Download - Annual Report 2009

DEPARTMENT OF CLINICAL NEUROSCIENCES

Department of Clinical NeurosciencesAnnual Report 2009

Again in 2009, the Department of Clinical Neurosciences (DCNS) provided exemplary neurosurgical, neurological

and rehabilitative care to the citizens of the Calgary Zone of Alberta Health Services and to others from across southern Alberta. We also provided important emergency and

complex neurological care to patients from Saskatchewan and British Columbia who were in need of our services.

This year we felt the full impact of the economic slow down in Alberta and began to adjust to the new site-based

organizational structure for the delivery of health care services in Calgary. Although there were challenges on both fronts, there were many more successes.

This year the new Neurosciences Unit at the Rockyview General Hospital became fully operational under the

leadership of Dr. Chris White. Further expansion of ambulatory and EEG-EMG services in the new space is

eagerly anticipated.

We also established a new Cognitive Neurosciences Unit at the Foothills Medical Centre under the direction of Dr. Eric

Smith and continued to be a catalyst for the strengthening of stroke care across Alberta through the Alberta Provincial Stroke Strategy.

As Department Head, I continue to have overall responsibility for the provision of neurological patient care

in the Calgary Zone, and overall responsibility for the training and recruitment of the next generation of

neurosurgeons, neurologists and rehabilitation specialists for our community. In 2009, several outstanding new medical experts joined our Clinical Neurosciences team:

Dr. Farnaz Amoozegar Dr. Jodie Burton, Dr. Bradley Jacobs, Dr. Lawrence Korgut, and Dr. Paula de Robles.

Although we are most proud of and most committed to high performance in the care of the sick, the educational and research missions of Clinical Neurosciences are

DEPARTMENT OF CLINICAL NEUROSCIENCESDepartment of Clinical Neurosciences

Department Head: Dr. Gregory Cairncross

thriving. Our reputation as leaders, innovators and scholars in the clinical brain sciences is growing exponentially. While

in our field there is no single measure of best in Canada, this team stands above the rest in most respects. Our trainees in Neurosurgery, Neurology and Rehabilitation

Medicine excel each year at the national examinations of the Royal College of Physicians and Surgeons of Canada

and our faculty members compete successfully in the intense competition for national research funding and for national awards on a yearly basis. Clinical Neurosciences

is a remarkable 28-year success story!

I hope you enjoy our 2009 Annual Report.

New FacultyDr. Farnaz Amoozegar

Dr. Farnaz Amoozegar is a headache specialist; headache

is the single most common neurological disorder worldwide and is a leading cause of both time from work and discomfort. Headache is a particularly common

problem in Calgary where the altitude and

Chinook winds may contribute to higher incidence than in other

parts of Canada. Dr. Amoozegar trained in

Neurology at the University of Ottawa and was a Fellow in the

Headache Program at the University of Calgary,

led by the Canadian authority on Headache Disorders, Dr. Werner

Becker. With Dr. Becker and others, Farnaz is

developing clinical trials to test new drug therapies and other approaches to the management of patients with severe episodic headaches (e.g., migraine) and various

chronic unrelenting headache conditions.

Dr. Jodie Burton

Dr. Jodie Burton is a neurologist and clinical researcher with specialization in Multiple Sclerosis (MS). She too

trained at the University of Toronto in both

Neurology and Clinical Science (MSc) and joined our Department

after completing a Fellowship in the MS

Program in Toronto. Jodie is the newest member of our very busy

MS Clinic, led by Dr. Luanne Metz. Jodies

research focuses on vitamin D deficiency as a possible causative factor

in MS. She is also studying the role of vitamin D replacement in preventing full-blown MS in those who are

at high-risk for the disease or have early MS. Dr. Burton is an astute clinician and critical thinker who brings new ideas and ways of thinking to our well-known MS team.

Dr. Bradley Jacobs

Dr. Bradley Jacobs is a neurosurgeon and scientist with specialization in Spine Surgery. He trained in Neurosurgery

and Science (PhD) at the University of Toronto and joined Clinical Neurosciences after completing a Spine Surgery Fellowship at the

University of Washington in Seattle. Clinically, Brad

specializes in complex reconstructive spine surgery. In the laboratory,

he studies the individual cellular elements in the

spinal cord and how they behave and react on normal and disease

states and after injury. Brad joins an

exceptionally strong surgical team in DCNS and Orthopaedics, and is

also a member of the Nerve Regeneration Research Group within the Hotchkiss Brain Institute (HBI).


Dr. Lawrence Korngut

Our long-standing commitment to improve care through

research is further solidified by the appointment of Dr. Lawrence Korngut. A neurologist and clinical investigator

with specialization in Neuromuscular Disorders (i.e., conditions of the peripheral nerves and muscle), Lawrence trained in Neurology at the University of Western Ontario;

he is also currently pursuing a Masters Degree in Clinical Epidemiology in Calgary. Together with others in DCNS,

Lawrence is leading a study of intranasal insulin to prevent diabetic degeneration of peripheral nerves and brain white matter. Lawrence is also spearheading the creation of pan-

Canadian registries of neuromuscular disorders to foster patient education and support, and to facilitate patient-

based research and communication between specialists.

Dr. Paula de Robles

This year the highly regarded brain tumour program in Calgary is strengthened by the recruitment of Dr. Paula de

Robles. She is a graduate in Medicine from the University of Buenos Aires. Paula also trained in

Neurology in Argentina before moving to

Canada to join the Clinical Fellowship Program in Neuro-

Oncology at the Tom Baker Cancer Centre

and University of Calgary. She is the clinical leader of a new

research team in brain tumour imaging, which

is led by Dr. Ross Mitchell in the Department of

Radiology. Paula, Dr. Mitchell and others are developing non-invasive methods

to identify molecular genetic alterations in brain tumours using Magnetic Resonance Imaging (MRI). This is an exciting area of inquiry because in the future cancers of all

kinds are envisioned to be treated individually based on their genetic make-up, which we hope to be able to

discern through routine MRI scans.


A stroke neurologist with the Department of Clinical Neurosciences is playing a key role in a North American study looking at an alternative treatment option for the leading cause of stroke.

Dr. Michael Hill is heading the research in Calgary one of

three Canadian centres participating in the clinical trial

which looks at the use of a non-invasive treatment option for patients suffering from carotid

artery disease.

The Carotid Revascularization

Endarterectomy versus Stenting Trial (CREST) is a randomized

clinical trial that compares stent-assisted carotid angioplasty (CAS) to the traditional and

accepted surgical approach for the treatment of blocked

arteries.


Stenting: A Safe Alternative to Surgery

Dr. Michael Hill, PI for Crest in Calgary, and patient Max Copeland, during a routine check-up for the study.

A stent is a small, mesh-like tube that is fitted inside an artery to keep it open and allow blood to flow more freely.

Stents are commonly used for treatment of heart disease. CAS involves the insertion of a catheter or tube into an artery in the groin, where it is threaded through the arteries

of the body to the location of the plaque within the carotid artery in the neck. When in place the stent expands inside

the artery to hold the vessel open. The advantage of this method is that it is not performed under general anaesthesia; patients are usually conscious during the

procedure and go home a few hours later.

The study is published online in the May 26, 2010 issue of

the prestigious New England Journal of Medicine.

"This study gives us treatment options, says Hill, director

of the Stroke Unit at the Foothills Medical Centre in Calgary, Associate Professor in the Department of Clinical

Neurosciences at the University of Calgary and a member of the Hotchkiss Brain Institute. It confirms that surgery is the gold standard for preventing stroke when there is

narrowing of the carotid arteries. We also found that stenting is a safe, effective alternative for those who are

unable to have surgery for technical or medical reasons." Max Copeland suffered from a stroke three years ago and received a stent in his left carotid artery as part of the

study. Now he is healthy and able to joke about his experience.

I was in Safeway on a Sunday morning, says Copeland, describing his stroke in the spring of 2007. All of a sudden

my right arm started to pull towards my body, my left leg started to lift up and I went down in the aisle. It was a wet clean-up in aisle four.

After he was transferred from Calgarys Rockyview Hospital to the Foothills Medical Centre, Copeland took

little time in deciding to be part of the study.

But Copeland realized that if a stroke could happen to him,

it could happen to anyone. Participating in the study was a way he could help others.

Its through studies like this that they find out what works and what doesnt work, he says. If they dont do these

studies, and if people like me dont participate in these studies, who is going to know?

