Medical care

Introduction

Within the field of the neurosciences, the 3 main objectives of the department are :

1. The diagnosis and treatment of illnesses involving the nervous system using the latest available technology and knowledge, and in close coloboration with other institutions both within Spain and abroad;
2. The study of the mechanisms, pathogenesis and the treatment of neurological diseases; and
3. The teaching of the Neurosciences at all levels, from undergraduate level to the training of residents.

These objectives are closely integrated such that the medical service offered to the patient benefits from the latest research advances, and that the future generations of doctors learn to care for their patients with a sense of optimism founded on the real hope of an effective cure.

The clinical service and research efforts coincide in as much as they are centred on the treatment of illnesses that owing to their frequency and the problems they produce, generate serious problems in the area of healthcare in Europe, Spain and Navarra.

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1) Motor and Basal ganglia disorders

These illnesses cause a deterioration in the ability of the patient to move freely. Although the patients cognitive abilities often remain intact, the limitation of their motor facilities mean that many give the impression of being mentally retarded or of suffering an impaired mental capacity. Patients are often unable to work and require intensive care and assistence from their families. The most common of these illlnesses is that of Parkinson's disease, which principally affects patients of  50 years or over, and whose frequency grows with age. Approximately 20% of patients that show signs of Parkinson's disease also suffer from other motor diseases that require a specialized diagnosis and treatment.

There are approximately 70.000 sufferers of Parkinson's in Spain and some 1000 in Navarra alone. A large number of these sufferers, particularly those that have been treated for various years, don't respond to the normal treatments or these treatment have important secondary effects.

The Unit of Motor Disorders in the CUN is specialized in the treatment of these patients. Dr Maria del Rosario Luquin, in colaboration with Dr Miguel Manrique, is studying the possibilty of treating patients by transplanting cells from another part of their own nervous system to replace those affected by the disease, thereby improving their response to the disease. The value of these studies has been recognised by awards from the Spanish Neurology Society (Sociedad Española de Neurología) in 1999.

Dr José Obeso, the Co-ordinator of the Unit, is one of the world pioneers in the use of stimulation of the subthalmic nucleus to treat patients that respond poorly to the usual treatments. Along with Dr Maria Rodriguez in the Unit, they have demonstrated the improvements this new treatment can offer to a large proportion of these patients, a treatment that when carefully performed by experienced specialists, is now accepted for such patients.

The Drs Julio Artieda, Maria Asunción Pastor, y Javier Arbizu employ neurophysiological and advanced neuroimaging techniques such as PET, to aid in the diagnosis of complex cases, and to identify the underlying causes of these disorders.

Other motor illnesses that do not behave in the same way as Parkinson's disease still have serious reprecussions on the health and well being of those affected.  For example, movement disorders in ageing people are often not the result of rheumatism but rather of neurological dysfunctions. After Alzheimer's, movement disorders are the major cause of chronic disability in people over 65 years of age. Dr. José Masdeu has performed pioneering studies on the diagnosis and treatment of these problems, as described in his book "Gait Disorders of Aging," published in the United States, where he was the director of the Neurology department at the New York Medical College.

The Unit includes a group of scientists whose prestige has been gained by mapping the nervous tracts between the basal ganglia and the cerebral cortex, and in studying the signals that are used for the communication between these two areas.  These studies have great importance in helping to define the basis of the distinct neurodegenerative illnesses, and as such, aid in the development of efficient therapies.

Dr. Javier Arbizu	Dr. Ma. Rosario Luquin	Dr. Lourdes Ortiz Hernandez
Dr. Julio Artieda	Dr. Miguel Manrique	Dr. Asunción Pastor
Dr. Elena Erro Aguirre (postdoc)	Dr. José Masdeu	Dr. Alberto Pérez Mediavilla
Dr. Jose Manuel Gimenez Amaya	Dr. Elisa Mengual Poza	Dr. Lucía Prensa Sepúlveda
Dr. Jose Luis Lanciego Perez	Dr. José Obeso	Dr. Ma. Cruz Rodriguez

