A multidisciplinary team of experienced specialists and subspecialists with Health Quest Medical Practice Neurosciences provides comprehensive, leading-edge care for patients with a broad spectrum of neurological and neurodegenerative conditions.
Numbering more than 1,000, neurological disorders affect the lives of nearly one-third of the U.S. population. Effective diagnosis and treatment of many of these conditions require the care of highly skilled providers using latest-generation technologies and techniques. That often forces patients in less-populated communities to seek advanced care at large, impersonal academic institutions in major metropolitan areas or to be transferred to a hospital away from their familial support systems in the event of an emergency. Some, unable to navigate those logistical barriers, settle for suboptimal care.
Health Quest Medical Practice (HQMP) Neurosciences, now part of Nuvance Health, provides patients in the Mid-Hudson Valley with local access to state-of-the-art neurological care. Staffed by an attentive, experienced team of neurologists, neurosurgeons, neurointerventional surgeons, physiatrists and other providers, HQMP Neurosciences offers comprehensive diagnoses and treatment services for wide-ranging conditions. These include Alzheimer’s disease, stroke, epilepsy, multiple sclerosis, peripheral neuropathy, migraine and other headaches, neck pain, lower back pain, and movement disorders such as Parkinson’s disease.
“Patients are able to receive top-notch, cutting-edge care close to home in a manner that is personal,” says Paul Wright, MD, MBA, Assistant Vice President of Neurosciences for HQMP. “Many people travel to big institutions only to sometimes get lost in the shuffle. Discussions about their care are often fewer and abbreviated because patients aren’t given the opportunity to spend as much time with their providers. Here, we discuss diagnoses and treatments with patients and family members in-depth and provide them with continuity and consistency of care.”
“As a result of incredible institutional support, Health Quest Medical Practice, now part of Nuvance Health, provides patients with compassionate, cutting-edge care in the Mid-Hudson Valley. Health Quest Medical Practice is committed to providing the resources and technology to allow physicians and nursing staff to deliver excellent care. It is an organization that really wants to do right by patients.”
— Paul Wright, MD, MBA, Assistant Vice President of Neurosciences for HQMP
Paul Wright, MD, evaluates a patient’s cranial nerve VI (abducens nerve).
Treatment for Movement Disorders
Based at Vassar Brothers Medical Center in Poughkeepsie, New York, and an on-site outpatient clinic, the Movement Disorders Program is the first and only one in the Mid-Hudson Valley and northwestern Connecticut to offer advanced diagnostic and treatment options for patients with neurological and neurodegenerative conditions that cause involuntary movement, a loss of the ability to move or a combination of the two. Common movement disorders managed through this program are chorea, dystonia, essential tremor, Huntington’s disease, Parkinson’s disease, restless leg syndrome, tardive dyskinesia and Tourette syndrome.
Jennifer Pallone, DO, a neurologist and movement disorders specialist with HQMP, says patients with these conditions benefit from the program’s collaborative, interdisciplinary approach, including the incorporation of rehabilitative therapies, pharmacological interventions and surgical treatments, as well as from providers’ depth of experience and subspecialized expertise.
“This is what we do all day, every day,” Dr. Pallone says. “Having a sole focus on movement disorders allows us to better understand our patients’ needs and address their challenges. Parkinson’s disease, for example, can cause multiple symptoms. If patients are not given enough time to discuss everything they are experiencing, and we do not take the time to query them, some important problems are going to fall through the cracks. Based on our experience, we have a very specific approach to asking patients questions about their symptoms. That leads to a higher-quality, more comprehensive treatment plan.”
Dr. Wright examines the patient’s pupil as part of a cranial nerve III (oculomotor) test.
Dr. Wright tests the patient’s motor function.
The Movement Disorders Program has invested in advanced diagnostic and treatment technologies. In addition to MRI and SPECT imaging of the brain, the program’s specialists use the radiopharmaceutical known as a DaTscan to help diagnose Parkinson’s disease and similar conditions in patients with unclear diagnoses. During the DaTscan, a tracer is injected into the patient’s vein and then binds to the dopamine transporter molecule (DAT) in the brain and can be seen using single-photon emission computed tomography. This allows providers to visualize dopamine degeneration in the nigrostriatal pathway and can lead to a more confident diagnosis.
A study published in the American Journal of Neurodegenerative Disease found that when providers used DaTscan to help diagnose Parkinson’s disease in patients with unclear symptoms:
- Diagnoses changed for more than 30% of patients.
- Nearly 70% of providers said DaTscan affected their diagnoses.
- Almost 60% of providers said it had an impact on clinical management of their patients going forward.
Deep brain stimulation (DBS) is an advanced treatment option brought to the area as part of the Movement Disorders Program. Often recommended for patients with advanced Parkinson’s disease, essential tremor, dystonia and other movement disorders, DBS is a surgical treatment involving the implantation of electrodes into targeted areas of the brain. An impulse generator battery is placed under the collarbone or in the abdomen. The electrodes deliver electrical impulses to the brain and disrupt the neurologic signals responsible for the patient’s symptoms. This procedure was first approved by the FDA in 1997 for Parkinson’s disease patients who have medication-resistant symptoms. DBS frequently adds effective relief for the right patient.
