2010 dcns annual report
DESCRIPTION
The 2010 Department of Clinical Neurosciences Annual Report, Alberta Health Services and University of Calgary.TRANSCRIPT
2010 ANNUAL REPORT
The expansion of neurological services to the new South Health Campus, slated to open in 2012, is just one of many examples of growth in Clinical Neurosciences in the last decade. Story on page 8.
2 Department / Division Overviews The Department of Clinical Neurosciences is dedicated to building excellence in clinical care, education, and research.
10 Excellence in Clinical Care From the world’s first robotic arm for micro- neurosurgery to nationally accredited clinical programs, we continue to push the boundaries in neurological and rehabilitative clinical care.
32 A Passion for Teaching Great teachers are instrumental in shaping our education and career choices. Dr. Lara Cooke is one of many DCNS faculty members making a difference - continuing to build excellence in education for the clinical neurosciences in Calgary.
34 Excellence in Education Within the Department of Clinical Neurosciences, we actively support education initiatives through Undergraduate Medical Education, graduate and post-graduate training, residency, and fellowships.
36 Training the Clinician Scientist Through a combined MD/PhD from the Leaders in Medicine Program at the University of Calgary’s Faculty of Medicine, Sarah Walsh is part of a new wave of students studying medicine and science.
38 Stem Cells Unlock Brain Tumour For over six years, Dr. John Kelly has been exploring the relationship between stem cells and brain cancer to dispel the mystery surrounding this illness.
40 Music Therapy in Disease Treatment Through a multifaceted approach to Parkinson’s Disease treatment, Dr. Bin Hu and his team are trying to find out if music could be the key to relieving symptoms for his patients.
43 Excellence in Research Advances in patient care and commitment to research go hand in hand. Members of DCNS are involved in basic, translational, clinical trials, health services, and population health research.
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Message from the Department HeadBuilding ExcellenceThe last nine years have been a time of tremendous change for the Department of Clinical Neurosciences (DCNS). We have grown strategically -- building and fostering an environment that promotes and values excellence in all aspects of clinical care, education, and research.
Again in 2010, DCNS provided exemplary neurosurgical, neurological, and rehabilitative care to the citizens of the Calgary Zone of Alberta Health Services and to others from across southern
Alberta. We also provided important emergency and complex neurological care to adults and children from Saskatchewan and British Columbia who were in need of our services.
This year we finalized planning for a phased opening of DCNS at the new South Hospital in Calgary. In the spring of 2012, ambulatory services in general neurology, EEG and EMG, together with an urgent care clinic, will begin. Twelve months later, when the emergency room and intensive care unit are open, the in-patient
unit at the Rockyview General Hospital (RGH) will also be transferred to the South Health Campus. Discussions are underway to provide in-house physician services in rehabilitation medicine at the new hospital, and in the near future, neurosurgical care will also be delivered at that location. Dr. Chris White has been appointed Chief of Clinical Neurosciences at the South Health Campus and together, he and I will oversee patient care services and develop important teaching and research programs in the clinical neurosciences.
Dr. Greg Cairncross,Head, Department of Clinical Neurosciences,University of Calgary and Alberta Health Services.
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$3 Million for Stroke ResearchDr. Andrew Demchuk is the first recipient of the Heart and Stroke Foundation Chair in Stroke Research at the University of Calgary’s Faculty of Medicine. The award winning stroke neurologist will use the gift to provide leadership in stroke research - helping the university develop, attract and retain talented people, strengthening capacity for leading edge research.
“Stroke remains an extremely challenging disease with few effective treatments,” says
Demchuk, an Associate Professor in DCNS and Co-leader of the Stroke and Vascular Dementia Program at the HBI. “But we are making a difference. Neuroimaging has advanced dramatically and is simplifying the disease. There is a need to build upon the Faculty’s main international strength in the area of stroke image analysis using MRI, CT and ultrasound.”
The $3 million endowment for the Heart and Stroke Foundation Chair in Stroke Research was established with $1.5 million in funding from the Foundation and a $1.5 million matching donation.
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“The Canada Research Chair funding will allow us to provide new knowledge that is necessary in planning for the health care needs of those with brain conditions, and as a result, improve their health and wellbeing.”
Dr. Andrew Demchuk is a neurologist and Associate Professor for DCNS. He is also Director of the Calgary Stroke Program.
Dr. Nathalie Jetté is an Assistant Professor in the Departments of Clinical Neurosciences and Community Health Sciences.
We are justly proud and most committed to high performance in our care of the sick, but the educational and research missions of Clinical Neurosciences is thriving too. Our reputation as leaders, innovators, and scholars in the clinical brain sciences continues to grow. Dr. Jetté, a neurologist and clinical researcher was named a top 40 under 40 Calgarian, and both she and Dr. Wee Yong were nominated by the University of Calgary for Canada Research Chairs in health services and multiple sclerosis research, respectively. Once again, our trainees in neurosurgery, neurology and rehabilitation excelled at the national examinations held by the Royal College of Physicians and Surgeons of Canada and our faculty members competed successfully for national research funding and national awards.
Like all high performing groups, people continue to be our most valuable asset. And, like all high performing groups we are constantly trying to improve ourself through the recruitment of new faculty from all across North America. For example, In 2010, several outstanding medical experts in rehabilitation joined Clinical Neurosciences. Dr. Vincent Gabriel, a specialist in trauma and burn rehabilitation, was recruited from the University of Texas Southwestern Medical Center in Dallas (story on page 29) and Dr. Rodney Li Pi Shan, a generalist clinician with expertise in medical education, joined us from the University of Saskatchewan. Also in 2010, Dr. Chester Ho, Chief of the Spinal Cord Injury Service at the Stokes VA Hospital and Case Western University in Cleveland, was recruited
Calgary to be the new Head of the Section of Physical Medicine & Rehabilitation in DCNS. Dr. Ho developed an award-winning program in telehealth to support rehabilitation care in rural Ohio.
I hope you enjoy our 2010 Annual Report.
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DIVISION OF NEUROSURGERYHead, Dr. Rajiv Midha
Overview
The Division of Neurosurgery at the University of Calgary (U of C) and Alberta Health Services (AHS) continues to strive to create a world-class institution known for excellence in neurosurgical education, research, and clinical care.
Unlike most other Canadian medical schools and large quaternary level hospitals where neurosurgery would be placed organizationally within a Division of Surgery, Calgary has developed a Department of Clinical Neurosciences. Within this unique framework, the Division of Neurosurgery works alongside its partners in Neurology and Physical Medicine and Rehabilitation to create a greater co-ordination of academic and clinical activity across the broad spectrum of brain, spine, nerve, pain, muscle and movement disorders that afflict our patients.
Clinical Care
The Division of Neurosurgery 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 Region through the Foothills Medical Centre (FMC) and Alberta Children’s Hospital (ACH).
The level of clinical service delivered by Calgary’s neurosurgical community is comprehensive, and is built around the qualities of excellence, competence, quality, safety, and innovation. The roll-out of the Alternate Relationship Plan for Neurosurgery (in 2001, and renewed in 2008) has fostered a mechanism of timely, appropriate transfer of cases to neurosurgical subspecialties - skull-base surgery, paediatrics, peripheral nerve disease, cerebrovascular and endovascular neurosurgery, epilepsy, functional neurosurgery, and stereotactic radiosurgery - thereby allowing the highest quality of care for each and every patient.
Education
Division members strongly contribute to education at undergraduate, graduate, and post-graduate levels. The neurosurgical residency program accreditation was achieved in 2009 without probation and the number of residents has increased to 15 in 2010/11. Locum Tenens positions are provided for neurosurgeons to transition from residency to full-time staff in a structural and rigorously controlled environment.
Research
Clinical and/or science research is conducted by all full-time faculty members, five of whom run externally-funded research programs. This includes funding for research programs associated with electronic axon interface, sensory cueing, nanomedicine, stroke therapy, deep brain stimulation, spinal cord injury biomarkers, nerve regeneration, and molecular imaging, to name a few.
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Dr. Rajiv Midha, Division Head of Neurosurgery and Professor for the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services.
2010 Highlights:
The Calgary Neurosurgery physician manpower plan established a target of 14.0 FTEs (achieved as of January 2010).
As of March 31, 2010, the AARP included 15 neurosurgeons. The recruitment strategy is designed to achieve the appropriate number and type of sub-specialists to lead innovations and deliver the clinical and academic service.
Clinic, day surgery, and emergency department visits to neurosurgery exceeded 7,500 2009/2010 -- an increase of over 20% from 6,000-6,200 visits in 2007/08-2008/09 at FMC. An additional 900 out-patient visits were encountered by neurosurgeons at the Alberta Children’s Hospital (ACH) site.
An increase in the number of surgical cases to 2,020 in 2009/10 was observed. Neurosurgeons used fewer beds, but increased in-patient discharges to 1,969 by reducing length of stay. Overall, ALOS was 90% of expected stay, and over the three-year AARP evaluation period, this saved an equivalent of 7.6 bed years.
Five nurse practitioners have been trained and are now being utilized to their full scope of practice, improving neurosurgeon productivity, quality of patient care, and efficiency on the health system as a whole.
A physician extender has been employed to screen and triage hundreds of referrals for spine problems, to improve access to neurosurgical assessments for those who need it most and identifying non-surgical management cases earlier in the process.
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DIVISION OF NEUROLOGYHead, Dr. Samuel Wiebe
Overview
Comprised of 47 neurologists, the Division of Neurology in the Department of Clinical Neurosciences (DCNS) provides neurological clinical care to the population of southern Alberta, southwestern Saskatchewan, and southeastern British Columbia.
The interests and level of specialization vary among division members with a breadth of expertise that enables excellence in clinical care, health administration, research, and education. The Division consists of nine specialty programs: Cognitive Disorders, Epilepsy, Headache, Movement Disorders, Multiple Sclerosis, Neuromuscular Disorders, Neuro-oncology, Neuro-ophthalmology and Stroke. Each of these programs is engaged in content-specific research, education and clinical care. In addition, urgent neurological care is provided through the urgent neurology clinic.
Through well-established links with basic science researchers in the Hotchkiss Brain Institute (HBI), and with health services and population health research through the Department of Community Health Sciences and the newly formed Calgary Institute of Population and Public Health, each of these programs thrives clinically and academically -- through participation in a broad variety of research areas, and through the training of the next generation of post-doctoral clinical and research fellows.
Research
Clinical research in the Division of Neurology is thriving. The Neurosciences Clinical Research Unit (CRU story, page 44) continues to provide support for investigator-initiated research. The expansion of data and project management capabilities, new platforms, and additional personnel, allow us to serve the wide range of needs of neurosciences researchers.
In addition, investigator-initiated research this year received substantial national funding for projects involving the disciplines of health services, clinical trials, cohort studies, and the creation of disease specific registries.
Education
This year our Division members continued to excel academically. They obtained numerous external salary awards and operational research grants from national and international organizations, authored extensive peer reviewed scientific publications, delivered keynote lectures at international scientific meetings, and received several teaching awards.
The Division joins other department members every Friday at Clinical Neurosciences Grand Rounds. In addition, individual programs hold numerous teaching and research sessions throughout the week, providing a rich and valuable source for in-depth learning in diverse areas of clinical neurology.
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Dr. Samuel Wiebe, Division Head of Neurology and Professor for the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services.
2010 Highlights:
The Division’s Alternate Relationship Plan underwent a successful external review and received accolades for the following accomplishments: expansion of clinical services, increase of 20% in publications and 48% in research funding, increase in undergraduate and postgraduate education, and development of 36 clinical care innovation projects.
Stroke Accreditation – The Calgary Stroke Program was one of two centres in Canada to earn Stroke Services Distinction from Accreditation Canada -- awarded to health organizations that meet or exceed the best standards of stroke care.
Development of a central triage system for patient referrals to the various out-patient programs in Neurology.
Further expansion of the new cognitive neurosciences clinic led by Eric Smith.
Development and Implementation of Quality improvement measurements for patient safety and care in the Seizure Monitoring Unit at the Foothills Medical Centre.
Creation of a national neuromuscular disease registry led by Dr. Lawrence Korngut.
Neurology Program initiatives at South Health Campus through the leadership of Dr. Chris White.
Further expansion of ambulatory and EEG-EMG services at the Rockyview General Hospital.
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DIVISION OF PHYSICAL MEDICINE AND REHABILITATIONActing Head, Dr. Christine McGovern
Overview
From mobility and communication, to emotional concerns and activities of daily living, rehabilitation addresses all spheres of life. Within theDepartment of Clinical Neurosciences (DCNS), University of Calgary and Alberta Health Services, the Division of Physical Medicine and Rehabilitation provides local and regional clinical rehabilitation programs (out-patient and in-patient) to the people of southern Alberta, southeastern British Columbia, and southwestern Saskatchewan. Through collaboration with our interdisciplinary team of health professionals, we aim to enhance and restore functional ability and quality of life to those with physical impairments or disabilities – to achieve their goals, to optimize functional independence, and to increase participation within their communities. Together with the Divisions of Neurology and Neurosurgery, we provide the whole spectrum of clinical care, from acute and chronic management of medical conditions to rehabilitative care.
Clinical Care
Our comprehensive and diverse programs include rehabilitation services for adults and children with stroke, spinal cord injury, acquired brain injury, amputation, musculoskeletal problems, pain, burns and spasticity. We continue to strive to meet the needs of the population we serve. Currently, we provide in-patient and out-patient services at Foothills Medical Centre and Alberta Children’s Hospital; out-patient services at the Chronic Pain Centre and community clinics; and consultative services at the Peter Lougheed Centre, Rockyview General Hospital, and Carewest facilities such as the Dr. Vernon Fanning Centre. We look forward to further program expansion in 2011.
Research and Education
We actively support education and research initiatives both within our Division, and across the sphere of DCNS, through:Undergraduate Medical Education, graduate and postgraduate training, residency, and relevant clinically based research programs. Our residency program now accepts two residents per year, and we have nine residents at present.
2010 marked a great year for PM&R research at the University of Calgary. There was a significant increase in research funding from different sources, including the Canadian Institutes of Health Research, Heart and Stroke Foundation of Alberta, Alberta Innovates – Health Solutions, Rick Hansen Institute, Robertson Fund, and the Canadian Paraplegic Association (Alberta). Drs. Dukelow, Hill and McGowan all had active research funding.
