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2017 Congress of Neurological Surgeons Annual Meeting — live surgical presentation on Tuesday, October 10

For those attending the 2017 Congress of Neurological Surgeons Annual Meeting, be sure to visit the Demonstration Theater for a live surgical presentation on Tuesday, October 10, 2:00-2:30 p.m.:

Endoscopic and Endoscopic Assisted Skull Base Surgery

Operating Surgeon: Paul Gardner, MD, UPMC

Moderator: Garni Barkhoudarian, MD

This live surgical presentation is available to 2017 CNS attendees only.

Neuro-Oncology Researcher at Children’s Hospital of Pittsburgh of UPMC Receives Grant from St. Baldrick’s Foundation

PrintGary Kohanbash, PhD, a neuro-oncology researcher at Children’s Hospital of Pittsburgh of UPMC, has been awarded a scholar grant of $298,000 from the St. Baldrick’s Foundation, a volunteer-driven charity dedicated to raising money for childhood cancer research.

These grants provide resources to institutions to conduct more research and enroll more children in ongoing clinical trials. Kohanbash and his team will look at improving immunotherapy for ependymomas, the third most common kind of brain tumor in children.

“As a scientist and a father, I am driven to help save kids from brain cancers, so I am very excited about the potential of immunotherapy. Unimaginable advances within the last 10 years are enabling us to create new, safer and more effective treatments,” said Kohanbash, who also is an assistant professor of neurological surgery at the University of Pittsburgh School of Medicine. “With this funding from the St. Baldrick’s Foundation, I am hopeful that we can bridge the gap between lab research and clinical care for kids with ependymomas.”

Kohanbash’s team has identified three peptides that might activate immune cells to specifically fight one of the more lethal types of ependymoma. He will be testing these peptides in the lab and also is looking at how immunotherapy could help fight all six types of ependymoma that affect kids.

“We are thrilled Dr. Kohanbash is receiving this grant based on his experience and accomplishments in the field of brain tumor immunology and his ongoing work to translate findings from the lab into promising treatments for children with ependymomas,” said Ian Pollack, MD, chief, Pediatric Neurosurgery, Children’s Hospital.

The grant is supported by the St. Baldrick’s Henry Cermak Fund for Pediatric Cancer Research.

For more information, please visit www.chp.edu.

Concussions are Treatable, More Research Needed, say Leading U.S. Experts in Published Paper

Concussions, often viewed by the public as dire and perplexing, can be effectively treated despite their complexity, according to experts from around the US in a Statement of Agreement available online and published in the December issue of the journal Neurosurgery.

In October, 2015, leading concussion clinicians and researchers gathered at UPMC in Pittsburgh for the “Targeted Evaluation and Active Management” (TEAM) symposium, an unprecedented meeting and white paper designed to propose and share nationally the participants’ agreement on the best practices, protocols and active therapies for treating concussions.

The conference discussions, led by chair Micky Collins, PhD, director of the UPMC Sports Medicine Concussion Program, along with co-directors Anthony Kontos, PhD, and David Okonkwo, MD, PhD, of UPMC and the University of Pittsburgh, resulted in the Statement of Agreement publication. The two-day meeting was fully funded by a grant from the NFL Foundation.

“This conference was remarkable because it brought together a diverse group of leading experts in cutting-edge research and clinical treatment to approach this injury in ways that will help move concussion treatment forward,” said Anthony Kontos, PhD, research director for the UPMC Concussion Program, associate professor in the University of Pittsburgh Department of Orthopaedic Surgery.

The US Center for Disease Control (CDC) estimates that as many as 4 million concussions occur each year in the US, and sport- and recreation-related concussions in particular have increasing incidence. Symptoms, which can be subtle and last days or weeks, include but are not limited to headache, confusion and nausea.

“There has been only limited evidence-based guidance, particularly for primary care providers, about the active treatment of concussion,” Dr. Collins said. “This makes it difficult for clinicians to determine how best to treat patients with this injury. Many are treating patients with concussion using a uniform, rest-based approach today much the same way they did a decade ago.”

