Healthy Rounds With Dr. Anthony Alessi

UConn Health

Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention, hosted by Dr. Anthony Alessi, UConn Health neurologist and clinical professor of neurology and orthopedics in the UConn School of Medicine.

  1. 4d ago

    The Breast Cancer Breakdown

    How much of a factor is genetics when it comes to breast cancer, and how does that inform the best treatment approach? As Dr. Daniel Morgenstern, who specializes in breast cancer and genetics at UConn Health, explains, there's quite a spectrum when it comes to types of breast cancer, and immunotherapy, while promising, is not effective with a majority of them. Dr. Morgenstern also discusses the evolution of breast cancer awareness, today's recommendations on mammograms, and how personalized medicine figures into the future of breast cancer treatment. Submit questions for the Healthy Rounds Podcast: healthyrounds@uchc.edu Dr. Daniel Morganstern: https://www.uconnhealth.org/providers/profiles/morganstern-daniel Breast cancer diagnosis and treatment at UConn Health: https://www.uconnhealth.org/cancer-blood-disorders/services-specialties/breast-cancer Breast cancer screening at UConn Health: https://www.uconnhealth.org/cancer-blood-disorders/prevention-screening/breast-cancer-screening UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date, timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health with support from the Department of Orthopedic Surgery and a grant from Coverys. This podcast is not designed to direct your personal healthcare, and that should only be done with your physician.  I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Daniel Morgenstern. Dr. Morgenstern is an associate professor of medicine here at the University of Connecticut, and working at UConn Health in the Carole and Ray Neag Comprehensive Cancer Center. His specialty is breast cancer and genetics.  Dan, welcome to the show.   Dr. Morganstern: It’s great to be here.   Dr. Alessi: Let’s chat a little bit. As we all know, this is Breast Cancer Awareness Month. Nowhere in our history have we seen a more successful campaign than Breast Cancer Awareness Month, right? National Football League players are wearing pink. Baseball players are wearing pink.  Everything merges at one time. And yet, I guess my real question is, in this period of time where we’ve raised awareness of breast cancer, what has been the result? Are we making headway?   Dr. Morganstern: Absolutely. I mean, I think if you go back to the 1970s and think about Betty Ford, when we all remember her diagnosed, you know, one of the original problems was that this was a disease in the shadows, and there was all kinds of embarrassment and shame associated with that.  And as you mentioned, this has sort of been flipped, the script’s been flipped, and, really no one has shame anymore. People are comfortable talking about the experiences they’ve had, peer support among survivors, and again, it’s sort of out of the cloaks of embarrassment and so forth, and really something that everyone feels comfortable addressing with their primary care provider, screening, and so forth.  So it really has become something that I think has worked to improve screening and outcomes.   Dr. Alessi: You know, one of the things that’s impressed me most about breast cancer care is the development of a multidisciplinary team that approaches breast cancer. Can you tell our listeners what they should be looking for in a team?  Because it’s not just a surgical approach, as it has been in the past. Can you talk a little bit about the team here at UConn Health and the approach to breast cancer?   Dr. Morganstern: So yes, it is a multidisciplinary disease, and our patients will be the first one to tell you that, both in a positive and negative ways.  In a positive way, they have a group of physicians. You might say the triad is between a medical oncologist, a radiation oncologist, and a surgeon. So they have three people who independently but collaboratively are thinking about their case, and all cases are reviewed at our multidisciplinary tumor board, and this results in sort of a optimized outcome and a tailored outcome for each patient.  I say there’s a flip side of it, which is I always say that the most multidisciplinary person of all is the patient because they’re subject to both the benefits and also the toxicities of all therapies. So sometimes those are sort of mitigated. For example, we have data that shows that in some patients, if they take an endocrine therapy, they can safely defer radiation therapy.  So not only do we work together, sometimes we decide who can step aside and patients who can defer various modalities.   Dr. Alessi: I just want to talk a little bit about probably a somewhat controversial topic that shouldn’t be controversial, and that is mammography, right? When a woman should get mammograms, right?  We’ve had the Professional Services Task Force, the Federal Task Force come out with their recommendations. And in many cases, that’s been in conflict with the professional societies. Can we clear up for our listeners, when should women begin to go and get a mammogram?   Dr. Morganstern: Okay. Correct.  There are different recommendations. The American College of Radiology recommends annual screening for average-risk women beginning at age forty, with the U.S. Preventative Task Force prior to this administration, recommending a more liberal onset that considering once every other year mammography within the forties and not going annually until the fifties.  I would break down two aspects of how you address this question. One is a public health question. Where is our money best spent in screening and so forth? And the other relates to how screening could harm if misapplied to the wrong population. And what I would say is that unquestionably there is some element of what we call over-diagnosis.  We know that with the onset of mammography from the nineteen eighties to the two thousands, there was a skyrocketing incidence of early-stage breast cancer, but not a requisite decrease in later stages of breast cancer, and much of that was the DCIS or so-called pre-cancer, stage zero. But I think we’ve pretty much landed at an annual mammography for the average risk patient beginning at age forty.  Now, very interestingly, Laura Esserman spearheaded a trial that was reported last year called the Wisdom Trial, which was an online phone app-based research which risk-stratified patients for either more intensive screening than annually or less intensive screening than annually based on risk factors like genetic testing, breast density, and so forth. They actually showed with that study that even when they had risk-adapted screening with many women having screening at lesser intervals, the outcomes were essentially the same in terms of the ability to identify early-stage disease and cure rate.  So this was a very important contribution. There may be more evolution of our guidelines in the future where we can say to someone that based on your polygenic risk score and your risk factor estimates, maybe they can defer to every other year. And that is a growing emerging field that I have a lot of interest in.  Dr. Alessi: Let’s talk a little bit about taking a step back, you mentioned risk factors, right? I’m assuming those include smoking and other things such as that. But what else? How big a role do genetics and family history play? And do you recommend that if there’s a family history, women begin getting mammograms earlier?  Dr. Morganstern: So I’ll use our vocabulary a little bit carefully. We can talk about familial breast cancer where there seems to be some overabundance of breast cancer within a family tree, but no gene identified. And then we can talk about those cases where there’s sort of a smoking gun, if you will, BRCA1, BRCA2.  The latest and most important gene second to those is PALB2. In those cases, we can say that probably about five to seven percent of breast cancers can be explained by a single gene mutation that predisposes the woman to develop breast cancer or man. Alternatively, we know there’s this other familial clustering that occurs in families that is independent of any single gene mutation, and this is the growing field of polygenic risk scores where they look at all throughout your genome, little subtle changes that by themselves don’t do anything very much.  But if you have a number of these, it does elevate your risk. Again, this is a field that’s a hot field that I hope to be doing some research in terms of risk stratification as well.   Dr. Alessi: Is it because of the genetics that some women advocate for bilateral mastectomies?   Dr. Morganstern: So again, we have to talk carefully about which genes and so forth.  So we call BRCA1, BRCA2, and PALB2 highly penetrant or highly to moderately penetrant genes where the cumulative lifetime risk of developing breast cancer and developing breast cancer at early age is quite high, over 50%. And in those patients, risk-reducing mastectomy and reconstruction has come a long way.  Obviously, it’s an option for those patients, although there are many patients who choose to do surveillance with enhanced surveillance such as MRI as well, and this has been shown to save lives as well in that patient population. So, there is an alternative to risk-reducing surgery. When we have lesser penetrant genes such as CHEK2, ATM, which might be having a lifetime risk of breast cancer anywhere from like 15 to 30%, in those individuals, most do not opt for risk-reducing surgeries.  Dr. Alessi: I’m going to shift gears a little bit and get into a field that’s somewhat confusing even for me, and that is receptors, right? Are receptors good? Are receptors bad? Are some good, some bad? Because we hear about these receptor-positive, receptor-negative tumors. Can you give us th

