The department of neurology at the University of Florida College of Medicine – Jacksonville has come a long way in the past 23 years. Under the leadership of chair Alan Berger, M.D., what was once a small department with two neurologists in 1995 has grown to one with 17 neurologists and 10 neurology-trained advanced registered nurse practitioners.
The neurology department covers all aspects of general and subspecialty neurological care, using a specialty program approach that integrates clinical care, research trials, support groups, rehabilitation and psychosocial support into comprehensive specialty centers. Each center has a dedicated clinical coordinator who supports the patient’s medical and psychosocial needs, as well as integrated clinical research trials.
In 2003, UF Health Jacksonville formed the Neuroscience Institute, which represented a clinical and research collaboration between the departments of neurology and neurosurgery. Over the past 15 years, neurology and neurosurgery have run intertwined clinical programs, providing patients with medical and surgical options for their illnesses. The departments share an inpatient ward, neurocritical care unit, and clinical offices at Emerson Medical Plaza and the UF Health North medical office building.
The department of neurology operates clinical sites at UF Health Jacksonville’s downtown campus, at Emerson Medical Plaza, and at the north campus medical office building. In 1997, neurology became the first clinical department to have an office in St. Mary’s, Georgia. We operated there until last year, when we left to focus on the north campus. We continue to see significant numbers of patients from Camden County, Georgia, and our overall volume of patients at the north campus has tripled in the past year. Neurology maintains a five-day-a-week presence at both the Emerson and north campus and provides general and subspecialty consultations, as well as specialized tests such as electromyography/nerve conduction studies at all three care sites.
Education and Research
In 2005, a neurology residency was formed, training four residents per year. In 2006, a neurovascular fellowship was developed, training two fellows per year in cerebrovascular disease. Both programs are accredited by the Accreditation Council for Graduate Medical Education.
The department has a shared clinical research program with neurosurgery, with dedicated research space and personnel. Over the years, neurology has participated in many leading-edge clinical trials funded by the industry and the National Institutes of Health. The stroke program has been a leading recruiter for most of the major NIH clinical trials involving new treatment methods.
Here’s more about our programs and centers:
Comprehensive Stroke Program
Scott Silliman, M.D., directs the Comprehensive Stroke Program, which also includes stroke specialists Ryan Crooks, M.D., and Constance Katsafanas, M.D.; neurocritical care specialist Michael Pizzi, D.O., Ph.D.; and cerebrovascular neurosurgeon Grzegorz Brzezicki, M.D., Ph.D. All are cerebrovascular and/or interventional fellowship-trained.
Wayne Hodges directs the outreach program and stroke education, and Vicki Coppen is the stroke clinical coordinator. The stroke program was among the first in North Florida to use thrombolysis in the treatment of stroke, and among the first centers in the country to be a Joint Commission-designated primary stroke center.
The program was designated as a Comprehensive Stroke Center in 2007 by the Florida Agency for Health Care Administration, or AHCA, and has received the Gold Seal of Approval from The Joint Commission for exemplary stroke care. The program was the first in North Florida to use thrombolysis in the treatment of acute ischemic stroke. Since its inception in 1996, the program has used a helicopter-based field-to-stroke-center transport paradigm to transport patients with suspected stroke from rural counties in Northeast Florida and Southeast Georgia. In a study published in 2003, we were the first program to demonstrate that helicopter-based transport can increase access to thrombolytic therapy for acute stroke victims who live in rural areas.
We are strengthening our links to rural counties. The stroke program was among the first on our campus to use telemedicine. For instance, the EMS stroke telemedicine program has worked with four Georgia counties to place video-conferencing technology in all of the ambulances to increase the rapidity of stroke intervention. These on-ambulance assessments help our physicians identify patients pre-arrival who are potential candidates for stroke interventions.
This year, we anticipate becoming a receiving site for patients treated at Coffee Regional Medical Center in Douglas, Georgia, who are candidates for thrombectomy. Following initiation of this transfer arrangement, the stroke program will be providing acute care to residents of 11 counties in Southeast Georgia. These counties have a combined population of about 250,000 and encompass a land mass — 6,500 square miles — equivalent to the size of Connecticut. Meanwhile, in Florida, Baker County’s EMS service and Fernandina Beach Fire Rescue are each in discussions about joining our EMS telemedicine program.
