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Barriers to diagnosis and lack of access to modern medications have combined to place caregivers and HIV-positive patients in sub-Saharan Africa between a rock and a hard place. A new study shows that physicians are often forced to choose between controlling seizures, which can occur if the disease goes undiagnosed for too long, or treating the underlying HIV infection.

The study was led by Gretchen Birbeck, M.D., M.P.H., the Edward A. and Alma Vollertson Rykenboer Professor in Neurology at University of Rochester Medical Center (URMC). Birbeck also serves as director of the Epilepsy Care Team at Chikankata Hospital in rural Zambia and is an honorary lecturer at the University of Zambia.

While the study, which appears in the journal Neurology, was undertaken for the purpose of identifying risk factors for seizures in HIV-positive patients and thereby providing physicians with a blueprint for care, it has instead highlighted the difficult decisions that providers and patients must confront.

Neurologists involved in telemedicine programs say that, despite the challenges with reimbursement, credentialing, and turf issues, they have observed more support for the approach — increasing their ability to provide care for neurologic patients who find it difficult to travel and/or who live in rural and remote areas of the country without access to specialists.

The most formidable barrier has been the federal government — the biggest single payer for health care services, neurologist Raymond Dorsey, MD, FAAN, director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center (URMC) told Neurology Today. Its Medicare payment policy does not support patient-centered care, he said.

Dr. Dorsey works with many patients with chronic, degenerative conditions that make it difficult to travel for specialty care, including Parkinson's disease and Alzheimer's disease.

Dr. Gretchen Birbeck

University of Rochester Medical Center neurologist Gretchen Birbeck, M.D., M.P.H., has been chosen to serve on the Advisory Board of the National Institutes of Health's Fogarty International Center, which supports basic, clinical, and applied medical research and training for U.S. and foreign investigators working in the developing world.

Birbeck, the Edward A. and Alma Vollertsen Rykenboer Professor in Neurology, has spent the last 20 plus years studying the burden of neurological disorders and the effectiveness of health care delivery in sub-Saharan Africa. She divides her time between Rochester and projects in Africa.

Birbeck's specific interest is epilepsy and seizure disorders -- which are far more common in Africa due to higher rates of parasitic and viral infection and constitute a significant public health problem -- and the creation of scalable interventions to prevent seizures and provide better care to vulnerable populations on the continent. She is also collaborating with local academic institutions, hospitals, and government officials in Zambia, Malawi, and Uganda to develop the networks necessary to conduct clinical trials and create education and training programs for health care providers and researchers.

The Fogarty International Center funds some 400 research and training projects involving more than 100 U.S. universities. These U.S. scientists, in turn, collaborate with colleagues in numerous foreign countries, most of them in the developing world. Fogarty also convenes the best scientific minds around the world to address critical global health research problems and guide national and international global health policies.

Bill Lawler is behind the bar at Caverly's Irish Pub.

A retired Rochester police investigator, Lawler pours drinks as some of his former colleagues — and some current cops — wander in.

Lawler is well known here, where he proudly wears the nickname "Three-quarters." There's a reason for the nickname: Stricken with Huntington's disease, Lawler suffers from tremors that are obvious as he pours a draft from a tap or hands a glass to a customer. Often, as his hand quavers, some of the brew sloshes over the edge. Rarely does one get a beer filled to the top; hence, the nickname "Three-quarters."

There is also the nickname "Lefty," a reference to Lawler's off-balance gait. "It's not because of my politics but because I kept walking to the left," Lawler said.

Some may find the nicknames of questionable taste, but not Lawler. This is the kind of humor he was accustomed to on the police force. Sure, Lawler may have a disability, but that does not mean he is disabled by Huntington's. At Caverly's on South Avenue, where a friend has him bartend on Wednesday afternoons, Lawler gives as well as he gets when his cop buddies give him grief.

"I refuse to be pitied," Lawler said in an interview. "If anybody ever pitied me I would bite off their nose."

A former marathoner, Lawler still runs regularly, accompanied by his guide dog, Kermit, and friends or family. Winter weather does not stop him. He keeps in touch with many of his friends, and often joins them for breakfast or lunch. He accepts any new experimental treatment offered for Huntington's, even one that left him with terrible abdominal pains.

He is, for many, a lesson about how to live a life — a life slowed by a disease with no known cure, a disease that may ultimately bring his life to an end.