  2. Sep 15

    Progress With ALS and Other Neuromuscular Disorders

    ALS (amyotrophic lateral sclerosis, commonly known as Lou Gehrig's disease) is a devastating motor neuron disease that effects movement, speech, swallowing, and breathing. Dr. Cristina Viguera, who practices neuromuscular medicine at UConn Health, joins Dr. Alessi to discuss some potentially promising research findings in ALS, as well as some progress in treating the genetic condition spinal muscular atrophy.  Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Cristina Viguera: https://www.uconnhealth.org/providers/profiles/viguera%20altolaguirre-cristina Neuromuscular Medicine at UConn Health: https://www.uconnhealth.org/neurology/neuromuscular-medicine UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their field. This podcast is brought to you by UConn Health with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. It gives me great pleasure to have as my guest today Dr. Cristina Viguera. Dr. Viguera.is assistant professor of neurology, and she is a specialist in neuromuscular diseases that affect the nervous system. Cristina, welcome to the program. Dr. Viguera: Thank you so much for having me. Dr. Alessi: Let’s chat a little bit. You’re relatively new here at UConn Health, so can we talk a little bit about, your background? What brought you to us? Dr. Viguera: So let’s see. It was a long journey to specialize in neuromuscular medicine. So I’m originally from Spain, and I came to the United States to do a degree in neuroscience at first, actually, and then I got really interested in neuromuscular medicine, had an early interest in ALS, decided that I wanted to not just do research, but I decided to pivot to clinical work. I was at Johns Hopkins for university, medical school, and then I went to Boston to do my residency in neurology and then neuromuscular medicine, and then I came over here to do just that. Dr. Alessi: Let’s talk a little bit about neuromuscular medicine and various neuromuscular diseases. What are some of the conditions that you spend your time researching and treating? Dr. Viguera: I like to tell people in neuromuscular medicine, within neurology, there’s so many different fields. You have stroke for things related to the brain, dementias. In neuromuscular medicine, it’s really about select type of neurons that go from the spinal cord to your muscle. So I joke if it’s anything that can affect your ability to move or feel, it probably is related to neuromuscular medicine. So commonly that’s going to be neuropathies are a common condition that we see, myasthenia gravis, so that’s on the more autoimmune side, and also a lot of genetic conditions like muscular dystrophies, spinal muscular atrophy. We see all of those. Dr. Alessi: So when a patient comes to your clinic, what can they expect in terms of the amount of time they spend and what tests are typical that you might order? Dr. Viguera: So oftentimes when a patient sees a neuromuscular doctor, they’ve probably seen a couple of doctors by then. So someone has probably evaluated that person and said, “Hmm, there’s something else going on here,” or, “This is not your typical neurological condition.” And they’re suspecting maybe one of these more rare disorders. And they might order some tests in advance, they might order some MRIs to make sure that there’s not something in the brain, an EMG, an electromyography study, where they test the function of the nerves and the muscles. And then they come to our clinic. We review all the information. We take a careful history and examination, and we come up with a plan. And we order those tests as well if they haven’t been done, but it’s a very comprehensive evaluation, and we do many of those tests in-house. So usually we’re talking about a one-hour appointment for the first time. Dr. Alessi: One of the things in neuromuscular medicine that I think distinguishes it from neurology is that it’s so multidisciplinary. Can you talk about some of the other disciplines that play an important role in seeing a patient in the neuromuscular clinic? Dr. Viguera: For sure, yeah. So one of the things in neuromuscular medicine, to your point, I mean, a disease can affect so many parts of a patient’s life, right? So we’re talking about these conditions that affect people’s mobility, people’s day-to-day function, their speech. So a lot of what we do in neuromuscular medicine is that we’re bringing all these other fields, so the occupational therapists, physical therapists, respiratory therapists, and have this team-based approach so that we can treat people and try to improve their quality of life and their independence as long as possible. Dr. Alessi: One of the most feared diagnoses we ever have to share with a patient is Lou Gehrig’s disease, amyotrophic lateral sclerosis, and it is one of the motor neuron diseases. Can you talk a little bit about, globally, what motor neuron diseases are, and maybe we’ll drill down a little bit on some of the other ones that are less familiar to our listeners? Dr. Viguera: Yes, of course. So yeah, the nomenclature of motor neuron disease has changed quite a bit. It was coined by Lord Brain way back, and since then our understanding has changed a little bit. So amyotrophic lateral sclerosis is the more classic disorder, or Lou Gehrig’s disease, where it affects certain types of these motor neurons, the neurons that affect motion, movement, speech, and swallowing, and breathing. Dr. Alessi: I’ve got to ask you a question. It just came to mind. Do they call it Lou Gehrig’s disease in other parts of the world? Like, I trained in Italy, and we didn’t really call it Lou Gehrig’s disease. Did they call it that in Spain? Dr. Viguera: They did not. Dr. Alessi: OK Dr. Viguera: They did not. Dr. Alessi: I’m just curious. I just struck me. I mean, I just wondered if Lou Gehrig reached international fame, but anyhow, sorry for the interruption. But it just struck me. Dr. Viguera: No, no, no, it’s a good question. But I feel like it’s more known as Lou Gehrig’s here, ‘cause that’s how it was popularized. But right, so within motor neuron diseases, there’s, depending on which type of motor neuron, the final appearance of it in a person and on the testing that we do is a little bit different, and that’s kinda where some of the nomenclature changes. But at the end of the day, we think that the biology of it is actually quite similar. Dr. Alessi: In terms of all -- So in other words, all motor neuron diseases share the same biology? Dr. Viguera: Yes. Dr. Alessi: OK Dr. Viguera: Yes. So something happens at the level of the neuron that results in its degeneration. And then just the way that it looks in a given person can change depending on whether it starts in the lower motor neurons, in the upper motor neurons, in the hand, around the face, and that’s where a given person with Lou Gehrig’s disease can look very different from another person where maybe the site where the disease started looked a little bit different. Dr. Alessi: One of the areas where we’ve had some success in treatment has been spinal muscular atrophy, which is one of the motor neuron diseases. Can you talk a little bit about spinal muscular atrophy and the success? And I know that you have a system here for treating these patients, which is fairly complex. So can you talk a little bit about that and the system you have in place here for treating patients? Dr. Viguera: Of course. Yeah, spinal muscular atrophy, it is one of these disorders that affects the motor neurons. It is a genetic condition, so, it is now included in the newborn screen, so people know from birth if they have the condition, and it’s a treatable disorder. It’s one of the great examples that we have in neuromuscular medicine, but also in, in neurology, I would say, of really getting to the understanding of how the disease comes about, what’s the biology behind it, and then how can we do a targeted therapy to stop the disease. And it’s been extremely successful, so we have multiple treatments now available for spinal muscular atrophy, and we do have a clinic dedicated towards that here as well. So these are treatments that are targeting, I mean, are going into the spinal fluid, some of them. Other ones are taken by mouth, and they stop the disease progression. Dr. Alessi: That’s fascinating, right? Because, as someone who’s much older than you who’s trained in it, we often didn’t have anything to share with them. But let’s go to ALS and Lou Gehrig’s disease, and you mentioned about it affecting upper and lower motor neurons. Can you explain that distinction and how it affects the patient? Dr. Viguera: Yes. So the way that it would most typically present is it starts with weakness. Usually will start in an arm, like a hand with a clumsy hand, dropping things, in the foot, so people will start tripping over things, or maybe their speech and they have trouble swallowing and with their speech, and it’ll progress from there. So it’ll start involving other parts, other neurons nearby. And so when we say the lower motor neurons, that’s going to be in the form of losing the muscle, getting twitching, things like that that we observe on examination. And then the upper motor neurons, those are the ones that go from the spinal cord above, and they will result more in the stiffness that people might experience, and it changes some of the symptomatic, the treatment options that we offer. Dr. Alessi: So let’s talk about those. In terms of -- one of the things we

