News

The apparent simplicity of picking up a cup of coffee or turning a doorknob belies the complex sequence of calculations and processes that the brain must undergo to identify the location of an item in space, move the arm and hand toward it, and shape the fingers to hold or manipulate the object. New research, published today in the journal Cell Reports, reveals how the nerve cells responsible for motor control modify their activity as we reach and grasp for objects. These findings upend the established understanding of how the brain undertakes this complex task and could have implications for the development of neuro-prosthetics.

"This study shows that activity patterns in populations of neurons shift progressively during the course of a single movement," said Marc Schieber, M.D., Ph.D., a professor in the University of Rochester Medical Center (URMC) Department of Neurology and the Del Monte Institute for Neuroscience and a co-author of the study. "Interpreting these shifts in activity that allow groups of neurons to work together to perform distinctive and precise movements is the first step in understanding how to harness this information for potential new therapies."

UR Medicine's Golisano Children's Hospital has been designated an official Leukodystrophy Care Network Center by the Hunter's Hope Foundation.

Hunter's Hope Foundation co-founders Jim and Jill Kelly announced the designation on Monday, making Rochester just the seventh Leukodystrophy Care Network Center in the nation and the first in New York State.

Led by Robert Thompson-Stone, M.D., assistant professor of Pediatrics and Child Neurology, the UR LCC will work across disciplines to provide the best care to patients and families. Thompson-Stone and others will also participate in regular meetings with fellow Leukodystrophy Care Network clinicians throughout the United States, allowing providers to share best care practices and discuss new and ongoing research into leukodystrophies.

"Our Child Neurology team works across disciplines to put the needs of our patients and families above all else, and this designation really validates the work we've done so far," said Thompson-Stone. "Going forward, we are eager to work collaboratively with this national network of talented physicians and care providers on both clinical care and research efforts."

One in 7,000 children are born with a leukodystrophy, a group of rare, progressive genetic diseases that affect the brain and spinal cord. Jim and Jill Kelly's son, Hunter, was diagnosed in 1997.

"Jill and I were told to go home, make Hunter comfortable and that he wouldn't live to see his second birthday. Hunter lived to be eight and a half years-old," shared Jim Kelly, Hunter's Hope Co-Founder and Pro Football Hall of Fame Member. "We believe he lived so much longer than expected because of the good Lord, and because we treated Hunter as though he was living, not dying. Twenty-one years later, families are being told the same thing that Jill and I were, and that has to change."

The Hunter's Hope Foundation established the Leukodystrophy Care Network in 2015 with the goal of improving the health and quality of life of individuals affected by leukodystrophies. Through the designation, the foundation will support a patient care coordinator in Rochester who will help families navigate their treatment

A multidisciplinary group of clinical and bench researchers has been formed at the University of Rochester Medical Center (URMC) to study cerebrovascular disease. The Cerebrovascular and Neurocognitive Research Group (CNRG), which consists of faculty from Neurology, Neurosurgery, Electrical and Computer Engineering, Microbiology and Immunology, and Vascular Biology will leverage advanced brain imaging technologies to investigate a number of diseases, including stroke, cerebral small vessel disease (CSVD), and vascular dementia.

The University of Rochester Medical Center (URMC) has been selected as one of the first four institutions in the U.S. to participate in the SMA Care Center Network. The network is being created as new treatments and approaches to care are transforming how spinal muscular atrophy (SMA) is treated.

The University of Rochester has been selected as a Morris K. Udall Center of Excellence in Parkinson's Disease Research by the National Institute of Neurological Disorders and Stroke (NINDS). The new $9.2 million award brings together researchers from industry and multiple academic institutions to focus on the development of digital tools to enhance understanding of the disease, engage broad populations in research, and accelerate the development of new treatments for Parkinson's disease.

The Department of Neurology would like to welcome residency applicants, interviewing on Monday, January 14^th. A wine and cheese reception for the applicants will be held from 4:00 - 4:30 PM in the Garvey Room. All Faculty & Residents are invited to attend.

Adult Neurology Applicants

Nicole Baldwin -- University of Minnesota
Cara Doyle -- Campbell University School of Osteopathic Medicine
Daniel Orme -- University of Utah
Allan Phan -- University of Wisconsin
Noellie Rivera-Torres -- Universidad Central del Caribe, Puerto Rico
Janani Sadasivan -- Michigan State University

Next month, UR Medicine will begin operation of a Mobile Stroke Unit (MSU), a high-tech 'emergency room on wheels' that is designed to provide life-saving care to stroke victims. The $1 million unit will be operated in partnership with AMR as a community resource and represents a significant step forward for stroke care in the Rochester region.