The first long-term study of its kind, CREST followed over 2,500 patients at 110 different centres. Participants were

randomly assigned to undergo either surgery or stenting. All patients were followed for four years.

One of the largest risk factors for stroke is the narrowing of the carotid arteries, which is usually caused when cholesterol, fat, and other substances build up in the inner

lining of the arteries.

We estimate that of the 50,000 strokes occurring each

year in Canada, approximately one quarter are caused by narrowing of the carotid arteries, says Hill. Imagine if we

could use early detection and treatment to help prevent more than 12,000 strokes each year.

CREST is sponsored by the National Institute of Neurological Disorders and Stroke (NINDS), and the National Institutes of Health (NIH).


Overview

The Division of Neurology in DCNS comprises all 44 neurologists practising within the Calgary zone of Alberta

Health Services. Led by Dr. Sam Wiebe, the Division also encompasses emeriti members and cross-appointees from outside the Calgary zone, such as Red Deer and

Edmonton. The division provides neurological clinical care to the population of southern Alberta, southwestern

Saskatchewan and southeastern British Columbia. The interests and level of specialization vary among division members, and there is a strong spirit of collaboration. This

breadth of expertise enables excellence in clinical care, health administration, research, and education.

The Division of Neurology is comprised of eight specialtyprograms: Epilepsy, Headache, Movement Disorders,

Multiple Sclerosis, Neuromuscular Disorders, Stroke, Neuro-oncology and Neuro-ophthalmology. Each of these

programs thrives clinically and academically through involvement in a broad variety of research areas, as well astraining of post-doctoral clinical and research

fellows.These programs have strong links with basic science researchers through the Hotchkiss Brain Institute,

and with health services and population health research through the Department of Community Health Sciences and the newly formed Calgary Institute of Population and

Public Health.

During the academic year 2008-2009 four new members

have joined our division and will also provide general and urgent neurology care: Dr. Farnaz Amoozegar, specializing in headache and clinical research Dr. Jodie Burton, specializing in Multiple Sclerosis and

clinical research


Division of Neurology

Division Head: Dr. Samuel Wiebe

Dr. Lawrence Korngut, specializing in Neuromuscular disorders and translational research Dr. Paula de Robles, specializing in neuro-oncology and

clinical trials.

Two programs, Urgent Neurology and General Neurology, are centrepieces for delivery of neurological care in our zone. The Urgent Neurology Clinic has expanded to the

Rockyview General Hospital and the General Neurology Programme is developing. An important innovation this

year is the development of a central triage system for patient referrals to our various out-patient programs. Implementation is scheduled for 2010.

A dedicated neurology in-patient unit at the Rockyview General Hospital opened on September 29, 2008 and is

maturing clinically and academically. We foresee the addition of a formal neurology residents presence starting

in the fall of 2010. The out-patient program at the Rockyview has been significantly expanded, and now includes an Urgent Neurology clinic, a neuromuscular

clinic, and enhanced EMG and EEG services. This development is of particular importance as we continue to

cultivate out-patient and in-patient neurological units at the new South Health Campus. This new facility is slated to open in 2012.

Clinical ResearchClinical research in the Division of Neurology is thriving.

The Neurosciences Clinical Research Unit continues to provide support for investigator-initiated research. The expansion of data and project management capabilities,

new platforms, and additional personnel, allow us to serve the wide range of needs of neurosciences researchers. In

addition, investigator-initiated research this year received substantial national funding for projects involving the disciplines of health services, clinical trials, cohort

studies, and the creation of disease specific registries.

This year our Division members continued to excel

academically. They obtained numerous external salary awards and operational research grants from national and

international organizations, authored extensive peer reviewed scientific publications, delivered keynote lectures at international scientific meetings, and received several

teaching awards. Our division has the distinct honour of

having two of its members, Drs. Fiona Costello, andAndrew Demchuk named to Canadas Top 40 Under 40 list, compiled by Caldwell Partners International.

EducationDuring this year the Academic Alternate Relationship Plan

(AARP) of the Division of Neurology will undergo a formal external review. This substantial undertaking will provide

an assessment of our performance in the areas of care, administration, research, and education. The review will allow us to plot a course of innovation in these four areas

and to maximize the opportunities realized by the AARP.

The Division comes together every Friday at Clinical

Neurosciences Grand Rounds. In addition, individual programs hold numerous teaching and research sessions

throughout the week which provide a rich and valuable source for in-depth learning in diverse areas of clinical neurology.



Dr. John Hurlbert, spinal neurosurgeon and lead PI for the minocycline study, discusses therapy options with patient Helen Martin.

New Hope for Spinal Cord Injury Patients

A team of researchers in the Department of Clinical Neurosciences, Faculty of Medicine, UCalgary, is showing how minocycline - a common antibiotic used to treat acne and joint pain - shows promise for limiting the severity of spinal cord injuries (SCI). In Canada, there are approximately 1200 spinal cord injury (SCI) cases per year, and it is the leading cause of disability

in young adults. When a car crash, diving accident, fall, or even a bullet crushes or cuts through the spinal cord, the

resulting damage does not stop there. Instead, tissues continue to discharge toxic chemicals for hours and sometimes days or weeks after the initial incident, killing

and disabling cells away from the core injury - compounding the damage and making rehabilitation much

more difficult, and sometimes impossible.

Current treatments for SCI are limited, and used to involve the use of a steroid to reduce swelling and decrease

inflammation. So far, these treatments have failed to provide positive outcomes for people affected by a spinal

cord injury.

Putting together clues about how brain and other nerve cells die, Dr. John Hurlbert, a neurosurgeon and an

associate professor in DCNS, and his team, are trying to find new ways to reduce the extent of this progressive

tissue loss (neuroprotection), which could result in better recovery for SCI patients. In partnership with colleagues in the Hotchkiss Brain Institute, they are continuing to explore

how minocycline could influence several secondary injury mechanisms implicated in spinal cord injury.

Our goal as researchers and clinicians is to make an impact and have a therapeutic strategy available for spinal cord injury patients," says Hurlbert, the lead clinical

investigator for the clinical trial. "If minocycline, or a similar drug, is successfully tested in humans and approved for

use, any small benefit resulting from drug treatment could greatly improve the quality of life for our patients."

Preliminary results using animal models to test minocycline were extremely positive. Over the course of the study, researchers exposed the spinal cords of mice and applied

an aneurysm clip to mimic specific spinal cord injuries. The mice were then given injections of the drug or a placebo

beginning one hour after the injuries occurred, and monitored for seven specific measures to see if minocycline displayed any benefits over a placebo.

They found that minocycline significantly reduced tissue damage and improved mobility in mice with SCI. The hind

limbs of mice that had not received the drug remained paralyzed. In contrast, animals that received minocycline could walk with their hind legs supporting their weight and

stand in a way that was close to normal. Their reflexes were better than those of the untreated mice. Moreover,

gross lesion size in the spinal cord was significantly reduced by minocycline, and there was evidence of increased survival of nerve cells vital for passing signals

along their spinal cords (axonal sparing).

We think that the anti-cell death, anti-scaring and anti-

inflammatory effects of this drug are primary factors for reducing the secondary damage of spinal cord injuries," says Hurlbert. "Initial results were exciting because they

demonstrated a novel strategy in the form of a safe substance that could serve as a prototype drug for

developing better treatments for people suffering from spinal cord injuries."

Although approved by the Food and Drug Administration

for other uses, minocycline still has to be tested on humans with spinal cord injuries before it can be used

specifically for this purpose. Because of its FDA approval status, translation into human clinical trials has occurred much more quickly.

Over 50 patients have already been enrolled in the new clinical trial, estimated for completion in November of

2010. In addition to evaluating the feasibility of minocycline as a treatment option for patients with acute spinal cord injury, Hurlbert and his team also hope to ensure adequate

drug dosing and metabolic effect for their patients.


Overview

The Division of Neurosurgery at the University of Calgary

(U of C) and Alberta Health Services (AHS) continues to strive to create a world-class institution known for excellence in neurosurgical education, research, and

clinical care.

Unlike most other Canadian medical schools and large quaternary level hospitals where neurosurgery would be placed organizationally within a Division of Surgery,

Calgary has developed a Department of Clinical Neurosciences. Within this unique framework, the Division

of Neurosurgery works alongside its partners in neurology and physiatry to create a greater coordination of academic and clinical activity across the broad spectrum of brain,

spine, nerve, pain, muscle and movement disorders that afflict our patients.