  3. Sep 1

    Great Strides in Cancer Treatment

    The idea of using cells from your own tumor to develop a personalized vaccine that guides your immune system to fight your cancer goes back several decades. Today, we are on the verge of using messenger RNA to bring this concept to a new level, one that could change how we treat melanoma and other cancers. Dr. Margaret Callahan, chief of UConn Health’s Division of Hematology and Oncology and medical director of the clinical trials office, explains how immunotherapy works and why it holds so much promise. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Margaret Callahan: https://www.uconnhealth.org/providers/profiles/Callahan-Margaret UConn Health Division of Hematology/Oncology: https://health.uconn.edu/medicine/divisions/hematology-oncology/ UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information provided by national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. I’m your host, Dr. Anthony Alessi, and it’s important for me to mention that this podcast is not an indication of what you should be doing in regard to your personal health. It is only there for information, and any personal health decisions should be provided between you and your personal physician. I’m very happy to have as my guest today, Dr. Margaret Callahan. Dr. Callahan is a professor of immunology and medicine here at UConn Health. In addition, she’s chief of the division of hematology and oncology. Maggie, welcome to the show. Dr. Callahan: Thanks so much for having me, Tony. Delighted to be here. Dr. Alessi: One of the things that prompted us to do this show today has been a lot of new information for the treatment of melanoma. But before we get into that, let’s backtrack a little bit, and if you could, tell our listeners a little bit more about skin cancer and melanoma. When I think of those topics, I think, when I was young, we didn’t have SPF, right? People used to go to the beach to get tanned. Some still do. I remember people using baby oil and iodine combinations, right? And now, I mean, we have so many levels of SPF, and we are more alert to the fact of skin cancer. When did that shift change? Dr. Callahan: Well, I’d say in the past couple decades, and if we bring it to today, where I slather my kids up with, I think it’s SPF 70 now, multiple hours at the pool, some of that just comes from knowledge of the biology of skin cancers. Skin cancer is the most common cancer we see in humans, and there are two big families. There are keratinocyte skin cancers, which are basal and squamous skin cancers, and these are usually very treatable, but they are related to sun exposure, so you can save yourself some trouble by avoiding or safely interacting with the sun. The more dangerous cancer that we’re talking about today, melanoma, starts with the pigment-producing cells in the skin. Those same skin cells that give you a great tan, they produce that pigment, and the tan we’re looking for can also go awry and become melanoma. And the reason we get scared about melanoma is because if it’s not caught early, it can spread to other organs and become a bigger problem. Dr. Alessi: Maggie, are we becoming more aware of it also? Has it become more dangerous? Now, I’m talking about in the last 40 or, 40 or 50 years. Has the sun become a more potent enemy? Dr. Callahan: Oh boy, this is a little outside of my area of expertise as a medical oncologist, but I do think the evidence out there is that changes in the environment and environmental exposures are exposing us to a little bit more UV, and maybe also changes in patterns of behavior. But I do think part of the reason that we are seeing more melanoma comes from a couple of good problems we have. First, we’re living longer, and skin cancer and other cancers are often a disease of accumulated exposure over lifetimes. So the longer you live, the more exposure you’ve had. That’s a good problem to have. Dr. Alessi: Oh, absolutely. Dr. Callahan: And second, we’re looking harder, and we have better tools to find skin cancer, and so we’re finding more. And that’s also, in a way, a good problem to have. On a positive note, and to circle back to this idea that sun avoidance or safe sun exposure is a good strategy, according to the American Cancer Society, even though skin cancer rates are rising in people 50 and above, for people 50 and under, those folks who maybe were exposed to this high SPF environment, skin cancer rates are actually stable or slightly down. And so it does appear that maybe there are some modifiable risk factors that we can control our risk. Dr. Alessi: Well, that’s interesting because, I’m encouraged, because it sounds like we’re having some benefit from all these new fabrics we’ve designed and people are wearing, and you see so many, especially children, in the pool wearing long sleeves and, and covering up. Dr. Callahan: Hats. I’m a big fan of hats. Dr. Alessi: You know, hats are key, especially with a big brim. Dr. Callahan: Yeah. Dr. Alessi: Because I’ve seen, and have had friends, where they get it right on the top of their ears with that exposure. But can we talk a little bit about what is messenger RNA? We all have come to know this term from COVID. How has that helped us design vaccines, and how is that helping us with designing a, a treatment for cancer? I have to say, and I appreciate you sending me over some articles because I never heard the term “neoantigen” before, despite my years in medicine, so I’ve learned a lot, and that’s the advantage of doing this show. But can you talk a little bit about messenger RNA and what role that is playing in what I consider almost a revolutionary change in medicine? Dr. Callahan: Yeah. Messenger RNA, in part because of the success with the COVID vaccine as a strategy, has gotten a lot of press, and it’s a tool, and I’m going to try to explain how this tool works. So if we think of DNA, our genetic material, DNA, as kind of a master cookbook, has all the recipes we need to do whatever our cells need to do, a messenger RNA is like a photocopy of that recipe, like, a single little recipe from the whole cookbook, and you can deliver it, bring it to the kitchen and say, “Hey, can you make, I don’t know, a donut?” And the cell reads that recipe, makes the donut, and throws it away. The messenger RNA vaccine is simply taking that little snippet, that little recipe of messenger RNA, putting it in a little fat bubble to protect it, and delivering it to the cell, and then the cell carries out that recipe, but it doesn’t change your DNA. It’s a temporary instruction. The mRNA degrades, and it’s gone. Dr. Alessi: OK. And I hope we really get that out there because I think there’s this fear of messenger RNA even from the people who determine our funding, right? I think right now, NIH and the federal government no longer provides funding for messenger RNA studies. Dr. Callahan: Gosh, it’s hard to keep track, and I wouldn’t purport to be an expert in what’s approved and not approved right now from a federal funding level. But certainly there’s been a lot of concern, and I think some concern along the lines that, that maybe just fundamentally show some misunderstandings or some mistaken understandings. Like I said before, this does not change your genetic material, it’s a temporary message, and so maybe not as scary as some people have led us to think about it as. And then from a scientific standpoint, the real advantage, the reason this is being embraced as a technology is it is fast and flexible, meaning we can invent this recipe, deliver this recipe, as you saw with the COVID vaccine, in a matter of months, expediting the delivery of new therapies in a way that’s almost inconceivable, and manufacture it, get it to patients, and really help them out very quickly. Dr. Alessi: Well, clearly the pharmaceutical companies have not turned their back on messenger RNA since I think that’s where most of the research, whenever we hear of research coming out, it’s coming out from Biogen and companies such as that. But if we’re to move on, how have we used messenger RNA to treat melanoma? Dr. Callahan: Well, up until now, we haven’t, meaning messenger RNA platforms up until now have mostly been applied to vaccines in a more classic setting in infectious diseases, COVID being a good example of that. And so what’s really novel here is marrying the technology of messenger RNA, which is novel and cool in and of itself to a second really cool idea, and that’s the idea you alluded to before, which is neoantigens. Dr. Alessi: Right. Dr. Callahan: So infection-oriented vaccines are going to give you a little taste of whatever infection we want to prevent in advance of you being exposed to the infection and try to get your immune system geared up and ready to fight off that infection if it comes along. But this is a very different challenge we have in cancer We’re not preventing cancer with these vaccines yet, not in this setting. What we’re doing is taking patients who have had melanoma, where we can cut them out, cut out the melanoma with a surgery, but we know there’s a risk that the melanoma will come back, and we’re using the vaccines in this setting to try to redirect the immune system to pay attention, eradicate residual melanoma cells, and protect the patient from the melanoma coming back. And the strategy we’re using here is a little different than the preventive vaccines we use for infection. Dr. Alessi: So one of the things, this all falls into the idea of personalized medicine, right? So when we create a spe

