2008 dcns annual report

2008 ANNUAL REPORT

Clinical NeurosciencesDEPARTMENT OF

N e u r o l o g y • N e u r o s u r g e r yP h y s i c a l M e d i c i n e & R e h a b i l i t a t i o nE x p e r i m e n t a l N e u r o s c i e n c e s

CONTENTS

.......................................................................................................Message from the Chair! 3

......................................................................................................Administrative Overview! 5

........................................................................................................Departmental Structure! 6

.........................................................................................................................New Faculty! 8

..........................................................Alberta Heritage Foundation for Medical Research! 10

.....................................................................................................2008 Program Updates ! 13

...........................................................................................Adult Hydrocephalus Program! 13

..............................................................................................Alberta Radiosurgery Centre! 14

...........................................................................................................Chronic Pain Centre! 15

...............................................................................................................Epilepsy Program! 16

...........................................................................................Epilepsy Golf Tournament! 20

.................................Calgary Headache Assessment & Management Program (CHAMP)! 21

...........................................................................................Movement Disorders Program ! 23

..............................................................................................Intraoperative MRI Program! 25

................................................................................................Multiple Sclerosis Program! 26

................................................................................................Neuromodulation Program! 30

.........................................................................................................Neuromuscular Clinic! 32

..................................................................................................Neuro-Oncology Program! 35

.......................................................................................Pediatric Neurosurgery Program! 36

....................................................................................Peripheral Nerve Surgery Program! 38

..............................................................................................................Project NeuroArm! 39

..............................................................................................Skull Base Surgery Program! 41

...................................................................................................................Spine Program! 42

....................................................................................Stroke & Neurovascular Programs! 43

.....................................................................................................Urgent Neurology Clinic! 47

....................................................................................................2008 Divisional Updates! 48

....................................................................................................Division of Neurosurgery! 48

.........................................................................................................Division of Neurology! 56

..............................................................Division of Physical Medicine and Rehabilitation! 65

...........................................................................Division of Experimental Neurosciences ! 68

................................................................................................2008 Educational Updates! 72

............................................................................Neurology Residency Training Program! 72

.......................................................................Neurosurgery Residency Training Program! 74

......................................Physical Medicine & Rehabilitation Residency Training Program! 77

..........................................Undergraduate Medical Education in Clinical Neurosciences ! 78

...........................................................................................................Fellowship Program! 79

..............................................................................................................2008 Publications ! 80

.................................................................................................................List of Members! 88

DEPARTMENT OF CLINICAL NEUROSCIENCES

! 2

Message from the ChairExecutive Summary from Dr. Gregory Cairncross,

Department Head

In 2008, the Government of Alberta created a new

leadership structure for health care delivery. Alberta Health

Services now plans and coordinates the provision of health

care across the province. All health

care services fall under the jurisdic-

tion of a single Board which reports

directly to the Minister of Health

and the Premier of Alberta. This

structure promises to eliminate du-

plication of services and barriers to

seamless care for Albertans. Our

Department embraces these

changes toward better care for the

sick.

Throughout 2008, the Depart-

ment of Clinical Neurosciences

provided exemplary neurosurgical,

neurological and rehabilitative care

to the citizens of Calgary and

Southern Alberta. We also provided

emergency services to regions of

Saskatchewan and British Colum-

bia that are close to Calgary. Those

who suffered from stroke, serious

head injuries, spinal disorders, epi-

lepsy, multiple sclerosis, brain infections and a host of

other neurological conditions were cared for skillfully and

compassionately by our expert team of surgeons, physi-

cians, nurses and therapists. It remains an honour for me

to be associated with such an inspiring group of health

care professionals.

As Department Head, I have the unique opportunity to

shape the future of Clinical Neurosciences in Calgary and

beyond through the recruitment of new medical faculty and

2008 was a terrific year.

Dr Eric Smith, a stroke specialist and scientist, joined

us from the Massachusetts General Hospital and Harvard

University. Eric is studying the connection between small

silent strokes, which occur in patients with high blood

pressure and diabetes, and Alzheimer’s disease. He be-

lieves that certain types of dementia may be preventable in

many instances. His research pro-

gram is funded by the National In-

stitutes of Health in the United

States. Eric brings a new area of

research strength to Clinical Neu-

rosciences and its highly regarded

Calgary Stroke Program.

Clinical Neurosciences also played

a pivotal role in the recruitment of

Dr Jennifer Chan, Eric’s wife. Jen-

nifer is a pathologist and clinician

scientist also from Harvard Univer-

sity. She uses molecular genetic

approaches to understand the

causes of brain cancer. This

knowledge will bring us closer to

better treatments for these devas-

tating illnesses. Jennifer is the

newest member of the Clark H

Smith Brain Tumour Centre. The

Centre is located in the new Health

Research Innovation Centre of the

Faculty of Medicine.

Dr Tamara Pringsheim and her husband Dr Jeptha

Davenport were recruited to Calgary from the University of

Toronto, where Tamara, a neurologist, was pursuing post-

doctoral training in movement disorders, and Jeptha, was a

clinical neurologist. Since arriving in Calgary in April,

Tamara has established the first specialized clinic in south-

ern Alberta for children with Tourette’s syndrome. The

Tourette’s clinic is located in the Child Development Centre

adjacent to the new Alberta Children’s Hospital. Tamara is

studying the psychological and genetic underpinnings of


! 3

Dr. Gregory Cairncross

this perplexing neurological disorder, characterized by tics.

Jeptha is a wonderful clinician who works in the Multiple

Sclerosis and Headache Clinics and provides expert neuro-

logical care to patients at the Peter Lougheed Centre. We

are so fortunate to have attracted them to Calgary.

I am especially pleased to have been able to attract to

Clinical Neurosciences, Dr

Sean Dukelow, a physia-

trist and clinician-scientist,

who studies how patients

with stroke can be rehabili-

tated more quickly and

completely. Sean received

his MD and PhD degrees

from the University of

Western Ontario and

trained in Physical Medi-

cine & Rehabilitation at

Queen’s University. As one

of the very few scientists in

the field of Rehabilitation

Medicine, he was highly

sought after by many aca-

demic Departments and

Universities in Canada. I

believe that the emphasis

we have placed on innova-

tion and excellence in

Clinical Neurosciences,

and the extra-ordinary

Stroke Program that we

have built in Calgary over

the past decade, where

two of the main reasons

why Sean and his family chose to move to our City, Univer-

sity and Department. And it only gets better!

Also in 2008, we successfully recruited Dr Shalina

Ousman, a scientist of exceptional accomplishment and

promise. Shalina did her research training at Queen’s,

McGill and the University of California at San Diego before

moving to Calgary. In her laboratory, she is discovering the

molecules in the brain that control inflammation. These

studies are yielding new insights into the causes and future

treatment of Multiple Sclerosis, a progressive neurological

disorder of young adults that is especially common in Al-

berta.

In September, the Rehabilitation Service Task Force,

commissioned by the Calgary Health Region and led jointly

by Ms BettyLynn Morrice and myself, table its final report.

The report made recom-

mendations on organiza-

tional structure, service

integration and academic

enhancement for the Cal-

gary context, and will be

the foundation for Calgary

input to provincial re-

organization of Rehabilita-

tion Care by Alberta Health

Services.

The educational and re-

search missions of Clinical

Neurosciences continue to

thrive and grow. All of the

senior trainees in Neuro-

surgery and Neurology

successfully completed

their Fellowship Examina-

tions of the Royal College

of Physicians and Sur-

geons of Canada.

Once again, the Depart-

ment had a very high rate

of success in research ap-

plications to the Alberta

Heritage Foundation for Medical Research and Canadian

Institutes of Health Research. Nearly 25% of our faculty

members hold an external salary award or research grant

from a provincial or national agency – a remarkable suc-

cess story! I hope you enjoy our 2008 Annual Report and

welcome feedback.


! 4

Department of

Clinical Neurosciences

Dr. Gregory

CairncrossHead,

Department of


Dr. Gregory

CairncrossHead,

Department of


Dr. Rajiv Midha

Division

of

Neurosurgery

Dr. Rajiv Midha

Division

of

Neurosurgery

Dr. Samuel Wiebe

Division

of

Neurology

Dr. Samuel Wiebe

Division

of

Neurology

Dr. John Latter

Division of

Physical Medicine

& Rehabilitation

Dr. John Latter

Division of

Physical Medicine

& Rehabilitation

Dr. Bin Hu

Division of

Experimental

Neurosciences

Dr. Bin Hu

Division of

Experimental

Neurosciences

Executive Assistant

Danielle SikanderExecutive Assistant

Danielle Sikander

Administrative Assistant

Linda Menzies -BurrowsAdministrative Assistant

Linda Menzies -Burrows


Patricia MossAdministrative Assistant

Patricia Moss


Linda JennettAdministrative Assistant

Linda Jennett


Sue NelsonAdministrative Assistant

Sue Nelson

Regional Manager

Stephen JeffersonRegional Manager

Stephen Jefferson

Administrative OverviewCathy Edmond, Director of Serv-

ices

The context for planning and de-

livering services to patients and fami-

lies in 2008 included some significant

capacity challenges, human and finan-

cial resource constraints and the intro-

duction of a major re-organization of

provincial health services. Despite

these circumstances, services in Clini-

cal Neurosciences both expanded and

improved. Physician, nursing and al-

lied health leaders demonstrated

commitment, collaboration and crea-

tivity is achieving a number of suc-

cessful service related achievements.

The expansion of Neurology serv-

ices at the Rockyview Site represents

a key accomplishment. This devel-

opment saw increases to ambulatory

neurology clinics, EEG and EMG visits,

the addition of a second urgent neu-

rology clinic and the introduction of a

neurology admitting service to 8 inpa-

tient beds on Unit 46. The addition of

the second urgent clinic was the first

departmental opportunity to establish

a program on 2 sites. The nursing

staffing model established for this

program is quite unique and includes a

rotational plan that involves existing

staff from Unit 46. It is expected that

this model will allow nurses to en-

hance their understanding of the con-

tinuum of care across settings and

expand their knowledge base in neu-

rological care. Nurse practitioner, Pam

Sweeney, also commenced practice

as part of the team supporting en-

hanced neurological care at the site.

Several quality improvement pro-

jects were completed including those

related to patient flow under the

GRIDLOCC (Getting Rid of Delays that

Limit Our Capacity to Care) Initiative

and those using General Electric Lean

Methodology to improve efficiency

and quality. A number of departmental

leaders and staff had the opportunity

to learn and apply the “Lean” ap-

proach to addressing process im-

provement opportunities. The main

projects included the discharge proc-

ess on Units 111 and 112, admission

to Unit 58 (Tertiary Rehabilitation) and

a project focused upon the Stroke

Prevention Clinic. Although there were

some challenges with applying and

sustaining proposed changes as part

of these initiatives, a number of signifi-

cant outcomes were realized and

those results have been sustained. A

continuous quality management proc-

ess was also established in this year

that provides a systematic method of

monitoring, priority setting and plan-

ning for ongoing quality improvement

in Clinical Neurosciences.

Patient and family involvement

was a continued priority in the plan-

ning, delivery and evaluation of our

services. A growing number of com-

mittees and most initiatives included a

patient or family representative. This

involvement proved invaluable to the

success and quality of the Lean pro-

jects and reinforced our commitment

this important strategy in supporting

patient-centred care in service deliv-

ery.

The ambulatory services man-

agement model was reorganized to

increase staff training and to support

and facilitate management across in-

patient and ambulatory services by

program. An evaluation plan is cur-

rently being developed. In addition, an

ambulatory services re-design project

commenced in late 2008 with a man-

date to improve quality in ambulatory

processes.

A number of ongoing priorities

were established by the Clinical Neu-

rosciences Executive Team in 2008.

These include improvements to the

quality and efficiency of ambulatory

services, continued management of

capacity and demand and the strate-

gic planning process for the develop-

ment of Neuroscience services across

the region with a focus upon the

Rockyview and South Health Campus

Sites.

The Clinical Neurosciences physi-

cians, managers and staff have seen a

number of successes in sustaining,

developing and even enhancing serv-

ices through the complexity of the

healthcare environment in the past

year. I have no doubt that services will

continue to thrive in the current year

with such a committed and talented

team.


! 5

Departmental StructureHistory of the Department

Clinical Neurosciences was cre-

ated in 1981 when the Division of Neu-

rosurgery then in the Department of

Surgery and the Division of Neurology

in the Department of Medicine joined

forces to create a new academic De-

partment of the University of Calgary

focused on disorders of the nervous

system. Dr Robert Lee was the first

Head of the Department and Dr Frank

LeBlanc was the first Chief of Neuro-

surgery. Initially, there were two units

one at the Foothills Medical Centre

and the other at the Calgary General

Hospital. Subsequently, neurological

services were consolidated at the

Foothills Medical Centre and a period

of rapid growth ensued with both in-

ternal and external recruitment and

research expansion under the leader-

ship of Dr Tom Feasby (Department

Head and now Dean of the Faculty of

Medicine at the University of Calgary).

Dr Feasby was joined by Dr Garnette

Sutherland (Head of Neurosurgery), Dr

Werner Becker (Head of Neurology)

and Dr Christine McGovern (Acting

Head of Physical Medicine and Reha-

bilitation).

Today, in addition to being an aca-

demic department of the University of

Calgary (U of C), Clinical Neurosci-

ences is a regional clinical department

of the Calgary Health Region (CHR).

Physician members of the Department

of Clinical Neurosciences provide neu-

rosurgical, neurological and medical

rehabilitation services to the citizens of

Southern Alberta, southwestern Sas-

katchewan and southeastern British

Columbia. Clinical Neurosciences now

consists of three clinical divisions,

Neurosurgery, Neurology and Physical

Medicine & Rehabilitation, and one

basic research division, called Experi-

mental Neurosciences. Each division

has a leader and Head – Dr Rajiv

Midha (Neurosurgery), Dr Samuel

Wiebe (Neurology), Dr John Latter

(PM&R) and Dr Bin Hu (Experimental

Neurosciences). Collectively, members

of Clinical Neurosciences are actively

involved in undergraduate and post-

graduate medical education, with

Royal College of Canada approved

residency training programs in Neuro-

surgery, Neurology and Physical Medi-

cine and Rehabilitation. In addition,

many of the subspecialty programs in

Clinical Neurosciences attract clinical

fellows from other Canadian Centres

and abroad. Members of the Depart-

ment also teach clinical skills to ad-

vanced practice nurses and to other

health professionals, and directly su-

pervise graduate students and post-

doctoral research fellows. Clinical

Neurosciences now includes over 70

primary members many of whom are

also members of the Hotchkiss Brain

Institute.

Inpatient and outpatient services,

including neurosurgical services for

adults and children, are provided at

the Foothills Medical Centre and at the

new Alberta Children’s Hospital. Out-

patient and consultation services are

provided at the Tom Baker Cancer

Centre (TBCC), the Rockyview General

Hospital and the Peter Lougheed Cen-

tre. Medical services are also provided

at the Chronic Pain Centre and at the

Fanning Centre. The Department also

provides limited neurological outreach

services to the Chinook and Palliser

Health Regions (Neurology consulta-

tions only). Research programs are

based at the Foothills Hospital, Faculty

of Medicine and Tom Baker Cancer

Centre, especially in partnership with

the Hotchkiss Brain Institute, Southern

Alberta Cancer Research Institute and

the Institute of Maternal and Child

Health.

Throughout its short history, the

Department of Clinical Neurosciences

has had an exemplary record of re-

search accomplishment. Tangible ex-

amples of research success include

two Canadian Foundation for Innova-

tion (CFI) awards, first for the devel-

opment of intraoperative MRI and

more recently for the design and test-

ing of neuroArm, a MRI compatible

robot for micro-neurosurgery, 10 ex-

ternal salary awards, eight from the

Alberta Heritage Foundation for Medi-


! 6

cal Research (AHFMR) and two from

the Canadian Institutes of Health Re-

search (CIHR), over 100 major publica-

tions annually and over $10 million in

active research funding. Aided by the

AHFMR, CIHR, Heart & Stroke Foun-

dation of Canada, University of Cal-

gary, Calgary Health Region,

Hotchkiss Brain Institute

and the generosity of Cal-

garians, Clinical Neurosci-

ences has garnered a well

deserved national reputa-

tion for innovation in patient

care, teaching and re-

search.

Structure of the Depart-

ment


is one of 20 academic De-

partments of the Faculty of

Medicine and one of 14

Regional Clinical Depart-

ments of the Calgary Health

Region. With regard to Uni-

versity matters, principally

research and education, the

Department Head of Clini-

cal Neurosciences reports

to the Dean of Medicine.

With regard to patient care

and clinical service delivery

issues, the Department

Head of Clinical Neurosci-

ences reports to the Executive Medical

Director of the Northwest portfolio of

the Calgary Health Region and also to

the Chief Medical Officer of the Cal-

gary Health Region. In regard to aca-

demic recruitment, training and re-

search development and support, the

Department Head of Clinical Neurosci-

ences works in concert with the Insti-

tute Directors, especially the Director

of the Hotchkiss Brain Institute. De-

partmental affairs are conducted by

two senior committees: the Academic

Executive Committee, which is chaired

by the Department Head, and by the

Clinical Executive Committee, which is

co-chaired by the Director of Neuro-

science Programs of the Calgary

Health Region and the Deputy De-

partment Head of Clinical Neurosci-

ences, currently the Head of Neuro-

surgery.

Patient care and research occur

seamlessly in Clinical Neurosciences

through the use of multidisciplinary

teams in areas such as Stroke Care,

Epilepsy, Movement Disorders, Spinal

Disorders and many others. The major

care programs and teams and their

medical leaders are summarized in the

attached figure.

Two major challenges face the

Department of Clinical Neurosciences

over the next five to ten years. The first

is the development of a

new strategic plan for Re-

habilitation Services in the

Calgary Health Region that

includes the development

of vibrant, research-

intensive Division of Physi-

cal Medicine and Rehabili-

tation and the second will

be the transition from an

academic and clinical De-

partment consolidated at

the Foothills Medical Cen-

tre and Alberta Children’s

Hospital to a Department

that achieves greater suc-

cess on two sites, the

Northwest (FMC) and

South Health Campuses.

Continued success for

Clinical Neurosciences can

be expected. There is a

strong commitment to pa-

tient care and a palpable

esprit de corps, the latter

most evident at Grand

Rounds, which occur

weekly. The training programs in Clini-

cal Neurosciences are strong, well

managed and heavily subscribed.

Aided by the Hotchkiss Brain Institute

and the “Alberta Advantage”, the

prospect for major recruitment and

significant discovery in Clinical Neuro-

sciences has never been greater. Our

future is bright!


! 7

DirectorNeuromuscular and EMG Lab

Doug Zochodne

Director

EEG & EpilepsyNeelan Pillay

Director

Alberta Radiosurgery Centre& Neuromodulation

Zelma Kiss

Director

Neurosurgery Education

John Hurlbert/John Wong

Director

Peripheral NerveRajiv Midha

Director

Neuro Vascular

John Wong

Director, MRI &

NeuroArm Robotics Garnette Sutherland

DirectorQuality Improvement

And SafetyW. Becker/M. Hamilton

Director

Paediatric NeurosurgeryMark Hamilton

DirectorPaediatric PM & R

John LatterDirector

Stroke ProgramAndrew Demchuk

Director

Stroke Unit

Michael Hill

DirectorMultiple Sclerosis

Luanne Metz

DirectorIBTRC

Gregory Cairncross

Director

SACRI

Peter Forsyth

Director

Headache Program

Werner Becker

DirectorUrgent Neurology

ClinicBill Murphy

Director

Neurology Education

Drs. William Fletcher/David Patry

Director

Therapeutic Brain

Stimulation Program

Bin Hu

Director

Movement Disorders

Oksana Suchowersky

Calgary Spine Program

Jacques Bouchard

& Stephan duPlessis

DirectorALS Clinic

Chris White

Department

Of



Program Leaders

New FacultyDr. W. Jeptha Davenport

Dr. Davenport graduated

from the University of Illinois

College of Medicine in 1996

after undergraduate studies

in philosophy and

neurosciences." He special-

ized in neurology after com-

pleting an internship at the

Royal Victoria Hospital and

neurology residency in

Montreal at McGill

University." He received his

fellowship in the Royal Col-

lege of Physicians of Can-

ada in 2002 and became a

diplomate of the American

Board of Psychiatry and

Neurology in 2004." He

worked on basic science

studies of pain at the Hospi-

tal for Sick Children under

Dr. Mike Salter before work-

ing in several community

hospitals and in a general

neurology practice in

Toronto." He came to Cal-

gary in the spring of 2008,

working in the headache

group of the Chronic Pain

Centre, the Multiple Sclero-

sis Clinic of the Foothills

Medical Centre,"as well as in

other areas of neurology in

the Department of Clinical

Neurosciences of the Cal-

gary Health Region.

Dr. Sean Dukelow

Dr. Dukelow obtained

his B.Sc. with specialization

in Human Kinetics from the

University of Guelph." He

went on to do his M.D. and

his Ph.D. at the University

of Western Ontario." His

doctoral research, super-

vised by Dr. Tutis Vilis, fo-

cused on using high field

functional MRI to map out

areas of the brain that were

responsive to visual motion

and eye movements." After

completing his doctoral

studies, he continued on to

do his residency in Physical

Medicine and Rehabilitation

at Queen’s University in

Kingston, Ontario." During

his residency and post-

doctoral fellowship at

Queen’s he collaborated

with Dr. Stephen Scott to

develop novel robotic tech-

niques for assessment of

neurologic function in stroke

rehabilitation subjects." Cur-

rent research interests in-

volve further development of

robotic assessment and

treatment tools following

stroke." Clinically his"prac-

tice areas are"stroke reha-

bilitation"and electromyog-

raphy.

Dr. Shalina Ousman

Dr. Shalina Ousman is

an Assistant Professor in the

Department of Clinical Neu-

rosciences at the Hotchkiss

Brain Institute and the Uni-

versity of Calgary. She did

her PhD in Neurosciences at

McGill University followed

by two postdoctoral fellow-

ships at The Scripps Re-

search Institute (Neuro-

pharmacology Department)

and Stanford University

(Department of Neurology

and Neurological Sciences).

She is funded by the Alberta

Heritage Foundation for

Medical Research, Canadian

Institutes of Health Re-

search and the Multiple

Sclerosis Society of Can-

ada. Dr. Ousman is inter-

ested in identifying endoge-

nous protective mecha-

nisms in multiple sclerosis.

Dr. Tamara Pringsheim

Dr Tamara Pringsheim is

a neurologist specializing in

the treatment of Tourette

Syndrome and related

comorbid disorders includ-

ing Attention Deficit Hyper-

activity Disorder and Ob-

sessive Compulsive Disor-

der. She also has an interest

and expertise in the diagno-

sis of movement disorders

in children and adults, as

well as primary headache

disorders. "She completed

her five year residency at

the University of Toronto in

adult neurology, and then a


! 8

Dr. Shalina Ousman

Dr. Sean Dukelow

Dr. Jeptha Davenport

3 year neuropsychiatry and

movement disorders fellow-

ship under Dr Paul Sandor

and Dr Anthony Lang in To-

ronto. "She also did a one

year clinical and research

fellowship in headache at

McGill University. "In addi-

tion to her clinical subspe-

cialty training, Dr Pringsheim

completed a Master degree

in Clinical Epidemiology in

the department of Health

Policy, Management and

Evaluation at the University

of Toronto. "Dr Pringsheim

is the director of the Cal-

gary Tourette Syndrome

Clinic, and is a member of

the Movement Disorders

Program and CHAMP clinic.

Dr. Clare Gallagher

Dr. Gallagher graduated

from the University of Cal-

gary with a PhD in Bio-

chemistry in 1995. After an

industrial post doctoral fel-

lowship in the USA she re-

turned to Canada to attend

medical school at the Uni-

versity of Alberta (2000).

Neurosurgical training was

then undertaken at the Uni-

versity of Calgary and com-

pleted in 2006. A fellowship

in Neurotrauma was com-

pleted at the University of

Cambridge (UK) in 2006-7

and followed with Pediatric

Neurosurgery training at the

University of Texas-

Southwestern (Dallas) in

2007-8. She returns to take

a position at the University

of Calgary with special in-

terest in traumatic brain in-

jury and pediatric neurosur-

gery.

Dr. Gallagher’s research

interests are in the field of

neurotrauma. Both clinical

and basic research projects

are underway. The field of

cerebral metabolism after

traumatic brain injury is be-

ing investigated in the labo-

ratory setting and with brain

injured patients. Neuro-

chemistry and vascular re-

activity is currently being

investigated in both the

adult and pediatric popula-

tion.

Dr. Eric Smith

Dr. Smith was recruited

in 2008 from Massachusetts

General Hospital, where he

was Associate Director of

Acute Stroke Services and

Assistant Professor of Neu-

rology at Harvard Medical

School."His"clinical interests

are vascular cognitive im-

pairment,"cerebral small

vessel disease (including

ischemic white matter dis-

ease and intracerebral hem-

orrhage) and acute stroke

care.

He is the Principal In-

vestigator of a U.S. National

Institute of Health grant to

identify MRI and PET imag-

ing markers of cerebral

small vessel disease and

Alzheimer's disease, and

determine their contribution

to cognitive decline. Another

avenue seeks to identify

predictors of appropriate

medical care for stroke and

the impact of stroke treat-

ments in the “real world”

outside the context of highly

monitored clinical trials. The

data comes from local and

national databases such as

the American Heart Associa-

tion Get With the

Guidelines-Stroke quality

improvement program, of

which"he is a member of

the"Science Subcommittee.


! 9

Dr. Eric Smith

Dr. Clare Gallagher

Alberta Heritage Foundation for Medical ResearchOverview

The Department of Clinical Neurosciences is fortunate

to have been able to recruit and nurture bright individuals

who are making substantial contributions to academic

medicine. The following individuals are scholars whose re-

search is supported by the Alberta Heritage Foundation for

Medical Research in 2008.

Dr. Phil Barber!

Currently, Dr. Barber is focusing

on experimental stroke and the

imaging of neuro-inflammation,

blood brain barrier breakdown dur-

ing early ischemia and the neuro-

protective properties of resveratrol."

His research accomplishments

have been recognized by the Heart

and Stroke Foundation of Canada

with the Henry Barnett Scholarship

in 2005 and the University of Cal-

gary Innovator Award." He is

funded by the Alberta Heritage

Foundation for Medical Research, The Heart and Stroke

Foundation of Canada and the Canadian Institutes of

Health Research (CIHR).

Dr. Andrew Demchuk

Dr. Demchuk’s primary research interest is in the area

of vascular imaging where he is developing imaging guided

treatment for stroke and transient ischemic attack. Spe-

cific areas he is currently studying include: (1) CT angi-

ography’s detection of ischemic core, thrombus burden

and collateral flow; (2) CT angiography’s detection of ongo-

ing bleeding during intracerebral hemorrhage for targeting

hemostatic therapy. (3) Transcranial Doppler’s role as a

continuous monitoring bedside tool for recanalization dur-

ing thrombolysis. (4) Transcranial Doppler emboli detection

for assessing vulnerability to recurrent stroke after TIA/

minor stroke. (5) Multimodal MRI detected perfusion ab-

normalities and ischemia for predicting vulnerability to re-

current stroke after minor stroke/TIA. These research pro-

jects are supported by grants from Heart and Stroke Foun-

dation of Alberta, NWT and Nunavut; CIHR; Canadian

Stroke Consortium and NovoNordisk Canada.

Dr. Paulo Federico

Dr. Federico has received support from Alberta Heri-

tage Foundation for Medical Research as well as the Ca-

nadian Institutes of Health Re-

search for the project entitled “Mul-

timodal analysis of the pre-ictal

state”. This research involves a

functional MRI study, EEG analysis

of high frequency oscillations, and

near infrared spectroscopy study of

blood flow changes during the pe-

riod leading up to the onset of a

seizure. The goal of this project is

to identify biomarkers that may

predict seizure onset. As a result,

we will have a better understanding

of how seizures begin and how to anticipate them. This

would significantly impact future treatment modalities (e.g.,

direct the placement and activation timing of implantable

devices), which would reduce the suffering and economic

burden in a challenging group of persons with epilepsy.

Dr. Michael Hill

Dr. Hill’s area of research interests include clinical trials

in stroke and the use of administrative data for stroke re-

search and surveillance. He has participated in multiple

clinical trials, leads the Calgary Stroke Program Clinical

Trials Group and is leading 4 large clinical trials as the PI,

co-PI or Steering Committee member. He has begun fun-

damental work on stroke surveillance using administrative

data to monitor stroke rates and stroke outcomes.

Dr. Hill has been funded by the CIHR, Heart & Stroke

Foundation of Alberta/NWT/NU and the NINDS (NIH) since


! 10

2001. He currently holds the Heart & Stroke Foundation of

Alberta/NWT/NU Professorship in Stroke Research and is

the Director of the Stroke Unit.

Dr. Natalie Jette

Dr. Jetté’s research interests are primarily focused on

the development of a health services research program in

epilepsy."She is studying: (1) quality and appropriateness of

care in epilepsy; (2) health resource use and access to care

in epilepsy; (3) comorbidities of epilepsy an other health

ourcomes; (4) behavioral determinants of health in epilepsy.

Her AHFMR funded project consists of the development

and application of a new tool which will allow the identifica-

tion of individuals with focal epilepsy who should be re-

ferred for a surgical evaluation.

This project has also received national and interna-

tional funding support from the American Epilepsy Society,

the CIHR, the Milken Family Foundation and the Hotchkiss

Brain Institute Clinical Research Unit.

Dr. Zelma Kiss

Dr. Zelma Kiss is a CIHR Clinician Scientist and a Clini-

cal Scholar of the Alberta Heritage Foundation for Medical

Research (AHFMR). She directs the regional program in

Neuromodulation and her clinical and research interests

involve stereotactic and functional neurosurgery.

Dr. Kiss’ research interests have focused on the

mechanisms of action of deep brain stimulation for move-

ment disorders. Her recent research has extended to the

development of Neural Prostheses to restore sensorimotor

function. Along with co-leaders in Edmonton, she was re-

cently awarded an AHFMR Interdisciplinary Team Grant on

this theme.