The second annual provincial PM&R Resident Research Day was held in Calgary in association with the Alberta Physiatry Association Annual Meeting on October 1, 2010. Dr. Hermano Igo Krebs from the Massachusetts Institute of Technology presented his researchon the use of upper limb robotic devices for treatment following stroke. Our resident, Brian Rambaransingh, won the Best Research Project award for his study combining neuroimaging and robotic assessment techniques.
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Dr. Christine McGovern, Acting Division Head of Physical Medicine and Rehabilitation and Clinical Associate Professor for the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services.
In January, the second annual Education Retreat was held by the Division and
Residency training program in PM&R to provide staff and residents dedicated time to review the residency training programand faculty teaching, to brainstorm changes and formulate an action plan. Actions items included several collaborative upgrades to core rotations and improved evaluation methods and tools.
2010 Highlights:
Dr. Jaime Yu, our finishing resident published her resident research project in the journal PM&R.
Dr. Sean Dukelow won the Dr. John Latter Award for Excellence in Teaching, and had two publications in Neurorehabilitation and Neural Repair.
Drs. Noorshina Virani and Pamela Barton presented in multiple national meetings on musculoskeletal pain conditions in 2010.
Recruited four new physiatrists to the Division (below), increasing our total to18 and allowing us to further expand the scope of our services:
• Dr. Arun Gupta (a graduate of our residency program) joined us in August of 2010. He completed a Spine Fellowship at the Hospital for Special Surgery in New York City. He plans to enhance our programs in musculoskeletal rehabilitation.
• Dr. Vincent Gabriel (story page 29) joined us in early October and is collaborating with the Department of Surgery to develop a brand new program in burn and trauma rehabilitation.
• Dr. Lee Burkholder, another graduate of our residency program, completed fellowship training in Paediatric Rehabilitation at the University of Alberta in Edmonton. He joined us in October.
• Dr. Rodney Li Pi Shan joined us in December to work with the Brain Injury Rehabilitation Program. He was Assistant Professor and Residency Program Director of PM&R at the University of Saskatchewan. He is an Executive Committee Member and the Chair of the Neuromuscular Special Interest Group at the Canadian Association of PM&R.
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DIVISION OF EXPERIMENTAL NEUROSCIENCESHead, Dr. Bin Hu
Overview
Established in 2007, the Division of Experimental Neurosciences(DEN) in the Department of Clinical Neurosciences (DCNS) currently consists of five primary and five secondary members. Research areas span from neurodegenerative diseases and movement disorders, to multiple sclerosis and specialized medical device development. Almost all members within DEN maintain meaningful and productive collaborations with clinicians or clinician scientists within the Department, in addition to our partners in the Hotchkiss Brain Institute (HBI), University of Calgary and Alberta Health Services.
Research
The Department of Clinical Neurosciences is rapidly growing -- not only in terms of personnel and research support, but in the national and international recognition of its research achievements. Over 15 post-doctoral fellows, graduate students, and support staff are directly involved in the research conducted by DEN faculty members. In addition to this, our members continue to work in state-of-the-art research facilities, including the newly established Boone Pickens Centre for Neurological Science and Advanced Technologies.
Education
DEN members offer graduate studies in both clinical and basic neurosciences, year-round research projects for senior undergraduates, and summer research programs. Division members are also active participants in community-oriented educational events.
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Dr. Bin Hu, Division Head of Experimental Neurosciences and Professor for the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services.
2010 Highlights:
Dr. Minh Dang Nguyen:- Awarded a 5-year CIHR operating grant - Awarded a 2-year AIHS operating cancer grant (~255 000$) - Trainees received Alberta Innovates Health Sciences doctoral Scholarship, Queen Elizabeth II Scholarships, the William Davies Scholarship, and the Frank Ramsay Neuroscience Research Award.
Dr. Shalina Ousman:- Awarded a Canada Foundation for Innovation (CFI) Leaders Opportunity Fund - Awarded a Government of Alberta Advanced Education and Technology Small equipment grant program (SEGP)- Trainees received T. Chen Fong Studentship, Multiple Sclerosis Society of Canada Studentship, and a Alberta Innovates-Health Solutions Studentship
Dr. Bin Hu (story, page 40):- Awarded a 2-year CIHR operating grant- Awarded two team development grants from the CIHR- Awarded the Dr. Morton Shulman Achievement Award from Parkinson’s Society of Canada-Trainees received the Killam studentship, the NSERC studentship, and a Canadian Graduate Student Award.
Left: Mr. Boone Pickens
Housed in the Hotchkiss Brain Institute (HBI) at the Faculty of Medicine, the Boone Pickens Centre for Neurological Science and Advanced Technologies brings together Canada's top brain researchers to conduct neurological and biomedical engineering research.
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CLINICAL CARE
Dr. Chris White is aClinical Associate Professor for the Department of Clinical Neurosciences. He will also be the new Chief of Clinical Neurosciences at the South Health Campus when it opens in 2012.
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New South Health Campusbuilding excellence in clinical careby Léora Rabatach
From Alzheimer’s disease to stroke and Epilepsy, neurological diseases, disorders and injuries represent one of the leading causes of disability in the Canadian population and cost the economy over 9 billion a year.
As a nationally recognized leader in Clinical Neurosciences care, Calgary has experienced tremendous demand for services to treat these diseases in recent years. With existing urban health care facilities at capacity, the new South Health Campus is one of many improvements intended to address this need.
“The layout of this new hospital takes neurological services to a new level by bringing specialized teams of nurses, allied health care professionals, and neurologists together in one place – truly supporting team-based care,” says Dr. Chris White, a clinical associate professor for the Department of Clinical Neurosciences and Site Chief of Neurology at the Rockyview General Hospital in Calgary.
For the last few years Dr. Chris White has worked to expand neurological programs in the south side of the city. Through his leadership, the Rockyview has grown to encompass nine neurologists and an in-patient service -- an almost impossible feat within the limited space imposed by the walls of the existing three hospital sites.
Now, along with colleagues Drs. Greg Cairncross and Samuel Wiebe, White is leading the team designated to develop and implement neurological programs and services at the new South Health Campus. When the initial phase of construction is completed in early 2012, the South Health Campus will encompass a diversity of care from urgent neurology, to services to promote research and education of
health care professionals for the future.
“At the South Health Campus, in-patient and out-patient units are located side by side,” says Dr. White. “ Combined with a new organizational structure and care given by multi-disciplinary teams, this new hospital allows us to support the patient
through the entire continuum of care - from admission through to discharge to the community - all in one centralized location.”
“The cross-pollination from both in-patient and out-patient worlds will also create the perfect training ground for the next generation of clinicians to develop expertise across the spectrum of care,” adds White.
“In healthcare today, as in other industries, change is continual, sweeping through at a rate that is staggering to many,” says Dr. Wiebe, Division Head of Neurology, University of Calgary and Alberta Health Services. “The new programs being developed at the South Health Campus are embracing that change -- supporting a new standard of health that moves care around the patient instead of the other way around.”
“Our goal is to build programs and services that continue to attract the very best physicians and nurses, to accommodate our patients with comfort and convenience, and to house the latest technology to keep our facilities and clinicians at the forefront of medical care,” says Dr. Cairncross, Department Head for Clinical Neurosciences, University of Calgary and Alberta Health Services. “The neurological services at the South Health Campus will take us one step closer to making that goal a reality.”
The campus will serve southeast Calgary and the surrounding rural areas, but is also designed as a referral centre for southern Alberta. In addition to neurological care, services provided at the South Health Campus will include medicine, surgery, emergency services and critical care, maternal and neonatal care, mental health services, paediatrics, laboratory services, and diagnostic imaging.
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Dr. White has been in Calgary since 1997, and specializes in electromyography and neuromuscular disease. He is Site Chief at the RGH, Director of the ALS Program, and is also a member of the Neuromuscular Program. He has been the recipient of a number of awards over the years, including the ARP Merit Award and a Performance Recognition Award for his outstanding work on the development of the new neurology services at both the RGH and South Health Campus sites.
“The layout of this hospital takes neurological services to a new level by bringing specialized teams of nurses, allied health care professionals, and neurologists together in one place - truly supporting team-based care.”
Dr. Chris White
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Overview iMRI
For over 12 years, the Intraoperative MRI (iMRI) Program within the Department of Clinical Neurosciences (DCNS), University of Calgary (U of C) and Alberta Health Services, has pioneered research in the clinical application of MR technology to surgery and to variousneurological disorders, including stroke and multiple sclerosis.
Since 2009, the P3T iMRI system has been operational, allowing an increased signal-to noise. It also provides improved image quality and implementation of new imaging sequences, including diffusion tensor imaging and functional MRI. In addition to traditional MR images, surgeons using the iMRI system are able to image fibre tracts in the operating room. Through our industrial partner, IMRIS, surgeons from around the world continue to travel to Calgary to view the technology in use.
Surgical Robotics (Project NeuroArm)
Developed in 2008 by a team led by Dr. Garnette Sutherland, the NeuroArm is the first MRI-compatible image-guided computer- assisted device specifically designed for neurosurgery. Since its inception, NeuroArm has been undergoing some modifications. As previously mentioned, the iMRI system was upgraded to a 3.0 T platform. As the MR system was changed from locally-shielded to a roomshielded system, this necessitated a complete renovation of the iMRI operating theatre. This change also necessitated some major modifications to the robot, which were completed this year.
The surgical robotics program also conducts research in the Health Research Innovation Centre at the University of Calgary. The space (over 750m2) includes a haptic performance laboratory, an advanced engineering and prototyping lab, an experimental operating room and a telementoring and debriefing room. The space and associated technology is impressive and has already drawn in collaborators from across faculties and research disciplines, including: members of the National Research Council, the Faculty of Engineering, and Faculty of Medicine.
Grant Support
• Canada Foundation for Innovation (Infrastructure and• Operating)• Alberta Advanced Education and Technology• (Infrastructure)• Western Economic Diversification (Infrastructure)• Reach! (Infrastructure and Operating)• Alberta Heritage Foundation for Medical Research
• (Student Support)• Canadian Institutes for Health Research (Operating-• Molecular Imaging)
Faculty
Project Leader:Garnette Sutherland
U of C Investigators(not inclusive):Alex GreerJames LarssonYves StarreveldGail KoppChris MacnabYaoping HuTeodor VeresRoger MackenzieDanica StanimirovicMaureen O’ConnorAbedelnasser Abulrob
2010 Research Highlights
Surgical roboticsHapticsSurgical simulationEducation
Brain Imaging and Surgical RoboticsDirector: Dr. Garnette Sutherland
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The neuroArm in action. Photo by Bruce Perrault, Faculty of Medicine, University of Calgary.
MDA Lead Engineers:Tim FieldingPerry NewhookSimon HuGeorge FeilAndrew SkorupskiCalvin Bewsky
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Overview
In 2003, the University of Calgary Adult Hydrocephalus Clinic was established with the goal to standardize and enhance the care for adult patients with hydrocephalus. Hydrocephalus patients have typically been assessed and cared for by individual physicians in an unstructured and unfocused clinic environment. The population of adult patients with hydrocephalus is increasing as diagnostic and therapeutic techniques improve identification and survival of treated patients. Hydrocephalus represents a treatable cause for approximately 5% of adult patients with a diagnosis of dementia.
The University of Calgary Adult Hydrocephalus Program has developed in response to the strengths of the Adult Hydrocephalus Clinic. Targeting the care of adult patients with hydrocephalus in a specialty clinic represented an important development that has helped promote a better understanding of the natural history of adults with untreated hydrocephalus, allowed the standardization of investigative strategies for patients with a potential diagnosis of hydrocephalus and helped improve management of patients with hydrocephalus using shunts and endoscopic techniques. Clinical research is progressing along these avenues. The goals of the Adult Hydrocephalus Program are to provide excellent care for adults with hydrocephalus and to improve the care of adults with hydrocephalus through education, research and advocacy.
Clinical Care
In 2010 there were approximately 500 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, adults with previously untreated congenital hydrocephalus (APUCH), and patients with idiopathic Normal Pressure Hydrocephalus (iNPH). Research
• Neuroendoscopy treatment and outcome for hydrocephalus
• Neuropsychological effects of endoscopic treatment of hydrocephalus
• Infections in ventricular catheters and shunts
• Treatment of idiopathic normal pressure hydrocephalus (iNPH)
• Transition care for paediatric patients with hydrocephalus
• Endoscopic management of patients with brain tumours
• Pseudotumor Cerebri (Idiopathic intracranial hypertension)
Grant Support
Public Health Agency of CanadaCodman CorporationMedtronic Corporation
Members
Program Director and Neurosurgeon: Dr. Mark G Hamilton
Neurosurgeons:Dr Clare GallagherDr. Walter HaderDr. David Omahen
Hydrocephalus FellowDr. Geberth Urbaneja
NeurologistDr. David Patry
Neuro-OpthamologistsDr. Fiona CostelloDr. Bill Fletcher
Geriatrician Dr. David Hogan
Nurse Practitioner Ron Prince (In-Patient)
Hydrocephalus Program Director: Dr. Mark Hamilton
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Overview
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. Numerous conditions are treated including movement disorders, epilepsy, pain, angina, headache, spasticity, and urinary incontinence. Therefore, other divisions within DCNS, as well as specialists from several departments, are involved in the program.
Education
The Neuromodulation Program participates in a variety of educational activities to advance care. Nurses attend and present at national conferences on neuromodulation and take clinical trial courses provided by industry on device programming and updates. In addition, a Clinical fellowship has been established, and the pain neuromodulation journal club (occurring three times yearly) facilitates all levels of continuing education. Members of the team have also given a number of invited presentations at bothCanadian and international meetings.
Members
Neurosurgery:Drs. Zelma Kiss, Mark Hamilton
Neurology:Drs. Werner Becker, Scott Kraft, Neelan Pillay, OksanaSuchowersky, Sam Wiebe
Physical Medicine and Rehabilitation:Drs. Dan McGowan, Noorshina Virani
Nursing:Susan Anderson, Marlene Blackman, Thea Dupras, ColleenHarris, Karen Hunka, Jackie Martini, GraceNeustaedter, Valerie Sherwood, Tammy Still, Angela Tse,Robyn Warwaruk
Research:Drs. Misha Eliasziw, Bin Hu
2010 Clinical Care/Research Highlights
The Intrathecal Baclofen Pump Program, in variousiterations, has been functioning in Calgary for nearly 20years. The indication for such treatment is spasticity inboth adults and children.
