OhioHealth's Neuroscience Center opened last year at Riverside Methodist Hospital. A new Brain and Spine Hospital is opening at Ohio State this month, giving Columbus two dedicated in-patient facilities for neurological patients.
Imagine an annual physical that includes a blood test and brain imaging that reveal whether you are predisposed to Alzheimer's or Parkinson's disease. Then, imagine that any prognosis does not terrify you, but instead empowers you to take simple measures to prevent illness.
Physicians and researchers in central Ohio and around the world are working to make that a reality. Such discoveries would represent the Holy Grail of neurological research, said Dr. Brendan Kelley, associate professor of neurology and psychiatry at Ohio State University's Wexner Medical Center.
“It's saying we can figure out that you’re at risk of this disease, and we can give you a treatment that’s either going to prevent you from ever getting it or delay it for so long that it’s not really relevant to your life,” said Kelley, who specializes in dementia disorders.
Think along the lines of a wearable device that monitors stress, anxiety, inflammation and circadian rhythms, said Dr. Ali Rezai, who directs the Neurological Institute at Ohio State. Or maybe even a temporary tattoo that monitors sweat, devices that read saliva in the mouth or computer cameras that track eye movement.
All of these could link to a cellphone app that tells you when something looks askew.
"Maybe if you're better able to monitor or manage your overall brain health with your sleep-wake cycles, with your stress and inflammation and anxiety, maybe if you can manage those better you may not get the diseases," Rezai said.
One goal is to study the brains of elite athletes, military personnel, the general population and people with neurological disorders to determine ways to achieve optimal brain health and performance under various circumstances.
Other advancements likely will include the broadening of neuromodulation devices or what Rezai calls “pacemakers for the brain, spinal cord and nerves.” These are implants that work with external controllers to reduce chronic pain and migraines, improve urinary incontinence, decrease tremors and improve movements in Parkinson’s disease and other conditions that cause involuntary muscle contractions.
The future also might hold similar treatments for people who have suffered severe traumatic brain injuries and for people with Alzheimer’s disease, autism and addictions.
With a new Brain and Spine Hospital opening at Ohio State this month and OhioHealth's Neuroscience Center, which opened last year at Riverside Methodist Hospital, Columbus is rare in that it has two dedicated in-patient facilities for neurological patients, said Dr. Janet Bay, vice president and physician lead for OhioHealth’s neuroscience program.
Other institutions are part of the Ohio effort, including Battelle and Nationwide Children's Hospital locally, Wright Patterson Air Force Base in Dayton, Ohio University in Athens, Vanderbilt University in Nashville and the Center for Neuroprosthetics in Geneva, Switzerland.
"It’s an exciting time for us because Ohio is a major hub for this,” Rezai said. "We want to call Ohio 'brain central.' "
Discussions with Bay, Rezai, and other central Ohio brain and spine experts revealed other predictions for the future of neurological health.
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| Dr. Ali Rezai, who directs the Neurological Institute at Ohio State, envisions wearable devices to help patients monitor their brain health. |
Bay said treatment for people with poorly controlled epilepsy typically involves two craniotomies, one to open the skull to place a grid or electrodes to monitor the brain and a second if findings dictate the need for surgery.
But a robotic stereotactic EEG method can insert electrodes deep in the brain through pencil-sized incisions, which also can be used to send in lasers to eliminate seizure trigger points.
“People can go home the next day, and there’s a very drastic reduction in morbidity,” Bay said. “ Right now, patients are loathe to consider surgery. … I think this is going to blossom, and we’ll see more surgeries in the future.”
Dr. Stephen Kolb, who directs clinical and research programs at Ohio State on diseases including ALS, or Lou Gehrig's Disease, said the ability to understand what's going on in the brain on a genetic level is expanding quickly.
He said a Columbus researcher has shown that a virus can be modified and turned into "a taxi cab, so that it will deliver a gene cargo directly into specific cells within the nervous system.”& amp; amp; amp; amp; amp; amp; amp; amp; lt; /p>
If this works for ALS, Kolb said, it could also work for other diseases such as Alzheimer’s and Parkinson’s.
He specifically discussed a research project by Ohio State and Nationwide Children's Hospital that is looking at spinal muscular atrophy, a motor-neuron disease that makes patients weak and is fatal in infants.
Researchers have identified a genetic marker and are working on a way of delivering therapy to affected motor neurons and to determine when to give therapy to babies, he said.
“Our ability to alter gene expression in the nervous system is making huge leaps," Kolb said. "It’s a new day for those types of things.”
Dr. Michel Torbey, medical director of the neurology-stroke center at Ohio State, said stroke research is focused on doubling the time frame during which treatment can be effective following a stroke.
Right now, there is up to an eight-hour window for certain treatments. Techniques being considered include injecting stem cells to repair damaged areas of the brain.
Dr. Chad Miller, OhioHealth’s neuroscience medical chief for regional development and clinical integration, said he expects further innovations in delivery of care to make it more personalized and accessible.
He said increased virtual visits and telemedicine can be further used to reduce patient wait times for appointments and prevent them from having to travel far to see specialists.
In the clinic, patients will see a physician, physical therapist, social worker, dietitian and other relevant providers during the same visit, preventing them from having to return three and four times.
Dr. John Kissel, chairman of the neurology department at Ohio State, boiled it all down to two approaches: the big and the small.
The small include molecular genetic research that will allow blood tests to identify a host of illnesses, including some that might not have yet been described. The big include expanding deep-brain stimulation research that already has used electrodes to allow a paraplegic man to move his limbs.
“It’s never been more hopeful,” Kissel said. “For 20 years, I would tell patients there’s always hope; it was a little bit hollow. But now the rules of the game have changed.”
http://www.dispatch.com/content/stories/local/2016/09/25/your-health/neuroscience-experts-say-advances-research-pushing-brain-treatments.html#
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