University of Pennsylvania Health System

Penn Neuroscience Update

The Penn Neuroscience Update is dedicated to helping patients, families and their providers understand how conditions, diseases and disorders of the brain, spine and nervous system are being researched, treated and clinically advanced at the Penn Neuroscience Center and through its affiliated programs and services.

Friday, November 20, 2015

Foods that Can Trigger Headaches

Roderick Spears, MD, a neurologist at Penn Neurology Valley Forge, discusses which foods to avoid in helping to prevent headaches.

Roderick Spears, MD
Roderick Spears, MD
Is there anything worse than that moment a headache strikes? You know the one, when that throbbing pain makes it difficult to do virtually anything.

Headaches, a pain in the nerves and muscles of the head and neck, are by far the most complained about issue at the doctor’s office. They are classified into two types:
  • Primary (not associated with an underlying medical condition), and
  • Secondary (associated with infections, fever, injury, etc.). 
While most recognize the connection between headaches and illness, many struggle to understand why they may be feeling fine one moment and suffering from a headache the next.

Would you believe that the horrible pounding in your head may actually be caused by something you ate or drank? And we aren’t just talking about the morning after partying. Caffeine, smoked meats and even cheese can cause you to feel like someone is using your head as a bongo.

Below is a list of some lesser-known food and drink-related headache triggers.

Coffee and Chocolate

Coffee and chocolate can both be headache triggers and inhibitors. Regular caffeine consumption – found in both – can lead to a physical dependence, which manifests as withdrawal symptoms when a user abruptly stops their caffeine intake.

For example, a regular coffee drinker sleeps a little late on the weekend. She wakes up and decides she doesn’t need a cup of joe to get her day going. An hour passes and her head starts pounding. Why? Her blood vessels have dilated too much. When this occurs, caffeine can actually help to ease the pain.


When it comes to cheese, older isn’t always better… for headaches.

If eating cheese makes your head hurt, it’s likely an aged-type like Swiss, Parmesan, Brie or cheddar. Aged cheeses are high in tyramine, a natural chemical found in some foods. Tyramine can cause headaches by constricting and dilating blood vessels.


Tyramine is once again the culprit. Try avoiding pepperoni, salami, summer sausage and mortadella, and limiting processed meats to four ounces per meal. Processed meats, such as hot dogs, deli meats and bacon can also cause your head to hurt due to synthetic food preservatives.

Soy sauce

Soy sauce also contains tyramine and sometimes monosodium glutamate (MSG). MSG, which is used as an additive in many other foods, has been found to cause cramps, diarrhea and headaches. Additionally, soy has large amounts of salt, which can lead to dehydration – and, therefore, to headaches.

Ice cream

I scream, you scream, we all scream… ugh, brain freeze!

We’ve all felt the terrible sensation before. That big bowl of ice cream is placed on the table, and you just can’t wait to dive in. You take a scoop or two and – boom – you get hit with the mind-numbing pain.

Here’s the scoop on how you got that brain freeze (which is in fact a form of a headache). When something cold touches the center of the palate, it sets off certain nerves that control how blood flows to your head. The nerves respond by causing the blood vessels in your head to swell up. This quick swelling is what causes your head to hurt. Luckily, these particular headaches tend to only last about a minute, and there’s an easy way to prevent them: Eat slower!

We know that the foods and drinks listed here likely make up a significant portion of your diet. You don’t need to cut everything out, but it may be wise to keep track of when you get headaches and what you indulged in prior to the pain.

Friday, October 16, 2015

Ready, Set, Go: Exercise Therapy for Parkinson’s Disease

Imagine your body and brain connected by a plug.

With the plug in place, your body is able to respond to every command your brain gives. Your brain says, “Walk,” and your legs move with ease. Your brain says, “Sit,” and your hips bend. Your brain says, “Write,” and your hand picks up the pen.

Now, pull that plug.

Your limbs feel stiff with every movement. A lack of balance makes sitting dangerous. And constant tremors make writing impossible. This is Parkinson’s disease.

Your brain cells deliver a hormone called dopamine that controls your muscles.

When the brain cells that deliver dopamine slowly die, messages from your brain can’t get to your muscles. This debilitating movement disorder gets progressively worse and has no cure.

While Parkinson’s can be treated with medication and surgery, symptoms can managed – and even slowed down – with consistent exercise.

Here are the benefits of exercise therapy for Parkinson’s disease:

Good for the Brain

Your brain is miraculous. It has the ability to morph. In fact, it can reorganize and change based on your experiences through a process called neuroplasticity.

Exercise can actually contribute to this. It actually helps the brain create new connections and restore lost ones. This may actually slow or even halt the advance of Parkinson’s.