Dr. Minh Dang Nguyen

Dr. Nguyen looks for ways to protect neurons from the

damage that occurs with aging and from such disorders as

Alzheimer’s disease. Dr. Nguyen’s research focuses mainly

on the cytoskeleton (the internal scaffolding) of nerve cells

in the brain. Mutations in the cytoskeleton can lead to such

neurodegenerative disorders as Frontal Temporal Demen-

tia, Parkinson’s disease and amyotrophic lateral sclerosis.

Dr. Minh Dang Nguyen is an AHFMR Scholar and a

CIHR New Investigator affiliated with the Hotchkiss Brain

Institute at the University of Calgary. He also holds the

Brenda Stafford Chair in Alzheimer Research. Past and

present agencies funding his research include the AHFMR,

CIHR, Human Frontier Science Program, MS Canada and

the ALS USA and Canada society.

Dr. Peter Stys

Dr. Stys is a neurologist/neuroscientist and a world

leader in the detailed study of pathophysiological mecha-

nisms of white matter injury in stroke and trauma. He has

extensive expertise in electrophysiological recording meth-

ods in myelinated axons, and his team has recently devel-

oped confocal, multiphoton and coherent anti-Stokes Ra-

man scattering (CARS) imaging techniques for both fixed

immunostained and live myelinated axons and glial cells.

Dr. Stys' insights provide a rational basis for devising drug

therapy for the acute phases of stroke, spinal cord injury,

brain trauma, and neuroinflammatory conditions.

Dr. Stys is the recipient of the Dr. Frank LeBlanc Chair

in Spinal Cord Research, Canada Research Chair (Tier I) in

Axo-glial biology, and Alberta Heritage Foundation for Re-

search (AHFMR) scientist award." His work is supported by

a number of important funding partners (in addition to the

ones mentioned above), including the Canadian Founda-

tion for Innovation (CFI), CIHR, Multiple Sclerosis Society

of Canada, Neuroscience Canada, HBI, Canadian Stroke

Network (CSN), NSERC, Alberta Paraplegic Foundation,

Adelson Foundation for Medical Research, and the Na-

tional Institutes of Health (NIH).

Dr. Cory Toth

In type 1 diabetes, a lack of insulin not only contributes

to poor glucose control. It also"starves the brain of a

needed growth factor, leading to brain atrophy, loss of

white matter, and cognitive decline. Dr. Toth will be study-

ing the impact of deficiency of insulin within the brain upon

important pathways and examining methods to shore up

these pathways without affecting the rest of the body. His

recent AHFMR award will be used to perform this work un-

til 2012, while Dr. Toth's previous work supported by

AHFMR led to new discoveries about the impact of insulin

deficiency in the brain and its potential replacement

through intranasal delivery to access the brain. In addition,

AHFMR sponsored work has led to discoveries regarding


! 11

the AGE-RAGE pathway within the diabetic brain and on-

going JDRF sponsored"work to identify potential therapeu-

tic targets of this pathway as well.

Dr. Wee Yong

Dr. V. Wee Yong research interests lie in the area of

neuroimmunology, neuroprotection and CNS regeneration.

His scientific projects have been guided by 4 disorders:

multiple sclerosis (MS), spinal cord injury, intracerebral

hemorrhage and malignant gliomas. Dr. Yong co-directs

the MS Program of the Hotchkiss Brain Institute at the Uni-

versity of Calgary. Dr. Yong currently chairs the Medical

Advisory Committee of the Multiple Sclerosis Society of

Canada and he sits on the International Advisory Board of

the International Society of Neuroimmunology.

Dr. Doug Zochodne

Dr. Zochodne is a Scientist of the Alberta Heritage

Foundation for Medical Research. The Zochodne lab re-

search is been funded by the CIHR, (the current lab is sup-

ported by three ongoing CIHR awards), the Canadian Dia-

betes Association (CDA), National Institutes of Health (NIH

USA, PI Dr. Chris Power), the Natural Science and Engi-

neering Research Council of Canada (NSERC, PI Dr. David

Cramb), and the Juvenile Diabetes Research Foundation

International (JDRFI, PI Dr. Danielle Pacaud).

The laboratory has made contributions to the field of

experimental diabetic neuropathy and peripheral nerve re-

generation. Dr. Zochodne is the team leader of a major

($2.25M) CIHR Regenerative Medicine and Nanotechnol-

ogy team grant with collaborators at the University of Cal-

gary in Neurosciences and Engineering, the University of

Alberta, and the University of Saskatchewan.


! 12

2008 Program UpdatesAdult Hydrocephalus ProgramProgram Director: Dr. Mark G Hamilton

Overview

In 2001, the University of Calgary Adult Hydrocephalus

Clinic was established with the goal to standardize and

enhance the care for patients with hydrocephalus. The

population of adult patients with hydrocephalus is increas-

ing as diagnostic and therapeutic techniques improve iden-

tification and survival of treated patients. Hydrocephalus

patients have typically been assessed and cared for by

individual physicians in an unstructured and unfocused

clinic environment. In 2008 there are 350 patients followed

in the Adult Hydrocephalus Clinic. This population includes

patients who initially had a diagnosis of hydrocephalus as a

child, adults with acute and subacute hydrocephalus, pa-

tients with long-standing overt ventriculomegaly in adults

(LOVA), and patients with idiopathic Normal Pressure Hy-

drocephalus (iNPH). An audit of all adult patients who have

undergone treatment of their hydrocephalus over the last

14 years has been started.

The University of Calgary Adult Hydrocephalus Pro-

gram has emerged as a response to the success of the

Adult Hydrocephalus clinic. The effort to focus the care of

adult patients with hydrocephalus in a specialty clinic rep-

resented an important development to help foster a better

understanding of the natural history of patients with un-

treated hydrocephalus, to standardize the investigative

strategies for patients with a potential diagnosis of hydro-

cephalus and to manage the issues related to problems

with treatment of hydrocephalus using shunts. Clinical re-

search is progressing along these avenues. A Canadian

Adult Hydrocephalus Study Group is being established to

help advance these objectives nationally.

Members "

Neurosurgeons

Dr. Mark G Hamilton

Dr Clare Gallagher

Dr. Walter Hader

Medical Neurologist and Geriatrician#

Dr. David Hogan

Dr. David Patry

Neuropsychology

Michael King, Ph.D.

Nurse Practitioner#

Ron Prince (Inpatient)

Research Interests

Neuroendoscopy treatment and outcome for hydro-

cephalus

Neuropsychological effects of endoscopic treatment of

hydrocephalus

Infections in ventricular catheters and shunts

Treatment of idiopathic Normal Pressure Hydrocepha-

lus (iNPH)

Transition care for pediatric patients with hydrocepha-

lus

Endoscopic management of patients with brain tumors

Grant Support

Codman Corporation

Medtronic Corporation


! 13

Alberta Radiosurgery CentreProgram Director: Dr. Harold Lau

Overview

This program, using a Novalis system, the

first of its kind in Canada, is a collaborative ef-

fort between the Divisions of Neurosurgery and

Radiation Oncology, and was originally estab-

lished as a joint program between the Calgary

Health Region and the Alberta Cancer Board.

The technology offers focused radiation treat-

ment for diseases of the brain and spinal cord in

single daycare sessions, thus obviating the need

for lengthy hospital stays associated with stan-

dard surgical treatments. By reducing risks of

therapy, and ease of returning to normal activi-

ties, it results in much higher patient satisfac-

tion. The program has, since its initiation, in

2002 has grown steadily, such that in 2007, 64

patients were treated with stereotactic radiosur-

gery and another 33 patients treated with frac-

tionated stereotactic radiotherapy.

Members

Neurosurgery: Drs. Zelma Kiss, Yves Starreveld, John Wong

Radiation Oncology: Drs. Alex Chan, Harold Lau, Rob Nordal

Medical Physics: Karen Breitman, Drs. Chris Newcomb, David Spencer, Eduardo Villarreal Barajas

Nursing: Rhonda Manthey

Radiation Therapists: Carol Boyle, Mark Lesiuk, Kim Kraus, Salimah Fazel, Shannon Murland

Dosimetrists: Darren Graham, Daphne Walrath, Nathan Wolfe

Administration: Brenda Hubley (Interim Program Manager), Jody Derdall

Fellows: Dr. Ben Jonker


! 14

Chronic Pain CentreOverview

The Calgary Health Region Chronic Pain Centre has

now completed 8.5 years of operations within the CHR

Regional Pain Program. It is now the largest such Centre

in Canada and is a leader in interdisciplinary rehabilita-

tion for individuals with chronic pain.

Three members of the Division of Physical Medicine

and Rehabilitation currently practise at the Chronic Pain

Centre: Dr. Pamela Barton, co-founder and former medi-

cal director, Dr. Noorshina Virani and Dr. Nwamara Dike.

In addition to their strong background in pain manage-

ment and interdisciplinary rehabilitation, Drs. Barton and

Virani contribute specific expertise in clinical biomechan-

ics, while Dr. Dike has shared her expertise from a pain

fellowship at Memorial Sloan-Kettering Cancer Centre in

New York. Dr. Dike has also participated in the newly

inaugurated Chronic Pain Inpatient Consultation Service

now available in all of Calgary’s hospitals.

The physiatrists work in the Neuromusculoskeletal

Program alongside anaesthetists, family practitioners and

all members of the rehabilitation teams. They have many

patients who are co-managed with the gynecologists and

neurologists of the Pelvic Pain and Headache Programs.

They also participate in teaching medical students, resi-

dents and fellows in family practice, anaesthesiology,

psychiatry, physical medicine and rehabilitation and neu-

rology who rotate through the Centre.

During 2008, the physiatrists contributed a total of

0.6 FTE, completing 58 new patient assessments and an

additional 302 follow up visits on a total of 162 unique

patients. Due to their competence in the interdisciplinary

management of complex patients, their caseloads carry

many of the more complicated patients referred to the

Chronic Pain Centre.


! 15

Epilepsy ProgramOverview

The overall objective of our team is to be a centre of

clinical and academic excellence, and to maximize the full

potential of each individual with epilepsy through improved

consolidated services, education and research. Patients

and families often present with complex needs arising from

the impact of this chronic illness on their lives coupled with

the experience of change in their disease process and /or

response to treatment.

The Calgary Epilepsy Program has a unique core of

pediatric and adult epileptologists, epilepsy surgeons, EEG

technologists, clinical physician assistants, residents, fel-

lows basic scientists, neuroradiologists, neuropsycholo-

gists, and nurses providing comprehensive care for epi-

lepsy patients. This team of experts works in collaboration

to find the most appropriate treatment for each patient. We

are one of the premier epilepsy centres in Canada, and we

are developing innovative ways to diagnose and treat epi-

lepsy in children and adults.

Epilepsy is much more than seizures. Research by

members of our team and others demonstrates that up to

70% of persons with epilepsy suffer from anxiety, depres-

sion and other psychological disorders. A similar propor-

tion suffers from cognitive deficits and learning difficulties

as a result of the seizures, the medications or underlying

conditions. The risk of death in patients with poorly con-

trolled epilepsy is 5 times higher than in the population.

Accidents, social stigma, and disability are well docu-

mented in our studies of the Canadian epilepsy population

who also use more acute health care resources and allied

health services than patients with other common chronic

conditions. In addition, our researchers have shown than in

Canada, chronic conditions such as hypertension, cancer,

stroke, heart disease, gastrointestinal disorders, migraine,

allergies, chronic fatigue, diabetes, and psychiatric disor-

ders are significantly more common in patients with epi-

lepsy than in the general population.

Service delivery

EEG and Epilepsy

The Calgary Comprehensive Epilepsy Program pro-

vides diagnostic, therapeutic and follow-up services to pa-

tients referred with new and uncontrolled seizures. Seven

epileptologists contribute to the program. Dr. Neelan Pillay,

adult epilepsy program director; Dr. Bill Murphy; Dr. Sam

Wiebe, Division Chief of Neurology and Director of the

Comprehensive Epilepsy Program; Dr. Paolo Federico; Dr.

Nathalie Jette; Dr. Alex Hanson; and Dr. Brian Klassen. Drs.

Pillay and Murphy have just completed research sabbati-

cals at the Brain Research Institute in Melbourne, Australia.

The seizure monitoring unit (SMU), staffed by five epilep-

tologists, is the 3rd in-patient service in the division of Neu-


! 16

Voxel based relaxometry

rology, in addition to general neurology and stroke. Our

neurophysiology laboratory faces increasing demands for

urgent and emergent EEG and for ICU continuous EEG

monitoring, a reflection of population growth and changes

in practice patterns. Similarly, requests for intra-operative

somatosensory and motor evoked potential from spine

surgeons and neurosurgeons have increased markedly.

The Seizure Monitoring Unit Quality Improvement Team

The CEP is committed to providing high quality and

safe patient-centered care. A major initiative towards this

goal is our Seizure Monitoring Unit (SMU) Quality Im-

provement (QI) Team. This multidisciplinary team, originally

developed with the support of Michael Suddes, previous

Neurosciences QI consultant, meets six times a year to

monitor and improve quality and safety of care on the four-

bed SMU. The team is currently comprised of representa-

tives from EEG technology (Mike Rigby, Erin Phillip), Qual-

ity and Safety (Jason Knox), Neurology (Dr. Federico, Dr.

Jetté, Dr, Pillay, Dr. Wiebe), Nursing (Barb Seal, Christanne

Krassman, Jackie Martini, Robert Cooper, Shelly Mikkel-

sen, Chris Murray), Psychology (Dr. Macrodimitris, team

lead), and a patient representative who is also a former

patient of our SMU, Ms. Valerie Gibbons. Initiatives to date

include regular assessment of staff and patient experience

of the SMU, regular collection of key quality indicators

(presently collected by our Clinical Assistants, Dr. Obianyor

and Dr. Dhaliwal), staff education and training programs,

and the development of a specific protocol and training

program for Generalized Tonic-Clonic seizure interventions.

The success of our QI program was highlighted at a plat-

form presentation at the December, 2008 American Epi-

lepsy Society meeting in Seattle, Washington.

Neurophysiology Laboratory

The laboratories at the three adult sites in the city are

managed by Mr. Mike Rigby. The main services provided

are inpatient and outpatient EEGs. In the past year we had

about 20% increase in inpatient EEG requests. On the

other hand there was a slight decline in SMU admissions

because of more complex patients requiring a lengthier

stay in the unit.

The Epilepsy Psychology Program

The CEP is committed to providing comprehensive

care, which requires addressing the psychological and so-

cial needs of patients in addition to their medical issues.

Over the past year, Dr. Macrodimitris, our program’s psy-

chologist, and her colleague Dr. Kate Hamilton, have

launched a cognitive Behavioral Therapy group program

the “CBT Basics II.” The program is run by Dr. Macro-

dimitris and the Ambulatory Neurosciences Social Worker,

Melinda Hatfield, MSW, RSW. Seven patients completed

this weekly 10-session structured program for depression

and anxiety disorders. This program will continue to run in

2009 as a multi-center research initiative supported by the

Hotchkiss Brain Institute Clinical Research Unit Pilot Pro-

ject Funding. Dr. Macrodimitris and Dr. Sherman, through

support from the Kinsmen Chair in Pediatric Neurosci-

ences, are also developing pediatric epilepsy mental health

initiatives, including a group program for adolescents with

epilepsy and co-morbid anxiety and depression, and a

parent support group for parents of epilepsy patients.


! 17

Surgery for refractory epilepsy associated with a lesion in-

volving eloquent cortex after comprehensive pre-operative

evaluation

Teaching and training

The Comprehensive Epilepsy Program brings together

adult and pediatric epilepsy groups during weekly seizure

conferences and EEG rounds and monthly journal club.

The educational components of the program comprise

teaching neurology residents, clinical physician assistants,

epilepsy fellows, nurses and EEG technologists. Dr. Adnan

Al-Sarawi from Saudi Arabia completed a one-year fellow-

ship in epilepsy and transferred to EMG fellowship in To-

ronto. Dr. Abdel Hamid Seiam from Egypt will be complet-

ing his 2-year epilepsy fellowship in March 2009. Dr.

Ayataka Fugimoto, epilepsy surgeon from Japan joined our

fellowship program in July for a year. Dr. Harinder Dhaliwal

a graduate from the Armed Forces Medical College in India

and Dr. Florence Obianyor, a graduate of Premier Medical

College, University of Ibadan, have been recruited through

the Calgary Clinical Assistant program this year. Dr. Radwa

Badawi, EEG/epilepsy fellow from Melbourne, Australia,

joined us for an elective during the spring of 2008, and Dr.

Jeremy Moeller, senior neurology resident from Dalhousie

University, joined us for an elective during the fall.

Special events

1. The Second Calgary Epilepsy Program Research

Retreat was held at the Best Western Village Park, Inn on

Friday September 12, 2008. There were 38 participants

from all disciplines in this half-day event.

2. The special guest for the annual Mary Anne Lee

symposium, held on October 03, 2008 was Dr. Nicholas M.

Barbaro, Professor, Department of Neurological Surgery,

Vice Chair, Department of Neuro-

logical Surgery , Director, Neuro-

surgical Residency Program,

University of California, San

Francisco. Dr Barbaro has ex-

tensive expertise in the treatment

of disorders that are manageable

by stereotactic and functional

neurosurgical techniques, includ-

ing epilepsy, Parkinson's dis-

ease, and chronic intractable

pain syndromes. He is recog-

nized internationally for his work

in epilepsy surgery.

3. The annual Calgary Epilepsy Program Barbecue took

place at the Pioneer Club on Friday June 6, 2008.

4. Second annual Calgary Epilepsy Golf tournament

was held on August 21 at Lynx Ridge Golf club. Golf en-

thusiasts braved the inclement weather and made it a great

success. The details are in the separate report appended

Research Staff

Dr Supriya Save has joined our team as the new Clini-

cal Trial’s Coordinator. Dr. Save has a BSc and PhD de-

grees in science from Mumbai University, India. She brings

expertise in clinical trials and clinical research and is an

asset to our team.

Research Activities

Dr. Federico’s research program uses leading-edge

imaging and EEG approaches to better understand the

neural and vascular correlates of epilepsy. These studies

include using EEG combined with simultaneous functional

MRI to better understand the cortical and subcortical cir-

cuits underlying the generation of interictal discharges in

patients with focal and generalized epilepsy (see Figure).

Other projects include fMRI studies of language and motor

reorganization in focal epilepsy as well structural MRI stud-


! 18

Dr. Nick Barbaro

Language fMRI

ies of seizure-related structural brain changes. Dr. Federico

also has an interest in advanced EEG analytical tech-

niques, including the study of high frequency oscillations in

humans and animal models of epilepsy. He currently holds

funding from the Canadian Institutes of Health Research

and Alberta Heritage Foundation for Medical Research.

Dr. Jetté’s research interests are primarily focused on

the development of a health services research program in

epilepsy. She is studying: (1) quality and appropriateness

of care in epilepsy; (2) health resource use and access to

care in epilepsy; (3) comorbidities of epilepsy and other

health ourcomes; (4) behavioral determinants of health in

epilepsy. She is working on the development of an appro-

priateness rating tool to identify individuals with epilepsy

who should be referred for an epilepsy surgery evaluation.

She is also working on the development of a national epi-

lepsy surveillance program. Dr. Jetté's research is currently

funded by the Canadian Institutes for Health Research

(CIHR), the Alberta Heritage Foundation for Medical Re-

search (AHFMR), the American Epilepsy Society, the Milken

Family Foundation, the Public Health Agency of Canada,

the University of Calgary, and the Hotchkiss Brain Institute

Clinical Research Unit. She also holds new investigator

awards from CIHR, AHFMR, the American Epilepsy Society

and the Milken Family Foundation.

Dr. Samuel Wiebe’s research focuses on outcome as-

sessment, quality of life, comorbidity, epidemiology, and

randomized surgical trials in epilepsy. He is undertaking a

multicentre randomized trial of Medical versus Electrical

Therapy in Temporal Lobe Epilepsy (METTLE study), and is

the PI for a number of planned NIH-supported studies on

epilepsy and depression, early refractory epilepsy and neu-

roprotection. He is developing scales to assess severity of

epilepsy and patient satisfaction with therapy. Dr. Wiebe

established and leads the Canadian Epilepsy Surgery

Study Group (CESSG), a research consortium aimed at

facilitating and coordinating collaborative research in all

areas related to epilepsy surgery. The group is supported

by the Hotchkiss Brain Institute through its Epilepsy and

Brain Circuits program, and it is affiliated to the Canadian

League Against Epilepsy. Dr. Wiebe is supported by the

Canadian Institutes for Health Research (CIHR), the Alberta

Heritage Foundation for Medical Research (AHFMR), the

Alberta Medical Services Incorporated Foundation (MSI),

the National Institutes of Neurological Disorders and Stroke

(NINDS), and the Hotchkiss Brain Institute.

In addition to the specific research activities outlined

above, our epilepsy program is fortunate to have a strong

group of experts who collaborate in various capacities to

our research enterprise. These include experts from the

areas of Pediatric Epilepsy (Dr. Ismail Mohammed) Neuro-

pathology (Dr. Harvey Sarnat), Neurosurgery (Drs. Walter

Hader, Zelma Kiss, Yves Starreveld), Neuropsychology

(Drs. Elisabeth Sherman and Lisa Partlo), Psychiatry (Jer-

emy Quickfall) and Neuroimaging (Drs. James Scott and

Chris Molnar). We also enjoy strong collaborations with

basic scientists from the Epilepsy and Brain Circuits Pro-

gram in the Hotchkiss Brain Institute, in particular Drs. Cam

Teskey, Jaideep Bains, Quentin Pittman, Michael Collicos

and Jeff Dunn.


! 19

Epilepsy Golf TournamentThe 2nd Annual Epilepsy Golf Tournament was held

at Lynx Ridge Golf Club on Thursday August 21, 2008

and despite trying weather was another great success.

The tournament continues to grow and this year over 50

brave souls battled rain and cold winds to complete the

18-hole event. Many thanks go out to our hole sponsors

and those who made donations of prizes for the event or

donations to the program. A special thanks goes out to

our many volunteers who helped make this event possi-

ble. Proceeds of the tournament will continue to benefit

patients by supporting the development of clinical, edu-

cational and support programs within the Calgary Epi-

lepsy Programme.

Hole Sponsors

Johnson & Johnson

AMJ Campbell Moving

Dr Sam Wiebe#

Dr Walter Hader

Prize Sponsors

AMJ Campbell

Bernard Florence, Calgary

Johnson & Johnson

Donations

LaFarge#

Magstim#

R Anand#

Jennifer Buchanan#

Jason Cottle#

Monty Arun Gaur

Walter Hader Sr

Nathalie Jetté

B Raskin

Maureen Robertson

Doug Walsh

Volunteers

Thea Dupras #

Kim Ford#

Lysa Gallagher

Jack Hasna

Lisa Partlo

Ceri Rawji


! 20

The Winners!

Frank LeBlanc, Adam Kirton, Ian Stang, Greg Cairncross

The Wettest Team!

Ron Bridges, Tom Feasby, Ed Block, Eric Payne

Calgary Headache Assessment & Management Program (CHAMP)Introduction

CHAMP is a multidisciplinary headache management

program with 5 neurologists, 3 nursing, 1 occupational

therapy, 1 psychologist, 1 kinesiologist, 3 clerical, and 1

research assistant / data analyst team members.

Mission Statement

Vision: Empowered patients and their families actively

engaged in headache self-management.

Mission: To reduce the burden of headache related

disability carried by patients and their families.

Objectives: Deliver care for patients with difficult head-

ache disorders more efficiently and effectively through inter

professional teams focused on both medical and behav-

ioral therapies.

Contribute to headache care through clinical research

and education of health care professionals.

Reduce utilization of expensive health care resources

such as emergency rooms and inpatient beds through bet-

ter outpatient management of patients with headache.

CHAMP will:

Provide patients with a caring and empathetic envi-

ronment in which to monitor progress towards their func-

tional goals.

Encourage patient self reliance and active partnership

in their headache care, with an emphasis on self manage-

ment.

Provide access to program services in a timely manner

immediately following admission to the program.

Serve the headache health care needs of the CHR in

conjunction with the headache program of the CHR

chronic pain center.

Maintain a comprehensive quality management pro-

gram with appropriate quality indicators and outcome

measures.

Deliver “best practice” care based on evidence avail-

able, with a commitment to develop new evidence where

needed.

Ensure all team members are committed to remain cur-

rent in terms of best practices in headache care.

Involve patients in the design of the program CHAMP

offers and in the design of their individualized treatment.

Carefully foster communication between patients and

staff, and between the members of the inter-professional

team to create a forum for the discussion of patient care

plans.

Work towards following every patient with outcome

measures and team discussions so that all are accounted

for.

Summary of activities

The clinical core of the CHAMP program consists of

group workshops and one-on-one outpatient visits to phy-

sicians and other health care professionals. The nursing

component of CHAMP provides additional valuable patient

service through telephone follow up and problem solving.

The educational session is the entry point for many pa-

tients to the CHAMP program, and during 2007, 362 pa-

tients and over 200 additional family / friends attended the

education sessions which are offered 2 or 3 times a month.

There were over 2203 one-on-one patient visits to physi-

cians and other health care professionals. Many patients

attended our self management, relaxation, sleep and body

works workshops.

Education: In addition to continuing medical education

programs and teaching directed at University of Calgary

residents and medical students, the CHAMP program pro-

vided elective rotations to 4 senior University of Alberta

Neurology residents in 2007 (Drs. Jickling, Phan,

Narasingh, and Jassal), and for one senior neurology resi-

dent from the University of Ottawa (Dr. F. Amoozegar). Ms.

Khara Sauro, holder of the 2007 Canadian Headache Soci-

ety National Headache Fellowship, completed her fellow-

ship with CHAMP during 2007.

Research activities: CHAMP continues to participate in

industry-sponsored multi center clinical trials, and these

have included in 2007 trials to evaluate the efficacy of


! 21

botulinum toxin type A, occipital nerve stimulation, patent

foramen ovale closure, and tonabersat in migraine and / or

chronic daily headache prophylaxis. CHAMP has also ana-

lyzed the properties of two headache outcome measure-

ments, the HIT-6 and the MIDAS, and an abstract has been

submitted to the Canadian Neurological Sciences Federa-

tion annual meeting. In conjunction with Dr Z. Kiss, out-

comes on a CHAMP patient with implantation of a deep

brain stimulator for the treatment of chronic cluster head-

ache have been assessed, and an abstract submitted to

the same meeting.

Quality Improvement: CHAMP has studied program

outcomes. In addition,

an abstract has been

submitted to the Cana-

dian Neurological Sci-

ences Federation an-

nual meeting on the

CHAMP program and

its outcomes. Several

patient focus groups

have also been held to

determine what im-

provements our pa-

tients think should be

made in our program.

We are grateful to Ja-

son Knox and Michael

Suddes for their assis-

tance with these focus

groups.

Awards

The CHAMP program is extremely pleased that one of

its members, Ms Irene O’Callaghan, RN, was awarded a

People First Award in the healing hands category by the

Calgary Health Region. The People First Award is the

highest award which the CHR offers.

Moving forward

A number of action items to improve the program were

developed and the program will work on these over the

coming year.

Revising the education session to reduce the division

between the medical and behavioral content, and to em-

phasize more our integrated comprehensive approach to

headache care.

To review and possibly expand the role of the lifestyle

assessment in the program.

To initiate a formal quality management program for the

CHAMP, complete with a small quality council. This pro-

gram would include quality improvement education for our

staff, and the commitment of all staff to identify where

processes could be improved, and to contribute to their

improvement.

To focus more on “best

practice” through the

development of more

standardized patient

treatment processes.

Ensure that all staff

have access to the

necessary continuing

professional education

in headache manage-

ment.

Facilitate inter-

professional education

regarding the care of

individual patients

through team rounds,

etc.

Improve our capacity to

meet the needs of the

CHR with regard to headache care and reduce our wait

times by working to make our patient care processes more

efficient.

Develop further the kinesiology component of CHAMP

as better posture, neck health, and physical conditioning

contribute to headache management.

Conclusion

CHAMP continues to work towards meeting the head-

ache care needs of the CHR, together with the CHR

Chronic Pain Center Headache Program and to fulfill its

educational and research objectives.


! 22

CHAMP nursing staff (left to right) Brenda Kelly-Bessler (research

nurse), Ruth Sutherland and Irene O’Callaghan (clinic nurses).

Movement Disorders ProgramOverview

Movement Disorders are diseases that result in invol-

untary movements such as tremor, dystonia, bradykinesia

(slowness) and tics. These disorders cause significant dis-

ability in 1/100 Albertans and touch over 30,000 Albertan

families.

The program provides for a multidisciplinary clinic with

a staff of over 20 individuals including specialists in neurol-

ogy, neurosurgery, psychiatry, nursing, social work, psy-

chology, and physiotherapy, treating over 2000 patients

with Parkinson disease, Huntington disease, Tourette syn-

drome, spinocerebellar ataxia, dystonia, and tremor. We

follow approximately 2000 patients with close to 10,000

patient visits per year.

We have a large research program involved in develop-

ing improvements in treatment of Parkinson disease and

related disorders. Research to understand basic mecha-

nisms of disease is coordinated through the Hotchkiss

Brain Institute.

The program continues to be designated as a Center of

Excellence for PD by National Parkinson Foundation (USA).

Highlights

This year Dr. Tamara

Pringsheim joined us. Dr

Tamara Pringsheim is a neu-

rologist specializing in the

treatment of Tourette Syn-

drome (TS). She completed

her five year residency at

the University of Toronto in

adult neurology, and then a

3 year neuropsychiatry and

movement disorders fellow-

ship under Dr Paul Sandor

and Dr Anthony Lang in To-

ronto. In addition to her

clinical subspecialty train-

ing, Dr Pringsheim completed a Master degree in Clinical

Epidemiology in the department of Health Policy, Manage-

ment and Evaluation at the University of Toronto.

She opened the Calgary Tourette Syndrome Clinic in

April 2008 at the Child Development Centre adjacent to the

Alberta Children’s Hospital. This was joint initiative by the

departments of Clinical Neurosciences and Pediatrics at

the University of Calgary. The clinic provides consultation

and continuing care for children and adults with Tourette

Syndrome, as well as other conditions commonly seen in

individuals with Tourette Syndrome, such as Attention Defi-

cit Hyperactivity Disorder and Obsessive Compulsive Dis-

order. The Calgary Tourette Syndrome clinic is the only

centre for expertise in Tourette Syndrome in southern Al-

berta. It will also serve the province of Alberta as well as

neighbouring communities in Saskatchewan and British

Columbia. The aim is to develop a multidisciplinary team

model for the Calgary Tourette Syndrome Clinic, which will

include medical expertise, nursing, clinical psychology, and

occupational therapy.

