2007 dcns annual report

2007 ANNUAL REPORT

Clinical NeurosciencesDEPARTMENT OF

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

CONTENTS

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

.............................................................Historical Perspective and Departmental Structure! 4

.......................................................................................................2007 Program Updates! 7

................................................................................................................Project NeuroArm! 7

...............................................................................................................Epilepsy Program! 10

.........................................................................1st Annual Epilepsy Golf Tournament! 12

..............................................................................................Alberta Radiosurgery Centre! 13

.................................Calgary Headache Assessment & Management Program (CHAMP)! 14

...........................................................................................Movement Disorders Program! 16

................................................................................................Multiple Sclerosis Program! 17

................................................................................................Neuromodulation Program! 20

......................................................................................................Pediatric Neurosurgery! 21

....................................................................................Peripheral Nerve Surgery Program! 23

........................................................Southern Alberta Cancer Research Institute (SACRI)! 24

................................................................................University of Calgary Spine Program! 25

.......................................................................Stroke Program & Neurovascular Program! 26

....................................................................................Surgical Neuro-Oncology Program! 31

.....................................................................................................Urgent Neurology Clinic! 32

....................................................................................................2007 Divisional Updates! 34

....................................................................................................Division of Neurosurgery! 34

.........................................................................................................Division of Neurology! 41

..............................................................Division of Physical Medicine and Rehabilitation! 44

...........................................................................Division of Experimental Neurosciences! 47

................................................................................................2007 Educational Updates! 49

............................................................................Neurology Residency Training Program! 49

.......................................................................Neurosurgery Residency Training Program! 51

......................................Physical Medicine & Rehabilitation Residency Training Program! 53

...........................................................................................................Fellowship Program! 54

..............................................................................................................2007 Publications! 55

.....................................................................Division of Experimental Neurosciences! 55

..................................................................................................Division of Neurology! 55

....................................................................................................Division of Neurosurgery! 62

.................................................................................................................List of Members! 64

DEPARTMENT OF CLINICAL NEUROSCIENCES

!

Message from the ChairExecutive Summary

from Dr. Gregory Cairn-

cross, Department Head

In 2007, as in every year

since 1981, the Department

of Clinical Neurosciences

has provided exemplary

neurosurgical, neurological

and rehabilitative care to the

citizens of Southern Alberta

and beyond. Those who

suffered from head injuries,

spinal disorders, epilepsy,

stroke, brain tumor, multiple

sclerosis and a host of other

acute and chronic neuro-

logical conditions were

cared for skillfully and com-

passionately by our expert

team of surgeons, physi-

cians, nurses and therapists.

Once again, it has been my

honor and pleasure to lead

and work side by side with

this outstanding group of

professionals.

As Department Head, I

have the unique and won-

derful opportunity to shape

the future of Clinical Neuro-

sciences in Calgary through

the recruitment of new

medical faculty, and 2007

was a banner year. Dr Peter

Stys, a neurologist and sci-

entist, joined us from the

University of Ottawa. Dr

Stys is the inaugural recipi-

ent of the Le Blanc Chair in

Spinal Cord Research at the

University of Calgary and

holder of a Canada Re-

search Chair in Neurobiol-

ogy. He is also a new Scien-

tist of the Alberta Heritage

Foundation for Medical Re-

search. His studies of the

interaction of nerve cell

processes with neighboring

glia have been published in

the world’s leading science

journals. His research prom-

ises to shed light on trau-

matic, ischemic and inflam-

matory disorders of brain

and spinal cord.

Drs Dawn Pearson and

Jeffrey Joseph were re-

cruited from Boston, where

Dawn was a clinical neu-

rologist specializing in cog-

nitive disorders and rehabili-

tation and her husband Jef-

frey was a neuro-pathologist

and educator at the Beth

Israel & Deaconess Hospital.

Dawn is now practicing neu-

rology at the Rockyview

General Hospital and Jeffrey

is the Chief of the Neuro-

Pathology Service at the

Foothills Medical Centre. Six

additional faculty members

were recruited in 2007 – Eric

Smith and Jennifer Chan for

Boston, Tamara Pringsheim

and Jeptha Davenport from

Toronto, Shalina Ousman

from Montreal and Sean

Dukelow from Kingston. All

will arrive in 2008. Sean’s

arrival is eagerly awaited. He

will be our first clinician-

scientist in the field of Re-

habilitation Medicine.

In 2007, an important

and insightful external re-

view of Rehabilitation Serv-

ices and the Division of

Physical Medicine & Reha-

bilitation was tabled by Drs

Marks and Birdsong. This

report has prompted a Re-

habilitation Services Review

in Calgary endorsed by both

the Calgary Health Region

and the Faculty of Medicine.

The Rehabilitation Task

Force led by Ms BettyLynn

Morrice and myself will table

its final report on organiza-

tional structure, service in-

tegration and academic en-

hancement in June 2008.

The educational and

research missions of Clinical

Neurosciences continue to

thrive and grow. All of the

senior trainees in Neurosur-

gery and Neurology suc-

cessfully completed their

Fellowship Examinations of

the Royal College of Physi-

cians and Surgeons of Can-

ada. Once again, the De-

partment had a 100% suc-

cess rate in new and re-

newal applications to the

Alberta Heritage Foundation

for Medical Research and to

the Canadian Institutes of

Health Research. Incredibly,

nearly 20% of our faculty

hold an external salary from

either a provincial or na-

tional research agency – a

remarkable success story

and one that is unmatched

across the clinical depart-

ments of the University of

Calgary. Furthermore, mem-

bers of Clinical Neurosci-

ences hold external operat-

ing grants for research

whose total value now ex-

ceeds $10 million annually.


!

Dr. Gregory Cairncross

Historical Perspective and Departmental StructureHistory of the Department

Clinical Neurosciences

was created in 1981 when

the Division of Neurosurgery

then in the Department of

Surgery and the Division of

Neurology in the Depart-

ment of Medicine joined

forces to create a new

academic Department of

the University of Calgary

focused on disorders of the

nervous system. Dr Robert

Lee was the first Head of

the Department and Dr

Frank LeBlanc was the first

Chief of Neurosurgery. Ini-

tially, there were two units

one at the Foothills Medical

Centre and the other at the

Calgary General Hospital.

Subsequently, neurological

services were consolidated

at the Foothills Medical

Centre and a period of

rapid growth ensued with

both internal and external

recruitment and research

expansion under the lead-

ership of Dr Tom Feasby

(Department Head and now

Dean of the Faculty of

Medicine at the University of

Calgary). Dr Feasby was

joined by Dr Garnette Suth-

erland (Head of Neurosur-

gery), Dr Werner Becker

(Head of Neurology) and Dr

Christine McGovern (Acting

Head of Physical Medicine

and Rehabilitation).

Today, in addition to

being an academic depart-

ment of the University of

Calgary (U of C), Clinical

Neurosciences is a regional

clinical department of the

Calgary Health Region

(CHR). Physician members

of the Department of Clinical

Neurosciences provide neu-

rosurgical, neurological and

medical rehabilitation serv-

ices to the citizens of

Southern Alberta, south-

western Saskatchewan and

southeastern British Colum-

bia. Clinical Neurosciences

now consists of three clini-

cal divisions, Neurosurgery,

Neurology and Physical

Medicine & Rehabilitation,

and one basic research divi-

sion, called Experimental

Neurosciences. Each divi-

sion has a leader and Head

– Dr Rajiv Midha (Neurosur-

gery), Dr Samuel Wiebe

(Neurology), Dr John Latter

(PM&R) and Dr Bin Hu (Ex-

perimental Neurosciences).

Collectively, members of

Clinical Neurosciences are

actively involved in under-

graduate and postgraduate

medical education, with

Royal College of Canada

approved residency training

programs in Neurosurgery,

Neurology and Physical

Medicine and Rehabilitation.

In addition, many of the

subspecialty programs in

Clinical Neurosciences at-

tract clinical fellows from

other Canadian Centres and

abroad. Members of the

Department also teach clini-

cal skills to advanced prac-

tice nurses and to other

health professionals, and

directly supervise graduate

students and postdoctoral

research fellows. Clinical

Neurosciences now includes

over 70 primary members

many of whom are also

members of the Hotchkiss

Brain Institute.

Inpatient and outpatient

services, including neuro-


!

Department of Clinical Neurosciences

Dr. GregoryCairncross

Head,Department of


Dr. GregoryCairncross

Head,Department of


Dr. Rajiv MidhaDivision

of Neurosurgery

Dr. Rajiv MidhaDivision

of Neurosurgery

Dr. Samuel WiebeDivision

of Neurology

Dr. Samuel WiebeDivision

of Neurology

Dr. John LatterDivision of

Physical Medicine& Rehabilitation

Dr. John LatterDivision of

Physical Medicine& Rehabilitation

Dr. Bin HuDivision of

ExperimentalNeurosciences

Dr. Bin HuDivision of

ExperimentalNeurosciences

Executive AssistantDanielle Sikander

Executive AssistantDanielle Sikander

Administrative AssistantLinda Menzies -Burrows

Administrative AssistantLinda Menzies -Burrows

Administrative AssistantPatricia Moss

Administrative AssistantPatricia Moss

Administrative AssistantLinda Jennett

Administrative AssistantLinda Jennett

Administrative AssistantSue Nelson

Administrative AssistantSue Nelson

Regional ManagerStephen Jefferson

Regional ManagerStephen Jefferson

surgical services for adults

and children, are provided at

the Foothills Medical Centre

and at the new Alberta Chil-

dren’s Hospital. Outpatient

and consultation services

are provided at the Tom

Baker Cancer Centre

(TBCC), the Rockyview

General Hospital and the

Peter Lougheed Centre.

Medical services are also

provided at the Chronic Pain

Centre and at the Fanning

Centre. The Department

also provides limited neuro-

logical outreach services to

the Chinook and Palliser

Health Regions (Neurology

consultations only). Re-

search programs are based

at the Foothills Hospital,

Faculty of Medicine and

Tom Baker Cancer Centre,

especially in partnership

with the Hotchkiss Brain

Institute, Southern Alberta

Cancer Research Institute

and the Institute of Maternal

and Child Health.

Throughout its short

history, the Department of

Clinical Neurosciences has

had an exemplary record of

research accomplishment.

Tangible examples of re-

search success include two

Canadian Foundation for

Innovation (CFI) awards, first

for the development of in-

traoperative MRI and more

recently for the design and

testing of neuroArm, a MRI

compatible robot for micro-

neurosurgery, 10 external

salary awards, eight from

the Alberta Heritage Foun-

dation for Medical Research

(AHFMR) and two from the

Canadian Institutes of

Health Research (CIHR),

over 100 major publications

annually and over $10 mil-

lion in active research fund-

ing. Aided by the AHFMR,

CIHR, Heart & Stroke Foun-

dation of Canada, University

of Calgary, Calgary Health

Region, Hotchkiss Brain

Institute and the generosity

of Calgarians, Clinical Neu-

rosciences has garnered a

well deserved national repu-

tation for innovation in pa-

tient care, teaching and re-

search.

Structure of the Depart-

ment


is one of 20 academic De-

partments of the Faculty of

Medicine and one of 14 Re-

gional Clinical Departments

of the Calgary Health Re-

gion. With regard to Univer-

sity matters, principally re-

search and education, the

Department Head of Clinical

Neurosciences reports to

the Dean of Medicine. With

regard patient care and

clinical service delivery is-

sues, the Department Head

of Clinical Neurosciences

reports to the Executive

Medical Director of the

Northwest portfolio of the

Calgary Health Region and

also to the Chief Medical

Officer of the Calgary Health

Region. In regard to aca-

demic recruitment, training

and research development

and support, the Depart-

ment Head of Clinical Neu-

rosciences works in concert

with the Institute Directors,

especially the Director of the

Hotchkiss Brain Institute.

Departmental affairs are

conducted by two senior

committees: the Academic

Executive Committee, which

is chaired by the Depart-

ment Head, and by the

Clinical Executive Commit-

tee, which is co-chaired by

the Director of Neuroscience

Programs of the Calgary

Health Region and the Dep-

uty Department Head of

Clinical Neurosciences, cur-

rently the Head of Neuro-

surgery.

Patient care and re-

search occur seamlessly in


through the use of multidis-

ciplinary teams in areas

such as Stroke Care, Epi-

lepsy, Movement Disorders,

Spinal Disorders and many

others. The major care pro-

grams and teams and their


!

DirectorNeuromuscular and EMG Lab

Doug Zochodne

DirectorEEG & Epilepsy

Neelan Pillay DirectorAlberta Radiosurgery Centre

& NeuromodulationZelma Kiss

DirectorNeurosurgery Education

John Hurlbert/John Wong

Director Peripheral Nerve

Rajiv Midha

DirectorNeuro Vascular

John Wong

Director, MRI &NeuroArm Robotics Garnette Sutherland

DirectorQuality Improvement

And SafetyW. Becker/M. Hamilton

DirectorPaediatric Neurosurgery

Mark Hamilton

DirectorPaediatric PM & R

John LatterDirectorStroke Program

Andrew DemchukDirector

Stroke UnitMichael Hill

DirectorMultiple Sclerosis

Luanne Metz

DirectorIBTRC

Gregory Cairncross

DirectorSACRI

Peter Forsyth

DirectorHeadache Program

Werner Becker

DirectorUrgent Neurology

ClinicBill Murphy

DirectorNeurology Education

Drs. William Fletcher/David Patry

DirectorTherapeutic Brain

Stimulation ProgramBin Hu

DirectorMovement Disorders

Oksana Suchowersky

Calgary Spine Program

Jacques Bouchard& Stephan duPlessis

DirectorALS Clinic Chris White

DepartmentOf



Program Leaders

medical leaders are summa-

rized in the attached figure.

Two major challenges

face the Department of

Clinical Neurosciences over

the next five to ten years.

The first is the development

of a new strategic plan for

Rehabilitation Services in

the Calgary Health Region

that includes the develop-

ment of vibrant, research-

intensive Division of Physi-

cal Medicine and Rehabilita-

tion and the second will be

the transition from an aca-

demic and clinical Depart-

ment consolidated at the

Foothills Medical Centre and

Alberta Children’s Hospital

to a Department that

achieves greater success on

two sites distant sites, the

Northwest (FMC) and South

Health Campuses. Contin-

ued success for Clinical

Neurosciences can be ex-

pected. There is a strong

commitment to patient care

and a palpable esprit de

corps, the latter most evi-

dent at Grand Rounds,

which occur weekly. The

training programs in Clinical

Neurosciences are strong,

well managed and heavily

subscribed. Aided by the

Hotchkiss Brain Institute

and the “Alberta Advan-

tage”, the prospect for ma-

jor recruitment and signifi-

cant discovery in Clinical

Neurosciences has never

been greater. Our future is

bright!


!

Brain tumor stem cells derived from human glioblastoma tissue. Image courtesy of Dr.

John Kelly, neurosurgery resident and PhD candidate and Dr. Sam Weiss, Hotchkiss Brain

Institute, University of Calgary.

2007 Program UpdatesProject NeuroArm

Brain Surgery meets Rocket Science

Surgery is about to change with the introduction of a

new surgical robotic system at the University of Calgary/

Calgary Health Region. NeuroArm aims to revolutionize

neurosurgery and other branches of operative medicine by

liberating them from the constraints of the human hand.

The world’s first MRI-compatible surgical robot, un-

veiled today, is the creation of neurosurgeon Dr. Garnette

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

six years leading a team of Canadian scientists, in coop-

eration with MacDonald, Dettwiler and Associates Ltd.

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

medical technology.”

“Many of our microsurgical techniques evolved in the

1960s, and have pushed surgeons to the limits of their pre-

cision, accuracy, dexterity and stamina,” says Dr. Suther-

land, professor of neurosurgery, Uni-

versity of Calgary Faculty of Medicine

and the Calgary Health Region. “Neu-

roArm dramatically enhances the spa-

tial resolution at which surgeons op-

erate, and shifts surgery from the or-

gan towards the cell level.”

Designed to be controlled by a sur-

geon from a computer workstation,

neuroArm operates in conjunction

with real-time MR imaging, providing

surgeons unprecedented detail and

control, enabling them to manipulate

tools at a microscopic scale. Ad-

vanced surgical testing of neuroArm is

currently underway, followed by the

first patient, anticipated for this sum-

mer.

“The launch of neuroArm places the U

of C and the Calgary Health Region at

the forefront of the emerging field of

biomedical engineering, and estab-

lishes Canada’s leadership role in

image-guided robotic surgery,” says U

of C President Harvey Weingarten, PhD.

“The Calgary Health Region considers the introduction

of the neuroArm an historic moment in our ability to provide

unprecedented care and safety to patients in Alberta,” says

the Calgary Health Region’s Chief Executive Officer and

President Jack Davis. “We are extremely proud to be a

partner in neuroArm and to have worked with such a dedi-

cated team of individuals and funding partners.”

NeuroArm, one of the most advanced robotic systems

ever developed, was designed and built in collaboration

with MDA, known for creating Canadarm and Canadarm2.

Bringing neuroArm to life required a unique partnership

between medicine, engineering, physics, and education;

some of Calgary’s most visionary philanthropists; the high-

tech sector, and numerous government agencies and re-


!

search funding organizations. “This unprecedented col-

laboration is a direct result of Calgary’s optimistic and en-

trepreneurial community spirit,” says Dr. Sutherland. “It’s

no accident a project like this is coming out of Calgary. Our

community believes in innovation and supporting challeng-

ing projects.”

“This is truly a flagship program for the University of

Calgary and all the partner agencies involved,” says Wein-

garten. “Visioning and building neuroArm required un-

precedented collaboration be-

tween numerous government

departments, funding agen-

cies and the private sector.

Making this a reality will have

impacts and benefits we

can’t even anticipate as Cal-

gary and Canada become

known as world leaders in

the field of robotic surgery.”

The project began in

2001 when the namesakes of

the Seaman Family MR Re-

search Centre, Calgary phi-

lanthropists, oilpatch pio-

neers and brothers Doc, B.J.

and Don Seaman provided

$2 million to begin planning

neuroArm. Their contribution

was a natural extension of their support for the research

centre that began with the development of the world’s first

intraoperative MRI scanner based on a movable high-field

magnet.