  4. Aug 18

    Concussions and Sports Neurology

    As we get ready for football season, Dr. Alessi brings on a fellow expert in sports neurology, Dr. Stephanie Aless-LaRosa, program director of the UConn Health Sports Neurology Fellowship. They discuss not only concussions (which is more than just a football issue) but also other conditions they see in the sports context, how more folks seem be active for longer, the perspective of a team physician on the sideline, ways to possibly reduce injury risk, and other specialties involved in sports neurology,  Submit questions for Healthy Rounds: healthyrounds@uchc.edu UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine UConn Health Sports Neurology Fellowship: https://health.uconn.edu/graduate-medical-education/sports-neurology/fellowship-program-contacts/ NeuroSport at UConn Health: https://www.uconnhealth.org/orthopedics-sports-medicine/services-specialties/neurosport Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery, and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have today as my guest, Dr. Stephanie Alessi-LaRosa, who some of you may know is also my daughter, of whom I’m very proud of her accomplishments as assistant professor of neurology here at UConn Health, and also team consultant for UConn Sports. Steph, welcome to the show. Dr. Alessi-LaRosa: Thanks for having me. Dr. Alessi: Let’s talk a little bit. You’re a sports neurologist. Can you explain to our listeners your training and what a sports neurologist does? Dr. Alessi-LaRosa: Absolutely. So I am a board-certified neurologist, and I completed a residency in neurology here at UConn, and I did a fellowship, an additional training year, in sports neurology at the Kutcher Clinic for Sports Neurology in Michigan, and now I’m a practicing sports neurologist here in Connecticut. Dr. Alessi: What are some of the conditions that you run across? I think right away when people think sports neurologist, they think concussion, but it’s obviously a lot more. So can you talk about some of the conditions people come to you with? Dr. Alessi-LaRosa: Yes. Concussion is certainly the number one thing, I think, again, like you said, most people think of, but we treat most commonly headaches or migraines. Those are the number one thing we treat outside of that. But really anything neurologic that occurs in active people is really our patient population. That could be patients who have dizziness or neurologic symptoms that we will then determine what’s the source of it, how to get them back playing and participating in their life the way that they want. Dr. Alessi: What do you find are some of the typical sports the laypeople — We know you see a lot of football players and high-level athletes, but — during the course of your day when you say active people, what are people doing now? Because it seems like people who are older and older are becoming more active in sports. What are some of the sports you see people participating in now that you may not have seen previously? Dr. Alessi-LaRosa: I think there’s all levels of participation. I do think that overall the population, especially in the aging population, has recognized that activity is very important for longevity of their life. So I do think that I see older folks even doing hockey leagues, and so there’s just quite a spectrum. Some folks do yoga and more gentle sort of exercises, but really being active does seem to be carrying people through their life in a healthy way. Dr. Alessi: Well, we’re coming up on football season, so let’s talk a little bit about football itself. Obviously, the thing we fear most and people fear most are injuries to the brain and spine, as a result of a high-velocity collision sport like football. When we’re on the sideline working, can you share with our listeners a little bit about what we’re doing on the sideline, and what is our job, our role standing on the sideline? Dr. Alessi-LaRosa: Yes. Really, we have to be paying attention to every play, because if we miss the hit, that’s really our first examination, how players are getting up from each play. So our observation is extremely important, especially because a lot of the players want to continue to play and act like nothing happened, and they may have even lost consciousness and not be aware of what happened. So if we don’t see it, then that does put us at a disadvantage, and we really want to keep the athletes as safe as possible, so our awareness is key. But also, we’re available to evaluate anybody for potential concussions, or other even peripheral nerve injuries, or, like you mentioned, spinal cord injuries, anything that may have occurred during the play. And sometimes we use the tent that’s on the sideline at UConn or even taking athletes into the locker room and assessing them to try and limit the distractions. Dr. Alessi: Since we’re chatting about the sideline, when I started out in this field, we didn’t have a lot of video. But now, how important is having video available instantaneously on the sideline for you to make a decision? Dr. Alessi-LaRosa: I find it’s extremely helpful. I think that’s one of the benefits of having a spotter that they put high up, someone else who can actually watch just the plays and look at all the monitors that are happening above, and then getting us that information on the sideline, because our view is not great, to be honest, where we’re standing. So it makes it hard in a lot of ways, but at the same time, we need to be there. So it’s difficult, but I find that the videos help a lot because you can see different angles, you could slow it down, you can see what happened after the hit, how long it took the person to get up, what initial post-impact signs there were. Dr. Alessi: Well, now we have the tent, which we’ve had in the last few years, where we bring a player in and do an assessment. Can you share with the audience what we’re doing in the tent to help make a decision? Dr. Alessi-LaRosa: Well, certainly we take the, especially in football, we take the athlete’s helmet off. Someone has to hold the helmet so that they don’t try to run back out on the field too quickly. Dr. Alessi: Good, good point. Dr. Alessi-LaRosa: Yes, that’s number one. But really we’re asking a couple of questions, really just doing our assessment. Neurologically, we would be asking some questions about what happened, what they recall, what quarter we’re in, who they played last week, things like that. And then going into our assessment, checking their eyes, checking their coordination, checking their eye movements, balance, some things like that, to get to a decision that everyone’s comfortable with. And there’s very few people usually in the tent, because it is a small space. So it’s usually just the necessary folks there. Dr. Alessi: A lot of people are curious about baseline testing. Baseline testing has become kind of a buzzword, with, I think it was back in the early 2000s, maybe even the 1990s, when impact became available, and they started doing impact testing, which is still done today. And then there’s sway testing and, C3 Logic. How important do you find baseline testing in your work? Dr. Alessi-LaRosa: I think it’s, it has a role. In some ways, it’s very important to understand what somebody looked like before if you have that information available. But in the most recent consensus statement that came out, it really does not emphasize too much of that. You can actually use normative data of what we would expect in people that age. So you don’t have to have baseline testing, but I do find that clinical over computerized baseline testing is the most beneficial because you can really put any findings into a clinical context, whereas with a computer, it’s leaving that part out. So impact or sway or some of these other computerized testing, they do have their limitations, but really the clinical evaluation and baseline testing from like a SCAT type of evaluation, which an athletic trainer typically can do preseason, is usually higher quality there. Dr. Alessi: Now, your research has actually looked at doing clinical examinations as baselines in athletes before they would have an injury, meaning an actual clinical examination. Can you tell us a little bit about, um, how... what you found by, by looking at that in high school athletes? Dr. Alessi-LaRosa: Sure. We have a small study being done, and over time of a high school career, so over the four years of a high school career, we haven’t found any significant changes in the athlete’s neurologic examination, their eye movements. We do a depression screening before each season starts with their first contact practice, and we have not seen dramatic changes. So over the course of a high school career, I think that’s important information, that there is maybe more benefits than risks at that level. Dr. Alessi: So it sounds like the brain is a fairly resilient organ if you treat it right. Dr. Alessi-LaRosa: Absolutely. Yes. Dr. Alessi: Let’s move on to injury prevention. Everybody wants to know, how do I prevent a concussion? And people are always coming up with new designs for helmets. Do I buy a more expensive helmet? Is that the best helmet? But there are other ways, so can you talk a little bit about some of the other ways that we’re able to prevent concussions from happening in young athletes? Dr. Alessi-LaRosa: Yes, I think there’s a few that certainly the helmets and mouth guards, those get a lot of the focus. People thin