While the MSU resembles an ambulance on the outside, inside it contains highly specialized staff, equipment, and medications used to diagnose and treat strokes. The unit is equipped with a portable CT scanner that is capable of imaging the patient's brain to detect the type of stroke they are experiencing. The scans and results from a mobile lab on the unit are wirelessly transmitted to UR Medicine stroke specialists at Strong Memorial Hospital, who will consult with the on board EMS staff via telemedicine and decide if they can begin treatment immediately on scene.

If it is determined that the patient is experiencing an ischemic stroke -- which account for approximately 90 percent of all strokes -- the MSU team can administer the drug tissue plasminogen activator (tPA) to attempt to break up the clot in the patient's brain. While en route to the hospital, UR Medicine specialists will continue to remotely monitor and assess the patient's symptoms.

"The UR Medicine Mobile Stroke Unit essentially brings the hospital to the patient," said neurosurgeon Tarun Bhalla, M.D., Ph.D., with the UR Medicine Comprehensive Stroke Center. "This unit will improve care and outcomes by shortening the gap between diagnosis and treatment and enable us to initiate care before the patient reaches the hospital."

It is estimated that 3,000 people in Monroe County suffer from a stroke every year. Stroke is the fifth leading cause of death and the number one cause of long-term disability in the U.S. However, if caught early, many stroke victims can make a full recovery.

"Ten years ago we realized there was an epidemic of stroke in our community which resulted in tremendous human suffering and health care costs," said Web Pilcher, M.D., Ph.D., chair of the UR Medicine Department of Neurosurgery. "We decided to embark on a long-term plan to provide the best stroke care in upstate New York. The Mobile Stroke Unit represents the next evolution in that effort and places Rochester among an elite list of communities with this cutting-edge technology."

The current best treatment for stroke is tPA. But in order to work properly, the drug must be given within four and half hours of the first stroke symptoms. Depending upon the circumstances, doctors may also elect to perform a minimally invasive endovascular surgical procedure that involves threading a catheter through the blood vessels and physically removing the obstruction in the brain. The capabilities provided by the MSU to diagnose, start treatment, and prepare hospital staff to receive the patient before they arrive at the emergency department will save lives and improve chances of recovery.

"In stroke care, time equals brain," said neurologist Curtis Benesch, M.D., M.P.H., with the UR Medicine Comprehensive Stroke Center. "The approximately 30 minutes that could be saved by the Mobile Stroke Unit by starting treatment before a stroke patient reaches the hospital could mean the difference between the recovery of function or a lifetime of impairment."

"Patients who receive tPA sooner are more likely to go home and retain the ability to walk and care for themselves," said Bob Holloway, M.D., M.P.H., chair of the UR Medicine Department of Neurology. "The Mobile Stroke Unit will improve outcomes for stroke victims in our community and, because people with less disability use fewer health care resources, lower costs in the long term."

The unit is owned by UR Medicine and will be operated by AMR. The MSU will be staffed by a UR Medicine nurse trained in stroke care and a CT technician, an AMR paramedic and emergency medical technician, and remotely by a stroke specialist at UR Medicine.

The construction and operating costs of the unit, which was custom built by Frazer Ltd. in Houston, are being funded by UR Medicine and philanthropy, including a lead gift from Elena Prokupets and support from the Del Monte family and other donors in the Rochester community.

"We are extremely grateful to Elena for her gift to the School of Medicine and Dentistry, which has made it possible to bring this life saving technology to Rochester," said Mark Taubman, M.D., CEO of the University of Rochester Medical Center. "Her generosity, along with the support of many others, has provided us the resources to invest in the infrastructure, technology, and clinical talent necessary to provide the most advanced stroke care to our community."

The MSU is part of a broader UR Medicine initiative to bring state-of-the-art stroke care to the region. This includes Strong Memorial Hospital's designation as the region's only Comprehensive Stroke Center by the Joint Commission, a certification that indicates that the hospital either meets or exceeds the highest standards of care required to provide timely, advanced, and coordinated care to patients with cerebrovascular disease, and the Neuromedicine Intensive Care Unit, a 12-bed ICU that provides care to critically ill patients with complex neurological life threating illnesses such as stroke. UR Medicine stroke specialists also provide 24/7 consultation services for emergency department personnel in several hospitals in the region via telemedicine.

Eight years ago, UR Medicine, in partnership with the Greater Rochester Health Foundation, created the Stroke Treatment Alliance of Rochester/New York (STAR-NY), to educate medical professionals and the broader community about stroke recognition and prevention.

A new study out today in the Journal of Neurology finds that pregabalin is not effective in controlling the chronic pain that sometimes develops following traumatic nerve injury. The results of the international study, which was driven by an effort to identify effective non-opioid pain medications, did show potential in relieving in pain that sometimes lingers after surgery.