Sacral nerve stimulation is a program that involves trialsand implantations of sacral nerve stimulators, and is
unique in Western Canada. This year, 30 patients werefollowed (13 from Calgary, eight from other regions inAlberta, 5 from BC and 4 from Saskatchewan).
The Pain neuromodulation program follows approximately 50 patients per year with implanted devices and receives up to 32 new referrals each year.
Ongoing studies include the (i) Canada-side multicentre METTLE trial of hippocampal DBS for epilepsy, (ii) multicentre RCT of motor cortex stimulation for specific pain syndromes, (iii) local pilot projects on area 25 subgenual cingulate DBS for refractory depression, (iv) treatment of various craniofacial headache syndromes with occipital region stimulation.
Neuromodulation ProgramDirector: Dr. Zelma Kiss
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Dr. Zelma Kiss is a Professor in the Department of Clinical Neurosciences, Faculty of Medicine University of Calgary. In addition to her clinical duties, she is actively involved in training of residents, post-doctoral fellows and graduate students. In 2009, Dr. Kiss established and now directs the University of Calgary Royal College Clinician Investigator Program -- a program that provides a specialized environment to allow residents in any specialty to pursue intensive research training while keeping their residency status.
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Overview
As a multi-disciplinary program in the Department of Clinical Neurosciences (DCNS), the Neuro-oncology Program was established to focus on neurosurgical care for brain tumour patients. The goals of the Surgical Neuro-Oncology Program are to provide excellent care for patients with brain tumours and to improve care in the future through education, research, and advocacy.
Clinical Care
Our patients have both low grade and malignant brain tumours, including those involving the brain and the skull base. Neurosurgeons work in concert with neuro-oncologists, neuroradiologists, neuropathologists, and radiation oncologists specializing in treatment of brain tumour. Regular clinical meetings and teaching rounds occur to coordinate care plans for patients. We are also able to offer access to unique treatment modalities such as the intra-operative MRI theatre for assisting in the surgical treatment of brain tumour and intraoperative monitoring or cortical mapping for complex brain tumour resection.
Research
Members of the Program are actively involved in clinical research to test new and innovative therapies to treat patients with brain tumours. Dr. Hamilton is a member of the Clark H. Smith Brain Tumor Center (www.ucalgary.ca/braintumourcentre) and The Southern Alberta Cancer Research Institute (www.sacri.ucalgary.ca). The Neurosurgeons are participants in multicentre clinical trials, including those involving convection-enhanced delivery of agents into the brain to treat brain tumours. Members of the program have also initiated clinical trials. In addition to this, the Brain Tumour Tissue Bank is available to store tissue from consenting patients for current and future research.
Grant Support
Canadian Institute for Health Research (CIHR)Canadian cancer SocietyAlberta Cancer BoardTom Baker Cancer CentreHotchkiss Brain Institute
Members
Neurosurgeons: Dr. Mark G HamiltonDr. Yves Starreveld Dr. Garnette Sutherland
Surgical Neuro-Oncology Fellow:Dr. Geberth Urbaneja
Neuro-Oncologists: Dr. Jay Easaw Dr. Peter Forsyth Dr. Greg Cairncross Radiation Oncologists:Dr. Rob Nordal Dr Gerald Lim
Nurse Clinician: Crystal Tellett
Research Nurse:Errin St Thomas
2010 Research Highlights
• Surgical treatment of malignant brain tumour• Surgical management of low-grade glioma• Clinical trials for adjuvant treatment of malignant brain
tumours• Treatment wait times for brain tumour patients• Endoscopic treatment of skull base and pituitary
tumours
Neuro-Oncology ProgramDirector: Dr. Mark Hamilton
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Overview
The Paediatric Neurosurgical Program is comprehensive, offering all aspects of paediatric neurosurgical care including: management of hydrocephalus, brain and spinal injury, myelomeningocele, other forms of spinal dysraphism, refractory epilepsy surgery, spasticity, craniofacial disorders, and paediatric brain tumour (in conjunction with the Paediatric Neuro-Oncology Group). The Program is a division of Paediatric Surgery (Department of Surgery) and the members are also part of the Division of Neurosurgery for the DCNS.
Clinical Care
The Paediatric Neurosurgeons provide weekday call at the Alberta Children’s Hospital (ACH), and with the other members of the Division of Neurosurgery participate in evening and weekend call schedules.
Neurosurgery clinics are held every week. Clinics include: General Neurosurgery, Craniofacial Clinic, Infant Cranial Screening and Remodeling Clinic (Paediatricians), and Myelomeningocele Clinic. Approximately 2000 out-patient visits occur each year.
Research and Education
The Paediatric Neurosurgical Division members participate in local and national administrative and educational functions. They also lead and collaborate in clinical research involving
paediatric and adult hydrocephalus, epilepsy and brain tumour.
During the last five years, Paediatric Neurosurgery Program members have published a number of peer-reviewed manuscripts, book chapters, and abstracts. In addition, Drs. Hamilton and Hader have collaborated on 10 successful research grant applications and have been local principal investigators for eight Clinical Trials. The Paediatric Neurosurgery Division is an active participant of the Canadian Paediatric Neurosurgery Research Study Group.
Members
Neurosurgeons:Dr. Walter Hader (Director) Dr. Mark Hamilton Dr. Clare Gallagher
Paediatricians:Dr. Heather Graham Dr. Keith Jorgensen
Nurse Practitioner:Kelly Bullivant
Nurse Clinicians:Valerie Sherwood Linda Gill
Paediatric Neurosurgery ProgramDirector: Dr. Walter Hader
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Radiosurgery Centre of AlbertaDirector: Dr. Harold LauOverview
This program, using the Novalis system - the first of its kind in Canada - is a collaborative effort between the Divisions of Neurosurgery and Radiation Oncology, and was originally established as a joint program between the Calgary Health Region (now Alberta Health Services) and the Alberta Cancer Board.
The technology offers 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 surgical treatments. By reducing risks of therapy, and ease of returning to normal activities, it results in much higher patient satisfaction. Since its inception in 2002, the program has grown steadily, and continues to treat patients from across the western provinces.
Members
Director:Dr. Harold Lau
Neurosurgeons:Zelma KissDr. Yves StarreveldDr. John Wong
Radiation Oncology:Dr. Harold LauDr. Gerald LimDr. Rob NordalDr. Jon-Paul Voroney
Medical Physics:Karen BreitmanDr. Chris NewcombDr. David SpencerDr. Alana Hudson
Administration:Erin Mckimmon (Program Manager)Kari Pickering
2010 Highlights
Participation in NCCTG N0574 Phase III Randomized Trial of the Role of Whole Brain Radiation Therapy in Addition to Radiosurgery in Patients with One to Three Cerebral Metastases.
Clinical Protocol for Frameless Stereotactic Radiosurgery for Brain Metastases (Principal Investigator: Dr. Jon-Paul Voroney.
Nursing:Rhonda MantheRadiation TherapistsStacey AllenHenry ChowSarah Blackmore
Dosimetrists:Darren GrahamDaphne WalrathNathan Wolfe
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Overview
The Surgical Peripheral Nerve Program within the Department of Clinical Neurosciences (DCNS), University of Calgary and Alberta Health Services, is a multi-disciplinary program encompassing both clinical and electrodiagnostic services. Our Program focuses on the diagnosis and treatment of a variety of peripheral nerve problems, including complex peripheral nerve injuries, nerve tumours, brachial plexus surgery, in addition to advanced nerve repair and nerve transfer techniques. Our goal is to minimize pain and to maximize function, providing a better quality of life for patients living with these painful and sometimes disabling disorders.
In collaboration with the Divisions of Neurology (Neuromuscular Program) and Physical Medicine and Rehabilitation, the Surgical Peripheral Nerve Program was initiated with the recruitment of the Division Head in neurosurgery (Dr. Rajiv Midha), an established peripheral nerve expert; state-of-the-art surgical management of peripheral nerve conditions is now possible in Western Canada. The Peripheral Nerve Program attracts referrals for patients from throughout Alberta, in addition to a few select patients from across Canada, and surgically treats approximately 60 patients a year with advanced peripheral nerve conditions.
Education
The Peripheral Nerve Program actively supports educational initiatives of DCNS. Together with our partners, both within the University of Calgary, the Hotchkiss Brain Institute, and Alberta Health Services, we are working to increase accessibility and delivery of evidence-based practice in peripheral nerve disease treatment.
We support the educational initiatives of all residents within the Division of Neurosurgery. We also participate in weekly neuroscience rounds, Continuing Medical Education sessions through the Faculty of Medicine, and bed-side rounds.
The following are current fellows within the Peripheral Nerve Program: Dr. Kathleen Khu (2009-10)Dr. Helene Khoung (2010-11)
Research
Research is an important aspect of the Peripheral Nerve Program. Over the last year, some of our members launched a clinical randomized control trial comparing surgical decompression to best medical management for ulnar neuropathy at the elbow. Three of our faculty members (Drs. Midha, Toth, and Zochodne) within the Program also have independent basic science research
laboratories investigating various facets of peripheral nerve disease, including:
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
neuropathy Diabetic neuropathy
In addition to being faculty members within DCNS, our researchers are also members of the Hotchkiss Brain Institute (HBI), in the Axon Biology Program. The collaborative environment of this partnership between DCNS and the HBI (in addition to other internal and community partners) allows our neuroscientists and clinicians to bring research and clinical care together – enhancing patient care more efficiently and effectively for the future. Go to www.hbi.ucalgary.ca or www.ucalgary.ca/spinalnerve/ for more information.
Grant Support
Canadian Institute for Health Research (CIHR) Alberta Heritage Foundation for Medical Research (AHFMR) Aegera Therapeutics Canadian Diabetes Association National Institute of Health (NINDS) Pfizer Corporation Integra Life Sciences
Members
Neurosurgeon and Director:Dr. Rajiv Midha
Medical Neurologists & Electrodiagnostics: Dr. Chris WhiteDr. Doug ZochodneDr. Cory TothDr. Stephen McNeilDr. Lawrence Korngut
Division of Plastic Surgery:Christiaan ShraagRobertson Harrop Intra-operative Electrophysiology Support: Michael RigbyErin Phillip
Peripheral Nerve Surgery ProgramDirector: Dr. Rajiv Midha
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Overview
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 follow-up for these challenging lesions. In addition, close ties to both endocrinology and the Alberta Radiosurgery Centre ensure that the nonsurgical aspects of treatment are also managed appropriately. Endoscopic approaches to pituitary and anterior skull base lesions are also offered when appropriate. Research interests represented within the program include clinical epidemiology, image guidance, robotic surgery, and surgical simulation.
Clinical Care
Building on the experience gained in endoscopic pituitary tumour resection, extended endonasal approaches to skull base pathology are being used. Esthesioneuroblastomas,
olfactory groove and tuberculum sellae meningiomas are all being addressed endoscopically where appropriate. Advances in image guidance are also being exploited to minimize surgical risk and reduce post-operative morbidity in best serving this patient population.
Members
Neurosurgery:Dr. Elizabeth MacRae Dr. Garnette Sutherland Dr. Yves Starreveld
Intraoperative Electrophysiology Support: Erin Phillip Michael Rigby
Skull Base and Endoscopic SurgeryDirector: Dr. Yves Starreveld
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Overview
The University of Calgary Spine Program is a multidisciplinary program dedicated to the delivery of care for individuals affected by conditions and diseases of the spine and spinal cord. With over 10 surgeons, and a team of research support staff, research nurses, a clinical coordinator, and a database coordinator, we have grown to become the largest spine program in Canada, and one of the largest in North America.
Clinical Care
Our Program continues to optimize clinical service delivery through the streamlining of the spinal referral system, which incorporates scoring, prioritization and a clinical triage system. This allows for patients to be stratified according to the severity of their specific problem. Through the triage systems at Foothills Medical Centre within Alberta Health Services, patients are directed to the appropriate provider for both surgical and non-surgical treatment. Waiting lists for initial spine assessments have decreased dramatically as a result of the efficacy of the triage process.
Research/Education
The program has been very active in clinical research and we currently have more than 15 active studies. These include both industry-sponsored and internally generated projects. Our focus has shifted towards internally generated
research and collection of data from our referral and surgical population. The research database is growing rapidly with definitive plans to expand it across the province. As a team we are also working to expand our research and educational mandates to focus on public education and awareness of spine diseases.
Members
Adult SpineDrs. Stephan du Plessis (Chairman), Ken Thomas (Fellowship Director), Jacques Bouchard, Steve Casha, Roger Cho, Rick Hu, John Hurlbert, Paul Salo, Ganesh Swamy, Brad Jacobs
Paediatric SpineDr. Jason Howard Dr. David Parsons
Research NurseTara Whittaker
Database ManagerEmi Sanders
Calgary Spine ProgramDirector: Dr. Stephan du Plessis
Otolaryngology:Dr. Joe Dort Dr. Brad Mechor Dr. Phil Park
Otolaryngology:Dr. Joe Dort Dr. Brad Mechor Dr. Phil Park
Research CoordinatorIsh Bains
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Overview
Treatment of vascular diseases of the nervous system has been evolving to encompass less minimally invasive interventions over the past decade. Such treatments are quickly becoming the standard of care for diseases such as intracranial aneurysms and carotid stenosis. The Neurovascular Program is a joint collaborative effort of specialists and allied healthcare staff from multiple disciplines (cerebrovascular and endovascular neurosurgery, interventional neuroradiology, and stroke neurology), to combat neurovascular disease. With the recruitment of Alberta’s first endovascular neurosurgeon, Calgary has advanced to the forefront in this type of therapy. Many patients are treated with a single day admission, using minimally invasive approaches (as opposed to the more traditional open surgery), and avoiding long in-hospital stays. In conjunction with our well-known and internationally recognized Stroke Program, the Neurovascular Program has already become an important partner in stroke research.
Research
Over the past few years, there has been increased academic integration with the Neurovascular Program and the Calgary Stroke Program. Shared resources have allowed for new and continued participation of neurosurgery and radiology in several international stroke studies, such as IMS-3, CREST, ENACT, ALISAH, and CONSCIOUS-2 and -3.