Currently, the team includes Dr Tamara Pringsheim (Di-

rector of the Calgary Tourette Syndrome Clinic), Dr Bonnie

Moshenko-Mitchell (Registered Psychologist), Nancy La-

belle (Clinical and Research Nurse), Charmaine Orchard

and Carolyn Baldwin, Administrative Assistants

Program Staff

Neurology: Dr. Oksana Suchowersky (Program Direc-

tor)

Dr.Sarah Furtado

Dr. Scott Kraft (Neuromodulation)

Dr. Tamara Pringsheim (Director, Tourette Syndrome

Clinic)

Dr. Ranjit Ranawaya (Clinical Director)

Neurosurgery: Dr. Zelma Kiss (Neuromodulation)

Neurophysiology: Dr. Bin Hu (Research Director)

Neuropsychology: Dr. Angela Haffenden

Psychiatry: Dr. Jeremy Quickfall, Dr. Michael Trew

Graduate Students: Aarti Shankar


! 23

Dr. Tamara Pringsheim

Fellows: Dr. Cid Diesta

Nurses - Clinical: Karen Hunka, Michelle Zulinick, Ro-

byn Warwaruk, Nancy Labelle

Nurses - Research: Lorelei Derwent, Carol Pantella,

Mary Lou Klimek

Secretarial Support: Sheila Pinkney, Marlene Conrad,

D’evan Cooper, Linda Lukindo, Rhiannon D’Haene and Ka-

tie Kraft

Fellowship

The program offers 1-2 yr clinical fellowships for appli-

cants who have completed neurology residency training in

Canada (or equivalent abroad). #

Dr. Cid Diesta successfully completed a one year clini-

cal fellowship and has returned to Manila (Philippines) in

June 2008.

Current Research Interests

Neuroprotection for Parkinson disease (PD)

Music therapy in PD

Identification of genetic factors in PD

Neuroprotection for Huntington disease (HD)

Abnormalities in reaching in PD

Novel treatments in PD, HD, dystonia, and spinocere-

bellar ataxia.

Tourette Syndrome clinic research interests include;

creation of a disease specific quality of life instrument for

children with TS, defining and measuring rage/explosive

anger in children with TS, predicting outcome in TS, identi-

fying factors present early in life which predict resolution of

tics in adulthood, understanding the links between TS and

Autistic Spectrum Disorders, and randomized controlled

trials of drug therapy for TS.

Grant Support

PHAROS – Pilot Huntington At Risk Observational

Study (1999-2010)

O. Suchowersky (Local PI)

National Institutes of Health##

$45,000US/yr Multicenter Grant

PREDICT-HD Neurobiologic Predictors of Huntington’s

disease (2002 – 2008)


National Institutes of Health

$20,000US/yr

Cooperative Huntington’s Observational Research Trial

(COHORT) (2006-2011)


HP Therapeutics Foundation, Inc.

$8,000US/yr

Prospective data collection from HD families.#

The effect of music therapy on motor and non-motor

symptoms in PD (2006 – 2011)

O. Suchowersky (Sub PI) #

Canadian Institute of Health Research (CIHR)

$26,000/yr

NET-PD Neuroprotective PD# (2008-2012)

O. Suchowersky (PI)#

$75,500US/yr

The major goal of this project is to identify drugs to

delay disease progression#


! 24

From left to right; Carol Pantella, Robyn Warwaruk, D'evan

Cooper, Rhiannon DHaene, Dr. Ranjit Ranawaya, Katie Kraft,

Karen Hunka, Dr. Oksana Suchowersky, Sheila Pinkney, Dr.

Tamara Pringsheim, Nancy Labelle

Intraoperative MRI ProgramProgram Director: Garnette Sutherland

Overview

The year 2008 was an interesting year for the iMRI

program. Last year, the program celebrated its 10th year

of operation in December. Early this year, the program

marked another milestone- treating over one thousand

patients in the iMRI suite. The iMRI program success-

fully raised full funding (~$10M) to allow the Advancing

iMRI initiative to occur. The prototype 1.5T iMRI system

was upgraded to an IMRIS-Siemens 3T platform based

on the world’s first ceiling mounted 3T magnet. The MR

system includes high performance gradients and a work-

ing aperture of 70cm.

Planning for the upgrade began in March 2008 re-

quiring considerable input from CHR Planning and De-

velopment, architects from McKay Hlavacek, Ledcor as

the lead contractor and various subcontractors. In June

of 2008 the iMRI suite was closed and construction was

completed by December 2008.

Members

Project Leader""

Garnette Sutherland

NRC Scientists

Boguslaw Tomanek

David Hoult

Scott King

Calvin Bewsky

University of Calgary investigators (not inclusive)

Alex Greer

All members and residents of the Division of Neuro-

surgery

Oliver Bathe

Andrew Kirkpatrick

Phil Park

Andrew Maitland

Mark Hudon

Carla Wallace

Mayank Goyal

Will Morish

Research Interests

Application of iMRI to neurosurgery

Whole body application of iMRI technology

Molecular imaging

Robotics

Grant Support

Alberta Advanced Education and Technology

Western Economic Diversification

Calgary Health Trust

Significant in-kind support from Alberta Health Serv-

ices, NRC Institute for Biodiagnostics, and IMRIS


! 25

Multiple Sclerosis ProgramClinical Highlights

Medical Services: Two new

neurologists joined the MS Clinical

Team in 2008. Dr Dawn Pearson, a

cognitive neurologist, joined our MS

team in January and Dr Jeptha

Davenport, a pain specialist, joined

in April. Dr Pearson has been prac-

tising neurology in Boston and Dr

Davenport has been practising neu-

rology in Toronto. Both Drs Pearson

and Davenport spend 30% of their

time as MS Clinic physicians. In

addition, Dr K Busche increased his

time in the MS Clinic from 10% to

almost 20%.

Electronic Health Record: Dur-

ing 2008 the MS Program (L Metz

and research manager Winona Wall)

continued to develop the electronic

health record (EHR) for the DCNS.

After an extensive process of de-

veloping system requirements and

evaluation of vendors a vendor was

selected in June 2007. The choice

was Eclypsis, the system supported

by the Calgary Health Region. This

system will support a continuous

inpatient and outpatient record. The

choice of this system has, as ex-

pected, slowed development of the

department EHR as development

will in many ways be part of devel-

opment for the entire Calgary

Health Region but linkage with the

inpatient system and long term

support were believed to be good

trade-offs. Development has been

further delayed due to changes in

the organization of the Alberta

Health system but the MS clinic will

be the first regional clinic to imple-

ment the system. This implementa-

tion is planned for early 2009. A

great deal of work developing the

system has taken place during 2008

as decisions that will impact all clin-

ics needed to be made. Start-up of

this project in 2005 was supported

by a generous donation of 1 million

dollars from Teva Neuroscience to

the MS Program of the Hotchkiss

Brain Institute (HBI).

Alberta MS Program: During

2008 there was further development

of an Alberta MS Program led by Dr

L Metz. In December, a pilot pro-

posal for a provincial telehealth

proposal was submitted to the Al-

berta Rural development fund. Be-

tween June and October regional

meetings were held to discuss the

current status of mental health serv-

ices provided to people with MS, to

identify gaps, and to develop a plan

to move forward. A province-wide

MS Mental Health meeting/

education program is scheduled for

late June 2009. Preliminary planning

to evaluate rehabilitation services

for MS has started. A meeting of

those providing these services will

be held in April 2009. Funding for

development of an Alberta MS Pro-

gram was provided by Jayman

Masterbuilt who donated 1 million

dollars to the MS Program of the

HBI over the period 2007-2011 to

develop a Provincial MS Program.

Clinic expansion: Clinic expan-

sion is necessary as both clinic

space and staffing limit any in-

crease in the number of patients

that can be seen per month in the

clinic or in OPTIMUS. In addition,

our ability to include residents in our

clinics has been severely restricted

by space limitations. During 2008

planning became more concrete for

an MS Clinic site at Rockyview

General Hospital. Planning for de-

velopment of a fully operational site

at the South Hospital also started;

this clinic site is expected to open

in 2011.

Research Highlights

Translational Research: The

Calgary MS clinical and research

teams are primarily focused on

translational research. Major re-

search activities involve bringing

therapies from the laboratory to pa-

tients. The following projects repre-

sent translational research activities

ongoing during 2008.


! 26

Optic Neuritis

Minocycline program: We have

been leading the translation of

minocycline from the Yong lab to

the clinic.

In 2008 a manuscript describing

the final results of a phase IIa trial of

minocycline in relapsing remitting

MS led by Dr Metz and completed

in Calgary was published (funded

by CIHR).

In 2008 a manuscript describing

the results of a phase II Canadian

multicentre randomized, double-

blind, controlled trial of minocycline

versus placebo in patients starting

glatiramer acetate was submitted

(study funded by Teva Neurosci-

ence Canada).

Recruitment began in 2008 for a

phase III randomized controlled trial

of minocycline in patients with sus-

pected MS. This study was funded

by the MS Foundation of the MS

Society of Canada for $4,040,000.

The study principal Investigator is

Dr Metz; Calgary co-investigators

include Drs Yong, Eliasziw, Hill, and

Wiebe. Dr Michael Yeung is leading

the Calgary site in this trial. The

Clinical Research Intelligence Unit

of the HBI, led by Dr Wiebe, is

managing trial data from across the

country.

A Brain Repair Team Grant to

study “Fine-tuning Inflammation for

Neuroprotection and Regeneration

in Multiple Sclerosis” was funded

by Neuroscience Canada for

$1,500,000 over 3 years in late

2007. During 2008 over 60 partici-

pants with optic neuritis were en-

rolled into a follow-up study of optic

neuritis by Dr Costello. In early 2009

patients a clinical trial of mino-

cycline versus placebo in optic neu-

ritis will begin. This study aims to (a)

determine if the optic nerve can

serve as system model to measure

neuroprotection and (b) to obtain

pilot data on the effects of mino-

cycline on optic neuritis in order to

plan phase IIb trials. Meanwhile,

basic scientists are working to de-

velop new therapies that may move

to the clinic as trials in the future;

targets of interest include vitamin D.

[Team Leader: Dr VW Yong; Clinical

Team: Drs. F Costello and L Metz;

collaborators: Dr P Stys (University

of Calgary) and Drs C Power and

Rivest (Universities of Alberta and

Montreal)].

Endogenous Progenitor Cell

Repair in MS: Research led by Drs

Sam Weise and Wee Yong demon-

strated that prolactin stimulates dif-

ferentiation of oligodendrocyte pro-

genitor cells into functional oli-

godendrocytes, the cells that myeli-

nate nerves.

A team grant submitted and

awarded in 2008 from the Stem Cell

Network for $783,600 over 3 years

will support the project: “Endoge-

nous progenitor cell repair in MS”.

The goal of the current three-year

proposal is to generate both pre-

clinical and clinical (Phase IIa) re-

sults to determine whether Phase

IIb-III clinical trials of prolactin to

stimulate repair in MS are war-

ranted. If the findings are positive, it

is envisaged that the Phase IIb-III

clinical trials would occur during

years 5-7 of the SCN. The first pro-

ject aims to determine prolactin’s

ability to stimulate remyelination

within a compromised immune set-

ting that is reminiscent of MS in

humans and in the presence of im-

munomodulatory drugs given to MS

patients. The second project asks


! 27

In an animal model of multiple sclerosis in mice, as compared to con-

trols (A & B), demyelination and axonal loss are reduced by the com-

bination of glatiramer acetate and minocycline (C & D).

whether prolactin regulates the fate

of adult human myelin progenitor

cells and, again, how is this affected

by the presence of immunomodula-

tory drugs. The third project, a

Phase IIa safety and efficacy study

of prolactin actions in an optic neu-

ritis subset of MS patients, should

provide a clear sense of the poten-

tial benefit of prolactin treatment to

a larger MS population. Team

members include Drs Weiss, Yong,

Costello, Metz, and Antel (McGill

University).

Alpha beta crystalline: Dr

Shalina Ousman, who joined our

program in April 2008, has been

developing humanized monoclonal

alpha beta crystalline a molecule

that appears to put a break on in-

flammation in MS. Dr Ousman

submitted grants in 2008 to further

her research. In the meantime, fur-

ther laboratory projects are under-

way funded by start-up funding

from an anonymous donor to the

HBI.

Other basic science develop-

ment: Mr Hank Swartout donated

$1,000,000 over 3 years to the

Hotchkiss Brain Institute MS Pro-

gram to develop the Swartout Neu-

roprotection and Repair Centre.

Funding was increased by $500,000

over 5 years by his colleagues at

Precision Drilling. The Swartout

Centre includes an EAE Unit to fa-

cilitate assessment of potential MS

therapies in animal models, a clini-

cal measurement unit to develop

models of optic neuritis and corpus

callosum function to measure neu-

roprotection and repair in MS, and

development of an imaging data-

bank. In 2008 the Swartout EAE

Unit supported pilot studies of other

potential MS therapies. This re-

search is ongoing.

Measurement Research: Evalu-

ating MS therapies requires precise

measurement of treatment effects.

Classically fairly crude scoring if

diseases along with pathology are

used in EAE studies. In humans

fairly insensitive and fairly variable

measures along with MRI measures

that focus on lesions are used. To

improve the efficiency of EAE stud-

ies in vivo imaging would be very

useful in accelerating research. In

humans, precise in vivo measures

of injury, repair, and inflammation

within targeted lesions are needed

to allow us to test therapies that

may be neuroprotective or promote

repair. Development of such meas-

ures is another focus of our re-

search.

The clinical evaluation unit and

imaging databank of the Swartout

Neuroprotection and Repair Centre

will help us achieve these aims.

During 2008 an optical coherence

tomography machine was pur-

chased and installed in the MS

Clinic. This allows precise meas-

urement of the retinal nerve fibre

layer, the anterior aspect of the op-

tic nerve. As over 90% of people

with MS suffer from optic nerve in-

volvement, and because acute epi-

sodes of optic neuritis are usually

symptomatic, this provides an op-

portunity to precisely measure optic

nerve integrity to determine the

natural history of optic nerve

changes and to measure the effects

of optic neuritis. This capacity has

been necessary for our success in

getting funding for the studies of

optic neuritis and to study the natu-

ral history of optic nerve changes.

During 2008 Dr Fiona Costello

led a study in collaboration with Drs

Richard Frayne and Brad Goodyear

as well as PhD candidate Noorhan

Zayed to image the optic nerve dur-

ing acute optic neuritis and to de-

velop novel optic nerve imaging

techniques. This study is funded by

the MS Society of Canada ($180,

563).

In 2008 Dr Lenora Brown, al-

ready an experimental psychologist,

completed training in neuropsy-

chology. She is now evaluating

measures that aim to develop the

corpus callosum as another poten-

tial model to evaluate neuroprotec-

tion and repair therapies . She is

collaborating with Drs Costello and

Metz.

In 2008 Drs Metz and post-

doctoral student Dr Yunyan Zhang

continued development of MRI tex-

ture analysis as another method of

evaluating recovery within lesions.

The imaging bank of the Swartout

Unit supports this research. The

ability to use existing MRI data to

evaluate this technique will likely

accelerate its development and en-

hance its value.

2008 was a very good year for

recruitment to the MS research pro-

gram. Drs Shalina Ousman is a neu-

roscientist whose basic research

focuses on MS; in particular pre-

clinical therapy development. She

arrived in April 2008.


! 28

Education Highlights

Weekly MS Clinical Rounds

continued through 2008; 30-60 fac-

ulty, staff and students attend.

The Calgary MS Program con-

tinued to host MS Preceptorships.

In June 2008 Pavan Ahluwalia

completed his MSc research to de-

termine the frequency of vitamin D

insufficiency in MS patients and to

evaluate methods of dose adjust-

ment. He received a studentship

from the MS Society of Canada. He

became a medical student at the

University of Calgary in August.

Dr Yunyan Zhang completed a

post-doctoral fellowship in MS Im-

aging with Dr Metz in June 2008

and went on to undertake an MS

Society funded fellowship at the

University of British Columbia co-

supervised by Drs. David Li and

Tony Traboulsee. She received a

fellowship stipend and travel sup-

port from Teva Neuroscience and

submitted Fellowship applications

to the MS Society of Canada.

The following trainees received

national studentships or fellowships

from the MS Society of Canada:

Pavan Ahluwalia, Yunyan Zhang,

Smriti Agrawal, Viktor Skihar, Lor-

raine Lau, Rowena Cua, Angelika

Goncalves DaSilva, Jennifer Hahn.

Dr. Jian-Qiang Lu (neuropathol-

ogy resident), conducted basic sci-

ence research training within the

MS program.

Statistics

During 2008 there were 3484

patient visits to clinic physicians,

over 5000 telephone encounters by

clinic nurses, and over 2000 visits

to OPTIMUS. There were over 19

MS clinical trials ongoing during

2008.

Members

Physicians

Dr. Luanne Metz (Clinic Director)

Dr. Michael Yeung (Clinical Trials

Unit Director)

Dr. Robert Bell

Dr. Kevin Busche

Dr. Fiona Costello

Dr Jeptha Davenport

Dr. Dan McGowan

Dr. Jean Mah (Pediatric Neu-

rologist)

Dr. William Murphy

Dr. David Patry

Dr Dawn Pearson

Non-clinical MS Research Team

Dr. Lenora Brown, PhD

Dr Jeff Dunn, PhD

Dr. Richard Frayne, PhD

Dr. Brad Goodyear, PhD

Dr Shalina Ousman, PhD

Dr. V Wee Yong, PhD

Nursing

Colleen Harris MN, NP (Clinic

Manager)

Kathy Billesberger, RN

Brenda Buckner, RN

Jackie Gaythorpe, RN

Janice Hammond, RN

Janet Moores, BN, MBA

Sharon Peters, BN

Lori Tillotson, BN

OPTIMUS (Rehab Program)

Jutta Hinrichs, BScOT (Program

Coordinator)

Risha Joffe, PhD (psychologist)

Erin Gervais, BScOT

Neera Garga, PT

Myrna Harden, PT

Tara Bramfield, RSW

Janice Lake, RN

Clerical Staff

Rochelle Lappan

Vanessa Rosenzweig

Sharon Stadnyk

Colleen Selin

Joanne Woo

Rosalee Thorsen

Clinical Research Staff

Winona Wall (Research Man-

ager/ clinic IT support)

Nicole Anderson

Charlotte Caunt

Graziela Cerchiaro

Michel Dube

Shelly Jelinski

Shirley Jorge

Kathryn Linton

Christina Ma

Ellen Martin

Beth Price

Jose Ranawaya

Jessie Trufyn

Laboratory Research Staff

Claudia Silva

Yan Fan

Hollie Mowbray

Michelle Smekal

Brooke Verhaeghe

Fiona Yong

Shuhong Liu

Students and postdocs

Pavan Ahluwalia

Yunyan Zhang, MD, PhD

Smitri Agrawal, PhD

Lorraine Lau

Victor Skihar, MD, PhD

Angelika Goncalves DaSilva

David Stirling, PhD

Rowena Cua

Cheryl McCrea, PhD

Natalia Liapounova

Axinia Doering, PhD

Mengzhou Xue, PhD

Nourhan Zayed


! 29

Neuromodulation ProgramOverview

Neuromodulation is the altering / modulation of nervous system function by means of implantable devices or neural

prostheses. It includes peripheral nerve, spinal cord and brain electrical stimulation, as well as drug delivery devices.

Many conditions are treated including movement disorders, epilepsy, pain, angina, headache, spasticity, urinary inconti-

nence; thereby involves all divisions within the Department of Clinical Neurosciences as well as specialists from other

disciplines.

Members

Neurosurgery: Drs. Mark Hamilton, Zelma Kiss

Neurology: Drs. Werner Becker, Scott Kraft, Neelan Pillay, Oksana Suchowersky, Sam Wiebe

Physical Medicine and Rehabilitation: Drs. Dan McGowan, Noorshina Virani

Pain physicians: Drs. John Clark, Darryl Guglielmin, Geoffrey Hawboldt, John Pereira, Chris Spanswick (Chronic Pain

Centre), Dr. Peter Farran (ACH)

Urogynecology: Dr. Magali Robert

Cardiology: Dr. Jim Stone

Gastroenterology: Drs. Christopher Andrews, Phil Mitchell

Psychology: Melanie Denheyer, Drs. Angela Haffenden, Michael King, Paul Taenzer

Psychiatry: Drs. Jeremy Quickfall, Raj Ramasubbu

Nursing: Susan Anderson, Marlene Blackman, Thea Dupras, Colleen Harris, Karen Hunka, Tracy Hyndman, Jackie

Martini, Grace Neustaedter, Christine O'Leary, Valerie Sherwood, Tammy Still, Angela Tse, Robyn Warwaruk

Research: Drs. Michael Eliasziw, Bin Hu

Grant Support

Alberta Heritage Foundation for Medical Research

Canadian Institutes for Health Research

New Initiatives / Highlights

Clinical care

New procedures performed this year include area 25 subgenual cingulate DBS for the HBI-CRU funded pilot project

on refractory depression

Ongoing studies include the METTLE study of hippocampal DBS for epilepsy (enrolled 2 new patients)

Nursing Neuromodulation Group is going strong, interacts with the Canadian Neuromodulation Society as pertains to

database development and guidelines

Training/teaching

Nurses attend national and international conferences on neuromodulation, presenting at local meetings (e.g. CANN

meeting in Feb-08)

Clinical fellowship established, with the 3rd fellow (Mr. Ben Jonker from Australia) arriving later in the academic year;

previous fellow, Dr. Jean Oropilla presented both a poster and platform presentation at the American Society for Stereo-

tactic and Functional Neurosurgery meeting in Jun-08, published 1 chapter, 1 letter and 1 paper under revision.


! 30

Academic activities

Members of the team gave invited presentations at the Canadian Neuromodulation Society, American Association of

Neurological Surgeons, University of Alberta, University of Minnesota, University of Victoria

Poster presentation at CNSF on “Deep brain stimulation for chronic cluster headache”, 2 posters presented at Soci-

ety for Neuroscience Sue Anderson presented her project on “Nursing time required for a neuromodulation pain pro-

gram” at the Canadian Neuromodulation Society meeting in Jun-08

Poster at the Neural Interfaces (NIH Neural Prostheses) conference was selected (from a total of 225) as 1of 7 high-

lighted as a platform presentation

The group co-hosted Professor Helen Mayberg as an AHFMR visiting scientist in Apr-08

Mini-symposium in May during an extended Grand Rounds on Mechanisms of Neuromodulation: How electromag-

netic stimulation can change nervous system function with world leaders, Professors Alim Benabid, Ronald Tasker and

Robert Chen, and local UofC faculty Professors Bin Hu, Brian Bland and Sam Wiebe

The GI Research Group hosted Drs. Richard McCallum and Edy Soffer, two world leaders in the field of Gastric Neu-

rostimulation, at a research symposium in Jun-08

Knowledge translation

Presentations to the Canada Trigeminal Neuralgia Association and the Parkinson’s Society of Southern Alberta

“Hope Conference - Paving Your Path to Wellness”

Participation in an advisory capacity to Alberta Health and Wellness through a funded workshop “Innovations in Sur-

gery: Looking to the horizon”


! 31

Stereotactic planning for hippocampal deep brain stimulation for epilepsy

Neuromuscular ClinicArea 3 Health Sciences Center 403-944-4415

Members

Dr. Keith Brownell (muscle disorders, myasthenia gravis, education)

Ms. Roula Simmons (Clinic Facilitator/Coordinator)

Dr. Cory Toth (nerve disorders, neuropathic pain, complications of diabetes)

Dr. Chris White (ALS clinic director; myasthenia gravis, electrophysiology)

Dr. Douglas Zochodne (Director; nerve disorders, regeneration and diabetes)

Fellows: Dr. Lawrence Korngut, Dr. Jennifer Bestard

Research nurses: Susan Wood, Shefina Mawani

Support staff: Jennifer Anderson

Social work: Melinda Hatfield and Domenica Smit

Vision

Within five years, the Neuromuscular Clinic, within the newly constituted Southern Alberta Nerve and Muscle Clinical

Program Cluster, will emerge as an internationally recognized model for accessible, evidence based and compassionate

care for patients with nerve and muscle disorders.

Mission Statement

To provide timely, expert and comprehensive consultation and care to patients with neuromuscular disorders.

We will achieve this by offering state-of-the-art diagnostic and treatment services, developing specialized clinics,

developing cutting-edge research and providing education to health care personnel.

Our work will be characterized by a focus on our patients, excellence, collegiality and innovation.

Trajectory

Development of a five year plan for the Alberta Nerve and

Muscle Clinic Cluster “without walls” based at FMC, RGH and

the South Hospital

The Clinic Cluster would comprise the current Neuromuscu-

lar Clinic, ALS Clinic, Neuropathic Pain Clinic, Peripheral Nerve

Surgery Clinic with new models: Intake rapid review clinics,

myasthenia gravis clinic, neuropathy clinic, and muscle sub-

speciality clinics focusing on muscular dystrophies and inflam-

matory myopathies

Integration of Nerve and Muscle Clinical Neurophysiology

and Rehabilitation within the clinic cluster

Recruitment of one additional Neuromuscular Neurologist

to our group for each one-two years of the five year plan in or-

der to enhance our service, educational and research goals

Integration of the NP (nursing practitioner) role within the

Nerve and Muscle Clinic concept

Current Strategic Alliances

ALS Clinic (Dr. C. White)

Peripheral Nerve Surgery Clinic (Dr. R. Midha)


! 32

Neuropathic Pain Clinic (Dr. C. Toth)

Neuromuscular Clinic, Alberta Children’s Hospital (Dr. Jean Mah)

Clinical Neurophysiology (Drs. White and Zochodne)

Regeneration Node (SCNR), Hotchkiss Brain Institute (Drs. Toth, White and Zochodne)

2008 Member Highlights

Dr. Brownell worked extensively in medical education in 2008 at undergraduate, graduate, postgraduate medical and

postgraduate nursing levels. He served as co-chair of the Physicianship Unit of the Medical Skills Unit and served as the

Chair of the Multiple-Mini-Interview Development Committee. Activities included being a small group leader for both the

Physicianship and Medical Ethics Unit of the Medical Skills Unit and in the Neuroscience and Aging curriculum.

Ms. Roula Simmons pursued work on her Master Degree in Nursing with the goal of becoming a Nurse Practitioner

in Neurosciences. With UofC nursing students she facilitated a major research project focused on the analysis of comor-

bidities in Neuromuscular clinic patients. She also worked extensively on patient education materials for NMC patients

(e.g MG group, see below).

Dr. Cory Toth served as the Director of the Neuropathic Pain Clinic where he has supervised or initiated five clinical

trials in the management of neuropathic pain. He published several high impact papers in 2008 including papers in Dia-

betes, Neuroscience, PLoS One and Pain. He was awarded a Juvenile Diabetes Research Foundation (JDRF) Innovative

operating grant for his work on diabetic complications. He received teaching awards (Gold Star, AMA Honourable Men-

tion) in 2008.

Dr. Chris White served as the Site Director for Clinical Neurosciences at Rockyview General Hospital in 2008. His

administrative work included Membership on the Departmental Executive Committees, the Division of Neurology ARP

committee, the South Hospital Campus Clinical Design Team and the Neurology residency training program. He is the

Director of the ALS Clinic. He participated in two multicenter ALS clinical trials and a myasthenia gravis trial. He received

the CMSA Letter of Excellence Preceptor award. He is an examiner for the Canadian Society of Clinical Neurophysiology

(EMG).


! 33

NMC Retreat September 2008: (From left) D. Zochodne, D. Smit, J Bestard, K. Brownell, R. Simmons, C.

White, S. Mawani, L. Korngut, S. Wood, and J. Anderson. Absent, C. Toth.

Dr. Douglas Zochodne served as the Director of the Neuromuscular Clinic and Clinical

Neurophysiology and was Co-Leader of the Regeneration Node, Hotchkiss Brain Institute.

The Zochodne lab (currently 8 members including PDFs, graduate students and techni-

cians supported by 6 external grants) published work on nerve regeneration and diabetes

and renewed a key CIHR operating grant. He authored a text entitled “Neurobiology of

Peripheral Nerve Regeneration” (Cambridge Press) published in 2008.

The Neuromuscular Clinic facilitates"the Myasthenia Gravis (MG) patient support

group, on a bi-yearly basis. The nonprofit MG support Group was initiated in the fall of

2006 and is facilitated by"our"clinic patient care coordinator and social worker. The sup-

port group"is dedicated to empowering patients and families to live well in the face of

chronic MG through"education, peer support and"community networks."Activities included

the organization of a patient and healthcare staff MG education day, and a patient MG

identification and alert card.

2008 Research Funding: Lab based

Number of External Project Grants: 8

External Personnel Awards: 5 (excluding summer studentships)

Canadian Institutes of Health Research (CIHR; 3 grants)

Canadian Diabetes Association (CDA)

Juvenile Diabetes Research Foundation (JDRF)

Natural Sciences and Engineering Research Council of Canada (NSERC)

Alberta Heritage Foundation for Medical Research (AHFMR) [Scientist, Clinical Investigator, Postdoctoral Fellow-

ships, Graduate Studentships, Summer studentships]

National Institutes of Health (NIH)

2008 Research Funding: Clinical trials

Number of Trials: 8

Industry partners: Johnson and Johnson, Talecris, Pfizer, Valeant, Purdue

Juvenile Diabetes Research Foundation (JDRF)

National Institutes of Health (NIH)

Lundbeck and the University of Alberta

ALS Society of Canada


! 34

Dr, Douglas Zochodne

Neuro-Oncology ProgramDirectors

Dr. Greg Cairncross - Medical

Dr. Mark Hamilton - Surgical

Overview

The Neuro-Oncology Program,

spanning multiple Departments, Insti-

tutes and medical disciplines, is dedi-

cated to the care of patients with pri-

mary brain tumours and neurological

complications of cancer. The Program

includes formal Fellowship Training in

the medical and surgical aspects of

Neuro-Oncology and also includes

research activities that span the clini-

cal to basic biomedical continuum.

