The Institute of Clinical Neurosciences - 2nd Annual report

The idea of a Clinical Neurological Institute was first floated by Mr Alexander, a neurosurgeon in Bristol, in the 1950s. The concept lay dormant for a while. The first report of the embryo institute was produced in April 1990 and contained details of 340 papers produced by neurosciences members during the recent years. A second document was produced in 1994 giving a further list of publications together with proposals for the formal establishment of an Institute of Clinical Neurosciences at Frenchay Hospital combining NHS and university elements together with the Burden Neurological Institute, which was itself founded over 50 years ago. The Institute was eventually established in 2001. The second Annual Report of the newly formed Institute has recently been published.

The Institute has achieved high profile in both the scientific world and in the lay media by the promising preliminary results of the pioneering neurosurgical pilot trial treating Parkinsons patients with growth factor infusions. The breadth, depth and success of research activities has been demonstrated in 97 publications produced in 2002 and a total of over £7.5 million worth of grants and other research-related income generated.

The core ICN groups at the beginning of the 2001-2002 period included the Burden Neurological Institute, the Bristol Alzheimers Research Group, the Brain Injury and Rehabilitation Unit, the Speech and Language Therapy Research Unit and the various neurosciences clinical departments. In late 2001 the Neonatal Neurology Group joined the ICN bringing their high profile research interests in neonatal acute brain injury. The growing academic ENT Laryngeal Research Group also joined at this time. In mid-2002 the group was joined by Dr Ben-Shlomo, a neuro-epidemiologist in the Department of Social Medicine.

We give below some of the areas currently being researched by members of the Institute of Clinical Neurosciences.

The Multiple Sclerosis Research Groups activities continue to centre on the underlying cell biology of multiple sclerosis and the development and implementation of myelin repair treatments. The Group continues to be interested in the developments and delivery of immune-modifying treatments.

With substantial financial input from the Pharmaceutical Industry and with support from the local Primary Care Trusts, 2 new specialists MS nurse posts have been established.

It is hoped to start building the proposed Multiple Sclerosis Centre in the old stable-block on the Frenchay site and this will combine "high-quality coordinated focused science with multi-faceted clinical and social care".

Delivering high-frequency electric stimulation through tiny electrodes implanted into the brain (deep brain stimulation DBS) has been shown to be a reliable and efficient treatment for patients with movement disorders. However little is known about how this works. Studies of the neurophysiological changes induced by DBS are being undertaken. A further study is evaluating whether repetitive low-frequency transcranial magnetic stimulation can induce clinical improvement.

Coma

Electro-physiological techniques are being developed which test the functional integrity of different systems within the brain. They provide additional information about the probability of recovery and possibility the quality of recovery of survivors.

The Group now has a brain-bank which is being used to study the destructive processes in Alzheimers disease and other dementias. The main thrust of research involves investigation for new risk factors or possible genes that may affect AD progression. There are a number of projects examining neuropathological changes in dementia.

Mild cognitive impairment (MCI) falls between normal aging and AD. Not everyone with MCI develops AD but there is an increased risk. Research is in progress to determine whether simple tests of particular cognitive functioning (such as visuo-spatial attention), could be useful in prediction.

This Group is investigating the mechanisms and developing treatments for brain injury in the newborn infant. It has been shown that mild cooling after hypoxia can reduce brain injury in a newborn model. Another important finding is that sedation appears to be necessary for mild cooling to reduce brain damage. These laboratory studies have been running in parallel with a multi-centre randomised trial of head cooling.

The issue of quality of life in PD is part of a large European study of focal dystonias being undertaken. The Caerphilly Cohort is currently being studied to examine the determinants of healthy aging and cognitive decline and dementia.

Current studies concern the clinical and pathological effects and genetic risk factors for the development of cerebral amyloid angiopathy in normal elderly people and in AD. MRC funding for various studies is being obtained within the framework of the MRC Centre for Synaptic Plasticity.

The Department has participated in a DOH-funded retrospective study of variant CJD and related disorders. More recently a study of prion disease has broadened to encompass studies of murine scrapie.

Investigations are being undertaken into the cognitive, educational, and psychosocial outcome of children who have sustained traumatic brain injury and children who have been diagnosed as brain cancer. Research is being undertaken into the cognitive effects of functional surgery for Parkinsons disease.

Studies are being undertaken into the clinical effects and pathophysiological substrate of stereotactic lesions in various parts of the basal ganglia complex. Bristol is one of the lead centres in a large national trial. Another trial involves the continuous infusion of specific growth factors into parts of the brain damaged in PD. Initial results are highly encouraging.

The technique of endoscopic choroid plexus coagulation has been applied to the treatment of normal pressure hydrocephalus. A clinical trial has been commenced.

The above are some examples of research projects currently being undertaken in the Institute. For reasons of space the names of the various participants have not been given but are freely available.

The Institute continues to be actively involved in the training of undergraduates and every final year student now spends a week in the Neuroscience Department during their medical block.

In this short article it is not possible to encompass all the areas of research currently being undertaken. In particular we have not covered research being undertaken in the Speech and Language Therapy Research Unit. We hope to cover this in a future edition of the site.