“As engineers, the technology involved in neuroArm

intrigued us from the start. We really understood the chal-

lenges and appreciated the brilliance that had to go into it,”

Doc Seaman says. The family realized that a project like

neuroArm would place Calgary on the leading-edge of sur-

gery worldwide.

“The best surgeons in the world can work within an

eighth of an inch. NeuroArm makes it possible for surgeons

to work accurately within the width of a hair,” Doc Seaman

says. “This will put us on the world stage and will help at-

tract more top people in medicine and surgery, which will

benefit the university and the community as a whole.”

“This is a shining example of Canadian science making

breakthroughs that will improve quality of life for people in

Canada and around the globe,” says President and CEO of

the Canada Foundation for Innovation Dr. Eliot Phillipson.

“This world-class project will further develop Canada's in-

ternational reputation as a place where outstanding re-

search is being conducted.”

“Our mission is to be a leader in health and a partner in

care. Patient care and safety are always our number one

priority,” says Davis. “We are

thrilled that the neuroArm will

improve recovery and wait

times for patients, and most

of all, improve their quality of

life following surgery so they

can get back to daily life ac-

tivities.”

The Seaman family’s dona-

tion, combined with funding

from Western Economic Di-

versification Canada, allowed

for detailed planning and de-

sign of the project. That set

the stage for substantial

support from the Canada

Foundation for Innovation,

the National Research Coun-

cil of Canada, Alberta Ad-

vanced Education and Technology, Alberta Heritage Foun-

dation for Medical Research and additional philanthropists

to build the one-of-a-kind machine and create a compre-

hensive medical robotics program.

A global search for robotics expertise led Sutherland to

MDA, a perfect fit for neuroArm because of the company’s

background in creating specialized space robots, used

aboard NASA space shuttles and the International Space

Station.

“NeuroArm is a great fit for us, allowing us to apply our

world-renowned space solutions to medical applications

that will benefit patients here on Earth,” says Bruce Mack,

vice-president of development programs of MDA’s Bramp-

ton operations. “The combination of our remote operation

and sensory information expertise, coupled with our ma-

nipulation technologies, will enable improved decision

making and performance in the operating theatre.”


!

Dr. Garnette Sutherland

Developing neuroArm required an international collabo-

ration of health professionals, physicists, electrical, soft-

ware, optical and mechanical engineers to build a robot

capable of operating safely in a surgical suite and within

the strong magnetic field of the intraoperative MRI envi-

ronment.

“Building a robot is complex to begin with. Adding the

constraints of operating in a sterile operating room, within

an MRI machine and alongside the other people involved in

surgery makes it a very complex environment,” says the

project’s robotics engineer Alex Greer. By acquiring first-

hand knowledge of the demands in the operating room,

Greer and Paul McBeth, the first U of C neuroArm robotics

engineer, acted as the bridge between the physicians, sci-

entists and engineers involved in the project.

“Doctors and engineers are good at what they do but

they speak different languages,” Greer says. “Translating

surgical requirements into technical terms can be a chal-

lenge.” When the project began, engineers from MDA trav-

eled to Calgary and worked with surgeons for several

weeks to define the requirements necessary for the suc-

cessful design of neuroArm.

Sutherland’s team is developing specialized training

programs in partnership with the Calgary Health Region,

and U of C’s faculties of medicine and education to train

surgeons in the use of neuroArm. Many other surgical dis-

ciplines have and continue to participate in applying neu-

roArm to various types of surgical procedures.

“We’re not just building a robot, we’re building a medi-

cal robotics program,” Dr. Sutherland says. “We want the

neuroArm technology to be translated into the global

community, i.e. hospitals around the world,” he says. “To

accomplish this, we will need our students and young pro-

fessionals because they’re the powerhouse when it comes

to embracing new technology and applying it to clinical

care.”

From: www.ucalgary.ca/ news/april2007/neuroarm/

Program Staff

Project Leader: Garnette Sutherland

MDA Lead Enginneers: Tim Fielding, Perry Newhook,

Simon Hu, George Feil, Andrew Skorupski

NRC Scientists, Boguslaw Tomanek, Scott King

University of Calgary investigators (not inclusive): Alex

Greer, Isabelle Latour, James Larsson, Dr. Yves Starreveld,

Yaoping Hu, Carolyn Anglin, Gail Kopp, Qiao Sun, Bryan

Donnelly"

Research Interests

Surgical robotics, Haptics, Surgical simulation

Grant Support

Canada Foundation for Innovation

Alberta Advanced Education and Technology

Western Economic Diversification

Reach!

Alberta Heritage Foundation for Medical Research


!

Team NeuroArm

http://www.ucalgary.ca

http://www.ucalgary.ca

Epilepsy ProgramIntroduction

During this year, the epi-

lepsy programme has con-

tinued to thrive.

Service Delivery

Six epileptologists (Dr

Paolo Federico, Dr Alexan-

dra Hanson, Dr Nathalie

Jetté, Dr Brian Klassen, Dr

William Murphy, Dr Neelan

Pillay and Dr Samuel Wiebe)

provided out-patient serv-

ices in epilepsy clinics In the

Calgary Health Region. Dr

Neelan Pillay was on sab-

batical in Melbourne, Aus-

tralia for most of this year.

Seven physicians con-

tinue to provide electroen-

cephalography inpatient and

outpatient services in the

region. In addition, we as-

sist with EEG interpretation

for Lethbridge.

The need for support of

inpatient continuous EEG

monitoring both in the In-

tensive Care Unit and the

inpatient wards has in-

creased substantially. The

epilepsy/EEG service has

been able to provide this

service in a timely and effi-

cient manner. All inpatient

EEGs are interpreted on the

same day and a verbal re-

port is provided on the day

of the recording to the clini-

cal team in charge of the

patient.

The Seizure Monitoring

Unit has been continuously

occupied with the exception

of slow down period in

August and December 2007,

due to capacity issues. The

unit provides highly special-

ized investigations and sur-

gical therapy for epilepsy.

This includes video EEG

monitoring, intracranial sub-

dural and depth electrode

EEG recordings, cortical

stimulation for function

mapping, detailed neurop-

sychological testing, ictal

and interictal SPECT, func-

tional and structural MRI, as

well as a variety advanced

imaging techniques such as

T2 relaxometry, and MR

spectroscopy. Recently we

have welcomed the addition

of PET scanning for se-

lected patients with epilepsy

in consideration for surgical

treatment.

Teaching and Training

We have had four na-

tional and international clini-

cal and research fellows this

year. Dr John McDermott

from Quebec finished his

training and currently is

working in Quebec. Dr Bas-

sam Addas recently finished

his neurosurgical epilepsy

fellowship under the super-

visor of Dr Walter Hader and

returned to Jeddah, Saudi

Arabia. Dr Abdel Hamid

Seiam and Dr Adnan Al-

Sarawi from Egypt and

Saudi Arabia, respectively,

are our current clinical and

research fellows. Our re-

cently graduated clinical and

research fellow, Dr Jose

Tellez-Zenteno is now Assis-

tant Professor in Neurology

at the University of Sas-

katchewan and the Director

of the Epilepsy Programme.

He received the prestigious

Bruce Schoenberg Neu-

roepidemiology Award from

the American Academy of

Neurology for work he has

undertaken both with us and

internationally.

We continue to have a

steady source of residents

rotating both through the

EEG service and our epi-

lepsy clinics.

International visiting

students have joined us

from Saudi Arabia, Korea,

and Australia.

We continue to have a

rich variety of teaching ac-


!

tivities including weekly

electroencephalography

rounds, seizure conference

rounds, epilepsy journal

club and opportunity to par-

ticipate in educational clini-

cal and research rounds in

our department and the

Hotchkiss Brain Institute.

Special Events

Our Mary Anne Lee lec-

turer this year was Dr Jean

Gotman from the Montreal

Neurological Institute. Dr

Gotman brought a wealth of

experience and information

to our clinicians and also to

our clinical and basic sci-

ence researchers. He dis-

cussed his research in elec-

trophysiology, which is

unique in that it derives ex-

clusively from human data.

Dr Gotman is the recipient

of the prestigious American

Epilepsy Society Research

Award and Canadian

League Against Epilepsy

Penfield Award.

Our association with

Epilepsy and Brain Circuits

Program of the Hotchkiss

Brain Institute continues to

be successful. This year’s

retreat of the Epilepsy and

Brain Circuits Program in

Banff displayed a rich vari-

ety of research activities

both clinically and in basic

sciences.

Social and team build-

ing activities continue to be

a priority. Our annual Bar-

beque and our inaugural

Golf Tournament were very

successful and we are plan-

ning future events.

Research

Research activities have

blossomed in our program

and have taken on a truly

collaborative mode. This

research spans the spec-

trum of health services re-

search (lead Dr Nathalie

Jetté), randomized trials and

outcome assessment (lead

Dr Wiebe), clinical research

aspects (leads Drs Pillay

and Hader), psychological

aspects and quality im-

provement as well as patient

experience (lead Dr Sophie

Macrodimitris), advanced

imaging (lead Dr Paolo

Federico) and neuromodula-

tion (leads Drs Kiss and

Starreveld). There have

been extensive collabora-

tions locally with paediatric

epilepsy, health services

research, Department of

Community and Health Sci-

ences, and the Hotchkiss

Brain Institute. In addition,

our team has developed

strong links with national

and international research-

ers and is engaging in sev-

eral large projects funded by

National Institute of Health

(NIH), Canadian Institute of

Health Research (CIHR),

Alberta Heritage Foundation

for Medical Research

(AHFMR), Public Health

Agency of Canada (PHAC),

American Epilepsy Society

(AES), Medical Services In-

novation Foundation (MSI),

the Hotchkiss Brain Institute

(HBI), and the Calgary

Health Region (CHR). In-

dustry sponsored studies

continue as well. Our mem-

bers participate in the peer

review process of all major

epilepsy granting agencies

nationally, and they also

participate as peer review-

ers of flagship epilepsy sci-

entific journals. There has

been a high level of produc-

tivity in research presenta-

tions at the major interna-

tional epilepsy conferences,

with over thirty scientific

presentations of various

types at the last American

Epilepsy Society and inter-

national epilepsy con-

gresses.


!

Fused CT-MRI reconstruction showing subdural strip electrodes for seizure monitoring

1st Annual Epilepsy Golf TournamentA great success!

The first annual Calgary Epilepsy Program golf tourna-

ment organized by Dr Walter Hader was held August 20,

2007 at the Lynx Ridge Golf Club. Forty-Four participants

enjoyed a great day of golf and fun and were treated to

great prizes at the end of the day for their efforts. This in-

augural event was an astounding success due in part to its

enthusiastic volunteers led by Pat Moss who contributed a

great deal of her time in preparation for the tournament.

Many thanks go out to all participants and sponsors who

made this initial event a great success. The Calgary Epi-

lepsy Program is grateful for the tremendous support it re-

ceived.

The tournament will return to Lynx Ridge on Thursday,

August 21, 2008; it promises to be another great success.

Hole Sponsors

IMRIS

AMJ Campbell Van Lines

Carolyn Blaney-Longay

Ceri Rawji

Dapajo Construction

Emerging Equities

Dr Walter Hader

Johnson and Johnson

Dr Frank Leblanc and

Dr Elizabeth MacRae

Schidendanz West

Dr Samuel Wiebe"

Prize Sponsors

AMJ Campbell

Bernard Florence, Calgary Jewelry

Kirsty Hughes Creekside Inn

IMRIS Inc. "

Colin Moster, ATB Financial

Robert Nimmo

Ted and Brigette Sauermann

Tanya Sauermann

Ron Townsend

Donations

Dennis Best

Ryan Buchberger

Trans Canada Corporation

Monty Arun Gaur

Dr Nathalie Jetté

Ron & Beryl Jones

Mark & Sarah Kidner

Dwayne Lashyn

Carisa Naistus

Woodrow Oldford

Jean Prieur

Maureen Robertson

Sam Travis

Gerry Watson

Harry Wheeler

Gaites & Irene Zinkan

Volunteers

Thea Dupras

Jack Hansa

Sophie Macrodimitris

Jackie Martini

Pat Moss

Ceri Rawji

Maureen Robertson


!

Alberta Radiosurgery CentreStaff

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

Radiation Oncology: Drs. Alex Chan, Harold Lau, Elizabeth Yan

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

Nursing: Rhonda Manthey

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

Dosimetrists: Darren Graham, Daphne Walrath, Nathan Wolfe

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

Fellows: Drs. Zsolt Gábos, Jean Quint Oropilla

Introduction

This program, using a Novalis system, the first of its kind in Canada, is a collaborative ef-

fort between the Divisions of Neurosurgery and Radiation Oncology. 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 sur-

gical treatments. By reducing risks of therapy, and ease of returning to normal activities, it

results in much higher patient satisfaction. The program has, since its initiation, in 2002

has grown steadily, such that in 2007, 64 patients were treated with stereotactic radiosur-

gery and another 33 patients treated with fractionated stereotactic radiotherapy.

Educational and Research Activities

Image-guided frameless stereotactic radiotherapy for spine tumours (Yan)

Time and motion study examining the costs of stereotactic radiation (Newcomb)

Fractionated stereotactic radiotherapy (FSRT) for cranial patients: CHREB approved, ac-

cruing patients, target accrual 24 patients x 25 images each = 600 images (Lesiuk)

Use of biplanar X-ray for repositioning of patients treated with benign skull base tumours:

Poor-mans SRT, accrual complete, awaiting analysis of post treatment localization images

(Chan, Spencer)

Radiotherapy of acoustic neuroma: Fractionated stereotactic radiotherapy (FSRT) versus intensity modulated RT

(IMRT) (Yan)

Outcomes of AVMs treated with stereotactic radiosurgery (Wong)

Quality of life in patients treated with stereotactic radiotherapy and radiosurgery (Chan, Manthey)

Digital method of measuring the accuracy of stereotactic radiation beams and alignment of setup lasers (Spencer)

Proposal for a multicentre randomized controlled trial of SRS vs. conventional deafferenting surgery for trigeminal

neuralgia (Kiss)

Grant Support

Research Grant from the Alberta Cancer Board Nursing and RT Innovation Fund to Mark Lesiuk (PI): "Image-Guided

treatment of Fractionated Stereotactic Radiotherapy (FSRT) Cranial Patients: A Quantitative Analysis of Pre and Post

Treatment Images"

BrainLab, Inc.


!

Calgary Headache Assessment & Management Program (CHAMP)Introduction

CHAMP is a multidisciplinary headache management

program with 5 neurologists, 3 nursing, 1 occupational

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

research assistant / data analyst team members.

Vision: Empowered patients and their families actively

engaged in headache self-management.

Mission: To reduce the burden of headache related

disability carried by patients and their families.

Objectives: Deliver care for patients with difficult head-

ache disorders more efficiently and effectively through inter

professional teams focused on both medical and behav-

ioral therapies.

Contribute to headache care through clinical research

and education of health care professionals.

Reduce utilization of expensive health care resources

such as emergency rooms and inpatient beds through bet-

ter outpatient management of patients with headache.

CHAMP will:

Provide patients with a caring and empathetic envi-

ronment in which to monitor progress towards their func-

tional goals.

Encourage patient self reliance and active partnership

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

ment.

Provide access to program services in a timely manner

immediately following admission to the program.

Serve the headache health care needs of the CHR in

conjunction with the headache program of the CHR

chronic pain center.

Maintain a comprehensive quality management pro-

gram with appropriate quality indicators and outcome

measures.

Deliver “best practice” care based on evidence avail-

able, with a commitment to develop new evidence where

needed.

Ensure all team members are committed to remain cur-

rent in terms of best practices in headache care.

Involve patients in the design of the program CHAMP

offers and in the design of their individualized treatment.

Carefully foster communication between patients and

staff, and between the members of the inter-professional

team to create a forum for the discussion of patient care

plans.

Work towards following every patient with outcome

measures and team discussions so that all are accounted

for.

Summary of activities

The clinical core of the CHAMP program consists of

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

sicians and other health care professionals. The nursing

component of CHAMP provides additional valuable patient

service through telephone follow up and problem solving.

The educational session is the entry point for many pa-

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

tients and over 200 additional family / friends attended the

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

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

cians and other health care professionals. Many patients

attended our self management, relaxation, sleep and body

works workshops.

Education: In addition to continuing medical education

programs and teaching directed at University of Calgary

residents and medical students, the CHAMP program pro-

vided elective rotations to 4 senior University of Alberta

Neurology residents in 2007 (Drs. Jickling, Phan,

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

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

Khara Sauro, holder of the 2007 Canadian Headache Soci-

ety National Headache Fellowship, completed her fellow-

ship with CHAMP during 2007.

Research activities: CHAMP continues to participate in

industry-sponsored multi center clinical trials, and these

have included in 2007 trials to evaluate the efficacy of


!

botulinum toxin type A, occipital nerve stimulation, patent

foramen ovale closure, and tonabersat in migraine and / or

chronic daily headache prophylaxis. CHAMP has also ana-

lyzed the properties of two headache outcome measure-

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

submitted to the Canadian Neurological Sciences Federa-

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

comes on a CHAMP patient with implantation of a deep

brain stimulator for the treatment of chronic cluster head-

ache have been assessed, and an abstract submitted to

the same meeting.

Quality Improvement: CHAMP has studied program

outcomes. In addition, an abstract has been submitted to

the Canadian Neurological Sciences Federation annual

meeting on the CHAMP program and its outcomes. Sev-

eral patient focus groups have also been held to determine

what improvements our patients think should be made in

our program. We are grateful to Jason Knox and Michael

Suddes for their assistance with these focus groups.

Awards

The CHAMP program is extremely pleased that one of

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

People First Award in the healing hands category by the

Calgary Health Region. The People First Award is the

highest award which the CHR offers.

Moving forward

A number of action items to improve the program were

developed and the program will work on these over the

coming year.

Revising the education session to reduce the division

between the medical and behavioral content, and to em-

phasize more our integrated comprehensive approach to

headache care.

To review and possibly expand the role of the lifestyle

assessment in the program.

To initiate a formal quality management program for the

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

gram would include quality improvement education for our

staff, and the commitment of all staff to identify where

processes could be improved, and to contribute to their

improvement.

To focus more on “best practice” through the devel-

opment of more standardized patient treatment processes.

Ensure that all staff have access to the necessary con-

tinuing professional education in headache management.