The Division of Neurosurgery provides full neurosurgical

services for adults and children including Level One Trauma support to the southern half of the province of

Alberta as well as the eastern part of British Columbia in the Kootenay Region through the Foothills Medical Centre (FMC) and Alberta Childrens Hospital (ACH).

The level of clinical service delivered by Calgarys neurosurgical community is comprehensive, and is built

around the qualities of excellence, competence, quality, safety, and innovation. The roll-out of the Alternative

Relationship Plan for Neurosurgery (in 2001, and renewed in 2008) has fostered a mechanism of timely appropriate transfer of cases to neurosurgical subspecialties and

thereby allowing the highest quality of care for each and every patient.


Division of Neurosurgery

Division Head: Dr. Rajiv Midha

General neurosurgical services as well as subspecialty care in complex spinal diseases, skull-base surgery,

paediatrics, peripheral nerve disease, cerebrovascular and endovascular neurosurgery, epilepsy, and functional neurosurgery are provided at the FMC and the ACH sites.

Stereotactic radiosurgery is provided in the Tom Baker Cancer Centre, which houses the innovative Alberta

Radiosurgery Centre (ARC), in collaboration with the radiation oncologists.

In addition to general neurosurgical call, sub-specialty call coverage is provided for paediatric neurosurgery, spine, and cerebrovascular (including endovascular) surgery.

While leading and encouraging the development of innovation in neurosurgery service in southern Alberta,

Divisional Members have continued to deliver core neurosurgical services to our patients in the catchments

area. In 2009/10 at the FMC site, there were approximately 1,800 in-patient discharges from neurosurgery and nearly 8,000 out-patient visits to the

neurosurgery ambulatory clinics. Neurosurgeons within the Calgary Zone of AHS performed 1,788 procedures in

2009/10 comprising procedures in the regular OR, and over 350 procedures in the endovascular, stereotactic radiosurgery ARC unit and ICU settings.

Clinical Service

With the addition of several neurosurgeons over the past

10 years to our faculty, subspecialty neurosurgical care in all major areas is covered, with several new services now

being delivered through considerable innovation in care. Three examples of innovation in neuro-surgery care are described below:

a) Spinal triage service and clinic The Division has met the ever growing clinical challenge to diagnose and treat its rapidly expanding referral base in

diseases of the degenerative spine. The needs of many of these patients are now addressed through an innovative

process of clinical screening, referral and treatment which ensures that the appropriate treatments are provided to the right patients by the appropriate clinician.The Division of

Neurosurgery has established a medical Spine Clinic overseen by Dr. Stephan DuPlessis and divisional

members within the Foothills Medical Centre site. Dr. Salma Yaseen, an international medical graduate who has previously completed the Calgary Clinical Assistants

Program (CCAP) with the neurosurgical service, is now helping manage the medical Spine Clinic, where she helps

triage patients with degenerative spinal complaints to surgical or medical treatment. Patients are neurologically evaluated under the supervision of an attending


Neurosurgery Division Members with visiting lecturer Dr. Gavin Fabinyi.

neurosurgeon with a view towards identification of surgically remediable disease. The clinic provides

expedited spinal advice to about 80 patients per month, and has significantly reduced neurosurgical waiting lists.

b) Neurosurgery and Nursing Collaboration in the Hospital SettingA second example of innovation in neurosurgical patient care is in the hospital setting, through the development of a Clinical Nurse Practitioner (CNP) program. Nurses who

are trained through the nurse practitioner program offered by the University of Calgary Faculty of Nursing take a third

year clinical placement that focuses on the ward care of neurosurgical patients, the evaluation of medical problems in pre- and post-surgical care and the technical and clinical

skills related to the care of neurosurgical patients.

Enhancement of all facets of in-patient care, pre- and

post-surgical education and continuity into the community has been possible with the training and implementation of

five Clinical Nurse Practitioners (CNPs) within the system.

c) Neurosurgical Locum Tenens OpportunitiesThe Division of Neurosurgery is now able to offer qualified

individuals with the opportunity to initiate their surgical career within the Department on a per annum contract basis. Typically newly credentialed by the Royal College of

Surgeons, these physicians are well-trained neurosurgeons from respected programs who wish to transition from

residency to full-time staff in a structured and rigorously academic environment. The locum position offers the benefits of quickly adopting a busy general neurosurgical

practice with administrative and operative resources, with the ready availability of subspecialty neurosurgical advice

from divisional members. Dr. Aleksa Cenic completed a fellowship with the Division, and in 2009, Dr. Cenic took up a locum tenens position within the Division. Dr. David

Omahen came to Calgary from Victoria, BC to undertake a locum tenens position in October 2009.

Research

Research within the Division of Neurosurgery is

accomplished through cooperation and close alignment 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 translating basic science discoveries 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 treatment.

Clinical and basic science research is completed by all division members, four of whom run externally funded research programs. Many also play prominent roles in

Hotchkiss Brain Institute programs and themes, including: NeuroArm, Axonal biology (Spinal cord and nerve

regeneration), Epilepsy and brain circuits, and movement disorders and therapeutic brain stimulation.

As one measure of academic productivity, grant money from National and Provincial agencies awarded to divisional Members has increased several-fold over the

past decade, and was $17,180,685 in 2009/10. Out of the 10 GFT faculty, three have independent operating grant

support from CIHR, an extraordinary level of success for a surgical Division in Canada. Another measure is peer-reviewed publications, which continue to increase yearly,

and are fully documented in the publication section elsewhere in the Annual Report.

Fostering the Bio-Science Economy of the FutureThe research program of members of the Division has a significant focus on technology commercialization and the

development of effective partnerships and alliances with interested and committed partners from the private sector.

The worlds first MRI-compatible surgical robot is the creation of Calgary neurosurgeon Dr. Garnette Sutherland

and his team. Dr. Sutherland has spent the last 7 years leading a multi-disciplinary team of Canadian scientists, in cooperation with MacDonald, Dettwiler and Associates

Ltd. (MDA), to design neuroArm, a machine, that represents a milestone in medical technology.

Designed to be controlled by a surgeon from a computer workstation, neuroArm operates in conjunction with real-

time MR imaging, providing surgeons unprecedented detail and control, and enabling them to manipulate tools at a


microscopic scale. Advanced surgical testing of neuroArm was completed in 2008, and several patients have had

neuroArm assisted robotic cranial neurosurgery. Developing neuroArm required an international collaboration of health professionals, physicists, electrical,

software, optical and mechanical engineers to build a robot capable of operating safely in a surgical suite and

within the strong magnetic field of the intra-operative MRI environment. This past year the 1.5 Tesla intra-operative MR has been upgraded to a state-of the-art 3.0 Tesla

system. Many other surgical disciplines have and continue to participate in applying neuroArm to various types of

surgical procedures.

Education

The Division of Neurosurgery provides teaching excellence

in the UCalgarys Faculty of Medicine to both undergraduate medical students and post graduate

trainees in the neurosurgical residency program.

Directed by Dr. John Hurlbert, the University of Calgary

Neurosurgical Residency Training Program has continued to excel, and has flourished with an increasing resident complement pool from five residents in 2000 to 15 in

2009/10. The Program has now realized a stable complement of residents and has gained approval of two

PGME-funded positions a year.

Resident operating room teaching and technical skill

training, critical care unit, emergency room, clinical ward and out-patient experience are provided at the Foothills and Alberta Childrens Hospital sites by neurosurgical

faculty member mentors and supervisors.

In addition to postgraduate training, the Division of

Neurosurgery offers Fellowship training in complex diseases of the spine (several dozen Fellows trained over

the past decade), the surgical treatment of epilepsy, functional and stereotactic neurosurgery, endovascular neurosurgery and peripheral nerve surgery. Each of these

programs has or is training Fellows, and (given that International Fellows can choose to go anywhere) this is

reflective of the maturity and the prominence of these programs.

Calgarys neurosurgeons have utilized the advanced

practice nursing program from the University of Calgary to

train clinical nurse practitioners who work with neurosurgery patients 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 neurosurgeons.

Additionally, divisional members are involved in various teaching activities targeting the public, and continuing

medical education seminars for primary care physicians, emergency physicians, and referring doctors. Given their

national and international stature, several members are also prominently involved in the teaching of residents, fellows, and their colleagues at Specialty and Sub-

specialty meetings.


Neurosurgery residents and staff


The Future of Health: Using Robotics for Stroke Recovery

Dr. Sean Dukelow assesses a patient using the KINARM.