Members
Neurosurgeons:Dr. John WongDr. Garnette Sutherland
Neuroradiologists:Dr. William MorrishDr. Mark HudonDr, Mayank Goyal
2010 Clinical Highlights
The Program has continued to see growth and expansion in the number of patients with complex cerebrovascular disease. Approximately 700 patients with neurovascular disease are seen yearly in a specialized out-patient clinic for evaluation and follow-up.
Currently about 200 patients are treated annually via minimally invasive endovascular means such as endovascular coiling, 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 endarterectomy, resection of vascular malformations, and extracranial-intracranial bypass.
An integrated relationship with the Alberta Radiosurgery Centre, which was the first to use special shaped-beam focused radiotherapy techniques in Canada, has allowed the non-invasive and safe treatment of patients with complex arteriovenous malformations.
Over the past year, we have consolidated the out-patient experience of patients with neurological vascular disease from both clinical and administrative standpoints and launched the Neurovascular Clinic in Calgary in conjunction with specialists from neurosurgery, neurology, radiology, and nursing. This will allow the rapid triage and evaluation of patients to expedite and provide high-quality care, and allow further opportunities for teaching and clinical studies.
Vascular Neurosurgery ProgramDirector: Dr. John Wong
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Dr. John Wong is Director of the Neurovascular Program and an assistant professor in DCNS and Radiology. He is one of the few neurosurgeons in Canada with dual fellowship training in both open surgery and minimally invasive endovascular therapy of the brain and spine.
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Overview
The Calgary Epilepsy Program consists of a unique core of specialists -- paediatric and adult epileptologists, epilepsy surgeons, EEG technologists, neuroradiologists, neuropsychologists, clinical psychologists, basic scientists, physician clinical assistants, residents, fellows, and nurses -- working together to provide comprehensive care for epilepsy patients. As one of the premiere epilepsy centres in Canada, our team works collaboratively to find the most appropriate treatment for each patient, developing innovative ways to diagnose and treat epilepsy in children and adults.
Patients and families often present with complex needs arising from the impact of this chronic illness on their lives. This, coupled with the experience of change in their disease process and /or response to treatment, makes it increasingly important to maximize the full potential of each individual with epilepsy in our community through integrated care. The Calgary Epilepsy Program continually strives to be a centre for clinical and academic excellence through the improvement of consolidated clinical services, education, and research -- enhancing local and national initiatives to improve care for our patients.
Members
Director and NeurologistDr. Samuel Wiebe
Neurologists Dr. Neelan Pillay - Adult Epilepsy Program DirectorDr. Paolo FedericoDr. Alexandra HansonDr. Nathalie JettéDr. Brian KlassenDr. William Murphy
Highlights
The development of quality and safety initiatives (Quality Improvement) for the Seizure Monitoring Unit to achieve better outcomes for patient care.
Increasing success in national research funding, including a 5-year CIHR operating grant ($610,000) received by Dr. Paolo Federico.
The publication of a biannual Epilepsy newsletter through Dr. Nathalie Jetté.
The continued coordination of training for both medically qualified and non-medical graduates interested in epilepsy through weekly seizure conferences, EEG rounds, and a
monthly journal club -- with specific teaching for neurology residents, physician clinical assistants, epilepsy fellows, nurses, EEG technologists, and graduate students.
Participation in numerous national and international conferences, including the International League Against Epilepsy Congress, and the 8th Annual International Symposium on Non-invasive Functional Source Imaging of the Brain (Dr. Paolo Federico was both plenary speaker and organizer for this event).
Organization of annual Calgary Epilepsy symposia. Our first symposium focused on malformations of cortical development in epilepsy and featured two internationally renowned guest speakers, Dr Sam Berkovic from Melbourne, Australia, and Dr Charles Raybaud from the Toronto Sick Children’s Hospital.
Calgary Epilepsy ProgramDirector: Dr. Samuel Wiebe
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Dr. Samuel Wiebe is also Division Head of Neurology, DCNS, and Director for the Clinical Research Unit (CRU) -- an innovative in-house resource to aid researchers at every stage of clinical trials development (story page 44).
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Overview
CHAMP is a full service headache program that provides: diagnostic services for difficult to diagnose headache patients, state-of-the-art pharmacological management for patients with headache disorders (including cluster headache, migraine, tension-type headache, and other headache disorders), and behavioural modalities for headache management. As a valuable resource for the primary care physicians of Southern Alberta, CHAMP receives an average of 136 referrals per month.
Members
Program Director and Neurologist: Dr. Werner Becker
Neurologists:Dr. Lara CookeDr. Farnaz AmoozegarDr. Arnolda Eloff Dr. Jeptha Davenport
Occupational Therapists:Kathryn Coutts Allison McLean
Clinical Nurses:Irene O’CallaghanRuth Sutherland
Research nurse:Brenda Kelly-Besler
Psychologist:Janice Cathcart
Research Assistant:Khara Sauro
2010 Highlights
Education: Dr Prin Chitsantikul joined CHAMP as a post-doctoral fellow in Sept 2010.
Research: CHAMP ran two clinical trials during 2010, one evaluating the role of patent foramen ovale closure in migraine with aura, and another evaluating the benefit of daily frovatriptan for ten days in the initial management of patients with medication overuse headache.
Leadership: CHAMP has provided leadership on the national level, and spearheaded a publication with the Canadian Headache Society on a consensus statement regarding the development of a National Canadian Migraine Strategy.
Quality Improvement: CHAMP completed a study on the use of pacing in our patient population, and this has been submitted for publication along with a literature review. In addition, an analysis of the HIT-6 and MIDAS as Measures of Headache Disability in a Headache Referral Population was completed and published in the peer-reviewed literature in 2010.
Calgary Headache Assessment and Management Program (CHAMP)Director: Dr. Werner Becker
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Dr. Werner Becker is a professor for the Departments of Clinical Neurosciences and Medicine, Faculty of Medicine, University of Calgary.
In addition to leading CHAMP, Dr. Becker is also Director of he Headache Program for the Chronic Pain Centre (page 28), Alberta Health Services. Both are multi-disciplinary programs which bring a broad range of treatment options to each patient suffering from headache pain.
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Overview
The Calgary Stroke Program is recognized as one of the leading programs in North America for stroke treatment and research. Within the Department of Clinical Neurosciences, Alberta Health Services (AHS), and the University of Calgary, our Program works alongside other departments to provide quality acute, rehabilitative, and preventative care to people with stroke and their families.
Members
Program Director and Stroke Neurologist: Dr. Andrew Demchuk
Clinical Unit Director and Stroke Neurologist:Dr. Michael Hill
Stroke Neurologists:Dr. Phillip BarberDr. Shelagh CouttsDr. Tim WatsonDr. Peter StysDr. Eric Smith
Neurologists:Dr. Gary KleinDr. Dawn Pearson
Physiatrists:Dr. Sean DukelowDr. Ken LamDr. Stephen McNeil
Additional Partnerships:Dr. Mayank Goyal, RadiologistDr. Mark Hudon, RadiologistDr. Will Morrish,RadiologistDr. John Wong, Neurosurgeon
2010 Highlights
In June 2010 the Calgary Stroke Program became the first comprehensive stroke system in Canada to receive the Stroke Services of Distinction Award from Accreditation Canada.
Dr. Shelagh Coutts received the Michael J. Pessin leadership award from the American Academy of Neurology April 2010.
Dr. Sean Dukelow received a HSF Alberta grant-in-aid and a CIHR operating grant titled: "REhabilitation, Stroke deficiTs and Robotic Technology (RESTART)".
Dr. Teri Green obtained her first independent operating grant for the MIST-2 study funded by Heart and Stroke Foundation of Alberta, NWT, and Nunavut.
Dr. Bijoy Menon joined the stroke neurology on call group as a Clinical Scholar in November 2010 after completing a two-year fellowship with the program.
Drs. Michael Hill and Andrew Demchuk were both promoted to Full Professor.
The Program launched an Early Supported Discharge and Transition Team to enable early discharge from in-patient care following an acute stroke, by providing trans-disciplinary tertiary level rehabilitation based within a client’s home and community.
The Program made significant progress in two large pivotal Phase III clinical trials, IMS-3 and ALIAS. The Program plays a leadership role in both major clinical trials via collaboration with the NIH, University of Cincinnati, University of Miami, and other sites across North America, Europe, Israel, and Australia.
Completion of recruitment to the ENACT pilot clinical trial of neuroprotection during aneurysm coiling. The ENACT trial is the first aneurysm coiling neuroprotective trial and Calgary is the co-ordinating centre for this study.
Dr. Andrew Demchuk and the PREDICT team completed the PREDICT study coordinated from University of Calgary at 11 sites in six countries.
Dr. Shelagh Coutts and the CATCH team completed the single centre CIHR funded CATCH study enrolment of 515 patients in just over two years at Foothills Medical Centre and will present results at European Stroke Conference Hamburg 2011.
Calgary Stroke ProgramDirector: Dr. Andrew Demchuk
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Women need clot-busting therapy after strokeby Marta Cyperling
Research from the University of Calgary’s Faculty of Medicine shows that women who don’t get the clot-busting drug tPA after a stroke fare worse than men who receive the same level of care. However, the study found that women and men respond equally well when the clot-busting therapy is administered. The study is published in the March 2, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.
“Like men, women need to be treated for stroke as soon as possible,” says study author Dr. Michael Hill, a stroke neurologist and Director of the Stroke Unit at the Foothills Hospital, Alberta Health Services. “We found that women who weren’t treated with the drug were 12-per-cent less likely than men to have a good outcome.”
“There could be many reasons why women who weren’t treated with the clot-busting drug fared worse than men, including biological reasons,” says Dr. Hill. “One social reason may be that more than 30 per cent of women were widowed compared to seven per cent of men at the time of stroke, and therefore did not have a spouse who could act as a caregiver. Also, post-stroke depression is more common in women than in men, which slows down recovery.”
Anne Tremblay knows how difficult it can be to recover from a stroke. The 34-year-old suffered a stroke last fall, going to hospital in an ambulance and leaving her three-month-old daughter and husband at home. “This study is
very important. I was not pre-disposed to having a stroke. It was a very scary time for my family. My whole family could have collapsed. I hope this research helps more people recover.”
Scientists examined the Registry of the Canadian Stroke Network data of more than 2,000 stroke patients. Of those, 232 were treated with tPA and 44 per cent were women. After six months, former stroke patients were
interviewed by phone about their ability to function and quality of life.
The study is consistent with previous research which increased the validity of the effect.
“Like men, women need to be treated for stroke as soon as possible,” says study author Dr. Michael Hill, a stroke neurologist and Director of the Stroke Unit at the Foothills Hospital, Alberta Health Services. “We found that women who weren’t treated with the drug were 12-per-cent less likely than men to have a good outcome.”
“This study highlights the interaction between our health and our social environment,” says Dr. Antoine Hakim, CEO and Scientific Director of the Canadian Stroke Network. “Women recover less well from stroke because they don’t
have the same access to care providers. It is important that women can access tPA so they leave hospital with minimal deficits from stroke.”
The study was supported by the Canadian Stroke Network, a Network of Centres of Excellence (NCE), and the Ontario Ministry of Health and Long-Term Care.
Our stroke fellowship training program continues to evolve, becoming one of the premier stroke training programs in the world. In 2010-2011, six stroke neurologists completed training in Calgary and returned to other parts of Canada or their native countries, to continue their research and to establish stroke centres back home.
Dr. Tim Watson continues to lead the increasingly successful monthly Acute Stroke Case Rounds aimed at improving knowledge and clinical practice of acute stroke care across Canada, through an interactive case-based educational forum via Telehealth.
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Dr. Michael Hill is a stroke neurologist and Director of the Stroke Unit at the Foothills Medical Centre in Calgary. He is also Associate Dean, Research, Faculty of Medicine, University of Calgary.
Stroke is the single most common cause of neurological disability in North America and the fourth leading cause of death in Canada.
Five thousand strokes occur in Alberta each year, and approximately 1300 patients are treated in Calgary alone.
Right: Dr. Andrew Demchuk and a multidisciplinary team on the stroke unit, Foothills Medical
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Overview
Movement Disorders are diseases that result in involuntary movements such as tremor, dystonia, chorea, bradykinesia (slowness) and tics. These disorders cause significant disability 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 neurology, neurosurgery, psychiatry, nursing, social work, psychology, and physiotherapy, treating over 2000 patients with Parkinson disease, Huntington disease, Tourette syndrome, 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 developing improvements in treatment of Parkinson disease and related disorders. Research to understand basic mechanisms 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).
Research
• Neuroprotection for Parkinson disease (PD)
• Music therapy in PD
• Identification of genetic factors in PD
• Neuroprotection for Huntington disease (HD) as well as 2 long-term follow up prospective observational trials for HD
• Novel treatments in PD, HD, dystonia, and spinocerebellar ataxia
Members
Neurology: Dr. Ranjit Ranawaya (Program Director)Dr. Sarah Furtado ( CME)Dr. Scott Kraft (Neuromodulation)Dr. Tamara Pringsheim (Director, Tourette Syndrome Clinic)
Neurosurgery: Dr. Zelma Kiss (Neuromodulation)
Neurophysiology: Dr. Bin Hu (Research Director)
Neuropsychology: Dr. Angela Haffenden and Dr. Stewart LongmanPsychiatry: Dr. Jeremy Quickfall, Dr. Michael Trew Fellows: Dr. David Salat-Foix and Dr. Justyna Sarna
Nurses - Clinical: Karen HunkaMichelle ZulinickErin ThomasNancy Labelle
Nurses - Research: Lorelei DerwentCarol PantellaMary Lou Klimek
Secretarial Support: Sheila PinkneyMarlene ConradD’evan CooperRhiannon D’Haene
2010 Highlights
Dr. Suchowersky left the program in Dec 2010. Dr. Ranawaya is now the acting Program Director.
Through our partnership with the Parkinson’s society of Alberta a part-time nurse continues to provide telephone support via a toll free province wide PD helpline.
Our partnership with the Chronic Disease Management program continues with educational classes for patients with Parkinson’s disease being given by our staff.
Our Telehealth clinics in Lethbridge and outreach clinic in Medicine Hat continue.