But that day is, for Lawler, a distant future and not one worth imagining. And his willingness to push ahead with a life of some normalcy, and to exercise almost as vigorously as he once did, seems to have its benefits: The disease is not progressing as quickly as it does with some who settle into a sedentary lifestyle.

"The fact that he continues to get out there and run, kudos to him," said Dr. Kevin Biglan, a neurologist at University of Rochester Medical Center who works closely with Lawler. "But I also think it helps" combat the disease's effects, he said.

"He does not let the disease impact him or get him down," Biglan said. "He's just going to do his thing."

A new award from the CHDI Foundation will advance promising research that aims to slow the progression of Huntington's disease. The funding, anticipated to total more than $10.5 million over next five years, will help University of Rochester Medical Center (URMC) scientists develop a stem cell-based therapy that swaps sick brain cells for healthy ones.

The new award will go to the lab of Steve Goldman, M.D., Ph.D., the co-director of the URMC Center for Translational Neuromedicine, which has research operations in both Rochester and at the University of Copenhagen.

Huntington's is a hereditary neurodegenerative disease characterized by the loss of medium spiny neurons, a nerve cell in the brain that plays a critical role in motor control. As the disease progresses over time and more of these cells die, the result is involuntary movements, problems with coordination, and cognitive decline, depression, and often psychosis. There is currently no way to slow or modify this fatal disease.

The new award will support research that builds upon findings published by Goldman earlier this year in the journal Nature Communications showing that researchers were able to slow the progression of the disease in mice by transplanting healthy human support cells, called glial progenitor cells, into the animals' brains.

Maiken Nedergaard, M.D., D.M.Sc.

More than $4.5 million in new grants to the lab of University of Rochester Medical Center scientist Maiken Nedergaard, M.D., D.M.Sc., underscore the important role the brain's waste disposal system may play in a range of neurological disorders. The new awards will advance understanding of how small vessel disease and traumatic brain injury can give rise to cognitive and behavioral problems.

Nedergaard and her colleagues first unveiled the brain's unique method of removing waste -- dubbed the glymphatic system -- in a paper in Science Translational Medicine in 2012. The research revealed that the brain possesses a circulation network that piggybacks on blood vessels and uses cerebral spinal fluid to flush away waste products from brain tissue. Since that time, the team has gone on to show that the glymphatic system works primarily while we sleep, could be a key player in diseases like Alzheimer's, and is disrupted after traumatic brain injury.

Michelle A. Burack, M.D., Ph.D., sat in with a panel of experts on WXXI's Connections with Evan Dawson (Sept. 28) examining how—from diagnosis to research and resources—Rochester has become more welcoming to those living with Parkinson's Disease.

The University of Rochester Medical Center (URMC) Department of Neurology is honoring the 50^th anniversary of its founding. The occasion will be marked with four day-long celebration of the department’s history, achievements, alumni, and vision for the future.

“The history of the department is ultimately a human story of relationships, inspiring leadership, and how a rare combination of great intellect, common sense, humility, wit, and charm can move the neurological needle on a global scale,” said Robert Holloway, M.D., M.P.H., the chair of the Department of Neurology. “From its humble beginnings 50 years ago, this department has shaped the careers of hundreds of caregivers and, through its care and research, impacted the lives of millions of patients.”

The URMC Department of Neurology was founded by Bob Joynt, M.D. in 1966 who served as its chair until 1986. The department has been subsequently led by Robert Griggs (1986-2008) Steve Goldman (2008-2012), and Holloway (2012-present).

New research has shown that the corticosteroid deflazacort is a safe and effective treatment for Duchenne muscular dystrophy. The findings, which appear this month in the journal Neurology, could pave the way for first U.S.-approved treatment for the disease.

"Duchenne muscular dystrophy patients have limited treatment options and a desperate need for effective therapies," said University of Rochester Medical Center (URMC) neurologist Robert Griggs, M.D., lead author of the study. "This study shows that deflazacort may provide an important treatment for delaying the progression of the disease."

Duchenne muscular dystrophy (DMD) is a condition found almost exclusively in boys. The disease is characterized by muscle weakness which begins to appear at a young age and progresses rapidly leading to significant disability. Boys with the disease often end up in a wheelchair by age 9 or 10 because of weakness in their legs. The symptoms eventually spread to other parts of the body, including the heart and muscles responsible for breathing, and the disease is often fatal by the time the individual reaches his late teens. An estimated 28,000 people in the U.S. suffer from the disease.