Physically active people have healthier brains than those who are sedentary. Not only does exercise get your heart pumping, it also produces:
  • Improved memory function
  • Better problem-solving skills
  • Less brain inflammation
  • Proteins in the brain that foster nerve cell growth and longevity

Improved Physical Condition

Your brain is not the only thing that benefits with exercise. Your body will undergo changes as well, which can help your symptoms of Parkinson’s disease.

Physical benefits, according to the 2014 National Parkinson Foundation report, include:

  • Improved posture
  • Increased strength
  • Better balance
  • Improved mobility
  • Limited physical decline
  • Restored functional ability
  • Reduced motor-related symptoms (tremors, stiff limbs, speech difficulty)
  • Reduced non-motor-related symptoms (depression, fatigue, constipation)

How to Get Moving

It’s important to begin an exercise program as close to diagnosis as possible, even if you’re not experiencing severe symptoms. You may be nervous if you haven’t exercised in a while or have a fear of falling. However, the earlier you start, the more likely you are to slow down the disease’s progression.

7 Exercises That Benefit People With Parkinson’s Disease

  1. Intensive sports training
  2. Treadmill training with body weight support
  3. Resistance training
  4. Aerobics
  5. Yoga, tai chi, and other meditative forms
  6. At-home video workouts
  7. Practicing movement strategies

“Keep these things in mind when planning your home exercise routine,” says Heather Cianci, PT, MS, at Penn’s Parkinson Disease & Movement Disorders Center:
Exercise should be physically and mentally challenging.
Exercise should be intensive enough to raise your heart rate and make you sweat.
Focus on making your exercise movements as big as possible.
Make exercise a part of your daily routine.
Work on exercises that focus on improving areas you struggle with (e.g., getting up from a chair).

Think of exercise as an additional prescription for your Parkinson’s disease. Get a daily dose, and the more often you take it, the better you’ll likely feel.

Ready to get started with your exercise plan? Request a therapy appointment with a Parkinson’s disease specialist.

Wednesday, October 7, 2015

Penn Proud to Serve as Flagship Sponsor for Race for Hope

Now entering its 10th year, the National Brain Tumor Society's Race for Hope is a 5K Run/Walk fundraiser to support the brain tumor community. The Race for Hope is a way to reach other families, patients and survivors affected by brain tumors.

Penn Neurosurgery
Penn Neurosurgery is proud to once again serve as a flagship sponsor for this year's Philadelphia Race for Hope to be held on Sunday, November 1.

Learn how you can help the fight against brain tumors by either donating to the team or joining the race by visiting the Penn Pioneers page on the Race for Hope website.

Race for Hope - Event Details
Date: November 1, 2015
Location: Steps of Philadelphia Art Museum-Eakins Oval
Race/walk starts: 8:30 a.m.

About the National Brain Tumor Society

The National Brain Tumor Society is the largest nonprofit dedicated to the brain tumor community in the United States. It is "fiercely committed to finding better treatments, and ultimately a cure, for people living with a brain tumor today and those who will be diagnosed tomorrow."

Brain Tumor Facts

  • Nearly 700,000 people in the United States are living with a primary brain tumor.
  • In 2015, an estimated 69,000 new primary brain tumor diagnoses will be made in the U.S.
  • About 120 types of brain and CNS tumors have been identified to date and some have multiple subtypes. Each tumor type/subtype is genetically distinct, making the search for treatments or a cure extremely difficult.

Wednesday, August 19, 2015

Exercise and Parkinson’s: What You Need to Know

Most people living with Parkinson’s disease (PD) know that exercise is an important part of managing their disease. But what many do not know is what type of exercise is best. Luckily, research looking at the effects of exercise on PD has grown dramatically in the last 5 to 10 years.

Heather J. Cianci, PT, MS, GCS, physical therapist with the Dan Aaron Parkinson's Rehabilitation Center, shares some important information on recent research that can help you to better plan your home exercise program:
    Parkinson's Physical Therapy
  • If you are not currently exercising, you really should get started. Even if you feel you are not having any difficulties, research suggests that certain types of exercise may actually slow disease progression.
  • Exercise should be both mentally and physically challenging.
  • Exercise should be intensive, which means it should raise your heart rate and make you sweat.
  • Exercise should focus on making your movements as big as possible.
  • You should exercise daily. Just as you take your prescription medications every day, you should exercise every day.
  • Exercise should help you improve in areas where you are having a hard time. If you struggle with getting up from a chair, work on exercises that focus on exactly how you get up and down. If you have trouble with balance, ask your therapist to prescribe exercises specifically focused on that.
Remember, simply moving around during your normal daily activities does NOT count as exercise. It is always better to stand than to sit, but to consider it exercise, you have to move more and work harder! The rehab team at the Dan Aaron Parkinson's Rehabilitation Center can provide more information on exercise and PD.