  5. Aug 4

    Wide World of Western Sports

    The term “Western sports” refers to events like roping, steer wrestling, bareback riding, saddle bronc riding, and bull riding — some of the most dangerous forms of competition. Applying his expertise in neurology and sports medicine to care for these athletes over the last several years, Dr. Anthony Alessi has developed a unique perspective on this world. Professional bull riders have been flying in from other parts of the Americas to see him at UConn Health since 2018, when the first two arrived, concerned they’d leave with doctor’s orders to stop competing. In this solo episode, he shares his insight on the dynamic of the Western sports culture, why many of them lie to him, and what became of those first two bull riders who came in for neurological evaluations. Submit questions for Healthy Rounds: healthyrounds@uchc.edu UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine NeuroSport at UConn Health https://www.uconnhealth.org/orthopedics-sports-medicine/services-specialties/neurosport Western Sports Foundation https://wsf.org Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health. with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to be with you as always on this podcast. Today’s going to be a little bit different. I’m going to be talking about a program that I’m involved with here at the University of Connecticut, and it involves Western sports. Now, Western sports present a unique challenge for sports medicine physicians, and we’re going to talk about that and my work with this outstanding group of athletes. In the podcast, we’re going to define what Western sports are, talk a little bit about the historical background and the rules of Western sports, my involvement, as well as the involvement of UConn Health. So let’s get started. When we talk about Western sports, we’re talking about two different types of events. There are timed events, such as tie-down roping, team roping, steer wrestling. So basically, your success is based on the amount of time it takes you to do something. Then there’s what we call “rough stock” events. Now, the rough stock events are events that focus on riding and breaking animals, and basically we’re talking about bareback riding, saddle bronc riding, and bull riding. And we spend, most of our discussion today will be centered around bull riding. A little bit about the history: The Western sports really came to light in about the 16th century as a contest back in what was old Mexico, and it was a variant of bullfighting. So when we think of bull riding, it was a variant of bullfighting, and basically the idea was to stay on the back of the bull. It was modeled after the matadors and bullfighting itself. In 1992, 20 professional bull riders got together and formed what’s now known as PBR; it’s basically a professional bull riders tour. Bull riding was always the last event in a rodeo, and it was one that people felt was the single most exciting event. So they decided to start their own system, their own company. And because bull riding is really among the single most dangerous sporting activities in the modern era — and that’s been documented throughout the literature; it’s really an extreme sport — and people especially now are drawn to these extreme sports. So in bull riding, the rules are that the rider has to stay on the bull for a period of eight seconds. Doesn’t sound like it’s very long, but you’d be surprised when you actually watch an event. It begins when the bull’s shoulders or their hind parts break the plane of the chute. That’s when the clock starts, and it ends when the rider either falls off, or his hand comes loose from the bull, or he touches the bull with what we call his free arm, the arm that’s not strapped onto the bull itself. And the rider then gets assigned points. The points are based on a 100-point scale. Fifty points are attributed to the bull’s performance and 50 points to the rider’s performance. There’s always been a lot of talk about cruelty to the bulls, and I can tell you from personal experience that the bulls are treated like VIPs. The reason is, stock contractors make their money from the bulls. The bulls are highly paid, or at least the contractors are paid. So it really would be a mess for them from a financial standpoint to harm or be cruel to the bulls. So these bulls are bred and treated quite well. A lot of the bull riders now are international, mainly from Brazil. So I’d say about half of the bull riders are from Brazil, many from Western Canada, and we’ve had the pleasure of working with all of them over the years. The number of participants now, there are about 1,200 professional bull riders. The typical bull rider is an average age of 20 years old, average height of 5 feet, 7 inches, and weight of 139 pounds. So physically, they are smaller and lighter athletes. And again, I use the term “athlete.” Let me digress a little bit. For many years, they were treated much like performers, that they are, like all athletes, but they were not treated like athletes. So the traditions that we extend to other athletes in organized sports were not really extended to Western sports athletes. In fact, it’s only the PBR tour that has their own athletic trainers and physician at every event, and really only at the highest level. There are physicians at many other events, especially with the PRCA, but not to the degree of PBR. Riders usually start riding steers at age 7, so they start very young. Before age 7, they’re riding calves and sheep. And it’s also important to note that professional bull riders and Western sports athletes fit into the category of “self-employed athletes.” The difference being, when we think of baseball, football, basketball, these are employed athletes, right? They come under the employment of a team. They have benefits. If they’re injured, they still get paid. Self-employed athletes are somewhat different. When we think of those athletes, we think of boxers and MMA athletes, combat sports athletes, Western sports athletes, golfers, same thing. They’re self-employed. Bowlers, again, self-employed athletes. I often say that employed athletes lie to me half the time to tell me that they’re ready to go back to the event. But self-employed athletes clearly lie to me all the time because they’re in a situation where it’s no play, no pay. So it’s important to keep that in mind as a physician treating these folks. Now, the program at the University of Connecticut started in 2018, and it was done in conjunction with a group called the Western Sports Foundation. This is a foundation set up to provide assistance to these self-employed athletes when they are injured to help them with whatever, car payments, house payments, and whatever that can be done in a charitable way. The people who support it are an interesting group. These are people who believe strongly in trying to preserve the Western culture, and it’s a different culture. As I’ve gotten to know people involved in this, it is a totally different culture. And for someone like myself, born and raised in the Bronx, it is a very different culture than I’m used to. And over the years, I’ve come to really appreciate these people and their dedication to this Western culture. So we started this program in 2018, and it was following the death of a professional bull rider named Ty Pozzebon. To briefly summarize, I saw Ty Pozzebon in 2015 as a patient and advised him not to ride in professional bull riding anymore because of damage to his brain. Unfortunately, he persisted and rode at other levels other than PBR for a period of time. Two years later, at the young age of 25, he sadly took his own life, and he was subsequently found to have CTE As a result, PBR felt that they were somewhat responsible for the health of their athletes. And by this time, the original 20 athletes who started it had sold this to Endeavor at the time, which is a big sports management company. So they felt it was necessary to have a way of evaluating athletes before they get on a bull and to make sure their brains were healthy. And that’s where I came in, in working with them and developed this program at UConn Health. Over the years, we’ve seen about 35 professional athletes who are involved in PBR, and some even at the amateur level. What was interesting was, the first two participants that came to us in 2018 came with the idea that they were being sent, and as a neurologist, I was going to end their career. What we found with the testing we did was one of them really had a learning disability that needed to be treated, and the other had migraine headaches. So they had conditions that had nothing to do with getting hit in the head or their performance. What was more interesting was that when we corrected their problem and treated them, they both rose to being among the top 10 bull riders in the world. So it was interesting because suddenly our program developed into a program about brain health and how we can help athletes improve their performance in Western sports, and that has led to what has been a great relationship. Our process is basically doing a detailed neurologic examination, MRIs of the brain, neuropsychometric testing, and in many cases, having them consult with a physical therapist. We do this over a period of three days, so they are flown out here thanks to Western Sports Foundation, and all their expenses are paid for, including our fees at UConn Health. And what i