Members of the Department of

Clinical Neurosciences make a signifi-

cant contribution to the success of the

Neuro-Oncology Program in a number

of important ways. First and foremost,

members provide Neurosurgical and

Neuro-Oncological patient care serv-

ices for adults and children at the

Foothills Medical Centre, Alberta Chil-

dren’s Hospital and Tom Baker Cancer

Centre, oversee the Fellowship Train-

ing Programs in Neuro-Oncology, su-

pervise Graduate Students and pro-

vide senior leadership to the Clark H.

Smith Brain Tumour Centre

(http://www.ucalgary.ca/braintumource

ntre) and Southern Alberta Cancer Re-

search Institute (SACRI;

http://www.sacri.ucalgary.ca) at the

University of Calgary. Members of

Clinical Neurosciences were instru-

mental in establishing the Brain Tumor

Stem Cell Core Facility; Molecular Di-

agnostics Core Facility; Brain Tumor

Tissue Bank and Bio-Repository; Al-

berta Radiosurgery Centre, Neuro-

Oncology Nurse Practitioner Program;

and Advanced Image Processing

Laboratory. The Intraoperative Imaging

Program in the Seaman Family MR

Centre and the highly innovative ro-

botic NeuroArm are other initiatives led

by members of Clinical Neurosciences

that directly enhance the care of pa-

tients by improving surgical therapies

for all types of brain tumor.

A patient care conference (i.e.,

Tumor Board) and clinical trials meet-

ing is held weekly at the Tom Baker

Cancer Centre and every other week

there is informal research and visiting

speaker seminar in the Faculty of

Medicine. Clinical research efforts are

focused on low and high gliomas in

adults and medulloblastomas in chil-

dren. Most clinical trials are conducted

within large National or North Ameri-

can co-operative groups, such as the

National Cancer Institute of Canada –

Clinical Trials Group or the Radiation

Therapy Oncology Group, but

industry-sponsored studies and small

in-house trials are also supported. Ar-

eas of basic research emphasis in-

clude 1) brain tumor stem cell biology,

2) mechanisms of chemotherapy and

radiation resistance in brain tumor, 3)

non-invasive detection of molecular

changes in brain tumor using new im-

aging techniques and 4) development

of experimental therapies for brain tu-

mor including oncolytic viruses, drugs

that block the spread of brain tumor

cells and methods for drug delivery.

Members

Neurosurgeons " "

Dr. Mark G Hamilton

Dr. Betty MacRae

Dr. Yves Starreveld

Dr. Garnette Sutherland

Neuro-Oncologists" "

Dr. Jay Easaw

Dr. Peter Forsyth

Dr. Greg Cairncross ##

Neuro-Pathologists"

Dr Jennifer Chan

Dr Jeff Joseph

Dr David George

Radiation Oncologists

Dr. Rob Nordal

Dr. Alex Chan

Dr Siraj Husain

Nurse Clinician" "

Crystal Tellent

Research Nurse

Annabelle DeGuzman

Neuro-Oncology Fellow

Dr Paula de Robles

Graduate Students

Dr. John Kelly

Michael Blough

Morgan Westgate

Grant Support

Canadian Institute for Health Re-

search

Alberta Cancer Research Institute

Tom Baker Cancer Centre

Hotchkiss Brain Institute

National Cancer Institute of Can-

ada

Alberta Cancer Foundation


! 35

Pediatric Neurosurgery ProgramStaff

Neurosurgeons: Dr Mark G Hamilton (Division Head), Dr

Walter Hader, and Dr Clare Gallagher

Pediatricians: Dr Heather Graham and Dr Keith Jorgensen

Nurse Practitioner: Kelly Bullivant

Nurse Clinicians: Valerie Sherwood and Linda Gill

Overview

Pediatric Neurosurgery is a division of Pediatric Sur-

gery (Department of Surgery) and the members are also

part of the Division of Adult Neurosurgery (Department of

Clinical Neurosciences). There are currently three Pediatric

Neurosurgeons, all of whom participate in adult Neurosur-

gery Programs. Dr. Hamilton is the Head of the Division of

Pediatric Neurosurgery, Dr. Hader and Dr Gallagher are the

other Division members. Dr. Terry Myles, the former Head

of Pediatric Neurosurgery, has recently retired from full-

time neurosurgical practice in Pediatric Neurosurgery.

There are two Pediatricians who work in the Infant Cranial

Screening and Remodeling Clinic. Kelly Bullivant is a full-

time Pediatric Neurosurgical Nurse Practitioner who pro-

vides inpatient and outpatient pediatric neurosurgical care

and two nurse clinicians (Valerie Sherwood and Linda Gill)

who provide outpatient pediatric neurosurgical care.

Clinical Aspects

The Pediatric Neurosurgical Program in comprehen-

sive, offering all aspects of pediatric neurosurgical care

including management of hydrocephalus, brain and spinal

injury, myelomeningocele, other forms of spinal dys-

raphism, refractory epilepsy surgery, spasticity, craniofacial

disorders, and pediatric brain tumor (in conjunction with

the Pediatric Neuro-Oncology Group).

The Pediatric Neurosurgeons provide weekday call at

the Alberta Children’s Hospital (ACH), and with the other

members of the Division of Adult Neurosurgery participate

in nighttime and weekend call schedules.

#

Approximately 210 elective and emergent surgeries

occurred in 2008 at the Alberta Children’s Hospital.

Ninety-seven percent of the surgical patients required inpa-

tient stays. The average length of stay for Neurosurgical

patients was 5 days compared to the average of 2.9 days

for the whole inpatient surgery population. We are able to

offer access to unique treatment modalities such as the

intra-operative MRI theatre for assisting in the surgical

treatment of epilepsy and brain tumor, a comprehensive

neuro-endoscopic program, and the Stereotactic Radio-

surgery Program for selected cerebrovascular malforma-

tions and brain tumors.


! 36

Alberta Children’s Hospital

Neurosurgery clinics run every week. Clinics include

General Neurosurgery, Craniofacial Clinic, Infant Cranial

Screening and Remodeling Clinic (Pediatricians), and Mye-

lomeningocele Clinic. Approximately 1700 outpatient visits

occurred in 2008.

Clinical Program Examples

The Adult hydrocephalus Clinic is now in its 6th year at

the Foothills Hospital. This was initiated by Dr Hamilton to

provide transition care for pediatric patients with hydro-

cephalus or tethered spinal cord after age 18 years. This

clinic also coordinates care and assesses adults with un-

treated congenital hydrocephalus and untreated new onset

hydrocephalus. A Hydrocephalus Registry has been estab-

lished, currently with over 100 patients. Care guidelines

have been created. This is a unique Canadian clinic provid-

ing an essential service for patients with two serious

chronic diseases.

A comprehensive Craniofacial Program is coordinated

through ACH. A community-based parent education and

screening program involves Public Health Nurses and

Nurses from ACH. Two Pediatricians coordinate the Infant

Cranial Screening and Remodeling Clinic. Infant patients,

who require Cranial Remodeling Headbands for correction

of positional-related cranial deformities, can have their

head scanned in a state-of-the-art Laser Unit. This allows

creation of a custom treatment headband for each unique

patient. Finally, a monthly Craniofacial Clinic attended by

Dr Mark Hamilton and Dr Don McPhalen from Plastic Sur-

gery evaluates new patients for surgical treatment of

craniosynostosis and provides long-term followup for all

surgically treated children.

An Intrathecal Baclofen pump can be offered to treat

appropriate patients with severe spasticity. These patients

undergo screening by Dr Hader and the Program Nurse

Clinician, Val Sherwood. They must demonstrate a suc-

cessful response to intrathecal injection of Baclofen

through a lumbar catheter. This treatment can provide a

dramatic improvement in quality of life for these severely

affected patients.

Other Activities

The Pediatric Neurosurgical Division members partici-

pate in local and national administrative and educational

functions. They also lead and collaborate in clinical re-

search involving pediatric and adult hydrocephalus, epi-

lepsy and brain tumor. During the last five years, the Divi-

sion of Pediatric Neurosurgery members have published 14

peer-reviewed manuscripts. There are also 4 peer-reviewed

manuscripts in-press, 1 manuscript undergoing peer-

review, 5 book chapters published or in-press and 45 pub-

lished abstracts. In addition, Drs Hamilton and Hader have

collaborated on 8 successful research grant applications

and been local principal investigators for 7 Clinical Trials.

The Pediatric Neurosurgery Division is an active participant

of the Canadian Pediatric Neurosurgery Research Study

Group.


! 37

Peripheral Nerve Surgery ProgramProgram Director: Dr. Rajiv Midha

Overview

This program is multi-disciplinary, encompassing clini-

cal and electrodiagnostic services provided by Neurology

and PMR faculty, electrophysiology support and surgical

treatment of patients. The latter consists of state of the art

surgical management of peripheral nerve conditions, such

as complex peripheral nerve injuries, nerve tumors, bra-

chial plexus surgery as well as advanced nerve repair and

nerve transfer techniques. Members have recently

launched a clinical randomized control trial which will be

comparing surgical decompression to best medical man-

agement for ulnar neuropathy at the elbow. Three of the

faculty members (Midha, Toth, Zochodne) within the pro-

gram also have independent basic science research labo-

ratories investigating various facets of peripheral nerve dis-

ease, including neuropathy, nerve injury and nerve regen-

eration. There is considerable collaboration amongst the

principal investigators, of their graduate students and fel-

lows. These individuals are also member of the spinal cord

and nerve regeneration and repair program within the HBI

(The links, http://www.hbi.ucalgary.ca or

http://www.ucalgary.ca/spinalnerve/ have more details for

those interested).

Members

Director & Neurosurgeon:

Dr. Rajiv Midha

Medical Neurologist & Electrodiagnostics:#

Dr. Chris White

Dr. Doug Zochodne

Dr. Cory Toth

Dr. Stephen McNeil

Fellows:

Dr. Bassam Addas 2007-8

Dr. Jacob Alant 2008-9

Intraoperative Electrophysiology Support:

Michael Rigby

Erin Phillip

Research Interests

Experimental nerve injury

Nerve guidance tubes to repair nerve injuries

Growth factors and stem cell therapy to enhance nerve

regeneration

Electrical regeneration interfaces (CIHR Regenerative

Medicine and Nanomedicine Team grant)

Insulin and IGFI effect on nerve injury and diabetic neu-

ropathy

Diabetic neuropathy

Grant Support

Canadian Institute for Health Research (CIHR)


(AHFMR)

Aegera Therapeutics

Canadian Diabetes Association

National Institute of Health (NINDS)

Pfizer Corporation

Integra Life Sciences


! 38

Local and visiting residents attending the 2008 annual Uni-

versity of Calgary Spine and Peripheral Nerve Surgery

Course

Project NeuroArmProgram Director - Dr. Garnette Sutherland

Overview

In 2008, full engineering sign off for the neuroArm

robotic system was completed. Preclinical studies were

performed and Health Canada, together with University

of Calgary/ Calgary Health Region conjoint ethics board

approvals for clinical application were acquired. The sys-

tem was introduced to neurosurgery in a graded fashion

and has been used on five patients, all with brain tumors.

An index case was selected and the system was intro-

duced to the media. This provided the University of Cal-

gary with considerable international visibility, with articles

appearing in various mediums.

NeuroArm was featured in three documentary series

including the Discovery Channel’s Daily Planet, CBC’s

The Nature of Things with David Suzuki and a documen-

tary from the BBC on medical frontiers entitled Super-

doctors. The system was also featured in a number of

prominent publications such as The London Times, The

Economist, and The Times of India. This also produced a

number of invited speaking engagements to neurosurgi-

cal conferences such as the Society of Neurological Sur-

geons and the Congress of Neurological Surgeons, to

teaching engagements at Dartmouth College and Johns

Hopkins Hospital, and to influential policy-changing con-

ferences as The Conference Board of Canada’s Centre

for Advancing Health Innovations and The Science and

Technology in Society forum in Kyoto, Japan. In this way,

neuroArm innovation and the pathway to that innovation

is shared around the world.

In June of 2008, the operating room that housed in-

traoperative MRI (iMRI) and neuroArm was closed for

renovations and an upgrade from a 1.5Tesla magnet to a

3Tesla platform. This improvement to the imaging capa-

bility of the iMRI will also improve the abilities of the neu-

roArm system. In parallel, neuroArm underwent modifi-

cations to allow full integration into the 3Tesla environ-

ment. Further application of the robotic technology is

slated to begin in January 2009. Related to the neuroArm

project, a new CFI grant entitled MR-PET guided, ro-

botic, molecular characterization of brain tumor for indi-

vidualized therapy was prepared and considered for

round 6 consideration.

During 2008, the research group continued to make

progress in the development of cell-specific imaging

technology. The project has required collaborations with

multiple NRC institutes. Cell and vascular specific single

domain antibodies have been successfully attached to

nanoparticles based on silicon-coated ferrous oxide. An

animal model has been used to show both sensitivity and

specificity.


! 39

NeuroArm performing robotic-assisted surgery on live

human patient.

Members

Project Leader:# # #

Garnette Sutherland

MDA Lead Engineers:

Tim Fielding

Perry Newhook

Simon Hu

George Feil

Andrew Skorupski

NRC Scientists:

Boguslaw Tomanek

Scott King

Calvin Bewsky

Teodor Veres

Roger Mackenzie

Danica Stanimirovic

Maureen O’Connor

Abedelnasser Abulrob

University of Calgary investigators (not inclusive):

Alex Greer

James Larsson

Yves Starreveld

Yaoping Hu

Gail Kopp

Chris Macnab

Students:

Peter Rizun

Jason Motkoski

Shawna Pandya

David Brandman

Residents:

Cesar Serrano-Almeida

John Kelly

Shelly Lwu

Atya Alflouse

Zhunyu Fu

Research Interests

Surgical robotics

Haptics

Surgical simulation

Education

Grant Support

Canada Foundation for Innovation (Infrastructure and

Operating)

Alberta Advanced Education and Technology (Infra-

structure)

Western Economic Diversification (Infrastructure)

Reach! (Infrastructure and Operating)


(Student Support)

Canadian Institutes for Health Research (Operating-

Molecular Imaging)


! 40


Skull Base Surgery ProgramOverview

In conjunction with colleagues from the Division of

Otolaryngology, the skull base surgery group combines

long experience with novel approaches to offer patients

the best surgical treatment and long term followup for

these challenging lesions. In addition, close ties to both

endocrinology, and the Alberta Radiosurgery Centre en-

sure that the nonsurgical aspects of treatment are equally

well dealt with. Endoscopic approaches to pituitary and

anterior skull base lesions are also offered when appro-

priate. Research interests represented within the program

include clinical epidemiology, image guidance, robotic

surgery, and surgical simulation.

Clinical Initiatives

Endoscopic Skull Base Surgery

Building on the experience gained in endoscopic pi-

tuitary tumor resection, extended endonasal approaches

to skull base pathology are being used. Esthesioneuro-

blastomas, olfactory groove and tuberculum sellae men-

ingiomas are all being addressed endoscopically, where

appropriate. Advances in image guidance are being ex-

ploited to minimize surgical risk and reduce post-

operative morbidity in best serving this patient popula-

tion.

Members

Neurosurgeons:# #

Dr. Elizabeth MacRae


Dr. Yves Starreveld

ENT Surgeons:

Dr. Joe Dort

Dr. Brad Mechor

Dr. Phil Park

Intraoperative Electrophysiology Support:#

Erin Phillip

Michael Rigby


! 41

Spine ProgramOverview

The University of Calgary Spine Program is a multi-

disciplinary program dealing with the care of individuals

affected by conditions and diseases of the spine and

spinal cord. It encompasses a combined fellowship pro-

gram offering fellows exposure to Orthopedic Spine and

Neurosurgical spinal care. We are now in the 11th year of

our official existence and have provided training to 4 fel-

lows per year. Our staff has grown to 6 orthopedic spine

surgeons and we are recruiting for an additional neuro-

surgical spine surgeon to complement the existing 3 neu-

rosurgical spine surgeons.

Members

Dr Stephan du Plessis (Chairman) - Adult Spine

Dr Ken Thomas (Fellowship Director) - Adult Spine

Dr Jacques Bouchard - Adult Spine

Dr Steve Casha - Adult Spine

Dr Roger Cho - Adult Spine

Dr Jason Howard - Pediatric Spine

Dr Rick Hu - Adult Spine

Dr John Hurlbert - Adult Spine

Dr David Parsons - Pediatric Spine

Dr Paul Salo - Adult spine

Dr Ganesh Swamy - Adult Spine

Tara Whittaker - Research Nurse

Ish Bains - Research Coordinator

Emi Sanders - Database Manager

Research

On the research front the Spine Program has been

active in a large number of clinical studies. There are cur-

rently 21 clinical trails ongoing within the program. The

Odontoid screw study, Minocycline study, Bryan disc

study and the Lumbar stenosis study has been going on

for a number of years and are in the process of being

finalized.

The Novartis SCI study, Bioset TLIF and P15 Bone

putty studies are new for this year and have started en-

rolling patients.

The intrathecal morphine study, Cethrin study, Hel-

met study and the Traumatic SCI predictive index study

are in the process of going through the review process.

Fellowship

Thanks to the efforts of John Hurlbert we were fortu-

nate to have two fellows from Australia this year. Dr Ball

from Australia joined us in February and Dr Pope from

Australia, Dr Bajammal from Saudi Arabia and Dr Cenic

from Ontario started their fellowships in July. Our current

fellows have active research projects ongoing and will be

presenting their work at the Canadian Spine Society

Meeting.

New Developments

Caleo Health Spine opened its doors in February;

this multidisciplinary spine clinic is offering a one stop

spine service. Services offered include primary and sec-

ondary assessments and treatments by physiotherapists,

chiropractors, medical spine physicians as well as sur-

geons. This facility is geared to provide the full spectrum

of spine care and rehabilitation.

Spine Referral Project was started in the second part

of the year. The goal of this project is to improve access

to spine care. The hiring of a medical spine physician has

allowed for consistent flow of patients through the outpa-

tient facilities on the 12th floor. This has enabled us to

centralize the referral process and by utilize a prioritiza-

tion tool developed by the spine program. The goal is to

provide patients with timely access to appropriate care

by the appropriate provider.

Spine database expansion is planned for the next

year with the goals being the capturing of all data from

patients referred for spine care. This will involve a major

expansion of our existing database infrastructure and

would allow for an electronic web based process to inte-

grate with the spine referral project. The database will be

used to capture outcome data form surgical as well as

non surgical patients and would provide us with the abil-

ity to track outcomes on a long term ongoing basis.


! 42

Stroke & Neurovascular ProgramsOverview

The Calgary Stroke Program experienced substantial

growth in 2008 with the recruitment of three new stroke

faculty members: Dr. Sean Dukelow, Dr. Eric Smith and

Dr. Roger Thompson, bringing the program’s total stroke

staff/faculty to 60. All three individuals bring unique skill

sets to our program which will round out our academic

strengths to include stroke recovery, white matter

disease/vascular dementia, and basic science/

neuroprotection, respectively. Our program can now has

an academic focus that spans the stroke care continuum.

The Program has been able to maintain important lead

roles with respect to professional and practice develop-

ment, rehabilitation program facilitation and telestroke

coordination and has established two new roles of

Knowledge Management Advisor and Patient Experience

Strategy Consultant: the first of their kind within the Cal-

gary Health Region. A new Clinical Nurse Educator posi-

tion, specifically dedicated to Unit 100 has also been

established.

The Calgary Pediatric Stroke Program was estab-

lished in 2008 by Dr. Kirton at the Alberta Children’s

Hospital. This is the only the second such program in

Canada. This significantly advances the scope and depth

of the Calgary Stroke Program. Research initiatives that

are developing from this program include neuroimaging

studies, international epidemiology, and mapping of brain

plasticity/recovery.

The Neurovascular Program was brought under the

Stroke Program umbrella significantly advancing the

scope and depth of the Calgary Stroke Program and a

Neurovascular Clinic which integrates specialist Neuro-

surgical, Neuroradiological, Neurointerventional and Neu-

rological ambulatory care has been established.

Stroke research continues to be a major portion of

the program’s work. To date we are involved with over

15 clinical trials directed by Dr. Michael Hill. This includes

several trials where members of our program play signifi-

cant steering or executive committee roles.

Publication activity is steadily accelerating. Grant

season was very busy with four faculty members apply-

ing for AHFMR junior investigator scholarship awards.

Dr. Barber also received his AHFMR Clinical Investigator

renewal.

Dr. Shelagh Coutts had a very successful grant fund-

ing cycle this year. She received a CIHR operating grant


! 43

Dr. Tim Watson, a Calgary stroke neurologist, pauses for a photo before he and his wife, Doone Watson, rappelled off the Heart and Stroke Foundation building in Kensington. (Leah Hennel, Calgary Herald)

and Pfizer grant for her CATCH study which examines

CTA in the minor stroke/TIA population. CATCH is cur-

rently recruiting at a brisk pace due to the enthusiasm

the entire team has the project. This CIHR funding is Dr.

Coutts first major grant as an independent investigator.

Dr. Coutts also received pilot funding for her TIA Hotline

project with a major grant submission pending.

The PREDICT multinational, multicenter observa-

tional study coordinated by our program continues to

recruit intracerebral hemorrhage patients for acute CT

angiography. Preliminary findings demonstrating the

dramatic utility of CTA for identifying patients at risk of

ICH growth when the “spot sign” is present. This work

was presented as a platform by Dr. Demchuk at the In-

ternational Stroke Conference and European Stroke Con-

ference. PREDICT has spawned the development and

successful funding for the STOP-IT randomized Phase 2

clinical trial evaluating recombinant Factor VIIa in Trial in

CTA spot sign positive patients. The trial is being coordi-

nated by University of Cincinnati with our program lead-

ing the CT scan analysis. The trial was funded by Na-

tional Institutes of Health SPOTRIAS program.

The fellowship program continues to be highly re-

garded on an international level. To date the Calgary

Stroke Program has graduated a total of 28 fellows from

10 different countries. This past year, four fellows left our

program: Dr. Mohammed Alzawahmah, moved to Lon-

don, Ontario to continue a fellowship in Neurocritical

Care before returning to a faculty appointment at Royal

Military Hospital in Riyadh, Saudi Arabia. Dr. Alex Poppe

returned to Montreal, joining the faculty at the University

of Montreal CHUM. Dr. Albert Jin has joined the faculty at

Queen’s University in Kingston, Ontario, and Dr. Cynthia

Herrera returned to Brazil to neurology practice.

Dr. Talip Asil joined our program in February of 2008

from Idirne, Turkey. Dr. Nan Shobha joined in May from

Bangalore India, Dr. Bijoy Menon in November from

Chennai, India. Dr. Dar Dowlatshahi (Ottawa) also joined

the fellowship in July. He was successful at obtaining

external funding for fellowship through the CIHR and

University of Ottawa fellowship award programs. We are

continuing to pursue other international links and part-

nerships and hope to establish a formal collaboration

with at least one major stroke care provider in the UK in

2009.

We have continued to make improvements in clinical

services for people affected by stroke right across the

continuum. These improvements are aligned with our role

as one of two Comprehensive Centres within the overall

Alberta Provincial Stroke Strategy (APSS). Our formal

Telestroke connection with Drumheller as a Primary

Stroke Centre has been established and we continue to

provide Comprehensive Stroke Centre support to

Lethbridge and Medicine Hat. Around 10% of ischaemic

stroke patients receive tPA at the FMC site and we are

working to increase this number alongside reducing door

to needle time through our HASTE Six Sigma project

which is moving from its Analyse to Improvement phase.

We believe this to the first application of Six Sigma as an

quality improvement process in stroke care in Canada.

Working with the team on Unit 112 FMC we have

been able to improve our capacity to provide intensive

care to hyperacute and acute stroke patients by increas-

ing the number of monitors available to beds on the unit.

With the support of Rehabilitation and Specialised Clini-

cal Services we were able to extend a pilot project en-

hancing acute inpatient therapy to patients on Unit 100

for a full year. A full time Therapy Assistant position has

been now funded on a permanent basis and we are look-

ing to secure ongoing funding for more Speech and Lan-

guage Therapy, in particular with regard to communica-

tion interventions, which has been a critical component

to the project (which completes at the end of 2008.)

Other benefits of this work have included full implemen-

tation of the TOR-BSST swallowing screen and having

therapy positions dedicated to the acute stroke unit it-

self.

The Stroke Facilitated Discharge and Transition Team

has been established through a partnership with Home-

care services and Rehabilitation and Specialised Clinical

Services. This service will run as a pilot throughout 2009

and will provide home / community based rehabilitation

interventions, thereby facilitating early supported dis-

charge from inpatient care units across the city and more


! 44

comprehensively supporting transition for stroke patients

and their families.

The Stroke Prevention Clinic maintains a high volume

of clinical activity and completed a very successful Ka-

izen in the summer which resulted in significant im-

provements in clinic process and our ability to measure

the performance of our ambulatory stroke care. Again,

we believe this to be first application of LEAN improve-

ment techniques in stroke care in Canada.

Learning About Stroke, and Living With Stroke are

two new patient education and self management inter-

ventions which we be offering to people affected by

stroke through our partnership with Regional Chronic

Disease Management. These new services will be avail-

able in May 2009. Other initiatives designed to address

stroke prevention include pilot projects in community

awareness of stroke, and community based hypertension

detection and management.

We have continued to develop our professional de-

velopment and education profile in 2008 with a wide

range of different teaching and learning opportunities

provided by physicians and staff associated with the

Program. More than 1600 members of Regional staff and

physicians attended educational sessions about stroke

and stroke care between February and November 2008.

Educational resources about stroke are also a major

component of a new internal website for the Program

which is being launched at the time of writing this report.

Neurovascular Program

The Neurovascular Program is a joint collaborative

effort of specialists and allied healthcare staff from multi-

ple disciplines (cerebrovascular and endovascular neuro-

surgery, interventional neuroradiology, and stroke neurol-

ogy), to combat neurological vascular disease. The past

year has seen further academic integration of the Neuro-

vascular Program into the Stroke Program. Shared re-

sources have allowed greater new and continued partici-

pation of neurosurgery and radiology in several interna-

tional stroke studies, such as IMS-3, CREST, ENACT,

ALISAH, and CONSCIOUS-2.

The program has continued to see growth and ex-

pansion in the number of patients with complex cerebro-

vascular disease. Approximately 500 patients with neu-

rovascular disease are seen yearly in a specialized out-

patient clinic for evaluation and follow-up. Currently

about 200 patients are treated annually via minimally in-

vasive endovascular means such as endovascular coil-

ing, embolization, and carotid stenting. As well, surgical

volumes and expertise in open neurosurgery have been

maintained with the availability of specialized procedures

such as craniotomy and aneurysm clipping, carotid en-

darterectomy, resection of vascular malformations, and

extracranial-intracranial bypass. An integrated relation-

ship with the Alberta Radiosurgery Centre, which uses

focussed radiotherapy techniques unique in Canada, has

allowed the non-invasive and safe treatment of patients

with complex arteriovenous malformations.

In 2008, the outpatient experience of patients with

cerebrovascular disease from both clinical and adminis-

trative standpoints was consolidated and the weekly

Neurovascular Clinic was launched. A joint initiative of

specialists from cerebrovascular neurosurgery, interven-

tional neuroradiology, and stroke neurology, this will fa-

cilitate the rapid triage and evaluation of patients to ex-

pedite and provide high-quality care, and allow further

opportunities for teaching and clinical studies.

We continue to attract applicants to the endovascu-

lar fellowship program from countries worldwide and

from multiple disciplines including neurosurgery, radiol-

ogy, and neurology.


! 45

Faculty and Staff Listing

Dr. Andrew Demchuk, Director, Calgary Stroke Pro-

gram (Emily Collins, Administrative Assistant)

Dr. Michael Hill, Director, Stroke Unit (MichelleRae

Wright, Administrative Assistant)

Dr. Nic Weir, Director, Calgary Stroke Prevention

Clinic (Lori Finch, Administrative Assistant)

Dr. John Wong, Director, Neurovascular Program

(Brent Lester-Satzke, Neurovascular Clinic Coordinator)

Dr. Mark Hudon, Head, Neuroradiology

Michael Suddes, Program Manager, Alberta Health

Services

Stroke Neurologists

Dr. Phil Barber, Dr. Shelagh Coutts, Dr. Keith Hoyte

(Part-time), Dr. Gary Klein, Dr. Peter Stys, (Part-time), Dr.

Tim Watson, Dr. Eric Smith#

Cerebrovascular Neurosurgery

Dr. John Wong, Dr. Garnette Sutherland

Interventional Neuroradiology & Endovascular Neuro-

surgery

Dr. Mark Hudon, Dr. William Morrish, Dr. Mayank

Goyal, Dr. John Wong

Diagnostic Neuroradiology

Dr. William Hu, Dr. James Scott, Dr. Carla Wallace,

Dr. Kate Bell, Dr. John Lysack, Dr. Rob Sevick

Stroke Fellows (2008)

Drs. Talip Asil, Mohamed Alzawahmah, Dar Dowlat-

shahi, Pablo Garcia, Al Jin, Bijoy Menon, Alexander

Poppe, Nan Shoba, Nikolai Steffenhagen

Interventional Neuroradiology Fellows (2008)

Dr. Pranshu Sharma

Dr. Muneer Eesa

Stroke Research Nurses

Karla Ryckborst, Karyn Fischer, Marie McClelland,

Carol Kenney# # # #


! 46

Urgent Neurology ClinicStaff

Director: Dr A. Hanson

Nurse Clinician: Janet Warner

FMC UNC clerk: Patricia Hammel ( maternity leave

coverage - Addie Stowe)

RGH UNC Nursing" Staff: rotation every 3 months from

Unit 46 (Laura Murdock, Regan Thomson and Vita Mina)

RGH UNC"clerk: "Holly Wowk"

"

FMC Physicians: Drs P. Barber, R.Bell, S. Coutts, T.

Feasby, P. Federico, S. Furtado, A. Hanson, J. Kohli, L.

Korngut, W. Murphy, T. Watson, and M. Yeung.

"

RGH Physicians: Dr C. White (RGH" Associate Direc-

tor), Drs. F. Amoozegar, R. Bell, K. Busche, D. Patry, D.