Doctors typically advise patients to rest—both the brain and body—until symptoms abate, which might require accommodations at school or work. If the injury was sustained during sports, the patient is instructed not to return to play on the same day and to gradually increase aerobic, exertion-based activity while symptoms are carefully monitored.

But, as described at the symposium and in the published Statement of Agreement, research is beginning to show active rehabilitation can help people recover more quickly and safely than simply resting.

“More research in large, multicenter trials is needed to figure out what kinds of treatments are most effective for a set of symptoms and for individual patients,” Dr. Collins said. Most importantly, we believe concussions are treatable and patients can and do get better.”

A 2015 Harris Poll of more than 2,000 US adults found that 71 percent did not recognize that concussions are treatable. In the same report, 1 in 3 patients who had been diagnosed with a concussion reported receiving no prescribed treatment.

“The purpose of the UPMC symposium was to engage leading clinicians and scientists in a discussion of what we know about concussion and its treatment,” Dr. Okonkwo said. “We hope to build on this effort to share the best available information to improve public understanding and guide future research.”

The authors feel the Statement of Agreement is a step forward in the field and will lead to a collaborative era.

“Over the past decade, many of us individually have accumulated quite a bit of experience about which treatments work for specific symptoms and deficits caused by concussion. We are looking forward to working together to rigorously test these treatments,” said David Brody, MD, PhD, co-author and professor of neurology, Washington University School of Medicine in St Louis.

The Neurosurgery paper was co-written by 37 experts representing 32 clinical and academic institutions, including:

• Jon Almquist, ATC, VATL, ITAT, Fairfax Concussion Center
• Julian Bailes, MD, University Health System, University of Chicago Pritzker School of Medicine
• Mark Barisa, PhD, Baylor Institute for Rehabilitation
• Jeffrey Bazarian, MD, MPH, University of Rochester
• Joshua Bloom, MD, Carolina Sports Concussion Clinic
• David Brody, MD, PhD, Washington University St. Louis
• Robert Cantu, MD, Emerson Hospital, Boston University
• Javier Cardenas, MD, Barrow Neurological Institute
• Jay Clugston, MD, University of Florida
• Randy Cohen, DPT, ATC, University of Arizona
• Ruben Echemendia, PhD, Psychological and Neurobehavioral Associates
• R.J. Elbin, PhD, University of Arkansas Office for Sports Concussion Research
• Richard Ellenbogen, MD, University of Washington
• Janna Fonseca, ATC, Carolina Sports Concussion Clinic
• Gerry Gioia, PhD, Children’s National Health System
• Kevin Guskiewicz, PhD, ATC, University of North Carolina Chapel Hill
• Robert Heyer, MD, Carolinas Medical Center
• Gillian Hotz, PhD, University of Miami
• Grant L. Iverson, PhD, and Ross Zafonte, DO, Harvard Medical School
• Barry Jordan, MD, MPH, Burke Rehabilitation and Research
• Geoffrey Manley, MD, University of California San Francisco
• Joseph Maroon, MD, University of Pittsburgh
• Thomas McAllister, MD, and Daniel Thomas, MD, Indiana University
• Michael McCrea, PhD, Medical College of Wisconsin
• Anne Mucha, DPT, UPMC Centers for Rehabilitation Services
• Beth Pieroth, PhD, North Shore University Health System
• Ken Podell, PhD, Methodist Concussion Center at Houston Hospital
• Matt Pombo, MD, Emory University Healthcare
• Teena Shetty, MD, Hospital for Special Surgery, Weill Cornell Medical College
• Allen Sills, MD, and Gary Soloman, PhD, Vanderbilt University Sports Concussion Center
• Tamara C. Valovich-McLeod, PhD, ATC, FNATA, AT, Still University
• Tony Yates, MD, Pittsburgh Steelers

For more information on concussion research at UPMC, please visit rethinkconcussions.com.