  6. Jul 21

    The Brain and Spine Frontier

    Neurosurgery is a relatively young discipline in medicine, one that began with a focus on survival. Today the focus goes beyond survival to restoring personalities, memories, limb function, even the ability to walk. Dr. Ketan Bulsara, chair of UConn Health’s Department of Neurosurgery, joins Dr. Alessi to discuss restorative neurosurgery, as well as UConn Health’s elite position when it comes to identifying and treating complex brain tumors, and how UConn is now attracting, training, and producing the next generation of talented neurosurgeons. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Ketan Bulsara: https://health.uconn.edu/neurosurgery/message-from-the-chair UConn Health Department of Neurosurgery: https://health.uconn.edu/neurosurgery UConn Today: ‘1 of 4 in the US for Advanced Brain, Spine Tumor Diagnostics’ https://today.uconn.edu/2026/02/1-of-3-in-the-us-for-advanced-brain-spine-tumor-diagnostics/ UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not inclined to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Ketan Bulsara. Dr. Bulsara is professor and chairman of the Department of Neurosurgery here at UConn Health. Ketan, welcome to the show. Dr. Bulsara: Tony, thank you for having me on the show. Dr. Alessi: You know, it’s always a pleasure to chat with you because it always opens new horizons for me, and one of the things I said in the teaser for this program is that people often describe the brain as the new frontier, and I’ve always felt that it’s neurosurgeons who are the new explorers, or even the old explorers, when it comes to the brain. But I really would like to ask you a little bit about your background. You know, we became familiar with each other back when you were at Yale, but if you could, talk a little bit about your training and what it took to get where you are today. Dr. Bulsara: Well, Tony, thanks a lot. I love the concept of being an explorer, and there’s nothing more exciting than being, on sort of the final frontier in terms of trying to understand the essence of what makes us who we are. And certainly, the brain and spinal cord certainly are integral to that. You know, in terms of my training, I went to medical school at Duke and then stayed there for residency. And when I was at Duke, there was this very pioneering Japanese neurosurgeon who really got me very interested in brain and spine surgery and all the technical nuances. Interestingly, the man that was named the neurosurgeon of the century had moved from Zurich to Little Rock, Arkansas, and I got to go work with him and some of the other pioneers there. When I finished there and I initially started my practice, I realized that the world was changing very rapidly, and I was at this point where I felt very, very skilled at performing micro-neurosurgery, but the world was changing, and endovascular neurosurgery was really kicking in. So after about a year in practice, a year and a half in practice, I decided to go back and do a fellowship and learn how to do endovascular neurosurgery. And the plan was always to stay, stay down South, but then, you know, I was attracted to Connecticut because I was given in New Haven the opportunity to build something that would be a legacy, and that sort of has continued in Connecticut with my move to the University of Connecticut about eight years ago. Dr. Alessi: Now, you’ve talked about interesting how in a field such as neurosurgery and even neurology, things change a great deal. I was with a cardiothoracic surgeon earlier this week chatting, and we talked about how his field has changed dramatically. What are some of the changes we’re starting to see in neurosurgery now? I know you have so much experience with skull base surgery, which is a big part of neurosurgery. What are the hot topics? We just had Chris Connor on the show talking a little bit about stereotactic and functional neurosurgery. Where do you think things are going now? Dr. Bulsara: Yeah, I think the beauty of neurosurgery in terms of brain and spine is that it’s a profession, that is, an organized profession that is only about 100 years old. And where initially we were focused on survival, we’ve really moved into an age where we’re focused on restorative neurosurgery, restorative for the brain, restorative for the spine. And what that entails is that, whereas before we were measuring our outcomes in terms of survival, we’re now measuring outcomes and our ability to make the person whole again like they were prior to the pathology that afflicted them. And again, as this has happened, it’s really, really exciting because you have functional neurosurgery like you mentioned, you have vascular neurosurgery, you have endovascular neurosurgery, you have complex spine surgery. You have all these different arenas that are harnessing the advantages of AI, of robotics, and just sort of continuing to push the frontier forward. So I think it’s very exciting. I think for me, what’s most exciting is, is as we’re expanding our department and as we’re recruiting to bring in folks that focus on sort of integrating all of this together, such as in brain-computer interfaces, and that’s an area that’s very, very exciting for me and an area that I think the department is going to start venturing into. Dr. Alessi: Let’s talk a little bit about being a department chairman. Actually, I didn’t know you weren’t a department when, when I came here, so I’m finding out that it, it recently became a department, but let’s talk a little bit about it. What’s the biggest challenge right now in chairing a department such as neurosurgery here at UConn Health? Dr. Bulsara: Well, Tony, I was really fortunate that when I started here, Dr. McFadden, my chair of surgery, had always helped me chart out this plan where we would become an independent department, and he gave me the liberty, in many ways, to function as a department, so I’m always grateful to him. In terms of the challenges, my challenges as a department chair are probably no different than any of the other department chairs. We’re in an era now where our resources across the board, across the country, are limited, and yet we have all these technological advances. And so you’re faced with the situation where you have these limited resources, all these technological advances. You want to have the technological advances ’cause you want to make sure that you provide care to your patients that’s second to none, and you’re shaping the future of care, but it becomes a struggle sometimes in terms of navigating that. I think the other thing as a department chair is it’s very, very exciting to grow a program, to grow a department, and I think what’s really, really important, especially for neurosurgery as we’re continuing to grow, is that, sort of the, the main ingredient of our success has been the culture that we’ve cultivated within the department, within the context of the institution. And I think maintaining that as we continue to grow is something that I’m, I’m really, really focused on. Dr. Alessi: What’s recruitment like? I mean, obviously you’re competing for a very limited pool of gifted neurosurgeons. I mean, for example, we have a residency here now in neurosurgery. How many residents do you train in neurosurgery? Dr. Bulsara: We accept one resident a year. The number of graduates is, as you point out, is very, very small. I think it’s probably about 220 or 230 a year, if I recall correctly. Dr. Alessi: Nationally? Dr. Bulsara: Nationally. So the number of graduates, it’s a small number of graduates, but you know, something absolutely amazing has happened at our institution. I remember when I first came here and I was recruiting, we were getting people that were applying for jobs and things to that extent, but now during our recruitment process, maybe it’s because, I know for a fact it’s because of, sort of the reputation that all of us have contributed to for UConn Health and the University of Connecticut, we have had a tremendous number of applications for our open positions. And so now the onus is to try to screen through those and, try to make sure that the individuals that we bring in will fit into the culture, not only of the department, but also the culture of our university. Dr. Alessi: One of our challenges in medicine here in the state of Connecticut has been retaining our trainees, right, to go into practice and either stay at our institution or, or another institution in Connecticut rather than go south or go west. Are you seeing a change in that from the neurosurgical standpoint? Dr. Bulsara: You know, we haven’t had a, neurosurgery, since it’s a seven-year training program, a new residency program, we haven’t seen a graduate yet. However, my general sense is UConn Health and University of Connecticut has become a very desirable place to work, at least that’s the sense that I’m getting. And, and what sort of reinforces that for me is the vast number of applications we’re getting for neurosurgery positions. And I have tremendous trainees right now, and would be happy if all of them or any of them decided to stay with us. Dr. Alessi: Oh, that would be great. Dr. Bulsara: So I think it would be tremendous. Dr. Alessi: Let’s move on. We chatted a little bit about middle meningeal artery occlusions, correct, for chronic subdural hematoma. And it took me a

  7. Jul 7

    Keeping Women Active and Healthy

    You don’t have to be an athlete to benefit from the expertise of sports medicine physicians. While Dr. Allison Schafer and Dr. Katherine Coyner are team physicians for UConn athletics, they also run the Women’s Center for Motion and Performance at UConn Health, a collection of coordinated services to keep women of all ages active and healthy, athlete or not. They join Dr. Alessi to discuss the advantages of this care model, how their individual specialties with sports medicine fit into it, and how women tend to be more susceptible to certain orthopedic injuries. Submit questions for Healthy Rounds: healthyrounds@uchc.edu UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine Women’s Center for Motion and Performance at UConn Health https://www.uconnhealth.org/orthopedics-sports-medicine/womens-center-motion-performance  Dr. Allison Schafer https://health.uconn.edu/find-a-provider/physician/Schafer-Allison  Dr. Katherine Coyner https://health.uconn.edu/find-a-provider/physician/Coyner-Katherine  Women's Center for Motion and Performance nurse navigator: 860-679-6330

