Think Neuro

Parkinson’s disease is a neurologic movement disorder. It affects the brain and causes difficulty with movement, with the most common motor symptoms being tremors, stiffness or rigidity of muscles, and slowness of movement. According to the American Parkinson Disease Association, it is the fastest growing neurodegenerative disease in the world, and the second most common after Alzheimer’s disease, with an estimated 1 million people in the U.S. and more than 10 million people worldwide living with Parkinson’s.

In addition to the well-known motor symptoms of tremors, rigidity and slowness, Parkinson’s disease also manifests in non-motor symptoms including sleep problems, constipation, anxiety, depression, and fatigue, among others, which can be present well before any visible motor symptoms.

Dr. Melita Petrossian is a movement neurologist and medical director of Pacific Neuroscience Institute’s Movement Disorders Center. In today’s episode, Dr. Petrossian discusses these non-motor symptoms and explains the different types of testing that can lead to a diagnosis of Parkinson's disease—and what someone living with Parkinson’s may need to consider.

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Two slender muscles carry out some of the most important—and taken-for-granted—tasks in our lives. These muscles make up what we have come to call our “voice box,” and they not only produce the sounds that we make—they also close on cue to protect our lungs as we swallow. In this Spotlight Replay, we revisit a conversation with Dr. Omid Mehdizadeh, who treats voice and swallow disorders, in which he helps us appreciate the vital role of this unsung hero, our voice box. Let’s listen in!

Survey after survey is telling us that Americans are increasingly feeling lonely. It’s a trend that’s been growing for years and, while it was exacerbated during the pandemic when we were instructed to socially isolate, it continues even as society has reopened. In this Spotlight Replay, we revisit a panel discussion in which three doctors at Pacific Neuroscience Institute tell how they help people deal with different causes of loneliness. Doctors at PNI discover loneliness in their patients, often for specific causes that can be treated. Dr. Courtney Voelker sees patients with hearing so compromised that they can’t follow conversations with loved ones. Dr. Amit Kochhar has patients who are unwilling to socialize because their facial paralysis prevents them from expressing emotions. And Dr. Shanthi Gowrinathan works with patients struggling with depression from a cancer diagnosis. Each doctor has tools to help ease the social impact of these neurological diseases. Let’s listen in!

Fellowship trained, Noa Tal, MD, is a devoted endocrinologist committed to delivering exceptional care and striving for excellence in her field. With a diverse background encompassing medicine, research, teaching, and wellness, she endeavors to make significant contributions to healthcare. At the Pituitary Disorders Center at Pacific Neuroscience Institute®, Dr. Tal cares for patients with endocrine issues as a result of pituitary tumors.

Dr. Tal earned her medical degree from Tel Aviv University School of Medicine and completed her internal medicine residency at Montefiore Medical Center in Bronx, NY. Subsequently, she pursued further specialization through an endocrinology fellowship at Cedars-Sinai Medical Center in Los Angeles, CA. Her research focuses on advancing understanding in areas such as microbiome, pituitary pathology, and endocrine pathways related to aging and age-related diseases.

Beyond her medical achievements, Dr. Tal is deeply passionate about promoting wellness. She has volunteered at “Plant Powered Metro New York,” sharing insights on plant-based nutrition, chronic disease management, and diabetes prevention. Dr. Tal has also undergone additional training in diet and lifestyle intervention and has served as a yoga instructor, integrating holistic approaches into her practice. She firmly believes in a comprehensive approach to patient care, encompassing research, quality improvement, and wellness promotion, with the ultimate aim of making a positive impact in medicine, academia, and wellness.

When someone is diagnosed with a brain tumor, their world can shift overnight, bringing challenges that reach far beyond the medical diagnosis. A tumor is, first and foremost and most obviously, a health challenge. Like any serious illness, however, it also taxes people mentally and psychologically. Patients and their families have to navigate a complex medical system, take in new and challenging information, and make large, potentially life-changing decisions. Because of this stressful environment, Pacific Neuroscience Institute’s Dr. Shanthi Gowrinathan, a psychiatrist who specializes in treating people with cancer, is part of a team that helps people cope with the mental aspects of their illness. In today’s episode, Dr. Gowrinathan explains how she helps patients and their families maintain their sense of self in the face of tremendous challenges.