Facilitate inter-professional education regarding the

care of individual patients through team rounds, etc.

Improve our capacity to meet the needs of the CHR

with regard to headache care and reduce our wait times by

working to make our patient care processes more efficient.

Develop further the kinesiology component of CHAMP

as better posture, neck health, and physical conditioning

contribute to headache management.

Conclusion

CHAMP continues to work towards meeting the head-

ache care needs of the CHR, together with the CHR

Chronic Pain Center Headache Program and to fulfill its

educational and research objectives.


!

CHAMP: (Left to right) Shannon Rogers (kinesiologist),

Brenda Kelly-Bessler (research nurse), Ruth Sutherland

(clinical nurse), Arnolda Eloff (neurologist), Irene O”Cal-

laghan (Nurse coordinator), Kathyrn Coutts (occupational

therapist), Meredith Debnam (secretary), Janice Cathcart

(psychologist), Khara Saura (fellow, data analyst), Lara

Cooke (neurologist), Ingrid Hayden (clerk), Werner Becker

(neurologsit), Kelly Tuckwell (clerk), Allsion McLean (occu-

pational therapist). Missing: Kevin Busche (neurologist),

Jagdeep Kohli (neurologist).

Movement Disorders ProgramIntroduction

Movement Disorders are diseases that result in invol-

untary movements such as tremor, dystonia, bradykenesia

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

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

families.

The program provides for a multidisciplinary clinic with

a staff of over 20 individuals including specialists in neurol-

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

chology, and physiotherapy, treating over 2000 patients

with Parkinson disease, Huntington disease, Tourette’s

syndrome, spinocerebellar ataxia, dystonia, and tremor.

The program follows approximately 2000 patients with

close to 10,000 patient visits per year. In addition, we have

a large research program involved in developing improve-

ments in treatment of Parkinson disease and related disor-

ders. Research to understand basic mechanisms of dis-

ease is coordinated through the Hotchkiss Brain Institute.

Highlight

Chosen as a Center of Excellence for PD by National

Parkinson Foundation (US)

Program Staff

Neurology: Dr. O. Suchowersky, (Program Director), Dr.

S. Furtado, Dr. R.G. Lee, Dr. S. Kraft, Dr. R. Ranawaya

(Clinical Director)"

Neurosurgery: Dr. Z. Kiss

Neurophysiology: Dr. B. Hu, Research Director

Neuropsychology: Dr. A. Haffenden

Psychiatry: Dr. M. Trew, Dr. J. Quickfall

Nurses – Clinical: Karen Hunka, Kristina Beyaert!

, Michelle Zulinick, Kari-Lynn Papic

Nurses – Research: Lorelei Derwent, Carol Pantella,

Mary Lou Klimek

Graduate Students: Cathy Lu, Aarti Shankar

Fellows: Dr. B. Ghosh, Dr. C. Diesta

Current Research Interests

Neuroprotection for Parkinson disease (PD)

Music therapy in PD

Identification of genetic factors in PD

Neuroprotection for Huntington disease (HD)

Risk of gambling in PD

Abnormalities in reaching in PD

Novel treatments in PD, HD, dystonia and spinocere-

bellar ataxia.

Grant Support

CIHR Multidisciplinary Grant for $1.5 million Sensory

Cueing, Neuroplasticity and PD !Rehabilitation (P.I.’s – Hu,

Whishaw). To study the effects of music in Parkinson’s dis-

ease animal models and PD patients.

National Institutes of Health – NET-PD (P.I. O. Suchow-

ersky)

Canadian Institute for Health Research

Maunders-McNeil Foundation

Parkinson Society of Canada

Parkinson’s Society of Southern Alberta

Boehringer-Ingelheim, Novartis, Kyowa Pharmaceuti-

cals, Allergan, Amarin, Solstice, Solvay


!

Front: Marlene Conrad, Lorelie Derwent, Cid Diesta, Aarti

Shankar, Karen Hunka, Dr. Ghosh. Middle Row: Mary Lou

Klimek, Michelle Zulinick, Dr. Ranawaya, Judy McMillan, Dr.

Suchowersky, Dr. Furtado. Back Row: Sheila Pinkney, Kari-

Lynn Papic, Carol Pantella, Angela Haffenden, Dr. Quickfall,

Dr. Kiss

Multiple Sclerosis ProgramClinical Highlights:

During 2007 the MS Program (L Metz and research manager Winona Wall) continued to lead the development of an

electronic health record for the DCNS called NeuroCARE (Clinical Automation, Research, and Education for Neurosci-

ences). Start-up of this project in 2005 was supported by a generous donation of 1 million dollars from Teva Neurosci-

ence to the MS Program of the Hotchkiss Brain Institute (HBI). After an extensive process of developing system require-

ments and evaluation of vendors a vendor was selected in June 2007. The choice was Eclypsis, the system supported

by the Calgary Health Region. This system will sup-

port a continuous inpatient and outpatient record.

The choice of this system will slow development of

the NeuroCARE system as development will in many

ways be part of development for the entire Calgary

Health Region. The long term benefits however were

felt to be worth slower progress. The initial devel-

opment then required selection of a vendor for a

scheduling package. The Cerner system was cho-

sen and development is under way. This will provide

tremendous support for clinical care as well as

business processes, research, and education.

In December 2006 Jayman Masterbuilt donated 1

million dollars to the MS Program of the HBI to de-

velop a Provincial MS Program. In 2007 develop-

ment of an Alberta MS Program began. Consulta-

tions with care providers, the MS Society, regional

leaders in both Capital and Calgary Health Regions,

Alberta Health and Wellness staff and patients was

initiated, a vision was revised, and a pilot proposal

for a Provincial Telehealth Initiative was submitted to Alberta Health and Wellness.

During 2007 a great deal of work went in to planning for a move of the MS Program to new clinical and research

space in the TRW building. Unfortunately it was determined that there was insufficient space in the TRW building to ac-

commodate all the programs scheduled to move into it so the MS program will not move.

Research Highlights:

Minocycline program: The Calgary MS Research Team (Metz and Yong) have been leading the translation of mino-

cycline from the Yong lab to the clinic. In 2007 a grant for a phase III randomized controlled trial of minocycline in pa-

tients with suspected MS was funded by the MS Foundation of the MS Society of Canada for 4.04 million dollars. The PI

is Dr Metz; Calgary co-investigators include Drs Yong, Eliasziw, Hill, and Wiebe. This trial will be managed in the Clinical

Research Intelligence Unit of the HBI led by Dr Wiebe. Recruitment will begin early in 2008.

A Brain Repair Team Grant to study “Fine-tuning Inflammation for Neuroprotection and Regeneration in Multiple

Sclerosis” was funded by Neuroscience Canada for 1.5 million dollars over 3 years. This initiative is led by Drs Yong. Drs

Metz, Costello and Stys are members along with collaborators at the Universities of Alberta (Dr Power) and Montreal

(Rivest).


!

2007 Rona Multiple Sclerosis Bike Tour

Mr Hank Swartout of Precision Drilling donated 1 million dollars over 3 years to the MS Program to develop the

Swartout Neuroprotection and Repair Centre. This funding has been increased by 500,000 over 5 years by his colleagues

at Precision Drilling. The Swartout centre will include an EAE Unit to facilitate assessment of potential MS therapies in

animal models, a clinical measurement unit to develop optic nerve and use of tools such as ocular coherence tomogra-

phy as a model to measure neuroprotection and repair in MS, and it funds an MS-MRI research coordinator and infra-

structure to build an imaging databank. This will facilitate MS translational research.

2007 was an exceptionally good year for recruitment to the MS program. Drs Fiona Costello and Shalina Ousman

were recruited to the MS Program. Dr Costello arrived in September. She is a neurophthalmologist / MS neurologist with

a research interest in optic neuritis. Her expertise will accelerate translational research within the MS program as well as

enhance care of people with MS. Dr Ousman is a neuroscientist whose basic research focuses on MS; in particular pre-

clinical therapy development. She will arrive early in 2008. Dr Peter Stys was recruited to the Spinal Cord Program but

his research into white matter function and injury overlaps with MS and Stroke. Dr Stys arrived in July 2007.

Dr Michael Yeung assumed the role of Director of the MS Clinical Trials.

Education Highlights

Weekly MS Clinical Rounds grew in popularity and attendance through 2007; 30-60 staff and students attend (when

room size permits). Once per month rounds are videoconferenced to Red Deer for Red Deer MS Clinic Staff participation.

The Calgary MS Program continued to host MS Preceptorships throughout 2007 including a weekend program at-

tended by over 25 neurologists from across Canada that was funded by Teva Neuroscience.

Pavan Ahluwalia continued his MSc research which is to determine the frequency of vitamin D insufficiency in MS

patients and to evaluate methods of dose adjustment. He received a studentship from the MS Society of Canada.

Dr Yunyan Zhang started a post doc with Dr Metz in January 2007 and by the end the year was co-supervised by

Drs David Li and Tony Traboulsee at UBC. She received a fellowship sti-

pend and travel support from Teva Neuroscience and submitted Fellow-

ship applications to the MS Society of Canada and NSRC.

The following trainees received national studentships or fellowships from

the MS Society of Canada: Pavan Ahluwalia, YunYan Zhang, Smriti

Agrawal, Viktor Skihar, Lorraine Lau, Rowena Cua, Angelika Goncalves

DaSilva, Jennifer Hahn

Two residents, Drs. Erin O’Ferrall (neurology) and Jian-Qiang Lu (neuropa-

thology), conducted basic science research training within the MS pro-

gram. Dr. Lu’s won the UC Department of Laboratory Medicine‘s Best

Resident presentation, October 2007.

Statistics

During 2007 there were 4098 patient visits to clinic physicians, 5269 tele-

phone encounters by clinic nurses, and 2132 visits to OPTIMUS.

There were over 15 MS clinical trials ongoing during 2007.

Special awards and other Highlights

Dr Yong was featured as one of the top 20 Calgarians of 2007.


!

Optical Coherence Tomography Machine

Program Staff

Physicians

Dr. Luanne Metz (Clinic Director, HBI MS Program Co-Leader)

Dr. Michael Yeung (Clinical Trials Unit Director)

Dr. Robert Bell, Dr. Kevin Busche, Dr. Fiona Costello, Dr. Dan McGowan, Dr. William Murphy, Dr. David Patry, Dr Rana

Zabad

MS Research Team (in addition to above clinicians)

Dr. V Wee Yong, PhD (HBI MS Program co-Leader)

Dr Scott Patten, MD, PhD, FRCPC, Dr. Lenora Brown, PhD (adjunct DCNS), Dr. J Ross Mitchell, PhD (adjunct DCNS),

Dr Jeff Dunn, PhD, Dr. Brad Goodyear, PhD (adjunct DCNS), Dr. Richard Frayne, PhD (adjunct DCNS), Dr. Quentin Pitt-

man, PhD, Dr. Paul Kubes, PhD, Dr. Frank Jirik, PhD, Dr. Minh Dang Nguyen, PhD

Nursing

Colleen Harris (Nurse Practitioner / MS Clinic Manager/ Research), Kathy Billesberger, Brenda Buckner, Melodie

Becker*, Sandi Beers*, Jackie Gaythorpe, Janice Hammond, Irene Irving, Janet Moores, Sharon Peters, Lori Tillotson

OPTIMUS (Rehab Program)

Jutta Hinrichs, BScOT (Program Coordinator), Cate Archibald, PhD (psychologist), Erin Gervais, BScOT, Neera

Garga, PT, Myrna Harden, PT, Tara Bramfield, RSW, Janice Lake, RN

Clerical Staff (clinical and research)

Anne Elliott, Teren Leboldus, Colleen Selin, Joanne

Woo, Rosalee Thorsen, Nuha Shubeita-Haddad, Carrie Me-

lanson, Emily Lightheart, Vanessa Rosenzweig

Clinical Research Staff

Winona Wall (Research Manager/ clinic IT support)

Dina Lavorato, Michel Dube, Beth Price, Christine

O’Grady, Jose Ranawaya, Graziela Cerchiaro, Nicole An-

derson, Ellen Martin, Shirley Jorge

Laboratory Research Staff

Claudia Silva, Yan Fan, Hollie Mowbray, Michelle

Smekal, Brooke Verhaeghe, Fiona Yong, Shuhong Liu

Students and Post-doctoral Research Associates

Pavan Ahluwalia (MSc candidate, Neuroscience – L Metz), Yunyan Zhang (MD, PhD post-doc – L Metz), Smitri

Agrawal (post-doc – VW Yong), Lorraine Lau (PhD candidate – VW Yong), Victor Skihar (post-doc—VW Yong), Angelika

Goncalves DaSilva (PhD candidate- VW Yong), David Stirling (post-doc – VW Yong), Rowena Cua (PhD candidate - VW

Yong), Thor Bjarnason (PhD candidate- JR Mitchell), Jennifer Hahn (PhD candidate – F Jirik), Trina Johnson (post-doc –

VW Yong), Cheryl McCrea (post-doc – J Dunn), Natalia Liapounova (MSc candidate – J Dunn), Axinia Doering (postdoc –

VW Yong), Mengzhou Xue (postdoc – VW Yong


!

Health Research Innovation Centre

Neuromodulation ProgramMembers

Medical Director: Dr. Zelma Kiss

Neurosurgery: Drs. Walter Hader, Mark Hamilton, Zelma Kiss

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

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

Anaesthesia: Drs. John Clark, Darryl Guglielmin, Geoffrey Hawboldt, Chris Spanswick (Chronic Pain Centre), Dr. Peter

Farran (ACH)

Urogynecology: Dr. Magali Robert

Cardiology: Dr. Jim Stone

Gastroenterology: Drs. Christopher Andrews, Phil Mitchell

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

Psychiatry: Drs. Jeremy Quickfall, Raj Ramasubbu

Nursing: Susan Anderson, Kristina Beyaert, Marlene Blackman, Thea Dupras, Colleen Harris, Karen Hunka, Tracy Hynd-

man, Jackie Martini, Grace Neustaedter, Christine O'Leary, Valerie Sherwood, Tammy Still, Angela Tse

Research: Drs. Michael Eliasziw, Bin Hu

Introduction

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 stimula-

tion, as well as drug delivery devices. We treat many conditions in-

cluding movement disorders, epilepsy, pain, angina, headache,

spasticity, urinary incontinence, and gastroparesis. Therefore Neu-

romodulation involves all divisions within the Department of Clinical

Neurosciences as well as specialists from other disciplines.

Research Interests

Mechanisms of action of therapeutic electrical stimulation

Deep brain stimulation for cervical dystonia

Smart neural prosthetics for sensorimotor rehabilitation

Clinical trials of neuromodulation for new indications, including on-

going trials for headache, epilepsy, specific pain syndromes, and

refractory depression

Brain pathways involved in music, rhythm and movement (CIHR

Regenerative and Nano-Medicine Team grant)

For further information see www.ucalgary.ca/~zkiss

Grant Support

Alberta Heritage Foundation for Medical Research, Canadian Institutes for Health Research, Medtronic Inc., Univer-

sity of Calgary Robertson Fund for Cerebral Palsy Research


!

http://www.ucalgary.ca/~zkiss

http://www.ucalgary.ca/~zkiss

Pediatric NeurosurgeryStaff

Neurosurgeons: Dr Mark G Hamilton

(Division Head), Dr Walter Hader, Dr S.

Terry Myles

Pediatricians: Dr Heather Graham and

Dr Keith Jorgensen

Nurse Practioner: Kelly Bullivant

Nurse Clinicians: Valerie Sherwood

and Linda Gill

Introduction

Pediatric Neurosurgery is a divi-

sion of Pediatric Surgery (Department

of Surgery) and the members are also

part of the Division of Adult Neurosur-

gery (Department of Clinical Neurosci-

ences). There are currently two Pediat-

ric Neurosurgeons, both of whom par-

ticipate in adult Neurosurgery Pro-

grams. Dr. Hamilton is the Head of the

Division of Pediatric Neurosurgery and

Dr. Hader is the other division member.

Dr. Terry Myles, the former Head of

Pediatric Neurosurgery, has recently

retired from full-time neurosurgical

practice but still participates in some

of the Pediatric Neurosurgery Pro-

grams. There are also two Pediatri-

cians who work in the Infant Cranial

Screening and Remodeling Clinic.

There is a full-time Pediatric Neurosur-

gical Nurse Practitioner (Kelly Bulli-

vant) who provides inpatient and out-

patient pediatric neurosurgical care

and two nurse clinicians (Valerie Sher-

wood and Linda Gill) who provide out-

patient pediatric neurosurgical care.

Clinical Aspects

a) Overview

The Pediatric Neurosurgical Pro-

gram in comprehensive, offering all

aspects of pediatric neurosurgical care

including management of hydrocepha-

lus, brain and spinal injury, myelomen-

ingocele, other forms of spinal dys-

raphism, refractory epilepsy surgery,

spasticity, craniofacial disorders, and

pediatric brain tumor (in conjunction

with the Pediatric Neuro-Oncology

Group).

The Pediatric Neurosurgeons pro-

vide weekday call at the Alberta Chil-

dren’s Hospital (ACH), and with the

other members of the Division of Adult

Neurosurgery participate in nighttime

and weekend call schedules.!

Approximately 210 elective and

emergent surgeries occurred in 2006-

2007 at the Alberta Children’s Hospi-

tal. Ninety-seven percent of the surgi-

cal patients required inpatient stays.

The average length of stay for Neuro-

surgical patients was 5 days com-

pared to the average of 2.9 days for

the whole inpatient surgery population.

We are able to offer access to unique

treatment modalities such as the intra-

operative MRI theatre for assisting in

the surgical treatment of epilepsy and

brain tumor, a comprehensive neuro-

endoscopic program, and the Stereo-

tactic Radiosurgery Program for se-

lected cerebrovascular malformations

and brain tumors.

Neurosurgery clinics run every

week. Clinics include General Neuro-

surgery, Craniofacial Clinic, Infant Cra-

nial Screening and Remodeling Clinic


!


(Pediatricians), and Myelomeningocele

Clinic. Approximately 1700 outpatient

visits occurred in 2006-2007.

b) Clinical Program Examples

A comprehensive Craniofacial

Program is coordinated through ACH.

A community-based parent education

and screening program involves Public

Health Nurses and Nurses from ACH.