In a First, Pitt-UPMC Team Help Paralyzed Man Feel Again Through a Mind-Controlled Robotic Arm

PITTSBURGH, Oct. 13, 2016 – Imagine being in an accident that leaves you unable to feel any sensation in your arms and fingers. Now imagine regaining that sensation, a decade later, through a mind-controlled robotic arm that is directly connected to your brain.
That is what 28-year-old Nathan Copeland experienced after he came out of brain surgery and was connected to the Brain Computer Interface (BCI), developed by researchers at the University of Pittsburgh and UPMC. In a study published online today in Science Translational Medicine, a team of experts led by Robert Gaunt, Ph.D., assistant professor of physical medicine and rehabilitation at Pitt, demonstrated for the first time ever in humans a technology that allows Mr. Copeland to experience the sensation of touch through a robotic arm that he controls with his brain.
“The most important result in this study is that microstimulation of sensory cortex can elicit natural sensation instead of tingling,” said study co-author Andrew B. Schwartz, Ph.D., distinguished professor of neurobiology and chair in systems neuroscience, Pitt School of Medicine, and a member of the University of Pittsburgh Brain Institute. “This stimulation is safe, and the evoked sensations are stable over months.  There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.”
This is not the Pitt-UPMC team’s first attempt at a BCI. Four years ago, study co-author Jennifer Collinger, Ph.D., assistant professor, Pitt’s Department of Physical Medicine and Rehabilitation, and research scientist for the VA Pittsburgh Healthcare System, and the team demonstrated a BCI that helped Jan Scheuermann, who has quadriplegia caused by a degenerative disease. The video of Scheuermann feeding herself chocolate using the mind-controlled robotic arm was seen around the world. Before that, Tim Hemmes, paralyzed in a motorcycle accident, reached out to touch hands with his girlfriend.
But the way our arms naturally move and interact with the environment around us is due to more than just thinking and moving the right muscles. We are able to differentiate between a piece of cake and a soda can through touch, picking up the cake more gently than the can. The constant feedback we receive from the sense of touch is of paramount importance as it tells the brain where to move and by how much.
For Dr. Gaunt and the rest of the research team, that was the next step for the BCI. As they were looking for the right candidate, they developed and refined their system such that inputs from the robotic arm are transmitted through a microelectrode array implanted in the brain where the neurons that control hand movement and touch are located. The microelectrode array and its control system, which were developed by Blackrock Microsystems, along with the robotic arm, which was built by Johns Hopkins University’s Applied Physics Lab, formed all the pieces of the puzzle.
In the winter of 2004, Mr. Copeland, who lives in western Pennsylvania, was driving at night in rainy weather when he was in a car accident that snapped his neck and injured his spinal cord, leaving him with quadriplegia from the upper chest down, unable to feel or move his lower arms and legs, and needing assistance with all his daily activities. He was 18 and in his freshman year of college pursuing a degree in nanofabrication, following a high school spent in advanced science courses.
He tried to continue his studies, but health problems forced him to put his degree on hold. He kept busy by going to concerts and volunteering for the Pittsburgh Japanese Culture Society, a nonprofit that holds conventions around the Japanese cartoon art of anime, something Mr. Copeland became interested in after his accident.
Right after the accident he had enrolled himself on Pitt’s registry of patients willing to participate in clinical trials. Nearly a decade later, the Pitt research team asked if he was interested in participating in the experimental study.
After he passed the screening tests, Nathan was wheeled into the operating room last spring. Study co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, M.D., Ph.D., assistant professor, Department of Neurological Surgery, Pitt School of Medicine, implanted four tiny microelectrode arrays each about half the size of a shirt button in Nathan’s brain. Prior to the surgery, imaging techniques were used to identify the exact regions in Mr. Copeland’s brain corresponding to feelings in each of his fingers and his palm.
“I can feel just about every finger—it’s a really weird sensation,” Mr. Copeland said about a month after surgery. “Sometimes it feels electrical and sometimes its pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”
At this time, Mr. Copeland can feel pressure and distinguish its intensity to some extent, though he cannot identify whether a substance is hot or cold, explains Dr. Tyler-Kabara.
Michael Boninger, M.D., professor of physical medicine and rehabilitation at Pitt, and senior medical director of post-acute care for the Health Services Division of UPMC, recounted how the Pitt team has achieved milestone after milestone, from a basic understanding of how the brain processes sensory and motor signals to applying it in patients
“Slowly but surely, we have been moving this research forward. Four years ago we demonstrated control of movement. Now Dr. Gaunt and his team took what we learned in our tests with Tim and Jan—for whom we have deep gratitude—and showed us how to make the robotic arm allow its user to feel through Nathan’s dedicated work,” said Dr. Boninger, also a co-author on the research paper.
Dr. Gaunt explained that everything about the work is meant to make use of the brain’s natural, existing abilities to give people back what was lost but not forgotten.
“The ultimate goal is to create a system which moves and feels just like a natural arm would,” says Dr. Gaunt. “We have a long way to go to get there, but this is a great start.”
The lead author on the research publication is Sharlene N. Flesher, of Pitt. Additional authors on this research are Stephen T. Foldes, Ph.D., Jeffrey M. Weiss and John E. Downey, all of Pitt; and Sliman J. Bensmaia, Ph.D., of the University of Chicago.
Primary support for the study was provided by the Defense Advanced Research Projects Agency’s (DARPA) Revolutionizing Prosthetics program through contract N66001-10-C-4056. Additional support was provided by the Office of Research and Development, Rehabilitation Research and Development Service, U.S. Department of Veterans Affairs, grant numbers B6789C, B7143R, and RX720 and the National Science Foundation Graduate Research Fellowship grant DGE-1247842.

