Neurology and Neurorehabilitation

Ospedale San Raffaele

The Department includes two Operative Units: one for Neurology and one for Neurological Specialist Rehabilitation, each have their own ward.

The Department of Neurology is characterized by a strong integration between clinical activity and research activity favoured by the internal organization of Specialist Centres such as: The Multiple Sclerosis Centre, the leading Italian centre assessed by the number of patients treated and for its research activities, the Centre for Memory Disorders, the Centre for Epilepsy and the Headache Centre which is currently studying the genetics of headaches and new therapies.

It is also closely connected to the Institute of Experimental Neurology, a centre for neurological disease research and pharmaceutical experimentation.

 

NEUROLOGY UNIT

The Department of Neurology and Neurorehabilitation is organized in disease-specific Units as follows:

  • Multiple Sclerosis and Related Disorders
  • Neuromuscular Diseases
  • Dementia
  • Movement Disorders
  • Acute Cerebrovascular Diseases
  • Paroxysmal Disorders
  • Neuropediatric

A Stroke Unit of 15 beds is located within the Neurology Department, including 8 for semi-intensive care. It is one of the largest services of Clinical Neurophysiology in Italy.

PROCEDURES PERFORMED PER YEAR:

  • 1700 hospitalization per year

 

NEUROREHABILITATION

This Unit is specialized in the intensive motor and cognitive rehabilitation of patients with diseases of the central (multiple sclerosis, stroke, amyotrophic lateral sclerosis, movement disorders) or peripheral (polyneuropathies, myopathies) nervous system. Clinical activity is multidisciplinary and involves neurologists, physiatrists, physiotherapists (physical therapy, virtual reality training), psychologists (neuropsychological assessment, cognitive rehabilitation, psychological counseling, behavioral therapy, psychotherapy, computerized and virtual reality cognitive training, rehabilitation) neurophysiologists (sensory and motor evoked potentials, nerve conduction studies, cognitive potentials, botulinum toxin injections to treat muscle spasticity), logopedics, occupational therapists, pneumologists, cardiologists, internists, social workers. The Unit is involved in national and international projects on remote monitoring with wearable sensors, action observation training, proprioceptive stimulation with innovative devices (e.g. Keope), noninvasive neuromodulation with up-to-date equipment such as H-coils, allowing noninvasive deep transcranial magnetic stimulation and enabling to reach brain structures to enhance brain plasticity.

PROCEDURES PERFORMED PER YEAR:

  • 470 hospitalization per year

 

CLINICAL NEUROPHYSIOLOGY

This Unit is ranked as the most important Lab of Clinical Neurophysiology in the Country. It consists of:

  • Three Labs of Electromyography and related techniques
  • Two labs of Doppler ultrasonography
  • Three Labs of EEG and related Techniques, including Video EEG, Holter EEG
  • Three Labs of Evoked Potentials (Visual, Multifocal Visual, Motor, Sensory, Auditory, Event Related Potentials)
  • One Lab of Optical Coherence Tomography
  • One Lab of Autonomic Function Tests

The Service provides monitoring for vascular and neurosurgical surgery, as well as treatment of focal dystonia and spasticity.

PROCEDURES PERFORMED PER YEAR:

  • 1617 Electroencephalographs (EEG)
  • 11.351 Electromyographs (EMG) and nerve conduction studies
  • 2.006 Sensory Electrophysiology studies
  • 1.000 Motor Evoked Potentials
  • 2.950 TSA Dopplers
  • 200 Autonomic tests

 

MULTIPLE SCLEROSIS CENTRE

It is considered as one of the top MS Centres in the World. Pioneer in the advanced treatment of multiple sclerosis and related diseases, including neuromyelitis Optica. It is a coordinating Centre for many International and National Clinical Trials, Phase 1-4, and experimental Stem Cell Treatment. It has an infusion centre with 8 positions for antibody therapies. The Unit provides regular monitoring of infusion related events, cardiovascular monitoring, as well as treatment of patients in paediatric age. Its excellencies are also recognised in the symptomatic treatment of Multiple Sclerosis.