Dr. Pallone notes that while advanced diagnostic tests such as DaTscan can be life-changing for many patients, providers in the Movement Disorders Program make most diagnoses based on information gathered during detailed clinical evaluations.
The specialists’ ability to provide outstanding care stems from their extensive experience, but sometimes even more important is their willingness to spend sufficient time with patients.
“It is a very visual specialty and is dependent on quality, one-on-one time with patients,” Dr. Pallone says. “That is one of the reasons I developed an interest in movement disorders in the first place. It is about evaluating patients firsthand, listening to what they have to say, looking into their history and providing them with the most thorough, up-to-date care — all while genuinely getting to know them as people and not just as patients.”
“We have access to numerous highly skilled providers, which fosters interdisciplinary collaboration. Whenever you perform a neurosurgical procedure or are managing a complex neurological patient, you also need the support of internal medicine physicians, cardiologists and rehabilitation specialists. HQMP Neurosciences is directly enhanced by the strength of the personnel in other departments.”
— Michael Cho, MD, neurosurgeon with HQMP
Before surgery, Michael Cho, MD, evaluates his patients with tests such as muscle and motor function.
“We are all highly motivated to do what is best for our patients. In addition to helping them manage their neurological conditions, we are genuinely concerned about them, their families, what is going on with them neurologically and the effect it has on their overall quality of life. It is about looking at the whole patient and developing a treatment plan that takes all factors into consideration.”
— Jennifer Pallone, DO, movement disorders specialist with HQMP
Jennifer Pallone, DO, administers a skilled injection of botulinum toxin for movement disorder treatment.
Expertise in Trauma
The HQMP Neurosciences team also provides advanced medical and surgical treatments for patients presenting with emergent neurological syndromes. For instance, Michael Cho, MD, a neurosurgeon with HQMP, treats patients in Vassar Brothers Medical Center’s emergency department who are affected by brain tumors; seizures; head trauma, including traumatic brain injuries, subdural hematomas, brain hemorrhages and skull fractures; headache; autonomic neuropathies; spine-related injuries and diseases; and stroke, including ischemic stroke, transient ischemic attack and hemorrhagic stroke.
“Vassar Brothers Medical Center is a very busy hospital with an even busier emergency department,” Dr. Cho says. “As a Primary Stroke Center [see “Accreditation by The Joint Commission” sidebar] and a Level II trauma center, we frequently see patients with strokes and head- and spine-related injuries who potentially require neurosurgical attention. I help evaluate these patients and determine whether or not surgery is needed.”
Dr. Cho’s ability to quickly weigh the benefits of neurosurgery for each patient is a skill he has honed through more than 20 years of practice.
“I have performed a high number of surgeries, and I have seen which patients benefit from a particular procedure and which do not,” Dr. Cho says. “As a result, I am much more confident deciding when to operate and when to advise alternative treatment. I make decisions based on what I would want for myself or for one of my family members.”
Myoguide is an electromyography (EMG)-guided system using hypodermic needle electrodes for the targeted injection of neuromodulator drugs.
Dr. Cho in neurosurgery at Vassar Brothers Medical Center
Expansive Telehealth Capabilities
HQMP Neurosciences has incorporated telehealth into both inpatient and outpatient care as well.
In an inpatient setting, telehealth is imperative to facilitating urgent consultations between internal providers and referring physicians in cases of emergent neurological syndromes. However, according to Dr. Wright, telemedicine in an outpatient setting is proving just as vital.
“I was seeing a patient for Alzheimer’s disease and found out her daughter had to take the day off work to pick her mom up from the assisted-living facility where she lived and bring her in to see me,” he says. “The patient’s son, who lived in Manhattan, also had to take the day off whenever he came. I recommended we conduct telehealth visitations at her mother’s assisted-living facility instead so the daughter could just drive to the facility and take part in the consultation or follow-up evaluation remotely. That switch saved the daughter time and energy and enabled us to include the son either over the phone or through a video conference, as well.”
Telehealth capabilities reduce logistical difficulties for patients with limited access to transportation and for busy loved ones. They also allow providers to see patients in their natural setting, which can often give them a more accurate picture of how patients are faring in their day-to-day lives.
“Through telehealth, we can practice in a manner that is more accessible, convenient and humane for patients,” Dr. Wright explains. “It is also much easier for patients’ families. That increased convenience can, in turn, facilitate greater involvement from those important sources of support.”
Dr. Wright serves as Assistant Vice President of Neurosciences for HQMP.
An Expanding Neurological Service Line
HQMP Neurosciences provides patients in the Mid-Hudson Valley with more than access to skilled specialists and comprehensive diagnostic and treatment services; it strives to ensure every patient walks away feeling informed and cared for by his or her provider.
“Referring providers should know the patients they send to HQMP will receive individualized, concerned care,” Dr. Pallone says. “Our providers are going to do everything within their power to improve patients’ lives and address their concerns — through a collaborative team approach.”
HQMP also plans to remain on a growth trajectory by continuing to expand its provider numbers as well as the services and clinical trials available, according to Dr. Wright. That will expedite innovative treatments to patients in the region.
“We can already provide the majority of neurosurgeries,” Dr. Cho says. “The team is growing, and our hospitals are strong. However, we are committed to continuing to grow and improve on our capabilities.”
For more information about HQMP, visit healthquest.org/HQMP.