California Pacific Medical Center

Quelling the Storms of Seizures in People with Epilepsy

Posted on Nov 1, 2019 in Affiliates, California Pacific Medical Center, Innovation, Neuroscience, Quality, Research, Scroll Images, Sutter Medical Center of Santa Rosa, Sutter Medical Center, Sacramento, Transformation, Uncategorized

SAN FRANCISCO, Calif. – An electrical “storm” in the brain causes seizures in people with epilepsy, producing symptoms that may include lapses in consciousness, twitching or jerking movements, weakened or limp muscles, spasms, blurred vision, experiencing unusual smells or tastes, and changes in sensation or emotions.

Epilepsy—a neurological disorder caused by abnormal electrical activity in the brain—impacts almost 3.4 million nationwide.1 Despite advances in epilepsy treatment, approximately one-third of adults with the illness experience recurrent seizures.2

Epileptic seizures are generally categorized into three main groups: generalized (affecting both sides of the brain), focal (seizures that start in one area of the brain), and those that could start anywhere.

The stormy weather of seizures can clear with medications called anti-epileptic drugs (AEDs). AEDs can to stop seizures from occurring, but they do not always lead to a remission or cure epilepsy. With the right AEDs, up to 70% of people with the illness may remain seizure-free, and sometimes may “outgrow” seizures or go into remission. For other people whose seizures are uncontrolled with conventional AEDs, other treatments including surgery may be an option. Surgery may involve removing part of the brain that causes the seizures.

Michael Chez, MD

“Knowing where seizures start in the brain provides us clues into what occurs during a seizure, what other conditions or symptoms may be seen, how they may affect someone and, most importantly, what treatment may be best for that seizure type,” says Michael Chez, M.D., a pediatric neurologist and epileptologist, and Sacramento regional director of pediatric epilepsy and research at the Sutter Neuroscience Institute.

“Life without seizures and improved quality of life is what specialists aim to provide epilepsy patients, through a treatment plan personalized to their particular type of epilepsy and seizures,” says Dr. Chez.

Two Sutter hospitals, California Pacific Medical Center and Sutter Medical Center, Sacramento are renowned for providing patients specialized Level 4 epilepsy care— a designation by the National Association of Epilepsy Centers—guided by leading-edge research. Sutter researchers are uncovering new clues about how epilepsy develops and how it can be treated more effectively.

Sutter examining new ways to ‘map’ and monitor brain activity

Epilepsy is usually diagnosed with magnetic resonance imaging (MRI) and electroencephalogram (EEG) testing. Those techniques are also used to regularly monitor brain activity in people with the illness. Sutter researchers are studying the use of novel neuroimaging techniques to visualize and track the brain’s electrical activity in people with epilepsy.

For patients with refractory epilepsy (in whom medications are not adequately controlling seizures), a new “high-density” EEG machine is being tested to locate precisely where a patient’s seizures originate in the brain.

“Use of these high-density or high-array EEG machines can help dramatically accelerate research and patient care by identifying the focal point of a seizure,” says Kenneth Laxer, M.D. a researcher in the Sutter Pacific Epilepsy Program at Sutter’s California Pacific Medical Center (CPMC).

With more than 40 years’ experience in epilepsy research, Dr. Laxer is renowned for studying neuroimaging techniques including magnetic resonance spectroscopy for the evaluation and management of the illness. With high-density EEGs, the patient wears a net over their head, and the brain’s electrical activity is recorded from 250-plus electrodes. The recordings are combined with the patient’s own high-resolution MRI scan to help localize the seizure focus. Surgeons use these precise images to remove the section of the brain that’s causing the seizures.

“If we pinpoint that abnormal area, we can remove a smaller portion of the abnormal brain tissue and therefore decrease the risk of serious complications from the surgery,” says Dr. Laxer. He notes that 50-70% of patients who undergo a focal resection may become seizure free. “Most of these patients remain on seizure medications, frequently at reduced dosages; however, the goal of surgery is to bring the epilepsy under control—not to stop epilepsy medication use. Patients who undergo such surgeries typically experience improved quality of life.” Stay tuned later this month for Part 2 of this series on Sutter epilepsy research, which will include information on neuromodulation and anti-epileptic medications.