In a First, Pitt-UPMC Team Help Paralyzed Man Feel Again Through a Mind-Controlled Robotic Arm

Imagine being in an accident that leaves you unable to feel any sensation in your arms and fingers. Now imagine regaining that sensation, a decade later, through a mind-controlled robotic arm that is directly connected to your brain.

That is what 28-year-old Nathan Copeland experienced after he came out of brain surgery and was connected to the Brain Computer Interface (BCI), developed by researchers at the University of Pittsburgh and UPMC. In a study published online today in Science Translational Medicine, a team of experts led by Robert Gaunt, PhD, assistant professor of physical medicine and rehabilitation at Pitt, demonstrated for the first time ever in humans a technology that allows Mr. Copeland to experience the sensation of touch through a robotic arm that he controls with his brain.

“The most important result in this study is that microstimulation of sensory cortex can elicit natural sensation instead of tingling,” said study co-author Andrew B. Schwartz, PhD, distinguished professor of neurobiology and chair in systems neuroscience, Pitt School of Medicine, and a member of the University of Pittsburgh Brain Institute. “This stimulation is safe, and the evoked sensations are stable over months.  There is still a lot of research that needs to be carried out to better understand the stimulation patterns needed to help patients make better movements.”

This is not the Pitt-UPMC team’s first attempt at a BCI. Four years ago, study co-author Jennifer Collinger, PhD, assistant professor, Pitt’s Department of Physical Medicine and Rehabilitation, and research scientist for the VA Pittsburgh Healthcare System, and the team demonstrated a BCI that helped Jan Scheuermann, who has quadriplegia caused by a degenerative disease. The video of Scheuermann feeding herself chocolate using the mind-controlled robotic arm was seen around the world. Before that, Tim Hemmes, paralyzed in a motorcycle accident, reached out to touch hands with his girlfriend.

But the way our arms naturally move and interact with the environment around us is due to more than just thinking and moving the right muscles. We are able to differentiate between a piece of cake and a soda can through touch, picking up the cake more gently than the can. The constant feedback we receive from the sense of touch is of paramount importance as it tells the brain where to move and by how much.

For Dr. Gaunt and the rest of the research team, that was the next step for the BCI. As they were looking for the right candidate, they developed and refined their system such that inputs from the robotic arm are transmitted through a microelectrode array implanted in the brain where the neurons that control hand movement and touch are located. The microelectrode array and its control system, which were developed by Blackrock Microsystems, along with the robotic arm, which was built by Johns Hopkins University’s Applied Physics Lab, formed all the pieces of the puzzle.