A robot is helping a physiatrist in the Department of Clinical Neurosciences to determine the complete and precise impact of strokes.

Dr. Sean Dukelow has been conducting research on

objective stroke assessments for several years. Last summer he began using an Exoskeleton robot, called KINARM (Kinesiologic Instrument for Normal and Altered

Reaching Movements), at the Foothills Medical Centre to assess stroke and brain-injury patients.

Dr. Dukelow, who is also an assistant professor in the Faculty of Medicine at the University of Calgary and member of the facultys Hotchkiss Brain Institute, uses the

robotics system to objectively measure and quantify the effects a stroke has on sensory and motor skills. Stroke

deficits can affect how a person sees, moves, senses, thinks and processes language, and are usually measured in a subjective way through observing the patient

performing different tasks.

What we find is that the robot is more sensitive in picking

the deficits up in terms of movement, and we hope this will give us new insight into developing treatments, says Dr. Dukelow.

He says determining a persons specific deficits has a significant impact on how well they recover following a

stroke and how they function in their daily lives.

The $140,000 robot, combined with an augmented reality system, creates a virtual environment where patients must

perform tasks, such as directing a hand to a target, or blindly copying a movement. The robot tracks the patients

movement, providing support or resistance to their movements, and then identifies minute differences when compared to what normal responses would be.

Often stroke patients undergo lengthy and repeated clinical testing. Dr. Dukelow says the KINARM can test for the

same deficits in a matter of minutes.

Sean Polischuk is a patient involved in Dr. Dukelows research. After the 21-year-old university student

experienced a stroke in February, his right side remains numb, his attention wanders, and moving his fingers, toes

and ankles requires utmost concentration.

"The robot triggers your brain and makes you think quite a bit more about what you're doing, says Polischuk.

The robotic system helps to identify deficits that are sometimes difficult to pick up on a standard clinical exam,

but are important for day to day function. In the next phase of his research, Dr. Dukelow will begin developing novel approaches towards helping patients recover from the

effects of their stroke.

This groundbreaking research has recently earned Dr.

Dukelow significant recognition from the Heart and Stroke Foundation of Alberta, NWT & Nunavut. In March 2010, he received a special Grant-In-Aid (GIA) for Patient-Centred

Research, valued at $90,000 annually for three years.

Dr. Dukelow believes objective assessments of stroke

deficits could soon be used to tailor rehabilitation programs for each patient and give individuals like Polischuk their best chance to regain a pre-stroke level of function.

About 5,000 Albertans have a stroke every year. A stroke occurs when the flow of blood to the brain (ischemic

stroke) is interrupted, or blood vessels in the brain are ruptured (haemorrhagic stroke). The interruption of blood flow or the rupture of blood vessels causes brain cells

(neurons) in the affected area to die.


Overview

From mobility and communication, to emotional concerns and activities of daily living, rehabilitation addresses all

spheres of life. Within the Department of Clinical Neurosciences, University of Calgary and Alberta Health

Services, the Division of Physical Medicine and Rehabilitation provides local and regional clinical rehabilitation programs (out-patient and in-patient) to the

people of southern Alberta, southeastern British Columbia, and southwestern Saskatchewan.

Through work with our interdisciplinary team of health professionals, we aim to enhance and restore functional

ability and quality of life to those with impairments or disabilities - to achieve their goals, to optimize functional independence, and to increase participation within their

communities.

Clinical Care

The Division provides services for tertiary inpatient neurorehabilitation, which occurs on Unit 58 in the Special

Services Building at the Foothills Medical Centre. Outpatient clinics run out of the same building, with occasional satellite clinics elsewhere. Consultation services

are provided to multiple centres in the city, including:


Division of Physical Medicine &Rehabilitation

Acting Division Head: Dr. Christine McGovern

Foothills Medical Centre, Rockyview General Hospital, Peter Lougheed Centre, Carewest Glenmore Park, and

Carewest Dr. Vernon Fanning Centre.

Research and Education

In addition to patient care, we actively support education and research initiatives both within our Division, and across the sphere of Clinical Neurosciences, through:

Undergraduate Medical Education, graduate and postgraduate training, residency, and relevant clinically

based research programs.

Highlights

Our young residency program had the first three graduates all successfully complete their fellowship examinations. We started to establish a more consistent research base within

our Division, particularly with the continued work of Dr. Dukelow in the area of stroke rehabilitation, research

projects underway at the Chronic Pain Centre, and the ongoing clinical collaborations of other physiatrists. We were pleased to welcome Drs. Tony Giantomaso and

Susan Beairsto to the Brain Injury Program, which helped to significantly reduce the prolonged out-patient clinic wait

times.

In addition to this, Dr. John Latter received the Award of

Merit from the Canadian Association of Physical Medicine and Rehabilitation. He has stepped down as Division Head and Dr. Christine McGovern has been appointed as the

Interim Division Head.


The Physical Medicine and Rehabilitation Team

Overview

The Division of Experimental Neurosciences (DEN) was established in 2007 as a result of a significant increase of

research scientists associated with the Department of Clinical Neurosciences as well as a strong desire by departmental executives to foster basic and translational

research in neuroscience. DEN currently consists of 7 primary and 8 secondary members. Their research areas

span from neurodegenerative diseases and movement disorders, to multiple sclerosis and innovative medical devices. The research capacity of the division has

expanded with the creation of Hotchkiss Brain Institute (HBI) and its disease-focused research programs. An

important feature of the division is that almost all of its members maintain meaningful and productive

collaborations with clinicians or clinician scientists within the DCNS. Together they either hold shared research grant

(s) and/or serve as co-supervisors of graduate students working on related research projects.


There are over20 postdoctoral fellows, graduate students, and support staff who are directly involved in the research

conducted by DEN faculty members. They work in state-of-the-art research facilities, including the newly

established Boone Pickens Centre for Neurological Science and Advanced Technologies. The Division of Experimental Neurosciences is rapidly growing, not only in

terms of personnel and research support, but also in the


Division of Experimental

Neurosciences

Division Head: Dr. Bin Hu

national and international recognition of its research achievements. Divisional members offer graduate studies

in both clinical and basic neurosciences, year-round research projects for senior undergraduates, and summer research programs. DEN members are also active

participants in community-oriented educational events.

In 2009, DEN members played an increasingly active and

leading role in many aspects of academic activities of 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, and recruitment and graduate student

education.

Technology

Gaitmeter and Movement Disorder ssessmentRecent advances in chip technology have led to a new

generation of miniature sensing devices that are particularly suitable for gait and mobility assessment and

rehabilitation training in clinical settings. GaitMeter is a prototype developed by our medical device lab. It utilizes a miniature triaxial accelerator and gyroscope and system-

on-the-chip technology to acquire high frequency gait and mobility data during long distance natural walking. The

device, which is equipped with high speed wireless and video connectivity, has significant cost advantages over existing technology. It is currently being tested in several

pilot trials.!

Funding

During 2009, DEN members obtained over $3, 000, 000 in

new external research funding:

Multiple Sclerosis Society of Canada (Function of alpha-crystallin in multiple sclerosis -

$586,244 Canadian Institutes of Health Research, Regulation of neuroinflammation and neuropathology in multiple sclerosis by the matrix metalloproteinase inducer, EMMPRIN - $841,563 Project: Diabetes and falling: the potential role of neuropathic pain - $146,000 Canadian Foundation for Innovation (CFI), Government of Alberta Advanced Education and Technology Small equipment grant - $907,839 Mechanisms underling alpha-crystallin function in multiple sclerosis - $586,244

Awards and Prizes

Dr. Wee Yong: U Make a Difference Award 2009, University of Calgary.

Dr. Shalina Ousman: Scholarly Dr. Donald Paty career Development Award.



Programs and Clinics

Calgary Adult Hydrocephalus ProgramOverview

In 2003, the University of Calgary Adult Hydrocephalus

Clinic was established with the goal to standardize and

enhance care for patients with hydrocephalus. The

population of adult patients with hydrocephalus is

increasing as diagnostic and therapeutic techniques

improve identification and survival of treated patients.

Hydrocephalus patients have typically been assessed and

cared for by individual physicians in an unstructured and

unfocused clinic environment. In 2009 there are 350

patients followed in the Adult Hydrocephalus Clinic. This

population includes patients who initially had a diagnosis of

hydrocephalus as a child, adults with acute and subacute

hydrocephalus, patients with long-standing overt

ventriculomegaly in adults (LOVA), and patients with

idiopathic Normal Pressure Hydrocephalus (iNPH).