A $2.3 million Department of Defense grant will help neuroscientists develop new treatments for the emergency room and the battlefield. The research will focus on the development of new therapies that could help protect brain and other at risk organs following a trauma, heart attack, or stroke.

“While we have made significant progress in our ability to restore blood flow after stroke or cardiac arrest, the medical community does not have drugs at its disposal to prevent the secondary damage that occurs after these events,” said University of Rochester Medical Center neurologist Marc Halterman, M.D., Ph.D., the principal investigator of the study. “This grant will further our research on a promising class of drugs that possess both anti-inflammatory and cytoprotective properties that we believe will be suitable for use in both military and emergency conditions.”

Jonathan W. Mink, M.D., Ph.D., chief of Child Neurology at Golisano Children's Hospital, will lead the nation's largest organization of child neurologists.

Mink, who is also Frederick A. Horner, MD Endowed Professor in Pediatric Neurology, was voted president of the organization by fellow pediatric neurologists from around the U.S. He will assume the position of president-elect following the annual meeting of the Child Neurology Society in November.

Mink will succeed Golisano Children’s Hospital’s pediatrician-in-chief, Nina F. Schor, Ph.D., William H. Eilinger Chair of Pediatrics.

The Child Neurology Society is a non-profit professional association of 1,300 pediatric neurologists in the United States, Canada, and worldwide who are devoted to fostering the discipline of child neurology and promoting the optimal care and welfare of children with neurological and neurodevelopmental disorders.

“It’s a tremendous honor to be elected,” Mink said. “Child neurology is a changing field. There is a real opportunity to leverage our increasing diversity to reach out to students, trainees and patients in a way that we couldn’t before.”

In addition to Mink’s clinical practice and research, he directs the Division of Child Neurology in the Department of Neurology and is associate director of the Child Neurology Residency Program. He also serves on the executive board of the International Child Neurology Association, on the board of directors of the American Neurological Association, and the executive committee of the American Academy of Pediatrics Section on Neurology. He is a member of the National Advisory Neurological Disorders and Stroke Council of the NIH, a medical advisory to the Batten Disease Support and Research Association, and is also an associate editor of Neurology. He served as chair of the Child Neurology Society’s Scientific Program Committee from 2013 to 2015, where he and Schor collaborated to plan the 2014 and 2015 Annual Meetings.

“Nina was a terrific president of the Child Neurology Society. She’s a born leader, and I have learned some lessons on how she fulfilled her duties,” Mink said. “I think it’s tremendous for the University of Rochester. When I started here, there were four child neurologists. Now there are 15, and our residency program is one of the top-rated programs nationally.”

Mink trained in Pediatrics Neurology at St. Louis Children’s Hospital. He received his M.D. and Ph.D. from Washington University.

Mink is nationally recognized as a movement disorders specialist. He’s known for his research on Tourette syndrome and understanding brain mechanisms involved in the control of movement, along with disorders that cause involuntary movement. His research also includes clinical trials that impact the function of children with movement disorders.

Mink will serve one year as president-elect, two as president, and one as past president.

Tarun Bhalla, M.D., Ph.D., has been named director of Stroke and Cerebrovascular Services in the Department of Neurosurgery and director of Inpatient Stroke and Cerebrovascular Services at UR Medicine. Bhalla, who was also appointed assistant professor in the Departments of Neurosurgery, Neurology, and Imaging Sciences, began his position on August 1, 2016.

“Dr. Bhalla is a tremendously skilled endovascular neurosurgeon who will build upon an already strong foundation of stroke and cerebrovascular services and help guide efforts to expand and improve care across the region,” said Web Pilcher, M.D., Ph.D., chair of the Department of Neurosurgery. “We are delighted that he has agreed to join the Medical Center and our team.”

“I am honored to join UR Medicine and look forward to contributing to a team of providers that is already providing the highest level of care for victims of stroke and cerebrovascular diseases,” said Bhalla. “In stroke, time is brain, so we need to continue to focus on new ways to accelerate the process of getting patients to where they need to be and receiving the level of care necessary to achieve good outcomes.”

Bhalla joins URMC from Geisinger Medical Center in Danville, PA where he served for three years as the director of Cerebrovascular and Endovascular Neurosurgery. He received his M.D. and Ph.D. from the University of Connecticut and did his residency training, as well as a fellowship in surgical endovascular neuroradiology, at the Cleveland Clinic. His specialties include cerebrovascular and endovascular treatment for stroke, aneurysms, arteriovenous malformations (AVM), carotid/vertebral artery disease, and a chronic facial pain called trigeminal neuralgia.