In the winter of 2004, Mr. Copeland, who lives in western Pennsylvania, was driving at night in rainy weather when he was in a car accident that snapped his neck and injured his spinal cord, leaving him with quadriplegia from the upper chest down, unable to feel or move his lower arms and legs, and needing assistance with all his daily activities. He was 18 and in his freshman year of college pursuing a degree in nanofabrication, following a high school spent in advanced science courses.

He tried to continue his studies, but health problems forced him to put his degree on hold. He kept busy by going to concerts and volunteering for the Pittsburgh Japanese Culture Society, a nonprofit that holds conventions around the Japanese cartoon art of anime, something Mr. Copeland became interested in after his accident.

Right after the accident he had enrolled himself on Pitt’s registry of patients willing to participate in clinical trials. Nearly a decade later, the Pitt research team asked if he was interested in participating in the experimental study.

After he passed the screening tests, Nathan was wheeled into the operating room last spring. Study co-investigator and UPMC neurosurgeon Elizabeth Tyler-Kabara, MD, PhD, assistant professor, Department of Neurological Surgery, Pitt School of Medicine, implanted four tiny microelectrode arrays each about half the size of a shirt button in Nathan’s brain. Prior to the surgery, imaging techniques were used to identify the exact regions in Mr. Copeland’s brain corresponding to feelings in each of his fingers and his palm.

“I can feel just about every finger—it’s a really weird sensation,” Mr. Copeland said about a month after surgery. “Sometimes it feels electrical and sometimes its pressure, but for the most part, I can tell most of the fingers with definite precision. It feels like my fingers are getting touched or pushed.”

At this time, Mr. Copeland can feel pressure and distinguish its intensity to some extent, though he cannot identify whether a substance is hot or cold, explains Dr. Tyler-Kabara.

Michael Boninger, MD, professor of physical medicine and rehabilitation at Pitt, and senior medical director of post-acute care for the Health Services Division of UPMC, recounted how the Pitt team has achieved milestone after milestone, from a basic understanding of how the brain processes sensory and motor signals to applying it in patients

“Slowly but surely, we have been moving this research forward. Four years ago we demonstrated control of movement. Now Dr. Gaunt and his team took what we learned in our tests with Tim and Jan—for whom we have deep gratitude—and showed us how to make the robotic arm allow its user to feel through Nathan’s dedicated work,” said Dr. Boninger, also a co-author on the research paper.

Dr. Gaunt explained that everything about the work is meant to make use of the brain’s natural, existing abilities to give people back what was lost but not forgotten.

“The ultimate goal is to create a system which moves and feels just like a natural arm would,” says Dr. Gaunt. “We have a long way to go to get there, but this is a great start.”

The lead author on the research publication is Sharlene N. Flesher, of Pitt. Additional authors on this research are Stephen T. Foldes, PhD, Jeffrey M. Weiss and John E. Downey, all of Pitt; and Sliman J. Bensmaia, PhD, of the University of Chicago.

Primary support for the study was provided by the Defense Advanced Research Projects Agency’s (DARPA) Revolutionizing Prosthetics program through contract N66001-10-C-4056. Additional support was provided by the Office of Research and Development, Rehabilitation Research and Development Service, US Department of Veterans Affairs, grant numbers B6789C, B7143R, and RX720 and the National Science Foundation Graduate Research Fellowship grant DGE-1247842.

Burning More Calories Associated with Greater Gray Matter Volume in Brain, Reduced Alzheimer’s Risk

Whether they jog, swim, garden or dance, physically active older persons  have larger gray matter volume in key brain areas responsible for memory and cognition, according to a new study by researchers at the University of Pittsburgh School of Medicine and UCLA.

The findings, published today in the Journal of Alzheimer’s Disease, showed also that people who had Alzheimer’s disease or mild cognitive impairment experienced less gray matter volume reduction over time if their exercise-associated calorie burn was high.

A growing number of studies indicate physical activity can help protect the brain from cognitive decline, said investigator James T. Becker, PhD, professor of psychiatry, Pitt School of Medicine. But typically people are more sedentary as they get older, which also is when the risk for developing Alzheimer’s disease and other dementias increases.

