Medicine seminars

Current disease-modifying therapies in multiple sclerosis are all focused on suppressing the inflammatory phase of the disease. This has been extremely successful, and it is doubtful that significantly more efficacious anti-inflammatory treatments will be found. However, it remains the case that people with relapsing-remitting multiple sclerosis acquire disability on treatment, and enter the secondary progressive phase. I argue that we now need treatments that prevent neuronal degeneration. The most promising approach is to prevent axons degenerating by remyelination. Since the discovery that the adult brain contains stem cells which can remyelinate, the problem now is how to promote endogenous remyelination, and how to know when we have achieved this! We have successfully identified one drug which promotes remyelination but unfortunately it is too toxic for use in the clinic. So the hunt continues.

Focal Cortical Dysplasia (FCD) is the most common focal cortical malformation leading to intractable childhood focal epilepsy. In recent years, we and others have shown that FCD type II is caused by mosaic mutations in genes within the PI3K-AKT-mTOR-signaling pathway. Hyperactivation of the mTOR pathway accounts for neuropathological abnormalities and seizure occurrence in FCD. We further showed from human surgical FCDII tissue that epileptiform activity correlates with the density of mutated dysmorphic neurons, supporting their pro-epileptogenic role. The level of mosaicism, as defined by variant allele frequency (VAF) is thought to correlate with the size and regional brain distribution of the lesion such that when a somatic mutation occurs early during the cortical development, the dysplastic area is smaller than if it occurs later. Novel approaches based on the detection of cell-free DNA from the CSF and from trace tissue adherent to SEEG electrodes promise future opportunities for genetic testing during the presurgical evaluation of refractory epilepsy patients or in those that are not eligible for surgery. In utero-based electroporation mouse models allow to express somatic mutation during neurodevelopment and recapitulate most neuropathological and clinical features of FCDII, establishing relevant preclinical mouse models for developing precision medicine strategies.

On Wednesday, January 25th, at noon ET / 6PM CET, we will host Roxanne Lofredi and Hagai Bergman. Roxanne Lofredi, MD, is a research fellow in the Movement Disorders and Neuromodulation Unit at Charité Universitätsmedizin Berlin. Hagai Bergman, MD, PhD, is a Professor of Physiology in the Edmond and Lily Safra Center for Brain Research and Faculty of Medicine at the Hebrew University of Jerusalem, and is Simone and Bernard Guttman Chair in Brain Research. Beside his scientific presentation on “Beta oscillations in the basal ganglia: Past, Present and Future”, he will also give us a glimpse at the “Person behind the science”. The talks will be followed by a shared discussion. You can register via talks.stimulatingbrains.org to receive the (free) Zoom link!

This talk will examine how approaches such as ‘big data’ and new ways of delivering clinical trials can improve current services for older people with mental illness (jam today) and identify and deliver new treatments in the future (jam tomorrow).

In epilepsy research, a holy grail has been the identification and understanding of the "epileptogenic zone" - operationally defined as the (minimal) area or region of the brain is indispensible for the generation of epileptic seizures. The identification of the epileptogenic zone is particularly important for surgical treatments of focal epilepsy patients, but I will highlight some recent clinical, experimental and theoretical work showing that it is also fundamentally linked with our understanding of epilepsy and seizures. I will conclude with a proposal for an updated understanding of the epileptogenic zone and ictogenesis.

Talk(1): Fetal and maternal NLRP3 signaling is required for preterm labor and birth. (DOI: 10.1172/jci.insight.158238) Talk(2): Maternal IL-33 critically regulates tissue remodeling and type 2 immune responses in the uterus during early pregnancy in mice (DOI: 10.1073/pnas.2123267119)

On Wednesday, November 30th, at noon ET / 6PM CET, we will host Alexandre Boutet and Erik H. Middlebrooks. Alexandre Boutet, MD, PhD, is a neuroradiology fellow at the University of Toronto, and will tell us about “How to become an integral part of the functional neurosurgery team as a radiologist”. Erik H. Middlebrooks, MD, is a Professor and Consultant of Neuroradiology and Neurosurgery and the Neuroradiology Program Director at Mayo Clinic. Beside his scientific presentation about “Bridging the Gap from Research to Clinical Decision Making in Epilepsy Neuromodulation”, he will also give us a glimpse at the “Person behind the science”. The talks will be followed by a shared discussion. You can register via talks.stimulatingbrains.org to receive the (free) Zoom link!

Chronic pain is a leading cause of morbidity, common to patients with gastrointestinal diseases such as irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD). Most pain killers are largely ineffective against this type of pain or restricted for use in these patients due to gut related complications and risk of addition. A significant unmet clinical need therefore exists to develop novel non-opioid based visceral analgesics.

Results: the main areas which were modified based on participatory feedback were the variety of immersive scenarios to cover a range of ages and interests, the number of levels of complexity to ensure small improvements were measured, the feedback and reward schemes to ensure positive reinforcement, and specific provision for participants with balance issues, who had difficulties when using head-mounted displays. The effectiveness of the finalised BEARS suite will be evaluated in a large-scale clinical trial. We have added in additional login options for other members of the family and based on patient feedback we have improved the accompanying reward schemes. Conclusions: Through participatory design we have developed a training package (BEARS) for young people with bilateral cochlear implants. The training games are appropriate for use by the study population and ultimately should lead to patients taking control of their own management and reducing the reliance upon outpatient-based rehabilitation programmes. Virtual reality training provides a more relevant and engaging approach to rehabilitation for young people.

Optimized Non-Invasive Brain Stimulation for Addiction Treatment