Pearson,

"

Relief Physicians: Drs K. Brownell, N. Jette

Overview

2008 was a busy year for the Urgent Neurology Pro-

gram, with the opening, in October, of a second site for

Urgent Neurology Clinics, at the Rockyview General Hospi-

tal.

The Rockyview Neurology Planning Committee was

comprised of Dr. Chris White, Cathy Edmond, Janice

Hagel, Tina McLean, Mike Rigby, Wendy Carruthers, Pam

Sweeney, and Janet Warner.

During the planning period, the Mandate of the Urgent

Neurology Program was reassessed and updated. New

guidelines for the triaging and distribution of referrals were

developed.

In June, a staff meeting of the Urgent Neurology Clinic

was held. A discussion regarding what patients were ap-

propriate to be seen in the clinic was held. Criteria for In-

clusion and Exclusion were agreed upon.

Doctors Busche, Pearson, Patry, and White moved

their Urgent Neurology clinic times to the RGH UNC, and

Dr. Brownell is the relief doctor for the RGH UNC. Dr. Far-

naz Amoozegar, the Headache Fellow, started seeing pa-

tients at the RGH UNC in November.

The Rockyview Urgent Neurology Clinic opened with a

full time clerk, and a nurse rotating through the clinic from

the Neurology Floor at the Rockyview. Both staff were ori-

ented at the Foothills Urgent Neurology Clinic.

The Foothills site receives all of the Urgent Neurology

clinic referrals, and triaging is done by the Program Direc-

tor, Dr. A. Hanson, with the Nurse Clinician, Janet Warner.

The opening of the Rockyview site has split the workload

of the Program, so that the staff at Foothills now have a

manageable load.

Approximately 50% of all referrals received, continue to

be inappropriate for the Urgent Criteria of the clinic. The

new referral form has resulted in more information being

received from referring doctors, but has not decreased the

number of inappropriate referrals. Emergency physicians

have sent 40% and general practitioners have sent 55%,

respectively, of the inappropriate referrals. The Urgent

Neurology Program Mandate which includes the inclusion

and exclusion criteria was sent to the Dr. R. Anderson,

Head of Emergency Medicine, for him to send to all of the

ER physicians.


! 47

2008 Divisional UpdatesDivision of NeurosurgeryAcademic Neurosurgery in Calgary

The Division of Neurosurgery, led by Dr. Raj Midha, is

committed to the Faculty of Medicine’s vision for academic

medicine in Calgary which is “Creating the Future of

Health” and the vision of the Calgary Health Region (CHR)

which is, “Our community working together for excellence

in health”.

Academic neurosurgery

in the Calgary Health Re-

gion and at the University

of Calgary centres

around the education,

research, clinical and

administrative work and

service performed by the

14 members of the Divi-

sion of Neurosurgery in

the Department of Clini-

cal Neurosciences.

Unlike most other Cana-

dian medical schools

and large quaternary

level hospitals where neu-

rosurgery would be placed organizationally within a Divi-

sion of Surgery, Calgary has developed a Department of

Clinical Neurosciences which brings together neurologists,

neurosurgeons and physiatrists into a single structure

which allows for greater coordination of academic and

clinical activity across the broad spectrum of brain, spine,

nerve, pain, muscle and movement disorders that afflict

patients.

Clinical Excellence in Neurosurgery Services

The Division of Neurosurgery of the Department of

Clinical Neurosciences, provides full neurosurgical services

for adults and children including Level One Trauma support

to the southern half of the province of Alberta as well as

the eastern part of British Columbia in the Kootenay Re-

gion through the Foothills Medical Centre (FMC) and Al-

berta Children’s Hospital (ACH).

The level of clinical service delivered by Calgary’s neu-

rosurgical community is comprehensive, and is built around

the qualities of excellence, competence, quality, safety and

innovation. The roll-out of the Alternative Relationship Plan

for Neurosurgery (in 2001, and renewed in 2008) has fos-

tered a mechanism of timely appropriate transfer of cases

to neurosurgical subspecialties and therefore allowing the

highest quality of care for each and every patient.

General neurosurgical services as well as subspecialty

care in complex spinal diseases, skull base surgery, paedi-

atrics, peripheral nerve disease, cerebrovascular and en-

dovascular neurosurgery, epi-

lepsy and functional neurosur-

gery are provided at the FMC

and the ACH sites. Stereotactic

radiosurgery is provided in the

Tom Baker Cancer Centre, which

houses the innovative Alberta

Radiosurgery Center (ARC), in

collaboration with the radiation

oncologists.

In addition to general neurosur-

gical call, sub-specialty call cov-

erage is provided for paediatric

neurosurgery, spine, and cere-

brovascular (including endovas-

cular) surgery.

While leading and encouraging

the development of innovation in

neurosurgery service in Southern

Alberta, Divisional Members

have continued to deliver core

neurosurgical services to the

patients in the catchments area.


! 48

Dr. Terry Myles

Dr. Rajiv Midha

Dr. Betty MacRae

In 2008, at the FMC site, there were approximately 1800 in-

patient admissions to neurosurgery and over 5700 outpa-

tient visits to a neurosurgeon office. Neurosurgeons in the

CHR performed approximately 2000 procedures in 2008,

comprising 1700 procedures in the regular OR, and another

300 procedures in the endovascular, stereotactic radiosur-

gery ARC unit and ICU settings.

Below are listed specific examples of excellence in

clinical care and innovation, in the various subspecialty

areas:

Leadership in spine surgery and spinal cord injury

The spinal neurosurgery group has embraced minimally

invasive techniques for spinal surgery and “bench to bed-

side” drug therapies for spinal cord injury and are leading

the way in Canada for their ap-

plication within clinical research-

centered trials. Calgary is one of

only two centres contributing to

a national database of spinal

cord injured patients. This cen-

tre has successfully launched

and is completing a clinical trial

in spinal cord injury based on

preclinical work performed at

the University of Calgary. We are

also actively involved with two

other industry initiated clinical

trials in this disease. The out-

come of this effort will be reduced post surgical lengths of

stay, and reduced recovery time for patients.

Traumatic Brain Injury & Neuro-critical Care

Basic combined with clinical research is beginning to

create an understanding of the complex neurochemistry

and physiology of severe traumatic brain injury. Given the

advances that have been made worldwide in this area both

Drs C. Gallagher and D. Zygun have undergone training in

treatment of neurotrauma at the University of Cambridge.

As a result the use of intracerebral microdialysis in the in-

vestigation and treatment of traumatic brain injury is now

underway at Foothills Medical Centre Intensive Care. This

means Calgary is the first Canadian centre to routinely use

the technique in a patient care setting. Microdialysis is be-

ing combined with other multimodality monitoring to de-

termine changes occurring in the brain after injury. These

insights into brain neurochemistry will allow us to tailor

treatment to each patient and we hope to provide a more

coordinated approach to therapy between intensivists and

neurosurgery, as well as obtain information that will lead to

better treatments in the future.

Endovascular Neurosurgery

Treatment of vascular diseases of the nervous system

has been evolving to less minimally invasive interventions

over the past decade. Such treatments are quickly becom-

ing the standard of care for the

treatment of diseases such as

intracranial aneurysms and ca-

rotid stenosis. With the recruit-

ment of the province’s first neu-

rosurgical endovascular neuro-

surgeon, Calgary has quickly

become Western Canada’s

leader. For instance, the endo-

vascular program treated ap-

proximately 200 patients annu-

ally. Many of these patients were

treated with a single day admis-

sion, using minimally invasive approaches (as opposed to

open traditional surgery), and were saved long in-hospital

stays. In conjunction with our well-known and internation-

ally recognized Stroke Program, the endovascular program

has already become an important partner in stroke re-

search.

Alberta Radiosurgery Centre

This program, using a Novalis system, the first of its

kind in Canada, is a collaborative effort between the Divi-

sions of Neurosurgery and Radiation Oncology. The tech-

nology is capable of offering focused radiation treatment

for diseases of the brain and spinal cord in single daycare

sessions, thus obviating the need for lengthy hospital stays

associated with standard neurosurgical treatments. With

our average length of stay of 7.6 days, this alone is a sub-

stantial system wide saving in bed days. By reducing risks

of therapy, and ease of returning to normal activities, it re-


! 49

Dr. Stephan DuPlessis

Dr. John Wong

sults in much higher patient satisfaction. The program,

since its initiation in 2002 has grown steadily, and treats

dozens of patients yearly with single and fractionated cra-

nial and extracranial radiosurgery.

Neuro-Surgical Oncology Program

In collaboration with the Department of Oncology at

the Tom Baker Cancer Centre, we have established a neu-

rosurgical oncology program

under the direction of Mark

Hamilton. This subspecialty

approach to surgical treatment

for patients with malignant brain

tumors has helped integrate

surgical care into existing neuro-

oncology programs in the region

which has facilitated timely ac-

cess to appropriate surgery. It

has also enabled development

of a clinical research program in

neurosurgical oncology. Since

its inception in 2005, several

neurosurgically-based clinical trials have been opened, giv-

ing neuro-oncology patients in Southern Alberta access to

novel therapies such as immunotherapy and convection-

enhanced toxin delivery that would otherwise be unavail-

able.

Surgical Epilepsy Program

Surgical treatment of epilepsy has been known to pro-

vide excellent results in properly selected patients with

medically refractory epilepsy.

Access to such treatment how-

ever remains limited. Tremen-

dous growth of the Calgary

comprehensive Epilepsy pro-

gram, a collaboration of adult

and paediatric epilepsy centres,

has been possible with addition

of a new 4 bed monitoring unit

at the FMC and 2 bed unit at the

ACH, for the assessment of

possible candidates for surgery.

In addition, the recruitment of

several new epileptologists (including the Division head of

neurology) and a recruit (in 2006), of a neurosurgeon who

has expertise in epilepsy surgery, has considerably en-

hanced the program. The volume of cases has steadily in-

creased, and averages approximately 75 cases yearly

within the CHR.

Peripheral Nerve Program

In collaboration with the Divisions of Neurology (neu-

romuscular program) and Physical Medicine and Rehabili-

tation, a surgical peripheral nerve program, has been initi-

ated with the recruitment of the Division head in neurosur-

gery, an established peripheral nerve expert. State of the

art surgical management of peripheral nerve conditions is

now possible in Western Canada. This program already

attracts referral of patients from all of Alberta, and indeed a

few select patients from across Canada, and treats ap-

proximately 70 patients a year with advanced peripheral

nerve surgery.

Skull Base Surgery Program

In conjunction with colleagues from the Division of Oto-

laryngology, the skull base surgery group combines con-

siderable experience with stan-

dard proven, as well as novel,

approaches to offer patients the

best surgical treatment and long

term follow-up for these chal-

lenging lesions.

In addition, close ties to both

endocrinology and the Alberta

Radiosurgery Centre ensure that

all aspects of treatment are con-

sidered and offered. An emerging

strength is the use of minimally

invasive endoscopic approaches

to pituitary and anterior skull base lesions for appropriate

cases.

Neuromodulation Program

In collaboration with the several other departments and

divisions, (Neurology, Cardiology, Anaesthesia/Chronic

Pain Centre, Urogynecology, and Gastroenterology). Cal-

gary patients are offered the full range of implantable de-


! 50

Dr. Walter Hader

Dr. Yves Starreveld

Dr. Mark Hamilton

vices to alter nervous system functioning. While this pro-

gram started by providing surgery for patients with move-

ment disorders (such as Parkinson’s disease, dystonia and

tremor) it has grown to involve

treatment of patients with spas-

ticity, epilepsy, chronic migraine,

refractory angina, various spe-

cific chronic pain conditions and

psychiatric disorders. The pro-

gram has continuously ex-

panded offering new therapies

and testing experimental treat-

ments by leading multicentre

clinical trials (e.g. Brain 2007).

The Division of Neurosurgery

continues to lead this program in

both hands-on surgery, adminis-

trative and academic aspects. This program attracts refer-

ral of patients from all across Alberta and eastern BC.

Paediatric Neurosciences Program

In collaboration with the paediatric neurology Division

at the ACH paediatric neurosurgery has lead the way in

development of Western Canada’s first paediatric neuro-

science unit, within the new children’s hospital (ACH).

Technological innovation with the introduction of ground-

breaking clinical and research technology, magneto en-

cephalography, which provides a novel way of understand-

ing brain function, will provide paediatric neurosciences

with further innovation at the new Children’s Hospital.

Robotics Program

As a continuation of the highly successful and interna-

tionally acclaimed intraoperative MRI neurosurgical pro-

gram, the development of a MR compatible robot to assist

with cranial (and non-cranial) microsurgery is proceeding.

This program is on the leading edge (world-wide) of inno-

vation and research, brings together experts (under the

leadership of neurosurgery) in robotics, engineering, imag-

ing, haptics and molecular biology. Our partners are the

University of Calgary, the Calgary Health Region, and in-

dustry. The robotics program technology initiative has the

potential to revolutionalize the way that neurosurgery is

performed in the future.

Creating the Future of Neurosurgical Clinical Service

With the addition of the several neurosurgeons over the

past 8 years to our faculty, subspecialty neurosurgical care

in all major areas is covered, with several new services now

being delivered through considerable innovation in care.

Two examples of innovation in neurosurgery care are de-

scribed below:

a) Neurosurgery, Physiotherapy and Chiropractic Col-

laborative Care

The Division has met the ever growing clinical chal-

lenge to diagnose and treat its rapidly expanding referral

base in diseases of the degenerative spine. New referrals

to neurosurgeons alone in this area number well over two

thousand patients per year. The needs of many of these

patients are now addressed through an innovative process

of clinical screening, referral and treatment which ensures

that the appropriate treatments are provided to the right

patients by the appropriate clinician.

This new approach involved different groups – specifi-

cally physiotherapists and chiropractors – in the process of

developing and delivering optimal neurosurgical care for

these patients


! 51

Dr. Zelma Kiss

Dr. Garnette Sutherland, performing live robotic micro-

neurosurgery in the control room using NeuroArm.

In order to help patients with diseases of the degenera-

tive spine, an innovative model of spinal care, National

Spine Care (NSC), was established. Degenerative spine

disease is usually accompanied by severe pain and debili-

tating pain in the lower back or neck most commonly as-

sociated with a degenerative spinal disc. NSC offers an

innovative multi-disciplinary approach to the efficient and

effective screening and assessment of patients facilitated

through the collaboration of the spinal neurosurgeons

working with specially trained physiotherapists and chiro-

practors.

This model of interdisciplinary collaboration was de-

veloped with the full endorsement of the College of Physi-

cians and Surgeons of Alberta. Prior to NSC, 90% of de-

generative spinal referrals were deemed to be nonsurgical

patients after assessment by a neurosurgeon. Patients

under the NSC are assessed by spinal neurosurgeon

trained chiropractic and physiotherapists to assess pa-

tients for suitability of assessment by the neurosurgeon.

Patients are therefore more appropriately triaged into a

non surgical spinal therapy program or surgical assess-

ment, where now approximately 85% of those now seen by

the neurosurgeon are offered

surgery. The result is significantly

increased throughput of patients,

and resulting decreased wait-

lists. An average assessment by

a physiotherapist or chiropractor

within the NSC program takes

about an hour. Each year about

1,500 assessments are being

done so the use of physiothera-

pists and chiropractors in the

this innovative care model has

freed up about 1,500 hours of

neurosurgeons’ time to be used on more difficult and com-

plex patients, and those actually requiring surgery.

The Division of Neurosurgery has also established a

medical Spine Clinic overseen by Dr. Stephan Duplessis

and Divisional members within the Foothills Medical Centre

site. Dr. Salma Yaseen, an international medical graduate

who has previously completed the Calgary Clinical Assis-

tants Program (CCAP) with the neurosurgical service, is

now helping manage the medical Spine Clinic, where she

helps triage patients with de-

generative spinal complaints to

surgical or medical treatment.

Patients are neurologically

evaluated under the supervision

of an attending neurosurgeon

with a view towards identifica-

tion of surgically remediable

disease. The clinic provides ex-

pedited spinal advice to about

80 patients per month, and has

significantly reduced neurosur-

gical waiting lists.

b) Neurosurgery and Nursing Collaboration in the Hos-

pital Setting

A second example of innovation in neurosurgical pa-

tient care is in the hospital setting, through the develop-

ment of a Clinical Nurse Practitioner (CNP) program.

Nurses who are trained through the nurse practitioner pro-

gram offered by the University of Calgary Faculty of Nurs-

ing take a third year clinical placement that focuses on the

ward care of neurosurgical patients, the evaluation of

medical problems in pre- and post-surgical care and the

technical and clinical skills related to the care of neurosur-

gical patients.

Enhancement of all facets of in patient care, pre- and

post-surgical education and continuity into the community

has been possible with the training and implementation of

4 Clinical Nurse Practitioners (CNPs) within the system,

with a 5th now nearing completion of training.

c) Neurosurgical Locum Tenens Opportunities

The Division of Neurosurgery is now able to offer highly

selected individuals, the opportunity to initiate their surgical

career within the Department on a per annum contract ba-

sis. Typically newly credentialed by the Royal College of

Surgeons, these physicians are well-trained neurosurgeons

from respected programs who wish to transition from resi-

dency to full-time staff in a structured and rigorously aca-

demic environment. The locum position offers the benefits

of quickly adopting a busy general neurosurgical practice


! 52

Dr. Salma Yaseen

Dr. Steve Casha

with administrative and operative resources, with the

ready availability of subspecialty neurosurgical advice

from Divisional members. Our locum tenens beginning in

July 2008, was Dr. Keith Mac-

Dougall from the University of

Western Ontario. Already a tal-

ented surgeon, Dr. MacDougall

has taken this opportunity to

hone his clinical skills and refine

his academic goals. Dr. Mac-

Dougall plans further subspe-

cialty training in epilepsy and

functional neurosurgery in Lon-

don Ontario and Australia begin-

ning in 2009.

Educating New Physicians and Creating the Neurosur-

gical Care Team of the Future

a) Undergraduate Medical Education

The Division of Neurosurgery provides teaching excel-

lence in the University of Calgary Faculty of Medicine to

both undergraduate medical students and post graduate

trainees in the neurosurgical residency program.

Within the undergraduate medical curriculum, Divi-

sional members serve as mentors in Course V: neurosci-

ence and aging course lecture. Division members are in-

volved in undergraduate small group seminars and bedside

teaching.

Several members of the neurosurgical faculty have re-

ceived undergraduate and post-graduate teaching awards

from the University of Calgary.

b) Post-Graduate Medical Education

Directed by Dr. John Hurlbert, the University of Calgary

Neurosurgical Residency Training Program has continued

to excel, and indeed has flourished with an increasing resi-

dent complement pool from 2000 (5 residents) to 2008 (13

residents). The Program has now realized a stable com-

plement of residents and has gained approval of 2 PGME

funded positions a year.

Resident operating room teach-

ing and technical skill training,

critical care unit, emergency

room, clinical ward and outpa-

tient experience are provided at

the Foothills and ACH sites by

neurosurgical faculty member

mentors and supervisors.

A resident-faculty partnered core

curriculum (2 hours weekly, with

a 3 year cycle) is supplemented

by lectures on basic neurosci-

ences, clinical case presentations/discussions and grand

neuroscience rounds (at the academic half day). In addi-

tion, weekly neuropathology rounds, core surgery semi-

nars, subspecialty rounds, and a visiting professorship

program round out the didactic teaching. Formal oral and

written neurosurgery examinations are conducted by the

neurosurgical team every 3-6 months to evaluate and

monitor resident academic performance profiles. Weekly

interesting case rounds and bimonthly morbidity and mor-

tality rounds provide an opportunity for open discussion

relating to challenges in patient care, including honest dis-

cussion of adverse events, ethical standards and medico-

legal issues. Finally, quarterly journal clubs enable instruc-

tion in reviewing and reading the literature to instill evi-

dence based-best outcome clinical practice.

In addition to postgraduate training, the Division of

Neurosurgery offers Fellowship training in complex dis-

eases of the spine (several dozen Fellows trained over the

past decade), the surgical treatment of epilepsy, functional

and stereotactic neurosurgery, endovascular neurosurgery

and peripheral nerve surgery. Each of these programs has

or is training Fellows, and (given that International Fellows

can choose to go anywhere) reflects the maturity and the

prominence of these programs.

Other Health Professional Education: Medical, Nursing,

Physiotherapy, and Chiropractic

Calgary’s neurosurgeons have utilized the advanced

practice nursing program from the University of Calgary to

train clinical nurse practitioners who work with neurosur-

gery patients in the pre- and post-surgical setting. This


! 53

Dr. Keith MacDougall

Dr. John Hurlbert

training occurs predominantly in the third year of the pro-

gram in a clinical setting where the advanced practice

nurses work closely with neurosurgeons.

The Division is pleased to be

offering clinical mentorship and

guidance to international medi-

cal graduates who intend on

entering into the Canadian phy-

sician workforce. Dr. Bipan

Sumbria, a previous general

surgeon, is currently enrolled in

the two-year Calgary Clinical

Assistants Program and is ex-

panding his knowledge base

and clinical repertoire of West-

ern medicine on the neurosurgi-

cal wards, emergency department, and in the clinic.

The neurosurgeons provide the training to the physio-

therapists and chiropractors involved with the clinical as-

sessment services offered through the NSC program. This

program received approval from the Alberta College of

Physicians and Surgeons and is a successful model of

inter-disciplinary cooperation.

d) Continuing Medical Education and Public Education

Additionally, Divisional Members are involved in various

teaching activities targeting the public, and continuing

medical education seminars for primary care physicians,

emergency physicians and referring doctors. Given their

National and International stature, several Members are

also prominently involved in the teaching of residents, fel-

lows and their colleagues at Specialty and Sub-specialty

meetings.

Creating Knowledge for the Future

Research within the Division of Neurosurgery is ac-

complished through cooperation and close alignment with

the Department of Clinical Neurosciences and the

Hotchkiss Brain Institute (HBI) at the University of Calgary.

The goal of the HBI, to be a world leader in Translational

Neuroscience and Mental Health research and commitment

to translating basic science discoveries into improved pa-

tient outcomes, is dependent on the excellence in the clini-

cal neurosciences provided by members of the Division of

Neurosurgery. The goal of the Division of Neurosurgery is

to foster the goals of the HBI and advance the HBI and

University of Calgary as a world leading institute for Neuro-

science research and translational clinical treatment.

Clinical and basic science research is completed by all

division members, four of whom run externally funded re-

search programs, and many who play prominent roles in

Hotchkiss Brain Institute programs including Neuroarm,

Spinal cord and nerve regeneration, Epilepsy and brain cir-

cuits, and Movement disorders and therapeutic brain

stimulation.

As one measure of academic productivity, grant money

from National and Provincial agencies awarded to Divi-

sional Members has increased several-fold over the past

decade, and was > $2.5 Million in 2007-8. Out of the 10

GFT faculty, 3 have independent operating grant support

from CIHR, an extraordinary level of success for a surgical

Division in Canada. Another measure is peer reviewed pub-

lications, which continue to increase yearly, and are fully

documented in the publication section elsewhere in the

Annual Report.

Fostering the Bio-Science Economy of the Future

The research program of members of the Division has

a significant focus on technology commercialization and

the development of effective partnerships and alliances

with interested and committed partners from the private

sector.

The world’s first MRI-compatible surgical robot is the

creation of Calgary neurosurgeon Dr. Garnette Sutherland

and his team. Dr. Sutherland has spent the last 7 years

leading a multi-disciplinary team of Canadian scientists, in

cooperation with MacDonald, Dettwiler and Associates Ltd.

(MDA), to design a machine “that represents a milestone in

medical technology.”

Designed to be controlled by a surgeon from a com-

puter workstation, neuroArm operates in conjunction with

real-time MR imaging, providing surgeons unprecedented

detail and control, enabling them to manipulate tools at a

microscopic scale. Advanced surgical testing of neuroArm


! 54

Dr. Bipan Sumbria

was completed in 2008, and the first few patients have had

neuroArm assisted robotic cranial neurosurgery.

Developing neuroArm required an international collabo-

ration of health professionals, physicists, electrical, soft-

ware, optical and mechanical engineers to build a robot

capable of operating safely in a surgical suite and within

the strong magnetic field of the intraoperative MRI envi-

ronment. Indeed, this past year the 1.5 Tesla intraoperative

MR has been upgraded to a state-of –the-art 3.0 Tesla sys-

tem. Many other surgical disciplines have and continue to

participate in applying neuroArm to various types of surgi-

cal procedures.

Administration/Leadership

All Divisional Members carry out important administra-

tive duties within the Foothills Hospital, ACH and CHR, and

for the purposes herein we will highlight just a few exam-

ples.

The Divisional Head, Dr Rajiv Midha, sits on multiple

hospital, Departmental and Regional Committees. Dr. Mark

Hamilton directs Neurosciences at the ACH, and is the

Chair of the important Quality Assurance and Safety Com-

mittee of the Department of Clinical Neurosciences. Dr

Zelma Kiss provides leadership in the Movement Disorder,

Therapeutic Brain Stimulation and Neuromodulation Pro-

gram. Dr John Hurlbert is the Director of the Residency

Training Program, a co-leader of the Spine and nerve re-

generation program of HBI, and was previously the director

and instrumental in setting up arguably the best multi-

disciplinary Spinal surgery program (in collaboration with

orthopaedic spinal surgery) in Canada.

Academic leadership within the Division of Neurosur-

gery is provided by Dr Rajiv Midha, a surgeon scientist re-

cruited in 2004 to help accomplish the Academic mission.

He presently also sits on the executive committee of the

Hotchkiss Brain Institute and is a member of the Spinal

Cord and Nerve Regeneration Team. Three additional

members of the Division of Neurosurgery have leadership

roles within 3 research programs within the HBI. For exam-

ple, Dr. Garnette Sutherland directs the NeuroArm Robotics

Program.

Many Divisional Members have prominent leadership

positions at National and International levels. For example,

Dr. Hamilton is past President of the Canadian Congress of

Neurological Sciences. Dr. Midha is the past President of

the (international) Sunderland Society, past President of the

American Society for Peripheral Nerves and prior Chair of

the Peripheral Nerve Task Force in organized American

neurosurgery. Dr Hurlbert was recently the Education

Committee Chair of the Joint Spine and Nerve Disorders

Section of AANS/CNS and was the Scientific Program

Chair for their meeting in 2007.

Summary

The Division of Neurosurgery at the University of Cal-

gary continues in its aim towards the development of a

world class institution known for excellence in clinical neu-

rosurgery as well as neuroscience education and research.


! 55

Division of NeurologyOverview

The Division of Neurology. led by Dr. Sam Wiebe, in the Department of Clinical Neurosciences comprises all 43 neu-

rologists practising within the former Calgary Health Region, in addition to emeriti members and cross-appointees from

outside our Region, such as Red Deer and Edmonton. The division provides neurological clinical care to the population

of southern Alberta, south-western Saskatchewan and south-eastern British Co-

lumbia. The interests, scope of activities and level of specialization varies among

members of this large neurological division. Yet, there is a strong spirit of collabo-

ration, which makes this division larger than the sum of its parts. The breadth of

scope and depth of expertise enables excellence in clinical care, research, educa-

tion, and health service delivery models.

During the academic year 2007-2008 three new members have joined our division,

Dr. Jeptha Davenport, Dr. Tamara Pringsheim, and Dr. Eric Smith. Our new col-

leagues will strengthen the areas of stroke, movement disorders, multiple sclerosis,

headache, and general neurology.

This year has also marked a milestone in our Division’s model for delivering neuro-

logical services. On September 29, 2008, we opened a second neurology inpatient

unit at the Rockyview General Hospital. This unit consists of eight dedicated neu-

rology beds, dedicated neurosciences nurses, and an enlarged presence of neu-

rologists at that site. Two new clinical assistants have been incorporated to the

inpatient and outpatient services, as well as a dedicated nurse practitioner. We

have also strengthened our links with general Internal Medicine inpatient services. The expansion to the Rockyview

Hospital includes a second neurology Urgent Clinic. Under the leadership of Dr Chris White, the new neurology inpatient

unit and Urgent Clinic are off to a great start. This development is of particular importance as we cultivate a large outpa-

tient and inpatient neurological unit to occupy the new South Health Campus, currently under construction.

Developments in Clinical Research

Through collaboration with and support from the Hotchkiss Brain Institute, we have developed a Clinical Research

Unit for Neurosciences. The research unit focuses on study design, methodological expertise, research database setup

and data management, and data analysis. The unit also provides the opportunity for training in clinical trials and outcome

assessment, as well as the ability to undertake small and large-scale, investigator initiated clinical research. The Clinical

Research Unit houses a flexible research platform and database, and staff dedicated to study setup and study manage-

ment. Monthly clinical research rounds address a variety of project-specific questions and provide an excellent learning

opportunity for clinical researchers, and mentoring of young clinical investigators.

Specialty Programs

The Division of Neurology comprises eight specialty programs, each thriving academically through involvement in a

broad variety of research areas as well as training of post-doctoral clinical and research fellows (see table). These pro-

grams have strong links with basic science researchers through the Hotchkiss Brain Institute, and with health services

and population health research through the Department of Community and Health Sciences.


! 56

Dr. Sam Wiebe

Two additional programs, Urgent Clinic and General Neurology, are a centrepiece of delivery of neurological care in

our region. The Urgent Neurology Clinic has expanded to the Rockyview General Hospital and the General Neurology

Programme is developing further.

