UAB implants responsive neurostimulator for epilepsy seizure control
UAB is the first medical center in the Southeast to implant a new type of electrical stimulator to control seizures in patients with epilepsy.
Written by Bob Shepard On June 18, neurosurgeons at the University of Alabama at Birmingham implanted a new type of electrical stimulator to control seizures in patients with difficult-to-control epilepsy.
It marked the first time in the Southeast the RNS system by NeuroPace had been implanted since the device gained FDA approval in November 2013. The first patient was a 24-year-old woman from central Alabama.
RNS stands for responsive neurostimulation.
“It is designed to record patient’s specific brain activity and recognize patterns that are associated with seizures,” said Kristen Riley, M.D., associate professor in the Department of Neurosurgery. “The RNS system then delivers stimulation in order to help modulate and control the seizures.”
The system consists of electrodes attached by leads to a generator which can communicate with a computer. The generator is curved so that it can be placed within a patient’s skull. It is a little bigger than a flash drive.
“We drill a trough for the device so that it is flush within the skull,” said Riley. “There is not a raised area; it’s basically hidden within the skull.”
The electrodes are placed near the location in the brain where a patient’s seizures are triggered. Jerzy Szaflarski, M.D., Ph.D., professor in the Department of Neurology and director of the UAB Epilepsy Center, says the RNS system can be customized for each individual patient so that it learns which patterns of brain activity lead to seizures in that patient. He says data from research studies dating back several years indicate that many patients will respond to the stimulation and have significant reduction in their seizures.
“This is not a treatment that will cure epilepsy,” he said. “This is a treatment that will help control seizures in a very specific group of patients who are not otherwise candidates for surgery. I don’t expect too many patients to become seizure-free; but if we can decrease their seizures by even half, we can make huge improvements in their lives.”
The RNS system is for patients with severe seizures who do not respond to medications and are not candidates for surgery because the location of their seizure onset is at a sensitive part of the brain. It is also only for patients whose seizure onset can be traced to just one or two locations in the brain.
“We’re very excited to offer this therapy to our patients who are not candidates for more traditional therapies for epilepsy,” said Szaflarski. “We see multiple patients like that every year, and the RNS system could make a huge difference in the lives of those patients. There is already data to show that the quality of life of those patients has improved significantly with RNS.”
For more information on the RNS system, contact the UAB Epilepsy Center or make an appointment via the Kirklin Clinic at 205-801-8986.
UAB Neurosurgery Residents Attend Advances in Brain Tumor Management Conference
The Department of Neurosurgery residents recently attended the Advances in Brain Tumor Management Conference jointly sponsored by the Columbia University Department of Neurosurgery and the American Association of Surgeons. The Conference was held June 6, 2014 in New York.
Dr. Mark Hadley, UAB neurosurgeon, was one of the presenters at the conference. He spoke on “Perfusion Pressure Management in the Peri-operative Treatment of Spinal Cord Pathology”.
The learning objectives of the conference were:
- Recognize CNS malignancies and other neurological diseases.
- Understand diagnosis and treatment of brain tumors and other neurological diseases.
- Discuss a multidisciplinary approach to treating brain tumors and other neurological diseases.
Coaches, Parents Offered Brain Injury Information at "Cutting Edge Concussion Summit" Conference
Children’s of Alabama was host to the inaugural “Cutting Edge Concussion Summit- Maintaining the Competitive Edge” on Friday, June 13, at 8 a.m. in its Bradley Lecture Center. The Summit attracted approximately 200 attendees.
The day-long conference was open to the public and hosted by UAB Sports Medicine at Children’s in conjunction with the Wise Up! Initiative. The conference featured presentations geared to coaches, athletic trainers and parents. Sessions included Critical Changes in Concussion Culture, Epidemiology of Sports and Recreation-Related TBI, and a panel discussion on Prolonged Recovery from Concussion among others.
“The evolution of concussion legislation and best practice is ongoing,” said Drew Ferguson, director of UAB Sports Medicine at Children’s of Alabama. “It’s imperative to understand how young athletes are affected by concussion symptoms in both the short term and the long term. The more parents, athletic trainers and coaches know about concussions, the safer our young athletes will be.”