“Our current treatments for dementia are limited in their effectiveness, so developing approaches to prevent or slow these disorders is crucial,” Dr. Becker said. “Our study is one of the largest to examine the relationship between physical activity and cognitive decline, and the results strongly support the notion that staying active maintains brain health.”

Led by Cyrus Raji, MD, PhD, formerly a student at Pitt School of Medicine and now a senior radiology resident at UCLA, the team examined data obtained over five years from nearly 876 people 65 or older participating in the multicenter Cardiovascular Health Study. All participants had brain scans and periodic cognitive assessments. They also were surveyed about how frequently they engaged in physical activities, such as walking, tennis, dancing and golfing, to assess their calorie expenditure or energy output per week.

Using mathematical modeling, the researchers found that the individuals who burned the most calories had larger gray matter volumes in the frontal, temporal and parietal lobes of the brain, areas that are associated with memory, learning and performing complex cognitive tasks. In a subset of more than 300 participants at the Pitt site, those with the highest energy expenditure had larger gray matter volumes in key areas on initial brain scans and were half as likely to have developed Alzheimer’s disease five years later.

“Gray matter houses all of the neurons in your brain, so its volume can reflect neuronal health,” Dr. Raji explained. “We also noted that these volumes increased if people became more active over five years leading up to their brain MRI.”

He added that advancements in technology might soon make it feasible to conduct baseline neuroimaging studies of people who already have mild cognitive impairment or who are at risk for a dementia disorder, with the aim of prescribing lifestyle approaches such as physical activity to prevent further memory deterioration.

“Rather than wait for memory loss, we might consider putting the patient on an exercise program and then rescan later to see if there are any changes in the brain,” Dr. Raji said.

In a journal press release, George Perry, PhD, Dean of Sciences at the University of Texas at San Antonio and Editor in Chief of the Journal of Alzheimer’s Disease, called the research “a landmark study that links exercise to increases in gray matter and opens the field of lifestyle intervention to objective biological measurement.”

Other members of the research team include Kirk I. Erickson, PhD, Oscar L. Lopez, MD, H. Michael Gachi, PhD, and Lewis Kuller, MD, DrPH, all of the University of Pittsburgh; David A. Merrill, MD, PhD., Harris Eyre, MD, Sravya Mallam, BS, Nare Torosyan, BS, and Paul M. Thompson, PhD, all of UCLA; Owen T. Carmichael, PhD, of University of California, Davis; and W.T. Longstreth, Jr., MD, of the University of Washington.

The research was supported in part by funds from contract numbers N01-HC-80007, N01-HC-85079 through N01-540 HC-85086, N01-HC-35129, N01-HC-15103, N01-541 HC-55222, N01-HC-75150, N01-HC-45133 and grant HL080295 from the National Heart, Lung, and Blood Institute, with additional contribution from the National Institute of Neurological Disorders and Stroke.

Structure of Brain Plaques in Huntington’s Disease Described by Pitt Team

Researchers at the University of Pittsburgh School of Medicine have shown that the core of the protein clumps found in the brains of people with Huntington’s disease have a distinctive structure, a finding that could shed light on the molecular mechanisms underlying the neurodegenerative disorder. The findings were published this week in the Proceedings of the National Academy of Sciences.

In Huntington’s and several other progressive brain diseases, certain proteins aggregate to form plaques or deposits in the brain, said senior investigator Patrick C.A. van der Wel, Ph.D., assistant professor of structural biology, Pitt School of Medicine.

“Despite decades of research, the nature of the protein deposition has been unclear, which makes it difficult to design drugs that affect the process,” he said. “Using advanced nuclear magnetic resonance spectroscopy, we were able to provide an unprecedented view of the internal structure of the protein clumps that form in the disease, which we hope will one day lead to new therapies.”

The gene associated with Huntington’s makes a protein that has a repetitive sequence called polyglutamine. In the 1990s, it was discovered that the patients have mutated proteins in which this sequence is too long, yet it has remained unclear how exactly this unusual mutation causes the protein to misbehave, clump together and cause the disease.