"The unrelenting burning or stabbing symptoms due to nerve trauma are a leading reason why people seek treatment for chronic pain after a fall, car accident, or surgery," said John Markman, M.D., director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery and lead author of the study. "While these finding show that pregabalin is not effective in controlling the long-term pain for traumatic injury, it may provide relief for patients experience post-surgical pain."

Pregabalin, which is marketed by Pfizer under the name Lyrica, is approved to treat chronic pain associated with shingles, spinal cord injury, fibromyalgia, and diabetic peripheral neuropathy. However, it is also commonly prescribed as an "off label" treatment for chronic nerve injury syndromes that occur after motor vehicle accidents, falls, sports injuries, knee or hip replacement and surgeries such as hernia repair or mastectomy.

A previous eight-week study had shown that pregabalin reduced pain intensity better than placebo in these chronic, post-traumatic pain syndromes. These results led many doctors to prescribe this medication for long-term pain that does not resolve as expected.

Chronic postsurgical pain syndromes occur in approximately one or two out of every 10 surgical patients and the levels rated as intolerable after roughly one or two in every 100 operations. With 55 million surgeries performed in the U.S. every year, severe chronic pain impacts more than a million new people annually. Roughly one third of these patients are believed to have neuropathic pain or ongoing pain related to nerve injury.

These rates vary widely by type of surgery. The risks factors and underlying mechanisms of this type of chronic pain are not well understood, but because the types of symptoms patients describe like "burning", "unpleasant tingling," or "numbness" resemble other nerve pain syndromes like shingles pain. As a result, physicians trying to find useful non-opioid pain relievers have often turned to prescribing gabapentin or pregabalin.

The current study was conducted in 101 centers in in North America, Europe, Africa, and Asia and followed 539 individuals for three months. Study participants were randomized into two groups who either prescribed pregabalin or a placebo.

The study found that pregabalin was not effective in controlling pain for individuals with traumatic nerve injury. A retrospective analysis of a subgroup of study of participants, whose nerve pain was attributed to surgery, showed that the drug did provide better pain relief than placebo at 3 months.

"The possibility that there was pain relief for those patients who had a hernia repair, or breast surgery for cancer, or a joint replacement lays the groundwork for future studies in these post-surgical syndromes where there is so much need for non-opioid treatments," said Markman.

One major challenge is that different biological changes in the nerves and other tissues that cause pain to persist after healing from trauma vary from one patient to the next. Currently, there is no diagnostic method that allows doctors to readily identify the patients whose pain will respond to a particular type of pain treatment.

Despite employing new strategies to reduce placebo effects, the patients receiving placebo also had a steady lowering of their pain over the course of the study. The pattern of these placebo effects in longer studies has proved to be a major challenge to the development of new pain medications.

"Given the rising rates of surgery and shrinking reliance on opioids, it is critical that we understand how to study new drugs that work differently in patients like the ones included in this study," Markman added.

Additional co-authors of the study include Malca Resnick, Scott Greenberg, Ruoyong Yang, Joseph Scavocne, Ed Whalen, Gabriela Gregorian, Bruce Parsons, and Lloyd Knapp with Pfizer and Nathaniel Katz with Analgesic Solutions. Pfizer funded the trial, and was involved in its design as well as the data collection and analysis. The company also paid for medical writing assistance and editorial support in preparing the article for the journal. Markman has received consulting fees and research funding support from Pfizer.

The University of Rochester movements disorders division has been designated as a lead body disorder Association research center of excellence. This designation is obtained at the understanding of the disorder, educating patients and caregivers, and investigating possible research activities specifically aimed at this difficult disease. While many people are always involved in obtaining such a designation, special kudos go to Dr. Katie Amodeo who has been instrumental in our success with this endeavor and will continue to play a key role in developing a successful UR program focused on the rapidly growing field of neurodegenerative diseases characterized by Parkinsonism and Dementia.

Research appearing in the New England Journal of Medicine could herald a new treatment approach for individuals with multiple sclerosis (MS) if confirmed in future studies. The results of a clinical trial, which involved researchers from the University of Rochester Medical Center (URMC), showed that the drug ibudilast slowed the brain shrinkage associated with progressive forms of the disease.

"These results indicate that ibudilast may be effective in protecting the central nervous system and slowing the damage to the brain that is caused by MS," said URMC neurologist Andrew Goodman, M.D., a co-author of the study who served on the national steering committee for the Phase II clinical trial, dubbed SPRINT-MS. "While more clinical research is necessary, the trial's results are encouraging and point towards a potential new type of therapy to help people with progressive MS."