Movement Disorders ProgramDirector: Dr. Ranjit Ranawaya
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Overview
The Multiple Sclerosis (MS) Program in the Department of Clinical Neurosciences (DCNS), University of Calgary and Alberta Health Services, has assembled a world-class team of clinicians, scientists, imaging experts, and population health researchers to treat and investigate MS. As a team we strive to provide expertise and leadership to our community – to expand knowledge of causes, treatments, and cures for MS, to provide unparalleled care to our patients, and to train the next generation of MS practitioners and scientists.
Research
Our major research focus is translational research. We are developing and piloting new outcome measures and novel trial designs to develop therapies that originate in our biomedical research laboratories. We are developing therapies that hold promise to provide neuroprotection and to promote remyelination –aspects of MS not currently managed by the available (and new) anti-inflammatory therapies. These potential therapies are at various stages of development from pre-clinical to phase III. During 2010, we also initiated a phase IIa clinical trial of minocycline in optic neuritis with the dual goals of piloting the optic neuritis model to test treatments for neuroprotection and repair, and to obtain pilot data with regard to the effect of minocycline on recovery of optic neuritis. Translational research has been generously supported by donations to the Hotchkiss Brain Institute by Mr. Hank Swartout and Precision Drilling.
Epidemiology and Health Services Research are also very important components of the MS Program. In 2010 two clinical pilot programs were introduced. They will be evaluated during 2011-12. The first provides nursing services (education and support) to waitlisted patients; the second provides group Cognitive Behaviour Therapy. Health services research continues to be generously supported by donations from Jayman Homes to the Hotchkiss Brain Institute. The long term objective is to develop an Alberta MS program that delivers state-of-the art care to all Albertans.
Clinical and research discussions continued to be influenced by a hypothesis that a putative condition called chronic cerebrospinal venous insufficiency (CCSVI) may cause MS and that venous interventions may treat the disease. Two major studies of CCSVI were initiated by our team. Dr. Fiona Costello leads an imaging study of CCSVI (see the MS Society of Canada Website) and Dr. Luanne Metz leads an epidemiologic study of CCSVI in MS (see TAMSI.ca).
MS Program researchers are also members of the Hotchkiss Brain Institute MS Program, which is led by Drs Luanne Metz and Dr V Wee Yong.
Education
The MS Program actively supports educational initiatives in DCNS, the Hotchkiss Brain Institute, and the endMS program funded by the MS Society of Canada. We regularly provide clinical education to fellows, residents, nursing students, psychology interns, and rehabilitation students in our clinics. Graduate students and post-doctoral students work in our labs and research programs and we collaborate with students from other research programs. We have weekly MS Clinical and Research rounds.
Members
The MS program is comprised of clinical research teams which overlap considerably. There are over 75 team members including clinicians, researchers, support staff and research staff. We also collaborate with several researchers whose primary appointment is in another department.
Physicians and researchers with primary appointments in the DCNS include:
Dr. Luanne Metz, Neurologist, MS Program Leader and HBI MS program co-leaderDr. Michael Yeung, Neurologist, Clinical Trials Unit DirectorDr. Robert Bell, NeurologistDr. Jodie Burton, Neurologist (new recruit as of September 2010)Dr. Kevin Busche, NeurologistDr. Fiona Costello, Neurologist/neuro-ophthalmologistDr Jeptha Davenport, NeurologistDr. Dan McGowan, PhysiatristDr. William Murphy, NeurologistDr. David Patry, NeurologistDr. Dawn Pearson, NeurologistDr. Shalina Ousman, PhDDr. V Wee Yong, PhD, HBI MS program co-leader, Alberta endMS Program DirectorDr. Lenora Brown, PhDColleen Harris, MN, NP, Clinic Manager, Clinical Trials Unit Assistant Director
Multiple Sclerosis ProgramDirector: Dr. Luanne Metz
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The following were postdoctoral fellows or graduate students in the MS Program during 2010:
Dr. Smriti AgrawalDr. Yunyan ZhangDr. Axinia DoeringDr. Mengzhou XueDr. David StirlingDr. Manoj MishraDr. Sarah HaylockDr. Shigeki TsutsuiRowena CuaWuLin TeoLorraine LauNabeela Nathoo
Grant Support
Canadian Institute for Health Research (CIHR) Alberta Heritage Foundation for Medical Research (AHFMR), now AI-HS Government of Alberta- Alberta Health and Wellness Multiple Sclerosis Society of Canada Neuroscience CanadaStem Cell Network Canada Foundation for InnovationNational Institute of Health (NIH)
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Additional Highlights:
In 2010 the recruitment of Dr. Marcus Koch, neurologist and epidemiologist (PhD), was finalized.
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New MS target identified by Canadian researchersFaculty of Medicine
Multiple sclerosis (MS) is a disease caused by damage to myelin – the protective covering wrapped around the nerves of the central nervous system (CNS).
Previous studies have shown that certain white blood (immune) cells, called leukocytes, infiltrate the CNS and play a significant role in causing the damage that contributes to MS symptoms. It has also been shown that these leukocytes enter the CNS with help from a family of molecules called MMPs.
Using a mouse model, researchers have discovered that a molecular switch called EMMPRIN plays an important role in MS. The researchers explored how in MS, EMMPRIN affects MMPs and the entry of leukocytes into the CNS to result in disease activity.
“In our studies we inhibited EMMPRIN and noticed a reduced intensity of MS-like symptoms in mice,” says Dr. V. Wee Yong, a professor of Clinical Neurosciences at the Hotchkiss Brain Institute at the University of Calgary’s Faculty of Medicine and the study’s principal investigator. “Our data suggests that if we target EMMPRIN in patients with MS, we may reduce the injury to the brain and spinal cord caused by immune cells.”
In addition to working with animal models, the authors also found that EMMPRIN is significantly elevated in the brain lesions of MS patients, indicating its potential significance in the disease.
"This study has identified a new factor in MS, the blockade of which resolves disease activity in an animal model of MS. The results are exciting as they offer new insights into the MS disease process", says Dr. Smriti Agrawal, a postdoctoral fellow in Dr. Yong's lab and the study's lead author.
“The authors have extended our knowledge of the molecules that regulate the trafficking of immune cells into the nervous system as occurs in multiple sclerosis. The current study identifies a new factor that can serve as a potential target of MS therapeutics,” says Dr. Jack Antel, Professor of Neurology at McGill University.
The research findings are published in the Jan 12th issue of the Journal of Neuroscience.The research was funded by the Canadian Institutes of Health Research and the MS Society of Canada.
MS afflicts 70,000 individuals in Canada and 250,000 in the US. It is the most common neurological condition in young adults. Worldwide, an estimated 1 million people suffer from MS.
Dr. V. Wee Yong is a Professor in the Departments of Clinical Neurosciences and Oncology. He is also the recipient of a Tier 1 Canada Research Chair in Immunology.
Michael KeoughTrisha FinlayVahid Hoghooghi
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Overview
The Urgent Neurology Clinic has been providing an urgent out-patient neurology consultation service for southern Alberta and eastern British Columbia since 2000. Its purpose is to see patients who require urgent neurological assessment within one week (aiming for 72 hours). The Urgent Neurology Clinic holds clinics at both the Foothills Medical Centre and the Rockyview General Hospital. In 2010, 2766 referrals were received. A total of 1419 new patients and 704 follow-up patients were seen. The Urgent Neurology clinic provides an excellent educational opportunity for residents in training.
Members
Director and Neurologist:Dr. Alexandra Hanson
Neurologists:Drs. Farnaz Amoozegar, Phillip Barber, Robert Bell, Jodi Burton, Kevin Busche, Shelagh Coutts, Paula de Robles, Tom Feasby, Paolo Federico, Sarah Furtado, Jagdeep Kohli, Lawrence Korngut, Moreau, William Murphy, Dawn Pearson, David Patry, Tim Watson, Chris White, and Michael Yeung.
Relief doctors include: Drs. Katayoun Alikhani, Keith Brownell, Lara Cooke, Nathalie Jetté, Cory Toth and Samuel Wiebe.
Clinic Coordinator/Nurse Clinician:Janet Warner
Nursing:Georgia Greidanus, Lorraine Sorge
Clerks:Patricia Hammel, Holly Wowk, Nancy Price
Urgent Neurology ClinicDirector: Dr. Alexandra Hanson
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Overview
The Neuromuscular Program was established in 1992 to meet the overall health needs of people with peripheral nerve, muscle and neuromuscular junction disorders. The mission of this program is to provide timely, expert and comprehensive consultation and care to patients with neuromuscular disorders. Additionally, this program aims to provide state of the art diagnostic and treatment services as well as developing cutting edge research. The overall emphasis of this program is on excellence in patient care, collegiality and innovation. To date, the program consists of three sub-specialty clinics: the Neuromuscular Clinic, the ALS clinic, and the Neuropathic Pain Clinic.
Within the next five years the Neuromuscular Program will develop into a newly constituted program cluster known as the Southern Alberta Nerve and Muscle Program. The vision of this program is to emerge into an internationally recognized program model for access and evidenced based and compassionate care for patients with nerve and muscle disorders.
Members
Neurologist and Program LeaderDr. Douglas Zochodne
Neurologists:Dr. Lawrence KorngutDr. Keith BrownellDr. Chris WhiteDr. Cory Toth
2010 Highlights:
The NMC welcomed Dr. Lawrence Korngut into full practice.
The Clinic underwent a detailed series of planning exercises in 2010 designed to position itself as a citywide program with key personnel located at FMC and transitioning from RGH to SHC. Planning included interfaces with Clinical Neurophysiology, Physical Medicine and Rehabilitation (PMR), Neurosurgery, the Southern Alberta Pain clinic and RRDTC Diabetes multidisciplinary clinics.
Neuromuscular Program Director: Dr. Douglas Zochodne
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New treatment insights into the dopamine dilemmaBy Jonathan Davies
Current treatments for Parkinson’s disease may be putting sufferers at higher risk of peripheral nerve damage, according to a new study published in the July 2010 edition of Annals of Neurology by Drs. Cory Toth, Oksana Suchowersky, and Douglas Zochodne, researcher clinicians in the Department of Clinical Neurosciences (DCNS) and members of the Hotchkiss Brain Institute (HBI) in Calgary.
According to the Parkinson Society of Canada, an estimated 80,000 Canadians suffer from Parkinson’s disease (PD), in which a lack of production of the neurotransmitter dopamine prevents the region of the brain responsible for movement, the motor cortex, from accurately relaying motor commands to muscles. This progressive, degenerative disease can lead to patients developing tremors and impaired movement and speech. Levodopa (L-dopa), a compound that neurons use to make more dopamine, is routinely used as a treatment for PD, to restore proper functioning of the motor cortex in the brain.
Neurological complications regularly occur
alongside Parkinson’s disease. One possible contributing factor to these problems is peripheral neuropathy – or damage to nerves in the peripheral nervous system that feed information into and out of the brain and spinal cord. Peripheral neuropathy poses a significant problem in Parkinson’s disease because any additional numbness and impaired balance in a patient who is already experiencing difficulty with movement can lead to a higher risk of falling and further loss of mobility. Yet no studies had been conducted to understand why those additional neurological issues were seen along with Parkinson’s disease.
“As far back as my residency, we were seeing about a 10% incidence of peripheral neuropathy along with Parkinson’s disease,” says Dr. Cory Toth. “But when I asked the specialists about it, they didn’t think it was attributable to the treatments we were using.”
Toth wanted more definitive answers, so in collaboration with Drs. Suchowersky and Zochodne, he conducted a longitudinal study of 58 Parkinson’s disease patients to test for links between Parkinson’s disease and peripheral neuropathy. The results were surprising. In their study, Dr. Toth and his team found over half of the Parkinson’s disease patients tested had peripheral neuropathy. And the severity of the peripheral neuropathy suffered went up with increased exposure to
L-dopa as a treatment.
Comprehensive blood testing showed that the Parkinson’s disease patients who also had peripheral neuropathy had increased serum levels of methylmalonic acid (MMA). MMA is a potentially toxic substance believed to damage neurons, which Toth believes may account for the high prevalence of peripheral neuropathy seen.
“With L-dopa, you get the good effects of reducing Parkinsonian symptoms, but you could also get the bad effects of peripheral neuropathy,” he says.
Dr. Toth and his team also found similar effects in the laboratory. They’ve shown that when neuronal cultures are exposed to elevated MMA, they exhibit multiple toxic effects including stunted axonal outgrowth. Together, these findings suggest that L-dopa use may create other unintended problems, and – hopes Toth - will make clinicians reconsider how they treat the disease.
With a demonstrated link between L-dopa and peripheral neuropathy, Drs. Toth, Suchowersky, and Zochodne can now focus on developing therapies that will stop that damage from happening in the future.
2010 Highlights continued:
Dr. Lawrence Korngut:• Launch of the Canadian Neuromuscular
Disease Registry (CNDR).• Best neuromuscular disease abstract award
at CFNS.• Preliminary development of the Canadian
ALS Registry as part of the CNDR.
Dr. Keith Brownell:• Continuing provision of clinical care to
patients with neuromuscular disease. • Being the senior investigator of a team,
which identified a new myopathy in the Hutterite population.
Dr. Chris White:• Expansion of peripheral nerve clinic to
include PMR as well as plastic surgery.• ALS clinic completion of Lithium trial.• Initiation of ceftriaxone trial in ALS.• Recruitment of Dr. Sam Chhibber.
Dr. Cory Toth:• Promoted to Associate Professor in
Neurology in October 2010.• University of Calgary Faculty of Medicine
Accomplishment Award, 2010, and teaching awards (Calgary Medical Student Association Gold Star Letter of Excellence, Platinum Award for Teaching Contribution, Faculty of Medicine).
• Papers examining neuropathic pain, diabetic neuropathy, and hypertension on the diabetic brain.
• Awarded a CIHR grant: pathways affected by insulin deficiency in the diabetic brain and their association to cognitive decline.
Dr. Douglas Zochodne:• Development of RUN (Regeneration Unit in
Neurobiology) with HBI• Renewal of 5-yr CIHR grant “Molecular
Roadblocks to Nerve Regeneration”• Publication, press release “PTEN Inhibition
to facilitate intrinsic regenerative outgrowth of adult peripheral axons”. J NSc 2010
• Visiting professor Salk Institute for Biological Studies Jan-June 2010.