The doctors at Pacific Neuroscience Institute believe strongly in educating other neurosurgeons in the latest techniques for minimally invasive surgery. PNI’s Pacific Rim Master Class in Endoscopic Endonasal and Keyhole Surgery is right around the corner, coming up at the end of March. In this Spotlight Replay, we return to the episode in which Dr. Garni Barkhoudarian talks about his commitment to pay forward his own neurosurgery education. We also hear from medical illustrator and animator Josh Emerson, manager of PNI’s Neuroanatomy Lab, who tells us how people can learn about the fascinating inner anatomy of the brain through illustration. Let’s listen in!

March is Essential Tremor Awareness Month. Essential tremor is one of the most common movement disorders, affecting millions of people around the world. In this Spotlight Replay, we return to the episode in which Dr. Melita Petrossian discusses the diagnosis and treatment of Essential Tremors, and explains how these tremors differ from those seen in people with Parkinson’s Disease. Keeping hope alive, the International Essential Tremor Foundation’s theme this year is, “Still Believing in Answers for ET.” While the exact cause of Essential Tremor remains unknown, Dr. Petrossian and the team at PNI work hard to help alleviate symptoms and provide patient support. Let’s listen in!

Spinal deformity refers to abnormal curvatures of the spine, such as scoliosis, lordosis, and kyphosis. These conditions can arise from genetic defects, injuries, diseases like osteoporosis or arthritis, neuromuscular disorders, or poor posture. Symptoms range from visible misalignment to pain, weakness, loss of sensation, and in severe cases, paralysis or organ compression. Treatment options vary from observation, bracing, medications, and physical therapy to complex surgeries, with early diagnosis offering the best outcomes.

Marcus D. Mazur, MD, FAANS, is a board-certified fellowship-trained spine neurosurgeon. His clinical practice focuses on adult spinal surgery for disorders on the cervical, thoracic, and lumbar spine. He is a recognized expert in the treatment of adult spinal deformity, complex revision surgery, spinal oncology, and minimally invasive spine surgery. He also practices general neurosurgery.

Don’t be surprised if you find yourself needing head and neck cancer surgery and your surgeon has an unexpected assistant: a robot. But it won’t be R2D2 or C3P0 from Star Wars. Instead, the modern medical robot is a high-tech tool that surgeons use to perform sensitive tasks in hard-to-reach places. In this episode, Dr. Vivian Wu, a head and neck surgeon at Pacific Neuroscience Institute, takes us into the new world of robotic surgeries. Dr. Wu also tells us about some new tests that can show how successful someone’s cancer treatment has been, without the need for invasive biopsies. She talks about how to prevent and treat Human Papillomavirus, or HPV, which has started showing up in people’s mouths in greater numbers. Dr. Wu also emphasizes the important role a care “village” plays in a patient's treatment and recovery.

Dural arteriovenous fistula (DAVF) is a rare vascular condition where abnormal connections (fistulas) form between branches of arteries and veins in the dura mater, the brain's covering. The dural arteries deliver high-pressure, oxygen-rich blood to the brain, while the dural veins return deoxygenated, low-pressure blood to the heart. DAVF causes high-pressure arterial blood to flow into veins or sinuses meant for low-pressure blood, which can lead to ruptures, brain hemorrhages, and other neurological issues.

Meet Dr. Aditya (Adi) Iyer, a board-certified, fellowship-trained neurosurgeon specializing in vascular diseases of the brain and spine at Pacific Neuroscience Institute®. As one of California’s few dual-trained neurosurgeons, Dr. Iyer offers both minimally invasive open surgical techniques and incisionless catheter-based procedures to treat strokes, aneurysms, AVMs, tumors, and pain.