Two Pediatricians coordinate the Infant

Cranial Screening and Remodeling

Clinic. Infant patients, who require

Cranial Remodeling Headbands for

correction of positional-related cranial

deformities, can have their head

scanned in a state-of-the-art Laser

Unit. This allows creation of a custom

treatment headband for each unique

patient. Finally, a monthly Craniofacial

Clinic attended by Dr Mark Hamilton

and Dr Don McPhalen from Plastic

Surgery evaluates new patients for

surgical treatment of craniosynostosis

and provides long-term followup for all

surgically treated children.

An Intrathecal Baclofen pump can

be offered to treat appropriate patients

with severe spasticity. These patients

undergo screening by Dr Hader and

the Program Nurse Clinician, Val

Sherwood. They must demonstrate a

successful response to intrathecal in-

jection of Baclofen through a lumbar

catheter. This treatment can provide a

dramatic improvement in quality of life

for these severely affected patients.

The Adult hydrocephalus Clinic is

now in its 5th year at the Foothills

Hospital. This was initiated by Dr

Hamilton to provide transition care for

pediatric patients with hydrocephalus

or tethered spinal cord after age 18

years. This clinic also coordinates care

and assesses adults with untreated

congenital hydrocephalus and un-

treated new onset hydrocephalus. A

Hydrocephalus Registry has been es-

tablished, currently with over 400 en-

rolled patients. Care guidelines have

been created. This is a unique Cana-

dian clinic providing an essential serv-

ice for patients with two serious

chronic diseases.

Other Activities

The Pediatric Neurosurgical Divi-

sion members participate in local and

national administrative and educa-

tional functions. They also lead and

collaborate in clinical research involv-

ing pediatric and adult hydrocephalus,

epilepsy and brain tumor. During the

last five years, the Division of Pediatric

Neurosurgery members have pub-

lished 14 peer-reviewed manuscripts.

There are also 4 peer-reviewed manu-

scripts in-press, 1 manuscript under-

going peer-review, 5 book chapters

published or in-press and 45 pub-

lished abstracts. In addition, Drs Ham-

ilton and Hader have collaborated on 8

successful research grant applications

and been local principal investigators

for 7 Clinical Trials. The Pediatric Neu-

rosurgery Division is an active partici-

pant of the Canadian Pediatric Neuro-

surgery Research Study Group.

Current Administrative and Teaching

Activities

a) Dr Hamilton

Division Head, Pediatric Neurosurgery

Director, Pediatric Neurosciences

Group

Director, Craniofacial Clinic (ACH)

Director, Neuroendoscopy Program

(ACH and FHH)

Co-director, Surgical Neuro-oncology

Group (FHH)

Member, Calgary Brain Tumor Pro-

gram Executive

Chair, Safety Committee Department

of Clinical Neurosciences (FHH)

Member Neurosurgical Residency

Training Committee Executive

Past President, Canadian Neurological

Sciences Federation (CNSF)

Vice President, Federation of Special-

ity Societies of Canada (FNSSC)

Past President, Canadian Neurosurgi-

cal Society (CNSS)

Host of the Canadian Congress of

Neurological Sciences Meeting

held in Edmonton, June 19-22,

2007.

Instructor Neurosciences course,

Clinical Core, University of Calgary

2003-Dr. Charles Taylor Award (In rec-

ognition of outstanding resident

teaching in Neurosurgery at the

University of Calgary)

b) Dr Hader

Surgical Director, Refractory Epilepsy

program University of Calgary

Representative to Neurosciences

Course Committee, University of

Calgary.

Instructor Neurosciences course,

Clinical Core, University of Calgary

Lecturer Neurosciences Course, 2006

2005-Dr. Charles Taylor Award (In rec-

ognition of outstanding resident

teaching in Neurosurgery at the

University of Calgary)


!

Peripheral Nerve Surgery ProgramStaff

Program Director & Surgeon

Dr. Rajiv Midha

Medical Neurologists & Electrodiagnostics"

Dr. Chris White

Dr. Doug Zochodne

Dr. Cory Toth

Dr. Steven McNeil

Fellows

Dr. Mohammed Bangash (2004-5)

Dr. Bassam Addas (2007-8)

Intraoperative Electrophysiology Support"

Michael Rigby

Erin Phillip

Introduction

This program is multi-disciplinary, encompassing clini-

cal and electrodiagnostic services provided by Neurology

and PMR faculty, electrophysiology support and surgical

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

surgical management of peripheral nerve conditions, such

as complex peripheral nerve injuries, nerve tumors, bra-

chial plexus surgery as well as advanced nerve repair and

nerve transfer techniques. Three of the faculty members

(Midha, Toth, Zochodne) within the program also have in-

dependent basic science research laboratories investigat-

ing various facets of peripheral nerve disease, including

neuropathy, nerve injury and nerve regeneration. There is

considerable collaboration amongst the principal investiga-

tors, of their graduate students and fellows. These indi-

viduals are also member of the spinal cord and nerve re-

generation and repair program within the HBI (The links,

http://www.hbi.ucalgary.ca or

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

those interested).

Research Interests

Experimental nerve injury

Nerve guidance tubes to repair nerve injuries

Growth factors and stem cell therapy to enhance nerve

regeneration

Electrical regeneration interfaces (CIHR Regengenera-

tive Medicine and Nanomedicine Team grant)

Insulin and IGFI effect on nerve injury and diabetic neu-

ropathy

Diabetic neuropathy

Grant Support

Canadian Institute for Health Research (CIHR)

Alberta Heritage Foundation of Medical Research

(AHFMR)

Aegera Therapeutics

Canadian Diabetes Association

National Institute of Health (NINDS)

Pfizer Corporation

AxoGen

Integra Life Sciences


!

Dr. Midha (center) and visiting residents during University of

Calgary Spine and Peripheral Nerve Anatomy and Surgery

Course

http://www.hbi.ucalgary.ca

http://www.hbi.ucalgary.ca

http://www.ucalgary.ca/spinalnerve/

http://www.ucalgary.ca/spinalnerve/

Southern Alberta Cancer Research Institute (SACRI)Introduction

Website URL: www.forsythlab.com

Our major research interest is to understand and alter

the malignant phenotype of tumors. Our laboratory focuses

on molecular genetics of invasion/metastasis in malignant

gliomas/medulloblastomas and oncolytic viral therapies.

In the area of brain tumor invasion we are identifying

novel genes not previously implicated in invasion. Several

candidate genes have already been identified which are

being validated using standard biochemical assays and

knockout/knockdown strategies. Our long-term plan in-

cludes screening a number of small molecule inhibitors to

identify inhibitors of glioma invasion. Overall we believe it is

extremely important for the effectiveness of cancer therapy

since invasive and non-invasive tumors are different at the

molecular level and the discovery of these differences

should lead to exciting new avenues for cancer treatment.

We are also working on several oncolytic viruses as

potential therapies for the treatment of brain tumors. Our

approach is several fold: 1) manipulation of a signaling

pathway to find susceptibility and cell killing by the virus

and 2) the use of functional screens to identify pathways

critical to virus lysis and cell killing. 3) Testing of these vi-

ruses in a number of brain tumor models. Our overall goal

is to identify mechanisms of viral oncolysis and susceptibil-

ity in order to design a better treatment for brain tumors.

For example, discoveries from our labs have lead to four

clinical trials in brain tumor patients. Forsyth is the P.I. in a

clinical trial of reovirus for recurrent malignant gliomas.

2007 Student and Post Doctoral Fellow Awards

Tommy Alain: AHFMR Studentship (2004-2007), CIHR Stu-

dentship (2004-2007)

Laura Shoots: AHFMR Summer Studentship Award (2007)

Yu-Shui Wu: TRTC (2006-2007)

Limei Wang: AHFMR (2006-2008)

Hamid Liacini: AHFMR (2006-2008)

Staff

Research Assistant Professors:

Dr. Donna Senger ([email protected])

Dr. Xueqing Lun ([email protected])

Undergraduate students:

Brienne McKennzie ([email protected])

Post-doctoral Fellows (within 5 years of obtaining PhD):

Dr. Abdulhamid Liacini ([email protected])

Dr. Limei Wang ([email protected])"

Dr. Tom Kim ([email protected])

Graduate Students

Tommy Alain PhD ([email protected])

Technicians:

Beichen Sun ([email protected])

Hongyuan Zhou ([email protected])

Sherri Liang ([email protected])

Administrative Assistant:

Carmen Coelho ([email protected] or

[email protected]) 403-210-3934


!

Left to right: Beichen Sun, Donna Senger, Xue Qing Lun,

Peter Forsyth, Tommy Alain

http://www.forsythlab.com

http://www.forsythlab.com

mailto:[email protected]
























University of Calgary Spine ProgramBackground

The University of Calgary Spine Program was estab-

lished more than ten years ago. The program is a com-

bined Neurosurgical and Orthopedic Surgery effort and is

the largest program of its kind in Canada. The program is

primarily responsible for providing an academically orien-

tated clinical spine service to the people of Alberta and

neighboring provinces.

Clinical Members

The University of Calgary Spine Program was estab-

lished more than ten years ago. The program is a com-

bined Neurosurgical and Orthopedic Surgery effort and is

largest program of its kind in Canada. The program is pri-

marily responsible for providing an academically orientated

clinical spine service to the people of Alberta and neigh-

boring provinces.

Dr J Bouchard " Chairman " "

Dr S du Plessis " Vice Chairman

Dr R Cho "" Fellowship Program Director

Dr R Hu " " Adult Spine" "

Dr J Hurlbert "Adult Spine

Dr P Salo "Adult Spine

Dr S Casha "Adult Spine

Dr K Thomas "Adult Spine

Dr G Swamy "Adult Spine

Dr D Parsons "Paediatric Spine

Dr J Harder "Paediatric Spine

Dr J Howard "Paediatric Spine

Dr D McGowan "Physical Medicine & Rehabilitation

Tara Whittaker" Research Nurse

Yvette Andreas " Research Nurse

Fellowship

The Spine program offers clinical spinal fellowships to

applicants from a neurosurgical or orthopedic surgery

background. Up to four fellowship positions are available to

Canadian and international applicants on an annual basis.

Opportunities for fellowship training are available in adult

spine as well as in pediatric spine.

The members of the Spine Program perform more than

1200 spinal procedures per year. The high volume of surgi-

cal procedures exposes fellows to an ideal amount of sur-

gical pathology and a large variety of surgical treatment

options. Surgical treatments include basic and complex

open surgical procedures for degenerative pathology,

trauma and tumors. Fellows are also exposed to minimally

invasive surgical techniques and motion preserving tech-

nologies such as disc replacements and dynamic stabiliza-

tion.

Research

The Spine Program is academically active with re-

search interests in both clinical and basic science. Mem-

bers of the Spine Program have close associations with the

Hotchkiss Brain Institute and the Bone and Joint Institute.

There is also close collaboration with the Faculty of Engi-

neering and Spine Implant Industry. The Spine Program is

actively involved in a number of local and multicenter pro-

spectively randomized clinical trials involving the following:

Spinal Cord Injury

Odontoid Fracture Management

Spinal stenosis

Cervical Disc Replacement

TL Fracture management

Proteins for fusion

Kyphoplasty for pathological fractures

Retrospective reviews and research involving residents

and fellows include the following:

Complications in spine surgery

Laminoplasty and laminectomy

Spinal instrumentation

Deformity surgery

Validation of Scoring systems and Classifications


!

Stroke Program & Neurovascular ProgramIntroduction

The Stroke Program has been very busy over the last year. Among the many achievements, we were successful in

re-imaging of the Stroke Unit. We were very successful with our session and review with support documentation cur-

rently in the process of development.

In June of 2007, key members of the Calgary Stroke

Program participated in HBI Stroke Month Lectures.

The guests were Dr. Ken Butcher from University of

Alberta and Dr. Mike Sharma from University of Ot-

tawa.

We were pleased to graduate four fellows from our

program during 2007. Youngbin Choi, from Seoul

Korea was here for two years then emigrated to USA

in June to pursue neurology residency training. Ali

Al-Khaathami completed 1 year fellowship in June

2007 and returned to Riyadh, Saudi Arabia. Firosh

Khan from Kerala, India completed training in No-

vember. Volker Peutz spent a year and a half with us

then returned to Dresden, Germany.

Calgary clinical research was involved in multiple

clinical studies. Calgary has contributed through

very active patient recruitment and has coordinating

centre and steering committee responsibilities in

several studies - some NIH funded.

One study, PREDICT, continues to garner substantial

international interest. To date 88 patients have en-

rolled in this study from 8 centres in 5 countries. The

project received additional funding from NovoNordisk

Canada.

Our greatest achievement was the publishing of our FASTER study in Lancet Neurology; the first ever randomized

trial of acute prevention in minor stroke and TIA patients.

Calgary has made great progress towards developing a strong international reputation in the field of stroke vascular

imaging with several publications in acute stroke TCD, non contrast CT imaging of Stroke and in minor stroke/TIA MRI

research. At least 15 vascular imaging manuscripts are currently in preparation, submitted or in press.

Stroke Program has recently secured three new stroke experts; Dr. Eric Smith, a vascular dementia expert from Mas-

sachusetts General Hospital, Harvard University; Dr. Sean Dukelow MD, PhD, a stroke recovery expert from Queen’s

University and Dr. Roger Thompson, PhD, who is a cell channel basic science stroke expert from UBC. These individuals

will strengthen the Calgary Stroke Program by addressing areas of the basic biomedical and stroke care continuum with

limited research strength to date.


!

Stroke Prevention Clinic

The Stroke Prevention and Follow Up Clinics have maintained their referral activity. About 125 new patients are seen

every month and about 100 patients are seen in clinic as follow up to their inpatient discharge.

In line with Pillar One recommendations from the Alberta Provincial Stroke Strategy (APSS), we are transitioning

some of the secondary prevention function of the clinic to existing vascular risk reduction services within the region and

also a tailor-made chronic disease management module for people with stroke. We are working in partnership with the

Heart and Stroke Foundation to provide “Living with Stroke” workshops designed to promote effective self-management

for people who have survived stroke and their families. These workshops will commence in the spring of 2008 and will

be jointly facilitated by the Stroke Program staff and the Heart and Stroke Foundation volunteers.

Alberta Provincial Stroke Strategy (APSS)

The work of the Alberta Provincial Stroke Strategy (APSS) has continued through 2007/2008. This has been an im-

portant year for the project team established within the Calgary Stroke Program for APSS as this has seen full recruit-

ment to the team, which consists of nursing, allied health, education, evaluation, communication, and web design spe-

cialists, and significant progress made in the project work associated with this team and physician colleagues. An in-

terim report for the Calgary Stroke Program’s participation in the APSS will be provided in June 2008 and will be submit-

ted to the department as an appendix to the contribution of the Calgary Stroke Program to this annual report; however

some of the highlights of the APSS work are outlined below:

Project Area Impact on Stroke Care and Outcomes

Enhanced therapy provision to Unit 100 (Acute

Stroke Unit)

Improved functional outcome for stroke survivors, provision of com-

munication therapy from speech and language pathology, reduced

length of stay

Development of pathways for screening triage and

transport between rural and urban sites

Improvements in timeliness and access to acute stroke care

Development of teleheath links between primary

stroke centres and Foothills Medical Centre (com-

prehensive stroke centre)

Improvements in timeliness and access to acute stroke care interven-

tionists including tPA

Development and delivery of urban and rural multi-

professional stroke ed days

Improved understanding and awareness of stroke, stroke manage-

ment and care, and clinical process across the healthcare continuum.

Enhanced public awareness of stroke through a

range of media (including the development and dis-

tribution of a “Stroke” in the public awareness film

Improved public awareness of stroke and stroke signs and symptoms

There are numerous important projects being conducted by the APSS project team or partners of the Stroke Pro-

gram. Projects are underway to improve community awareness of stroke and assessment and management of hyper-

tension (these projects are lead by partners in community care and family medicine respectively). We are working with

home care services to establish and facilitate a discharge in transition team. This will be a multi-professional team de-

signed to facilitate early supported discharge from hospital following stroke. The HASTE project (Hurry up And Start

Treatment Early) has the aim of improving tPA therapy following ischemic stroke and reducing dot and needle time. This

project will follow Six-Sigma methodology which has shown to be extremely valuable in improving process in several

areas of healthcare but which is not yet well described in stroke.


!

Neurovascular Program

The Neurovascular Program is a joint collaborative effort of specialists and allied healthcare staff from multiple disci-

plines (cerebrovascular and endovascular neurosurgery, interventional neuroradiology, and stroke neurology), to combat

neurovascular disease. The past year has seen further academic integration of the Neurovascular Program into the

Stroke Program. Shared resources have allowed greater new and continued participation of neurosurgery and radiology

in several international stroke studies, such as IMS-3, CREST, ENACT, ALISAH, and CONSCIOUS-2. The program has

continued to see growth and expansion in the number of patients with complex cerebrovascular disease. Approximately

500 patients with neurovascular disease are seen yearly in a specialized outpatient clinic for evaluation and follow-up.

Currently about 200 patients are treated annually via minimally invasive endovascular means such as endovascular coil-

ing, embolization, and carotid stenting. As well, surgical volumes and expertise in open neurosurgery have been main-

tained 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 Ra-

diosurgery Centre, which uses focussed radiotherapy techniques unique in Canada, has allowed the non-invasive and

safe treatment of patients with complex arteriovenous malformations. In the coming months, we plan to consolidate the

outpatient experience of patients with cerebrovascular disease from both clinical and administrative standpoints and

launch the Neurovascular Clinic in Calgary. This will allow the rapid triage and evaluation of patients to expedite and pro-

vide high-quality care, and allow further opportunities for teaching and clinical studies.

Quality Management in Stroke

Following the CCHSA (Canadian Council Health Services Accreditation) recommendations from the department of

Clinical Neurosciences Accreditation Survey in 2007, the Calgary Stroke Program will be working to further develop its

quality management arrangements in 2008/2009. We will be working with physicians, clinical leaders and managers to

articulate and stratify our clinical process, identify key supporting processes at a program departmental and process

level which will enable quality stroke care and then following measurement of performance of these processes will agree

and execute an improvement plan for each. Key to this approach to quality management is the identification of clinical

process owners who will be accountable for the development of each clinical process and the integration of supporting

clinical process at a program level. We look forward to sharing our progress with and learning from other programs

within the department over the coming years.