“This is exciting because it may suggest new ways to intervene with these disease-causing events,” Dr. van der Wel said. “For the first time, we were able to really look at the protein structure in the core of the deposits formed by the mutant protein that causes Huntington’s. This is an important breakthrough that provides crucial new insights into the process of how the protein undergoes misfolding and aggregation.

He added Huntington’s is one of many neurodegenerative diseases in which unusual protein deposition occurs in the brain, suggesting similar biochemical mechanisms may be involved. Lessons learned in this disease could help foster understanding of how these types of diseases develop, and what role the protein aggregates play.

The team included Cody L. Hoop, Ph.D., Hsiang-Kai Lin, Ph.D., Karunakar Kar, Ph.D., Jennifer C. Boatz, Abhishek Mandal, and Ronald Wetzel, Ph.D., all of the University of Pittsburgh; Gábor Magyarfalvi, Ph.D., of Eötvös University, Hungary; and Jonathan Lamley and Józef R. Lewandowski, Ph.D., of Warwick University, U.K.

The project was funded by National Institutes of Health grants GM112678, AG019322, GM099718 and GM088119; National Center for Research Resources grant RR024153; the Biotechnology and Biological Sciences Research Council; and the Engineering and Physical Sciences Research Council.

Lunsford Named Cushing Award Recipient

L. Dade Lunsford, MD, Lars Leksell Distinguished Professor of Neurological Surgery at the University of Pittsburgh and director of the UPMC Center for Image-Guided Neurosurgery, has been chosen for the 2016 Cushing Award for Technical Excellence and Innovation in Neurosurgery by the American Association of Neurological Surgery.

The award is bestowed on an AANS member for technical prowess and skill and/or innovation in the development of new procedures that have become part of the arsenal neurosurgeons use to treat disease or trauma.

In announcing the award, the AANS cited Dr. Lunsford for his “ability to improve the delivery of neurosurgical care by enhancing safety and efficacy and by making the field of neurosurgery safer, more accessible, more efficient and more effective.” The award is one of the highest recognitions bestowed upon a neurosurgeon.

Dr. Lunsford is an internationally recognized authority on stereotactic surgery, radiosurgery, and minimally invasive surgery. In 1987, he was responsible for bringing the Gamma Knife to then Presbyterian University Hospital, the first hospital in North America to offer the innovative, non-invasive, bloodless form of brain surgery. The installation of the Gamma Knife revolutionized neurosurgical care, drastically reducing hospital stays while significantly improving patient care.

In the nearly 30 years since it’s installation, more than 13,500 patients have undergone radiosurgery in the department’s Gamma Knife units. Dr. Lunsford’s team has published numerous books and more than 400 peer reviewed outcome studies, and his team has trained more than 1,700 physicians and physicists from around the world in the role, methods, and long-term outcomes of Gamma Knife radiosurgery.

Dr. Lunsford has also played a leading role in assisting Gamma Knife manufacturer Elekta develop further models of the Gamma Knife. In 2016, the latest version of the unit, The Leksell Icon®, will debut at UPMC Presbyterian.

Sekula Co-Edits MVD Book

Raymond F. Sekula Jr, MD, MBA, associate professor of neurological surgery at the University of Pittsburgh and director of the department’s cranial nerve disorders program, is co-editor of the newly released, first edition textbook, Microvascular Decompression Surgery, an update on MVD surgery, widely accepted as an effective remedy for cranial nerve hyperexcitability disorders including hemifacial spasm, trigeminal neuralgia, and glossopharyngeal neuralgia.

Shi-Ting Li, MD, PhD, and Jun Zhong, MD, PhD, from the department of neurosurgery at XinHua Hospital and Shanghai Jiao Tong University School of Medicine, in Shanghai, China, are co-editors of the book.