The University of Calgary Adult Hydrocephalus Program has emerged as a response to the success of the Adult

Hydrocephalus clinic. The effort to focus the care of adult patients with hydrocephalus in a specialty clinic represented an important development to help foster a

better understanding of the natural history of patients with untreated hydrocephalus, to standardize the investigative

strategies for patients with a potential diagnosis of hydrocephalus and to manage the issues related to problems with treatment of hydrocephalus using shunts.

Clinical research is progressing along these avenues. A Canadian Adult Hydrocephalus Study Group has been

established to help advance these objectives nationally.

Research

Neuroendoscopy treatment and outcome for hydrocephalus

Neuropsychological effects of endoscopic treatment of hydrocephalus

Infections in ventricular catheters and shunts

Treatment of idiopathic Normal Pressure Hydro-

cephalus (iNPH)

Transition care for paediatric patients with hydro-

cephalus

Endoscopic management of patients with brain tumours

Members

NeurosurgeonsDr. Mark G Hamilton (Program Director)Dr Clare Gallagher

Dr. Walter Hader

Medical Neurologist and Geriatrician

Dr. David Hogan Dr. David Patry

Nurse PractitionerRon Prince (Inpatient)

Funding

Codman Corporation

Medtronic Corporation


Alberta Radiosurgery CentreOverview

This program, using a Novalis system - the first of its kind in Canada - is a collaborative effort between the Divisions of Neurosurgery and Radiation Oncology, and was originally established as a joint program between the Calgary Health

Region (now Alberta Health Services) and the Alberta Cancer Board. The technology offers focused radiation treatment for diseases of the brain and spinal cord in single daycare sessions, thus obviating the need for lengthy hospital stays

associated with standard surgical treatments. By reducing risks of therapy, and ease of returning to normal activities, it results in much higher patient satisfaction. Since its inception in 2002, the program has grown steadily, and continues to treat patients from across the western provinces.

Faculty/Members

Program Director: Dr. Harold Lau

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

Radiation Oncology: Drs. Harold Lau, Gerald Lim, Rob Nordal

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

Calgary Headache Assessment & Management Program (CHAMP)Overview

Located at the Foothills Medical Centre in Calgary, Alberta, the Calgary Headache Assessment and Management

Program (CHAMP) has pioneered a unique health care delivery model focused on helping headache sufferers

regain control over their lives. Established in 2003, our Program draws on the expertise of neurologists, psychologists, nurses, occupational therapists,

kinesiologists, and administrative staff all working together to provide a team-based, share-care delivery

model approach.

The clinical core of the CHAMP program consists of group

workshops and one-on-one out-patient visits to physicians and other health care professionals. The nursing component of CHAMP provides additional valuable patient

service through telephone follow-up and problem solving.

Research

CHAMP participates in a number of industry-sponsored multi-centre clinical trials. In the past, these have included

trials evaluating the efficacy of:

botulinum toxin type A

occipital nerve stimulation

patent foramen ovale closure

tonabersat in migraine and/or chronic daily headache

prophylaxis.

CHAMP has also analyzed the properties of two headache

outcome measurements, the HIT-6 and the MIDAS, and an abstract was submitted to the Canadian Neurological

Sciences Federation annual meeting in 2009. In conjunction with Dr. Zelma Kiss, outcomes on a CHAMP patient with implantation of a deep brain stimulator (for the

treatment of chronic cluster headache) have been assessed, and an abstract submitted to the same meeting.

Education

In addition to Continuing Medical Education programs and

teaching directed at the University of Calgarys Faculty of Medicine residents and medical students, CHAMP

provides elective rotations to neurology residents from a variety of locations. In addition to this, the program also provides training and support for fellowships from around

the world in headache assessment and management.

Quality Improvement

People affected by headache deserve to receive the best care possible. CHAMP is committed to providing this care

and does so through an integrated approach and through quality improvement processes - using systematic techniques to improve how we provide and support care

delivery.

CHAMP is continually studying our Program outcomes,

and has previously submitted an abstract to the Canadian Neurological Sciences Federation annual meeting. Several patient focus groups have also been held to determine

improvements to the Program, as designated by our patient population.

Faculty

Dr. Werner BeckerDr. Lara Cooke

Dr. Arnolda EloffDr. Jagdeep Kohli

Dr. Farnaz Amoozegar


Calgary Stroke ProgramOverview

The Calgary Stroke Program is recognized as one of the

leading programs in North America for stroke treatment and research. Within the Department of Clinical Neurosciences, Alberta Health Services (AHS), and the

University of Calgary, our Program works alongside other departments to provide quality acute, rehabilitative, and

preventative care to people with stroke and their families.

Our team has achieved a number of notable accomplishments this past academic year. The most

significant was the Distinction in Stroke Services award received from Accreditation Canada. This award was given

to the Calgary Stroke Program, along with programs at the Dr. Vernon Fanning Centre for In-patient Stroke

Rehabilitation, and Community Accessible Rehabilitation (CAR), for demonstrating national leadership in the provision of high-quality stroke care. We are the first

comprehensive program to receive the Distinction Award in Canada.

Research

Stroke research continues to be a major portion of the programs work. To date we are involved with over 15

clinical trials directed by Dr. Michael Hill, including several trials in which program members play significant steering

or executive committee roles. Substantial progress has been made in two large pivotal Phase III clinical trials, IMS-3 and ALIAS, in collaboration with the NIH, University

of Cincinnati, University of Miami, and other sites across North America. Recruitment is almost complete for the

ENACT pilot clinical trial of neuroprotection during aneurysm coiling; ENACT is the first aneurysm coiling neuroprotective trial and Calgary is the coordinating centre

for this study. In addition, the Calgary stroke clinical trials group has successfully integrated neurosurgical clinical

trials into operations.

This year, a new Cerebral Circulation theme was created

within Hotchkiss Brain Institute aimed at bridging the foundational research expertise within the neuroscience and smooth muscle groups. This was made possible

because of the strong clinical research team across disciplines. Many workshops, journal clubs and lectures

have occurred with the momentum growing.

Education

Through the development of teaching programs and

education sessions (for health care providers, medical students, fellows, and Masters and PhD students), we

actively support the delivery of evidence-based practice in stroke treatment, management, care, and prevention. Stroke education is now part of the CORE education

program for all new nursing staff hired to the Emergency Department, AMNSP, and Clinical Neurosciences as well as

all new Nursing Assistants hired to the medical portfolio.

In 2009, Dr. Tim Watson established Acute Stroke Case Rounds to improve knowledge translation and clinical

practice in acute stroke care through an interactive case-based educational forum via Telehealth. These rounds

continue to foster a shared understanding of acute stroke


A multi-disciplinary team works together to treat a patient on the stroke unit at the Foothills Medical Centre.

management between personnel working in Primary and Tertiary Stroke Centres for all levels of health care

professionals involved in acute stroke care, including: clinicians, radiologists, nurses, rehabilitation specialists, and EMS personnel.

Stroke Fellowship

The stroke fellowship training program continues to evolve

and is becoming one of the premier stroke training programs in the world. In addition to their clinical and research activities, our fellows are exposed to weekly case

rounds, weekly academic lectures, and monthly journal clubs. Through various partnerships, many of our stroke

fellows have also first-authored close to 100 full-length original publication contributions.

This past year, four stroke neurologists completed training

in Calgary and returned to other parts of Canada or their native countries to continue their research efforts and to

establish stroke centres back home. Dr. Jin, one of our former fellows, obtained Canadian Foundation for Innovation funding this past year. Fellow applications

continue to be numerous with fellows committed to coming to Calgary for training into 2012. This past year, nine new

fellows have joined the program from India, England, Spain, South Korea, United States and Canada.

Highlights

The first Calgary and Area Stroke Rehabilitation Summit meeting took place in 2009. A multidisciplinary working

group was created to improve the delineation of entry/exit criteria for stroke rehabilitation in the Calgary zone and accountability/communication across these services.

The Stroke Facilitated Discharge Team a pilot program aimed at providing rehabilitation right in the patients home

or community - was successfully completed with new funding secured for 2010-2011.

The Calgary Stroke Program Patient Reference Group was

successfully launched - a group of patients and members acting as a forum for consultation and advice on a broad

range of operational and strategic priorities for the Program.

Chronic Pain CentreOverview

The Chronic Pain Centre, Alberta Health Services, has now completed 9 years of operations within the Calgary zones

Pain Program. It is now the largest such Centre in Canada and is a leader in interdisciplinary rehabilitation for

individuals with chronic pain.

