On July 18th, I had the privilege of attending a neuroscience conference hosted by some of the world's leading neurosurgeons. "Advances In Neurosciences Third Annual Bay Area Symposium" was a neuroscience conference aimed bringing neuroscience professionals together in order to outline the direction of neuroscience for the next 5-10 years. The program was designed mainly for neurologists, neurosurgeons, radiation oncologists, and primary care physicians, but I was lucky enough to attend as it was co-hosted by my mentor Dr. Kunwar. There were about 10 presentations most of which were profession specific so I did the best I could in understanding the details, but my main focus was to understand the basic idea of each presentation. I thought it was that Washington Hospital, a local community hospital, was able to get academic professionals from across the nation to come and present their work in a conference that probably rivals neuroscience conferences held at UCSF. I'll write a small summary of some of some particularly interesting presentations.
The first presentation focused on a "Systems" approach to neuromedicine, which looks at the interaction between various functional elements of the nervous system to identify diseases arising from perturbed networks in real time. It was hosted by a faculty neurologist from Georgetown University who researches characteristics of degenerative diseases, specifically those of Alzheimer's, in order to define protocols for early detection. His research focuses on specific genetic and gene characteristics of diseases that can be identified through various tests done early in the life of the patient. By detecting the disease early, health care professionals can start managing the disease even before it shows any symptoms of degeneration. The doctor predicts that this early management philosophy represents a promising paradigm shift in the way neurological diseases are treated. The current philosophy of treatment focuses on managing the disease when it comes clinically relevant. However, in the case of most neurodegenerative disease the presence of symptoms generally means it is too late to effectively manage the disease. The presented research indicated that the only way to effectively combat these diseases is to identify (via RNA-based Microarrays) and treat them preclinically, or before they present any symptoms. Thus, the presenter put a lot of weight into the development of early detection protocols, which would allow physicians to start treatments in patients who have certain genes or gene-process irregularities as early as childhood. The earlier the disease carrier is identified the better chance they have from benefitting from treatment as all available treatment are aimed at delaying the onset of degenerative symptoms.
The second presentation was conducted by my future principal investigator at UCSF, Dr. Bankiewicz. His presentation was focused on the application of regenerative medicine to neurodegenerative diseases such as Parkinson's. Dr. Bankiewicz research applied gene therapy to the brain (substantia nigra) through a new MRI-guided delivery method called Convection Enhanced Drug Delivery (CED). Convection Enhanced Drug delivery delivers viral vectors and drugs to the brain by the insertion of a catheter directly to the target tissue. This method is promising because it allows the delivery of drugs past the blood brain barrier, directly localized to the tissue of interest. Advantages include minimized side-effects and minimally invasive surgery which translates to quicker recover times. The main challenge in researching this method is understanding the specific fluid dynamics of the brain. There is a big problem with leakage in this method, where the injected liposomes (which contain drug or gene of choice) end up leaking out of the tissue into the CSF, which is bad because the target tissue is not exposed to the injected substance long enough. Not to mention, if the injected substances enter the CSF they may interact with non-target tissue causing side-effects. The method has been shown to effectively work for gene therapy in animal models. Animal models have shown some promising recovery from neural degeneration, which is amazing!
The third presentation which caught my eye was on the advances in imaging of mild traumatic brain injury (mTBI). Mild traumatic brain injury is commonly known as a concussion, which can result from falls or a variety of mildly traumatic events in which injury to the brain is not severe. Unforturantely, people who have suffered mTBI may suffer a symptoms ranging from head-aches to memory loss. The injuries are currently imaged with CT scan, which is generally too insensitive very small TBIs. Through a series of images the presenter (an M.D./Ph.D Neuroradiologist from UCSF) showed that CT scans missed a lot of TBIs that were seen with 3T and 7T MRis. The presenter also introduced a new type of imaging called 3D Diffusion Tensor Imaging (DTI). DTI is fascinating because it will image entire neural tracts in various color and shades to distinguish between them; it does so by following vectorial directions of neurons (VERY COOL STUFF). The images from DTI were so clear and unique, I've never seen anything like them. Imaging technology has come along way and it's improving at an incredible rate, we're able to resolve neural tissue at a level of detail never thought possible. These new imaging techniques will allow neurosurgeons to asses various conditions and interventions without even needing to open up the brain. It's truly fascinating stuff.
The neuroscience conference was an invaluable experience for me because it immersed me to the next generation of neurological medicine, which will benefit me greatly as I now have perspective on way medicine will be practiced when I become a health care professional. This level of immersion really puts me at an advantage to understand and formulate a goal of the type of neurosurgeon I want to be because I am now aware of the approaches and developments in research I can expect to see when I enter or leave a residency program. The conference was amazing because it allowed neuroscience professionals to collaborate their research and expertise to benefit the field of neuromedicine as a whole. For example, the protocols formulated in systems neuromedicine will benefit not only neurologists but neurosurgeouns and primary care physicians in collaborating patient care for a variety of neurodegerative disorders. Primary care physicians will be able to identify certain markers in their younger patients for a particular degenerative disease, and refer them to neurologists to begin preclinical management; ultimately improving outcomes for patients with degenerative disorders. More powerful MRI technology (7 TESLA!!) can now resolve very minor traumatic brain injury point in the brain, which was normally undetectable by normal CT. Newer imaging technology will allow neurosurgeons to effectively manage acute and chronic symptoms in patients where the location of injury was previously unknown. New delivery methods to the brain offer the promise of low-side effect delivery of chemotherapeautics and viral vectors to regions of the brain previously unaccessible by other modalities. CED can deliver a highly focused dose of drug to brain tumors without effecting surround brain tissue, which is revolutionary in cancer treatment. Personally, my favorite aspect of the conference was CED and I'm glad to be part of that lab for this upcoming year. As an aspiring neurosurgeon, I could find no better way to contribute to the field than by improving techniques and methods used by neurosurgeons to treat their patients. This conference really allowed me to see different aspects of neuroscience, and how I can integrate these aspects into the way I ant to shape my career. So far, it seems that CED delivery to the brain is extremely promising, and can maybe even treat traumatic brain injury patients by delivering various substances to damaged areas. Who knows? The Limitations are endless, and I definitely intend to explore!!!