Faculty and Staff Listing

Dr. Andrew Demchuk, Director, Calgary Stroke Program

Joanne Morgan, Administrative Assistant

Dr. Michael Hill, Director, Stroke Unit

MichelleRae Wright, Administrative Assistant

Dr. Nic Weir, Director, Calgary Stroke Prevention Clinic

Lori Finch, Administrative Assistant

Dr. John Wong, Director, Neurovascular Program

Cynthia Gillmore, Administrative Assistant

Dr. Mark Hudon, Head, Neuroradiology

Michael Suddes, Program Manager, CHR

Stroke Neurologists

Dr. Phil Barber (Nancy Verhelst, Administrative Assistant), Dr. Shelagh

Coutts (Lori Finch, Administrative Assistant), Dr. Keith Hoyte (Part-time),


!

Dr. Gary Klein, Dr. Peter Stys, (Part-time), Dr. Tim Watson (Patrica Fawcett, Administrative Assistant)"

Cerebrovascular Neurosurgery

Dr. John Wong, Dr. Garnette Sutherland

Interventional Neuroradiology & Endovascular Neurosurgery

Dr. Mark Hudon, Dr. William Morrish, Dr. Mayank Goyal, Dr. John Wong

Diagnostic Neuroradiology

Dr. William Hu, Dr. James Scott, Dr. Carla Wallace, Dr. Kate Bell, Dr. Rob Sevick

Stroke Fellows (2007)

Dr. Mohamed Alzawahmah (Riyadh, Saudia Arabia)

Dr. Albert Jin (Kingston, Ontario)

Dr. Alex Poppe (Montreal, Quebec)

Dr. Nikolai Steffenhagen (Leipzig, Germany)

Dr. Youngbin Choi (Seoul, Korea)

Dr. Volker Puetz (Dresden, Germany)

Dr. Ali Al-Khaathami (Riyadh, Saudia Arabia)

Dr. Cynthia Herrera (San Paulo, Brazil)

Interventional Neuroradiology &

Endovascular Neurosurgery Fellows (2007)

Dr. Sujoy Sanyal

Dr. Pranshu Sharma

Dr. Muneer Eesa

Clinical Trials

Nursing Neuropsych Students Summer Students Grad Students

Karla Ryckborst Ainsley Elliott Erica Ropper Anjali Pandya Haifeng Zhu

Karyn Fischer" " Devika Kashyap Adrian Specogna

Marie McClelland

Carol Kenney

Imaging Studies

Students: Christine O’Reilly, Jayme Kosieer, Sarah Tymchuk, Sherif Idris


!

Stroke Fellows 2007

Statistical Information, Patient Care

Quality Indicators, Performance Measures and Activity

Quality indicator/performance data is taken from Stat-It reported administrative data prepared for the program by the

Regional Health Outcomes Portfolio. Data is available up to and including Sept 07 and all metrics relate to patients with a

main diagnosis of stroke: the term “stroke patients” operationally defined as patients with a main diagnosis of stroke.

Emergency Department (ED) Care

On average, approximately 170 patients per month present to an urban regional hospital ED department with a main

diagnosis of stroke. The running average of median length of ED stay (from decision to admit to ED discharge) for stroke

patients admitted at the FMC site is 2.6 hrs for our acute stroke unit (Unit 100) and 2.3 hrs for admission to any

other unit on this site. On average about 23% of patients are admitted to a unit within an hour of the ED decision to ad-

mit.

70% of ED visits take place at the FMC, with remaining visits split equally between the PLC and RGH sites. Forty

percent (40%) of patients presenting to any adult urban ED with a main diagnosis of TIA are admitted, although the per-

centage of TIA patients admitted from the RGH site is less (22% for Sept 07).

Approximately 15 patients per month are transferred from one urban ED site to another, with the numbers of trans-

fers to FMC from PLC and RGH roughly equal.

Inpatient Care

Around 80% of stroke patient admissions to inpatient units from ED occur at the FMC site (on average 90 admis-

sions per month) with the remainder equally split between the RGH and PLC sites. Each month approximately 120 stroke

patients are discharged from urban hospital sites with about 85% of these discharges being made from the FMC site.

Over 80 stroke patients per month are admitted to the FMC site. One in six of all stroke patients discharged from these

sites are not residents of the Calgary Health Region area.

65% of FMC stroke inpatients will have spent at least part of their admission on Unit 100 with 75% of stroke inpa-

tients admitted to Unit 100 or Unit 112.

12% of patients with acute ischemic stroke received tPA as an inpatient in 2007. Four to five carotid revascularisa-

tions are performed per month, with 85 % of the total number of procedures completed within 14 days of the patient’s

admission or discharge from their original stroke visit.

Average length of stay (LOS) for patients admitted to Unit 100 has decreased from 8.7 days in 2006 to 6.8 days in

2007.

Inpatient mortality for stroke overall is 13% (FMC 12%, PLC 15%, RGH 20%; Ischemic 13%, Intracerebral 28%,

Subarachnoid 25%). 55% of patients are discharged home directly from acute inpatient care across all urban sites and

19% are transferred to a rehab or recovery facility. On average 5% of stroke patients are admitted to a long term care

facility directly from all acute care units with this rate highest at the RGH (13%) and lowest at the FMC (4%).

The unplanned readmission rate to inpatient care within 90 days of discharge following a stroke admission is 7.6%

with rate of presentation to ED within 90 days (not resulting in an admission to hospital), 12.6%.


!

Surgical Neuro-Oncology ProgramIntroduction

This program is multi-disciplinary and was established

to focus the Neurosurgical care for brain tumor patients

and to enhance clinical research. These patients have both

low grade and malignant brain tumors, including those in-

volving the brain and the skull base. The Neurosurgeons

work in concert with Neuro-oncologists, Neuroradiologists,

Neuropathologists, and Radiation Oncologists specializing

in treatment of brain tumor. Regular clinical meetings occur

to coordinate care plans for patients. We are able to offer

access to unique treatment modalities such as the intra-

operative MRI theatre for assisting in the surgical treatment

of brain tumor and intraop-

erative monitoring or cortical

mapping for complex brain

tumor resection.

The members of the

program are actively in-

volved in clinical trial re-

search. The Neurosurgeons

are participants in multicen-

ter clinical trials including

those involving convection-

enhanced delivery of agents

into the brain to treat brain

tumors. Members of the

program have also initiated

clinical trials. A Brain Tumor

Bank is available to store

brain tumor tissue from

consenting patients for cur-

rent and future research. Dr

Parney has an independent

basic science research labo-

ratory investigating brain tumor immunology and brain tu-

mor stem cells. Drs Hamilton and Parney are also members

of the Clark H. Smith Brain Tumor Center, which is a part of

The Southern Alberta Cancer Research Institute (The link,

http://www.sacri.ucalgary.ca/programs/ibtrp.html has more

details for those interested).

Program Co-Directors

Drs. Mark Hamilton and Ian Parney

Neurosurgeons ! !

Dr. Mark G Hamilton

Dr. Ian Parney

Dr. Betty MacRae


Dr. Yves Starreveld

Neuro-Oncologists

Dr. Jay Easaw

Dr. Peter Forsyth

Dr. Greg Cairncross ""

Radiation Oncologists

Dr. Elizabeth Yan

Dr. Alex Chan

Dr Siraj Husain

Nurse Clinician

Crystal Tellent

Research Nurse

Annabelle DeGuzman

Research Interests

Surgical treatment of malig-

nant brain tumor

Surgical management of

low-grade glioma

Clinical trials for adjuvant

treatment of malignant brain

tumor

Treatment wait times for

brain tumor patients

Grant Support

Canadian Institute for Health Research (CIHR)

Alberta Cancer Board

Tom Baker Cancer Center



!

http://www.sacri.ucalgary.ca/programs/ibtrp.html

http://www.sacri.ucalgary.ca/programs/ibtrp.html

Urgent Neurology ClinicStaff

Dr. W. Murphy: Director

Dr. A. Hanson: Acting Director

Janet Warner: Nurse Clinician

Rochelle Lappan: Clerk

Physicians:"

Drs. P. Barber, R. Bell, K. Busche, S.

Coutts, T. Feasby, P. Federico, S. Fur-

tado, A. Hanson, J. Kohli, W. Murphy,

D. Patry, D. Pearson, T. Watson. C.

White, M. Yeung

Relief Physicians:

Drs. K. Brownell, N. Jette

Introduction

The Urgent Neurology Clinic is

now in its eighth year of operation.

The clinic opened in September 2000

with three half-day clinics a week.

We are now averaging seven half-day

clinics a week.

Summary of Services

In 2007, two thousand, eight hun-

dred and seventy-one (2870) referrals

were received. This was an increase

of two hundred and three referrals (or

7.6%) over 2006. Fifty-two percent

(52%) came from Family Physicians,

forty-four percent (44%) were from

Emergencies, and four percent (4%)

were from Specialists.

These referrals were all triaged by

the Nurse Clinician, Janet Warner, and

Dr. W. Murphy, the Urgent Neurology

Clinic’s Medical Director. Dr. Hanson is

now Acting Director while Dr. Murphy

is on sabbatical. The guidelines for the

referrals are: patients with acute neu-

rological problems, who require neuro-

logical consultation that is non-

emergent, but who need to be seen

within 72 hours. They must be patients

who present with a diagnostic or man-

agement problem; patients who have

not yet achieved a neurological diag-

nosis for a rapidly progressive prob-

lem, or whose diagnosis might require

confirmation and appropriate investi-

gations and treatment urgently.

One thousand, two hundred and

sixty-three (1263) new patients, and

five hundred and sixty-one (561)

follow-up patients were seen, for a

total of one thousand eight hundred

and twenty-four patients (1824). This

is an increase of 8.6% over 2006. Fif-

teen Neurologists work regularly, one

to three clinics a month, and two other

neurologists provide relief coverage.

The regular neurologists are: Doctors

Barber, Bell, Busche, Coutts, Feasby,

Federico, Furtado, Hanson, Kohli,

Murphy, Patry, Pearson, Watson,

White and Yeung. Doctors Brownell

and Jette do clincs on a as needed

basis. Residents, Clinical Assistants

and/or Clinical Clerks are scheduled to

work in most of the Urgent Neurology

Clinics. A Nurse Practitioner did some

of her training in the Urgent Neurology

Clinic this year.

One thousand, four hundred and

seventy (1470) referrals were triaged

as being inappropriate for the Urgent

Neurology Clinic. This is an increase

of 15 % over 2006. Seven hundred

and sixty-one were triaged as requiring

general neurology consultation; one

hundred and fifty were referred to the

Stroke Prevention Clinic; one hundred

and forty-six were sent to the Seizure

Clinic; sixty-seven were referred to the

family physician for follow-up;

seventy-two were referred back to

neurologists who had seen the pa-

tients before; fifty-six were sent to

neurosurgeons or spinal surgeons;

fifty-one were referred directly to EMG;

twenty-nine were referred to Neurol-

ogy at the Alberta Children’s Hospital;

nineteen were referred to the MS

Clinic; and twenty-two were referred to

the Headache Clinic. Other referrals


!

were sent to Cardiology, ophthalmol-

ogy,

Sleep Clinic, Neuromuscular

Clinic, Movement Disorders Clinic,

Neuro-ophthalmology, Cognitive As-

sessment Clinic, Psychiatry, Chronic

Pain Clinic, ENT, Syncope Clinic, In-

fectious Disease, Internal Medicine

Urgent Assessment Clinic, and to the

Emergency Room.

41 % of the inappropriate referrals

were from the Emergency Room, and

48 % were from family physicians.

The Nurse Clinician contacts the

General Neurology offices in Calgary,

every two weeks, to establish which

Neurologist has the shortest waiting

list. This information is conveyed to

the Emergency Departments, and to

the Family Physicians or Specialists, if

their referrals are triaged as requiring a

General Neurology appointment.

Some of the Urgent Neurology

Clinic referrals were seen in other clin-

ics for teaching purposes and to assist

with the workload. The Headache

Clinic saw three patients, the Epilepsy

Clinic saw two patients, the Senior

Residents Clinic saw ten patients and

the Neuro-ophthalmology Clinic saw

one patient.

The most common diagnoses

were: seizure/epilepsy (22.2%),

headache/migraine (16.3%), syncope

(8.9%), paresthesia (7.7%), vertigo/

vestibulopathy (5.3%), multiple

sclerosis/demyelinating disease (4.6

%), stroke/TIA (4.0%), DDD (2.9%),

nerve palsy (2.8%), radiculopathy (2.4

%), psychological (1.9%), Transient

Global Amnesia (1.9%), neuropathy

(1.9%), trigeminal neuralgia (1.2%),

and post concussion syndrome

(1.0%).

We also saw eleven patients with

brachial plexitis, eleven patients with

Bell’s Palsy, nine with myelitis, nine

with myelopathy, nine with optic neuri-

tis, eight with Myasthenia Gravis, eight

with brain/spinal tumor/mets, seven

with ALS, seven with myopathy, four

with meningitis/encephalitis, two with

pseudotumor cerebri, one with Pick’s

Disease, one with West Nile, one with

brain abscess, one with CADASIL, one

with ICA dissection, and one with

Creutzfeldt- Jakob Disease.

88 % of the patients were seen

within one week, 45.8 % were seen

within 72 hours. Most of the one hun-

dred and fifty-four patients who were

not seen within a week, were difficult

to reach or had difficulty arranging

transportation. One hundred patients

refused appointments, did not show

up for appointments, or we were un-

able to contact them.

Twenty-nine patients were admit-

ted to hospital from the Urgent Neu-

rology Clinic.

Issues Concerning the Urgent Neu-

rology Clinic

Triaging Referrals

A new referral form was developed

for the Urgent Neurology Clinic, in

hopes that this would aid in getting

more complete information from refer-

ring doctors. This referral form, and a

letter requesting doctors to consider

the urgency requirement more closely,

were sent to all physicians in Southern

Alberta and Eastern British Columbia.

Planning for RGH Urgent Neurology

Clinic

The Nurse Coordinator assisted

the Nurse Practitioner, Pam Sweeney,

in planning for the needs of a second

site for the Urgent Neurology Clinic at

the Rockyview General Hospital. This

clinic, when it opens, will help ease the

heavy workload of the present Urgent

Neurology Clinic at Foothills Medical

Centre. The opening of the RGH site

has been put on hold until the fall of

2008.

Staffing Requirements

The workload has been very heavy

in the Urgent Neurology Clinic as the

number of patients seen, and the

number of inappropriate referrals, have

been increasing. The last staffing in-

crease was in 2003, and since that

time the number of referrals received

has increased by 25 %, the number of

patients seen has increased by 16 %,

and the number of inappropriate refer-

rals has increased by 57 %. There has

been one augment day a month added

for the Nurse Coordinator, to allow her

to complete administrative duties. A

new clerk was hired in December.

Rochelle Lappan has quickly oriented

to the role, and is proving to be a valu-

able asset in the clinic. On review of

the job descriptions of Clerk III vs

Clerk IV, it would appear that the clerk

in the Urgent Neurology Clinic is func-

tioning more at a Clerk IV level, there-

fore we will be rewriting her job de-

scription and applying for an upgrade

in her position.

There has been times, over the

past year, due to holidays and Dr. Za-

bad leaving, when it was difficult to

get enough neurologists to see pa-

tients. Drs. Feasby, Kohli, and Pear-

son have joined the physicians work-

ing in the clinic on a regular basis.


!

2007 Divisional UpdatesDivision of NeurosurgeryAcademic Neurosurgery in

Calgary

The Division of Neuro-

surgery is committed to the

Faculty of Medicine’s vision

for academic medicine in

Calgary which is “Creating

the Future of Health” and

the vision of the Calgary

Health Region (CHR) which

is, “Our community working

together for excellence in

health”.

Academic neurosurgery

in the Calgary Health Region

and at the University of Cal-

gary centres around the

education, research, clinical

and administrative work and

service performed by the 12

members of the Division of

Neurosurgery in the De-

partment of Clinical Neuro-

sciences.

Unlike most other Ca-

nadian medical schools and

large quaternary level hospi-

tals where neurosurgery

would be placed organiza-

tionally within a Division of

Surgery, Calgary has devel-

oped a Division of Clinical

Neurosciences which brings

together neurologists, neu-

rosurgeons and physiatrists

into a single structure which

allows for greater coordina-

tion of academic and clinical

activity across the broad

spectrum of brain, spine,

nerve, pain, muscle and

movement disorders that

afflict patients.

Clinical Excellence in Neu-

rosurgery Services


surgery of the Department

of Clinical Neurosciences,

provides full neurosurgical

services for adults and chil-

dren including Level One

Trauma support to the

southern half of the province

of Alberta as well as the

eastern part of British Co-

lumbia in the Kootenay Re-

gion through the Foothills

Medical Centre (FMC) and


(ACH).

The level of clinical serv-

ice delivered by Calgary’s

neurosurgical community is

comprehensive, and is built

around the qualities of ex-

cellence, competence, qual-

ity, safety and innovation.

The roll-out of the Alterna-

tive Relationship Plan for

Neurosurgery (in 2001) has

fostered a mechanism of

timely appropriate transfer

of cases to neurosurgical

subspecialties and therefore

allowing the highest quality

of care for each and every

patient.

General neurosurgical

services as well as subspe-

cialty care in complex spinal

diseases, skull base surgery,

paediatrics, peripheral nerve

disease, cerebrovascular

and endovascular neurosur-

gery, epilepsy and functional

neurosurgery are provided

at the FMC and the ACH

sites. Stereotactic radiosur-

gery is provided in the Tom

Baker Cancer Center, which

houses the innovative Al-

berta Radiosurgery Center

(ARC), in collaboration with

the radiation oncologists.

In addition to general

neurosurgical call, sub-

speciality call coverage is

provided for paediatric neu-

rosurgery, spine, and cere-

brovascular (including endo-

vascular) surgery.

While leading and en-

couraging the development

of innovation in neurosur-

gery service in Southern

Alberta, Divisional Members

have continued to deliver

core neurosurgical services

to the patients in the catch-

ments area. In 2007, at the

FMC site, there were ap-

proximately 1800 in-patient

admissions to neurosurgery

and over 5700 outpatient

visits to a neurosurgeon of-

fice. Neurosurgeons in the

CHR performed approxi-

mately 2000 procedures in

2007, comprising 1700 pro-

cedures in the regular OR,

and another 300 procedures

in the endovascular, stereo-

tactic radiosurgery ARC unit

and ICU settings.