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2) Memory disorders

Memory disorders such as Alzheimer's disease and other types of dementia are a primary public health problem, particularly in elderly people. Epidemiological studies, many carried out by Dr Martínez-Lage, have calculated that there are nearly half a million sufferers of Alzheimer in Spain. This number reaches 675.000 when all the types of dementias are taken into account and some 850.000 patients that suffer isolated memory loss. In Navarra, these numbers equate to 6.000, 8.000 y 11.000 sufferers. This unit is dedicated to the treatment of these patients and to the study of more efficient diagnostic and therapeutic aids. To this end, the unit counts on sophisticated neuroimaging and research techniques including PET and functional magnetic resonance. Dr. Gómez Isla has also developed transgenic animals to experimentally explore the roles of the genes implicated in Alzheimer, with the aim of studying the origins of this illness and defining new strategies for its treatment.

Depression can be attributed, in a grand part, to biochemical disturbances in the brain. Dr Del Río's team is developing of more efficient medications to treat this all-to-common problem.

Although not as frequent as other disorders of the nervous system, tumours often affect younger people and their consequences may remain with them throughout the rest of their lives. Some tumour types are so malignant that they may prove to be fatal in a question of weeks if not treated appropriately. In the CUN there is an excellent programme for tumour treatment directed by Dr. Antonio Burgarolas that has attained worldwide prestige. The oncology unit is comprised of neurosurgeons, neuroradiologists and neuropathologists with a great deal of experience in treating patients with tumours that affect the nervous system and who collaborate intimately with  Dr. Burgarolas and with the gene therapy groups.

In the CUN, the treatment of tumours in the nervous system benefits from the use of the latest therapeutic and diagnostic techniques including PET, a technique particularly useful in distinguishing the degree of malignancy in cases of relapse, and radiosurgery that provides a non-invasive treatment for tumours that previously could only be treated surgically.

There are 380,000 people with chronic epilepsy in Spain, and 5,000 in Navarra. While approximately 70% of these patients can be adequately treated with medication, the remaining sufferers require alternative treatments, two of which require the close collaboration of neurologists and neurosurgeons. In many cases, following a detailed study of brain function and the location of the focal origin of the epilepsy, surgical extirpation can successfully remediate the attacks. However, in other patients, Vagal nerve stimulation with portable modules permits the patient to exert a greater control over their epileptic attacks. The doctors in this unit have worked in the best centres in the USA, France and UK, and have at their disposition the most advanced techniques to treat patients with this disease.

Fifty Seven thousand Spaniards, of which some 750 are Navarros, suffer from Multiple Sclerosis, a progressive disease of the nervous sytem that until recently had no cure. There are now four drugs that can be used to delay the progression of the disease. Remissions that can produce serious effects such as blindness or paralysis of the arms or legs, can also be treated. In the CUN, and in collaboration with other departments, research into immunological treatments is being carried out in order to continue improving our treatment of this disease. 

Dr. Purificación de Castro	Dr. José Masdeu
Dr. Michel Idoate	Dr Pablo Villoslada
Dr. José Manuel Martínez-Lage	Dr. José Luis Zubieta

This heterogeneous group of illnesses can give rise to back or neck pains, pins and needles in the arms or legs, loss of strength or difficulties in moving. Some of these illnesses only respond in a limited manner to treatment such as Ameliotrophic-Lateral Sclerosis (ALS), whereas others can be more successfully treated as is th case for autoimmune neuropathies. The success of the treatment depends on the rapid and accurate diagnosis of the illeness for which various neurophysiological techniques as well as biochemical and immunological tests are used. In some cases, it may be necessary to analyse muscle or nerve biopsies.

Cerebral Strokes are the third most common cause of death in men and the second in women. In Navarra, approximately 1,000 people suffer from strokes each year, of which some 30% are fatal in the short term and a large part of the remaining cases result in severe disabilities in their victims. The unit is above all focused on preventing strokes in conjunction Dr. Javier Diez whose research deals with risk factors involved in vascular diseases, another of the principal lines of study in the CUN.

Whilst they don't share the mortality of some of the diseases mentioned above, somnolence or insomnia are common yet little studied problems that interfere with the productivity in the workplace and the homelife of a great many people. The correct diagnosis and treatment of these problems often requires a study of sleep patterns performed in a laboratory where brainwaves and other parameters can be studied in the sleeping patient.