MS is a neurological disorder in which the body's own immune system attacks myelin, the fatty tissue that insulates the nerve fibers in the brain and spinal cord. These attacks are caused by inflammation which damages myelin, disrupting communication between nerve cells and leading to cognitive impairment, muscle weakness, and problems with movement, balance, sensation, and vision. MS usually presents with a relapsing-remitting course, in which symptoms occur then disappear for weeks or months and then may reappear, or primary and secondary progressive courses, which are marked by a gradual decline in function.

A new practice guideline update for the diagnosis and ongoing medical and rehabilitative care of individuals in a vegetative or minimally conscious state has a result of a brain injury have been published by the American Academy of Neurology, the American Congress of Rehabilitation Medicine, and the National Institute on Disability, Independent Living, and Rehabilitation Research.

URMC neurologist Richard Barbano, M.D., Ph.D., was part of a team of physicians and researchers who prepared the new guideline, which appears in the journal Neurology.

The experts carefully reviewed all of the available scientific studies on diagnosing, predicting health outcomes, and caring for people with disorder of consciousness, focusing on evidence for people with prolonged disorders of consciousness -- those cases lasting 28 days or longer.

The guideline recommends that a clinician trained in the management of disorder of consciousness, such as a neurologist or brain injury rehabilitation specialists, should do a careful evaluation and the evaluation should be repeated several times early in recovery.

Additional findings include:

• The outcomes for patients with prolonged disorder of consciousness differ greatly. It is estimated that one in five people with severe brain injury from trauma will recover to the point where they can live at home and care for themselves without assistance.
• There is moderate evidence that patients with a brain injury from trauma will fare better in terms of recovery than a person with a brain injury from another cause.
• Very few treatments for disorder of consciousness have been carefully studied. However, moderate evidence shows that the drug amantadine can hasten recovery in patients with disorder of consciousness after a traumatic brain injury when used within one to four months after the injury.

URMC neurologist Ralph Jozefowicz, M.D., has been awarded the American Academy of Neurology's (AAN) Leading in Excellence through Mentorship award. He received the recognition at the AAN's 2018 annual meeting.

Jozefowicz, a professor of Neurology and Medicine, is a nationally recognized leader and innovator in neurologic education and has received numerous awards and accolades from AAN, the American Neurological Association, the Fulbright Program, the Association of American Medical Colleges, and Jagiellonian University in Poland for his work in the field.

He currently serves as director for the second year medical student "Mind, Brain and Behavior" course and co-director of the third year Neurology Clerkship. He is also the Neurology Residency Program Director at the URMC.

You can read more about the award and perspectives from colleagues he has mentored over the years in Neurology Today.

National Institute of Neurological Disorders and Stroke (NINDS) has extended the University of Rochester Medical Center's (URMC) membership in the Network for Excellence in Neuroscience Clinical Trials, or NeuroNEXT, which was created to accelerate clinical research involving new treatments for neurological disorders. The $1.5 million grant will provide patients in the region access to cutting-edge experimental therapies and continue the Medical Center's key role in helping bring new drugs to market.

"Neurological diseases are some of the most challenging in all of medicine and the process of translating promising discoveries into new treatments requires building partnerships across many institutions in order to create the infrastructure necessary to recruit patients and run multi-site clinical trials," said Robert Holloway, M.D., M.P.H., chair of the URMC Department of Neurology and principal investigator of the URMC NeuroNEXT site. "The Medical Center has a long history in the field of experimental therapeutics and we are proud to be a part of NeuroNEXT and to support efforts that will make clinical research better, faster, and more efficient in the quest to aid patients and families affected by neurological disease."

In 2011, URMC was one of the original 25 institutions selected to participate in NeuroNEXT. The network was created to streamline the operations of neuroscience clinical trials and help increase the number of new treatments that get into clinical practice. The program is designed to encourage collaborations between academic centers, disease foundations, and industry.

Over the last five years, URMC has been involved in NeuroNEXT studies involving the testing of new drugs for myasthenia gravis, multiple sclerosis, Huntington's disease, stroke, brain cancer, and neuropathy. "We could not have accomplished this without the phenomenal talent and dedication of our faculty, study coordinators, and research teams." said Erika Augustine, M.D., M.S., co-Investigator on the grant.

"One of the advantages of NeuroNEXT, and something that makes it unique, is the network's ability to quickly mobilize a group of specialists from a certain disease area to initiate a clinical study when opportunities emerge for trials," said Robin Conwit, M.D., program director at NINDS. "The structure of NeuroNEXT, with its broad focus across neuroscience clinical studies, has the potential to reach many individuals who are affected by brain disorders."