The book’s author, Springer, notes “the authors describe in detail those steps of the process that need the most attention in order to achieve an excellent postoperative outcome, including positioning, craniectomy, approach and identification of the culprit, etc. Though it primarily focuses on surgical principles and technical nuances, the book also addresses the intraoperative electrophysiologic monitoring and pathogeneses of hemifacial spasm and trigeminal neuralgia.”

Dr. Sekula is known internationally for his development of microvascular techniques and has lectured worldwide on the subject.

For more information on the book, please visit the Springer website.

Gene Therapy Prevents Parkinson’s Disease in Animal Model, Says Pitt Study

PITTSBURGH, June 15, 2015 – Gene therapy to reduce production of a brain protein successfully prevented development of Parkinson’s disease in an animal study, according to researchers at the University of Pittsburgh School of Medicine. The findings, published online today in the Journal of Clinical Investigation, could lead to new understanding of how genetic and environmental factors converge to cause the disease, and the development of effective treatments to prevent disease progression.

Scientists have observed dysfunction of mitochondria, which make energy for cells, in Parkinson’s disease, as well as Lewy parkinsons
bodies, which are characteristic clumps of the cellular protein α-synuclein within neurons, said principal investigator Edward A. Burton, M.D., D.Phil., associate professor of neurology, Pitt School of Medicine.

“Until now, these have been pursued largely as separate lines of research in Parkinson’s disease,” Dr. Burton said. “Our data show that mitochondria and α-synuclein can interact in a damaging way in vulnerable cells, and that targeting α-synuclein might be an effective strategy for treatment.”

The team wanted to see what would happen if they knocked out the production of α-synuclein in the brain’s substantia nigra, home to the dopamine-producing cells that are lost as Parkinson’s disease progresses. To do so, they used a harmless virus called AAV2 engineered to transport into the neuron a small piece of genetic code that blocks production of α-synuclein. They delivered the gene therapy to the brains of rats and then exposed the animals to the pesticide rotenone, which inhibits mitochondrial function.

“Our previous work established that rotenone exposure in rats reproduces many features of Parkinson’s disease that we see in humans, including movement problems, Lewy bodies, loss of dopamine neurons and mitochondrial dysfunction,” explained co-investigator J. Timothy Greenamyre, M.D., Ph.D., Love Family Professor of Neurology, and director of the Pittsburgh Institute for Neurodegenerative Diseases at Pitt. “We found that our gene therapy prevented those symptoms from appearing, which is very exciting.”

Each side of the brain controls the opposite side of the body.  The left sides of rats that received gene therapy to the right side of the brain did not become stiff and slow, while their right sides did. The researchers determined that dopamine neurons on the treated side of the brain were protected from rotenone, accounting for the substantial improvement in movement symptoms. In contrast, untreated animals and animals that received a control virus that does not reduce α-synuclein production, developed progressive Parkinsonism and loss of dopamine neurons.

In next steps, the researchers plan to unravel the molecular pathways that enable α-synuclein levels to influence mitochondrial function and develop drugs that can target the underlying mechanisms.

“The viral vector AAV2 has been used safely in Parkinson’s disease patients in clinical trials, so the gene therapy approach might be feasible,” Dr. Burton said. “We think targeting α-synuclein has great potential to protect the brain from neurodegeneration in Parkinson’s disease.”

“We hope to be able to translate this general approach of reducing α-synuclein into human clinical trials soon,” Dr. Greenamyre added.

The team included Alevtina Zharikov, Ph.D., Jason R. Cannon, Ph.D., Victor Tapias, Ph.D., Qing Bai, Ph.D., Max Horowitz, M.D., Ph.D., Vipul Shah, M.D., Amina El Ayadi, Ph.D., and Teresa G. Hastings, Ph.D., all of the University of Pittsburgh.

The project was funded by the U. S. Department of Veterans Affairs grant 1I01BX000548;  National Institutes of Health grants ES022644, NS059806, ES018058, ES020718, ES019879 and ES020327; the Blechman Foundation; the Parkinson’s Chapter of Greater Pittsburgh; the JPB Foundation; the American Parkinson Disease Association; the Parkinson’s Unity Walk; and a gift from Mr. and Mrs. Henry Fisher.

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