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0Faculty of Medicine scientists led by Dr. Douglas Zochodne have discovered a way to enhance nerve regeneration in the peripheral nervous system. This important discovery could lead to new treatments for nerve damage caused by diabetes or traumatic injuries.
Full story by Jordanna Heller can be found at www.medicine.ucalgary.ca/about/Zochodne/SJN/nerveregrowth
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Overview
Since the opening of the Calgary Tourette and Paediatric Movement Disorders Clinic in April of 2008, the clinic has assessed more than 300 new patients. Our team provides consultation and continuing care for children and adults with Tourette Syndrome and children with other movement disorders such as motor stereotypies, tremor and dystonia. The clinic has become a referral centre for southern Alberta, as well as neighbouring communities in Saskatchewan and British Columbia. We provide evaluation and treatment for other common conditions seen in conjunction with Tourette Syndrome, including Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD).
With support from the Department of Clinical Neurosciences, we have developed a multidisciplinary team model for the Calgary Tourette and Paediatric Movement Disorder Clinic. This provides our patients with medical expertise in a variety of disciplines, including neurology, nursing, and clinical psychology. Together, our team performs diagnostic assessments, medication trials, and cognitive behavioural therapy. In addition, the Clinic has formed an alliance with the Tourette Syndrome Foundation of Canada to help support families with greater educational and community resources. The Tourette Syndrome Foundation of Canada provides free educational in-services to schools and employers, and holds public lectures and family support group meetings.
Research
The focus of the clinic research program is on furthering our understanding of the relationship between Tourette Syndrome and other neuropsychiatric disorders of childhood, and on improving drug safety for children with mental health disorders. Our current research projects include:
• Sociability, Language, and Communication Skills in Children with Tourette Syndrome: Understanding the Links between Tourette Syndrome and Autistic Spectrum Disorders.
• Post market Drug Safety and Effectiveness of Antipsychotic Medications in Children with Mental Health Disorders.
• Aripiprazole for Children with Autism Spectrum Disorder: A Cochrane Review
• The Diagnosis and Treatment of Tourette Syndrome: An Evidence-Based Guideline
Members
Tamara Pringsheim, NeurologistTracy Hammer, Clinic NurseBonnie Moshenko Mitchell, PsychologistJustyna Sarna, Clinical FellowCarolyn Baldwin, Administrative Assistant
2010 Highlights
Completion of the Canadian Institute of Health Research funded Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotic Medications in Children (CAMESA) guideline project. We created evidence- based guidelines on monitoring for and treating metabolic and neurological complications of antipsychotics in children, which will be disseminated to child psychiatrists, neurologists, paediatricians, and family doctors across the country. We are thankful to our clinic patients and families for participating in this research project, and their valuable input.
We received two research grants from the Public Health Agency of Canada for research related to the incidence and prevalence, and risk factors for onset and severity of Tourette Syndrome and dystonia.
Tamara Pringsheim received the Medical Award from the Tourette Syndrome Foundation of Canada in recognition of outstanding service to individuals with Tourette Syndrome.
Tourette and Paediatric Movement Disorders ClinicDirector: Dr. Tamara Pringsheim
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At the Calgary Tourette and Paediatric Movement Disorders Clinic, Dr. Tamara Pringsheim and her colleagues provide consultation and continuing care for both children and adults.
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Overview
The Amputee Rehabilitation Program in the Department of Clinical Neurosciences, Alberta Health Services, is dedicated to providing comprehensive care to patients with limb loss across the care continuum. We provide life long follow-up for our patients, and our specialized in-patient and out-patient services are provided year-round. We also offer peri-amputation consultation and our services continue to grow.
In 2010, over 120 new patients with limb loss entered into the Program. The majority of patients needing in-patient rehabilitation were admitted to the six-bed in-patient program at the Carewest Glenmore Park facility -- a site specifically designed to provide rehabilitative treatment for patients transitioning from acute care to the home.
Geriatric amputee patients with multiple medical conditions are now receiving rehabilitation at the Rockyview GARP program, which provides multi-disciplinary health services
to this population for all of southern Alberta. Other specialized out-patient rehabilitation is now provided through Calgary Accessible Rehabilitation (CAR) Program at the Sheldon M. Chumir Health Centre.
Education
In addition to our clinical services, the Amputee Rehabilitation Program is highly dedicated to medical education. Physiatry residents spend a mandatory three months with us during their residency, and our educational sessions for medical students are well received. We are also involved in the education and certification of prosthetists in training. Members Dr. Ken Lam
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The Brain Injury Rehabilitation Program continued seeing individuals on both an in-patient and out-patient basis for their acquired brain injuries. Although the majority of patients seen had sustained a traumatic brain injury, we also see people who have experienced ruptured aneurysms, brain tumours, brain hypoxia, encephalitis, and a variety of other conditions. The focus of our in-patient care and out-patient clinics is on individuals who are having difficulty carrying out normal daily duties due to the effects of their brain injury. Typically these might involve cognitive, communication, emotional or behavioural difficulties, as well as problems with mobility or coordination.
Members
Dr. Christine McGovernDr. Susan BeairstoDr. Tony GiantomasoDr. Rodney Li Pi Shan
2010 Highlights:
In September of 2010 the Calgary Brain Injury Strategy was launched. Brain injury survivors, family members, and service providers from throughout the zone attended a day long session which included education sessions as well as planning groups. The intent of the strategy is to help streamline care and improve communication along the continuum of care. The larger than expected turnout supported how many people are involved and interested in this area. Smaller working groups were struck out to carry through with the planning and implementation.
We also had the great pleasure of welcoming Dr. Rodney Li Pi Shan to our program in December. He had been working in Saskatoon previously. He has a special interest in teaching, and has brought both experience and enthusiasm to our program.
Brain Injury Rehabilitation Program
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Advancing burn care through stem cell research by Léora Rabatach
A physiatrist and Clinical Assistant Professor for the Department of Clinical Neurosciences (DCNS), Faculty of Medicine and Alberta Health Services, Dr. Vincent Gabriel’s specialty lies in understanding and treating hypertrophic scars, a common complication of burn and other soft tissue injuries.
Alongside a specialized therapy team consisting of other physicians, nurses, Occupational Therapists (OTs), and Physiotherapists (PTs) at the Foothills Medical Centre Burn Treatment Unit, Dr. Gabriel works to enhance therapy outcomes, relieve pain, and increase functional ability for his patients.
Dr. Gabriel is part of a growing team of physiatrists recruited to the Division of Physical Medicine and Rehabilitation in DCNS, working in both a research and clinical capacity. With 50 per cent of his time protected for research, Gabriel is working to find a variety of different avenues to help his patients achieve a better quality of life, both now and in the future.In collaboration with Dr. Jeff Biernaskie in the Faculty of Veterinary Medicine, University of Calgary, and Dr. Duncan Nickerson in the Division
of Plastic Surgery, AHS, Dr. Gabriel is trying to understand the role of endogenous stem cells in the process of tissue regeneration. Specifically, they are focusing on multiple stem cell populations present in the hair follicle, which has the unique ability to regenerate itself without the formation of scar tissue.
“We need to understand the biology of these specialized cells once we transplant them, where they go and what they do once they’re in there,” says Dr. Gabriel. “Eventually, an understanding of how resident stem cells become regulated in wounds could aid us in the development of new cell-based therapies to enhance the body’s natural mechanisms for repair and regeneration following a traumatic injury.”
Soon this type of therapy could become augment more traditional methods of burn treatment -- providing patients with the ability to feel again and move more easily and further improving their quality of life after injury.
“It’s the future of wound healing.”
Burns are one of the most devastating forms of injuries and the fourth most common cause of trauma world-wide. As recently as 1980, few serious burn victims survived their accidents. Although survival rates have increased, physical pain, change in appearance, immobilization, stiffness, scarring, and contracture are just some of the obstacles still faced by burn patients throughout their healing process.
Left: Dr. Vincent Gabriel.
Below: Dr. Gabriel working with Haley Derksen, an OT on the Burn Unit at the Foothills Medical Centre.
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Overview
The Chronic Pain Centre has completed ten years of operations within the Alberta Health Services Regional Pain Program. It is now the largest such centre in Canada and is a leader in interdisciplinary rehabilitation for individuals with chronic pain. Three members of the Division of Physical Medicine and Rehabilitation currently practice at the Chronic Pain Centre: Dr. Pamela Barton, co-founder and former medical director, Dr. Noorshina Virani and Dr. Nwamara Dike. 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. In addition to their strong background in pain management and interdisciplinary rehabilitation, Drs. Barton and Virani contribute specific expertise in clinical biomechanics, while Dr. Dike has shared her expertise from a pain fellowship at Memorial Sloan-Kettering Cancer Centre in New York. Our team of 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 gynaecologists and neurologists of the Pelvic Pain and Headache Programs. They also participate in teaching medical students, residents and fellows in family practice, palliative care, anaesthesiology, psychiatry, physical medicine and rehabilitation and neurology who rotate through the Centre.
Members Dr. Pamela BartonDr. Noorshina ViraniDr. Nwamara Dike
Highlights
In 2010, Dr. Barton was instrumental in the development of the MSK Special Interest Group (Dr. Virani is the chair) -- a highly valued model of interdisciplinary and inter-specialty collaboration on program and professional development initiatives within the Centre.
Dr. Virani also sits on the Calgary Pain Education Forum (CPEF) committee, formerly known as the Calgary Pain Interest Group, which holds the well-attended Calgary Pain Conference annually. She presented an updated overview on Myofascial Pain Syndrome at the Conference and as a result, was also invited to Victoria, British Columbia to present.
In 2010, Drs. Barton and Virani also presented posters at the Canadian Pain Society meeting in Calgary, the annual meeting of the SOGC in Montreal, and the 7th Interdisciplinary Congress on Low Back and Pelvic Pain in Los Angeles, California.
Chronic Pain Rehabilitation Program
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The Burn Rehabilitation program is new to the Division of Physical Medicine and Rehabilitation for 2010. It offers Canada’s only integrated interdisciplinary Physiatry and Surgery Burn clinics. The program is directed by Dr. Vincent Gabriel, who recently joined the division after directing the clinical services of the North Texas Burn Rehabilitation Project at the University of Texas Southwestern Medical Center/Parkland Hospital in Dallas, TX, where he was a three-time Faculty of the Year award winner and also completed a fellowship in the Rehabilitation Medicine Scientist Training Program (K12) that was funded by the National Institutes of Health and the Association of Academic Physiatrists.
Working closely with a team of Physiotherapists, Occupational Therapists and specifically with Dr. Duncan Nickerson, a plastic surgeon and Head of the Calgary Firefighters Burn Treatment Centre, Dr. Gabriel offers patients with acute and chronic effects of burn injuries a
focus on rehabilitation from the time of injury through to community re-integration at the Foothills Medical Centre as well as the Alberta Children’s Hospital. Although only opened late in 2010, the clinic has admitted over 140 new patients and over 500 patient visits in total. In addition to the out-patient clinic, Dr. Gabriel offers consultations to in-patients admitted to the Burn and Polytrauma units.
The Burn Rehabilitation program is actively involved with research. Dr. Gabriel collaborates with the Biernaskie laboratory in conducting experiments related to tissue regeneration as well as quantification techniques for assessing scar development and wound healing. Dr. Gabriel currently serves on the rehabilitation committee of the American Burn Association.
Members
Dr. Vincent Gabriel
Burn Rehabilitation Program
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Overview
The program provides in-patient rehabilitation on Unit 58. Members from all of the rehabilitation disciplines complete the Spinal Cord Injury team which collaborates with Transition Services, Home Care and community agencies, including the Canadian Paraplegia Association. Although we are designated the "SCI team", we also manage patients with other neurologic diagnoses, such as polyneuropathies, myopathies, and multiple sclerosis.
Members
Dr. Dan McGowanDr. Denise Hill
Highlights
For FY2010-2011, the SCI in-patient program discharged 52 patients with spinal cord injury (23 traumatic injuries, 29 non-traumatic injuries), and another 24 patients with other diagnoses. The SCI out-patient program served a total of 67 new patients and 432 follow-up visits.
There was significant progress with our clinical programs. Dr. Denise Hill worked with Respirology, Respiratory Therapy
Services and the Rehabilitation team to improve the approach to managing cough weakness in tetraplegic patients and those with higher level paraplegia. A new clinical guideline was drafted and plans to train all Calgary hospital respiratory therapists in obtaining peak cough flows, in providing manual cough assists (quad cough), and in the use of the Modified Manual Lung volume Recruitment (MMLVR) equipment were made. Plans to train physiotherapists who work on neurorehabilitation in MMLVR, and to review unit 58 rehab nurse expertise in providing manual cough assistance were also drafted, with support from the respective management obtained. Implementation of training is expected to be in 2011.
Both Drs. Hill and McGowan were actively involved with research programs. Dr. Hill was selected as a co-investigator for a national study on the use of telehealth for pressure ulcer management, while Dr. McGowan studied the effect of “Wii Fit” video game on the balance and mobility in individuals with multiple sclerosis. He also was the primary investigator for the Dalfampridine trials for multiple sclerosis.
Spinal Cord Injury Rehabilitation Program
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Overview
The Paediatric Rehabilitation Program takes place at Alberta Children’s Hospital as well as Foothills Medical Centre, and Dr. Latter is involved in interdisciplinary clinics. Over 90 patients were seen in the Spina Bifida Clinic last year, while over 200 hundred attended the Paediatric Neuromuscular Clinic. The Juvenile Amputee Clinic has over ninety active patients and over 40 new patients are seen each year. These clinics run once a month.
Dr. Latter is also a member of the Paediatric Brain Injury Program with both in-patient and out-patient involvement. In addition to this, the Young Adult Rehabilitation Clinic is held weekly out of the Foothills Medical Centre.
Members
Dr. John Latter (Program Leader) Dr. Lee Burkholder
Paediatric Rehabilitation Program
OverviewIt has been a productive year for the stroke rehabilitation and spasticity programs, which included the Foothills Medical Centre, as well as the Carewest Dr. Vernon Fanning Centre site.
The stroke rehabilitation program had 182 new inpatient consults, 83 new out-patient consults and 591 follow-up visits. In addition, at the Dr. Vernon Fanning Centre, 66 new inpatient consults were performed and weekly follow up service was provided.
Our outpatient spasticity program continues to grow with 71 new patients and 568 repeat injection patients last year.