Speakers included former college and NFL players including John Parker Wilson, Chris Redman and Tyler Watts as well as representatives from the CDC, renowned pediatric neurosurgeon Dr. Jim Johnston and Alabama High School Athletic Association Director, Steve Savarese. Topics that were addressed included Return-to-Play and Return-to –Think legislature as well as helmet standards, diagnosis and management of concussions and establishing a multi-disciplinary concussion program. Joel Stitzel and Alex Powers from Wake Forest University presented their groundbreaking research on impact biomechanics of youth football.
Children’s of Alabama has provided specialized medical care for ill and injured children across the state and throughout the southeastern U.S. since 1911. For the past four years, Children’s has been ranked among the best children’s hospital programs in the nation by US News & World Report. Last year, patients made more than 670,000 outpatient and nearly 14,000 inpatient visits to Children’s from every county in Alabama and from 41 other states and four foreign countries. With more than 2 million square feet, it is the third largest pediatric medical facility in the U.S. Children’s offers inpatient and outpatient services across its Russell Campus on Birmingham’s historic Southside with additional outpatient services provided at Children’s South and Children’s on 3rd. Primary care is provided at more than a dozen medical offices in communities across central Alabama. Children’s of Alabama is the only medical center in Alabama dedicated solely to the care and treatment of children. It is a private, not-for-profit medical center that serves as the primary site of the University of Alabama at Birmingham (UAB) pediatric medicine, surgery, research and residency programs. Children’s recently moved much of its inpatient services into a new building named The Benjamin Russell Hospital for Children. More information is available at www.childrensal.org.
Original source: https://www.childrensal.org/body.cfm?id=1730&action=detail&ref=313
UAB-developed viral therapy shows promise against brain tumors
Birmingham report a genetically engineered herpes simplex viral therapy is safe when used in conjunction with radiation in the treatment of malignant gliomas, one of the most deadly forms of brain cancer.The virus, G207, is a modified herpes simplex virus that in two previous UAB studies has been shown to be safe when used as a sole therapy. The new findings, published April 8, 2014 in Molecular Therapy, indicate the virus is also safe when used in combination with low doses of radiation therapy.
The study examined nine patients with malignant glioma, and all nine tolerated the therapy well. None developed encephalitis, the brain inflammation often associated with herpes simplex; the gene responsible for causing encephalitis has been removed from G207. Some patients also showed evidence of tumor reduction, and survival rates were increased for others.
“This was a phase one study designed foremost to see whether the therapy was safe,” said James M. Markert, M.D., Ph.D., professor and chair of the Department of Neurosurgery at UAB and the study’s first author. “While this study, with a limited number of patients and no controls, prevents any conclusions about the efficacy of this treatment, the decrease in tumor size seen on MRI’s in some patients, as well as an increase in survival in some patients without other proven treatment options, is highly encouraging.”
G207 was administered directly to glioma cells in the brain, followed the next day by a low-dose radiation treatment.
The virus works by infecting tumor cells and replicating until it overwhelms the cell’s machinery and causes the cell to rupture and die, releasing new viral particles. The virus has been genetically modified so that it can reproduce only in tumor cells, which lack the stronger antiviral defense mechanisms of healthy brain cells. After destroying a tumor cell, the virus moves on, looking for new tumor cells to infect.
While the study was designed for each patient to receive one dose of G207, two of the nine patients received a second dose as part of a compassionate-use protocol.
“While we cannot draw any firm conclusions from just two study subjects, we are encouraged to note that both of the compassionate-use patients tolerated the second dose extremely well, indicating that the drug may be suitable for multiple use,” said Markert.
UAB is gearing up for another study with a new modified version of herpes simplex virus called M032. Preliminary studies have indicated M032 could be an even more effective therapy. It includes a genetically engineered protein called IL12, which the researchers believe will induce a stronger immune response and will contribute to increased anti-angiogenesis, the process of shutting off the blood supply to tumor cells, denying oxygen and essential nutrients.
by Bob Shepard
30th Annual J. Garber Galbraith Scientific Session & Lecture
The main lecture, "Low Grade Gliomas: from Bench to Bedside," will be presented by Mitchel S. Berger, MD.
For further information, click here.