!

Below are listed specific

examples of excellence in

clinical care and innova-

tion, in the various sub-

specialty areas:

Leadership in spine sur-

gery and spinal cord in-

jury

The spinal neurosur-

gery group has embraced

minimally invasive tech-

niques for spinal surgery

and “bench to bedside”

drug therapies for spinal

cord injury and are leading

the way in Canada for their

application within clinical

research-centered trials.

Calgary is one of only two

centers contributing to a

national database of spinal

cord injured patients. This

center has successfully

launched a clinical trial in

spinal cord injury based on

preclinical work performed

at the University of Calgary.

We are also actively involved

with two other industry initi-

ated clinical trials in this dis-

ease. The outcome of this

effort will be reduced post

surgical lengths of stay, and

reduced recovery time for

patients.

Cerebrovascular and En-

dovascular Neurosurgery

Although the full com-

plement of open surgical

approaches to neurovascu-

lar disease remains avail-

able at our centre, the

treatment of vascular dis-

eases of the nervous system

has been evolving to less

minimally invasive interven-

tions over the past decade.

Such treatments are quickly

becoming the standard of

care for the treatment of

diseases such as intracra-

nial aneurysms and carotid

stenosis. With the recruit-

ment of the provinces first

neurosurgical endovascular

neurosurgeon, Calgary has

quickly become Western

Canada’s leader. For in-

stance, the endovascular

program treated approxi-

mately 200 patients in each

of 2004, 2005, and 2006.

Many of these patients

were treated with a single

day admission, using mini-

mally invasive approaches

(as opposed to open tradi-

tional surgery), and were

saved long in-hospital

stays. In conjunction with

our well-known and interna-

tionally recognized Stroke

Program, the endovascular

program has already be-

come an important partner

in stroke research.

Neuro-Surgical Oncology

Program

In collaboration with the

Department of Oncology at

the Tom Baker Cancer Cen-

tre, we have established a

neurosurgical oncology pro-

gram under the direction of

two of our division mem-

bers. This subspecialty ap-

proach to surgical treatment

for patients with malignant

brain tumors has helped

integrate surgical care into

existing neuro-oncology

programs in the region

which has facilitated timely

access to appropriate sur-

gery. It has also enabled

development of a clinical

research program in neuro-

surgical oncology. Since its

inception in 2005, five

neurosurgically-based clini-

cal trials have been opened,

giving neuro-oncology pa-

tients in Southern Alberta

access to novel therapies

such as immunotherapy and

convection-enhanced toxin

delivery that would not oth-

erwise be available.

Alberta Radiosurgery Cen-

tre

This program, using a

Novalis system, the first of

its kind in Canada, is a col-

laborative effort between the

Divisions of Neurosurgery

and Radiation Oncology.

The technology is capable

of offering focused radiation

treatment for diseases of the


!

Dr. Stephan DuPlessis

Dr. Steve Casha

Dr. John Wong

Dr. Ian Parney

brain and spinal cord in sin-

gle daycare sessions, thus

obviating the need for

lengthy hospital stays as-

sociated with standard

neurosurgical treatments.

With our average length of

stay of 7.6 days, this alone

is a substantial system

wide saving in bed days.

By reducing risks of ther-

apy, and ease of returning

to normal activities, it re-

sults in much higher patient

satisfaction. The program,

since its initiation in 2002

has grown steadily. The

number of patients treated

with radiosurgery in 2003

was 31, twice that of the

previous year. Thirty-five

patients were treated in

each of 2004 and 2005, and

36 patients treated in 2006

over the first nine months.

Surgical Epilepsy Program

Surgical treatment of

epilepsy has been known to

provide excellent results in

properly selected patients

with medically refractory

epilepsy. Access to such

treatment however remains

limited. Tremendous

growth of the Calgary com-

prehensive Epilepsy pro-

gram, a collaboration of

adult and paediatric epi-

lepsy centres, has been

possible with addition of a

new 4 bed monitoring unit

at the FMC and 2 bed unit

at the ACH, for the as-

sessment of possible can-

didates for surgery. In addi-

tion, the recruitment of 2

new epileptologists (includ-

ing the Division head of neu-

rology) and our most recent

recruit (in 2006), who has

expertise in epilepsy sur-

gery, has considerably en-

hanced the program. The

volume of cases has stead-

ily increased. For example,

surgical epilepsy cases

treated at the CHR have

increased from 50 patients

in 2004 to 60 in 2005, with

75 treated in the first 9

months of 2006.

Peripheral Nerve Program


Divisions of Neurology

(neuromuscular program)

and Physical Medicine and

Rehabilitation, a surgical

peripheral nerve program,

has been initiated with the

recruitment of the Division

head in neurosurgery, an

established peripheral

nerve expert. State of the art

surgical management of pe-

ripheral nerve conditions is

now possible in Western

Canada. This program al-

ready attracts referral of pa-

tients from all of Alberta,

and indeed a few select pa-

tients from across Canada,

and treats approximately 60

patients a year with ad-

vanced peripheral nerve

surgery.

Skull Base Program

In conjunction with col-

leagues from the Division of

Otolaryngology, the skull

base surgery group com-

bines considerable experi-

ence with standard proven,

as well as novel, ap-

proaches 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 all aspects of

treatment are considered

and offered. An emerging

strength is the use of mini-

mally invasive endoscopic

approaches to pituitary and

anterior skull base lesions

for appropriate cases.

Paediatric Neurosciences

Program


paediatric neurology Divi-

sion at the ACH paediatric

neurosurgery has lead the

way in development of

Western Canada’s first pae-

diatric neuroscience unit. A

flagship program ACH) the

neuroscience team has ush-


!

Dr. Walter Hader

Dr. Rajiv MidhaDr. Zelma Kiss

Dr. Betty MacRae

ered in the opening of the

new children’s hospital.

Technological innovation

with the introduction of

groundbreaking clinical and

research technology, mag-

neto encephalography,

which provides a novel way

of understanding brain

function, will provide paedi-

atric neurosciences with

further innovation at the

new Children’s Hospital.

Neuromodulation Program


several other departments

and divisions, (Neurology,

Cardiology, Anaesthesia/

Chronic Pain Centre, Urogy-

necology, and Gastroenter-

ology). Calgary patients are

offered the full range of im-

plantable devices to alter

nervous system functioning.

While this program started

by providing surgery for pa-

tients with movement disor-

ders (such as Parkinson’s

disease, dystonia and

tremor) it has grown to in-

volve treatment of patients

with spasticity, epilepsy,

chronic migraine, refractory

angina, various specific

chronic pain conditions and

psychiatric disorders. The

program has continuously

expanded offering new

therapies and testing ex-

perimental treatments by

leading multicentre clinical

trials (e.g. Brain 2007). The

Division of Neurosurgery

continues to lead this pro-

gram in both hands-on sur-

gery, administrative and

academic aspects. This

program attracts referral of

patients from all across Al-

berta and eastern BC.

Robotics Program

As a continuation of the

highly successful and inter-

nationally acclaimed in-

traoperative MRI neurosur-

gical program, the develop-

ment of a MR compatible

robot to assist with cranial

(and non-cranial) microsur-

gery is proceeding. This

program is on the leading

edge (world-wide) of innova-

tion and research, brings

together experts (under the

leadership of neurosurgery)

in robotics, engineering,

imaging, haptics and mo-

lecular biology. Our partners

are the University of Cal-

gary, the Calgary Health

Region, and industry. The

robotics program technol-

ogy initiative, has the poten-

tial to revolutionalize the

way that neurosurgery is

performed in the future.

Creating the Future of

Neurosurgical Clinical

Service

With the addition of the

several neurosurgeons over

the past 7 years to our fac-

ulty, subspecialty neurosur-

gical care in all major areas

is covered, with several new

services now being deliv-

ered through considerable

innovation in care. Two ex-

amples of innovation in neu-

rosurgery care are described

below:

Neurosurgery, Physiother-

apy and Chiropractic Col-

laborative Care

The Division has met the

ever growing clinical chal-

lenge to diagnose and treat

its rapidly expanding referral

base in diseases of the de-

generative spine. New refer-

rals to neurosurgeons alone

in this area number well over

two thousand patients per

year. The needs of many of

these patients are now ad-

dressed through an innova-

tive process of clinical

screening, referral and

treatment which ensures

that the appropriate treat-

ments are provided to the

right patients by the appro-

priate clinician.

This new approach in-

volved different groups –

specifically physiotherapists

and chiropractors – in the

process of developing and

delivering optimal neurosur-

gical care for these patients

In order to help patients

with diseases of the degen-

erative spine, an innovative

model of spinal care, Na-

tional Spine Care (NSC),

was established. Degenera-

tive spine disease is usually

accompanied by severe

pain and debilitating pain in

the lower back or neck most

commonly associated with a

degenerative spinal disc.

NSC offers an innovative

multi-disciplinary approach

to the efficient and effective

screening and assessment

of patients facilitated

through the collaboration of

the spinal neurosurgeons

working with specially

trained physiotherapists and

chiropractors.

This model of interdisci-

plinary collaboration was

developed with the full en-

dorsement of the College of

Physicians and Surgeons of

Alberta.


!

Dr. Mark Hamilton

Dr. Yves Starreveld

Prior to NSC, 90% of

degenerative spinal referrals

were deemed to be non-

surgical patients after as-

sessment by a neurosur-

geon. Patients under the

NSC are assessed by spinal

neurosurgeon trained chiro-

practic and physiotherapists

to assess patients for suit-

ability of assessment by the

neurosurgeon.

Patients are therefore

more appropriately triaged

into a non surgical spinal

therapy program or surgical

assessment, where now

approximately 85% of those

now seen by the neurosur-

geon are offered surgery.

The result is significantly

increased throughput of pa-

tients, and resulting de-

creased waitlists. An aver-

age assessment by a

physiotherapist or chiro-

practor within the NSC pro-

gram takes about an hour.

Each year about 1,500 as-

sessments are being done

so the use of physiothera-

pists and chiropractors in

the this innovative care

model has freed up about

1,500 hours of neurosur-

geons’ time to be used on

more difficult and complex

patients, and those actually

requiring surgery.

Neurosurgery and Nursing

Collaboration in the Hospi-

tal Setting

A second example of

innovation in neurosurgical

patient care is in the hospital

setting, through the devel-

opment of a Clinical Nurse

Practitioner (CNP) program.

Nurses who are trained

through the nurse practitio-

ner program offered by the

University of Calgary Faculty

of Nursing take a third year

clinical placement that fo-

cuses on the ward care of

neurosurgical patients, the

evaluation of medical prob-

lems in pre- and post-

surgical care and the tech-

nical and clinical skills re-

lated to the care of neuro-

surgical patients.

Enhancement of all fac-

ets of in patient care, pre-

and post-surgical education

and continuity into the

community has been possi-

ble with the training and im-

plementation of 4 Clinical

Nurse Practitioners (CNPs)

within the system, with a 5th

now nearing completion of

training.

Educating New Physicians

and Creating the Neuro-

surgical Care Team of the

Future

Undergraduate Medical

Education


surgery provides teaching

excellence in the University

of Calgary Faculty of Medi-

cine to both undergraduate

medical students and post

graduate trainees in the

neurosurgical residency

program.

Within the undergradu-

ate medical curriculum, Di-

visional members serve as

mentors in Course V: neuro-

science and aging course

lecture. Division members

are involved in undergradu-

ate small group seminars

and bedside teaching.

Several members of the

Neurosurgical Faculty have

received undergraduate and

post-graduate teaching

awards from the University

of Calgary.

Postgraduate Medical

Education

The University of Cal-

gary Neurosurgical Resi-

dency Training Program has

continued to excel, and in-

deed has flourished with an

increasing resident com-

plement pool from 2000 (5

residents) to 2008 (11 resi-

dents). The Program has

now realized a stable com-

plement of 11-12 residents

(with 1, often a 2nd CARMS

position offered) and has

gained approval of 2 PGME

funded positions a year.

Resident operating

room teaching and technical

skill training, critical care

unit, emergency room, clini-

cal ward and outpatient ex-

perience are provided at the

Foothills and ACH sites by

neurosurgical faculty mem-

ber mentors and supervi-

sors.

A resident-faculty part-

nered core curriculum (2

hours weekly, with a 3 year

cycle) is supplemented by

lectures on basic neurosci-

ences, clinical case

presentations/discussions

and grand neuroscience

rounds (at the academic half

day). In addition, weekly

neuropathology rounds,

core surgery seminars, sub-

specialty rounds, and a visit-

ing professorship program

round out the didactic

teaching. Formal oral and

written neurosurgery exami-

nations are conducted by

the neurosurgical team

every 3-6 months to evalu-

ate and monitor resident

academic performance pro-

files. Weekly interesting

case rounds and bimonthly

morbidity and mortality

rounds provide an opportu-

nity for open discussion re-

lating to challenges in pa-

tient care, including honest

discussion of adverse

events, ethical standards


!

Dr. John Hurlbert

and medico-legal issues.

Finally, quarterly journal

clubs enable instruction in

reviewing and reading the

literature to instil evidence

based-best outcome clinical

practice.

In addition to post-

graduate training, the Divi-

sion of Neurosurgery offers

Fellowship training in com-

plex diseases of the spine

(several dozen Fellows

trained over the past dec-

ade), the surgical treatment

of epilepsy, functional and

stereotactic neurosurgery,

endovascular neurosurgery

and peripheral nerve sur-

gery. Each of these pro-

grams has or is training Fel-

lows, and (given that Inter-

national Fellows can choose

to go anywhere) reflects the

maturity and the promi-

nence of these programs.

Other Health Professional

Education: Nursing,

Physiotherapy, and Chiro-

practic

Calgary’s neurosur-

geons have utilized the ad-

vanced practice nursing

program from the University

of Calgary to train clinical

nurse practitioners who

work with neurosurgery pa-

tients in the pre- and post-

surgical setting. This training

occurs predominantly in the

third year of the program in

a clinical setting where the

advanced practice nurses

work closely with neurosur-

geons.

The neurosurgeons pro-

vide the training to the

physiotherapists and chiro-

practors involved with the

clinical assessment services

offered through the NSC

program. This program re-

ceived approval from the

Alberta College of Physi-

cians and Surgeons and is a

successful model of inter-

disciplinary cooperation.

Continuing Medical Edu-

cation and Public Educa-

tion

Additionally, Divisional

Members are involved in

various teaching activities

targeting the public, and

continuing medical educa-

tion seminars for primary

care physicians, emergency

physicians and referring

doctors. Given their Na-

tional and International stat-

ure, several Members are

also prominently involved in

the teaching of residents,

fellows and their colleagues

at Speciality and Sub-

speciality meetings.

Creating Knowledge for

the Future

Research within the Di-

vision of Neurosurgery is

accomplished through co-

operation and close align-

ment with the Department of

Clinical Neurosciences and

the Hotchkiss Brain Institute

(HBI) at the University of

Calgary. The goal of the HBI,

to be a world leader in

Translational Neuroscience

and Mental Health research

and commitment to translat-

ing basic science discover-

ies into improved patient

outcomes, is dependent on

the excellence in the clinical

neurosciences provided by

members of the Division of

Neurosurgery. The goal of

the Division of Neurosurgery

is to foster the goals of the

HBI and advance the HBI

and University of Calgary as

a world leading institute for

Neuroscience research and

translational clinical treat-

ment.

Clinical and basic sci-

ence research is completed

by all division members, five

of whom run externally

funded research programs,

and many who play promi-

nent roles in Hotchkiss Brain

Institute programs including

Neuroarm, Spinal cord and

nerve regeneration, Epilepsy

and brain circuits, and

Movement disorders and

therapeutic brain stimula-

tion.

As one measure of aca-

demic productivity, grant

money from National and

Provincial agencies awarded

to Divisional Members has

increased several-fold over

the past decade, and was >

$2.5 Million in 2006-7. Out

of the 12 faculty, 4 (out of 5

surgical scientists) have in-

dependent operating grant

support from CIHR, an ex-

traordinary level of success

for a surgical Division in

Canada. Another measure is

peer reviewed publications,

which continue to increase

yearly. In 2006, Divisional

members published over 75

papers, including manu-

scripts, abstracts and chap-

ters.

Fostering the Bio-Science

Economy of the Future

The research program of

members of the Division has

a significant focus on tech-

nology commercialization

and the development of ef-

fective partnerships and

alliances with interested and

committed partners from the

private sector.

The world’s first MRI-

compatible surgical robot is

the creation of Calgary ARP

neurosurgeon Dr. Garnette

Sutherland and his team. Dr.

Sutherland has spent the

last six years leading a

multi-disciplinary team of

Canadian scientists, in co-

operation with MacDonald,

Dettwiler and Associates

Ltd. (MDA), to design a ma-

chine “that represents a

milestone in medical tech-

nology.”

Designed to be con-

trolled by a surgeon from a

computer workstation, neu-

roArm operates in conjunc-

tion with real-time MR imag-

ing, providing surgeons un-

precedented detail and con-


!

trol, enabling them to ma-

nipulate tools at a micro-

scopic scale. Advanced

surgical testing of neuroArm

is currently underway, fol-

lowed by the first patient,

anticipated for the late win-

ter of 2008.

Developing neuroArm

required an international

collaboration of health pro-

fessionals, physicists, elec-

trical, software, optical and

mechanical engineers to

build a robot capable of op-

erating safely in a surgical

suite and within the strong

magnetic field of the in-

traoperative MRI environ-

ment.

Sutherland’s team is

developing specialized train-

ing programs in partnership

with the Calgary Health Re-

gion, and U of C’s faculties

of medicine and education

to train surgeons in the use

of neuroArm. Many other

surgical disciplines have and

continue to participate in

applying neuroArm to vari-

ous types of surgical proce-

dures.

Administration/Leadership

All Divisional Members

carry out important adminis-

trative duties within the

Foothills Hospital, ACH and

CHR, and for the purposes

herein we will highlight just a

few examples.

The Divisional Head, Dr

Rajiv Midha, sits on multiple

hospital, Departmental and

Regional Committees. Dr.