The Division comes together every Friday at Clinical Neurosciences Grand Rounds. In addition, individual programs

hold numerous teaching and research sessions throughout the week which provide a rich and valuable source for in

depth learning in diverse areas of clinical neurology. Following is a list of ongoing rounds held by each program in addi-

tion to the regular resident teaching rounds:

Epilepsy Program:

Weekly Monday Epilepsy rounds (clinical and/or research)

Bi-monthly EEG rounds

Monthly Journal Club

Headache Program:

Weekly CHAMP academic program development rounds

Movement Disorders Program:

Monthly Unusual Movement Disorder rounds

Monthly Journal Club

Multiple Sclerosis Program:

Weekly MS Clinical Rounds

Bi-monthly Journal Club

Neuromuscular Program:

Monthly neuromuscular rounds

Bi-monthly Regeneration Journal Club

Weekly lab meetings (D Zochodne)

Monthly EMG rounds

Neuro-Oncology:

Weekly Neuro-Oncology Tumor Board rounds

Stroke Program:

Weekly Stroke Rounds

Weekly Update and Academic Lecture


! 57

PROGRAM MEMBERS

Calgary Headache and Management ProgramDr W Becker, Director

Dr K Busche, Dr L Cooke, Dr A Eloff, Dr J Kohli, Dr T Pringsheim

Calgary Comprehensive Epilepsy Programme

Dr S Wiebe, Director

Dr N Pillay, Adult Program Director

Dr P Federico, Dr A Hanson, Dr N Jette, Dr B Klassen, Dr W Murphy,

Dr I Mohamed (Paediatrics)

Calgary Stroke Programme and

Stroke Prevention Clinics

Dr A Demchuk, Program Director

Dr M Hill, Director Stroke Unit

Dr P Barber, Dr S Coutts, Dr K Hoyte, Dr G Klein, Dr E Smith,

Dr P Stys, Dr T Watson, Dr N Weir

General Neurology

Dr R Bell, Dr K Brownell, Dr K Busche, Dr J Davenport, Dr A Hanson,

Dr M Hill, Dr K Hoyte, Dr B Klassen, Dr G Klein, Dr J Kohli,

Dr W Murphy, Dr D Patry, Dr D Pearson, Dr C White, Dr S Wilson,

Dr M Yeung

Movement Disorders Programme

Dr O Suchowersky, Program Director

Dr R Ranawaya, Clinic Director

Dr S Furtado, Dr S Kraft,

Multiple Sclerosis Programme

Dr L Metz, Director

Dr R Bell, Dr K Busche, Dr J Davenport, Dr W Murphy, Dr D Patry,

Dr D Pearson, Dr M Yeung

Neuromuscular Programme/EMGDr D Zochodne, Director

Dr K Brownell, Dr C Toth, Dr C White

Neuro-OncologyDr G Cairncross, Director

Dr P Forsyth

Neuro-Ophthalmology Dr W Fletcher, Dr F Costello

Urgent Neurology

Dr Alexandra Hanson and William Murphy, Co-Directors

Janet Warner, Coordinator

Various Participating neurologists

Fellowship Programs:

Post-doctoral clinical and research fellowship programs in our division exist in the areas of epilepsy, epilepsy sur-

gery, EEG, EMG, headache, movement disorders, multiple sclerosis, neuromuscular diseases, neuro-oncology and

stroke. During this year our Division trained a total of 22 post-doctoral fellows in the following programs:

Epilepsy: Abdel Hamid Seiam, Adnan Al-Sarawi, Ayataka Fujimoto

Headache: Farnaz Amoozegar

Multiple Sclerosis: Scott Sloka


! 58

Movement Disorders: Cid Diesta

Neuromuscular: Lawrence Korngut, Jennifer Bestard, Christine Webber (PhD)

Neuro-Oncology: Gloria Roldan, Paula de Robles, Michael Blough (PhD), Morgan Westgate

(MSc)

Stroke: Talip Asil, Mohamed Alzawahmah, Dar Dowlatshahi, Pablo Garcia, Al Jin, Bijoy Me-

non, Alexandre Poppe, Nan Shoba, Nikolai Steffenhagen

Residency Program:

The neurology training program in our division is highly rated and attracts top candidates

from across the country. Under the exemplary leadership of Dr William Fletcher, our training

program continues to thrive, with thirteen residents at present and a foreseen expansion of up

to five more residents in the upcoming year. The current residents are:

R5: Dr. Fatima Abdulla

R4: Dr. Mohammed Almekhlafi, Dr. Sameer Chhibber, Senior Resident, Dr. Phillippe Couillard,

Dr. Justyna Sarna

R3: Dr Claire Hinnell, Dr. Scott Jarvis, Dr. Suresh Subramaniam

R2: Dr. Mohammed Alanazy, Dr. Katie Wiltshire

R1: Dr. Ahmad Abuzinadah, Dr. Sankalp Bhavsar, Dr. Janel Nadeau

Research: Dr. Aylin Reid is taking a research sabbatical during her residency program. Her

PhD focuses on long term effects of inflammation and febrile seizures. She will return as an

R4 in 2010 to complete her residency.

Physician Clinical Assistants Program:

The Division of Neurology also participates in the Calgary Clinical Assistants Program. Two

clinical assistants participate in the general neurology program at the Rockyview General

Hospital inpatient unit (Drs. Oje Imoukhuede and Sobia Rajput). Two additional clinical assis-

tants participate in the Epilepsy Programme and Seizure Monitoring Unit at the Foothills Hos-

pital (Drs. Harinder Dhaliwal and Florence Obianyor). These physicians play an important and

growing role in our health care services delivery model.

Innovations in Health Care Delivery:

Division of Neurology is focusing on three new aspects of health care delivery, ie., a central

triage system for outpatient services, implementation of an outpatient electronic medical re-

cord and booking system, and the development of a formal General Neurology Program.

These initiatives are greatly facilitated by our Academic Alternate Relationship Plan (ARP),

which supports innovation in health care delivery.


! 59

Dr. Florence Obianyor

Dr. Harinder Dhaliwal

Dr. Oje Imoukhuede

Neurologists

Dr. Samuel Wiebe, Head of the Division of Neurology, is an epileptologist and clinical epide-

miologist interested in outcomes research and surgical randomized trials. He is the Director of

the Calgary Comprehensive Epilepsy Programme.

Dr. Philip Barber is a neurologist specializing in stroke with re-

search interests in blood brain barrier breakdown, stroke in the

elderly, inflammation in stroke, and MRI.

Dr. Werner Becker has a major interest in headache, and directs

the Calgary Headache Assessment and Management Program at

the Foothills Hospital and the Headache Program at the Chronic

Pain Centre in Calgary."

Dr. Robert Bell’s expertise involves the diagnosis and treatment of

neuro-inflammatory disease of the Central Nervous System. He is

a member of the Multiple Sclerosis Program and is involved in

teaching clinicians and researchers.

Dr. Keith Brownell’s clinical interests are in neuromuscular dis-

eases and general neurology." His educational interests currently

focus on teaching in the neurosciences, physicianship, profes-

sionalism and medical ethics.

Dr. Kevin Busche's clinical activities include work in the MS clinic,

General and Urgent Neurology and the EMG lab. "He is involved

with Undergraduate Medical Education at multiple levels and is

the Director of the Office of Faculty Development.

Dr. Gregory Cairncross is the Head of the Department of Clinical

Neurosciences. He is a neuro-oncologist interested in the genetic

basis of glioma and new therapies for brain tumor.

Dr. Lara Cooke, is a neurologist in the Headache Program and is

an expert in medical education. She is Assistant Dean of Faculty

Development and Medical Education at the University of Calgary.

Dr. Fiona Costello is a neuro-ophthalmologist and a member of

the MS Program. She is developing a research program using the

visual pathway as a model of disease to change how MS is followed and treated.

Dr. Shelagh Coutts is an academic stroke neurologist. Her research involves using mod-

ern imaging techniques to predict outcomes in patients with TIA and minor stroke.


! 60

Dr. Andrew Demchuk

Dr. Phil Barber

Dr. Kevin Busche

Dr. Fiona Costello

Dr. Keith Brownell

Dr. Warner Becker

Dr. Jeptha Davenport works in the Multiple Sclerosis Clinic, in the Headache Group at the

Chronic Pain Centre Holy Cross Site, and at a General Neurology Clinic at the Peter

Lougheed Centre.

Dr. Andrew Demchuk is a stroke neurologist and the Director of the Calgary Stroke Program.

His research interests involve developing targeted treatments for stroke using ad-

vanced"acute vascular imaging.

Dr. Arnolda Eloff, is a neurologist dedicated to the clinical man-

agement of patients with headache in the Calgary Headache As-

sessment and Management Program.

Dr. Paolo Federico is an epileptologist in the Calgary Comprehen-

sive Epilepsy Program. His research program uses leading-edge

MRI imaging and EEG approaches to better understand the neu-

ral and vascular correlates of epilepsy."

Dr. William Fletcher is a neuro-ophthalmologist, Director of the

Neurology Residency"Program"and"Chair of"the Neurology"Spe-

cialty Committee of the Royal College of Physicans and Surgeons

of Canada."

"

Dr. Peter Forsyth is Associate Director Research Tom Baker Can-

cer Centre, the Provincial Co-Coordinator for the Terry Fox Re-

search Institute and Director of the Southern Alberta Cancer Re-

search Institute." His research focuses on the molecular genetics

of malignant gliomas, and their treatment with experimental

therapies."

Dr. Sarah Furtado is a neurologist in the Movement Disorders

Clinic. She participates in clinical trials for Movement Disorders

and in neuroimaging studies for Parkinson's Disease. She partici-

pates in the Urgent Neurology Clinic and in the surgical team for

Movement Disorders. She is interested in medical education.""

Dr. Alexandra Hanson is a clinical neurologist specialising in epi-

lepsy. She also works at the Tom Baker Cancer Centre and is the

Director of the Urgent Neurology Clinic.

Dr. Michael Hill is a stroke neurologist who has research interests in clinical trials. He is

the Director of the Stroke Unit and is quoted as saying, 'Give the juice'.

Dr. Keith Hoyte, has been a clinical neurologist for over 30 years, and consults on all

neurological disorders. In addition, he has a special interest in Stroke Prevention.


! 61

Dr. Alexandra Hanson

Dr. Keith Hoyte

Dr. Michael Hill

Dr. Sarah Furtado

Dr. Paulo Federico

Dr. Arnolda Eloff

Dr. Nathalie Jette is an epileptologist. She is also a CIHR and AHFMR population health in-

vestigator, and health services researcher. Her research interests include the study of appro-

priateness and necessity of medical interventions.

Dr. Brian Klassen practises General Neurology, with an interest in Epilepsy, EEG, and EMG."

He is"also Neurology Site Leader at the Peter Lougheed Hospital.

Dr. Gary Klein is a clinical neurophysiologist active in the EMG

clinics and in EEG interpretation. He also participates in the

Stroke Program and the general neurology clinic.

Dr. Jagdeep Kohli is a community-based neurologist with an in-

terest in headache and EMG.

Dr. Scott Kraft is a neurologist who divides his time between the

Movement Disorders Clinic and Clinical Informatics.

Dr. Luanne Metz, is a neurologist specializing in MS. She is the

Director of the Multiple Sclerosis Program. Her research interests

include new therapies for MS and the translation basic science

research into clinical investigation.

Dr. William Murphy, is neurologist participating in the MS Clinic,

Epilepsy, Sleep Disorders and General Neurology Programs.

Dr. David Patry is Clerkship Director, Clinical Research Director in

the Cognitive Assessment Clinic, UCMG Executive Council

Member, and Evaluation Coordinator for the UofC Undergraduate

Neuroscience Course. Multidisciplinary clinic participation in-

cludes the Urgent, MS, Cognitive and Senior Resident Clinics.

Dr. Dawn Pearson is a neurologist with special interests in neu-

rorehabilitation and cognitive change associated with brain injury,

including dementia, stroke and trauma.

Dr. Neelan Pillay is an epileptologist with expertise in neurophysi-

ology and evoked potentials. He is the Director of the Adult Epi-

lepsy Program. Following a research sabbatical, his acquired in-

terests are in EEG-fMRI in secondary generalized epilepsy, and in

language fMRI reorganization after temporal lobe surgery.

Dr. Tamara Pringsheim is the Director of the Calgary Tourette Syndrome clinic, and

member of Calgary Headache Assessment and Management Program and the movement

disorders programs.


! 62

Dr. Luanne Metz

Dr. Bill Murphy

Dr. Dawn Pearson

Dr. Brian Klassen

Dr. Gary Klein

Dr. Natalie Jette

Dr. Ranjit Ranawaya specializes in Movement Disorders. He is the Director of clinical services

of the Movement Disorders Program.

Dr. Eric Smith is a stroke neurologist with special interest in stroke, intracerebral hemorrhage

and dementia. His research seeks to disentangle the effects of cerebrovascular disease and

Alzheimer's disease on cognitive decline.

Dr. Peter Stys is a neurologist/neuroscientist whose clinical inter-

est is focused on stroke neurology. "He runs a basic science lab

where he studies the fundamental mechanisms of axonal and

glial injury in a variety of disorders such as spinal cord injury and

MS.

Dr. Oksana Suchowersky is a neurologist and neurogeneticist

specializing in movement disorders, and in adult onset hereditary

neurodegenerative disorders. She is Head of the Department of

Medical Genetics." Her research"is aimed at"improving treat-

ments for these disorders.

Dr. Cory Toth is a clinician-scientist who studies clinical and pre-

clinical effects of diabetes upon the nervous system and the im-

pact of neuropathic pain in humans and in animal models.

Dr. Timothy Watson is a stroke neurologist with interests in the

delivery of stroke clinical services in the community.

Dr. Nicolas Weir is a stroke neurologist with interests in clinical

epidemiology and evidence-based neurology.

Dr. Christopher White is the Site Chief of Neurology at the Rocky-

view Hospital. He is a member of the neuromuscular program and

Director of the ALS clinic.

Dr. Scott Wilson is a community general neurologist who also

provides EMG services.

Dr. Michael Yeung is Director of the Multiple Sclerosis Clinical

Trials Research Unit. He is a neurologist in the General Neurology

Clinics, Chronic Headache Clinic, and Multiple Sclerosis Clinic.

Dr. Douglas Zochodne is the Director of the Neuromuscular Clinic and of Clinical Neuro-

physiology for the Calgary Health region. He is an AHFMR Scientist and runs an externally

funded research lab addressing peripheral neurobiology.


! 63

Dr. Oksana Suchowersky

Dr. Peter Stys

Dr. Ranjit Ranawaya

Dr. Neelan Pillay

Dr. Cory Toth

Dr. Tim Watson

Awards Received by Division Members in 2008

Dr. Kevin Busche: Clinical Adjunct and Research Faculty Teaching Award, ARP merit award

for his work in education.

Dr. Shelagh Coutts: 2008 Petro Canada Young Innovator Award in Community Health.

Dr. Fiona Costello: ARP merit award for her research perform-

ance and her novelty in research.

Dr. Michael Hill: ARP merit award and Performance Recogni-

tion award for his role in research and his outstanding publica-

tion record.

Dr. Nathalie Jetté: ARP merit award and Performance Recogni-

tion award for her outstanding success as a junior clinical and

population health investigator.

Dr. Luanne Metz: ARP Performance Recognition award for her

work in the MS program and for bringing together a transla-

tional research program.

Dr. Oksana Suchowersky: Best Doctors of Canada for 2008.

Dr. Chris White: ARP merit award and Performance Recognition award for his outstanding

work on the development of the new neurology services the RGH and SHC sites.


! 64

Dr. Michael Yeung

Dr. Nic Weir

Dr. Chris White

Division of Physical Medicine and RehabilitationFaculty

Division Head: Dr. John Latter

Staff: Drs. Maryana Apel, Pamela Barton, Nwamara

Dike, Sean Dukelow, Denise Hill, Ken Lam, Daniel LeBlond,

Christine McGovern, Dan McGowan, Stephen McNeil,

Stephanie Plamondon, Perminder Ubhi, Noorshina Virani

Overview

The Division of Physical Medicine and Rehabilitation is

one of four divisions within the Department of Clinical Neu-

rosciences, the Faculty of Medicine, the University of Cal-

gary and the Calgary Health Region. The division provides

services for Southern

Alberta, South-eastern

British Columbia and

South-western Sas-

katchewan. The divi-

sion’s primary inpatient

unit is at the Foothills

Medical Centre with

amputee patients be-

ing treated at Carew-

est Glenmore Park and

stroke patients at

Carewest Dr. Vernon

Fanning Centre. The

division provides con-

sultation services at

Peter Lougheed Hos-

pital and Rockyview

General Hospital, Carewest Glenmore Park and Carewest

Dr. Vernon Fanning Centre.

Dr. Daniel LeBlond is in Lethbridge and we have had

one of our residents rotate through the program in

Lethbridge to experience general physiatry in a smaller

centre.

In-patients are treated on the Tertiary Rehabilitation

Unit 58 located in the Special Services Building.

The division members are actively involved in under-

graduate medical education and maintain a continued

strong presence with residency education. There are sev-

eral members involved in collaborate research.

Clinical

Traumatic Brain Injury Rehabilitation"

Dr. Christine McGovern, Dr. Stephanie Plamondon, Dr.

Nwamara Dike

The Brain Injury Rehabili-

tation Program consists of an

inpatient and an outpatient

component. This year there

were 178 inpatient consulta-

tions were performed this

year on patients with trau-

matic brain injury. The num-

ber of patients admitted to

the inpatient rehabilitation

unit, Unit 58, was 67. The

median age of the people

admitted to Unit 58 was 38,

with 82% male. Only 16%

were not from the Calgary

urban area. Based on the

Glasgow Coma Scale Score,

69% had sustained severe

injuries, 10% moderate, and

21% mild. The median length

of stay in acute care prior to

transfer was 29 days, and

the median length of stay on

the rehabilitation unit was 40

days. The majority of pa-

tients, 76%, were discharged

home.

In outpatient Brain Injury Clinic, 183 new referrals were

seen, and 545 follow-up visits were performed. Patients


! 65

Dr. John Latter

Dr. Christine McGovern

Dr. Stephanie Plamondon

varied from mild to severe type of injuries, and included

both recent and remote injuries.

Spinal Cord Injury Rehabilitation

Dr. Dan McGowan, Dr. Denise Hill

Dr. McGowan and Dr. Hill fol-

low patients who have neuro-

logic impairment resulting from

spinal cord abnormalities from

acute care, through rehabilita-

tion, and in the SCI outpatient

clinics. One hundred and

forty-nine patients were seen

in consultation in acute care.

Of the 64 patients admitted to

the in patient rehabilitation unit

with spinal abnormalities es-

sentially on half were a result

of trauma. 37 new patients

were seen in the outpatient

clinic and 358 patients were

seen in follow-up.

Dr. Hill presented a review of

sublesional osteoporosis at

the Third National Spine Injury

Conference in Toronto Ontario

and has combined her inter-

ests to become the team phy-

sician for Canada’s Paralympic

Nordic Ski Team.

Paediatric Rehabilitation

Dr. John Latter

The Pediatric Rehabilitation Program takes place at

Alberta Children’s Hospital as well as Foothills Hospital.

Dr. Latter is involved in interdisciplinary clinics. The Spina

Bifida clinic saw ninety patients last year. The Pediatric

Neuromuscular Clinic saw two hundred children, forty of

which were seen by physiatry. The Juvenile amputee clinic

has ninety active patients and 43 were seen in clinic in

2008. These clinics run once a month.

Dr. Latter is a member of the Pediatric Brain Injury Pro-

gram with both inpatient and outpatient involvement.

There were 122 inpatients and 214 outpatient visits with

139 of these seen by physiatry.

The Young Adult Rehabilitation Clinic is held weekly out

of the Foothills Hospital and this year there were 28 new

patient clinic visits and 112 repeat clinic visits.

Stroke Rehabilitation

Dr. Stephen McNeil, Dr. Ken Lam, Dr. Sean Dukelow

It was another busy year for

the stroke rehab and spasticity

programs with Dr. Stephen

McNeil and Dr. Ken Lam. We

of course have also recently

added a new physiatrist Dr.

Sean Dukelow who will bring a

significant research compo-

nent to the program.

Our spasticity program con-

tinues to grow with 90 new

patients and almost 500 re-

peat injection patients last

year. Dr. McNeil was also the

scientific chair of the 2008 Canadian Botulinum Toxin Con-

ference – Spasticity Section.

The stroke rehab program had 190 new inpatient con-

sults, 16 new outpatient consults and 500 follow up visit. In

addition on a weekly basis throughout the year consulta-

tion and follow up service was provided at the rehab unit at

the Fanning Centre.

EMG

Dr. Pamela Barton, Dr. Denise Hill, Dr. Ken Lam, Dr.

Stephen McNeil, Dr. Stephanie Plamondon, Dr. Noorshina

Virani, Dr. Sean Dukelow

Amputee

Dr. Ken Lam

The amputee program is a young and growing pro-

gram. The goal is to provide comprehensive care to pa-

tients with limb loss across the continuum. We provide in-


! 66

Dr. Denise Hill

Dr. Dan McGowan

Dr. Stephen McNeil

patient and out-patient services. In 2008 over 100 new pa-

tients with limb loss have en-

tered into the program. A joint

venture with the Bone and

Joint Institute has provided a

six bed in-patient program at

the Glenmore Park facility.

Specialized out-patient reha-

bilitation is now provided at

the new Sheldon Chumir Cen-

tre. The program is also dedi-

cated to medical education.

Physiatry residents spend a

mandatory 3 months with us

during their residency.

Chronic Pain

Dr. Pamela Barton, Dr. Noorshina Virani, Dr. Nwamara

Dike#

The Calgary Health Region

Chronic Pain Centre has now

completed 8.5 years of opera-

tions within the CHR Regional

Pain Program. It is now the

largest such Centre in Canada

and is a leader in interdiscipli-

nary rehabilitation for individu-

als with chronic pain.

Three members of the Division

of Physical Medicine and Re-

habilitation currently practise at

the Chronic Pain Centre: Dr.

Pamela Barton, co-founder and

former medical director, Dr. Noorshina Virani and Dr. Nwa-

mara Dike. In addition to their strong background in pain

management and interdisciplinary rehabilitation, Drs. Bar-

ton and Virani contribute specific expertise in clinical bio-

mechanics, while Dr. Dike has shared her expertise from a

pain fellowship at Memorial Sloan-Kettering Cancer Centre

in New York. Dr. Dike has also participated in the newly

inaugurated Chronic Pain Inpatient Consultation Service

now available in all of Calgary’s hospitals.

The physiatrists work in the

Neuromusculoskeletal Pro-

gram alongside anaesthetists,

family practitioners and all

members of the rehabilitation

teams. They have many pa-

tients who are co-managed

with the gynaecologists and

neurologists of the Pelvic Pain

and Headache Programs.

They also participate in teach-

ing medical students, resi-

dents and fellows in family

practice, anaesthesiology,

psychiatry, physical medicine and rehabilitation and neu-

rology who rotate through the Centre.

During 2008, the physiatrists

contributed a total of 0.6 FTE,

completing 58 new patient

assessments and an additional

302 follow up visits on a total

of 162 unique patients. Due to

their competence in the inter-

disciplinary management of

complex patients, their

caseloads carry many of the

more complicated patients

referred to the Chronic Pain

Centre.

Highlights

Dr. Sean Dukelow started with the division on October

1, 2008 with his primary role as a clinical scientist. Clini-

cally he will do some EMG and stroke rehabilitation.

The division signed off on its Academic Alterative Rela-

tionship Plan as of December 1, 2008. This will allow ap-

propriate stable funding to permit the division to recruit

more staff and continue to develop an academic service.


! 67

Dr. Pamela Barton

Dr. Nwamara Dike

Dr. Noorshina Virani

Dr. Ken Lam

Division of Experimental NeurosciencesOverview

Division of Experimental Neuroscience (DEN) is the newest division of the department."Translational research in neu-

rological science and medical technology has been a major emphasis of the division since its inception. DEN currently

consists of 7 primary and 8 secondary members. Their research areas span from neurodegenerative diseases, move-

ment disorders to multiple sclerosis and medical devices. The research capacity of the division has grown significantly

with the creation of Hotchkiss Brain Institute and its disease-focused research programs. An important feature of the di-

vision is that almost all its members maintain meaningful and productive collaborations with clinicians or clinician scien-

tists within the department. Together they either hold shared research grant(s) and/or serve as co-supervisors of gradu-

ate students working on related research projects.

There are over"30 faculty, postdoctoral fellows, graduate students and support staff who are directly involved in DEN.

They work in state-of-the-art research facilities including the newly established Boone Pickens Center for Neurological

Science and Advanced Technologies." The Division of Neuroscience is rapidly growing, not only in terms of personnel

and research support, but in terms of national and international recognition of its research achievements." The divisional

members offer graduate studies in both clinical and basic neurosciences, year-round research projects for senior under-

graduates and summer research programs. The division also hosts a number of community-oriented educational events."

In 2008, DEN members played an increasingly active and leading role in many aspects of academic activities of the

department and HBI. These included the mentorship for junior faculties and clinician scientists; development and expan-

sion of different research programs; launching new research initiatives; recruitment and graduate student education.

Current Members

Head

Bin Hu, MD. Ph.D.

Sutter Professor in Parkinson’s Disease Research

Research: Sensorimotor cueing, deep brain stimulation and devices

Primary Members

Yong, Wee Ph.D.

Professor/AHFMR Scientist/CRC Chair in immunology

Research: neuroinflammation and neuroprotection of MS and spinal cord in-

jury.

Ousman, Shalina, Ph.D.

Assistant Professor

Research: neuroprotection in the immune system and potential therapies for

MS

Hulliger, Manuel. Ph.D.

Professor


! 68

Dr. Bin Hu

Research: Spinal Cord and Nerve Regeneration

Nguyen, Minh Dang Ph.D.

Assistant Professor / AHFMR Scholar / Investigator Brenda Strafford Chair in Alzheimer Re-

search: Cytoskeleton proteins in neurodegenerative disorders and aging.

Melvill Jones, Geoffrey (BA, MA, MB BCh (Cantab), FRSC (Canada), FRS (UK)

Research Professor

Research: Human Neurophysiology, Posture, Gait & Spatial Orientation

Tomanek, Boguslaw Ph.D.

Research Assistant Professor

Research: functional imaging, Neurorobotics and Stroke

Zhao, Zonghang MD

Research Assistant Professor

Research: Mechanisms of ischemic neuronal injury and cell death

Block, Edward B.sc

Senior electrical Engineer

Research: Diagnostic and training devices for patients with movement disorders

Secondary Members

Brown, Lenora Ph.D. (Neuropsychology

Kim, Sung-Woo Ph.D. (Oncology)

Eliasziw, Michael Ph.D. (Population Health)

Mitchell, Ross Ph.D. (Imaging)

Frayne, Richard Ph.D. (Imaging)

Poulin, Marc Ph.D. (Stroke)

Goodyear, Brad (Imaging)

Tuor, Ursula Ph.D. (Imaging)

Haffenden, Angela Ph.D. (Neuropsychology)

Whelan, Patrick Ph.D. (Spinal Cord Injury)

Achievements: Research

Ndel1 and neuroregeneration

In 2008 Dr. Nguyen and his collaborators reported an important discovery on the role of

Ndel1 in axonal regeneration. Ndel1 is an integrator and stabilizer of the cytoskeleton. It is

upregulated in crushed and transected sciatic nerve axons. Lasting in vivo formation of

Ndel1/Vimentin complex is associated with robust axon regeneration whereas silencing of

Ndel1 by siRNA severely reduced regeneration (see figure below).


! 69

Dr. Boguslaw Tomanek

Dr. Manuel Hulliger

Dr. Zonghang Zhao

Descending reticular network of the temporal lobe

Sensory association and parahippocampal cortex in the ventral temporal

lobe plays an important role in sensory object recognition, sensory cue proc-

essing and control of top-down attention. A commonly held view is that corti-

cal neurons have only one projection target. Contrary to this view, Hu lab dis-

covered that single layer V neurons from the ventral temporal lobe can inner-

vate multiple cortical and subcortical targets. This reticular network may allow

large scale synchrony to occur among multiple brain structures during senso-

rimotor cueing.

Matrix metalloproteinase and autoimmune encephalomyelitis

Several matrix metalloproteinase (MMP) members contribute to pathology

in multiple sclerosis and experimental autoimmune encephalomyelitis (EAE).

Dr. Young’s lab has found that MMP-12 transcripts increased with EAE, and

protein was localized to a subset of macrophages/microglia. The temporal ex-

pression of MMP-12 largely corresponded to that of cytokines, and IL-1! and

TNF-" promoted MMP-12 expression in cultured macrophages. They postu-

late that cytokine — MMP-12 interactions are important in the disease process

of EAE.

Gaitmeter and movement disorder assessment

Recent advances in chip technology has led to a new generation of miniature sensing de-

vices that are particularly suitable for gait and mobility assessment and rehabilitation train-

ing in clinical settings. GaitMeter™ is a prototype device developed by our medical device

lab. It utilizes miniature triaxial accelerator and gyroscope and system-on-the-chip tech-

nology to acquire high frequency gait and mobility data during long distance natural walk-

ing. The device, which is equipped with high speed wireless and video connectivity, has

significant cost advantage over existing technology. It is currently being tested in several

pilot trials.

Funding

During 2008 DEN members have obtained $1,417,000 external research funding. In addition, >$500,000 was ob-

tained in the form of external PI salary support and studentship/fellowship.

Infrastructure

Under the leadership of Dr. Bin Hu and with the support of HBI and DCN, over 400 square feet of research and office

space has been created at the T. Boone Pickens Center. The new research space has its unique configuration in that

animal laboratory is directly across the hall from clinical labs conducting deep brain stimulation and medical device re-

search in humans. Currently the new labs host 5 research projects involving collaborations between basic and clinician

scientists.


! 70

Silencing Ndel1 by siRNA reduces

lesion-conditioned neurite outgrowth in

DRG neurons PLoS ONE. 2008; 3(4):

Recruitment

Dr. Shalina Ousman is the newest recruitment of our division. Shalina obtained her Ph.D. from McGill University. She

joined MS program as an assistant professor after completing two consecutive postdoctoral training at Stanford Univer-

sity. She is interested in the endogenous protective mechanisms in the immune system and central nervous system and

how these mechanisms can be deployed as potential therapies for multiple sclerosis. Welcome Shalina!

