren V, Nguyen S, Protopsaltis TS, Gupta 2015; 05(02):156-164. doi: 101055/s-0035- pelvic malalignment in adult thoracolumbar defor- M, Bess S, Shaffrey CI, Schwab F, Lafage V, 1547525. mity patients at 2-year follow-up. Spine J. 2015; Smith JS, Ames CP. Postoperative recovery Zusman N, Munch JL, Ching A, Hart R, Yoo J. 15(8):1756-1763. doi: 101016/jspinee201504007. after adult spinal deformity surgery. Spine. Preoperative epidural spinal injections increase the Paulson D, Page J, Oskouian R, Moisi M. 2015; 40(19):1505-1515. doi: 101097/ risk of surgical wound complications but do not Commentary on: Remote Cerebellar hemorrhage brs0000000000001062. affect overall complication risk or patient-perceived after revision lumbar spine Surgery. Global Spine Schroeder GD, Kepler CK, Kurd MF, Paul JT, outcomes. J Neurosurg Spine. 2015; 23(5):652-655. J. 2015; 05(06):538-538. doi: 101055/s-0035- Rubenstein RN, Harrop JS, Brodke DS, doi: 103171/20152spine14827. 1567837. Chapman JR, Vaccaro AR. A systematic review

34 Swedish Neuroscience Institute Swedish Neuroscience Institute Providers (As of October 2016)

Epilepsy Inpatient Neurology Lisa Caylor, M.D. and Stroke Quinn Crosta, ARNP James Bartscher, M.D. Michael Doherty, M.D. William Berg, M.D. Ryder Gwinn, M.D. Derek Clark, M.D. Alan Haltiner, Ph.D. Todd Czartoski, M.D. Kitti Kaiboriboon, M.D. Thomas Deuel, M.D. Jehuda Sepkuty, M.D. Keri Drury, PA-C Ednea Simon, M.D. Tatyana Erdmann, PA-C Marcio Sotero de Menezes, M.D. Holly Hensley, M.D. Nicole Warner, ARNP Kory Herrick, M.D. Emily Ho, M.D. General Neurology James Jordan, M.D. Alex Cooper, M.D. Stanley Kong, PA-C Todd Czartoski, M.D. Tom W. Kushner, D.O. Meghana Doreswamy, M.D., MBBS Liou Lee-Loung, M.D. Brian Droker, M.D. Ravi Menon, M.D. Suzanna Eller, M.A., LMHC Kariss Peterson, ARNP Michael Elliot, M.D. Lovelle Ralls, ARNP Eric Gierke, M.D. Nirav Shah, M.D. Thomas A. Deuel, M.D., Ph.D. Ali Aamer Habib, M.D. Tarvinder Singh, M.D. Kate Kennedy, ARNP Sheila Smith, M.D. Lee-Loung Liou, M.D. Aaron Stayman, M.D. Dongmei Liu, M.D. Ruth Thomson, M.D. Adult Hydrocephalus Cerebrovascular Anne Mai, M.D. Eric Gierke, M.D. Margaret Dancan, PA-C Joyce Mauk, M.D. Movement Disorder Ryder Gwinn, M.D. Johnny Delashaw, M.D. Ellen Modell, M.D. Rosalind Chuang, M.D. Anne Mai, M.D. Leisa Garrett, PA-C Lawrence Murphy, M.D. Suzanna Eller, M.A., LMHC Stephen Monteith, M.D. Cheri Geist, PA-C Brian Nago, M.D. Briccio Guillermo, PA-C Lawrence Murphy, M.D. Puneet Gupta, PA-C Hal Rappaport, M.D. Ryder Gwinn, M.D. Akshal Patel, M.D. Dustin Hayward, M.D. Mary Reif, M.D. Peter Nora, M.D. Susie Ro, M.D. Martin Holland, M.D. Jack Stigler, D.O. Susie Ro, M.D. Ruth Thiex, M.D. Amanveer Kaila, ARNP Carolyn Taylor, M.D. Jordan Steed, PA-C Jennifer Witt, M.D. Yince Loh, M.D. Anna Wong, M.D. Jennifer Witt, M.D. Amitoz Manhas, M.D. Audiology Benduan Yang, M.D., MSC Cameron G. McDougall, M.D. Dennis Zhou, M.D. Elizabeth Elkins, AuD, CCC-A Stephen Monteith, M.D. Alyson Mellish, AuD, CCC-A Joanne Osetsky, ARNP Alexandra Parbery-Clark, Akshal Patel, M.D. Ph.D., AuD, CCC-A Norman Rokosz, M.D. Stacey Watson, AuD, CCC-A Ruth Thiex, M.D. Balance Ryan Urbonas, M.D. Elizabeth Elkins, AuD, CCC-A Deep Brain Stimulation Myra Emami, P.T. Rosalind Chuang, M.D. Mary Goodman, P.T. Kristin Crosley, ARNP Judith White, M.D., Ph.D. Briccio Guillermo, PA-C Brain Tumor Ryder Gwinn, M.D. Peter Nora, M.D. The Ben & Catherine Samira Pardakhtim, ARNP Ivy Center for Advanced Susie Ro, M.D. Brain Tumor Treatment Martha Short, PA-C Tara Benkers, M.D. Jordan Steed, PA-C Robyn Callahan, MSW, LCSW Jennifer Witt, M.D. Charles Cobbs, M.D. Sheldon Goldberg, M.D. Jerome Graber, M.D. Marc Mayberg, M.D. Michelle Smith, PA-C Sarah Wade, PA-C Aaron N. Stayman, M.D.