Mark Hamilton directs Neu-

rosciences at the ACH, and

is the Chair of the important

Quality Assurance and

Safety Committee of the

Department of Clinical Neu-

rosciences. Dr Zelma Kiss is

Co-director of the Alberta

Radiosurgery Center, and

also provides leadership in

the Movement Disorder,

Therapeutic Brain Stimula-

tion and Neuromodulation

Program. Dr John Hurlbert is

the Director of the Resi-

dency Training Program, a

co-leader of the Spine and

nerve regeneration program

of HBI, and was recently the

director and instrumental in

setting up arguably the best

multi-disciplinary Spinal

surgery program (in collabo-

ration with orthopaedic spi-

nal surgery) in Canada.

Academic leadership

within the Division of Neuro-

surgery is provided by Dr

Rajiv Midha, a surgeon sci-

entist recently recruited to

help accomplish the Aca-

demic mission. He pres-

ently also sits on the execu-

tive committee of the


and is a member of the Spi-

nal Cord and Nerve Regen-

eration Team. Three addi-

tional members of the Divi-

sion of Neurosurgery have

leadership roles within 3

research programs within

the HBI. For example, Dr.

Garnette Sutherland directs

the Neuroarm Robotics Pro-

gram.

Many Divisional Mem-

bers have prominent leader-

ship positions at National

and International levels. For

example, Dr. Hamilton is the

recent past President of the

Canadian Congress of Neu-

rological Surgeons. Dr.

Midha is the immediate past

President of the (interna-

tional) Sunderland Society,

past President of the Ameri-

can Society for Peripheral

Nerves and prior Chair of

the Peripheral Nerve Task

Force in organized American

neurosurgery. Dr Hurlbert

was recently the Education

Committee Chair of the

Joint Spine and Nerve Dis-

orders Section of AANS/

CNS and was the Scientific

Program Chair for their

meeting in 2007.

Summary


surgery at the University of

Calgary continues in its aim

towards the development of

a world class institution

known for excellence in

clinical neurosurgery as well

as neuroscience education

and research.


!


Division of NeurologyNeurologists

Dr Samuel Wiebe (Head, Division of Neurology)

Dr Gregory Cairncross (Head of the Department of Clinical Neurosciences)

Dr Philip Barber, Dr Werner Becker, Dr Robert Bell, Dr Keith Brownell, Dr Kevin Busche, Dr Lara Cooke, Dr Fiona Cos-

tello, Dr Shelagh Coutts, Dr Andrew Demchuk, Dr Arnolda Eloff, Dr Paolo Federico, Dr William Fletcher, Dr Peter Forsyth,

Dr Sarah Furtado, Dr Alexandra Hanson, Dr Michael Hill, Dr Keith Hoyte, Dr Nathalie Jette, Dr Brian Klassen, Dr Gary

Klein, Dr Jagdeep Kohli, Dr Scott Kraft, Dr Luanne Metz, Dr William Murphy, Dr David Patry, Dr Dawn Pearson, Dr Neelan

Pillay, Dr Ranjit Ranawaya, Dr Peter Stys, Dr Oksana Suchowersky, Dr Cory Toth, Dr Timothy Watson, Dr Nicolas Weir, Dr

Christopher White, Dr Scott Wilson, Dr Michael Yeung, Dr Douglas Zochodne

Residents

Erin O’Ferrall (Chief Resident)

Fatima Abdullah, Mohammed Alanazy, Mohammed Al-Mekhalfi, Sameer Chhibber, Phillipe Couillard, Claire Hinnell, Scott

Jarvis, Dr Aylin Reid, Justyna Sarna, Suresh Subramaniam, Martin SuttonBrown, Katie Wiltshire

Fellows

Epilepsy - Bassam Addas, John McDermott, Abdel Hamid Seiam, Adnan Al-Sarawi

Movement Disorders - Stuart Reid and Cid Diesta

Neuromuscular - Lawrence Korngut

Neuro-Oncology - Gloria Roldan and Paula de Robles

Stroke – Ali Al-Khathaami, Mohamed Alzawahmah, Youngbin Choi, Cynthia Herrera, Al Jin, Firosh Khan, Volker Puetz,

Alexander Poppe, Nikolai Steffenhagen

Developments during 2007

The Division of Neurology obtained an Academic Alternate Relationship Plan (ARP) in September 2007, which in-

cludes 34 of the 37 division members at the time. This is an important milestone in our division. The AARP will enable

us to explore innovations in service delivery models and importantly, it will help us recognize the contributions of division

members in teaching, academic, administrative and clinical areas. Mr

Stephen Jefferson accepted the position of ARP Administrator.

With the promise of a recruitment plan for our ARP in the horizon, this

initiative will also allow us to recruit to our needs and for future devel-

opment as we contemplate expansion into other sites, in particular the

South Hospital

We are proud to have recruited people of the highest calibre into our

division this year. Drs Peter Stys and Fiona Costello joined us from the

University of Ottawa. Dr Stys research focus is on mechanisms of in-

jury to nerve fibres in the brain, spinal cord and peripheral nerves, rele-

vant for stroke, MS and spinal cord injury. His clinical interests are in

the stroke area. Dr Peter Stys brings a wealth of expertise and research

initiatives to our division. Dr Costello is a neuroophthalmologist, whose

research focuses on the optic nerve as a model for regeneration. Dr


!

Costello has an interest in demyelinating disorders as they pertain to neuroophthalmology. She brings much needed

support to both the neuroophthalmology and multiple sclerosis groups. Dr Dawn Pearson was recruited from Milford

Regional Medical Centre in Massachusetts. Her area of interest is in general neurology but particularly cognitive neurol-

ogy, which is an important area of need in our division.

Concrete growth plans were established for developing an extension of the Division of Neurology at the Rockyview

General Hospital. An initial phase will consist of creating additional space and clinic offices, as well EEG and EMG labo-

ratories, and increasing the number of neurologists at that site. Both Dr Fiona Costello and Dr Dawn Pearson will be

based at the Rockyview General Hospital. Concrete growth plans were established for developing an extension of the

Division of Neurology at the Rockyview General Hospital. An initial phase will consist of creating additional space and

clinic offices, as well EEG and EMG laboratories, and increasing the number of neurologists at that site. Both Dr Fiona

Costello and Dr Dawn Pearson will be based at the Rockyview General Hospital. Dr Christopher White leads the devel-

opment effort at that site, and will also move his office to the Rockyview Hospital. Speciality clinics, Urgent Neurology

and General Neurology are contemplated at that site. A future stage will involve development of an inpatient neurology

service.

Our subspecialty training programs continue to develop, with fellowships offered in the areas of epilepsy, Headache,

Movement Disorders, Multiple Sclerosis, Neuromuscular, Neuro-Oncology, Stroke

Neurology Training Program

Our Neurology Training Program continues to attract top candidates from across the country. Our trainees were all

successful in the Royal College Certificate Examinations this year. Our program has a total of thirteen residents. The

educational component continues to thrive under the able direction of Dr William Fletcher.

Education

Our division members continue to be involved at the undergraduate and post-graduate education levels. Dr Kevin

Busche has had an exemplary performance as a leader in the neurosciences undergraduate education program. The

following teaching awards were received by our division members: Gold Stars (Lectures)- Kevin Busche, Lara Cooke,

Cory Toth and the CMSA Letter of Excellence (small group teaching): Chris White and Scott Wilson

PROGRAMS

Calgary Headache and Management Program Dr W Becker, DirectorDr K Busche, Dr L Cooke, Dr A Eloff, Dr J Kohli

Calgary Comprehensive Epilepsy Program Dr S Wiebe, DirectorDr N Pillay, Adult Program DirectorDr P Federico, Dr A Hanson, Dr N Jette, Dr B Klassen, Dr W MurphyDr L Hamiwka, Pediatric Program Director, Dr I Mohamed, Dr E Wirrell

Calgary Stroke Program and Stroke Preven-

tion Clinics

Dr A Demchuk, Program DirectorDr M Hill, Director Stroke UnitDr P Barber, Dr S Coutts, Dr K Hoyte, Dr G Klein, Dr P Stys, Dr T Watson, Dr N Weir


!

General Neurology Dr R Bell, Dr K Brownell, Dr K Busche, Dr A Hanson, Dr M Hill, Dr K Hoyte, Dr B Klassen, Dr G Klein, Dr J Kohli, Dr W Murphy, Dr D Patry, Dr D Pearson, Dr C White, Dr S Wilson, Dr M Yeung

Movement Disorders Program Dr O Suchowersky, DirectorDr S Furtado, Dr S Kraft, Dr R Ranawaya,

Multiple Sclerosis Program Dr L Metz, DirectorDr R Bell, Dr K Busche, Dr W Murphy, Dr D Patry, Dr M Yeung, Dr R Zabad

Neuromuscular Program/EMG Dr D Zochodne, DirectorDr K Brownell, Dr C Toth, Dr C White

Neuro-Oncology Dr P Forsyth, DirectorDr G Cairncross

Neuro-Ophthalmology Dr W Fletcher, Dr F Costello

Urgent Neurology Dr William Murphy, DirectorJanet Warner, Coordinator


!

Division of Physical Medicine and RehabilitationFaculty

Dr. John Latter (Division

Head)

Drs. Maryana Apel, Pamela

Barton, Nwamara Dike,

Denise Hill, Ken Lam, Dan

LeBlond, Christine McGov-

ern, Dan McGowan, Ste-

phen McNeil, Stephanie

Plamondon, Perminder

Ubhi, Noorshina Virani

Introduction

The Division of Physical

Medicine and Rehabilitation

is one of four divisions

within the Department of

Clinical Neurosciences, the

Faculty of Medicine, the

University of Calgary and

the Calgary Health Region.

The division provides serv-

ices for Southern Alberta,

South-eastern British Co-

lumbia and South-western

Saskatchewan. The divi-

sion’s primary inpatient unit

is at the Foothills Medicinal

Centre with amputee pa-

tients being treated at

Carewest Glenmore Park

and stroke patients at

Carewest Dr. Vernon Fan-

ning Centre. The division

provides consultation serv-

ices at Peter Lougheed

Hospital and Rockyview

General Hospital, Carewest

Glenmore Park and Carew-

est Dr. Vernon Fanning Cen-

tre.

In August 2007, Dr. Dan

LeBlond moved to

Lethbridge to develop a

physiatry program and it is

hoped that our residents will

rotate through the program

in Lethbridge to experience

general physiatry in a

smaller centre.

Unit 58 is the primary

inpatient unit for the division

and one of the groups in-

volved in the GRIDLOCC

project and preliminary re-

ports for September to De-

cember are beginning to

show some ”fruit of their

labour”. This is evident with

patients feeling more in-

volved in the objectives for

their inpatient stay as well

as the transition from acute

care therapy to rehabilitation

therapy. This work is clearly

a team approach involving

physiatrists, therapists and

nurses.

The division members

continue to be actively in-

volved in undergraduate

medical education and con-

tinued strong presence with

residency education. There

are several members in-

volved in collaborate re-

search.

Clinical Programs

Traumatic Brain Injury

Rehabilitation

Dr. Christine McGovern,

Dr. Stephanie Plamondon,

Dr. Nwamara Dike

The Brain Injury Pro-

gram consists of an inpa-

tient and an outpatient

component.

Inpatients are treating

on the Tertiary Rehabilitation

Unit located in the Special

Services Building. Last year


!

Dr. John Latter, Division

Head

Dr. Pamela Barton

Dr. Denise Hill

Dr. Ken Lam

we treated 93 patients on

the inpatient unit, 74% of

whom had a traumatic etiol-

ogy for their brain injury, and

26% with a non-traumatic

etiology. The average length

of stay was 58 days.

The outpatient program

saw 189 people who were

new referrals to brain injury

clinic and 478 visits oc-

curred for people being

seen in follow-up.

The Brain Injury Pro-

gram does not have any

published research studies.

However, we are involved

with referring people to a

study being carried out in

the community entitled “The

lived experience following

acquired brain injury: a lon-

gitudinal study”.

Spinal Cord Injury Re-

habilitation

Dr. Dan McGowan, Dr.

Denise Hill

Stroke Rehabilitation

Dr. Stephen McNeil, Dr.

Ken Lam

General Rehabilitation

Dr. Christine McGovern,

Dr. Denise Hill, Dr. Stephanie

Plamondon

Chronic Pain

Dr. Pamela Barton, Dr.

Noorshina Virani

Pediatric Rehabilita-

tion!

Dr. John Latter

EMG!

Dr. Pamela Barton, Dr.

Denise Hill, Dr. Ken Lam, Dr.

Stephen McNeil, Dr.

Stephanie Plamondon, Dr.

Noorshina Virani

Competitive Support!

Investigators: P Barton

(principal investigator), G

Schultz, J Jarrell. Patient

Complexity Score as a Pre-

dictor of Human Resource

Utilization in an Adult Ambu-

latory Multidisciplinary

Chronic Pain Treatment

Program. Sponsor: Alberta

Heritage Foundation for

Medical Research Health

Research Fund (2005 and

renewed in November,

2006) - $123,570 Total.

($37,741.00 received in

2007) Extended to Novem-

ber 30, 2008.

Principal Investigator:

Dr. Dan McGowan. Open-

Label Extension Study to

Evaluate the Safety, Toler-

ability and Activity of Oral

Fampridine-SR in Subjects

with Multiple Sclerosis.

Sponsor: Acorda Therapeu-

tics Protocol No. MS-F 203

ext, 2005 – on going (MS

Clinic)


Dr. Dan McGowan. Double-

Blind, Placebo-Controlled,

Parallel Group Study to

Evaluate Safety and Efficacy

of Oral Fampridine-SR (10

mg b.i.d.) in Patients with

Multiple Sclerosis. Sponsor:

Acorda Therapeutics Proto-

col No. MS-F204 (MS Clinic)


Dr. Dan McGowan. Open-

Label Extension Study to

Evaluate the Safety, Toler-

ability and Activity of Oral

Fampridine-SR in Patients

with Multiple Sclerosis who

Participated in the MS-

F204Trial. Sponsor: Acorda

Therapeutics Protocol No.


!

Dr. Dan MacGowan

Dr. Christine McGovern

Dr. Stephen McNeil

Dr. Stephanie Plamondon

Dr. Noorshina Virani

MS-F204 Ext – on going

(MS Clinic)

Principal Investigator: A

Double–Blind, Randomized,

Placebo- and Active

Comparator-Controlled,

Parallel Group, Multinational

Study to Evaluate the Phar-

macokinetics and Pharma-

codynamics of IPX056 in

Subjects with Established

Spasticity Resulting from

Multiple Sclerosis, IMPAX

Laboratories, Inc. Protocol

No. IPX056-B06-03 (MS

Clinic)

Co-Investigator: Dr. Dan

McGowan. Metalloprote-

inase Inhibition in Acute

Spinal Cord Injury : A Pilot

Study to Assess Clinical

Safety and Tolerance to

Minocycline. Principal Inves-

tigators: R. John Hurlbert,

M.D., Ph.D., FRCSC, FACS,

Stephan J. DuPlessis, M.D.,

Daniel McGowan, M.D.,

FRCPC, Voon Wee Yong,

Ph.D. (2004 - ongoing) (U of

C Spine Program)

Co-investigator: Dr. Dan

McGowan. MS Clinic Trials

- Beyond Study

- Olympus Study

- Bio MS Study

- Sativex Study

Clinical Trials!

Zygun, D., Groeneweg,

G., Oberle, K., McGovern,

C. The lived experience

following acquired brain in-

jury: a longitudinal study.

Sponsor: Alberta Seniors

and Community Supports

Highlights

Recruitment of Dr.

Sean Dukelow as the first

Clinician Scientist for the

Division to start October

2008

Residency Training

Program expanding to two

positions per year as of

2009


!

Division of Experimental NeurosciencesIntroduction

DEN is the newest division of the Department of Clinical Neuroscience. The goal of establishing this new division is

two fold: 1) to strengthen the partnership between DCN and HBI by creating an environment that champions academic

medicine and research; 2) to provide an administrative structure by which the contributions of the scientists to the De-

partment of Clinical Neurosciences, are properly recognized and issues about their career development are properly ad-

dressed.

DEN currently consists of 7 primary and 8 secondary members. Their academic appointments range from full profes-

sors to assistant professors. They work in diverse fields such as imaging, cell biology, neurophysiology and molecular

biology. A common feature of DEN members’ research is that they almost all have established collaborations with the

clinicians in the department. All active members of DEN are also members of Hotchkiss Brain Institute. In 2007, DEN

members played an increasingly active role in the department and HBI. These included the mentorship for junior faculties

and clinician scientists; development and expansion of different research programs; launching new research initiatives;

recruitment; and graduate student education. The combined external funds obtained by members of DEN in the 2007

approximated 2 million dollars.

Current Members

Head: Bin Hu, MD. PhD

Sutter Professor in Parkinson Disease Research

Primary Members

Hulliger, Manuel - Professor

Melvill Jones, Geoffrey – Professor Emeritus

Nguyen, Minh Dang – Assistant Professor / AHFMR Scholar / Investigator

Brenda Strafford Chair

Tomanek, Boguslaw – Adjunct Assistant Professor

Yong, Wee – Professor / AHFMR Scientist

Zhao, Zonghang – Adjunct Assistant Professor

Block, Ed – Technical Officer / Project Leader

Secondary Members

Lenora Brown, Sung-Woo Kim, Michael Eliasziw, Ross Mitchell, Richard Frayne, Marc Poulin, Brad Goodyear, Ursula

Tuor, Angela Haffenden, Patrick Whelan,

Graduate Students

Steven Peters, Lorraine Lau, Susobhan Sarkar, Adrien Tennet, Taylor Chomiack, Viktor Skihar, Smriti Agrawal, Dave Stir-

ling, Rowena Cua, Mengzhou Xue, Angelika Goncalves DaSilva, Gernot Neumayer, Axinia Döring, Susan Park, Trina

Johnson, Hankyu Lee


!

Dr. Bin Hu

Significant Achievements

Dr. Wee Yong, named one of

the “20 Compelling Calgarians” by

the Calgary Herald, and his team

have recently received a 1.5 million

award from Neuroscience Canada

to support their work on “Harness-

ing beneficial aspects of neuroin-

flammation for regenerating the

central nervous system”.