Bhalla will join the UR Medicine’s Comprehensive Stroke Center. Strong Memorial Hospital is the only institution in the region designated by the Joint Commission and the American Heart Association/American Stroke Association as a Comprehensive Stroke Center. His appointment will expand the Center’s team of endovascular surgeons. In recent years, stroke care undergone a shift in care with studies showing that endovascular procedures – during which surgeons remove clots in the brain via a catheter fed through blood vessels – may result in better outcomes for some patients compared to care involving only clot busting drugs.

His appointment comes on the heels of several new investments in stroke and cerebrovascular care at Strong Memorial Hospital, including a new Hybrid Operating Room and Angio Suite designed to offer minimally invasive neurosurgical procedures, a new surgical technology to treat hemorrhages deep inside the brain, and a dedicated Neuromedicine Intensive Care Unit.

Bhalla will help lead efforts to expand stroke care, including working with community providers and emergency medical technicians to diagnose and potentially begin treatment for stroke patients before they reach the hospital.

Neurologist Alexander R. Paciorkowski, M.D. is being honored by the American Neurological Association (ANA) for his research in developmental disorders. The award will be presented at the ANA's annual meeting in October 2016.

Paciorkowski 's research focuses on early life epilepsies and his research has shed new light on mechanisms of a severe form of seizure disorders -- early myoclonic encephalopathy, Ohtahara syndrome, and infantile spasms -- collectively referred to as developmental epilepsies. Specifically, Paciorkowski has identified a mutation in a gene called salt-inducible kinase 1 (SIK1), a gene previously unidentified with the disease and one which researchers believe plays a role in a chain reaction of gene and protein interactions in neurons that contribute to seizures.

"Alex is a rising star in neurogenetics and child neurology who, just four years out of fellowship, has already made major contributions to our knowledge about human neurodevelopment genetics and disorders," said Jonathon Mink, M.D., Ph.D., chief of the Division of Child Neurology and vice chair of the Department of Neurology at University of Rochester Medical Center (URMC).

New research in the journal Neuron reveals how the brain is able to meet its massive energy demands with a "just in time" system that delivers oxygen that fuels nerve cells. The findings could shed light on diseases like Alzheimer's and help explain the cognitive decline that accompanies the disease.

"Our brains require a tremendous amount of energy and in order to meet this demand the flow of blood must be precisely choreographed to ensure that oxygen is being delivered where it is needed and when it is needed," said Maiken Nedergaard, M.D., D.M.Sc., co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the study. "This study demonstrates that microvessels in the brain play a key role in reacting to spikes in demand and accelerating the flow of blood to respond to neuronal activity."

Steven Goldman, professor of neurology, has been reappointed as codirector of the Center for Translational Neuromedicine and as the Dean Zutes Chair in Biology of the Aging Brain—both through June 30, 2020. Goldman also retains his joint appointments as professor of neurosurgery and as Distinguished Professor in Neurosciences.

Goldman is interested in cell genesis and neural regeneration in the adult brain. His lab focuses on the use of stem and progenitor cells for the treatment of neurodegenerative disorders such as Huntington’s Disease, as well as for the treatment of glial diseases such as the pediatric leukodystrophies and multiple sclerosis. He has published more than 250 papers in his field—more than 100 as first or senior author—as well as 20 issued patents with more pending.

Sleep is critical for rest and rejuvenation. A human being will actually die of sleep deprivation before starvation--it takes about two weeks to starve, but only 10 days to die if you go without sleep.

The CDC has also classified insufficient sleep as a public health concern. Those who don't get enough sleep are more likely to suffer from chronic diseases that include hypertension, diabetes, depression, obesity, and cancer.

It's thus vital to get enough shuteye, but it turns out your sleep position also has a significant impact on the quality of rest you get.

Now, a neuroscience study suggests that of all sleep positions, one is most helpful when it comes to efficiently cleaning out waste from the brain: sleeping on your side.

The study, published in the Journal of Neuroscience, used dynamic contrast-enhanced MRI to image the brain's "glymphatic pathway." This is the system by which cerebrospinal fluid filters through the brain and swaps with interstitial fluid (the fluid around all other cells in the body).

"It is interesting that the lateral [side] sleep position is already the most popular in humans and most animals--even in the wild," said University of Rochester's Maiken Nedergaard. "It appears that we have adapted the lateral sleep position to most efficiently clear our brain of the metabolic waste products that build up while we are awake."