How to Get Started

As stated above, if you aren’t currently exercising, you should be. It’s important that you take into account your overall fitness level, so that you don’t overdo it. Because of that, talking with your physical therapist is a good first step. This way you can get an exercise plan developed specifically for your needs and work with an expert to determine what you can (and can’t) do safely.

Happy Exercising!

Ready to get started with your exercise plan?
Schedule an appointment with a Parkinson’s disease specialist.

Tuesday, August 4, 2015

Trigeminal Neuralgia: A Patient’s Story

The excruciating pain caused by trigeminal neuralgia (TN) can be so bad that it can often keep individuals from working or participating in any sort of social life, making them prisoners of their pain.

Billie Jean (BJ) Caperelli of Doylestown, Pa., suffered for more than 10 years, with many unsuccessful attempts to get rid of the pain. It wasn’t until she came to Penn Medicine to receive a specialized surgery that she got relief.

Penn Neurosurgery
John Y. K. Lee, MD
This spring, she underwent surgery, a fully endoscopic microvascular decompression (E-MVD), at Pennsylvania Hospital performed by John Y.K. Lee, MD, an associate professor of Neurosurgery and director of the Penn Center for Cranial Nerve Disorders.

Dr. Lee performed the intricate skull-base surgery using an endoscope that is only one tenth of an inch wide, accessing the base of the trigeminal nerve via a one centimeter opening behind Caperelli’s ear.

Caperelli has been pain-free since the surgery, and is hoping for very long-lasting relief. She is grateful to have found Dr. Lee and his team.

Check out Billie Jean’s full story

Wednesday, May 27, 2015

Can New Therapy Stop Epileptic Seizures?

You’ve tried just about everything to get the seizures to stop.

For months, you’ve been on more than two types of anti-seizure medications with maximum dosages—and your seizures are still out of control.

Your epilepsy has been diagnosed as intractable, meaning the drugs aren’t working. So, your doctor recommends surgery. You may hear words such as “resection,” “lobectomy” or “craniotomy.”

The good news is that you may have other options; alternatives to major surgery that may help control your intractable epilepsy.

Getting Under Your Skin

The RNS, or responsive neurostimulation system, may sound like something out of a sci-fi movie, but it’s designed to control seizure frequency - kind of like a wearable device that collects health data and course corrects for seizures.

This advanced type of neuromodulation therapy that anticipates and overrides epileptic seizures is a technology that was pioneered by Brian Litt, MD, of the Penn Epilepsy Center.

Danielle Becker, MD, MS
“It’s approved for people over age 18 and has been shown to reduce seizures in those who have frequent and debilitating seizures,” explains Danielle Becker, MD, MS, neurologist and director of the RNS Program at the Penn Epilepsy Center.

It’s relatively new, but it’s been in development for nearly 15 years. The US Food and Drug Administration (FDA) approved the system in November 2013.

Yes, this is still brain surgery. But it’s not a resection where a part of the brain is removed. The procedure may take anywhere from two to five hours with a hospital stay of up to three days.

Once the device is implanted, the Penn Neurosciences team—including neurologists and surgeons—allows it to collect data for two weeks with no stimulation. Then, data collection continues with an eye toward fine-tuning settings around the spurts of stimulation on seizure patterns.

Kathryn Davis, MD, MTR
Patients can also collect data at home using their own programmer, which behaves like a mini computer. They then transmit information to their physician via the internet.

The device holds promise, but it’s not a cure. “It’s a palliative device,” says Kathryn Davis, MD, MTR, neurologist and medical director of the Epilepsy Monitoring Unity at the Penn Epilepsy Center. “About 65% of patients have shown a meaningful improvement in clinical trial.”

 “My hope is that it will give new options to people with intractable epilepsy, who otherwise had no other choices,” adds Dr. Becker.

Pinpointing The Problem

Still feeling like an implant is just a little too invasive? There are other options.

Laser technology called Visualase® MRI-guided laser ablation is where a laser beam zeroes in on a problem area of the brain that may be causing the seizure and literally burns it out.

Again, this is still brain surgery, but it’s far less invasive than a resection and offers shorter recovery time.

This usually requires “burr holes, which are just small holes in the skull,” Dr. Davis says. “We feed the laser catheter in, and it’s done right in the MRI suite.”

“And they’ll be conservative: Do a little bit, go back and check to see what the extent of the burn was, and extend it if necessary. And then the patients usually go home the next day,” explains Dr. Davis.