Stay tuned later this month for Part 2 of this series describing epilepsy research at Sutter.

References: 1. Centers for Disease Control and Prevention. https://www.cdc.gov/epilepsy/about/fast-facts.htm 2. Epilepsy Foundation. https://www.epilepsy.com/learn/types-seizures/refractory-seizures SAN .

Stroke Patient on Integrated Health Network: ‘This Is How Medicine Should Work’

Posted on Oct 25, 2019 in California Pacific Medical Center, Innovation, Neuroscience, Novato Community Hospital, Quality, Scroll Images, Uncategorized

When Patricia Mosier had a stroke, she was worried she wouldn’t be able to stay active. However, the integrated network of care from her community hospital in Novato to the more advanced neuroscience services at San Francisco’s California Pacific Medical Center got her back doing the activities that she loves. “This is how medicine should work,” she says about the continuum of care she received from Sutter’s integrated network. See her story in the following video:

For more on Sutter’s integrated network and how it leads to healthier communities, go to www.sutterhealth.org/newsroom/can-expect-integrated-network.

Sutter Research: Advancing Care for Patients with Breast Cancer

Posted on Oct 21, 2019 in Affiliates, Alta Bates Summit Medical Center, California Pacific Medical Center, Expanding Access, Innovation, Memorial Medical Center, Mills-Peninsula Health Services, Palo Alto Medical Foundation, Quality, Research, Scroll Images, Sutter Medical Center, Sacramento, Transformation, Women's Services

SAN FRANCISCO, Calif. – Breast cancer research has the potential to improve cancer care for the 3.8 million American women living with the illness. Recognizing Breast Cancer Awareness Month, we’re highlighting the bold science and game-changing breast cancer research at Sutter. This work can help advance knowledge of how to detect and treat the illness.

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Keeping pace with cardiovascular diseases research

Posted on Sep 3, 2019 in Affiliates, California Pacific Medical Center, Cardiac, Expanding Access, Innovation, Research, Scroll Images

SAN FRANCISCO – For many people, a quickened heart beat is a normal physiologic response to physical activity or stress. But for at least 2.7 million Americans with atrial fibrillation, an abnormal or irregular heartbeat can lead to blood clots, stroke, heart failure, and other heart-related complications if left untreated. Learn how research at Sutter is helping guide and inform care for patients with this cardiovascular disease.

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Girl Scout Fieldtrip Inspires Life Devoted to Caring for Seniors

Posted on Aug 30, 2019 in California Pacific Medical Center, Quality, Scroll Images, Transformation, Uncategorized

Dr. Wendy Zachary with 100 year old ACE patient Dorothy Bobbet

SAN FRANCISCO –Years ago, a Girl Scout Brownie troop visited patients in a nursing home in South Carolina. One of those little girls was especially impressed by the setting and enjoyed trying to engage with the patients, many whom likely suffered from dementia. Fast-forward to the present. The little girl who spent an afternoon visiting nursing home patients has dedicated her career to ensuring the special needs of older patients are carefully considered.

Wendy Zachary, M.D., is now a geriatrician and medical director of the Acute Care for the Elderly (ACE) unit at Sutter’s California Pacific Medical Center, Mission Bernal Campus hospital in San Francisco. The need for specialized care for older patients is urgent and growing larger, according to Dr. Zachary. “One of our greatest needs in medicine today is having enough physicians and nurses to care for our aging population,” she says.

Figures from the U.S. Department of Health and Human Services illustrate the size of the problem. In 2016, 49.2 million Americans (1 in 7) were 65 years and older. By 2020, there will be 56.4 million Americans over 65, with the fastest growing population being those aged 85 years and older.

Specialized Care for Older Patients Begins in the ER

The ACE unit at Mission Bernal, one of only six such units in California, was designed with the specific needs of older patients in mind. However, special care to address older patients’ needs actually begins at the point where the majority of ACE unit patients enter CPMC’s Mission Bernal Campus hospital—the emergency department.