A new program launched by neurologists at UR Medicine will expand access to care and serve as a national model for the management of Parkinson’s disease and other chronic illnesses. The Parkinson’s Disease Care, New York (PDCNY) program will be a largely virtual network providing free care to as many as 500 underserved patients across New York State.

“Providing coordinated, ongoing care to Parkinson’s patients in the traditional settings of a doctor’s office requires these individuals and their caregivers and families to travel, often long distances, and is expensive for payers and patients alike,” said URMC neurologist Kevin Biglan, M.D. M.P.H., the director of the PDCNY program. “The PDCNY program will break down the barriers of geography and deliver care directly to patients who have never seen a specialist and in the comfort of their own homes.”

Researchers have successfully reduced the symptoms and slowed the progression of Huntington’s disease in mice using healthy human brain cells. The findings, which were published today in the journal Nature Communications, could ultimately point to a new method to treat the disease.

The research entailed implanting the animals with human glia cells derived from stem cells. One of the roles of glia, an important support cell found in the brain, is to tend to the health of neurons and the study’s findings show that replacing sick mouse glia with healthy human cells blunted the progress of the disease and rescued nerve cells at risk of death.

“The role that glia cells play in the progression of Huntington’s disease has never really been explored,” said Steve Goldman, M.D., Ph.D., co-director of the University of Rochester Center for Translational Neuromedicine. “This study shows that these cells are not only important actors in the disease, but may also hold the key to new treatment strategies.”

Birbeck has provided care for more than 3,000 patients with seizure disorders in Africa during two decades of work there. (photo courtesy of Gretchen Birkeck)

Gretchen Birbeck’s first trip to Zambia came in 1994, when she was a University of Chicago medical student completing an elective at the remote Chikankata Mission Hospital, about 75 miles south of the capital city, Lusaka.

More than two decades later, she spends half her year in sub-Saharan Africa, working to improve care for people with seizure disorders.

The Edward A. and Alma Vollertsen Rykenboer Professor in Neurology at Rochester, Birbeck is the director for Chikankata’s Epilepsy Care Team. She’s also an adjunct faculty member at the University of Zambia.

Seizure disorders can be caused by many medical conditions, and they’re more common in the developing world. Neurological and psychological disorders account “for about a quarter of the global burden of disease, and much of that is in developing countries,” says Birbeck.

“There’s a disconnect between where disease is and where experts are,” she says.

She works to redress that disconnection, providing clinical care and conducting research. As a result, more than 3,000 patients have received treatment they otherwise wouldn’t have. And she has helped make changes to Zambia’s national policy that could help many more.

She’s also working to build up the resources and networks necessary to conduct clinical trials in Africa, and to create education and training programs for health care providers and researchers. She’s involved in cerebral malaria research in Malawi and Uganda, and mentors postgraduates and junior faculty carrying out research in Zambia, Malawi, Kenya, and South Africa.

On May 15, 2012, Manzone called his mother, Debbie Franczek, with exciting news. His wife, Danielle, was pregnant again. The joy was short-lived. Later that day, Franczek was diagnosed with Huntington's disease. It is slowly killing her.

A year before, the family started noticing changes in Franczek's mood, behaviors, speech and gait. She'd slur words as she was speaking and jerk uncontrollably. Her moods were unpredictable at best.

"We knew exactly what it was," says Manzone, who lives in upstate New York. The symptoms of Huntington's disease can be similar to those of amyotrophic lateral sclerosis, Alzheimer's and Parkinson's simultaneously. The Huntington's Disease Society of America reports that there are about 30,000 symptomatic Americans and more than 200,000 at risk of inheriting the disease today.

Kevin Biglan, professor of neurology at the University of Rochester and director of the Huntington's society's Center of Excellence, has treated patients with Huntington's disease for much of his career.

"It varies dramatically across individuals," Biglan says of the neurodegenerative disease. "Brain cells dysfunction and progressively die over a period of decades."

According to Biglan, patients with the fatal disease experience a slow progression of symptoms over a 10- to 25-year period. "You can imagine if you are 25 years old, you may not have symptoms for 25 to 30 years," Biglan says. "It can create quite a bit of anxiety among individuals. It doesn't give you much predicted value."