Clinical Care

Three members of the Division of Physical Medicine and

Rehabilitation currently practise at the Chronic Pain Centre: Dr. Pamela Barton, co-founder and former medical director,

Dr. Noorshina Virani and Dr. Nwamara Dike. In addition to their strong background in pain management and interdisciplinary rehabilitation, Drs. Barton and Virani

contribute specific expertise in clinical biomechanics, while Dr. Dike has shared her expertise from a pain fellowship at

Memorial Sloan-Kettering Cancer Center in New York. Dr. Dike has also participated in the newly inaugurated Chronic Pain Inpatient Consultation Service now available in all of

Calgarys hospitals.

The physiatrists work in the Neuromusculoskeletal

Program alongside anaesthetists, family practitioners and all members of the rehabilitation teams. Many patients are co-managed with the gynaecologists and neurologists of

the Pelvic Pain and Headache Programs. They also participate in teaching medical students, residents and

fellows in family practice, anaesthesiology, psychiatry, physical medicine and rehabilitation and neurology who rotate through the Centre.

The physiatrists are incredibly competent in the interdisciplinary management of complex patients. As a

result, their caseloads continue to increase and carry many of the more complicated patients referred to the Chronic Pain Centre.


Epilepsy ProgramOverview

The Calgary Epilepsy Program has a unique core of paediatric and adult epileptologists, epilepsy surgeons,

EEG technologists, clinical physician assistants, residents, fellows basic scientists, neuroradiologists,

neuropsychologists, and nurses providing comprehensive care for epilepsy patients. As one of the premier epilepsy centres in Canada, our team of experts works in

collaboration to find the most appropriate treatment for each patient, developing innovative ways to diagnose and

treat epilepsy in children and adults.

Research

Epilepsy is much more than seizures. Research by

members of our team and others demonstrates that up to 70 per cent of people with epilepsy suffer from anxiety, depression, and other psychological disorders. A similar

proportion suffers from cognitive deficits and learning difficulties as a result of the seizures, the medications, or

other underlying conditions. The risk of death in patients with poorly controlled epilepsy is five times higher than in

the general population. Accidents, social stigma, and disability are all well documented in studies of the Canadian epilepsy population, who also use more acute

health care resources and allied health services than patients with other common chronic conditions. In

addition, our researchers have shown that in Canada, chronic conditions (e.g., hypertension, cancer, stroke, heart disease, gastrointestinal disorders, migraine, allergies,

chronic fatigue, diabetes, and psychiatric disorders) are significantly more common in patients with epilepsy than in

the general population.

The overall objective of the Calgary Epilepsy Program is to be a centre of clinical and academic excellence, and to

maximize the full potential of each individual with epilepsy through improved consolidated services, education, and

research. Patients and families often present with complex needs arising from the impact of this chronic illness on their lives, coupled with the experience of change in their

disease process and /or response to treatment.

Education

There is a wide range of causes and treatments for brain dysfunction and damage, and the processes by which the

brain recovers are intricate and varied. Consequently, teaching and training offered in Calgary has a strong cross-disciplinary focus.

One of the primary objectives of the Calgary Comprehensive Epilepsy Program is the provision of co-

ordinated training for both medically qualified and non-medical graduates interested in epilepsy. The Program brings together adult and paediatric epilepsy groups

through weekly seizure conferences, EEG rounds, and a monthly journal club - with specific teaching for neurology

residents, clinical physician assistants, epilepsy fellows, nurses, EEG technologists, and graduate students.


Ictal SPECT, MRI and seizure recorded with intracranial EEG

Movement Disorders ProgramOverview

Movement Disorders are diseases that result in involuntary movements such as tremor, dystonia (involuntary

contractions of the muscles), bradykinesia (slowness), and tics. These disorders cause significant disability, affecting

over 30,000 Albertan families each year.

Established in 1984, the Program has grown to serve a population of over 2 million from southern Alberta, eastern

British Columbia, and western Saskatchewan. In 1997, a program dedicated to stereotactic surgery was also

established.

The clinic provides multidisciplinary care and treatment for Parkinson's Disease, Huntington's Disease, Essential

Tremor, Dystonia, Chorea, Myoclonus, Tourette Syndrome, and other movement disorders. Currently following over

3,000 patients, the Program is the only subspecialty clinic devoted to parkinsonian and movement disorders in the area. Our clinic is designated as a National Parkinson

Foundation Center of Excellence.

Research

We have a large research program involved in developing improvements in treatment of Parkinsons disease and

related disorders. Research to understand basic mechanisms of disease is coordinated through the

Hotchkiss Brain Institute. We conduct active research trials on movement disorders and regularly publish in leading medical journals. Currently our research focuses on the

following:

Neuroprotection for Parkinsons disease (PD)

Music therapy in PD

Identification of genetic factors in PD

Neuroprotection for Huntington disease (HD)

Abnormalities in reaching in PD

Novel treatments in PD, HD, dystonia, and

spinocerebellar ataxia.

Education

The Movement Disorders Program offers a variety of

education opportunities, including 1 to 2 year clinical fellowships.These are available for applicants who have

completed neurology residency training in Canada (or equivalent abroad).

Grant Support

a) PHAROS Pilot Huntington At Risk Observational Study (1999-2010)

O. Suchowersky (Local PI)National Institutes of Health $45,000US/yr Multicentre Grant

b) PREDICT-HD Neurobiologic Predictors of Huntingtons disease (2002 2008)

O. Suchowersky (Local PI)National Institutes of Health

$20,000US/yr

c) Cooperative Huntingtons Observational Research Trial

(COHORT) (2006-2011)O. Suchowersky (Local PI)HP Therapeutics Foundation, Inc.

$8,000US/yrProspective data collection from HD families.

The effect of music therapy on motor and non-motor symptoms in PD (2006 2011)O. Suchowersky (Sub PI)

Canadian Institute of Health Research (CIHR)$26,000/yr

d) NET-PD Neuroprotective PD (2008-2012)O. Suchowersky (PI)$75,500US/yr

The major goal of this project is to identify drugs to delay disease progression


Multiple Sclerosis ProgramOverview

The Multiple Sclerosis Program in the

Department of Clinical Neurosciences (DCNS), University of Calgary, has assembled a world-class team of

scientists, neurologists, imaging experts, and population health

researchers to treat and investigate MS. As a team we strive to provide expertise and leadership to our

community to expand knowledge of causes, treatments, and cures for MS,

to provide unparalleled care to our patients, and to train the next generation of MS practitioners and

scientists.

Clinical Highlights

Located at the Foothills Medical

Centre, the Calgary MS Clinic is an out-patient clinic that provides specialized interdisciplinary care to

people with demyelinating diseases of the brain, spinal cord, and optic nerve.

Serving approximately 5,000 people with MS living in southern Alberta and in the southeastern corner of British

Columbia, the comprehensive and integrated services provided at our

clinic include:

diagnosis education and support disease management symptom management rehabilitation linkage to mental health

services.

Research

Translational Research: The Calgary

MS clinical and research teams are

primarily focused on translational research. Major research activities

involve bringing therapies from the laboratory to patients. The following projects represent translational

research activities ongoing during 2009:

a) Minocycline program: We have been leading the translation of minocycline

from Dr. Wee Yongs lab to the clinic.

Our team is now conducting a phase III randomized controlled trial of

minocycline in patients with suspected MS, funded by the MS Foundation of

the MS Society of Canada for $4,040,000 (Principal Investigator: Dr. Metz; Calgary co-investigators: Drs.

Yong, Eliasziw, Hill, and Wiebe). Dr. Michael Yeung is leading the Calgary

site in this trial. The Clinical Research Unit of DCNS and HBI, led by Dr. Wiebe, is managing trial data from

across the country.

b) A Brain Repair Team Grant to study

Fine-tuning Inflammation for Neuroprotection and Regeneration in

Multiple Sclerosis - funded by

Neuroscience Canada for $1,500,000 over 3 years in late 2007. In early

2009, a clinical trial of minocycline versus placebo in optic neuritis began. This study aims to (a) determine if the

optic nerve can serve as system model to measure neuroprotection

and (b) to obtain pilot data on the effects of minocycline on optic neuritis in order to plan phase IIb trials.

