Exciting Changes In Neurology
Interviewed by Melissa Moniz
Wednesday - May 27, 2009
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Dr. Melvin Yee
Interviewed By Melissa Moniz
Where did you receive your schooling and training?
I’m locally born. I went to Punahou, then I went to Yale University for my undergraduate. Then I was at the University of California San Francisco for my medical school. I did my internship, medical residency and my neurology residency training there. I had a year of fellowship in clinical neuro-physiology at the University of Iowa.
How long have you been practicing?
I started practicing in 1986, so 23 years.
Since you started, what have been some of the biggest and most-exciting advancements in the field?
It’s a really big change. If you go back to when I started medical school, they just began having CAT scans. I remember I did some research when I was an undergraduate. Back then, how we could tell that there was a mass lesion inside the brain was we would bounce an echo of a membrane in the center of the brain to see if it was shifted off to one side. You tell medical students that and they think it’s medieval. One of the biggest changes is our ability to image the brain - CAT scans, MRI scans and even more-advanced MRI scans. It has changed so much that now you can take a picture of a brain and it’s almost as good as an anatomical dissection. More than that, though, they’re beginning to do functional imaging of the brain. They can actually look where and how much sugar or other chemicals are being used in the brain. This allows us to better define disease processes in the nervous system. The other big change is when I first started neurology, the joke was “diagnose and adios,” because we couldn’t do many things to help patients with neurologic disorders. But now things have changed so much, and we can treat so many diseases for which there was no previous treatment at all. For example, Alzheimer’s disease and multiple sclerosis - now we have treatments that can make a big difference as far as modifying disease progression. And the neuroscience has advanced so much that there are big changes coming in the near future. They are looking at various forms of muscular dystrophy, and things like using viruses to inject the DNA to correct the metabolic deficit that causes dystrophy in the muscle. So this can potentially cure it, and also things like deep brain stimulation for movement disorders. There are things that are changing so that we’re right on the cusp of expanding what we can do to treat a lot of these degenerative diseases of the brain. And we’re doing so much more with rehabilitation and improvement of these neurologic conditions, so there are changes in our ability to diagnose, treat and potentially cure these diseases. And that’s what is very exciting about neurology.
Are you a general neurologist or are you sub-specialized?
I do general neurology. I see adults; I don’t do any pediatric neurology. But I do have a strong interest in Parkinson’s disease. There are some neurologists who have special interests, but everyone pretty much does general neurology.
What are the most common neurological disorders/diseases you see and treat?
In the hospital, it would be strokes, coma, seizures and brain infection. In outpatient clinics, it’s Alzheimer’s disease, Parkinson’s disease, seizures, nerve and migraines. And then we get a bunch of rare things.
What are the early symptoms of Alzheimer’s and Parkinson’s diseases?
The problem with recognizing Parkinson’s disease is that the major symptoms - slowness of movement, stiffness of movement, walking difficulties and tremor - may be difficult to identify. If he doesn’t have a tremor, then the family thinks that Grandpa is just getting old, so a lot of people don’t realize that there’s anything wrong. A tremor is something obvious, but slowness of walking, difficulty standing or getting out of a chair could be early symptoms of Parkinson’s disease. There are many other things that cause difficulty walking in the elderly, but Parkinson’s disease is one of the things for which we have good treatment - and it’s actually a fairly common disease. With Alzheimer’s disease, the common thing people think is that people get forgetful because they’re getting old, but really that is not normal. With Alzheimer’s disease, it’s the family that comes to me with their concerns. Most patients with Alzheimer’s disease don’t realize that anything is wrong with them. The symptoms that are commonly mentioned are that they tend to repeat themselves, they forget appointments or what they’ve been told. They also begin to lose some of their functioning at home or at work. And that’s important for diagnosis. Forty percent of 80-year-olds have Alzheimer’s disease. It’s important to diagnosis it because we have medications that help slow the progression and symptoms. And the big area of research now is how to change the course of the disease early on.
In regard to Alzheimer’s disease, I’ve heard that keeping your brain stimulated and active aids in prevention. Is there truth to that statement?
They did a study looking at nuns. They looked at their essays to become a nun and their essays later on. So the nuns who had a more-complex essay when they were young had less of a chance of developing Alzheimer’s disease. So the question is, is this because they were better educated and they used their brain more? Or is it simply that they were at a higher level of intelligence, so they had to fall farther because of developing Alzheimer’s disease? That’s still, I think, an area of contention. I would like to think that keeping your mind active helps keep those synapses forming and changing, but I can’t say I know that as a scientific fact.
Can you talk briefly about migraine headaches and how they are diagnosed and treated?
With migraines, it’s easy to diagnose because they are so common. The things that tell me that a patient has migraine headaches are recurrent headaches with nausea and/or vomiting. Bright lights and loud sounds bother them, and sometimes they see bright lights before the headache starts. Forty percent of women between the ages of 20 and 40 have migraine headaches. It’s very common. Often it’s precipitated by menstrual periods because there’s a hormonal influence. But some foods also can trigger migraines. Or some people get them when they don’t get enough sleep. So there are some lifestyle changes that can help, but there also are very good medications to help with aborting or preventing migraines.
Is it pretty hard to figure out the cause of a migraine?
It depends a lot on the patient’s observations. With migraines, a lot depends on what we get from the patient’s history. Some patients can tell us if certain foods trigger their headaches. Other things that can cause migraines include changes in sleep pattern, strong smells, menstrual periods, stress, changes in weather, hot Kona weather, glaring sunlight and vog.
What are the most exciting treatments you see brewing on the horizon as far as advancements within the field?
In the near future, there will be new types of medications to abort migraine headaches, and medications that modify multiple sclerosis, that do not require injection. On the broader horizon there is a lot of promise about finding the causes and mechanisms of the common neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (Lou Gherig’s disease) and finding ways of diagnosing them in their earliest stages and modifying the disease course. Stem-cell research has great promise to be able to develop brain cells that can take over when the patient’s original cells have stopped functioning. Gene modification also may be able to modify some of the hereditary neurologic diseases such as Huntington’s chorea
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