The American Heart Association/American Stroke Association has once again honored UR Medicine’s Strong Memorial Hospital with its highest awards for heart failure, stroke and resuscitation care. Strong Memorial is the only Rochester-area hospital to earn the highest levels of recognition for these categories of care.

Strong Memorial earned Get With the Guidelines Heart Failure Gold Plus and Target Heart Failure Honor Roll Award, Stroke Gold Plus and Target Elite Plus Honor Roll Award and Resuscitation Gold Award in the AHA/ASA’s hospital-based quality improvement program.

Each year in the U.S., approximately 735,000 people suffer heart attacks, 5.7 million people endure heart failure and nearly 800,000 people suffer a stroke, according to the American Heart Association/American Stroke Association. The GWTG program is designed to measure outcomes and adherence to treatment guidelines to ensure high quality care at hospitals across the nation.

“We strive to provide the most comprehensive, leading-edge care for our patients,” said neurologist Curtis G. Benesch, M.D., M.P.H., medical director of the UR Medicine Comprehensive Stroke Center. “This award acknowledges the commitment of many individuals to the goals of advancing acute stroke care and improving stroke prevention.”

A study out today in the journal Science sheds new light on the biological mechanisms that control the sleep-wake cycle. Specifically, it shows that a simple shift in the balance of chemicals found in the fluid that bathes and surrounds brain cells can alter the state of consciousness of animals.

The study, which focuses on a collection of ions that reside in the cerebral spinal fluid (CSF), found that not only do these changes play a key role in stimulating or dampening the activity of nerve cells, but they also appear to alter cell volume causing brain cells to shrink while we sleep, a process that facilitates the removal of waste.

"Understanding what drives arousal is essential to deciphering consciousness and the lack thereof during sleep," said Maiken Nedergaard, M.D., D.M.Sc., co-director of the University of Rochester Center for Translational Neuromedicine and lead author of the study. "We found that the transition from wakefulness to sleep is accompanied by a marked and sustained change in the concentration of key extracellular ions and the volume of the extracellular space."

The current scientific consensus is that the brain is "woken up" by a set of neurotransmitters -- which include compounds such as acetylcholine, hypocretin, histamine, serotonin, noradrenaline, and dopamine -- that originate from structures deep within the brain and the brain stem. This cocktail of chemical messengers serve to activate -- or arouse -- a set of neurons in the cerebral cortex and other parts of the brain responsible for memory, thinking, and learning, placing the brain in a state of wakefulness.

URMC has been selected by The Michael J. Fox Foundation for Parkinson’s Research (MJFF) as one of six academic medical centers to host the second class of the Edmond J. Safra Fellowship in Movement Disorders.

By increasing resources for specialized training for clinician-researcher neurologists, the program—made possible by the Edmond J. Safra Foundation—aims to grow the global base of movement disorder specialists treating people with Parkinson’s and contributing to research toward breakthrough treatments for the disease.

“There is a growing need for neurologists with additional training in movement disorders,” said Irene Richard, M.D., professor of Neurology and fellowship director at URMC. “We are honored to have been selected by The Michael J. Fox Foundation to help increase the ranks of clinician-researchers that are equipped to provide both optimal care to Parkinson’s patients and conduct the urgent work to learn more about this disease and to develop new therapies.”

URMC is one of the nation’s largest centers for Parkinson’s care and research and serves as the hub of an international network of academic, government and industry researchers searching for new ways to treat the disease.

The Medical Center is one of six centers named by MJFF to participate in the fellowship program. The others are the Icahn School of Medicine at Mount Sinai, the University of California, San Francisco, Rush University in Chicago, the University of Pennsylvania in Philadelphia; and the University of Tübingen in Germany. URMC is now recruiting a neurology resident for the 2017-2019 Edmond J. Safra Fellowship in Movement Disorders class.

“This program is designed to give people with Parkinson’s the best possible care,” said Mrs. Lily Safra, chairwoman of the Edmond J. Safra Foundation. “These prestigious institutions provide fellows with expert training in the field of movement disorders, thus increasing the number of specialty physicians available to people with Parkinson’s disease.”

MJFF and the Edmond J. Safra Foundation launched the program in late 2014 with the goal of improving the landscape of Parkinson’s care at both an individual and a population level. The clinicians trained through the Edmond J. Safra Fellowship in Movement Disorders will design and conduct studies with their patients’ unmet needs in mind. From the front lines, they are poised to observe trends and nuances of the patient experience that can lead to investigations toward greater understanding of disease and open new avenues to better therapies.

