Warren symposium follows legacy of geneticist giant

If we want to understand how the brain creates memories, and how genetic disorders distort the brain’s machinery, then the fragile X gene is an ideal place to start. That’s why the Stephen T. Warren Memorial Symposium, taking place November 28-29 at Emory, will be a significant event for those interested in neuroscience and genetics. Stephen T. Warren, 1953-2021 Warren, the founding chair of Emory’s Department of Human Genetics, led an international team that discovered Read more

Mutations in V-ATPase proton pump implicated in epilepsy syndrome

Why and how disrupting V-ATPase function leads to epilepsy, researchers are just starting to figure Read more

Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

neurosurgery

Two birds with one stone: amygdala ablation for PTSD and epilepsy

The amygdala is a region of the brain known for its connections to emotional responses and fear memories, and hyperreactivity of the amygdala is associated with symptoms of PTSD (post-traumatic stress disorder). That said, it’s quite a leap to design neurosurgical ablation of the amygdala to address someone’s PTSD. This type of irreversible intervention could only be considered because of the presence of another brain disorder: epilepsy.

In a case series published in Neurosurgery, Emory investigators describe how for their first patient with both refractory epilepsy and PTSD, observations of PTSD symptom reduction were fortuitous. However, in a second patient, before-and-after studies could be planned. In both, neurosurgical ablation of the amygdala significantly reduced PTSD symptoms as well as reducing seizure frequency.

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Posted on by Quinn Eastman in Neuro Leave a comment

Device for viewing glowing brain tumors

People touched by a brain tumor — patients, their families or friends — may have heard of the drug Gliolan or 5-ALA, which is taken up preferentially by tumor cells and makes them fluorescent. The idea behind it is straightforward: if the neurosurgeon can see the tumor’s boundaries better during surgery, he or she can excise it more thoroughly and accurately.

5-ALA is approved for use in Europe but is still undergoing evaluation by the U.S. FDA. A team at Emory was the first to test this drug in the United States. [Note: A similar approach, based on protease activation of a fluorescent probe, was reported last week in Science Translational Medicine.]

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A hand-held device to detect glowing brain tumors could allow closer access to the critical area than a surgical microscope

Biomedical engineer Shuming Nie and colleagues recently described their development of a hand-held spectroscopic device for viewing fluorescent brain tumors. This presents a contrast with the current tool, a surgical microscope — see figure.

Nie’s team tested their technology on specimens obtained from cancer surgeries. Their paper in Analytical Chemistry reports:

The results indicate that intraoperative spectroscopy is at least 3 orders of magnitude more sensitive than the current surgical microscopes, allowing ultrasensitive detection of as few as 1000 tumor cells. Read more

Posted on by Quinn Eastman in Cancer Leave a comment

DBS for drug-resistant epilepsy

Space considerations in print forced us to slim down the feature on deep brain stimulation for drug resistant epilepsy, which appears in the Spring 2015 issue of Emory Medicine. While I encourage you to please read our story profiling playwright Paula Moreland, here are some take-away points:

*Surgery is a viable option for many patients with drug-resistant epilepsy, but not all of them, because the regions of the brain where the seizures start can have important functions. (Look for an upcoming post describing a patient I met for whom the surgical option was helpful.)

*Deep brain stimulation can reduce seizure frequency and improve quality of life for patients with drug-resistant epilepsy.

*In the large clinical trials on deep brain stimulation for epilepsy that have been run so far (SANTE and RNS), most participants do not see their seizures eliminated. Ms. Moreland is an exception.  Read more

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Lab Land looking back: Top ten themes for 2014

It is a privilege to work at Emory and learn about and report on so much quality biomedical research. I started to make a top 10 for 2014 and had too many favorites. After diverting some of these topics into the 2015 crystal ball, I corralled them into themes.
1. Cardiac cell therapy
PreSERVE AMI clinical trial led by cardiologist Arshed Quyyumi. Emory investigators developing a variety of approaches to cardiac cell therapy.
2. Mobilizing the body’s own regenerative potential
Ahsan Husain’s work on how young hearts grow. Shan Ping Yu’s lab using parathyroid hormone bone drug to mobilize cells for stroke treatment.
3. Epigenetics
Many colors in the epigenetic palette (hydroxymethylation). Valproate – epigenetic solvent (anti-seizure –> anti-cancer). Methylation in atherosclerosis model (Hanjoong Jo). How to write conservatively about epigenetics and epigenomics.
4. Parkinson’s disease therapeutic strategies
Container Store (Gary Miller, better packaging for dopamine could avoid stress to neurons).
Anti-inflammatory (Malu Tansey, anti-TNF decoy can pass blood-brain barrier).
5. Personal genomics/exome sequencing
Rare disease diagnosis featured in the New Yorker. Threepart series on patient with GRIN2A mutation.
6. Neurosurgeons, like Emory’s Robert Gross and Costas Hadjpanayis, do amazing things
7. Fun vs no fun
Fun = writing about Omar from The Wire in the context of drug discovery.
No fun (but deeply moving) = talking with patients fighting glioblastoma.
8. The hypersomnia field is waking up
Our Web expert tells me this was Lab Land’s most widely read post last year.
9. Fine-tuning approaches to cancer
Image guided cancer surgery (Shuming Nie/David Kooby). Cancer immunotherapy chimera (Jacques Galipeau). Fine tuning old school chemo drug cisplatin (Paul Doetsch)
10. Tie between fructose effects on adolescent brain (Constance Harrell/Gretchen Neigh) and flu immunology (embrace the unfamiliar! Ali Ellebedy/Rafi Ahmed)
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Monitoring the brain’s temperature

It’s been a little while since we had an Intriguing Image. This video illustrates a surgical technique for the treatment of medication-resistant temporal lobe epilepsy.