  8. Jun 16

    Retraining the Brain With Advanced Neurosurgery

    Already on the leading edge of electronic stimulation for new applications like stroke recovery, UConn Health's Dr. Christopher Conner, who specializes in stereotactic and functional neurosurgery, is on the verge of another one! He joins Dr. Anthony Alessi to explain how Vivistim has been opening new doors to regaining function after stroke, who the best candidates are, and how a similar concept for autoimmune disorders may not be far behind. Submit questions for Healthy Rounds: healthyrounds@uchc.edu Dr. Christopher Conner: https://www.uconnhealth.org/providers/profiles/conner-christopher UConn Health Department of Neurosurgery: https://www.uconnhealth.org/neurosurgery The Brain and Spine Institute at UConn Health: https://www.uconnhealth.org/brain-spine UConn Health Orthopedics and Sports Medicine: https://www.uconnhealth.org/orthopedics-sports-medicine “UConn Health Neuromodulation Center of Excellence for Veterans” (UConn Today, June 17, 2025): https://today.uconn.edu/2025/06/uconn-health-neuromodulation-center-of-excellence-for-veterans/ “Grateful Stroke Survivor Shares How New Technology Is Transforming His Recovery” (UConn Today, Nov. 25, 2024): https://today.uconn.edu/2024/11/grateful-stroke-survivor-shares-how-new-technology-is-transforming-his-recovery/ UConn Health: https://www.uconnhealth.org Grant support from Coverys: www.coverys.com Transcript Dr. Alessi: Welcome to the Healthy Rounds Podcast, where we provide you with up-to-date and timely medical information from national and international leaders in their fields. This podcast is brought to you by UConn Health, with support from the Department of Orthopaedic Surgery and a grant from Coverys. It is not designed to direct your personal healthcare, which should only be done by your physician. I’m your host, Dr. Anthony Alessi, and it’s great to have as my guest today Dr. Christopher Conner. Dr. Conner is an assistant professor in the Department of Neurosurgery, and he specializes in stereotactic and functional neurosurgery. Chris, welcome to the show. Dr. Conner: It’s fantastic being here, Dr. Alessi. Dr. Alessi: Let’s talk. Can you explain to our listeners what is stereotactic and functional neurosurgery? Dr. Conner: The simple answer is that I get paid money to put wires and batteries into people’s bodies, which is a really weird thing to do with your day-to-day work, but it is what it is. What it really means, though, is that a majority of what I’m doing is trying to improve people’s day-to-day lives. That’s kind of the functional aspect of it, and that can encompass a lot of things. It can encompass chronic pain. It can encompass stroke recovery. It can also involve Parkinson’s disease or movement disorders, and even epilepsy. And so these are some diseases that you might sometimes think of as not something that surgery can, can treat, but this is kind of where someone like myself comes into play. Dr. Alessi: That’s great. Now, let’s go back a little bit. I want to talk, you brought up several different topics, and I know we covered this about two years ago when you were on my radio show. So I want to touch base. Let’s go to Parkinson’s disease, doing deep brain stimulation. You were just starting that at the time here at UConn Health. Where are we with that program? Dr. Conner: The program has really gotten its feet underneath it. We’ve done upwards of, I think, about 25 or 30 patients with deep brain stimulation, primarily for Parkinson’s disease, although we also treat patients with essential tremor and some other disorders with that here at UConn Health. But at this point in time, we have a, a really full-fledged program. My movement disorder neurologists, like Dr. [Sarah] Mancone, Dr. [Bernardo] Rodrigues, Dr. [Chindhuri] Selvadurai, and I, we’re really proud of what we can accomplish here, and we can offer kind of a full-stack treatment for people who have advanced Parkinson’s disease. And again, that deep brain stimulation, when I use that term, stimulation, it generally means applying electricity somewhere in the body, and it’s been really gratifying seeing a lot of our patients now that are coming back in a year or two years who are having life-changing, remarkable improvements in their symptoms. And so we’re finally kind of at that point where we’re getting to our long-term patient outcomes, and I’m really happy to report that we’re doing as well or really much better than what kind of the typical program’s able to achieve. Dr. Alessi: Let me get back to the idea of putting batteries and wires in people How does that work? In other words, when you’re doing deep brain stimulation or, for years we talked about vagal nerve stimulation, right? People were, and still are, obsessed with the vagus nerve. But when you’re doing that, is it the depolarization? Is it the stim? What is actually taking effect when you’re doing something like that? Dr. Conner: So every one of these applications we have works in a different way, and the uncomfortable but honest answer that I have for you is