Meanwhile, basic scientists are working to develop new therapies that

may move to the clinic as trials in the future; targets of interest include vitamin D.

c) Endogenous Progenitor Cell Repair in MS: Research led by Drs. Sam

Weiss and Wee Yong demonstrated that prolactin stimulates differentiation

of oligodendrocyte progenitor cells into functional oligodendrocytes, the cells that myelinate nerves.

d) A team grant submitted and awarded in 2008 from the Stem Cell

Network for $783,600 over 3 years will support the project: Endogenous

progenitor cell repair in MS. The goal of the current three-year proposal is to generate both pre-clinical and clinical

(Phase IIa) results to determine whether Phase IIb-III clinical trials of

prolactin to stimulate repair in MS are warranted.

e) Alpha beta crystalline: Dr. Shalina Ousman has been developing humanized monoclonal alpha beta

crystalline a molecule that appears to put a break on inflammation in MS.

f) Measurement Research: Evaluating


Optic Neuritis

MS therapies requires precise measurement of treatment effects.

Improving the efficiency of EAE studies in vivo imaging would be very useful in accelerating research. In

humans, precise in vivo measures of injury, repair, and inflammation within

targeted lesions are needed to allow us to test therapies that may be

neuroprotective or promote repair. Development of such measures is

another focus of our research.

g) Dr. Lenora Brown is looking at

measures aimed to develop the corpus callosum as another potential model to evaluate neuroprotection and

repair therapies . She is collaborating with Drs. Costello and Metz.

Education

There are a wide range of causes and

treatments for brain dysfunction and damage, and the processes by which the brain recovers are intricate and

varied. Consequently, teaching and training offered in Calgary has a strong

cross-disciplinary focus.

Education is an important component of the MS Program in Calgary.

Integrated across clinical care and research facilities, our Faculty actively recruits and offers training and

education opportunities for future care providers and researchers. In addition,

our teams have lectured locally, nationally, and internationally on many aspects of MS treatment and care. A

variety of education initiatives are integrated into the Program, including

Preceptorships, Continuing Professional Education, and Undergraduate Medical Education, to

name a few.

Faculty

Dr. Luanne Metz (Clinic DirectorDr. Michael Yeung (Clinical Trials Unit Director)

Dr. Robert BellDr. Kevin Busche

Dr. Fiona CostelloDr Jeptha DavenportDr. Dan McGowan

Dr. Jean Mah (Paediatric Neurologist) Dr. William Murphy

Dr. David PatryDr Dawn Pearson

Non-clinical MS Research Team

Lenora Brown, PhD

Jeff Dunn, PhDRichard Frayne, PhD

Brad Goodyear, PhDShalina Ousman, PhDV Wee Yong, PhD


In an animal model of multiple sclerosis in mice, as compared to controls (A & B), demyelination and axonal loss are reduced by the combination of glatiramer acetate and minocycline (C & D).

Neuromodulation ProgramOverview

Neuromodulation is the altering / modulation of nervous system function by means of implantable devices or neural

prostheses. It includes peripheral nerve, spinal cord and brain electrical stimulation, as well as drug delivery

devices. Numerous conditions are treated including movement disorders, epilepsy, pain, angina, headache, spasticity, urinary incontinence. Therefore, other divisions

within DCNS, as well as specialists from several departments, are involved in the program.

Clinical care/Research

The Intrathecal Baclofen Pump Program, in various iterations, has been functioning in Calgary for nearly 20

years. The indication for such treatment is spasticity in both adults and children.

Sacral nerve stimulation is a program that involves trials and implantations of sacral nerve stimulators, and is unique in Western Canada. This year 30 patients were

followed (13 from Calgary, eight from other regions in Alberta, 5 from BC and 4 from Saskatchewan).

Only one gastric stimulator was implanted in 2009, due to funding constraints.

The Pain neuromodulation program follows 50 patients with implanted devices (34 with SCS, 3 with DBS, 8 with

ONS, 1 with MCS, 4 with intrathecal pain pumps) and receives 16-32 new referrals each year.

Ongoing studies include the (i) Canada-side multicentre METTLE trial of hippocampal DBS for epilepsy, (ii) multicentre RCT of motor cortex stimulation for specific

pain syndromes, (iii) local pilot projects on area 25 subgenual cingulate DBS for refractory depression, (iv)

treatment of various craniofacial headache syndromes with occipital region stimulation

Education

The Neuromodulation Program participates in a variety of

educational activities to advance care. Nurses attend and present at national conferences on neuromodulation and

take clinical trial courses provided by industry on device programming and updates. In addition, a Clinical fellowship

has been established, with the 4th fellow, Dr. Swati Chavda, receiving both a University of Calgary International Fellowship and the Denise Lajoie Lake Fellowship in Brain

Research. The pain neuromodulation journal club also facilitates all levels of continuing education and occurs

three times yearly.

Members of the team gave invited presentations at both

Canadian and international meetings:

Poster presentation at Society for Neuroscience, papers published on DBS in Neuroscience, Neuropsychologia

and Journal of Neurosurgery

Sue Anderson presented her project on Nursing time

required for a neuromodulation pain program at the Canadian Neuromodulation Society meeting in June 2009.

Grant Support

Alberta Heritage Foundation for Medical Research

Canadian Institutes for Health Research

Medtronic

Faculty/Members (not inclusive)

Neurosurgery: Drs. Zelma Kiss, Mark HamiltonNeurology:

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

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

Susan Anderson, Marlene Blackman, Thea Dupras, Colleen Harris, Karen Hunka, Jackie Martini, Grace

Neustaedter, Valerie Sherwood, Tammy Still, Angela Tse, Robyn WarwarukResearch:

Drs. Misha Eliasziw, Bin Hu


Intraoperative MRI and Surgical Robotics (Project NeuroArm)Overview

iMRI

For over 12 years, the Intraoperative MRI (iMRI) Program within the Department of Clinical Neurosciences (DCNS),

University of Calgary (U of C) and Alberta Health Services, has pioneered research in the clinical application of MR technology to surgery and to various

neurological disorders, including stroke and multiple sclerosis.

In January 2009, the P3T iMRI system became operational. The new system allows increased signal-to-

noise, providing improved image quality and implementation of new imaging sequences, including diffusion tensor imaging and functional MRI. In addition

to traditional MR images, surgeons using the iMRI system are able to image fibre tracts in the operating

room. Over the past year, more than 150 neurosurgical patients were evaluated using this imaging technology. Through our industrial partner, IMRIS, surgeons from

around the world continue to travel to Calgary to view the technology in use.

Surgical Robotics (Project NeuroArm)Developed in 2008 by a team led by Dr. Garnette

Sutherland, the NeuroArm is the first MRI-compatible image-guided computer- assisted device specifically designed for neurosurgery.

Since its inception, NeuroArm has been undergoing some modifications. As previously mentioned, the iMRI

system was upgraded to a 3.0 T platform. As the MR system was changed from locally-shielded to a room-

shielded system, this necessitated a complete renovation of the iMRI operating theatre. This change also necessitated some major modifications to the robot,

which are due for completion in 2010.

In 2009, the surgical robotics program also saw the

construction of a new research space in the Health Research Innovation Centre at the University of Calgary.

The space, over 750m2, includes a haptic performance laboratory, an advanced engineering and prototyping lab,

an experimental operating room and a telementoring and debriefing room. The space and associated technology is impressive and has already drawn in collaborators

from across faculties and research disciplines, including: members of the National Research Council, the Faculty

of Engineering, and Faculty of Medicine.Surgical Ltd., a spin-off company which held neuroArms

intellectual property, completed a transaction with IMRIS for the purchase of neuroArm technology. This success

provides the mechanism for the commercialization and distribution of image-guided robotic technology. Furthermore, the transaction included an ongoing

research agreement between the University of Calgary and IMRIS. The identification of intellectual property and

its protection that occurred over several years allowed this R&D project to enter the marketplace.

Research Interests

Surgical roboticsHapticsSurgical simulation

Education


Dr. Garnette Sutherland

Grant Support

Canada Foundation for Innovation (Infrastructure and

Operating)Alberta Advanced Education and Technology (Infrastructure)

Western Economic Diversification (Infrastructure)Reach! (Infrastructure and Operating)

Alberta Heritage Foundation for Medical Research (Student Support)Canadian Institutes for Health Research (Operating-

Molecular Imaging)

Faculty

Project Leader:

Garnette Sutherland

MDA Lead Engineers:Tim Fielding

Perry NewhookSimon HuGeorge Feil

Andrew SkorupskiCalvin Bewsky

U of C Investigators (not inclusive):

Alex GreerJames LarssonYves Starreveld

Gail KoppChris Macnab

Yaoping Hu


Teodor VeresRoger Mackenzie

Danica StanimirovicMaureen OConnorAbedelnasser Abulrob

Urgent Neurology ClinicOverview

The Urgent Neurology Clinic has been providing urgent neurology consultation service to the people of southern Alberta and eastern British Columbia since

2002. Its purpose is to see patients who require urgent, but not emergent, neurological assessment. With sites located at both the Foothills Medical Centre

and the Rockyview General Hospital, the clinic functions to: reduce the frequency of referrals to the emergency room by general practitioners, reduce the number of emergency referrals to neurologists for urgent, but not emergent patients (once

assessed by emergency physicians), and to reduce the number of neurological in-patient admissions, which were deemed necessary for investigations.