The stroke program partners with EMS agencies to provide up-to-date refresher stroke and other neurology education, and was the first to include a full-time EMS educator/liaison in its leadership structure. The program provides various levels of educational lectures to regional EMS personnel via YouTube. In 2016, the program assisted the north campus emergency room in becoming a Joint Commission Acute Stroke Ready hospital, the first in Duval County. That ER is now certified as a stand-alone program and partners with the clinical stroke program at our downtown campus.
The clinical coordinator facilitates the Stroke Busters support group, which has existed for nearly 20 years. Each month, stroke survivors and family members attend a meeting during which an education program is given over a wide range of topics important to the group. Many of the presentations are recorded and then uploaded to the Stroke Busters Facebook page.
Over the past two decades, UF Health Jacksonville has been a participatory site for a multitude of NIH- and industry-funded multicenter phase 2 and 3 studies that have explored secondary prevention strategies for ischemic stroke, medical therapies for intracerebral hemorrhage, and treatment of malignant edema associated with ischemic stroke. In addition, the stroke program has been a collaborating center in funded studies that have used genome widescreens to find gene associations with ischemic stroke and intracerebral hemorrhage. These studies have typically included five to 10 U.S. centers in their cohorts. Findings from these studies continue to be published.
Comprehensive Epilepsy Program
The Comprehensive Epilepsy Program includes director Ramon Bautista, M.D., M.B.A., and Suparna Krishnaiengar, M.D. — who are both fellowship-trained in electroencephalography and epilepsy — and Felicia Smith, the clinical coordinator. It’s the region’s largest epilepsy program, caring for more than 4,000 people, with a reach extending north into Georgia, west to the Florida Panhandle and south to Central Florida.
The epilepsy program was the first in Jacksonville to receive a Level 4 accreditation by the National Association of Epilepsy Centers. In addition to outpatient epilepsy care, the program features an epilepsy support group and a six-unit inpatient EEG video monitoring unit. In collaboration with neurosurgeon Carlos Arce, M.D., the program provides state-of-the-art epilepsy surgery, as well as neuromodulation therapies such as vagus nerve stimulation and responsive neurostimulation.
The epilepsy program has been involved in more than 20 clinical trials involving new drug therapies. It is a national leader in epilepsy research focusing on the psychosocial aspects of epilepsy care. The program has received funding from the Riverside Hospital Foundation, the Jessie Ball duPont Fund and the Florida Blue Foundation to establish the Epilepsy Wellness Center — a first of its kind that aims to integrate programs designed to improve the psychosocial well-being of epilepsy patients via state-of-the-art clinical care.
Comprehensive Multiple Sclerosis Program
The Comprehensive Multiple Sclerosis Program includes director Scott Silliman, M.D.; Constance Katsafanas, D.O.; Paul Hoffman, M.D.; and Kelly O’Brien, ARNP. Adam Chaifetz, D.C., provides clinical coordination, education and psychosocial support.
The program is one of the largest clinical multiple sclerosis programs in the Southeast, caring for nearly 1,000 patients. It’s the only clinical program between Orlando and Atlanta certified as comprehensive by the National Multiple Sclerosis Society. Although many of the program’s patients live in the greater Jacksonville area, referrals come from as far south as Melbourne, as far west as Pensacola and as far north as Savannah, Georgia.
The program uses an interdisciplinary care model involving the three neurology physicians, a nurse practitioner, two certified neurology doctors of physical therapy, a patient care navigator and a case manager who combine their skills to optimize care for each patient. Our program is one of a few in Florida that also has an active spasticity management service. Katsafanas oversees this subspecialty service and integrates Botox and/or intrathecal baclofen pump therapies into her care plans.
The program provides evidence-based, aggressive disease-modifying therapies. About 150 patients receive treatment with intravenously administered monoclonal antibodies.
Over the past decade, the program has been a high-recruiting research site for many phase 3 clinical trials that have explored the use of immune-modulating drugs. Three of these agents were subsequently approved by the Food and Drug Administration. The program also has been engaged in phase 4 extension studies that have helped gather safety data concerning these drugs.