There's a new tool for battling the opioid epidemic, compressed inside long, metal tanks at an emergency room in Paterson, N.J.

It's laughing gas, also known as nitrous oxide.

If you think this is a joke, spend a few hours with Alexis LaPietra, medical director of pain management at St. Joseph's Regional Medical Center's emergency department. She's developed an opioid-alternative program that's trying out unusual ways to help patients through their pain without using prescription painkillers in the ER, where the road to addiction began for many patients.

"The point here is not to be for or against opioids any more than it makes sense to be for or against antibiotics," says John Markman, a neurologist at the University of Rochester who specializes in pain management.

He says any ER's pain management program still has to keep opioids as an option.

"The goal is to learn to use them skillfully to minimize the public health risks because the public health risks are significant," says Markman, who's conducted research on opioids, some of which was funded by pharmaceutical companies. "There are many patients in the right context and in the right hands who can benefit."

Apple launched its ResearchKit program in March with five apps to investigate Parkinson's, asthma, heart disease, diabetes and breast cancer. A sixth app was released last month to collect information for a long-term health study of gays and lesbians by the University of California, San Francisco.

For scientists, a smartphone app is a relatively inexpensive way to reach thousands of people living in different settings and geographic areas. Traditional studies may only draw a few hundred participants, said Dr. Ray Dorsey, a University of Rochester neurologist who's leading the Parkinson's app study called mPower.

"Participating in clinical studies is often a burden," he explained. "You have to live near where the study's being conducted. You have to be able to take time off work and go in for frequent assessments."

Smartphones also offer the ability to collect precise readings, Dorsey added. One test in the Parkinson's study measures the speed at which participants tap their fingers in a particular sequence on the iPhone's touchscreen. Dorsey said that's more objective than a process still used in clinics, where doctors watch patients tap their fingers and assign them a numerical score.

We are extremely pleased to announce the results of the 2016 neurology match. We matched another outstanding group of six individuals for adult neurology and two for child neurology as follows:

Adult Neurology – 2016 Match

Melanie Braun – University of Rochester

Ryan Canissario – SUNY Downstate Medical Center

Dimitrios (Jim) Manou – University of Rochester

Kristen McCartney – University of North Carolina

Tyler Rehbein – University of Minnesota

Nicholas Taylor – Ohio State University

Child Neurology – 2016 Match (to start in 2018)

Emily Krainer – Vanderbilt University

Justin Rosati – Hofstra North Shore – LIJ School of Medicine

Eleven UR medical students had an equally outstanding match for neurology, as follows:

Adult Neurology – 2016 Match

• Melanie Braun – University of Rochester
• Kathryn Cooper – Stony Brook Hospital
• Spencer Craven – Wake Forest Medical Center
• Robert Fuino – University of Vermont
• Adrian Hadiono – University of Texas Southwestern
• David Ivanick – University of Washington
• Dimitrios (Jim) Manou – University of Rochester
• Lauren Patrick – University of California, San Francisco
• Jason Poon – University of Utah

Child Neurology – 2016 Match

• Danielle DeCampo – Johns Hopkins Hospital
• Krista Grande – Cincinnati Children’s Hospital

Now, a new program aims to play matchmaker between these researchers and second-chance funders. The Online Partnership to Accelerate Research (OnPAR), a collaboration between NIH and the defense, engineering, and health contractor Leidos, lets researchers upload rejected NIH proposals to an online portal where potential funders can review the scores received from reviewers, and decide whether to put up cash.

A Parkinson’s iPhone app developed by Sage Bionetworks and University of Rochester Medical Center (URMC) neurologists marks the first anniversary of its release. The app was also highlighted by Apple today during its semi-annual product launch event.

Sage Bionetworks, a Seattle-based nonprofit biomedical research organization, today released an updated version of its mPower (Mobile Parkinson’s Observatory for Worldwide, Evidence-based Research) app that includes an improved user interface and functionality developed in response to feedback by users. Sage also announced that mPower would be the first app incorporated into a new Apple platform called CareKit, which will turn the app into a valuable tool to help better inform patients about their symptoms and care.

The mPower app – which was created by Sage in collaboration with URMC neurologists Ray Dorsey, M.D., M.B.A., and Karl Kieburtz, M.D., M.P.H., and with the support of the Robert Wood Johnson Foundation – was first unveiled in March 2015 during Apple’s “Spring Forward” product launch event.