Members
Dr. Stephen McNeilDr. Ken LamDr. Sean Dukelow
Highlights
Under the direction of Dr. Sean Dukelow, the stroke rehabilitation research program has been expanding, with significant funding through national and local agencies, as well as collaboration with the Calgary Stroke Program, the Hotchkiss Brain Institute, and the Faculty of Kinesiology.
Stroke Rehabilitation Program
Dr. Sean Dukelow, a physiatrist in the Division of Physical Medicine and Rehabilitation for DCNS, won the 2010 Dr. John Latter Award for Excellence in Teaching.
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EDUCATION
Drs. Daryl Wile and Katie Wiltshire, residents in the Department of Clinical Neurosciences, Calgary.
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For over four years, Dr. Lara Cooke has been inspiring her students at the Faculty of Medicine University of Calgary. Here, along with Drs. Daryl Wile and Katie Wiltshire (opposite page), residents in the Department of Clinical Neurosciences, Dr. Cooke takes every opportunity she has to interact with her students.
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Dr. Lara Cooke is on a quest to find the perfect set of elements that make a great teacher; her students would argue that she’s already found them.
With over 15 years of post-secondary education, Dr. Lara Cooke has had a lot of time to think about how medicine should be taught. “I believe that physicians are obliged to pass on the knowledge of the profession to the next generation with the same integrity and compassion for our learners that we give to our patients," says Cooke.
A neurologist and assistant professor in the Department of Clinical Neurosciences, University of Calgary’s Faculty of Medicine and Alberta Health Services, Cooke has won a number of teaching awards over the years, including the prestigious Keith Brownell Teaching Award for Resident Teaching. As Assistant Dean of Faculty Development from 2006 and 2010, Dr. Cooke launched the Faculty of Medicine’s Office of Faculty Development. Now, she is not only responsible for teaching the students, but for teaching the teachers as well.
“There are so many gifted teachers, but a few just eat you for breakfast,” says Cooke. “Motivating students to learn is crucial. If you care passionately about what you’re teaching that will come through, and students will know it.”
Drs. Katie Wiltshire and Daryl Wile, both neurology residents at the University of Calgary, have experienced Dr. Cooke’s passion, enthusiasm, and commitment to teaching first-hand.
“Despite her busy schedule, Dr. Cooke’s commitment to education always comes through,” says Wiltshire, a third-year resident in neurology. “No matter what time of day it is, she always makes time for us.”
“All of us have and continue to benefit from her advanced knowledge in medical education,” says Wile, the junior resident representative for neurology in Calgary.
“The knowledge that she imparts will reach far beyond the years of our residency training.”
In addition to her teaching duties, Cooke is responsible for creating and implementing the U of C’s Teaching Scholars in Medicine Certificate Program -- a program designed for doctors who want to make teaching medicine a major focus of their careers. She also organizes an annual conference on Teaching the Art of Medicine (from 2006 to 2010), and travels locally, nationally, and internationally to present research and curricular reform in the area of teaching communication skills to specialty residents.
As if this weren’t enough, Cooke also runs a neurology clinic at the Calgary Urban Project Society (CUPS), and spends one day a week working at Calgary’s Headache Clinic treating migraine sufferers.
“Great teachers, several within our own department, have been instrumental in my education, and in influencing and inspiring my career choices,” says Cooke. “I want to do everything I can to make sure all our trainees have the same opportunity to work with great teachers, so that they too can feel inspired.”
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Dr. Cooke has received a number of awards over the years, including Avenue Magazine’s Top 40 under 40 (2009). This year, Dr. Cooke received both the 2011 A.B. Baker Teacher Recognition Award from the American Academy of Neurology (AAN) and the Association of Faculties of Medicine of Canada (AFMC) 2011 Award for Exemplary Contributions to Faculty Development.
A Passion for Teachingbuilding excellence in educationby Léora Rabatach
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“I believe that physicians are obliged to pass on the knowledge of the profession to the next generation with the same integrity and compassion for our learners that we give to our patients.”
Dr. Lara Cooke
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Overview
Medical students are taught about the neurosciences in the first course of the second year of the undergraduate curriculum. Provided over an eight-week period at the beginning of the second year (in the three-year curriculum), the neurosciences component is combined with content from geriatrics, otolaryngology and ophthalmology. The course, titled, ‘Course V – Neurosciences, Aging and Special Senses,’ is given under the auspices of the Undergraduate Medical Education office of the Faculty of Medicine at the University 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 neurological complaints. The remainder of the content covers clinical presentations of neurological illness as well as sessions devoted to specific neurological conditions. Taught by approximately 130 teachers - including 60 from the Department of Clinical Neurosciences – course content is delivered via a combination 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 committee members are from the Department of Clinical Neurosciences. Students have consistently ranked the neurosciences component highly in comparison to the other courses offered in the pre-clerkship curriculum.
Course V Committee 2010
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
UNDERGRADUATE MEDICAL EDUCATIONin Clinical Neurosciences
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Medical students at the University of Calgary start working directly with clinicians and patients in their first year.
Photo courtesy of the Faculty of Medicine U of C.
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Sarah Walsh was in the third year of her PhD when she decided to apply for the Leaders in Medicine Program at the University of Calgary - a program that allowed her to combine her PhD with a medical degree.
“My supervisor, Dr. Rajiv Midha, has been a huge inspiration for me,” says Sarah. “He’s a practicing neurosurgeon, but he also runs a successful lab. He showed me the value of being able to see both sides of the coin, to truly understand the clinical implications of our research.”
“Translation requires individuals who are fluent in two languages, and this is equally true of translational medicine,” says Dr. Midha, Division Head of Neurosurgery in the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services. “Clinician-scientists are an ideal solution to this. They create the essential conduit between the laboratory and clinic.”
Now in her third year of medical school at the University of Calgary, Sarah is part of the new generation of scientists focused on this translational model in education -- finding that perfect balance between research and clinical care.
“As a scientist, we are never truly content with the facts, it’s our instinct to keep asking why,” explains Sarah. “This Program has provided me with the flexibility to pursue research in the neurosciences to answer those questions.
But it also allowed me to find new questions through interactions with patients that could help me walk the bridge from disease research to disease cure.”
RESEARCH: Sarah Walsh is trying to find new ways to increase peripheral nerve regeneration following injury. Specifically, she is trying to find a alternative sources for Schwann cells - glial cells involved in many important aspects of peripheral nerve biology, from the conduction of nervous impulses along axons, to nerve development and regeneration.
Although peripheral nerves have the capacity for supporting regeneration, functional recovery of the end organ (skin, muscle, etc.) is rarely fully complete. Walsh has found that skin-derived stem cells act as functional Schwann cells when transplanted into lesioned peripheral nerves – essentially making a new rejuvenated distal nerve capable of supporting regenerating axons. In the future, she hopes they can use a patient’s own skin stem cells to obtain Swann cells -- to support axonal regeneration and potentially improve outcomes for patients following nerve injury.
Training the Clinician Scientistby Léora Rabatach
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Sarah Walsh, MD/PhD student, Leaders in Medicine Program, University of Calgary.
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Neurosurgery Residency
Program Director: Dr. John Hurlbert Assistant Program Director: John WongResearch Director: Zelma Kiss Program Administrator: Patti SullivanNumber of PGY-1 CaRMS positions per year: 2 Accreditation: Royal College of Physicians and Surgeons of Canada Length of Training: 6 yearsMandatory Research: 1 year
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 dynamic key opinion leaders representing all subspecialties of Neurosurgery, including: vascular, interventional, 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 eight full-time spine surgeons coming from both Neurosurgical and Orthopaedic backgrounds.
From the moment they enter the program, residents are continuously involved in research initiatives. Considerable resources are dedicated each year to facilitating this academic activity through faculty participation, existing peer-reviewed grants, project funding from divisional and departmental sources, and 12 months of mandatory clinical or basic science research at the PGY-4 level.
Friday morning “Neurosurgery School” runs each week for two hours after departmental Grand Rounds. The curriculum circumnavigates the neurosurgical universe every two years. Sessions are led by the residents and supervised by the faculty, creating a learning environment within the realm of neurosurgical expert. Once monthly interactive 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 hospital. In addition to dinners with each of the visiting professors, a faculty member hosts journal club every three months. Residents’ Night Out has become a favorite tradition as well. 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 hang out. 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, and 2011 is looking even better.
Neurology Residency
Program Director: Dr. Lara Cook Program Administrator: Elizabeth MartensNumber of PGY-1 CaRMS positions per year: 3 Accreditation: Royal College of Physicians and Surgeons of Canada Length of Training: 5 yearsMandatory Research Block: 3-6 months
The Neurology Residency Program prepares residents 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 as well as regular seminars on ethics, communication skills and evidence-based medicine. Evaluation of residents and the program occurs on a regular basis. The Program Director and Committee manage all aspects of the program, with the help of a program administrator. All members of the Division of Neurology participate in resident education. The Neurology Program has trained 26 neurologists since its inception in 1981.
Physical Medicine & Rehabilitation Residency
Program Director: Dr. Stephanie Plamondon Program Administrator: Linda JennettNumber of PGY-1 CaRMS positions per year: 2
Accreditation: Royal College of Physicians and Surgeons of Canada Length of Training: 5 years
A fully accredited program, the University of Calgary Physical Medicine and Rehabilitation (PMR) Residency Training Program commenced its 7th year in 2010. Through this Program, residents experience outstanding clinical practice in all aspects of adult and paediatric neuro-rehabilitation and musculoskeletal medicine. Residents from rheumatology, neurosurgery, neurology, and orthopaedic surgery rotate through this program, and a growing number of medical students have begun to participate in PMR electives, shadowing, and undergraduate 440 courses in PMR.
The program has developed a very active academic half-day schedule for residents. In addition to this, academic half-day teaching, especially in areas of local limited expertise, is now supported through the use of Tele-education, providing residents with access to staff educators at far distances in a time- and cost-effective manner.
The Residency Training Committee meets monthly (except July and August), and added two non-Physiatry staff members to the committee for better representation from off-service rotations. An annual PMR education retreat is also held for both staff and residents to assist in planning program improvement and faculty development.
The weekly Senior Medical Resident Clinic, under the supervision of Dr. Stephanie Plamondon, continued successfully for its third year. Rotation through this clinic provides residents with the opportunity to experience general rehabilitation out-patient care, which is invaluable in preparing them for both Royal College examinations, and for their future careers as staff members.
RESIDENCY PROGRAMSin Clinical Neurosciences
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For over six years, Dr. John Kelly has been exploring the relationship between stem cells and brain cancer to dispel some of the mystery surrounding the disease. In the future he hopes his research will lead to new treatment options and improve outcomes for patients with brain tumours.
“Initially, my research focused on stem cells in stroke, but I became increasingly obsessed with the causes, diagnosis, and treatment of brain cancers,” says Kelly, a neurosurgery resident in the Department of Clinical Neurosciences and PhD student at the University of Calgary.
Eventually, this obsession led him to ask questions about the relationship between stem cells and brain cancer, and he began to search for answers on his own time.
“Although it was known that stem cells worked as a repair system in the body, their ability to replicate also suggested a possible link with several cancers,” explains Kelly. “At the time, only one paper had been published on the relationship between stem cells and brain cancer (in paediatric patients). It was an extremely new area of research.”
With help from Dr. Peter Forsyth, an oncologist with the Tom Baker Cancer Centre, and mentor Dr. Samuel Weiss, Director of the Hotchkiss Brain Institute, Kelly began to take a closer look at tumour samples removed from adult patients. His results were astounding.
“We found that cancerous stem cells grew in the same manner as regular stem cells,” says Kelly. “This was incredibly exciting because it allowed us to start establishing an understanding of the true cellular origin of brain tumours.”
In June of 2011, Dr. Kelly is heading to New York to begin a fellowship in neurosurgery with a specialization in oncology. Afterwards though, he hopes to return to Calgary.
“The Department of Clinical Neurosciences provides a perfect environment for those of us who want to explore both basic research and clinical care, by supporting us to dedicate specific time to each of those pursuits,” says Kelly. “You don’t find that opportunity in many other places in North America.”
Using stem cells to understand brain tumoursby Léora Rabatach
With over 140,000 deaths each year and no known cure, brain cancer is considered one of the most devastating diseases in the world. In North America, 14 people per 100,000 are diagnosed with a brain tumour each year.
Left: Dr. John Kelly, Neurosurgery Resident in the Department of Clinical Neurosciences.
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FELLOWSHIPS in Clinical Neurosciences
The Department of Clinical Neurosciences (DCNS) at the University of Calgary offers one- and two-year basic and clinical research fellowships designed to provide enhanced broad-based clinical training and responsibility beyond the certification level, as well as clinical research opportunities.
Individual fellows work on specific projects targeted to clinical neurosciences problems in a variety of areas, including:
• Stroke • Spinal Neurosurgery• Peripheral Nerve• Functional Neurosurgery/• Stereotactic Radiosurgery
• Neuro-oncology• Endovascular Neurosurgery• Epilepsy• Headache• Multiple Sclerosis• Neuromuscular.
Within the University of Calgary and Alberta Health Services, the structure of DCNS is uniquely suited to advancing research from the laboratory directly to the patient’s bedside.
The Department 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 environment for all.
For more information on fellowship opportunities, please contact us at [email protected].
Weekly Neurosciences Grand Rounds always brings a big crowd at the Foothills Medical Centre.
Photo by PMG Images.
The Department of Clinical Neurosciences has an average of nine fellows per year studying in a variety of specialties.
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RESEARCH
Ed Block (far left), engineer and designer, and Stephan Bonfield, research assistant for
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Dr. Bin Hu adjusts the earphones on Clarence Pflanz’ head - one of the many patients volunteering to find out if music can
relieve her Parkinson’s symptoms. Research assistant Stephan Bonfield stands nearby ready to help - along with Ed Block, the
engineer responsible for designing the gait monitor, and all other software being used in the Parkinson’s study.
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Music has the power to transform our mood: a favorite song on the radio can bring a smile to our face. Music is also able to trigger us to move: an infectious rhythm can get us swaying to the beat. But, can music heal us?
According to the Canadian Association for Music Therapy, “music therapy is the skillful use of music and musical elements by an accredited music therapist to promote, maintain, and restore mental, physical, emotional and spiritual health”. The association lists a range of people that may benefit from music therapy, including individuals with autism, physical disabilities, or chronic illness.