Neuromuscular Disease Program
The Neuromuscular Disease Program has four subspecialty-trained neuromuscular specialists: Alan Berger, M.D.; director Michael Pulley, M.D., Ph.D.; electromyography lab director Jaimin Shah, M.D.; and Louis Russo, M.D. In addition to providing state-of-the-art electrophysiologic testing, these physicians offer neuromuscular consultations and maintain care for patients with myasthenia gravis, ALS, myopathies, neuropathies, spinal cord disorders and nerve entrapments. A multidisciplinary ALS clinic meets three half days each month, providing complete care to ALS patients. Pulley has a recently accepted manuscript detailing the experience in caring for those patients via telemedicine.
The program also provides subspecialty programs in myasthenia gravis and peripheral neuropathy, complete with integrated research trials and support groups. Multiple research trials are underway in ALS, demyelinating neuropathy and myasthenia gravis.
Movement Disorders and Parkinson’s Program
The Movement Disorders and Parkinson’s Program includes director Odinachi Oguh, M.D., and Natalya Shneyder, M.D., and provides comprehensive treatment of Parkinson’s disease and other types of movement disorders.
The neurologists are fellowship-trained in movement disorders. Daryoush Tavanaiepour, M.D., is the program’s neurosurgeon partner, with fellowship training in functional and deep brain neurosurgery. Lisa Smith is the full-time clinical and research coordinator, who helps educate patients and caregivers, assists in patient care and helps enroll eligible patients in clinical research trials. Physicians, pharmacists and nurses provide patients with medication management, psychosocial support and continuous disease education.
The program provides expert medication management, state-of-the-art neurosurgical procedures for medically refractory cases, supportive physical and exercise therapy designed to increase balance and overall function, speech and occupational therapy, and psychological counseling to patients and caregivers. The program operates a yearly educational symposium on Parkinson’s disease and a fundraising run-walk to support Parkinson’s research and its support services.
We host a well-attended monthly support group as part of our community outreach programs. We have a robust clinical trial repertoire for industry-related research involved in new-drug and device development.
Edward Neely, M.D., directs the headache program, which includes a dedicated specialty-trained headache neurologist, headache nurse practitioner Jean Young, doctors of pharmacy Catrina Graham and Adrienne DeBerry, a social worker, and neuroscience-credentialed physical therapists Heather Barksdale and Lauren Casanova.
The program cares for patients with acute and refractory headaches by using the latest inpatient and ambulatory care paradigms. Patients with chronic migraine may receive regular Botox injections.
Neurocritical Care Unit
The department of neurology, in collaboration with neurocritical care specialists from emergency medicine, has operated the neurocritical care unit for almost 10 years. In August 2017, Michael Pizzi, D.O., Ph.D., a neurocritical fellowship-trained and board-certified neurologist, was recruited to direct the unit. He joins emergency medicine physicians Joe Shiber, M.D., and Bert Whisenant, M.D., along with seven neurocritical care-trained nurse practitioners in caring for critically ill neurologic and neurosurgical patients.
The unit is actively enrolling patients in clinical trials addressing acute ischemic stroke, autoimmune diseases affecting the central nervous system, and acute spinal cord injury. The unit has been selected to participate in a multicenter trial for status epilepticus, and Pizzi is submitting a grant proposal to the Jacksonville Aging Studies Center, or JAX-ASCENT, to investigate inflammation during acute ischemic stroke.
The UF Health Sleep Center includes director Andreja Packard, M.D., Ph.D., and Nura Festic, M.D., as well as collaborators from the departments of surgery and oral and maxillofacial surgery. Sleep consultations are provided at all three neurology care sites, and inpatient sleep studies are performed on the downtown and north campuses.
The program provides the latest in medical and surgical care for adult and pediatric patients with sleep related-disorders. Conditions include sleep apnea, narcolepsy, sleep walking, night terrors, bed wetting, circadian rhythm disorders, teeth grinding, nocturnal seizures and REM sleep disorders.
We anticipate opening a clinical program for insomnia in the near future. Ongoing research investigations focus on the relationship between sleep apnea and stroke, as well as sleep patterns associated with dementia.