The team behind the Geriatric Accreditation. Sara Cohen, MS, RN, AGCNS-BC; Wendy Zachary, M.D., Geriatrician; Ritik Chandra, M.D., Emergency Medicine

Mission Bernal’s emergency department is the first in San Francisco to be geriatric accredited by the American College of Emergency Physicians. This accreditation is awarded to emergency departments that are set up to specifically care for older patients who may have cognitive deficits. Mission Bernal’s emergency department staff are trained to ensure that older patients are directed to the appropriate setting for their specific needs, whether they would benefit most from services provided in an outpatient setting or whether they would be best cared-for in the ACE unit.

Programs Enhance Patient Experience, Reduce Cost of Care

“You wouldn’t want your 8-year-old child to stay on a general medicine floor, you would want them to stay on a pediatrics floor,” said Dr. Zachary. “The same idea applies to older patients who have more chronic medical conditions, sensory deficits, cognitive impairment and may have need for special considerations in regards to medications. This individually-tailored care is what our physicians, staff and Hospital Elder Life Program (HELP) volunteers provide to our ACE unit patients.”

At CPMC’s Mission Bernal hospital, ACE unit patients receive tailored support through the HELP program, a comprehensive patient-centered program aimed at decreasing delirium in older hospitalized adults, thereby preserving mental and physical function. Decreasing delirium is important because it carries the same risk of mortality as a heart attack. Mission Bernal’s ACE unit is the only one in California to fully address all six key risk factors for delirium:  hearing impairment, visual impairment, cognitive impairment, functional impairment, having difficulty sleeping and kidney failure due to dehydration.

The cornerstone of the HELP program is deprescribing, which is the planned and supervised process of dose reduction or stopping of medication that might be causing harm, or no longer be of benefit. This starts with normalizing sleep/wake cycles to reduce the risk of delirium in patients. To address sleep/wake cycles, the ACE unit enlists specially trained volunteers to help staff gain insights to motivations that will help mobilize a patient to keep them awake and engaged during the day so that they sleep better at night.  With a better night’s sleep physicians can reduce or eliminate sleep aids and other medications, a step that is shown to lead to fewer complications, fewer falls and a reduced length of stay.

Combined, CPMC Mission Bernal’s HELP program and ACE unit have achieved notable success in the year since the hospital opened in August 2018. So far, length of stay for ACE patients our length of stay is 1.3 days less and our readmission rate is 3% less than standard of care for the older population on non ACE units. With lower length of stay and readmissions, CPMC is safely cutting the cost of care for these fragile patients by over $1 million per year.

By the Numbers

  • The average age of a patient in the ACE unit is 86.
  • Patients age 70 and older can be admitted to the unit for care.
  • The oldest patient to be at the ACE unit was 112 and on the day of discharge this patient walked out of the hospital on their own.
  • More than five percent of patient who are cared for at the ACE unit are 95 year of age or older.

What a Difference a Year Makes

Posted on Aug 29, 2019 in California Pacific Medical Center, Pediatric Care, People, Scroll Images

Baby and Mission Bernal Hospital Share a Birthday

SAN FRANCISCO –One year ago this week, newborn baby Francis Peterson and his mother, were the first patients admitted to the new hospital at Sutter’s California Pacific Medical Center (CPMC), Mission Bernal Campus. Mission Bernal camput hospital opened for service at 7:00 a.m. on August 25, 2018, and shortly thereafter Francis and his mother were wheeled over on a gurney from the old hospital where he was born, to be the first patients through the door.

Now Francis is one year old! For a child, celebrating a first birthday is a major milestone with parties and gifts—whereas a hospital’s first year milestone is acknowledged and quickly moved past in the name of focusing on continuing to provide high quality healthcare.

Opening Mission Bernal hospital’s doors was the beginning of a new chapter in medical care for San Francisco’s southern neighborhoods. With a beautiful new building, and a new name that reflects the neighborhoods in which it’s located. Mission Bernal hospital offers new and expanded services to the community including larger departments for emergency services–with a geriatric accreditation, as well as a larger labor and delivery unit, orthopedic surgeries and the Acute Care for the Elderly (ACE) unit dedicated to the care of patients over the age of 70.

In one year, with 800 babies delivered and over 3,200 surgeries performed, CPMC’s Mission Bernal Campus hospital has become the community hospital of choice in the southern section of San Francisco.

Happy birthday Francis and happy anniversary to Mission Bernal and its dedicated staff and physicians!