The Medical Center's site -- dubbed UR NEXT -- has made significant contributions to the success and vitality of the network. URMC is the dominant provider of comprehensive neurological care in upstate New York with growing referral networks that have a regional, national, and international reach. This breadth of geographic reach and specialization of services has resulted in the Medical Center being one of the network's leading performers in terms of clinical trial recruitment and performance.

The Medical Center is also home to the Experimental Therapeutics in Neurological Disease post-doctoral training program now entering its 28^th year of continuous funding from the National Institutes of Health, and the Center for Health + Technology (CHeT), a unique academic-research organization with decades of experience in development, management, and operation of multi-site clinical trials.

"The complexity of neurological diseases and the ever evolving nature of scientific innovation in this field mean that we must look always to the future and build the teams that turn new discoveries into new ways to diagnose, treat, and prevent these diseases," said Jonathan Mink, M.D., Ph.D., co-investigator on the grant who is leading Rochester's training of its investigators. "The UR NEXT grant will help us train the next generation of experts in leading and conducting multi-center clinical trials,"

In addition to URMC's role as a NeuroNEXT site, the Medical Center has two additional key roles supporting the national network. The URMC Clinical Materials Services Unit -- part of CHeT -- provides logistical support and drug supply distribution services for NeuroNEXT clinical trials and UR Labs provides central laboratory services for the network.

We are pleased to announce the formation of a combined pediatric and adult Neurofibromatosis clinic. This clinic will be held every four months, and will offer families the ability to be seen on the same day by clinicians expert in neurofibromatosis (NF). Our clinic is headed by Dr. Alex Paciorkowski, who is trained in both Neurology and Genetics. He has a particular interest in neuro-developmental disorders, and is an excellent resource particularly with challenging genetics cases. Dr. Marina Connolly, a child neurologist with special interest and expertise in pain, and headaches, which are common to our patients, will see pediatric NF patients. Dr. Joy Burke is the adult neuro-oncologist who will be joining us, with expertise in treating tumors of the nervous system including brain, spine, and nerves.

Patients with neurofibromatosis may be affected by these problems, and may also have other neurological problems such as migraines, nerve pain, or cognitive function issues which Dr. Burke can address. Dr. Bo Lee, our neuro-genetics fellow will also be involved in patient care, learning about this complex but relatively common neurologic disease. Carolyn Dickinson is the pediatric nurse practitioner on the team, and has been working with children with neurofibromatosis for many years. Finally, Kelly Minks, CGC MS, is our genetic counselor, and assists our team with genetic testing issues.

As neurofibromatosis may affect various organ systems a multidisciplinary clinic allows patients to coordinate appointments with various other specialties, and minimize travel. This combined clinic will also allow our specialists to discuss cases, ease the transition for adolescent and young adults, and facilitate research efforts.

The University of Rochester Medical Center is currently looking for people with Cryptogenic Sensory Peripheral Neuropathy for a research study conducted by the Network for Excellence in Neuroscience Clinical Trials (NeuroNEXT).

The purpose of the research study is to learn if the drug topiramate slows the progression of Cryptogenic Sensory Peripheral Neuropathy (CSPN), also known as "idiopathic neuropathy" or neuropathy of an unknown cause, and improves quality of life. As part of this study, we will use a number of assessments and questionnaires to determine iftopiramate improves symptoms of CSPN. There is a one in two (or 50%) chance of receiving the study drug or placebo pill.

Participants must be between 18-75 years of age to be in the study, have a diagnosis of CSPN or idiopathic neuropathy, have signs of metabolic disease including abdominal obesity, pre-diabetes, high blood pressure or abnormal cholesterol/lipids, and no history of prior therapy with topiramate.

This study is actively enrolling participants. To learn more information, please visit ClinicalTrials.gov, identifier number: NCT02878798. If you are interested in participating, contact Janet Sowden at the University of Rochester Medical Center by phone at (585) 275-1267 or email at janet_sowden@urmc.rochester.edu.

A series of awards from the American Heart Association (AHA) to a team of researchers at the University of Rochester Medical Center (URMC) will focus on the development of new treatments to thwart the damage in the brain caused by stroke.

One of the research projects brings together experts in stroke, cardiovascular biology, platelet biology, and peptide chemistry. Marc Halterman, M.D., Ph.D., with the URMC Center for Neurotherapeutics Discovery, Scott Cameron, M.D., Ph.D., and Craig Morrell, D.V.M., Ph.D., with the URMC Aab Cardiovascular Research Institute, and Bradley Nilsson, Ph.D., with the University of Rochester Department of Chemistry will focus on the role that platelets play in acute brain injury and inflammation during stroke.