In a standard resective surgery, patients would usually have a hospital stay of three or four nights.

Who Stands to Gain?

“Visualase is a less invasive way to treat temporal lobe epilepsy, which is the most common type of epilepsy in adults,” says Dr. Becker.

Penn Epilepsy CenterDr. Davis adds that it is best suited for patients who “have clear hippocampal sclerosis on their imaging.”

Hippocampal sclerosis, also called mesial temporal sclerosis, occurs when scar tissue forms in parts of the temporal lobe when nerve cells in the brain die.

This is a fairly new procedure, so there is still more to learn about its effectiveness. Visualase received US Food and Drug Administration clearance in 2007.

As of December 2014, more than 1,000 cases using Visualase ablation technology had been performed.

“We don’t have long-term outcomes for these patients,” Dr. Davis says. But her patients have been very receptive to it.

And if it doesn’t work? Then, it may be time to consider open surgery.

If you or a loved one is suffering from epilepsy and are interested in learning more about alternatives to major surgery, contact the Penn Epilepsy Center.

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Thursday, May 21, 2015

Someone is Having A Seizure: What Should You Do?

You’re in the grocery store and suddenly you hear a commotion. Another shopper is on the floor—convulsing. You’re terrified. What should you do?

Beyond calling 9-1-1, knowing what to do—and what not to do—when someone is having a seizure could mean the difference between safely allowing the seizure to pass and causing an injury.

How Do You Know If Someone Is Having A Seizure?

A seizure is uncontrolled brain activity, which can lead to uncontrolled movements and behavior. When someone is experiencing a generalized chronic seizure, they may:
  • Fall or collapse
  • Become unconscious
  • Convulse or shake
  • Stiffen and relax their muscles
  • Scream, grunt, or snort
  • Clench their teeth
  • Flail, twitch, or jerk their arms and legs
  • Drool
  • Become confused afterward

How Long Do Seizures Last?

The typical duration of a seizure lasts between one to three minutes. If it lasts longer than five minutes, you should call 9-1-1.

“Longer seizures can be damaging to the brain,” says Timothy Lucas II, MD, PhD, neurosurgeon at Penn Medicine. “This is because seizures can use up the brain’s supply of oxygen and glucose, leading to a secondary brain injury.”

Four Other Signs You Need To Call 911 When A Seizure Occurs:

  • If the person has trouble breathing afterward or does not awaken after the convulsing has stopped
  • If the person has another seizure shortly after the first
  • If the person becomes injured or starts getting aggressive
  • If the person has a known health condition, such as diabetes or heart disease, or is pregnant

When Someone Is Having A Seizure...

Now that you know how to spot a seizure, it’s very important to know how to best help.

Step 1: Don’t Put Anything in the Person’s Mouth.
“There’s an old wives’ tale that when someone is having a seizure, you should put something in the person’s mouth,” says Kathryn Davis, MD, MTR, neurologist and medical director of the Epilepsy Monitoring Unit at the Penn Epilepsy Center. “That is something you absolutely should not do.”

Here’s why: The person can clamp down on the object, bite off a piece, and choke on it. If you put your hand in their mouth, they could bite down on it.

The object will not prevent the person from choking on their tongue. “I’ve never heard of someone choking on their tongue,” Dr. Davis adds.

Step 2: Move The Person To A Safe Space.
“This doesn’t always mean hoisting the person around,” cautions Dr. Lucas. “It means getting them out of the way of any imminent threat.”

The Location The Threat What To Do
Stairs A fracture or head injury from falling down the stairs Take the person to the platform of the last step and lay them on their side.
Bathtub Drowning If the person is in the tub, make sure the head is above water to get air.

Drowning. “The seizure may only last a minute, but a minute under water can be dangerous,” says Dr. Lucas. Make sure the person is able to get air during the seizure and for a few minutes afterward until consciousness returns.
Kitchen Stabbing injury “If they are handling a sharp knife, take it from them, and remove any nearby,” says Dr. Lucas.

Step 3: Turn The Person Onto Her Side.
“The person can produce lots of saliva, which they could choke on,” explains Danielle Becker, MD, MS, neurologist and director of the RNS Program at the Penn Epilepsy Center. “Also, this can help keep the person’s airways clear, since the diaphragm can’t contract.”

When Someone Is Having A Seizure, Dr. Lucas says DO NOT…
  • Try to hold the person down: This can cause injury and won’t make the seizure stop.
  • Leave when the seizure is over: Wait a few minutes to make sure the person can breathe normally and returns to a normal state of awareness. If they still can’t breathe or still seem disoriented, call 9-1-1.
  • Offer them anything until they are alert: Avoid choking by waiting to offer water, pills, or food.
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