PROCEDURES PERFORMED PER YEAR:

  • 10.000 outpatient visits
  • 3.000 patients in regular treatment with disease modifying treatments
  • 1.400 Infusions

Multiple Sclerosis

The Centre, by participating in clinical trials, is contributing substantially in the successful definition of the degree of clinical and neuroradiological efficacy, both in RCTs and in post marketing real world studies. It has contributed particularly in the demonstration of the usefulness of disease modifying drugs (DMD) in patients at a first episode suggestive of multiple sclerosis (CIS- clinically isolated syndrome patients), strongly supporting the early treatment strategy in patients with MS and proving the efficacy of different treatments in delaying the conversion to MS in patients with CIS. In recent years, many studies have been conducted aiming at confirming the true effectiveness and safety of the new DMDs in real-world practice, and at the identification of the prognostic (Vitamin D, breastfeeding, intestinal microbiota, etc) as well as the predictive factors of response to disease-modifying treatments. In the last 15 years, the Centre has been involved in the process of validation of the stem cell treatment in MS. Currently, there are two ongoing clinical trials.  

Considering the “neurorehabilitative approach”, the team has evaluated the efficacy of different aspects of intensive multidisciplinary rehabilitation projects in MS patients and conducted a study on the identification of the predictors of disability improvement.

Cerebrovascular Diseases

The goal of the Cerebrovascular Disease Unit is to provide the highest quality, evidence-based care for patients dealing with stroke, transient ischemic attack, and other cerebrovascular conditions. Critical to achieving this goal, was providing an organized structure of dedicated

neurologists that operate as the hospital’s acute stroke team in order to guarantee a timely evaluation and treatment of stroke patients. Inpatient care is based in the Department of Neurology, which includes an eight-bed Stroke Unit with stroke-trained staff. Diagnostic capabilities include CT-Angiography, MRI and MRA, conventional (digital subtraction) angiography, among other diagnostic tests. In addition to acute care, stroke management includes secondary prevention, rehabilitation, occupational therapy and psychosocial support. The Unit is actively engaged in clinical research and is participating in a number of phase III trials on secondary prevention of a stroke. In the last year about 100 thrombolysis have been performed.

Dementia

In the Neurology Department of the San Raffaele Research Hospital, patients with a first diagnosis of dementia and/or for the management of dementia complications are managed. The Unit also manages a wide outpatient activity with about 1800 patients with cognitive deficits referring to its Memory Centre, also treated at the Neuropsychological outpatient clinic. The assessment of Dementia benefits from the advanced analysis of brain MRI, where the Unit plays a major role in Europe, from PET, including availability for beta amyloid and tau ligands, from body fluid evaluation that includes spinal fluid examination for beta amyloid, tau and phosphor tau, and both spinal fluid and blood neurofilaments.

The Unit’s team is involved in important international and national multicentre pharmacological trials.

Movement disorders

This section of the Department follows patients from the very beginning stages of the disease to the latest complicated phases, offering the most up-to-date available therapy but also new experimental drugs. Since 1994 the Unit has participated in several sponsored trials aimed to test new drugs, mainly in PHASE III, including Sumanirole, Pramipexole, Ropinirole, Lisuride, Entacapone, Rasagiline, Sarizotan and Safinamide for naïve and advanced Parkinson’s Disease (PD). Since 2003, for the advanced stage of PD, they have been performing Deep Brain Stimulation (DBS), in collaboration with the Neurosurgery Unit. This Unit is in charge for the selection of patients, clinical and neurophysiological intraoperative monitoring and follow-up, both in parkinsonian and dystonic patients (more than 70 patients treated to date). Moreover, they perform brain magnetic stimulation in isolation or in combination with physical exercise.

Neuromuscular Disorders

Since the opening of the Department, the team paid special attention to muscular and nerve diseases. The great experience in nerve and muscle pathology makes it one of the reference centres in Italy for neuromuscular disorders. In the Unit, a wide range of diagnostic tools are used (from neurophysiologic to neuropathological studies including sural nerve biopsies, motor biopsies and skin biopsies, from routine haematological exams to immunological ones) in order for patients with neuromuscular disorders to receive the best possible therapies, from the classical therapies to the innovative ones (off-label therapies and clinical trials). The centre is involved in the most advanced molecular and gene therapies of both nerve and muscular disease, including cellular therapies and advanced treatment of spinal muscular atrophies.

In patients affected by amyotrophic lateral sclerosis (ALS) the Unit’s team has improved management of the disability (i.e. timing of ventilations or PEG) and tested many new drugs (talampanel, and lithium) in CRT. These clinical trials are organized in different experimental designs from controlled multi centric trials to local observational and retrospective studies. 

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • One 3 TESLA Brain MRI
  • Three 1.5 TESLA Brain MRI
  • One Brain PET
  • One Brain/MRI
  • SIMOHA for Neurofilaments assessment
  • Four Brainswave H Coil Systems for transcranial magnetic stimulation
  • Two Devices for transcranial direct current stimulation