University of Rochester Medical Center (URMC) neurologist Charles Thornton, M.D. has received a Javits Neuroscience Investigator Award from the National Institutes of Health to further his research on muscular dystrophy. The unique award provides exceptional researchers with seven years of uninterrupted funding.

The Javits Neuroscience Investigator Award was created by the U.S. Congress in 1983 and is named in honor of former U.S. Senator Jacob Javits (NY), who was the victim of amyotrophic lateral sclerosis, a degenerative neurological disorder commonly known as Lou Gehrig's disease. The $2.3 million grant is administered by the National Institute of Neurological Disorders and Stroke and is given to scientists who have demonstrated exceptional scientific excellence and productivity in their field.

Making progress on treating paralytic diseases is difficult and requires a dedicated team of clinicians and researchers, said Thornton, the Saunders Family Distinguished Professor in Neuromuscular Research. To bring a team together and keep it together over the long run, you need a stable stream of financial support. This award will help us continue our work through a very important stage when new therapies are being tested and others are on the horizon.

In a perspective piece appearing in the journal Cell Stem Cell, URMC neurologist Steve Goldman, M.D., Ph.D., lays out the current state of affairs with respect to stem cell medicine and how close we are to new therapies for neurological disorders.

The dawn of stem cell medicine some 25 years ago was greeted with great enthusiasm, particularly by scientists who study diseases in the central nervous system (CNS). Many of the diseases found in the brain and spinal cord are degenerative in nature; meaning that over time populations of cells are lost due to genetic factors, infection, or injury. Because stem cell medicine holds the potential to repair or replace damaged or destroyed cells, scientists have considered these diseases as promising candidates for new therapies.

However, as with other emerging fields of medicine, the race to cures has turned out to be more of marathon than a sprint. While scientists have become very adept at manipulating stem and progenitor cells and understanding the complex choreography of genetic and chemical signals that instruct these cells to divide, differentiate, and proliferate, researchers are still grappling with the challenges of how to integrate new cells into the complex network of connections that comprise the human brain.

Goldman, co-director of the URMC Center for Translational Neuromedicine, takes a sweeping view of where we stand and which CNS diseases may or may not ultimately benefit from future stem cell-based therapies.

study out today sheds new light on multiple sclerosis (MS), specifically damage in the brain caused by the disease that may explain the slow and continuous cognitive decline that many patients experience. The findings, which appear in the Journal of Neuroscience, show that the brain’s immune system is responsible for disrupting communication between nerve cells, even in parts of the brain that are not normally considered to be primary targets of the disease.

“This study identifies for the first time a new disease mechanism in MS which causes damage to neurons independent of the loss of white matter and demyelination that is the hallmark of the disease,” said the lead author, neurologist Matthew Bellizzi, M.D., Ph.D., with the Center for Neural Development and Disease at the University of Rochester Medical Center (URMC). “This damage represents another component of the disease and one that is not prevented by the current immunosuppressive drugs employed to treat MS.”

Researchers at Strong Memorial Hospital are involved in clinical trials with a drug derived from cannabis.

The Investigational New Drug is called Epidiolex, and it's different from medical marijuana available through the state's dispensaries. It's almost pure Cannabidiol, which is a chemical compound in cannabis thought to help reduce seizures.

Currently, URMC is involved in an FDA-approved double blind study to test the effectiveness of the drug, the results of which should be available in about a year.

Researchers are now planning for another study, called a Compassionate Use Study, to test the side effects of Epidiolex, and how it reacts with other medications. This study will involved children and young adults.

Doctor David Wang is leading the research at URMC, where he's an Associate Professor of Neurology and Pediatrics. He says patients age one-to-21 with severe, treatment-resistant epilepsy will be eligible to participate.

New research shows that the cells responsible for protecting the brain from infection and inflammation are also responsible for repairing the system of defenses that separates the brain from the rest of the body. These findings have significant clinical implications because certain cardiovascular drugs could possibly impede the brain’s ability to repair itself after a stroke or other injury.

“This study shows that the resident immune cells of the central nervous system play a critical and previously unappreciated role in maintaining the integrity of the blood-brain barrier,” said Maiken Nedergaard, M.D., D.M.Sc., co-director of the Center for Translational Neuromedicine at the University of Rochester Medical Center (URMC) and lead author of the study. “When this barrier is breached it must be rapidly repaired in order to maintain the health of the brain and aid in recovery after an injury – a process that could be impaired by drugs that are intended to prevent this damage in the first place.”