UAB Neurosurgeons Recognized by Congress for Spinal Injury Guidelines
Taped Remarks from Congressman Jim Langevin at the Annual North American Spine Society (NASS) Meeting
Jim Langevin at the North American Spine Society Meeting from UAB Heersink School of Medicine on Vimeo.
Congressman Jim Langevin of Rhode Island, who is quadriplegic, addressed the North American Spine Society at their annual meeting, held October 9-12, 2013. His remarks included the story of how he became paralyzed, and he expressed his gratitude to the health care providers who assisted in his recovery. He also commended the authors of the updated Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries, published in the March 2013 issue of Neurosurgery.29th Annual J. Garber Galbraith, MD Scientific Session and Lecture
The Twenty-Ninth Annual J. Garber Galbraith, MD Scientific Session and Lecture took place November 2, 2012. Along with the faculty, the J. Garber Galbraith Lecturer, Daniel L. Barrow, MD evaluated qualifying resident presentations and abstracts. Presenters with the highest scores for content, organization, and delivery received awards for their research.
2012 Award Winners, Left to right: Third place – Richard B. Morawetz, M.D., Resident Prize for Research: Martin Mortazavi, M.D.; Second place – Griffith Rutherford Harsh III, M.D., Resident Prize for Research: Daxa Patel, M.D.; First place – James Garber Galbraith, M.D., Resident Prize for Research: Thomas Whisenhunt, M.D.
UAB Neurosurgery Granted Departmental Status
The Division of Neurosurgery will become the Department of Neurosurgery on October 1, 2013, elevating the profile of an already world-renowned program. To read the article on the School of Medicine’s website, click here. For further reading, visit these sites:
Dr. James M. Markert Elected Fellow of the American Surgical Association
James M. Markert, MD was elected a Fellow of the American Surgical Association (ASA) at their annual meeting in April 2013. ASA is America’s oldest and most prestigious surgical association, whose members are the world’s leading surgeons. The mission of the ASA ”is to be the premier organization for surgical science and scholarship and to provide a national forum for presenting the developing state of the art and science of general and sub-specialty surgery and the elevation of the standards of the medical/surgical profession.”
UAB Neurosurgeons Ranked Among the Top One Percent in the Nation by Peers
UAB physicians James M. Markert, MD; Barton L. Guthrie, MD; Mark N. Hadley, MD; and Jerry W. Oakes, MD have been recognized by a group of their peers for their outstanding work in neurosurgery. They have also been identified as the top 1% in their field by U.S. News Top Doctors.
Dr. Mark N. Hadley Named Director of the American Board of Neurological Surgery
Mark N. Hadley, M.D., professor in the Division of Neurosurgery in the University of Alabama at Birmingham Heersink School of Medicine, has been named to a six-year term as a director of the American Board of Neurological Surgery.ABNS is the primary professional organization in the field of neurosurgery and is the agency that approves board-certification for neurosurgeons. ABNS also works to maintain and elevate professional standards in the field and encourage the study and improve the practice of neurosurgery.
"Selection as a director of the ABNS is a great honor that brings with it great responsibility," said James Markert, M.D., Ph.D., division director for neurosurgery at UAB. "Mark Hadley is an outstanding choice to advance the goals of the ABNS, as he has demonstrated time and again throughout his career that he is a superlative surgeon, educator and researcher."
Cytochrome c Oxidase in Glioma: A Potential Marker and Therapeutic Target
In UAB's Division of Neurosurgery, Corinne E. Griguer, PhD and her research team is searching for potential therapeutic targets in malignant glioma. A recent recipient of a Research Project Grant, her research interests include exploring the bioenergetic pathways involved in the development and progression of malignant glioma. Patient chemoresistance to temozolomide (TMZ), the frontline drug of choice to treat glioblastoma multiforme, limits treatment options. Griguer and her colleagues at the Southern Research Institute and University of Geneva have determined that increased cytochrome c oxidase (CcO) activity is associated with TMZ resistance in glioblastoma multiforme. In the future, analysis of CcO activity in gliomas may be used to predict overall survival and progression free survivals in patients with malignant glioma. CcO activity may serve as a target for small molecule inhibitiors that could be used to block acquisition of chemoresistance in glioma. Reversing TMZ insensitivity may lead to improved outcomes in patients with GBM.