As part of the Department of Clinical Neurosciences (DCNS), University of Calgary and Alberta Health Services, the Urgent Neurology Clinic provides teaching

support for residents from neurology, neurosurgery, emergency medicine, psychiatry, physiatry, and internal medicine. Medical students also rotate through the clinic periodically.

Many of the Faculty members working in our clinic are regionally, nationally, and internationally recognized clinicians, teachers, and investigators, committed to

providing ongoing health education and career development for all of our students. Through a variety of opportunities provided through DCNS - including structured teaching programs, informal faculty/resident conferences, grand round

discussions, journal clubs, and busy clinical services - we seek to provide educational activities that maximize learning and comprehension for the field of neurology.

Neuromuscular ClinicOverview

The Neuromuscular Program was established in 1992 to meet the overall health needs of people with peripheral nerve, muscle and neuromuscular junction disorders. The mission of this program is to provide timely, expert and

comprehensive consultation and care to patients with neuromuscular disorders. Additionally, this program aims to provide state of the art diagnostic and treatment services as well as developing cutting edge research. The overall emphasis of this program is on excellence in patient care, collegiality and innovation. To date, the program consists of

three sub-specialty clinics: the Neuromuscular Clinic, the ALS clinic, and the Neuropathic Pain Clinic.

Within the next five years the Neuromuscular Program will develop into a newly constituted program cluster known as the Southern Alberta Nerve and Muscle Program. The vision of this program is to emerge into an internationally recognized program model for access and evidenced based and compassionate care for patients with nerve and muscle disorders.


Neuro-Oncology ProgramOverview

The Neuro-Oncology Program, spanning multiple

disciplines, Departments and Institutes, is dedicated to the care of patients with brain tumours and neurological complications of cancer.

Members of the DCNS make a major contribution to the Neuro-Oncology Program in a number of important ways,

including:

provision of Neurosurgical and Neuro-Oncological patient care services to adults and children at the Foothills

Medical Centre, Alberta Childrens Hospital, and Tom Baker Cancer Centre

establishment of the Brain Tumor Stem Cell Core Facility, Molecular Diagnostics Core Facility, Brain Tumor Tissue Bank and Bio-Repository, Alberta Radiosurgery Centre,

Neuro-Oncology Nurse Practitioner Program, and the Advanced Image Processing Laboratory

development of the Intra-operative Imaging and Robotics (neuroArm) Programs in the Seaman Family MR Centre. Each of these initiatives directly enhance the care of

patients with all types of brain tumour.

Research

Research initiatives in the Program span the clinical to basic biomedical continuum - from non-invasive imaging diagnosis through to innovative disease management.

Clinically, research efforts in the Program are focused on low and high gliomas in adults and medulloblastomas in

children. Most clinical trials are conducted within large national or North American co-operative groups, such as the National Cancer Institute of Canada Clinical Trials

Group and the Radiation Therapy Oncology Group.

Areas of basic research in the Program include:

1) Brain tumour stem cell biology2) Mechanisms of chemotherapy and radiation resistance in brain tumor3) Non-invasive detection of molecular changes in braintumor using new imaging techniques4) Development of experimental therapies for brain tumourincluding oncolytic viruses, drugs that block the spreadof brain tumor cells and methods for drug delivery.

Education

Teaching and training in the Neuro-Oncology Program is an

important aspect of enhancing patient care both now and in the future. We support educational initiatives through formal fellowship training in both medical and surgical

aspects of Neuro-Oncology. We also supervise graduate students and provide senior leadership to the Clark H.

Smith Brain Tumor Centre (www.ucalgary.ca/braintumourcentre) and the Southern Alberta Cancer Research Institute (SACRI; www.sacri.ucalgary.ca) at the

University of Calgary.

Our researchers are also engaged in multi-disciplinary

activities including our weekly patient care conference (i.e., Tumor Board), weekly clinical trials meeting (Tom Baker Cancer Centre), and through informal research and visiting

speaker seminars in the Faculty of Medicine.

Faculty/Members

Director:Dr. Mark Hamilton Neurosurgeons:Dr. Mark HamiltonDr. Betty MacRaeDr. Yves StarreveldDr. Garnette SutherlandNeuro-Oncologists: Dr. Greg CairncrossDr. Jay Easaw Dr. Peter Forsyth Dr Paula de Robles

Grant Support

Canadian Institute for Health ResearchAlberta Cancer Research Institute Tom Baker Cancer Centre

Hotchkiss Brain Institute National Cancer Institute of Canada

Alberta Cancer Foundation Ivy FoundationCCSRI nee NCIC

NCIC Terry Fox FoundationKids Cancer Care Foundation


Neuro-Pathologists: Dr. Jennifer Chan Dr. Jeff Joseph Dr. David George Radiation Oncologists: Dr. Rob Nordal Dr. Siraj Husain Nurse Clinician: Crystal Tellent Research Nurse: Annabelle DeGuzman

Neurovascular ProgramOverview

Treatment of vascular diseases of the nervous system has

been evolving to less minimally invasive interventions over the past decade. Such treatments are quickly becoming the standard of care for diseases such as intracranial

aneurysms and carotid stenosis.

The Neurovascular Program is a joint collaborative effort of

specialists and allied healthcare staff from multiple disciplines (cerebrovascular and endovascular neurosurgery, interventional neuroradiology, and stroke

neurology), to combat neurovascular disease. With the recruitment of Albertas first neurosurgical endovascular

neurosurgeon, Calgary has quickly become a leader in this type of neurosurgery. Many patients are treated with a single day admission, using minimally invasive approaches

(as opposed to the more traditional open surgery), and avoiding long in-hospital stays. In conjunction with our

well-known and internationally recognized Stroke Program, the Neurovascular Program has already become an important partner in stroke research.

Clinical Care/Research

Over the past few years, there has been increased academic integration with the Neurovascular Program and

the Calgary Stroke Program. Shared resources have allowed for 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 out-

patient clinic for evaluation and follow-up. Currently about 200 patients are treated annually via minimally invasive

endovascular means such as endovascular coiling, embolization, and carotid stenting. As well, surgical volumes and expertise in open neurosurgery have been

maintained with the availability of specialized procedures such as craniotomy and aneurysm clipping, carotid

endarterectomy, resection of vascular malformations, and extracranial-intracranial bypass. An integrated relationship

with the Alberta Radiosurgery Centre, which 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 out-patient 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 provide high-quality care, and allow further opportunities for teaching and

clinical studies.

Faculty

Neurosurgeons:Dr. John Wong

Dr. Garnette Sutherland

Neuroradiologists:

Dr. William MorrishDr. Mark HudonDr, Mayank Goyal


Paediatric Neurosurgery ProgramOverview

The Paediatric Neurosurgical Program is comprehensive,

offering all aspects of pediatric neurosurgical care including: management of hydrocephalus, brain and spinal injury, myelomeningocele, other forms of spinal

dysraphism, refractory epilepsy surgery, spasticity, craniofacial disorders, and paediatric brain tumour (in

conjunction with the Paediatric Neuro-Oncology Group). The Program is a division of Pediatric Surgery (Department of Surgery) and the members are also part of the Division

of Neurosurgery for the DCNS.

Clinical Care

The Paediatric Neurosurgeons provide weekday call at the Alberta Childrens Hospital (ACH), and with the other

members of the Division of Neurosurgery participate in nighttime and weekend call schedules.

Neurosurgery clinics are held every week. Clinics include: General Neurosurgery, Craniofacial Clinic, Infant Cranial Screening and Remodeling Clinic (Paediatricians), and

Myelomeningocele Clinic. Approximately 2000 out-patient visits occur each year.


The Pediatric Neurosurgical Division members participate in local and national administrative and educational

functions. They also lead and collaborate in c

Download - Annual Report 2009

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