Training and Education

Graduate Student Degree Awarded

NAME/SUPERVISOR DEGREE PROJECT TITLE

Adrien Tennet/Hu, B M.Sc Membrane Dynamics of Inferior Colliculus Neurons in the Young Rat

Steven Peters/Hu.B M.ScModulation of High Frequency Oscillations by Sleep-Like Frequencies

in the Anesthetized Rat: A Quantitative Analysis

Taylor Chomiak/Hu,B Ph.D.Posterior Temporal Association Cortex: A Comprehensive in vitro

Electrophysiological Study in Rats

Current Master and Ph.D. candidates and postdoctoral fellows

Callie Clark#

Lorraine Lau

Susobhan Sarkar

Gernot Neumayer

Camille Belzil # #

Dave Stirling

Viktor Skihar

Smriti Agrawal

Rowena Cua

Mengzhou Xue

Angelika Goncalves DaSilva

Gernot Neumayer

Axinia Döring

Susan Park

Trina Johnson

Hankyu Lee


! 71

2008 Educational UpdatesNeurology Residency Training ProgramIntroduction

The Neurology Residency Program prepares resi-

dents to become specialists in neurology during a five-

year period of study, which includes supervised clinical

and research experience and an academic program. The

academic program comprises

a weekly academic half-day

and daily educational rounds

and includes regular seminars

on ethics, communication

skills and evidence-based

medicine. Evaluation of resi-

dents and the program oc-

curs on a regular basis. The

Program Director and Com-

mittee manage all aspects of

the program, with the help of

a program administrator. All

members of the Division of

Neurology participate in resi-

dent education. The Neurol-

ogy Program has trained 25

neurologists since its incep-

tion in 1981.

Highlights

In 2008, the Neurology

Program grew to include 13

residents. Dr. Erin O’Ferrall

completed the program in

June, passed the Royal College examinations and

started a neuromuscular fellowship at McGill University.

Three PGY1 residents joined the program in July: Drs.

Janel Nadeau from Calgary, Ahmad Abuzinadah from

Saudi Arabia and Sankalp Bhavsar from London, Ontario.

Fifty residents from other disciplines, including internal

medicine, psychiatry, pediatric neurology, physiatry, neu-

rosurgery, ophthalmology and emergency medicine

completed neurology rotations in 2007-08. The11th an-

nual Rocky Mountain Basic Science Symposium was

held at Kananaskis in March, attracting 49 neurology and

neurosurgery residents from the 4 medical schools in the

Prairie Provinces. Guest

speakers included Drs.

Wendy Ziai (Johns Hopkins),

Mike Nicolle (U of Western

Ontario) and Raj Midha and

Greg Cairncross (U of Cal-

gary). The residency program

also hosted 3 visiting profes-

sors in 2008: Drs. Colin Chalk

(McGill), Tom Miller (McMas-

ter) and Chris Power (U of

Alberta). Reciprocal OSCE

examinations were mounted

with the University of Alberta

in November. The Amercian

Academy of Neurology

awarded Drs. Philippe Couil-

lard and Sam Chhibber resi-

dent travel scholarships to the

AAN meeting in Chicago. The

neurology residents voted Dr.

Lara Cooke winner of the A.

Keith W. Brownell Neurology

Teaching Award. Dr. William

Fletcher was awarded the

2008 Resident Well-Being Award by the Professional As-

sociation of Residents of Alberta.

Residents (2008-09)

Dr. Fatima Abdulla, PGY5

Dr. Mohammed Almekhlafi, PGY4


! 72

Neurology Residents2008-09

Sam Chhibber

Mohammed

Almekhlafi

Philippe Couillard Scott JarvisClaire Hinnell

Suresh SubramanianAylin Reid Katie Wiltshire

Bill FletcherProgram Director

Justyna SarnaJanel Nadeau

Sankalp BhavsarFatema Abdulla Ahmad

Abuzinadah

Mohammed

Alanazy

Dr. Sameer Chhibber, PGY4

Dr. Philippe Couillard, PGY4

Dr. Justyna Sarna, PGY4

Dr. Claire Hinnell, PGY3

Dr. Scott Jarvis, PGY3

Dr. Suresh Subramaniam, PGY3

Dr. Mohammed Alanazy, PGY2

Dr. Katie Wiltshire, PGY2

Dr. Ahmad Abuzinadah, PGY1

Dr. Sankalp Bhavsar, PGY1

Dr. Janel Nadeau, PGY1

Program Committee (2008-09)

Dr. William Fletcher (Program Director)

Dr. Fatima Abdulla (until June 2008)

Dr. Mohammed Almekhlafi (Chief Resident Jan -

June 2008)

Dr. Robert Bell (Resident Research Director)

Dr. Sameer Chhibber (Chief Resident July - Dec

2008)

Dr. Lara Cooke

Dr. Philippe Couillard (from Sept 2008)

Dr. Nathalie Jetté

Dr. Claire Hinnell (from Sept 2008)

Dr. Jean Mah

Dr. David Patry

Dr. Justyna Sarna (from Jan 2009)

Dr. Samuel Wiebe

Dr. Christopher White

Dr. Nic Weir

Program Administrator

Ms. Michelle Mills

CanMEDS Co-Ordinators

Communication Skills – Drs. Lara Cooke, Dawn

Pearson and Justyna Sarna

Ethics and Professionalism – Drs. A. Keith Brownell

and Philippe Couillard

Evidence-Based Neurology – Drs. Samuel Wiebe and

Nic Weir

Resident Publications (2008)

Almekhlafi MA, Hu WY, Hill MD, Auer RN. Calcifica-

tion and endothelialization of thrombi in acute stroke.

Ann Neurol. 200;64:344-8.

Almekhlafi MA, Fletcher WA. Levator palpebrae my-

ositis. Neurology 2008;71:1202

Teskey GC, Monfils MH, Flynn C, Young NA, van

Rooyen F, Henry LC, Ozen LJ, Henderson AK, Reid AY,

Brown AR." Motor maps, seizures, and behaviour. Can J

Exp Psychol. 2008; 62: 132-9.

Reid AY, Metcalfe A, Williams J, Patten S, Hinnell C,

Parker R, Wiebe S, Jetté N." Epilepsy is associated with

greater unmet health care needs compared to asthma,

diabetes or migraine despite higher health resource use -

A large national population-based study." Epilepsia (in

press).

V Puetz, I Dzialowski, M D Hill,"S Subramaniam, P N

Sylaja, A Krol, C O’Reilly, M E Hudon, W Y Hu, S B

Coutts, P A Barber, T W J Watson, J Roy, A M

Demchuk."Intracranial thrombus extent predicts clinical

outcome, final infarct size and hemorrhagic transforma-

tion in ischemic stroke: the Clot Burden Score."Int J

Stroke 2008;3:230-6.

S B Coutts, M D Hill, C R Campos, Y B Choi,"S

Subramaniam, J C Kosior, A M Demchuk."Recurrent

events in TIA and minor stroke: What events are happen-

ing and to which patients? Stroke 2008;39:2461-2466.

S B Coutts, M Eliasziw, M D Hill, J N Scott,"S

Subramaniam, A M Buchan, A M. Demchuk for the VI-

SION study group."An Improved Scoring System for

Identifying Patients at High Early Risk of Stroke and

Functional Impairment After an Acute Transient Ischemic

Attack or Minor Stroke."Int J Stroke. 2008; Feb 3: 3-10.


! 73

Dr. Mohammed Almekhlafi (right) enjoying snow-related ex-

tracurricular activities

Neurosurgery Residency Training ProgramStaff

Program Director: John Hurlbert

Assistant Program Director: John Wong

Research Director: Zelma Kiss

Program Administrator: Patti Sullivan

Number of PGY-1 CaRMS positions per year: 2

Accreditation: Royal College of Physicians and Surgeons of Canada

Length of Training: 6 years

Mandatory Research: 1 year

Overview

Education of our postgraduate and undergraduate students remains one of the highest priorities to the Department

of Clinical Neurosciences and the Division of Neurosurgery. The teaching faculty consists of a large complement of

young and dynamic key opinion leaders representing all subspecialties of Neurosurgery, including vascular, interven-

tional, glioma, skull base, epilepsy, functional, and peripheral nerve interests. In addition the University of Calgary boasts

the largest comprehensive Spinal Surgery program in Canada with a total of 8 full time spine surgeons coming from both

Neurosurgical and Orthopedic backgrounds. This year there were over 1900 neurosurgical admissions to the Foothills

Hospital and Alberta Children’s Hospital, almost all of which underwent a surgical procedure. In addition there were over

5000 visits to Neurosurgery clinics, 400 inpatient consultations, and 700 emergency room consultations.

There has been a stellar cast of visiting professors over the past year presenting on topics across the spectrum of

Neurosurgery from subarachnoid hemorrhage, meningomyelocele, primary gliomas, to cervical laminoplasty. At each of

these events in addition to the clinical and research expertise shared with the entire faculty by the honored guest, the

residents received the “inside story” through

one-on-one case presentations followed by an

evening of relaxed conversation over dinner

with the professor. Our guests included:

Dr. J. Sampson, Duke University (May, 2008)

Dr. R. Dempsey, University of Wisconsin (June,

2008)

Dr. H. Nakagawa, Aichi Medical University, Ja-

pan (Sept, 2008)

Dr. J. Jane, University of Virginia (Sept, 2008)

Dr. N. Barbaro, UCSF (Oct, 2008)

Dr. R. Dacey, Washington University, St. Louis

(Oct, 2008)

Dr. H. Rekate, Barrow Neurological Institute

(Dec, 2008)


! 74

Visiting professor Dr. R. Dacey (Madison, WI) guides the residents and

Dr. Midha through a neurosurgical tumor case scenario.

The residents have been continuously involved in research initiatives from the moment they entered the program.

Considerable resources are dedicated each year to facilitating this academic activity through faculty participation, exist-

ing peer-reviewed grants, project funding from Divisional and Departmental sources, and 12 months of mandatory clini-

cal or basic science research at the PGY-4 level. Resident publications from the past reporting period include:

Diaz RJ, Wong JH. Spinal arteriovenous fistula: a treatable cause of myelopathy. CMAJ [accepted for publication

May 2008]

Diaz RJ, Laughlin S, Nicolin G, Buncic JR, Bouffet E, Bartels U (2007) Assessment of chemotherapeutic response in

children with proptosis due to optic nerve glioma. Childs Nerv Syst. 2007Dec 22; [Epub ahead of print].

Gallagher CN, Hutchin- son PJA, Pickard JD. Neuro-

imaging in Trauma. Curr Opin Neurol

2007;20:403-407.

Grondin R, Hader W, MacRae E, Hamilton M. En-

doscopic versus microsurgi- cal resection of third ventri-

cle colloid cysts. Can J Neurol Sci

2007;34:197-207.

Sutherland GR, Kelly JJP. Ceramic aneurysm

clips for improved MR visualization. Neurosurgery. 2008

May;62(5 Suppl 2); ONS400- 5.

Chojnacki A, Kelly JJP, Hader WJ, Weiss S. Distinc-

tions between embryonic and adult human PDFG-

responsive neural precur- sors. Annals of Neurology.

2008 (in press).

Levy R, Lozano AM, Hutchison WD, Dostrovsky

JO. Dual microelectrode technique for deep brain

stereotactic surgery in humans. Neurosurgery

2007;60:4 Suppl 2, 277-284.

Levy R, Pitout J, Long P, Gill MJ. Late presentation of

Cryptococcus gattii menin- gitis in traveler to Vancouver

Island: a case report. Cana- dian Journal of Infectious

Diseases 2007;18:3, 197- 199.

Lwu S, Midha R. Clinical examination of brachial and

pelvic plexus tumors. Neurosurgical Focus, Current management of nerve tumors. 2007 June;22:6:E5.

Codd PJ, Mitha AP, Ogilvy CS. A recurrent cerebral arteriovenous malformation in an adult: Case report and review

of the literature. J neurosurg (accepted, in press)

Mitha AP, Wong JH, Lu JQ, Morris WF, Hudon ME, Hu WY. Communicating hydrocephalus after endovascular coiling

of unruptured aneurysms. J Neurosurg (accepted in press)

Wong JH, Mitha AP, Willson M, Hudon ME, Sevick R, Frayne R. Assessment of brain aneurysms after endovascular

coiling using high-resolution magnetic resonance angiography. J Neurosurg. 2007;107(2):283-289.

Mitha AP, Scott JN, George D, MacRae ME, Bell RB. Tumefactive demyelinating lesions. Canadian Journal of Neuro-

logical Sciences 2007;34(3):362-364.

Mitha AP and Ogilvy CS. Comment re: Edner G et al. The Stockholm 20 year follow-up of aneurysmal subarachnoid

hemorrhage. Neurosurgery. 2007;60:1023.


! 75

In addition, Friday morning “Neurosurgery School” runs each week for 2 hours after departmental Grand Rounds.

The curriculum circumnavigates the neurosurgical universe every two years. Sessions are led by the residents and su-

pervised by the faculty creating a learning environment within the realm of neurosurgical expert. Once monthly interac-

tive CanMeds seminars presented entirely from a neurosurgical perspective round off training of more subjective but

nonetheless important roles of Communicator, Collaborator, Advocate, Manager, Scholar, and Professional.

Team relationships outside the hospital are of equal importance to the Division of Neurosurgery as within the hospi-

tal. In addition to dinners with each of the visiting professors, journal club is hosted by a faculty member every three

months. Residents’ Night Out has become a favorite tradition where once every month or two faculty, Clinical Nurse

Practitioners, and students get together in a social setting to watch a hockey game, shoot some pool, bowl, drive go-

karts, play poker, or just sit around and watch people. Once a year this transforms into an entire day when the Division

sets off to the Rocky Mountains for a day of skiing.

In summary this year has been characterized by a rich blend of clinical, academic, research, and social activity. For

2009 it only looks better...


! 76

Dr. Zelma Kiss (right) finishes her hearty helping of rabbit food while Patti Sulli-

van (residency program administrator) politely laughs at her joke.

Physical Medicine & Rehabilitation Residency Training ProgramProgram Director

Dr. John Latter

Residents:" "

Drs. Lee Burkholder, Chantel Debert, Darren Gumbs, Arun Gupta, Jaime Yu, Andrew Willmott, Dr. Brian Rambarans-

ingh, Dr. Gentson Leung, Dr. Evan Kwong

Program Administrator

Linda Jennett

In 2008, the University of Calgary Physical Medicine and Rehabilitation Residency Training Program commenced its

fifth year. There are now 9 residents in the program. In 2008 we received two residents through the CaRMS match and

one resident transferred from another University of Calgary program. The division formally applied for two base positions

to commence in 2009 and the division was successful so as of July 2009 there will be two base positions each year.

The program has developed

a very active academic half day

for residents.

The Residency Training

Committee meets monthly (ex-

cept July and August) and the

Program Director has formal

biannual meetings with each

resident and informally more

frequently.

The Physical Medicine and

Rehabilitation Residency Train-

ing Program has residents from

rheumatology, neurosurgery and

neurology and orthopaedic sur-

gery rotating through the pro-

gram.

In September of 2008 we

commenced a weekly Senior

Medical Resident Clinic under

the supervision of Dr. Stephanie

Plamondon


! 77

Dr. Evan Kwong

(PGY-1)

Dr. Lee Burkholder

(PGY-5)

Dr. Darren Gumbs

(PGY-5) Dr. Jaime Yu (PGY-

4)

Dr. Brian Ramba-

ransingh (PGY-2)

Dr. Andrew Willmott

(PGY-2)Dr. Chantel Debert

(PGY-3)

Dr. Arun Gupta

(PGY-5)

Undergraduate Medical Education in Clinical NeurosciencesOverview

Medical students are taught about the neurosciences

in the first course of the second year of the undergradu-

ate curriculum. The course is provided over an eight

week period at the beginning of the second year in the

three-year curriculum. The neurosciences component of

the course is combined with content from geriatrics, oto-

laryngology and ophthalmology to give ‘Course V – Neu-

rosciences, Aging and Special Senses’. The course is

given under the auspices of the Undergraduate Medical

Education office of the Faculty of Medicine at the Univer-

sity of Calgary.

The neurosciences content in the course begins with

a presentation of the functional anatomy and physiology

required to approach patients who present with neuro-

logical complaints. The remainder of the course covers

clinical presentations of neurological illness as well as

sessions devoted to specific neurological conditions.

The course is taught by approximately 130 teachers,

including 60 from the Department of Clinical Neurosci-

ences. The content of the course is delivered via a com-

bination of lectures, patient presentations, small group

seminars and bedside teaching sessions.

The course is developed and administered by the

Course V Committee, co-chaired by Dr. Kevin Busche

from the Division of Neurology. The majority of the course

committee members are from the Department of Clinical

Neurosciences.

The course is always well received by the students

and is consistently ranked highly in comparison to the

other courses offered in the pre-clerkship curriculum.

Course V Committee 2008

Kevin Busche (Co-Chair)

Darren Burback (Co-Chair)

David Patry (Evaluations Coordinator)

Jeff Joseph

Paolo Federico

Sarah Furtado

Gary Klein

Cory Toth

Walter Hader

James Scott

Colin Powell

Chandrasekaran Sivakumar

Karin Verstraten

Vivian Hill

Beth Lange

Daryl Wile

Janel Nadeau

Tim Ramos


! 78

Even the clinical clerks get their hands wet in the operating

theatre. Visiting medical Student Teresa Langan (London ON)

assists Dr. Raoul Pope (neurosurgical spine fellow) with a com-

plex spinal decompression.

Fellowship ProgramOverview

The Department of Clinical Neurosciences has been fortunate to be able to attract fellows from a wide variety of

backgrounds seeking further subspecialty experience. Their presence has enriched the clinical and academic environ-

ment for all. Pictured below are some of our recent fellows.


! 79

Aleksa Cenic, Spinal

Neurosurgery Fellow

Raoul Pope, Spinal

Neurosurgery Fellow

Sohail Bajammal,

Spinal Neurosurgery

Fellow

Abdel Hamid Seiam,

Epilepsy Neurology

Fellow

Lawrence Korngut,

Neuromuscular Fel-

low

Nan Shobha, Stroke

Neurology Fellow

Jacob Alant, Periph-

eral Nerve Surgery

Fellow

Paula de Robles,

Neuro-Oncology Fel-

low

2008 Publications1. Abdullah AR, Smith EE, Biddinger PD, Kalenderian D, Schwamm LH. Advance hospital otification by EMS in acute stroke is

associated with shorter door-to-computed tomography time and increased likelihood of administration of tissue-

plasminogen activator. Prehosp Emerg Care. 2008;12:426-431.

2. Addas BMJ, Midha R. Nerve transfers for severe nerve injuries. Spinner R, Winfree C (eds) Neurosurgical Clinics North Amer-

ica, 20: 27-38, Dec 2008. doi:10.1016/j.nec.2008.07.018.

3. Almekhlafi MA, Fletcher WA. "Levator palpebrae myositis. Neurology. 71:1202, 2008.

4. Almekhlafi MA, Hu WY, Hill MD, Auer RN. Calcification and endothelialization of thrombi in acute stroke. Ann Neurol.

200;64:344-8.

5. Alcalay RN, Smith EE. MRI Showing White Matter Lesions and Multiple Lobar Microbleeds in a Patient with Reversible En-

cephalopathy. J Neuroimaging. 2008

6. Antel J, Arnold D, Bhan V, Bar-Or A, Bakker J, Bell B, et al." The use of disease-modifying agents in multiple sclerosis—by

the Canadian Network of MS Clinics." Can J. Neurol Sci. 2008; 35(2):127-32.

7. Armstrong L, Graham GE, Schimke RN, Collins DL, Kirse DJ, Costello F, Ardinger HH. The Hunter-MacDonald syndrome

with expanded phenotype including risk of meningioma: an update and review. Am J Med Genet A. 2008 Jan 1: 146 (1):

83–92.

8. Auer RN, Dunn JF, Sutherland GR. Hypoxia and related conditions. In: S Love, DN Louis and DW Ellison (eds), Greenfield’s

Neuropathology Eighth Edition. Edward Arnold (Publishers) Limited, London, 1:64-119, 2008.

9. Becker WJ. Headache progress in Canada over the decades. Headache 2008; 48: 678 – 679

10. Becker WJ, Purdy RA. Medication Overuse Headache In Canada. Cephalalgia 2008; 28: 1218-1220

11. Berg A, Langfitt J, Vickrey B, Wiebe S. “Postoperative Follow-up: Outcome Measurement”. In: Epilepsy. Engel,J.,Jr.;

Pedley,T.A. Lippincott Williams & Wilkins, Philadelphia, 2008;Volume II:1929-1937

12. Bristow MS, Poulin BW, Simon JE, Hill MD, Kosior JC, COUTTS SB, Frayne R, Mitchel JR, Demchuk AM (2008). Modeling

Infarct Growth in Acute Ischemic Stroke with MR Imaging. J Magn Reson Imaging; 28:837-846.

13. Brown R, Zlatescu M, Sijben A, Roldan G, Easaw J, Forsyth P, Parney I, Sevick R, Yan E, Demetrick D, Schiff D, Cairncross

JG, Mitchell R. Detecting Genetic Signatures in Oligodendroglioma Non-Invasively Using MR. Clinical Cancer Research 14:

2357-2362, 2008.

14. Busche K, Morrish WF." Sphenoid Sinus Mucocele – Rupture Causing Brainstem

Inflammation and Stroke." Can J Neurol Sci, 34: 381-385, 2008.

15. Brussee V, Guo GF, Dong YY, Cheng C, Martinez JA, Smith D, Glazner GW, Fernyhough P, Zochodne DW. Distal degenerative

sensory neuropathy in a long term type 2 diabetes rat model. Diabetes 57(6):1664-73, 2008.

16. Burneo JG, Tellez-Zenteno J, Steven DA, Niaz N, Hader W, Pillay N, Wiebe S. Adult-onset epilepsy associated with dyem-

bryoplastic neuroepithelial tumors. Seizure 2008;17(6):498-504

17. Casha S, Yong W, Midha R. Minocycline administration for nerve repair: a double edged sword. Commentary. Exp Neurol,

213: 245-248, 2008. DOI information: 10.1016/j.expneurol.2008.06.016

18. Cheng C, Webber CA, Wang J, Xu YQ, Martinez JA, Liu WQ, McDonald D, Guo GF, Nguyen MD, Zochodne DW. Activated

RHOA and peripheral axon regeneration. Experimental Neurology 212(2):358-69, 2008

19. Chou SH, Smith EE, Badjatia N, Nogueira RG, Sims JR, 2nd, Ogilvy CS, Rordorf GA, Ayata C. A randomized, double-blind,

placebo-controlled pilot study of simvastatin in aneurysmal subarachnoid hemorrhage. Stroke. 2008;39:2891-2893.

20. Claassen J, Jetté N, Chum F, Green R, Schmidt M, Choi H, Frontera JA, Connolly ES, Emerson RG, Mayer SA and Hirsch

LJ." Electrographic seizures and periodic discharges after intracerebral hemorrhage." Author reply." Neurology." 2008 Feb 14.

21. Costello F, Hodge W, Pan YI, Metz L, Kardon R. Retinal Nerve Fiber Layer and Future Risk of Multiple Sclerosis. Canadian

Journal of Neurological Sciences 2008 Sept 35: 482-487.


! 80

22. Costello F, Hodge W, YI Pan, Eggenberger, E, and Kardon R. Retinal Nerve Fiber Layer Changes after Optic Neuritis: A Pro-

spective Study with Optical Coherence Tomography. Mult Scler 2008 Aug;14 (7):893-905

23. Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan, AM, Demchuk AM for the VISION study group). An im-

proved Scoring System for Identifying Patients at High Early Risk of Stroke and Functional Impairment After an Acute Tran-

scient Ischemic Attack or Minor Stroke. International Journal of Stroke. 2008 3(1):3-10.

24. Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Koisor JC, Demchuk AM; for the VISION study group. Recurrent

events in Transcient Ischemic Attack and Minor Stroke: What Events are Happening and to Which Patients? Stroke

2008;39(9):2461-6.

25. Coutts SB, Hill MD, Herrera C, Choi YB, Koisor J, Subramaniam S, Demchuk AM for the VISION Study group (2008). Recur-

rent events in TIA and minor stroke: What events are happening and to which patients? Stroke. 39:2461-2466.

26. Cucchiara BL, Tanne D, Dem- chuk AM, Levine SR, Kasner SE. A risk

score to predict intracranial hemorrhage after rt-PA for acute ischemic

stroke. J Stroke Cerebrovasc Dis. 2008 Nov-Dec; IT(6):331-3.

27. Cunningham CJB, Zaamout MF, Goodyear BG, Federico P. Simultaneous

EEG-fMRI in human epilepsy. Canadian Journal of Neurological Sci-

ences 2008,35:420-435.

28. Delaney L, Chambers C, Roldan G, De Robles P, Cairncross G, Forsyth P,

Easaw J. A feasibility study to assess the integration of a pharmacist

into neurooncology clinic. J Oncol Pharm Pract. 2008 Nov 26. [Epub

ahead of print]

29. Demchuk AM, Gupta R, Khatri P. “Emerging Therapies.” In: Miller AE,

Marr CM, William MA (Eds) Con- tinuum, Lifelong Learning in Neurology,

American Academy of Neurol- ogy Vol. 14, Number 6, December 2008.

St. Paul, MN:Lippincott Williams & Wilkins. 2008:76-93.

30. Demchuk AM, Khan F, Hill MD, Barber PA, Silver B, Patel S, Levine SR

for the NINDS rtPA Stroke Study Group. Importance of Leukoaraiosis on

CT for Tissue Plasminogen Acti- vator Decision Making: Evaluation of the

NINDS rt-PA Stroke Study. Cerebrovasc Dis 2008; 26(2):120-5.

31. Demchuk AM, Khan F, Hill MD, Barber PA, Silver B, Patel S, Levine SR.

Importance of Leukoaraiosis on CT for Tissue Plasminogen Activator De-

cision making: Evaluation of the NINDS rt-PA Stroke Study. Cerebrovas-

cular Diseases 2008;26(2):120-125

32. de Robles P, McIntyre J, Kalra S, Roldan G, Cairncross G, Forsyth P,

Magliocco A, Hamilton M, Easaw J. Methylation status of the MGMT

gene promoter in meningiomas. Cancer Genet Cytogenet 187: 25-27,

2008.

33. Drabycz S, Mitchell JR, “Texture Quantification of Medical Images Using a Novel Complex Space-Frequency Transform” The

International Journal of Computer Assisted Radiology and Surgery, DOI: 10.1007/s11548-008-0219-4, 2008

34. Fallah A, Grochmal J, Lu J-Q, diFrancesco L, Khalil M, Clark A, Midha R. Nodular fasciitis presenting in the obturator nerve

and gracilis muscle. Peer Reviewed Letter. Can J Neurol Sci, 35(1):111-114, March 2008.

35. Federico P, Alqahanti S, Myers RP. Possible new clinical sign of hyperammonemia. Canadian Medical Association Journal

2008: 178:326.

36. FitzMaurice E, Wendell L, Snider R, Schwab K, Chanderraj R, Kinnecom C, Nandigam K, Rost NS, Viswanathan A, Rosand J,

Greenberg SM, Smith EE. Effect of statins on intracerebral hemorrhage outcome and recurrence. Stroke.

2008;39:2151-2154.

37. Fletcher WA. Eye signs in patients with parkinsonism: do they predict the development of multiple system atrophy?" Nature

Clin Pract Neurol. 4:540-1, 2008


! 81

Statue of Hippocrates in University of

Calgary Health Sciences Centre

38. Forsyth PA, Roldan G, George D, Wallace C, Palmer C, Morris DG, Cairncross G, Vallee Matthews M, Markert J, Gillespie GY,

Coffey M, Thompson B, Hamilton M. A phase I trial of intratumoral (i.t.) administration of reovirus in patients with histologi-

cally confirmed recurrent malignant gliomas (MGs). Molecular Therapy. 16: 627-632, 2008.

39. Frohman EM, Costello F, Stuve O, Calabresi P, Miller DH, Hickman SJ, Sergott R, Conger A, Salter A, Krumwiede KH, Froh-

man TC, Balcer L, Zivadinov R. Modeling axonal degeneration within the anterior visual system: implications for demon-

strating neuro-protection in multiple sclerosis. Arch Neurol. 2008 Jan; 65(1): 26 – 35

40. Giannini C, Burger PC, Berkey BA, Cairncross JG, Jenkins RB, Mehta M, Curran WJ, Aldape K.Anaplastic oligodendroglial

tumors: refining the correlation among histopathology, 1p 19q deletion and clinical outcome in Radiation Therapy Oncology

Group trial 9402. Am J Surg Pathol 18: 360-369, 2008.

41. Giovannoni G, Barbarash O, Casset-Semanaz F, King J, Metz L, Pardo G, Simsarian J, Soelberg Sørensen P, Stubinski B; on

behalf of the Rebif® New Formulation Study Group. Safety and immunogenicity of a new formulation of interferon beta-1a

(Rebif® New Formulation) in a Phase IIIb study in patients with relapsing multiple sclerosis: 96-week results. Multiple Sclero-

sis Mult Scler. 2008 Aug 28. [Epub ahead of print]

42. Goodman AD, Brown TR, Cohen JA, Krupp L, Shapiro R, Schwid SR, Cohen R, Marinucci LN, Blight AR for the Acorda-F202

Study Investigators. Dose comparison trial of sustained-release fampridine in multiple sclerosis. Neurology. 2008 Oct

7;71(15):1134-41. Epub 2008 Jul 30

43. Gorlia T, van den Bent MJ, Hegi ME, Mirimanoff RO, Cairncross G, EisenhauerE, Belanger K, Brandes AA, Allgeier A, La-

combe D, Stupp R. Nomograms for predicting survival of patients with newly diagnosed glioblastoma multiforme: a prog-

nostic factor analysis of EORTC/NCIC trial 26981-22981/CE.3. Lancet Oncol 9: 29-38, 2008.

44. Green TL, Mansoor A, Newcommon N, Stephenson C, Steward E, Madden B, Hill MD. Reliability of Point-of-Care Testing of

INR in Acute Stroke: a comparison with hospital laboratory testing. Can J Neurol Sci 2008; Jul;35(3):348-51

45. Greer AD, Newhook P, Sutherland GR. Human-machine interface for Robotic Surgery and Stereotaxy. IEEE/ ASME Transac-

tions on MRI Compatible Mechatronic Systems 13: 355-361, 2008

46. Greenberg SM, Grabowski TJ, Gurol ME, Skehan ME, Nandigam RNK, Becker JA, Garcia-Alloza M, Prada C, Frosch MP,

Rosand J, Viswanathan A, Smith EE, Johnson KA. Detection of isolated cerebrovascular beta-amyloid with Pittsburgh com-

pound B. Ann Neurol. 2008;64:587-591.

