One of the first of its kind, the UCSF Neurohospitalist Program specializes in caring for hospitalized patients with complex neurologic disorders. The team includes neurologists, neurosurgeons, neuroradiologists, neurointerventional radiologists and neuropathologists. “Our strength is interdisciplinary care,” said Vanja Douglas, MD, director and division chief of the Neurohospitalist Program. UCSF serves as a national referral center for patients with common, rare and difficult-to-diagnose neurologic conditions.
The following case examples illustrate how the team’s unparalleled clinical and scientific expertise results in outstanding patient care.
Electroconvulsive therapy for refractory status epilepticus
A 23-year-old woman who had a fever, cough and runny nose for five days went to her local emergency department when she began experiencing confusion. While in the ED, she developed status epilepticus and was intubated. After a month of hospitalization with refractory status epilepticus, she was transferred to UCSF, where she was seen by neurohospitalist team members, including Douglas and Manu Hegde, MD, PhD, neurologist and epileptologist.
When the patient arrived, an electroencephalogram (EEG) showed ongoing seizure activity and she was started on continuous video EEG monitoring. The team performed electroconvulsive therapy (ECT), which resulted in a remarkable resolution of her seizures. Soon after starting this therapy, she began responding and following commands. She recovered from status epilepticus and was discharged home a month later, with residual short-term-memory difficulty and intermittent seizures.
“This was a very dramatic case, and a wonderful outcome for a disease with very high mortality,” Douglas said.
Genetic metabolic disorder identified as cause of epilepsy and renal failure
A 41-year-old man had developed epilepsy 10 years after a traumatic brain injury. Four years later, he’d begun experiencing rapidly progressive cognitive decline and renal failure requiring dialysis over a three-month period. He was brought to a local hospital, where he continued to have seizures and profound confusion.
The patient was transferred to UCSF, where the neurohospitalist team started him on continuous video EEG monitoring. Intermittent seizures were detected and treated. However, he continued to experience confusion disproportionate to his seizure activity.
The team consulted with UCSF metabolic genetics and nephrology specialists to help identify the cause of the patient’s epilepsy and end-stage renal disease through genetic testing. He was found to have cobalamin C deficiency, an inherited metabolic error that can cause epilepsy, cognitive decline and renal failure. The patient had elevated homocysteine and methylmalonic acid levels and was treated with hydroxocobalamin, betaine, folinic acid and levocarnitine. He was discharged home and has been gradually recovering his cognitive function and participating in daily activities with his family.
“We looked at the case holistically to understand the underlying basis of his end-stage renal disease, cognitive decline and epilepsy, an unusual combination of symptoms in a young man,” Douglas said. “We found a unifying genetic diagnosis that led to a considerable change in management and will impact his life significantly going forward.”
Neurology and neurosurgery research and treatment take place within the UCSF Weill Institute for Neurosciences.
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