In this procedure, which is designed to minimize cognitive side effects, the surgeon carefully uses a laser probe to heat and ablate the regions of the brain doctors think are important for seizures. Magnetic resonance imaging allows the temperature in the brain to be precisely monitored. The video was provided by Robert Gross, MD, PhD, and accompanies an upcoming paper in the journal Neurosurgery. More discussion of this procedure here and here.

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The classic epilepsy surgery case

The epilepsy patient Henry Molaison, known for most of the 20th century as H.M., is one of the most famous in neuroscience. His case played an important role in telling scientists about structures of the brain that are important for forming short-term and long-term memories.

To control H.M.’s epilepsy, neurosurgeon William Scoville http://www.raybandasoleit.com/ removed much of the hippocampi, amygdalae and nearby regions on both sides of his brain. After the surgery, H.M. suffered from severe anterograde amnesia, meaning that he could not commit new events to explicit memory. However, other forms of his memory were intact, such as short-term working memory and motor skills.Henry_Gustav_1

This classic case helps us understand the advances that neurosurgeons at Emory are achieving today. The surgeries now used to treat some medication-resistant forms of epilepsy are similar to what was performed on H.M., although they are considerably less drastic. Usually tissue on only one side of the brain is removed. Still, there can be cognitive side effects: loss of visual or verbal memory abilities, and deficiencies in the ability to name or recognize objects, places or people.

Neurosurgeon Robert Gross has been a pioneer in testing a more precise procedure, selective laser amygdalohippocampotomy (SLAH), which appears to control seizures while having less severe side effects. Neuropsychologist Daniel Drane reported at the recent American Epilepsy Society meeting on outcomes from a series of SLAH surgeries performed at Emory.

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Brain tumor patient gives back and moves forward

Jennifer Giliberto

Don’t sweat the small stuff.

That’s the motto 36-year-old Jennifer Giliberto now lives by after recently welcoming a third child into the world. Late night feedings, diaper changes, mounds of dirty laundry and caring for two older boys (ages six and eight) would certainly be a challenge for most moms. But this mom is different.

Four years ago, Giliberto was diagnosed with a brain tumor – a slow growing Grade II astrocytoma located in her posterior right temporal lobe. The shocking diagnosis left Giliberto and her family with many choices and decisions to make.

Giliberto’s inspiring story was profiled on CNN on Aug. 16, 2011 in a special “Human Factor” segment, which takes a look at people accomplishing something significant after overcoming the odds.

The Long Road Ahead

After her second child was born in 2005, Giliberto began noticing a pattern of problems with her fine motor skills. Neurological testing revealed little, but an MRI (magnetic resonance imaging) revealed a lesion and possible tumor in the brain. Follow-up MRIs over the next year showed no new growth, but in June 2007, a definite brain tumor was detected by MRI.

While taking the watch and wait approach to determine if the tumor would grow, she became involved with the Southeastern Brain Tumor Foundation (SBTF) as a volunteer. She focused her efforts on raising money to support critical brain and spinal tumor research. She also met Emory neurosurgeon Costas Hadjipanayis, MD, PhD.

Hadjipanayis, an assistant professor in Emory’s Department of Neurosurgery, would soon become Giliberto’s physician. He confirmed her diagnosis and recommended surgical removal of the tumor.

Costas Hadjipanayis, MD, PhD and patient Jennifer Giliberto

On August 18, 2008, at Emory University Hospital Midtown, Hadjipanayis removed Giliberto’s brain tumor. “Jennifer underwent a craniotomy and had a gross total resection of the tumor, with no complications,” explains Hadjipanayis, who is chief of neurosurgery at the hospital. “She spent one night in the neurosurgical ICU and her recovery afterwards went well.”

Then he encouraged her to embrace life and live it to the fullest. Giliberto has taken her doctor’s orders to heart, and lives life with a new purpose than before.

Giving Back

To support and encourage other brain tumor patients, Giliberto serves as a patient and family advisor at Emory University Hospital Midtown. She visits with hospitalized patients and their families who are in similar situations as the young mother of three.

“This has been a very fulfilling experience and an outlet to give back,” says Giliberto. “Being a patient is lonely, even when you know you have support. Working to assist other patients and families and improve a system goes a long way to ease that lonely journey of the patient experience.”

Patient and family advisors also work to improve hospital processes and procedures from a patient perspective.