47. Hader WJ, Walker RL, Myles TM, Hamilton MG. Complications of endoscopic third ventriculostomy in previously shunted

patients. Neurosurgery 63 [ONS Suppl 1]: ONS170–ONS177, 2008

48. Hauck LJ, White C, Feasby TE, Zochodne DW, Svenson LW, Hill MD Incidence of Guillain-Barré syndrome in Alberta, Can-

ada: an administrative data study. J Neurol Neurosurg Psychiatry. 2008 Mar; 79(3):318-20

49. Hegi M, Murat A, Migliavacca E, Gorlia T, Lambiv W, Shay T, Hamou M-F, Diserens A-C, Luca R, Wick W, Kouwenhoven M,

Hainfellner J, Heppner F, Dietrich P-Y, Zimmer Y, Macdonald D, Guha A, Merlo A, Cairncross G, de Tribolet N, Janzer R-C,

Domany E, Delorenzi M, Stupp R. Self-renewal signature" and high EGFR expression associated with resistance to chemo-

radiotherapy inglioblastoma. J Clin Oncol 26: 3015-3024, 2008.

50. Holland CM, Smith EE, Csapo I, Gurol ME, Brylka DA, Killiany RJ, Blacker D, Albert MS, Guttmann CR, Greenberg SM. Spa-

tial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Stroke.

2008; 39:1127-1133

51. Hurlbert J, Hamilton MG. Methylperednisolone for acute spinal cord injury: 5-year practice reversal. Canadian Journal of

Neurological Sciences 35: 41-45, 2008.

52. Iloreta A, Sarna J, Sharma P, Klein G. Radiologic findings in a patient with spinal cord dysfunction.Can J Neurol Sci (Suppl 1)

May 2008 p S89

53. Jetté N, Marson AG, Hemming K, Hutton JL. Topiramate add-on for drug-resistant partial epilepsy." Cochrane Database Syst

Rev." Cochrane Database Syst Rev. 2008 Jul 16;3:CD001417.

54. Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders- a national population-

based study. Headache 2008; 48: 501 – 516.

55. Jetté N, Quan H, Faris P, Dean S, Li B, Fong A and Wiebe S." Health resource use in epilepsy:" disparity between aboriginals

and non-aboriginals." Epilepsia." 2008 Apr;49(4):586-93." Epub 2007 Dec 28.


! 82

56. Jetté N, Williams J, Patten S, Becker W and Wiebe S." Psychiatric comorbidities in migraine patients – a population based

study." Headache." 2008 April;48(4):501-516." Epub 2007 Dec 7.

57. Jovin TG, Demchuk AM, Gupta R. “Pathophysiology of Acute Ischemic Stroke.” In: Miller AE, Marr CM, William MA (Eds)

Continuum, Lifelong Learning in Neurology, American Academy of Neurology Vol. 14, Number 6, December 2008. St. Paul,

MN:Lippincott Williams & Wilkins. 2008:29-44.

58. Kawchuk G, Gian SJ, Hurwitz EL, Wynd S, Haldeman S, Hill MD. Spatial distribution of vertebral artery dissections in cases

associated with and without cervical manipulation. J Neurol 2008; 255(3): 371-377

59. Kemp SWP, Walsh S, Midha R. Growth factor and stem cell enhanced conduits in peripheral nerve regeneration and repair.

Neurol Res, 30(10): 1030-1038, December 2008.

60. Khatri P, Hill MD, Palesch Y, Spilker J, Jauch E, Carrozzella J, Demchuk

A, Martin R, Mauldin P, Dillon C, Ryckborst K, Janis S, Tomsick T, and

Broderick J for the IMS III Inves- tigators. Methodology of the Interven-

tional Management of Stroke (IMS) III Trial. Int J Stroke 2008; 3(2): 130-

137

61. Khatri P, Hill MD, Carrozzella JA, Demchuk AM, Martin R, Mauldin P, Dillon

C, Ryckborst KJ, Janis S, Tom- sick TA, Broderick JP, for the IMS III Inves-

tigators. Methodology of the Interventional Management of Stroke

Study III. Int J. Stroke 2008: 3:130-137.

62. Khosravani H, Mehrotra N, Rigby M, Hader WJ, Pinnegar CR, Pillay N,

Weibe S, Federico P, Spatial lo- calization and tie-dependant changed of

electrographic high frequency oscillations in human temporal lobe epi-

lepsy. Epilepsia. 2008 Aug 19 [Epub ahead of print}

63. Kim DH, Midha R, Murovic JA and Spinner RJ. Kline and Hudson: Nerve

Injuries. 2nd Ed, Saunders (El- sevier), Philadelphia, PA, 2008.

64. Kiss ZHT, Anderson TR: Cellular mechanisms of action of therapeutic brain

stimulation, Chapter 2 in Bronz- ino JD and DiLorenzo DJ (Eds): Neuroen-

gineering, CRC Press / Taylor and Francis Group, Boca Raton, chapt 2,

pp 2.1-2.20, 2008.

65. Langfitt J T, Wiebe S. Early surgical treatment for epilepsy. Curr Opin

Neurol 2008; 21(2):179-183.

66. Mason W, Cairncross JG. The expanding impact of molecular biology on

the diagnosis andtreatment of glioma. Neurology 71: 365-373, 2008.

67. Mauldin P, Simpson K, Palesch Y, Spilker J, Hill MD, Khatri P, Broderick J,

for the IMS III Investigators De- sign of the Economic Evaluation for the

Interventional Management of Stroke Trial. Int J Stroke 2008; 3(2): 138-

144

68. Mayer GS, Vrscay ER, Lauzon ML, Goodyear BG, Mitchell JR, “Self-

Similarity of Images in the Fou- rier Domain, with Applications”, Springer-

Verlag Lecture Notes in Computer Science: Image Analysis and Recognition, Campilho A, Kamel M (Eds), 5112:43-52, 2008

69. Midha R and Zager E, Editors: Surgery of Peripheral Nerves: A Case-Based Approach. New York, Thieme, 2008.

70. Mohile NM, Forsyth P, Stewart D, Raizer JJ, Paleologos N, Kewalramani T, Louis DN, Cairncross JG, Abrey LE. A phase II

study of intensified chemotherapy alone as initial treatment for newly diagnosed anaplastic oligodendroglioma: An interim

analysis. J Neuro-Oncol 89: 187-194, 2008. J. Neurooncol. (epub May 6, 2008

71. Murphy BD, Fox AJ, Lee D, Sahlas D, Black S, Hogan M, COUTTS SB, Demchuk AM, Goyal M, Symons S, Gulka I, Beletsky

V, Pelz D, Lee TY (2008). White Matter Thresholds for Ischemic Penumbra and Infarct Core in Patients with Acute Stroke: CT

Perfusion Study.: A CT Perfusion study. Radiology; 247:818-825.


! 83

ResolutionMD for iPhone, courtesy of

Dr. Ross Mitchell (iCORE/Calgary Sci-

entific Inc.

72. Murphy BD, Fox AJ, Lee DH, Sahlas DJ, Black SE, Hogan MJ, Coutts SB, Demchuk AM, Goyal M, Aviv RI, Symons S, Gulka

IB, Beletsky V, Pelz D, Chan RK, Lee TY. White matter thresholds for ischemic penumbra and infarct core in patients with

acute stroke: CT perfusion study. Radiology. 2008;247(3):818-825.

73. Murphy W." VNS Therapy. CJNS July 2008 Vol 35 No 3, pp 278-279.

74. O'Connor P, Devonshire V; Canadian Network of MS Clinic (Patry DG). The use of disease-modifying agents in multiple

sclerosis-by the Canadian Network of MS Clinics.

75. Can J Neurol Sci. 2008 May;35(2):127-32. English, French""

76. Patten SB, Williams JVA, Lavorato DH, Modgill G, Jetté N and Eliasziw M." Major depression as a risk factor for chronic dis-

ease incidence: longitudinal analyses in a general population cohort. J Hosp Psych." 2008 Sept-Oct;30(5):407-13

77. Patten SB, Williams JV, Metz L. Antidepressant Use in Association with Interferon and Glatiramer Acetate Treatment in Multi-

ple Sclerosis. Mult Scler. 2008 Apr;14(3):406-11. Jan 31 [Epub ahead of print

78. Polman C, Kappos L, Freedman MS, Edan G, Hartung HP, Miller DH, Montalbán X, Barkhof F, Selmaj K, Uitdehaag BM,

Dahms S, Bauer L, Pohl C, Sandbrink R; for the BENEFIT investigators**. Subgroups of the BENEFIT study: Risk of develop-

ing MS and treatment effect of interferon beta-1b. J Neurol. J Neurol. 2008 Apr; 255(4):480-7.

79. Polman CH, Reingold SC, Barkhof F, Calabresi PA, Clanet M, Cohen JA, Cutter GR, Freedman MS, Kappos L, Lublin FD,

McFarland HF, Metz LM, Miller AE, Montalban X, O’Connor PW, Panitch H, Richert JR, Petkau J, Schwid SR, Sormani MP,

Thompson AJ, Weinshenker BG, Wolinsky JS. Ethics of Placebo-Controlled Clinical Trials in Multiple Sclerosis: A Reas-

sessment. Neurology 2008 Mar 25; 70(13 Pt2): 1134-40.

80. Potucek RK, Kemp SWP, Syed NI and Midha R. Peripheral nerve injury, repair and regeneration. In: Strategies in Regenera-

tive Medicine: Integrating Biology with Materials Design, ed. Matteo Santin, Springer, 2008, ISBN 978-0-387-74659-3.

81. Pringsheim T, Davenport WJ, Dodick D. Evidence Based Review: Acute Treatment and Prevention of Mentrually Related

Migraine Headache. Neurology 2008:70:1555-1563.

82. Pringsheim T, Lang A, Kurlan R, Pearce M, Sandopr P. Understanding Disability in Tourette Syndrome. Development Medi-

cine and Child Neurology, 2008 Oct 24, Epub ahead of print.

83. Pringsheim T, Marras C, Pimozide for tics in Tourette Syndrome (Protocol). Cochrane Database of Systemaatic Reviews

2008: Isue I, Art. No: CD006996. DOI: 10.1002/14651858. CD006996.

84. PRoFESS Study Group. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J. Med. 2008 Sep

18;359(12):1225-37.

85. PRoFESS Study Group. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and temisartan on disabil-

ity and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively

Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008 Oct;

7(10):875-84.

86. Puetz V, Dzialoski I, Hill MD, Subramaniam S, Sylaja PN, Krol A, Hudon M, , Hu WY, Coutts SB, Barber PA, Watson T, Roy J,

Demchuk AM for the Calgary CTA study group (2008). Intracranial thrombus extent predicts the clinical outcome, final infarct

size and hemorrhagic transformation in ischemic stroke: the clot burden score. "International Journal of Stroke. 3:230-236

87. Puetz V, Gahn G, Becker U, Mucha D, Mueller A, Weir NU, Wiedemann B, von Kummer R. AJNR 2008;29:273-280 Endovas-

cular therapy of symptomatic intracranial stenosis in patients with impaired regional cerebral blood flow or failure of medical

therapy.

88. Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O’Reilly C, Barber PA, Sharma P, Goyal

M, Gahn G, von Kummer R, Demchuk AM (2008). Extent of hypoattenuation on CT angiography source images predicts

functional outcome in patients with basilar artery occlusion. Stroke;39:2485-2490.

89. Reid A, Jetté N, Quan H, Hill M and Wiebe S." Using administrative databases for research in epilepsy:" Validation of ICD-9

and ICD-10 epilepsy codes." Neuroconnections Symposium." Banff, AB, January 2008 (chapter in meeting book).

90. Roldán G, Brasher P, Vecil , Senger D, Rewcastle B, Cairncross G, Forsyth P*, Hamilton M. Population-based study of me-

dulloblastoma: outcomes in Alberta from 1975 to 1996. Can J Neurol Sci 35:210-5, 2008.


! 84

91. Roldan G, de Robles P, Cairncross JG. Searching for a new treatment for anaplastic oligodendroglioma. In: New Treatment

for Brain Cancer (International Oncology Updates Series). Ed. C Bala#á Quintero. Permanyer, Barcelona, Spain, 2008, pp 11-

27.

92. Roldan G, Li H, Brasher P, Vecil G, Senger D, Rewcastle B, Cairncross G, Forsyth P, Hamilton M. A population-based study

of Medulloblastoma: Outcomes in Alberta from 1975-1996. Canadian Journal of Neurological Sciences 35: 210-215. 2008

93. Roldán G, Scott JN, George D, Easaw J, Yan E, Parney I, Cairncross G, Forsyth P. Leptomeningeal disease from oligoden-

droglioma: a clinical and molecular analysis. Can J Neurol Sci 35: 204-209, 2008.

94. Rosenthal ES, Schwamm LH, Roccatagliata L, COUTTS SB, Demchuk AM, Schaefer PW, Gonzalez RG, Hill MD, Halpern EF,

Lev MH (2008). Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanali-

zation" Model. AJNR. Am J Neuroradiol ;29:1471-1475.

95. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM,

Rosand J. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke.

2008;39:2304-2309.

96. Rubin ZA, Wiebe S. “Social Issues: Issues in Health Outcomes Assessment. In: Epilepsy. Engel,J.,Jr., Pedley,T.A. Lippin-

cott Williams & Wilkins, Phila- delphia, 2008;Volume III:2267-2275

97. Sauro KM, Becker WJ. Mul- tidisciplinary treatment of headache in

the Canadian healthcare setting. Can J Neurol Sci 2008;35: 46 –

56

98. Saposnik G, Fang J, O’Don- nell M, Hachinski V, Kapral MK, Hill MD

on behalf of the Investigators of the Registry of the Canadian Stroke

Network (RCSN) for the Stroke Outcome Research Canada

(SORCan) working group. Escalating levels of Access to in-

hospital care and Stroke Mor- tality. Stroke 2008; Sep;39(9):2522-30.

99. Saposnik G, Hill MD, O’Don- nell M, Fang J, Hachinski V, Kapral MK,

on behalf of the investigators of the Registry of the Canadian Stroke

Network for the Stroke Out- come Research Canada (SORCan)

Working Group. Comparing variables associated with 7-day, 30-day

and 1-year fatality after ischemic stroke . Stroke 2008,

Aug;39(8):2318-24

100.Saqqur M, Tsivgoulis G, Mo- lina CA, Demchuk AM, Garami Z, Bar-

reto A, Spengos K, Forteza A, Mikulik R, Sharma VK, Brunser A, Mar-

tinez P, Montaner J, Kohrmann M, Schellinger PD, Alexandrov AV; CLOTBUST-PRO Investigators. Design of a PROspective

multi-national CLOTBUST collaboration on reperfusion therapies for stroke (CLOTBUST-PRO). Int J Stroke. 2008

Feb;3(1):66-72.

101.Sarna JR, Iloreta A, Sharma P, Klein G. Neuroimaging features of cerebellar venous infarct: a case report and review of litera-

ture. Can J Neurol Sci (Suppl 1) May 2008 p S105

102.Schmahmann JD, Smith EE, Eichler FS, Filley CM. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehav-

ioral correlates. Ann N Y Acad Sci. 2008;1142:266-309.

103.Sherman E, Griffiths SY, Akdag S, Connolly MB, Slick DJ, Wiebe S. Sociodemographic correlates of health-related quality of

life in pediatric epilepsy. Epilepsy & Behaviour 2008;12(1):96-101.

104.Sijben AE, McIntyre JB, Roldán GB, Easaw JC, Yan E, Forsyth PA, Parney IF, Magliocco AM, Bernsen H, Cairncross JG. Tox-

icity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neuro-Oncol 89: 97-103, 2008.

105.Smith EE, Vijayappa M, Lima F, Delgado P, Wendell L, Rosand J, Greenberg SM. Impaired visual evoked flow velocity re-

sponse in cerebral amyloid angiopathy. Neurology. 2008;7:1424-1430.

106.Smith EE, Egorova S, Blacker D, Killiany RJ, Muzikansky A, Dickerson BC, Tanzi RE, Albert MS, Greenberg SM, Guttmann

CR. Magnetic resonance imaging white matter hyperintensities and brain volume in the prediction of mild cognitive impair-

ment and dementia. Arch Neurol. 2008; 5: 4-100.


! 85

107.Smith EE, Dreyer P, Prvu-Bettger J, Abdullah AR, Palmeri G, Goyette L, McElligott C, Schwamm LH. Stroke center designa-

tion can be achieved by small hospitals: the Massachusetts experience. Crit Pathw Cardiol. 2008;7:173-177.

108.Speechley KN, Sang X, Levin S, Zou GY, Eliasziw M, Smith ML, Camfield C, Wiebe S. Assessing severity of epilepsy in chil-

dren: preliminary evidence of validity and reliability of a single-item scale. Epilepsy Behav 2008;13:337-342.

109.Sutherland CS, Hill MD, Kaufmann AM, Silvaggio J, Demchuck AM, Sutherland GR. Recombinant Factor VIIa plus Surgery

for Intracerebral Hemorrhage. Can J Neurol Sci 35:567-572, 2008.

110.Sutherland GR, Kelly JJP, Boehm DW, Klassen JB. Ceramic aneurysm clips for improved MR visualization. Neurosurg 62

[ONS Suppl 2]: 400-406, 2008.

111.#Sutherland GR, Newhook P, Feil G, Fielding T, Greer AD, Latour I. An image-guided MR compatible surgical robot. Neuro-

surgery 62: 286-293, 2008

112.Sutherland GR, Tyson RL, Auer RN. Truncation of the Krebs Cycle During Hypoglycemic Coma. Medicinal Chemistry

4:379-385, 2008.

113.Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM; VISION Study Group. When to expect negative diffusion weighted im-

ages in stroke and transcient ischemic attack. Stroke 2008:39(6):1898-1900

114.Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM for the VISION Study Group (2008). Diffusion weighted MRI negative

stroke and TIA-when to expect it? Stroke; 39:1898-1900.

115.Sylaja PN, Puetz V, Dzialowski I, Krol A, Hill MD, Demchuk AM. Prognostic Value of CT Angiography in Patients with Sus-

pected Vertebrobasilar Ischemia. J Neuroimaging. 2008 Jan; 18 (1):46-49

116.Tellez-Zenteno JF, Hunter G, Wiebe S. Injuries in people with self-reported epilepsy: a population-based study. Epilepsia

2008;49:954-961

117.Tellez-Zenteno JF, Wiebe S. Long-term seizure and psychosocial outcomes of epilepsy surgery. Curr Treat Options Neurol.

2008;10:253-259.

118.Tomsick T, Broderick J, Carrozella J, Khatri P, Hill MD, Palesch YY, Khoury J, for IMS II Investigators. Revascularization re-

sults in IMS II, AJNR 2008; Mar;29(3):582-587

119.Toth C. Epidemiology of Neurological Sports Injuries, Neurologic Clinics, February 2008, 26(1):1.31.

120.Toth C. Neuroepidemiology of Sports Injury, Trauma and Neurology, 2nd edition, Oxford Press, London, Chapter 25, 479-524

121.Toth C. Peripheral Nerve Injuries in Sports and Recreation, Neurologic Clinics, February 2008, 26(1): 89-113.

122.Toth C, Au S. A prospective identification of neuropathic pain in specific peripheral neuropathy syndromes and response to

pharmacological therapy. Pain 2008 Sep 15;138(3):657-66.

123.Toth C, Lee HK, Samuels BA, Shim SY, Liu WQ, Martinez J, Xu Y, Ayala R, Wang J, Zochodne D, Tsai L and Nguyen MD.

Ndel1 promotes axon regeneration via intermediate filaments, PLOS One, 2008 Apr 23;3(4):e2014.

124.Toth C, Martinez JA, Chen YY, Diggle J, Fang Q, Ramji N, Hoke A, Zochodne DW. Local erythropoietin signalling enhances

regeneration in peripheral axons, Neuroscience, 2008;154(2):767-83

125.Toth C, Rong LL, Yang C, Martinez J, Song F, Ramji N, Brussee V, Liu W, Durand J,Nguyen MD, Schmidt AM, Zochodne DW.

RAGE and experimental diabetic neuropathy. Diabetes. 2008 Apr; 57(4):1002-17.

126.Toth C, Shim SY, Wang J, Jiang Y, Neumayer G, Liu W-Q, Martinez J, Zochodne D, Nguyen. MD. Ndel1 promotes axon re-

generation via intermediate filaments. PLoS ONE 3(4):e2014,2008

127.Viswanathan A, Patel P, Rahman R, Nandigam RN, Kinnecom C, Bracoud L, Rosand J, Chabriat H, Greenberg SM, Smith EE.

Tissue microstructural changes are independently associated with cognitive impairment in cerebral amyloid angiopathy.

Stroke. 2008;39:1988-1992

128.Wang LM, Rahn JJ, Lun X, Sun B, Kelly JP, Weiss S, Robbins SMR, Forsyth PA*, Senger DL*. Intramembrane Proteolysis of

the p75 Neurotrophin Receptor (p75NTR) is required for Glioma Invasion. PLoS Biol., 6: 2496-2511, 2008. .

129.Webber CW, Xu YQ, Vanneste KJ, Martinez JA, Verge VM, Zochodne DW. Guiding adult mammalian sensory axons during

regeneration. Journal of Neuropathology and Experimental Neurology 67(3): 212-22, 2008

130.Weir NU, A neurological letter from Calgary, Canada. Practical Neurology 2008;8:128-132

131.Weir NU. An update on cardioembolic stroke. Postgraduate Medical Journal 2008;84:133-142

132.Weir NU, Dennis MSA triumph of hope and expediency over experience and reason?JNNP 2008;79:852


! 86

133.Wiebe S. “Organization of Health Care in Different Countries: Canada”. In: Epilepsy. Engel,J.,Jr.; Pedley,T.A. Lippincott

Williams & Wilkins, Philadelphia, 2008;Volume III:2859-2863.

134.Wiebe S. Why do some patients have seizures after brain surgery while others do not? A comment on the evidence. In:

Puzzling Cases of Epilepsy, Second Edition. Schmidt D and Schacter S (eds). Elsevier Inc Academic Press 2008:494-496.

135.Wiebe S, Tellez-Zenteno J, Shapiro M. An evidence based approach to the first seizure. Epilepsia 2008;49(Suppl 1):50-57

136.Wirrell E, Kozlik S, Tellez J, Wiebe S, Hamiwka L. Ambulatory electroencephalography (EEG) in children: diagnostic yield and

tolerability. J Child Neurol. 2008;23:655-662

137.Wu Y*, Lun XQ*, Zhou H, Sun B, Bell JC, Barrett J, McFadden G, Biegel JA, Senger DL,

138.Forsyth, PA. Oncolytic efficacy of recombinant vesicular stomatitis virus (VSV$M51) and myxoma virus in experimental

models of malignant rhabdoid tumours. Clinical Cancer Research 14:1218-27, 2008.

139.Xu QG, Midha R, Martinez JA, Guo GF, Zochodne DW. Facilitated sprouting in a peripheral nerve injury. Neuroscience

152(4):877-87,2008

140.Xue M, Fan Y, Liu s, Zygun D, Demchuk A, Yong VW. Contributions of multiple proteases to neurotoxicity in a mouse model

of intracerebral hemorrhage.” Brain 2008: Sept 4 [Epub ahead of print]

141.Zhang Y, Metz LM, Yong VW, Bell RB, Yeung M, Patry DG, Mitchell JR. Pilot study of minocycline in relapsing-remitting mul-

tiple sclerosis. Can J Neurol Sci. 2008 May;35(2):185-191

142.Zhu H, Hill MD. Risk Adjustment using the Elixhauser Index by ICD-9-CM and ICD-10 for Stroke Case Fatality. Neurology

2008; Jul 22;71(40);283-287

143.Zochodne DW. Diabetic polyneuropathy. An update. Current Opinion in Neurology 21(5):527-33. 2008

144.Zochodne DW, Ramji N, Toth C. Neuronal targeting in diabetes mellitus: a story of sensory neurons and motor neurons. Neu-

roscientist. 2008 Aug;14(4):311-8.


! 87

List of MembersGeographic Full-Time Academic Staff! ! !

Barber Philip Assistant Professor Neurology

Becker Werner Professor Neurology

Brownell Keith Professor Neurology

Cairncross Gregory Professor Neurology

Casha Steven Assistant Professor Neurosurgery

Cooke Lara Assistant Professor Neurology

Coutts Shelagh Assistant Professor Neurology

Demchuk Andrew Associate Professor Neurology

Dukelow Sean Assistant Professor Physiatry

Feasby Tom Professor Neurology

Federico Paolo Assistant Professor Neurology

Fletcher William Professor Neurology

Forsyth Peter Professor Neurology

Gallagher Clare Assistant Professor Neurosurgery

Hader Walter Assistant Professor Neurosurgery

Hagen Neil Professor Neurology

Hamilton Mark Associate Professor Neurosurgery

Hill Michael Associate Professor Neurology

Hu Bin Professor Scientist

Hulliger Manuel Professor Scientist

Hurlbert R. John Associate Professor Neurosurgery

Jette Nathalie Assistant Professor Neurology

Kiss Zelma Associate Professor Neurosurgery

Latter John Professor Physiatry

Metz Luanne Professor Neurology

Midha Rajiv Professor Neurosurgery

Nguyen Minh Dang Assistant Professor Scientist

Ousman Shalina Assistant Professor Scientist

Parney Ian Assistant Professor Neurosurgery

Smith Eric Assistant Professor Neurology

Starreveld Yves Assistant Professor Neurosurgery

Stys Peter Professor Neurology

Suchowersky Oksana Professor Neurology

Sutherland Garnette Professor Neurosurgery

Toth Cory Assistant Professor Neurology

Wiebe Samuel Professor Neurology

Wong John Assistant Professor Neurosurgery

Yong Wee Professor Scientist

Zochodne Douglas Professor Neurology


! 88

Major Clinical Staff! ! !

Barton Pamela Clinical Associate Professor Physiatry

Bell Robert Clinical Associate Professor Neurology

Busche Kevin Clinical Assistant Professor Neurology

Costello Fiona Clinical Assistant Professor Neurology

Davenport Jeptha Clinical Assistant Professor Neurology

Dike Nwamara Clinical Assistant Professor Physiatry

Du Plessis Stephan Clinical Assistant Professor Neurosurgery

Eloff Arnolda Clinical Assistant Professor Neurology

Furtado Sarah Clinical Assistant Professor Neurology

Hanson Alexandra Clinical Assistant Professor Neurology

Hoyte Keith Clinical Associate Professor Neurology

Klassen Brian Clinical Assistant Professor Neurology

Klein Gary Clinical Associate Professor Neurology

Kraft Scott Clinical Assistant Professor Neurology

Lam Kenneth Clinical Assistant Professor Physiatry

MacRae Elizabeth Clinical Associate Professor Neurosurgery

McGovern Christine Clinical Associate Professor Physiatry

McGowan Daniel Clinical Associate Professor Physiatry

Murphy William Clinical Associate Professor Neurology

Patry David Clinical Associate Professor Neurology

Pearson Dawn Clinical Assistant Professor Neurology

Pillay Neelan Clinical Associate Professor Neurology

Plamondon Stephanie Clinical Assistant Professor Physiatry

Pringsheim Tamara Clinical Assistant Professor Neurology

Ranawaya Ranjit Clinical Associate Professor Neurology

Virani Noorshina Clinical Assistant Professor Physiatry

Weir Nicolas Clinical Assistant Professor Neurology

White Christopher Clinical Associate Professor Neurology

Yeung Michael Clinical Assistant Professor Neurology

Watson Timothy Clinical Assistant Professor Neurology

Clinical Staff! ! !

Hill Denise Clinical Assistant Professor Physiatry

Kohli Jagdeep Clinical Assistant Professor Neurology

McNeil Stephen Clinical Assistant Professor Physiatry

Ubhi Perminder Clinical Assistant Professor Physiatry

Wilson Scott Clinical Assistant Professor Neurology

Professor Emeritus

LeBlanc Francis Professor Emeritus Neurosurgery

Lee Robert Professor Emeritus Neurology

Myles Terence Professor Emeritus Neurosurgery


! 89


2008 Visitors & HighlightsJanuary• 1st annual Spine & Peripheral Nerve Anatomy

& Surgery Course

• Dr. Colin Chalk, Neurology, McGill University

• Dr. Lorne Zinman, Neurology, University of

Toronto

February• Dr. Thomas A. Miller, Physical Medicine & Re-

habilitation, University of Western Ontario

• Dr. Marc del Bigio, Pathology, University of

Manitoba

March• Dr. Susan Fox, University of Toronto

• Douglas Cheyne, PhD, Medical Imaging, Uni-

versity of Toronto

• Dr. Helen Mayberg, Psychiatry and Neurology,

Emory University School of Medicine

April• Dr. John H. Sampson, Division of Neurosurgery,

Duke University

May• Dr Alim-Louis Benabid, Professor Emeritus,

Universitaire Joseph Fourier, Grenoble, France

• Robert Chen, Division of Neurology, University

of Toronto

• Ronald R. Tasker, Professor Emeritus, Division

of Neurosurgery, University of Toronto

June• Charles Taylor Memorial Lecture: Dr. Robert

J. Dempsey, Department of Neurological Sur-

gery, University of Wisconsin • Dr. Nina Paleologos, Professor of Neurology,

Northwestern University

July

• Welcome new resident housestaff

August• 2nd annual Epilepsy Golf Tournament

September• Dr. Hiroshi Nakagawa, Aichi Medical University,

Japan

• Dr. John Jane, Department of Neurological

Surgery, University of Virginia

October• Mary Anne Lee Memorial Lecture: Dr. Nicho-

las M. Barbaro, Department of Neurological

Surgery, University of California at San Fran-

cisco

• Dr. Ralph Dacey, Department of Neurosurgery,

Washington University – School of Medicine

• Dr. David Mcdonald, Sloan-Kettering Institute

November• Dr. Chris Power, Department of Medicine, Uni-

versity of Alberta

• Dr. Eric C. Holland, Department of Neurosur-

gery, Surgery, Neurology & Cancer Biology for

Genetics, Memorial Sloan Kettering Cancer

Center, New York

• Dr. Sandra E. Black, Brill Chair in Neurology,

University of Toronto

December• Dr. Michael Schlossmacher, Division of Neuro-

sciences – OHRI, University of Ottawa

• Dr. Harold L. Rekate, Chief of Paediatric Neu-

rosciences, Barrow Neurological Institute,

Phoenix

• Annual Christmas Rounds - a departmental

tradition!

2008 dcns annual report

Documents