Dr. Minh Dang Nguyen was

awarded a grant by Amyotrophic

Lateral Sclerosis, USA.

A presentation by Block, Melvill Jones, Fletcher and Hu at The International Meeting on Gait and Mental Function

(Amsterdam) has received the First Price for Poster Presentation.


!

Manuel Hulliger

Zonghang Zhao

Geoffrey Melvill Jones

Minh Dang NguyenBoguslaw Tomanek

Ed Block

2007 Educational UpdatesNeurology Residency Training ProgramIntroduction

The Neurology Residency Program has trained 24 neurologists since its inception in 1981. The Program provides

neurologists-in-training with comprehensive supervised clinical and research experience. The academic program com-

prises a weekly academic half-day and daily educational rounds and includes regular seminars on ethics, communication

skills and evidence-based medicine. There are regular formal written and oral evaluations. 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 partici-

pate in teaching residents. In 2007, the neu-

rology program also provided training to over

50 residents from other programs, including

internal medicine, psychiatry, pediatric neurol-

ogy, physiatry, neurosurgery, medical genetics

and emergency medicine.

Highlights

Dr. Martin Sutton-Brown completed the

program and passed the Royal College exami-

nations in May 2007. Two highly qualified ap-

plicants were accepted into the program, Dr.

Katie Wiltshire from the University of Alberta

and Dr. Mohammed Alanazy from King Saud

University in Riyadh, Saudi Arabia. The pro-

gram hosted the 10th Annual Rocky Mountain

Basic Science Symposium at Kananaskis

Lodge Mar 9 -11, 2006, attracting 51 neurol-

ogy and neurosurgery residents from the four

medical schools in the Prairie Provinces. Dr.

Howard Rowley from Madison, Wisconsin, and

Dr. Ian MacKenzie from Vancouver, B.C. were

guest lecturers. Reciprocal OSCE exams were

organized with the University of Alberta Neu-

rology Program. Dr. Aylin Reid (PGY-3) started

her PhD program supported by an award from

the HBI Resident Scientist Program. Dr. Philippe Couillard was awarded the American Academy of Neurology

Neurologist-In-Training Clinical Ethics Elective. The neurology residents voted Dr. Nathalie Jetté the winner of the 2007 A.

Keith W. Brownell Neurology Teaching Award.


!

Program Committee:! ! ! !Residents (2007-08):

Dr. William Fletcher (Program Director)" " Dr. Martin SuttonBrown, PGY-5

Dr, Fatima Abdulla ! ! ! ! Dr. Erin O’Ferrall, PGY-5

Dr. Robert Bell" " " " " Dr. Fatima Abdulla, PGY-4

Dr. Sam Chhibber (from Sept 2007)" " Dr. Sameer Chhibber, PGY-3

Dr. Lara Cooke" " " " " Dr. Philippe Couillard, PGY-3

Dr. Andrew Demchuk (until Sept 2007)" " Dr. Mohammed Almekhlafi, PGY-3

Dr. Erin O’Ferrall (Chief Resident)! ! Dr. Justyna Sarna, PGY-3

Dr. Nathalie Jetté! ! ! ! Dr. Claire Hinnell, PGY-2

Dr. David Patry "" " " " Dr. Scott Jarvis, PGY-2

Dr. Aylin Reid (until June 2007)" " " Dr. Suresh Subramaniam, PGY-2

Dr. Nicholas Weir (from Oct 2007)" " Dr. Katie Wiltshire, PGY-1

Dr. Chris White" " " " " Dr. Mohammed Alanazy, PGY-1

Dr. Samuel Wiebe (Division Head)

Dr. Jean Mah

Program Administrator

Ms. Michelle Mills

Resident Awards and Achievements

Dr. Philippe Couillard: American Academy of Neurology Neurologist-In-Training Clincal Ethics Elective

Dr. Aylin Reid: Hotchkiss Brain Institute Resident Scientist Award, AAN Resident Scholarship to the 2007 AAN meeting

Dr. Katie Wiltshire: 2007 Adult Masters Canadian National Champion in Figure Skating


!

Neurosurgery Residency Training ProgramStaff

Program Director: John Hurlbert

Assistant Program Director: John Wong

Research Director: Zelma Kiss

Program Administrator: Patti Sullivan

Number of PGY-1 CaRMS positions per year: 2

Accreditation: Royal College of Physicians and Surgeons of Canada

Length of Training: 6 years

Mandatory Research: 1 year

The education of our neurosurgical trainees remains a prime focus of the Division of Neurosurgery. Each of the at-

tending neurosurgeons contributes to training through hands-on operating room instruction, clinic supervision, ward

rounds, research supervision, teaching rounds, and seminars. In addition a major component of education stems from

interactions between clinical subspecialty fellows (spine, vascular, peripheral nerve), chief and senior residents, and jun-

ior residents. Graduated responsibility for patient care in and out of the operating room is the cornerstone of the resi-

dency training program.

The Neurosurgery training program is based primarily out of the Foothills Hospital. With the exception of some non-

neurosurgery rotations during the PGY-1 year, and Pediatric Neurosurgery training during the PGY-5 year at Alberta Chil-

dren’s Hospital, residency training occurs entirely within the corridors of the Foothills Hospital, currently the only Level 1

trauma centre in Southern Alberta. Hence, residents enjoy a rich interaction with all of their attending staff and their co-

residents throughout the entire training period. Besides benefiting from this large general neurosurgery and trauma

population, on-site subspecialty expertise in vascular and endovascular neurosurgery, epilepsy, functional, skull base,

peripheral nerve, and spinal surgery complements the overall training experience.

The typical layout of a training template includes:

Core Surgical Years: PGY-1 and PGY-2 (26 blocks – 24

months): Surgical, Medicine, and ICU rotations (15 blocks);

Adult Neurosurgery (9 blocks); Principles of Surgery Exam

PGY-3: Adult Neurosurgery (10 blocks); Neurology (3

blocks)

PGY-4: Research (13 blocks); Opportunity to go on to ad-

vanced degree (MSc, PhD)

PGY-5: Adult Neurosurgery (7 blocks); Pediatric Neurosur-

gery (6 blocks)

PGY-6: Adult Neurosurgery (7 blocks); Neuroradiology (3

blocks); Neuropathology (3 blocks); FRCSC exam (you’re

done …. YAHOO!!)


!

Weekly afternoon resident teaching session

Although education begins with hands-on exposure to the patients and their pathologies, it does not stop here.

Thursday afternoons are University academic half-days, dedicated to focused educational seminars. In the first two

years of residency Principles of Surgery sessions are provided in association with the Department of Surgery through the

lunch hour. CanMEDs seminars are intermittently scheduled during this time as well for residents through years 1-6.

Neuro-pathology seminars alternating with brain cutting are shared by Neurosurgery and Neurology residents in the early

afternoon. A curriculum of neurosurgical topics designed to comprehensively cover the specialty of Neurosurgery fills

out the rest of the afternoon, cycling over a three-year period during this protected academic half-day (insert link to resi-

dent’s web site seminar schedule here). Residents and staff alike participate in the teaching of these seminars.

A schedule of prominent visiting guest lectur-

ers and professors enriches the academic envi-

ronment facilitating both formal and personal in-

teractions between residents and internationally

renowned Neurosurgeons (insert link to visiting

professor list here). During all six years of training

residents are encouraged to attend local, national,

and international conferences through semi-annual

educational leave and Departmental/University

funding.

One year of formal supervised research expe-

rience is required during the six year training pro-

gram, typically during the PGY-4 year. This can be

in basic or clinical science. Advanced degrees

(MSc, PhD) are encouraged with funding available

through the Division of Neurosurgery, Hotchkiss

Brain Institute (insert link to Hotchkiss resident

funding page here), and Alberta Heritage Founda-

tion for Medical Research (insert link to AHFMR

funding for medical residents here). Ongoing in-

volvement with clinical research projects is facili-

tated throughout the training program by interac-

tions with staff and the research director, Dr. Kiss.

As hard as our residents work during the year,

social events are an important part of the program

as well. Dinners with visiting professors allow for

personal glimpses into the professional and private lives of others who have not only “been there” but been successful.

Journal club offers a casual atmosphere and camaraderie in the home of one of the attending Neurosurgeons one eve-

ning every other month. Residents’ Night Out is a fun evening at one of the local pubs highlighted by competition in

darts, pool, or even bowling. The annual Division of Neurosurgery ski day involves residents, nurse practitioners, and

attending staff for a day of skiing and an evening of good food at one of the mountains and restaurants in the Banff area.

We believe that the opportunities provided by the University of Calgary Neurosurgical Residency Training Program

are unparalleled throughout Canada and North America. Calgary itself is a growing, vibrant, and young city. From Phil-

harmonic Orchestra and Opera, to NHL and CFL excitement, to the outdoors of Canada’s finest National Parks there

isn’t a safer and more well-rounded environment in which to complete such a comprehensive residency training pro-

gram.


!

Physical Medicine & Rehabilitation Residency Training Program

Program Director

Dr. John Latter

Residents

Dr. Lee Burkholder

Dr. Chantel Debert

Dr. Darren Gumbs

Dr. Arun Gupta

Dr. Jaime Yu

Dr Andrew Willmott

Program Administrator

Linda Jennett

Highlights

In 2007, the University of Calgary Physical Medicine

and Rehabilitation Residency Training Program com-

menced its’ fourth year. There are now six residents in

the program. In 2007 an application was made for an

extra position for July 2008 and the program was

awarded a second position.

The division formally applied for two base positions

to commence in 2009 and the division was successful so

as of July 2009 there will be two base positions each

year.

The program has developed a very active academic

half day for residents.

The Residency Training Committee meets monthly

and the Program Director has formal biannual meetings

with each resident and informally more frequently.

The Physical Medicine and Rehabilitation Residency

Training Program has residents from rheumatology, neu-

rosurgery and neurology rotating through the program.


!

Dr. Andrew Willmott

(PGY-1)

Dr. Chantel Debert

(PGY-2)

Dr. Jaime Yu

(PGY-3)

Dr. Darren Gumbs

(PGY-4)

Dr. Arun Gupta

(PGY-4)

Dr. Lee Burkholder

(PGY-4)

Fellowship ProgramIntroduction

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

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

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


!

J.Q. Oropilla, Func-

tional Neurosurgery

and Stereotactic Ra-

diosurgery Fellow

Adnan Al-Sarawi,

Epilepsy Neurology

Fellow

Naj Attabib, Spinal

Neurosurgery Fellow

Anwar Alrabiah, Spinal

Orthopedic Fellow

Amro Al-Habib, Spinal

Neurosurgery Fellow

Jonathan Ball, Spinal

Neurosurgery Fellow

Gloria Roldan, Neuro-

Oncology Fellow

Paula de Robles,

Neuro-Oncology Fellow

Talip Asil, Stroke

Neurology Fellow

Jacob Alant, Peripheral

Nerve Fellow

2007 Publications1. Division of Experimental Neurosciences

1. Agrawal SM, Yong VW, Immunopathogenesis of multiple sclerosis, in Neurobiology of Multiple Sclerosis, Int Rev Neurobiol

79C:99-126, 2007

2. Agrawal SM, Lau L, Yong VW. MMPs in the Central Nervous System: Where the Good Guys Go Bad, Seminars Cell and Dev

Biol 19:42-51, 2008.

3. Chomiak T and Hu B.Axonal and somatic filtering of antidromically evoked cortical excitation by simulated deep brain stimu-

lation in rat brain. Journal of Physiology, Mar 1; 579:403-12, 2007

4. Gregg C, Shikar V, Larsen P, Mak G, Chojnacki A, Yong VW, Weiss S, White matter plasticity and enhanced remyelination in

the maternal CNS, J Neurosci 27:1812-1823, 2007

5. Kim D*, Nguyen MD*, Fischer A, Sanabenesi F, Dobbins M, Rodgers JT, Dellale I, Sui G, Baur JA, Armour S, Puigserver P,

Sinclair DA & Tsai LH. SIRT1 deacetylase protects against neurodegeneration in mouse models of Alzheimer#s disease and Amyo-

trophic Lateral Sclerosis. EMBO J. 26: 3169-3179 (2007). *These authors contributed equally to this work

6. Latta P, Gruwel MHL, Volotovskyy V, Weber M, Tomanek B, Simple phase method for measurement of magnetic field gradient

waveforms. Mag Res Imag,25: 1272-1276, 2007.

7. Majcher K, Tomanek B, Tuor UI, Jasi$ski A, Foniok T, Rushforth D, Hess G, Functional Magnetic Resonance Imaging within

the Rat Spinal Cord Following Peripheral Nerve Injury. NeuroImage: 38(4):669-676, Dec. 2007.

8. Nuttall RK, Silva C, Bar-Or A, Patel K, Edwards DR, Yong VW, Metalloproteinases (MMPs and ADAMs) are enriched in micro-

glia compared to leukocytes and they link microglia activation with cytokine levels, GLIA 55:516-526, 2007

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129.The IMS II Investigators. The Interventional Management of Stroke (IMS) II Study. Stroke 2007; 38(7): 2127-2135

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List of MembersGeographic Full-Time Academic Staff! ! !

Barber Philip Assistant Professor Neurology

Becker Werner Professor Neurology

Brownell Keith Professor Neurology

Cairncross Gregory Professor Neurology

Casha Steven Assistant Professor Neurosurgery

Cooke Lara Assistant Professor Neurology

Coutts Shelagh Assistant Professor Neurology

Demchuk Andrew Associate Professor Neurology

Feasby Tom Professor Neurology

Federico Paolo Assistant Professor Neurology

Fletcher William Professor Neurology

Hader Walter Assistant Professor Neurosurgery

Hamilton Mark Associate Professor Neurosurgery

Hill Michael Associate Professor Neurology

Hu Bin Professor Scientist

Hulliger Manuel Professor Scientist

Hurlbert R. John Associate Professor Neurosurgery

Jette Nathalie Assistant Professor Neurology

Kiss Zelma Associate Professor Neurosurgery

Latter John Professor Physiatry

Metz Luanne Professor Neurology

Midha Rajiv Professor Neurosurgery

Myles Terry Professor Neurosurgery

Nguyen Minh Dang Assistant Professor Scientist

Ousman Shalina Assistant Professor Scientist

Parney Ian Assistant Professor Neurosurgery

Smith Eric Assistant Professor Neurology

Starreveld Yves Assistant Professor Neurosurgery

Stys Peter Professor Neurology

Suchowersky Oksana Professor Neurology

Sutherland Garnette Professor Neurosurgery

Toth Cory Assistant Professor Neurology

Wiebe Samuel Professor Neurology

Wong John Assistant Professor Neurosurgery

Yong Wee Professor Scientist

Zochodne Douglas Professor Neurology


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Major Clinical Staff! ! !

Bell Robert B. Clinical Associate Professor Neurology

Eloff Arnolda Clinical Assistant Professor Neurology

Furtado Sarah Clinical Assistant Professor Neurology

Patry David Clinical Associate Professor Neurology

Pillay Neelan Clinical Associateprofessor Neurology

Costello Fiona Clinical Assistant Professor Neurology

Pringsheim Tamara Clinical Assistant Professor Neurology

Watson Timothy Clinical Assistant Professor Neurology

Clinical Staff! ! !

Apel Maryana Clinical Assistant Professor Physiatry

Barton Pamela Clinical Associate Professor Physiatry

Busche Kevin Clinical Assistant Professor Neurology

Davenport Jeptha Clinical Assistant Professor Neurology

Dike Nwmara Clinical Assistant Professor Physiatry

Du Plessis Stephan Clinical Assistant Professor Neurosurgery

Hanson Alexandra Clinical Assistant Professor Neurology

Hill Denise Clinical Assistant Professor Physiatry

Hoyte Keith Clinical Associate Professor Neurology

Klassen Brian Clinical Assistant Professor Neurology

Klein Gary Clinical Associate Professor Neurology

Kohli Jagdeep Clinical Assistant Professor Neurology

Kraft Scott Clinical Assistant Professor Neurology

Lam Kenneth Clinical Assistant Professor Physiatry

Macrae Elizabeth Clinical Associate Professor Neurosurgery

Mcgovern Christine Clinical Associate Professor Physiatry

Mcgowan Daniel Clinical Associate Professor Physiatry

Mcneil Stephen Clinical Assistant Professor Physiatry

Pearson Dawn Clinical Assistant Professor Neurology

Plamondon Stephanie Clinical Assistant Professor Physiatry

Ranawaya Ranjit Clinical Associate Professor Neurology

Ubhi Perminder Clinical Assistant Professor Physiatry

Virani Noorshina Clinical Assistant Professor Physiatry

Weir Nicolas Clinical Assistant Professor Neurology

White Christopher Clinical Associate Professor Neurology

Wilson Scott Clinical Assistant Professor Neurology

Yeung Michael Clinical Assistant Professor Neurology


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11th Floor, Foothills Medical Centre

1403 - 29th Street NW

Calgary Alberta T2S0S1

Canada

Addressee NameAddressCity, ProvincePostal Code

2007 YEAR HIGHLIGHTS

JanuaryDr. Krishman Unni (Mayo Clinic, Rochester

MN), visiting lecturer

FebruaryDr. Alessandro Olivi, (Johns Hopkins, Balti-

more MD), visiting lecturer

MarchDr. Howard Rowley (University of Wisconsin,

Madison WI), visiting lecturer

AprilNeuroArm, the world’s 1st MRI-compatible

surgical robot unveiled in Calgary

MayDr Arnold Menezes (Univ. of Iowa, Iowa City

IA), Terry Myles visiting lecturer

JuneDr. Mitch Berger (UCSF, San Francisco CA),

annual Charles Taylor visiting lecturer

July

Welcome new resident housestaff

August1st annual Epilepsy Golf Tournament

SeptemberDr. Tallie Baram (UCLA Irvine, Irvine CA),

visiting lecturer

OctoberDr. Jean Gotman (MNI, Montreal QC), annual

Mary Anne Lee Memorial visiting lecturer

NovemberDepartment of Clinical Neurosciences Re-

treat at Rimrock Hotel, Banff

DecemberDr. Charles Branch (Wake Forest University,

Winston Salem NC), visiting lecturer

2007 dcns annual report

Documents

program neurovascular

e d i c i n e r e h

program updates

disorders program

sclerosis program

t i o ne x p e r i

calgary spine program

nerve surgery program