She also serves as vice president of the Southeastern Brain Tumor Foundation, continuing the mission to raise funds for research. The SBTF consistently funds innovative brain tumor research at Emory’s Winship Cancer Institute.

And she is a devoted wife and mother.

Moving Forward

Last year, when Giliberto and her husband decided they would like to expand their family of four, she consulted with Hadjipanayis. He, once again, encouraged her to live life and move forward. They did, and their youngest child was born in July 2011.

While Giliberto has remained stable since her surgery in 2008, she continues to have MRI’s every six to nine months to check for any tumor recurrence. Astrocytomas, even once removed, can recur and can also become cancerous.

But for now, it’s on with life as she knows it – stable, moving ahead and enjoying every day with a new sense of hope.

And as for the small stuff – Giliberto’s learned there’s just no reason to sweat it at all.

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Support from Family and Close Friends Helps Recovery

Representative Gabrielle Giffords

Representative Gabrielle Giffords. Photo courtesy Giffords’ House office.

As we watch the daily progress of Representative Gabrielle Giffords, many close observers have commented that her recovery has been moving along more quickly than expected, and took a big leap after the visit from President Obama.  Related?  Perhaps.

Emory Psychologist, Dr. Nadine Kaslow, says there is no question that love and support from family, friends, and others individuals a patient is close to, can make an enormous difference in the recovery process.

She explains that after people come out of a coma, they often seem to have a special connection to those who were there for them during the coma, even if they don’t actually remember anything in a conscious way. Efforts to communicate with the patient, she says, whether those be verbal or physical, can reinforce linking and communication. She adds patients who have physical contact from a loved one seem to visibly relax and engage more.

At Emory, as we move more and more to patient and family centered health care, we actively encourage loved ones to talk with the patient, read to the patient, touch and stroke the patient. Additionally, beds and shower facilities are provided so that family members can be with their loved ones around the clock. Shop for top-quality hospital beds for sale at unbeatable prices.

Owen Samuels, MD, director of Emory University Hospital’s neuroscience critical care unit, reiterates that patient families are now recognized as central to the healing process and their presence can even reduce a patient’s length of stay. He says that in a neurology ICU, where the average length of stay is 13 days, but is often many, many more, this can be especially beneficial.

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First of its kind neurosurgery boot camp held at Emory

Emory’s Department of Neurosurgery recently hosted a two-day boot camp for first-year neurosurgery residents. The unique event was part of a new national course launched by the Society of Neurological Surgeons (SNS) in Atlanta and five other cities including Boston, Portland and Chicago.

The course focused on fundamental skills, patient safety, professionalism and communications. Day one was structured in a traditional lecture format, while day two placed participants in simulated operating room environments and neurosurgical procedures.

A first-year neurosurgery resident participates in the nation's first series of neurosurgery boot camps.

“This boot camp concept is the first of its kind in medicine providing interns with a strong foundation to learn basic concepts and procedures and helping to ultimately reduce the number of errors among training residents,” says Costas Hadjipanayis, MD, PhD, assistant professor of neurosurgery at Emory School of Medicine and chief of neurosurgery service at Emory University Hospital Midtown.

More than 90 percent of all incoming neurosurgery residents in the United States participated in the training at one of the sites. Emory neurosurgical faculty, fellows, and residents led intensive and interactive exercises oriented to fundamental bedside procedural and operative skills.

The exercises were designed to allow residents to familiarize themselves with the basics in an educational and risk-free environment. Skills relevant to all first-year residents were covered, such as line placement and suturing, as well as specific neurosurgical skills like drilling and performing a craniotomy.

According to Hadjipanayis, one of the Emory organizers and course directors, the group of 37 interns participating in the Atlanta training was the largest number nationwide. They were from universities across the region ranging from Virginia to Puerto Rico.

“This was definitely a great start to a course we will cultivate and enhance from year to year,” says Hadjipanayis. “Our goal is for continuous evaluation and improvement.”

Click here to view a CNN news story filmed at the Emory boot camp by CNN medical correspondent and Emory neurosurgeon, Sanjay Gupta, MD.

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Pituitary tumors removed using a 3-D endoscope

Although the size of a pea, the pituitary gland, located deep within the skull at the base of the brain, is indispensible.

Known as the master gland, it directs other glands to produce hormones that affect metabolism, blood pressure, sexuality, reproduction, and development and growth, as well as other bodily functions.

Nelson Oyesiku, MD, PhD, on right

So when something goes wrong with the pituitary, such as the development of a tumor, the consequences can be serious, even life threatening. Relatively common, pituitary tumors initially can be difficult to diagnose and, once found, difficult to remove because they are surrounded by so many nerves, such as those that supply the eye with movement and vision and blood vessels that supply the brain with blood.

Emory’s Pituitary Center is one of a handful of medical centers across the country using the latest 3-D endoscope for removal of pituitary tumors, a delicate and precise procedure. Having the new 3-D endoscope is a tremendous aid for a surgeon when operating on a small organ at the base of the brain, says Emory neurosurgeon Nelson Oyesiku, MD, PhD.

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