Platelets serve an important role in protecting against blood loss and repairing injured blood vessels. However, during a stroke the inflammatory properties of platelets can interfere with the restoration of blood flow once the clot in the brain is removed, particularly in micro-vessels, which can lead to permanent damage of brain tissue.

The research team will build synthetic peptides that activate platelets to study the phenomenon -- which is called no-reflow -- in an effort to identify specific switches within platelets that can be turned off and limit the cells' inflammatory functions without blocking their ability to prevent bleeding.

Two AHA pre-doctoral fellowship awards Kathleen Gates and Jonathan Bartko in Halterman's lab will support research that examines the link between an immune system response triggered by stroke in the lungs that can exacerbate damage in the brain and investigate the cellular mechanisms that determine whether or not brain cells die following stroke.

A final AHA award to the Halterman lab will seek to identify new drug targets by focusing on specific proteins activated during stroke that are suspected to play an important role in determining the survival of neurons.

Collectively, the AHA Collaborative Sciences Award, Pre-Doctoral, and Innovation awards represent $1.09 million in funding.

In this role, Nimish will work with me to lead our efforts to support faculty and residents in developing their careers and enhancing their contributions to the department, the medical center and the field of neurology. To achieve these goals, Nimish will collaborate with the Associate Chairs of the Department and various Associate Deans of the Medical School [Faculty Development (Janine Shapiro), Academic Affairs (Jeff Lyness) and Inclusion and Diversity (Linda Chaudron)].

As a Department, we seek to provide an open, warm and nurturing environment to enable and support our amazing faculty, residents and staff every day. Nimish has bold initiatives to create supportive structures for career growth and promotion, in addition to leading the Department's diversity initiatives. He will also participate as a member of the Department's Promotion and Tenure Committee.

Nimish joined the Department in 2007, after completing his neurology training at Northwestern University (2004) and his neuro-oncology training at Memorial Sloan-Kettering (2007). Nimish has created a vibrant, inclusive and forward thinking Division of Neuro-oncology, which excels in all of its missions. The clinical program now sees more than 100 brain tumor patients each year, he has been the PI for over 20 brain tumor clinical trials, and he Director for the UCNS Neuro-Oncology Fellowship and the Neurology Resident Mentoring Program. The program is simply flourishing under his leadership. While he will continue to lead the Neuro-Oncology Division, he is setting his sights higher however, as he takes on new leadership roles within the Department and nationally through the American Academy of Neurology.

Please join us in congratulating Nimish!

The American Heart Association/American Stroke Association (AHA/ASA) has once again honored the UR Medicine Strong Memorial Hospital for having achieved the highest standard of care for stroke. This award identifies hospitals that provide care that can speed the recovery and reduce death and disability for stroke patients.

Strong Memorial Hospital has received the 2018 AHA/ASA Get With The Guidelines program's Stroke Gold Plus Quality Achievement Award. The hospital was also recognized for the Target: Stroke Honor Role Elite Plus designation, which identifies hospitals that have consistently and successfully reduced door-to-needle time -- the window of time between a stroke victim's arrival at the hospital, the diagnosis of an acute ischemic stroke, and the administration of the clot-busting drug tPA. If given intravenously in the first four and a half hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability.

Wilmot's competitive seed-grant program aims to fund research projects that will generate preliminary data necessary to potentially apply for federal funding in the future. Thanks to financial support from two community organizations -- Adding Candles for a Cure and the Edelman Gardner Cancer Research Foundation -- four projects have received funding that started Jan. 1.

Mark Noble, Ph.D., Professor in the departments of Biomedical Genetics and Neuroscience, received a $50,000 grant for his project titled, "A biomarker for a novel glioblastoma (GBM) vulnerability." The co-investigators for this project are Kevin Walter, M.D., Mahlon Johnson, M.D., Ph.D., Nimish Mohile, M.D., and Peggy Auinger, M.S.

Bradford Mahon, Ph.D., Assistant Professor in the Departments of Neurology and Neurosurgery, received a $50,000 grant for his project seeking to demonstrate feasibility and preliminary efficacy of advanced MRI mapping in improving outcome in patients with glioblastoma. Kevin Walter, M.D., is the co-investigator for this project.

Congratulations to all Wilmot pilot grant recipients.

In 2015, he became the Director of the Vascular Neurology Fellowship Program at the University of Rochester Medical Center and has transformed the fellowship. In 2017, there were 76 Vascular Neurology Fellowship Programs across the United States and only 36 of them were filled. Under Dr. Sahin’s leadership, the University of Rochester’s program has filled for three consecutive years and counting.