that a vast majority of the time, we don’t understand how the electricity is really working on a pretty fundamental level. And that’s true of deep brain stimulation, of vagus nerve stimulation, of spinal cord stimulation. Every one of those is a different kind of wire. Every one of those is a different kind of thing we’re stimulating, and a lot of the time we don’t completely understand it. We might have a good idea about it, but it’s still more than a little bit of a mystery. Dr. Alessi: And I want to clarify, because I was talking to a patient about it today, and they said, “Oh, is that like ECT?” And this is very different from electroconvulsive therapy which we know how that works. Dr. Conner: Yeah. We have a better idea, kind of generally, of how electroconvulsive therapy works. The difference is that electroconvulsive therapy is, I think it’s fair to say that it’s a less targeted therapy. So when we’re talking about these wires, we’re talking about trying to deliver electricity to something that’s the, you know, maybe two or three millimeters in size. That’s a really small area. It’s really targeted that we’re trying to deliver therapy to. Electroconvulsive therapy is more of a whole-brain kind of style of therapy. And so the difference really is magnitude and targeting when we’re talking about the difference between those different approaches. Dr. Alessi: Let’s go to the vagus nerve, vagal nerve stimulation, I remember, I mean, we’ve been doing this for decades for epilepsy. How effective is it for epilepsy? Dr. Conner: Yeah. So it’s been around and FDA approved for several decades for both epilepsy and then also for depression. Epilepsy is a seizure disorder. Once you’ve had several seizures, you have a diagnosis of epilepsy, and in some people, we can’t really figure out exactly what area of the brain it’s coming from. It’s called generalized epilepsy. And in those patients, sometimes medications work, and in a shockingly large chunk of people, medications don’t work. And then, kind of one of the best therapies we had for a long time was stimulating the vagus nerve, which is a nerve in the neck, and the general kind of way I counsel patients is that in 50% of patients it’ll drop your seizures by 50%. So it’s kind of a 50/50 rule, which, in some people, that’s enough to have them be happy with the outcome and to think that the surgery was worthwhile. But it still wasn’t maybe the best that we could do. Fortunately, now there are some deep brain stimulation, wires inside of the brain, there are some ways that we can do that in order to treat epilepsy as well now. Dr. Alessi: I’ve seen several people using or purchasing these external vagal nerve stimulators. Do they work? Is it garbage? What is it? Dr. Conner: I mean, that’s a really great question. To my knowledge, no one’s ever really validated whether or not external vagus nerve stimulation works. The vagus nerve is not right at the surface. There’s a big muscle in your neck. If you turn your head, there’s a big muscle coming from the back of your skull all the way down to your collar or clavicle, and that muscle, it’s called the sternocleidomastoid, it’s a big, thick muscle, and it’s sitting right over the vagus nerve. I just don’t—it’s tough for me to see how electrical stimulations can get through that muscle and into the nerve and not cause that muscle to painfully contract. So I don’t know if it works or not. I think there’s a lot of people out there selling it to you, and it’s up to them to really tell you whether or not it’s effective and do that study. I don’t think it’s been done, though. Dr. Alessi: Well, it’s interesting because I had a patient who had a concussion, and he was a professional athlete, so he had unlimited means. And someone told him to buy one of these vagal stimulators. Now, professional athletes don’t buy anything, so he had somebody buy it for him, OK? I’m sure that they wanted an endorsement. He used it once and said it was so uncomfortable and painful, he would never touch it again. So I think that’s the idea of trying to get the stim through the sternocleidomastoid and probably made it very uncomfortable. And I’ve not known it to work at all for a concussion. Let’s move on, when we talk about the vagus nerve, and I really wanted to get to Vivistim. Because Vivistim is something we talked about back in February of 2024 when you were on my radio program, and you were really just starting that program. Can you tell people really what is Vivistim, and what are you using it for? Dr. Conner: Awesome question, something I love talking about. So Vivistim is the commercial name for a vagus nerve stimulator. It’s a totally new one, even though it’s very similar to the old one th

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Healthy Rounds covers a range of topics, including new medical technologies and treatments, research, disease prevention, hosted by Dr. Anthony Alessi, UConn Health neurologist and clinical professor of neurology and orthopedics in the UConn School of Medicine.

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