www.swedish.org/SNI 35 Neurosurgery Pediatric Neurology Johnny Delashaw, M.D. Pamela Betz, PA-C Anthony Bouldin, M.D. Leisa Garrett, PA-C Robyn Callahan, MSW, LCSW Quinn Crosta, ARNP Cheri Geist, PA-C Kristina Campbell, ARNP Ryder Gwinn, M.D. Briccio Guillermo, PA-C Jens Chapman, M.D. Nancy Hunter, R.D., C.D., CSP Puneet Gupta, PA-C Charles Cobbs, M.D. Ednea Simon, M.D. David Hanscom, M.D. Cara Cook, ARNP Marcio Sotero de Menezes, M.D. Robert Hart, M.D. Margaret Dancan, PA-C Timothy Steege, M.D. Martin Holland, M.D. Glen David, M.D. Brien Vlcek, M.D. Amanveer Kaila, ARNP Johnny Delashaw, M.D. Linda Lai, PA-C Todd Ensign, PA-C Physiatry Stephen Monteith, M.D. Leisa Garrett, PA-C Abraham Abu, PA-C Tanya Nguyen, ARNP Victoria Gasparyan, ARNP Glen David, M.D. Peter Nora, M.D. Cheri Geist, PA-C Eva Young, M.D. Joanne Osetsky, ARNP Briccio Guillermo, PA-C Pituitary Rod Oskouian, M.D. Peter C. Nora, M.D. Puneet Gupta, PA-C Johnny Delashaw, M.D. Jeni Page, ARNP Ryder Gwinn, M.D. Bart Keogh, M.D., PhD Akshal Patel, M.D. Multiple Sclerosis David Hanscom, M.D. Zachary Litvack, M.D. Andrea Pertoso, PA-C James Bowen, M.D. Robert Hart, M.D. Christopher Loiselle, M.D. Norman Rokosz, M.D. Lina Fine, M.D., M.Phil. Dustin Hayward, M.D. Marc Mayberg, M.D. Michelle Smith, PA-C Simon Gale, OTR/L Martin Holland, M.D. Robert Meier, M.D. Timothy Steege, M.D. Kimberly Kobata, P.T., NCS Shiveindra Jeyamohan, M.D. Jennifer Mercado, ARNP Jeff Stubblefield, PA-C Angeli Mayadev, M.D. Amanveer Kaila, ARNP Kelley Moloney, ARNP Ryan Urbonas, M.D. Katherine Kamm, PA-C Peiqing Qian, M.D. Steven Rostad, M.D. Stroke Linda Lai, PA-C Pavle Repovic, M.D., Ph.D. Sandra Vermeulen, M.D. Stanley Kong, PA-C Zachary Litvack, M.D. Barbara Severson, ARNP Kevin Yuen, M.D. Tom W. Kushner, D.O. Amitoz Manhas, M.D. Michelle Toshima, Ph.D. Sheila Smith, M.D. Shaheen Virani, M.A., CRC Marc Mayberg, M.D. Radiology Alan Wittenberg, R.C. Cameron G. McDougall, M.D. Pedro Vieco, M.D. TeleStroke Charene McElroy, ARNP David Westman, M.D. James Bartscher, M.D. Neuro-Critical Care Stephen Monteith, M.D. Radiosurgery Derek Clark, M.D. James Bartscher, M.D. Tanya Nguyen, ARNP Todd Czartoski, M.D. Steven Deem, M.D. Daniel Landis, M.D. Peter Nora, M.D. Brian Lee, M.D., Ph.D. Thomas Deuel, M.D. Arthur Lam, M.D. Joanne Osetsky, ARNP Holly Hensley, M.D. Paul Niemi, ARNP Christopher Loiselle, M.D. Rod Oskouian, M.D. Vivek Mehta, M.D. Kory Herrick, M.D. Neurologic Restoration Jeni Page, ARNP Robert Meier, M.D. Emily Ho, M.D. Kristen Crosley, ARNP Akshal Patel, M.D. Sandra Vermeulen, M.D. Lee-Loung Liou, M.D. Ryder Gwinn, M.D. Andrea Pertoso, PA-C Ravi Menon, M.D. Arthur Lam, M.D. Norman Rokosz, M.D. Spine Nirvav Shah, M.D. Samira Pardakhtim, ARNP James Saadi, M.D. Jens Chapman, M.D. Tarvinder Singh, M.D. Martha Short, PA-C Jordan Steed, PA-C Charles Cobbs, M.D. Sheila Smith, M.D. Jordan Steed, PA-C Timothy Steege, M.D. Cara Cook, ARNP Aaron Stayman, M.D. Anna Sturm, PA-C Margaret Dancan, PA-C Ruth Thomson, M.D. Neuromuscular Ruth Thiex, M.D. Glen David, M.D. Suzanna Eller, M.A., LMHC Ryan Urbonas, M.D. Michael Elliott, M.D. Sara Wade, PA-C Eric Gierke, M.D. Sanford Wright, M.D. Ali Aamer Habib, M.D. Lee-Loung Liou, M.D. Neurotology, Hearing & Skull Base Surgery Neuro-Ophthalmology Douglas Backous, M.D. Marybeth Grazko, M.D. Margaret Dancan, PA-C Steven Hamilton, M.D. Johnny Delashaw, M.D. Bonnie Keung, M.D. Elizabeth Elkins, AuD, CCC-A Eugene May, M.D. Zachary Litvack, M.D. Neuro-Psychiatry Sean McMenomey, M.D. Joshua Bess, M.D. Alyson Mellish, AuD, CCC-A Tuesday Burns, M.D. Irina Kimova Nescot, PA-C Suzanne Kerns, M.D. Alexandra Parbery-Clark, AuD, Kenneth Melman, M.D. Ph.D., CCC-A Michael Talty, PA-C Stacey Watson, AuD, CCC-A, M.S.