“Dr. Sahin is an outstanding clinical neurologist and a passionate educator. We look forward to Dr. Sahin bringing the same positive leadership approach to Highland that he’s brought to the Vascular Neurology Fellowship Program as we continue to integrate and expand our acute care service,” said Robert G. Holloway Jr., M.D., M.P.H., Professor and Chair of the Department of Neurology at the University of Rochester Medical Center.

“Highland Hospital is a New York State Designated Primary Stroke Center and an integral part of our stroke care network in UR Medicine. As a board-certified Vascular Neurologist, Dr. Sahin will also serve as the Stroke Center Director, ensuring Highland Hospital maintains its vital role in providing excellent stroke care to our community,” said Curtis Benesch, M.D., M.P.H., Professor of Neurology and Neurosurgery and Medical Director, URMC Comprehensive Stroke Center.

Dr. Sahin follows Adam Kelly, M.D., who served as Highland Hospital’s Chief of Neurology for almost six years.

The University of Rochester Medical Center (URMC) has been selected to participate in a national network created to develop new ways to diagnose and treat Lewy Body Dementia (LBD). The new initiative, which is being organized by the Lewy Body Dementia Association, will seek to raise awareness and advance research for this complex disorder.

"Lewy Body Dementia is a challenging, multifaceted disease and research to find new diagnostic tools and treatments is still in its infancy," said URMC neurologist Irene Richard, M.D., who will serve as director of the URMC Lewy Body Dementia Association Research Center of Excellence. "This new network of will create an infrastructure of clinician researchers who understand the disease, are able to identify patients to participate in research, and have experience participating in multi-site clinical trials."

LBD is a progressive brain disorder marked by abnormal protein deposits -- called Lewy Bodies -- in areas of the brain important for behavior, cognition, and motor control. This complex disease gives rise to a range of symptoms, including cognitive impairment, sleep disturbances, hallucinations, difficulty with blood pressure regulation, and problems with movement and balance. Individuals with the disease will often experience marked fluctuations in their levels of alertness and clarity of thought.

New research shows that stroke patients are increasingly being transferred out of smaller community and rural hospitals and sent to larger medical centers for their care and rehabilitation. While this is a positive sign for patients who need more advanced treatments, the trend has drawbacks in terms of cost and points to the need to improve the coordination of care between hospitals.

“The underlying goal of stroke care is to get the right person to the right hospital at the right time,” said University of Rochester Medical Center (URMC) neurologist Benjamin George, M.D., M.P.H., a co-author of the study which appears this month in the journal Neurology. “The findings of this study show that in recent years community-based hospitals are erring on the side of caution and transferring more patients from their emergency departments to larger hospitals. Given the high cost and burden associated with these transfers, striking a balance between cost and need is essential.”

The University of Rochester Medical Center (URMC) is helping lead two advocacy efforts to increase awareness of the value of telehealth for individuals with Parkinson's. These activities coincide with World Parkinson's Disease Day on April 11.

"The prevalence of Parkinson's disease is increasing and the number of people with the disease is expected to more than double in the next 20 years," said neurologist Ray Dorsey, M.D., director of the URMC Center for Health + Technology (CHeT). "Telemedicine, along with other technologies, will be key to meeting this growing demand and will serve to expand access to quality care, help reduce the burden of caregivers, and potentially lower costs."

CHeT is working with the Parkinson's Foundation to advocate for telehealth by encouraging all of the Foundation's 18 Centers of Excellence to provide at least one telemedicine visit on April 11. Dorsey has undertaken several studies over the last decade to demonstrate the feasibility and effectiveness of connecting Parkinson's patients with specialists using telemedicine. Results of a recent study funded by the Patient-Centered Outcomes Research Institute demonstrated that telemedicine can successfully deliver quality care.

In addition, CHeT has partnered with Burn Along -- an online video fitness and wellness platform that offers hundreds of classes at all fitness levels -- in inviting individuals with Parkinson's disease, caregivers, family members, and advocates to participate in free classes to raise awareness of the importance of exercising for Parkinson disease. Studies have shown that exercise can help keep the symptoms of Parkinson's at bay and may even slow the progression of the disease.

Burn Along has joined with Dance for PD -- a Brooklyn-based company that has created dance classes for people with Parkinson's -- to produce videos for distribution on their website. Individuals who sign up for the free classes with Burn Along on April 11 will have access to all of the site's video content for the entire month of April.

For more information or to sign up for free fitness classes for the month of April, visit: http://fit.burnalong.com/world-parkinson-day/

By Mark Michaud

A new study out today in the journal JAMA Neurology shows that smartphone software and technology can accurately track the severity of the symptoms of Parkinson's disease. The findings could provide researchers and clinicians with a new tool to both develop new drugs and better treat this challenging disease.