The therapeutic potential of music has also caught the attention of the scientific community. When Dr. Bin Hu, Professor in the Department of Clinical Neurosciences at the University of Calgary, heard some Parkinson’s patients felt their disease symptoms were alleviated while dancing, for example at a wedding, he designed a research program to examine the phenomenon.
Parkinson’s disease is a neurodegenerative disorder that affects approximately 1% of the general population. Although the disease isn’t fatal, it’s progressive and leads to a variety of mobility issues, such as tremor, loss of balance, and rigid muscles.
Medications are available to treat the symptoms of Parkinson’s disease, but their efficacy reduces over time, and they can be associated with negative side effects.
“Now there is more emphasis on rehabilitation, exercise and cognitive treatment,” says Dr. Hu. “So, we take a multi-faceted approach to manage the disease.”
Dr. Hu launched his research into the effect of music therapy on Parkinson’s patients by first addressing a simple question: does purely listening to music help Parkinson’s patients walk better?
Together with Dr. Brown at University of Lethbridge, the team recruited a group of patients and assigned them with the task of completing walking exercises at home while listening to songs of their choice, over a period of three months. A second group was asked to maintain their normal routine.In the case of the individuals who walked with music, “when they came back for a functional assessment, they were significantly better in terms of walking speed,” explains Dr. Hu. For him, this result begged the question, how does the addition of music lead to improvements in walking ability?
Dr. Hu posited that the success of the music therapy for Parkinson’s patients hinged on the fun of the experience. The key: walking with music is rewarding.To capitalize on the idea that reward is driving the observed positive walking outcomes in Parkinson’s patients, Dr. Hu and his team developed a device called the Gait Reminder. This device
is mounted on a patient’s leg and senses the size and speed of their step. If the patient walks with adequately large steps, the device rewards him or her with music. If their steps are too small, no music is provided.
“Once we put the Gait Reminder on,” describes Dr. Hu, “some patients who couldn’t walk properly prior would just keep walking for 40 minutes, even up to an hour. This is the highlight of the music therapy program.”
Given that individuals display a range of response to music, Dr. Hu thinks some patients will likely benefit more from music therapy than others. The question is what criteria do you use to select those patients early during the disease?
In collaboration with the Alberta Parkinson’s Society, Dr. Hu has initiated a community-based screening program, the first of its kind in North America. Individuals with Parkinson’s attend monthly or bi-weekly meetings in a community centre, where they engage in a detailed assessment of their gait, or the ability to perform different kind of walking tasks. Typically, this type of assessment isn’t performed in a doctor’s office where space is limited.
The individuals benefit from the feedback they receive on their step size and walking speed, which gives important information on how fast the disease has progressed over time. The gait assessments also provide Dr. Hu with invaluable data to develop selection criteria for the Gait Reminder Program.
As for what’s next on the agenda? Dr. Hu would like to investigate the long-term impact of music therapy on Parkinson’s patients. “My overall expectation is that once music if fully integrated with walking, i.e. walking is utilized to obtain the music through sustained and directed attention to leg movements, we will see benefits at multiple levels that will lead to improvements in the functional status of the patient, and maybe a slow-down in the disease progression. This is a big maybe, but it’s hopeful.”
Dr. Bin Hu receives funding from Alberta Innovates – Health Solutions, funded by the Alberta Heritage Foundation for Medical Research Endowment Fund. He is a Professor in the Department of Clinical Neurosciences and head of Division of Experimental Neurosciences in the Faculty of Medicine at the University of Calgary. Dr. Hu receives additional funding from CIHR, the Department of Clinical Neuroscience at the University of Calgary, and the Ross Family.
Selected Publicationde Bruin N, Doan JB, Turnbull G, Suchowersky O, Bonfield S, Hu B, Brown LA. Walking with music is a safe and viable tool for gait training in Parkinson's disease: the effect of a 13-week feasibility study on single and dual task walking. Parkinsons Disease. 2010 Jul 13;2010:483530.
Music Therapy in Disease Treatmentbuilding excellence in researchby Tara Narwani
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“Now there is more emphasis on rehabilitation, exercise and cognitive treatment,” says Dr. Hu. “So, we take a multi-faceted approach to manage the disease.”
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The Department of Clinical Neurosciences was founded 30 years ago on the premise that excellence in patient care and excellence in research go hand in hand -- we see them not only as inseparable, but synergistic. Not all of the physicians and surgeons in Clinical Neurosciences are actively engaged in research, many of them focus exclusively in patient care, but the spirit of research and innovation are integral to our team and continuously fostered.
Members of our department lead research programs of many different types. Facilitated by strong partnerships with the Hotchkiss Brain Institute (HBI), other clinical Departments within Alberta Health Services - Calgary Zone (and beyond), and other public and private organizations, our members focus in five main areas:
1. Basic Research - the study of biology and mechanisms of disease.
2. Translational Research (Parkinson’s story, page 40) – which involves taking findings from basic research and moving them quickly and efficiently into medical practice to improve disease treatment or other health outcomes.
3. Clinical Trials Research - the comparative testing of new treatment ideas against current standards of care to determine which is superior.
4. Health Services Research - the study of health care access and health care delivery to detect deficiencies and design improvements. Health services research often involves careful analysis of databases.
5. Population Health Research (CRU story, page 44) - the study of disease in populations to find risk factors and design prevention methods.
For example, Drs. Peter Stys, Douglas Zochodne, Gregory Cairncross and Cory Toth are engaged in basic research
seeking to understand the scientific basis of neurological diseases like multiple sclerosis, inflammatory neuropathies, brain cancer, and the slowly debilitating neurological complications of diabetes. Dr. Garnette Sutherland is developing new robotic surgical tools to improve the accuracy and safety of brain surgery and building novel brain imaging devices to help guide our brain and spine surgeons. Drs. Andrew Demchuk, Michael Hill, Shelagh Coutts, Eric Smith, Farnaz Amoozegar, Paolo Federico, and Luanne Metz are testing new treatments for common neurological disorders such as stroke, transient ischemic attacks, dementia, migraine, epilepsy, and multiple sclerosis. Finally, Drs. Nathalie Jetté, Samuel Wiebe, Lawrence Korngut, and Tamara Pringsheim are examining the ways in which neurological care is currently delivered across Canada and devising better ways to meet the needs of patients.
Our research-focused doctors and scientists are also members of the Institutes of the Faculty of Medicine and Alberta Health Services -- mainly the HBI, from which they receive invaluable assistance, mentorship and support. Indeed, much of our success in research as a clinical group can be traced to these very strong linkages. Also, we conduct much of our research that involves patients in the facilities of Alberta Health Services and are indebted to Alberta Health & Wellness for a funding mechanism that facilities all types of health care research.
Our faculty members publish the results of their studies in the top medical and scientific journals, and they play leading roles in a wide variety of local, national, and international academic and professional organizations. Their efforts are generously supported by grants from a wide range of external agencies.
We are very proud of our research tradition and international standing.
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Right: A pyramidal neuron from a primary occipital cortex culture.
Far right: Astrocytes gown in primary culture and immunostained with an antibody against GFAP (glial fibrillary acidic protein).
Photos courtesty of Johanna Hun, Faculty of Medicine, University of Calgary.
RESEARCH in Clinical Neurosciences
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Population Health Research through the Clinical Research Unitby Léora Rabatach
With leadership from Dr. Samuel Wiebe, the Clinical Research Unit (CRU) at the University of Calgary aims to bring research and treatment efforts closer together.
Developed in partnership with the Department of Clinical Neurosciences and the Hotchkiss Brain Institute, University of Calgary and Alberta Health Services, the Clinical Research Unit is an innovative in-house resource to aid researchers at every stage of clinical trials development, from implementation through to management and reporting.
“Clinical Trials are a key component to
advancing medical knowledge and patient care,” says Dr. Samuel Wiebe, Founder and Chair of the CRU and Director of Clinical Research for the Hotchkiss Brain Institute (HBI) at UCalgary’s Faculty of Medicine. “The first of its kind in Canada, the CRU brings together the expertise to aid in study design, data collection, and data management, all under one roof.”
A clinician and a scientist, Wiebe is no stranger to clinical trials research, and is internationally known for his groundbreaking research on the effectiveness of surgery in treating patients with epilepsy.
“Clinical research requires a broad array of infrastructure, support and the ability to link various sources of data together -- from surveys to randomized trials to outcome studies or health services research,” says Wiebe. “Clinical scientists and researchers need access to design expertise, optimal data capturing techniques, secure data management, data analysis capabilities and streamlined reporting.
The CRU is beneficial for researchers interested in initiating both single and multi-institutional clinical trials in the neurosciences. In addition to the development aspects, the financial
With leadership from Dr. Samuel Wiebe (right with Christina Ma, Manager of the CRU), the Clinical Research Unit at the University of Calgary aims to bring research and treatment efforts closer together.
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Linking Autism Spectrum Disorders with Tourette’s Syndromewith the help of the CRUby Léora Rabatach
One of the most disabling aspects of Tourette syndrome (TS) is that in 90% of cases TS exists in conjunction with another disorder. Autism Spectrum Disorders (ASD) – a range of neurological disorders that affect a child’s ability to communicate, relate to others, and understand or respond to sensory input – is known by clinicians to be a highly prevalent co-morbidity of TS; though the cause and rate of this association has yet to be determined.
With the help of the Clinical Research Unit (CRU) at UCalgary and her team at the Calgary Tourette Syndrome Clinic, Dr. Tamara Pringsheim is trying to understand the connection between TS and ASD. Over the next 10 years, patients referred to the Clinic will undergo a standard assessment using specialized data collections forms created by the CRU – gathering information on everything from age and gender, to whether or not they had any pre-existing conditions
(ASDs, ADHD, etc.), as well as symptom severity.
“Having one disorder can be difficult enough,” says Pringsheim, a neurologist and researcher n the Department of Clinical Neurosciences, UCalgary and Alberta Health Services. “Understanding how two diseases are related can not only aid in new treatment options, but could also lead to a more efficient diagnosis process for these patients.”
Tourette syndrome has a great spectrum of severity. People with TS have motor and vocal tics -- rapid, repetitive, meaningless movements and sounds. Common motor tics include forceful blinking, opening the eyes wide, head shaking and grimacing, while the most common vocal tics are sniffing, throat clearing and grunting. Some people are very mildly affected, while others have more severe symptoms, making the disorder more noticeable and disabling. It is believed that TS affects about 1 in 100 people.
“Many people with TS do not seek medical attention for the disorder because the symptoms are so mild,” states Pringsheim. “This is the same for less severe forms of ASDs as well, and because each child is
affected in a unique way, ASDs in particular are often very difficult to diagnose.”
Preliminary findings from the study show that the number of patients with both TS and ASD is more than would be expected by chance. Out of 116 patients, 14 patients were identified to have an ASD as well as TS, and six were newly diagnosed with an ASD derived from this study assessment process.
“The ability to communicate socially is an incredibly important tool for kids to learn in order to be successful in life,” says Pringsheim. “These skills can be taught. If we can find ways to identify patients with ASDs earlier, we will have more opportunities to improve treatment options and increase their quality of life.”
Pringsheim is also hoping to understand what happens to these patients over time. 50 per cent of patients have complete resolution of TS by adulthood. Data collected in this study may aid in predicting which of her patients will outgrow their symptoms in the future – easing the stress for at least some children and their parents who live with these disorders.
benefits of using CRU services are undeniable. Research support through the CRU is 1/10 of what it would cost through commercially available clinical trials support options.
Since 2007, the CRU has grown to accommodate over 24 studies at various stages of development, nine of which are multi-centre studies. Some areas that have benefitted from the CRU are Stroke, Multiple Sclerosis, Headache, Epilepsy, Family Medicine, Mental Health, Movement Disorders, Paediatrics, and Chronic Pain.
“We generally fund anywhere between 3 to 5 pilot studies annually, depending on the calibre of the applications that we receive each year,” says Christina Ma, Manager of the CRU. “We are dedicated to creating a system that not only supports our researchers to fulfill FDA and Health Canada requirements, but one that fosters funding for our new investigators as well.”
The CRU team is also in the process of
developing a patient interface to be launched next year that will allow patients to enter their own information (diaries, daily medical changes, etc.) in order to allow them to
participate more fully in clinical studies.
“The CRU is an incredibly important step in neurosciences research because it allows our researchers to save both time and money, and places Calgary at centre stage for bringing research discoveries to patients more quickly.” says Dr. Greg Cairncross, Head of the Department of Clinical Neurosciences, University of Calgary and Alberta Health Services. --------
“It is extremely rewarding to know that the CRU team is now setting the Canadian standard for collaborative neurosciences care and innovation.”-----------------Dr. Samuel Wiebe is a professor in the Departments of Clinical Neurosciences, Community Health Sciences, and Paediatrics. He is Founder and Chair of the Clinical Research Unit and is Clinical Director for the Hotchkiss Brain Institute and Clinical Neurosciences. In addition to this, Dr. Wiebe holds the Hopewell Professorship in Clinical Neurosciences, which was established in order to foster clinical research in neurosciences and mental health through the creation of research infrastructure.
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1. Abdulla F, Dhaliwal H, Pillay N and Jetté N. The resident and fellow’s survival guide to the epilepsy service rotation. University of Calgary, Neurology Division, June 2010
2. Agrawal SM, Silva C, Tourtellotte WW, Yong VW. EMMPRIN: a novel regulator of leukocyte transmigration into the CNS in multiple sclerosis and experimental autoimmune encephalomyelitis. J Neurosci. 2011 Jan 12;31(2):669-77
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Planning and editing by: Dr. Greg Cairncross, Dr. Rajiv Midha, Dr. Samuel Wiebe, Dr. Bin Hu, Dr. Christine McGovern, Dr. Chester Ho, Dr. John Wong, Danielle Sikander, Linda Jennett, Linda Menzies-Burrows, Sue Nelson, and Léora Rabatach.
Designed and produced by Léora Rabatach.Photography by Paul McGrath of PMG Image.Cover design by Dean Bartsch.Printed by Acorn Graphics.
Department of Clinical NeurosciencesAdministration Office: Room 1195Foothills Hospital1403 - 29 Street NWCalgary Alberta T2N 2T9T: 403.944.1260W: www.ucalgary.ca/dcns