36 Swedish Neuroscience Institute SNI in the Community Brain Cancer For nine years, patients, families and The clinical and administrative staff of the Swedish Neuroscience Institute (SNI) friends have come together to support works tirelessly to ensure patients receive the highest quality of care. At the cancer patients and survivors at the same time, SNI supports communities and organizations across the state Seattle Brain Cancer Walk. The fund- by providing care at outreach clinics, and through educational opportunities raising event benefits brain cancer research and patient care at The Ben and special events that help raise awareness and funding for various & Catherine Ivy Center for Advanced conditions that affect the nervous system or spine. The following events Brain Tumor Treatment at SNI. To date are an example of the many outreach programs SNI has sponsored or we have raised more than $398,000 supported throughout the years. through the walk.

Multiple Sclerosis Port Angeles, Yakima, Everett, Centralia, Wenatchee and Woodinville are a few Art Show: Six years ago the Swedish of the communities in Washington that MS Center hosted its first art show, have hosted a four-hour weekend giving individuals in the Pacific North- seminar about diagnosing and treating west touched by MS an opportunity to MS, and the latest MS research. express themselves. Since then, the show has become an eagerly awaited MS Walk: Every year for the past eight annual event. The show accepts every years, the Swedish MS Center has piece of artwork, regardless of the level participated in the annual MS Walk at of ability of the artist, and professionally the University of Washington. Swedish’s displays the pieces for public viewing. 150-member team raised more than More than 100 pieces of art were $15,000 at the most recent walk to submitted for this year’s show, and support MS research. about 200 patients and hundreds of Amyotrophic Lateral guests attended the event. The show, Epilepsy Sclerosis (ALS) which encourages individuals to thrive Supporting EFNW: SNI participates in SNI recognized the Microsoft Enable apart from their disease, helps raise the Epilepsy Foundation Northwest’s Team for its efforts to create technolo- community awareness about MS, while (EFNW) run/walk, now in its 13th year, gies that help restore capabilities offering a venue for artists to display to help increase public awareness to individuals living with disabilities. their creative works, meet others in the and understanding of epilepsy, and Ann Eichmeyer (far left), former care community and sell their art, if desired. to raise money for the organization’s coordinator, ALS Evergreen Chapter, programs and services. Swedish and Dr. Michael Elliott (far right), Neuroscience Epilepsy raised $3,600 associate chief of neurology and at the recent event. medical director of neuromuscular medicine at SNI, presented the Spirit TSC Community Walk: SNI both sponsored and participated in the local of Lou Gerhig Award to Microsoft’s Tuberous Sclerosis Complex (TSC) Ann Paradiso and Jamie Rifley (middle community walk. left and right). This event is just one example of the strong relationship SNI Education: Swedish Epilepsy, The LAM has with industry leaders in the Greater (lymphangioleiomyomatosis) Foundation Puget Sound Area. and the Tuberous Sclerosis Alliance partnered to host a regional educational conference at Swedish Cherry Hill. The MS Roadshows: Medical professionals conference shared updates on LAM from the Swedish MS Center take and TSC research, and explored ways pride in sharing their expertise with to improve quality of life for those living communities outside the Seattle metro with these medical conditions. area. Bellingham, Bremerton, Tacoma, Administrative Offices Neurology: 206-386-3880 Swedish Cherry Hill Neurosurgery: 206-320-2800 550 17th Ave., Suite 500 Swedish Cherry Hill: 206-320-2000 Seattle, WA 98122 www.swedish.org/SNI

Clinical Programs and Services

Ballard TeleStroke Program Neuromuscular Program Neurology The Ben and Catherine Ivy Center for Neurosurgery Stroke Program Advanced Brain Tumor Treatment Pediatric Neuroscience Program Radiosurgery Bellevue Edmonds Spine Specialists at SNI Neurology Neurology Stroke Program Neuro-Ophthalmology Neurosurgery Pediatric Neuroscience Program Longview Cherry Hill (Seattle) Stroke Program Neurosurgery Acute Rehabilitation Unit Balance Center Everett Mill Creek Center for Hearing and Skull Base Surgery Cerebrovascular Center Center for Hearing and Skull Base Surgery Cerebrovascular Center Movement Disorders Stroke Program Neurology Deep Brain Stimulation Northgate Neurosurgery (Seattle) Epilepsy Program Neurology: The Polyclinic Focused Ultrasound Skull Base Tumors Movement Disorders Sleep Health Redmond Multiple Sclerosis Center Spine Center Neuromuscular Program Neurologic Restoration Stroke Center Neurosurgery Stroke Program Neurology First Hill (Seattle) Neuromuscular Program Center for Hearing and Skull Base Surgery Sequim Neuro-Ophthalmology Neurology: Swedish Center for Neurosurgery Neuropsychiatry Comprehensive Care Seattle – North Neurosurgery Neurology: The Polyclinic Sleep Medicine Program Physiatry Pediatric Neuroscience Program Pituitary Center Pituitary Program West Seattle Radiosurgery Stroke Program Neurosurgery Skull Base Tumor Program Issaquah Anchorage, AK Sleep Medicine Program Adult Hydrocephalus Program Neurosurgery Spine Specialists at SNI Neurologic Restoration Spine Stroke Program Neurology

Program locations are current as of October 2016 and are subject to change.

TeleStroke Sites

Island Hospital, Anacortes Skagit Valley Hospital, Mount Vernon Swedish Mill Creek Jefferson Healthcare, Port Townsend Swedish Ballard, Seattle Swedish Redmond Kadlec Regional Medical Center, Richland Swedish Cherry Hill, Seattle Walla Walla Adventist Hospital, Walla Walla Lake Chelan Community Hospital, Chelan Swedish Edmonds Whidbey General Hospital, Coupeville Olympic Medical Center, Port Angeles Swedish First Hill, Seattle Providence Regional Medical Center, Everett Swedish Issaquah

© 2016 SWEDISH HEALTH SERVICES. ALL RIGHTS RESERVED. NI-16-0079 10/16