"This study demonstrates that we can create both an objective measure of the progression of Parkinson's and one that provides a richer picture of the daily lived experience of the disease," said University of Rochester Medical Center (URMC) neurologist Ray Dorsey, M.D., a co-author of the study.

One of the difficulties in managing Parkinson's is that symptoms of the disease can fluctuate widely on a daily basis. This makes the process of tracking the progression of the disease and adjusting treatment a challenge for physicians who may only get a snapshot of a patient's condition once every several months when they visit the clinic. This variation also limits the insight that researchers can gather on the effectiveness of experimental treatments.

The new study, which was led by Suchi Saria, Ph.D., an assistant professor of Computer Science at Johns Hopkins University, harnesses the capabilities of technology that already resides in most of our pockets all day, every day.

Researchers recruited 129 individuals who remotely completed a series of tasks on a smartphone application. The Android app called HopkinsPD, which was originally developed by Max Little, Ph.D., an associate professor of Mathematics at Aston University in the U.K., consists of a series of tasks which measure voice fluctuations, the speed of finger tapping, walking speed, and balance.

The Android app is a predecessor to the mPower iPhone app which was developed by Little, Dorsey, and Sage Bionetworks and has been download more than 15,000 times from Apple's App Store since its introduction in 2015.

As a part of the study, the researchers also conducted in-person visits with 50 individuals with Parkinson's disease and controls in the clinic at URMC. Participants were asked to complete the tasks on the app and were also seen by a neurologist and scored using a standard clinical evaluation tool for the disease. This aspect of the study was overseen by URMC's Center for Health + Technology.

John Markman, M.D.

The American Pain Society is the nation's leading organization of scientists, physicians, and allied professionals focused on increasing knowledge of pain and transforming clinical practice and policy to reduce pain-related suffering. Markman founded and directs the University's Neuromedicine Pain Management Center and Translational Pain Research Program. Together these programs were previously recognized as a Center of Excellence by the American Pain Society.

Congratulations Dr. Markman!

By Mark Michaud

While a couple of glasses of wine can help clear the mind after a busy day, new research shows that it may actually help clean the mind as well. The new study, which appears in the journal Scientific Reports, shows that low levels of alcohol consumption tamp down inflammation and helps the brain clear away toxins, including those associated with Alzheimer's disease.

"Prolonged intake of excessive amounts of ethanol is known to have adverse effects on the central nervous system," 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. "However, in this study we have shown for the first time that low doses of alcohol are potentially beneficial to brain health, namely it improves the brain's ability to remove waste."

The finding adds to a growing body of research that point to the health benefits of low doses of alcohol. While excessive consumption of alcohol is a well-documented health hazard, many studies have linked lower levels of drinking with a reduced risk of cardiovascular diseases as well as a number of cancers.

By Mark Michaud

The harm caused by a stroke can be exacerbated when immune cells rush to the brain an inadvertently make the situation worse. Researchers at the University of Rochester Medical Center (URMC) are studying new ways to head off this second wave of brain damage by using the lungs to moderate the immune system's response.

"It has become increasingly clear that lungs serve as an important regulator of the body's immune system and could serve as a target for therapies that can mitigate the secondary damage that occurs in stroke," said URMC neurologist Marc Halterman, M.D., Ph.D. "We are exploring a number of drugs that could help suppress the immune response during these non-infection events and provide protection to the brain and other organs."

Halterman's lab, which is part of the Center for NeuroTherapeutics Discovery, has been investigating domino effect that occurs after cardiac arrest. When blood circulation is interrupted, the integrity of our intestines becomes compromised, releasing bacteria that reside in the gut into the blood stream. This prompts a massive immune response which can cause systemic inflammation, making a bad situation worse.

While looking at mouse models of stroke, his lab observed that a similar phenomenon occurs. During a stroke blood vessels in the brain leak and the proteins that comprise the wreckage of damaged neurons and glia cells in the brain make their way into blood stream. The immune system, which is not used to seeing these proteins in circulation, responds to these damage-associated molecular patterns and ramps up to respond. Mobilized immune cells make their way into the brain and, finding no infection, nevertheless trigger inflammation and attack healthy tissue, compounding the damage.

The culprit in this system-wide immune response is neutrophils, a white cell in the blood system that serves as the shock troops of the body's immune system. Because our entire blood supply constantly circulates through the lungs, the organ serves as an important way station for neutrophils. It is here that the cells are often primed and instructed to go search for new infections. The activated neutrophils can also cause inflammation in the lungs, which Halterman suspects may be mistakenly identified as post-stroke pneumonia. The damage caused by activated neutrophils can also spread to other organs including the kidneys, and liver.