Trust: Methodist Neurological Institute

The Brain Trust

BY DENNY ANGELLE

When the brain goes wrong, the human body goes haywire. A single neuron misfiring or a blow to the head can change the way we think, turn simple emotions into a frightening funhouse mirror or slowly steal away our humanity. Brain disorders are costly, they take away people’s jobs and destroy families.

Each year, head injuries devastate the health of 600 people out of each 100,000 in the United States. Stroke and spinal disorders also affect tens of thousands every year. The Methodist Neurological Institute is one of only four centers in the United States dedicated solely to exploring the mysterious, myriad channels of the brain and its disorders. Established in 2004, this center is dedicated to finding the most effective treatments for Alzheimer’s disease, Parkinson’s disease, amyotrophic lateral sclerosis (ALS) and multiple sclerosis. Doctors and researchers at the institute are seeking genetic solutions for malignant brain tumors and pioneering new treatments for cerebral aneurysms and stroke. As the brain guides the body, two internationally acclaimed physicians with more than a half century of experience between them guide the Neurological Institute as it explores the most puzzling of human organs. Dr. Robert Grossman and Dr. Stanley Appel share leadership of this important organization, working to guide scientific discovery and usher new therapies into reality. They — and their colleagues in the Neurological Institute — are the Methodist brain trust.

The Past Meets the Future

In 2005, Methodist created its Neurological Institute — the first of its kind in the southern United States — and sought the expertise and leadership of Grossman, who became its director.

“Our institute is a great opportunity to create a concentration of expertise that can make breakthroughs on a number of fronts — in creating molecular therapies for brain tumors, for perfecting techniques to repair arteriovenous malformations (AVMs), as well as better treatment for traumatic head injuries,” Grossman says.

For decades, The Methodist Hospital has been well known for its neurosurgery program, not only in Houston but around the country. Methodist had one of the first dedicated neurosurgical intensive care units and it had a history of being a leader in all of the neurosciences.

“It is that rich history that has enabled us to take the steps toward becoming a great center for the neurosciences,” Grossman says.

Innovation and medical breakthroughs go hand-in-hand at the Neurological Institute. One example is the Medtronic O-arm imaging system, a multidimensional surgical navigation system for orthopedic and spine surgeries. The gantrymounted, portable scanner allows doctors to peer into the patient at any time before or during a surgery. It produces 3-D pictures in a matter of seconds, saving valuable time while a patient is on the operating room table.

The future also offers bright promise for the treatment of brain tumors, using an innovative technique to identify tiny pathways that may be used to safely deliver medication to cancer cells. Researchers at the Neurological Institute developed a technique to identify nanotubes, structures within cells that are too tiny to be seen even through a microscope.

This new technique could one day give researchers a new view into cancer cells, proteins and molecules and allow doctors to administer medications directly into a cancer while sparing surrounding healthy tissue.

Researchers at the Neurological Institute also are helping to develop the North American Clinical Trials Network for New Therapies for Spinal Cord Injury, supported by the Christopher Reeve Foundation. Reeve is the former actor who became a champion for spinal cord injury research after an accident left him paralyzed. This network promises to bring therapies from the laboratory to clinical trials to benefit patients being treated with spinal cord injuries more quickly.

Dr. Robert Grossman

Pathways of the Brain

Dedicated to the treatment of patients with Lou Gehrig’s disease (ALS) and committed to neurological research, Dr. Stanley Appel is chairman of the neurological side of the Neurological Institute.

Appel created the MDA (Muscular Dystrophy Association)/ALS Research and Clinical Center at Methodist, one of the world’s top centers for the

The Methodist Hospital’s neurology and neurosurgery services are ranked No. 9 in the nation by U.S.News & World Report’s “America’s Best Hospitals” list. Methodist has ranked in the top 20 in this field for the past 10 years.

treatment of these neurological disorders. The first multidisciplinary clinic in the United States dedicated to patient care and research for ALS patients, Appel’s clinic is the standard by which all other MDA/ALS clinics are modeled.

Appel says the breakthrough that could give a clue to a cure or a cause could be just around the corner. He believes that the immune system can play a significant role in the development of ALS.

The MDA/ALS Clinic and Research Center is the first and one of the nation’s largest multidisciplinary clinics for these conditions. Last year, researchers here published research that may lend insight into genetic clues to the cause of sporadic (non-inherited) ALS, the most common form of the disease.

“The only way we are going to make a breakthrough is to share research and get everyone who is looking into it at the same level,” Appel says.

In 2006, the Neurological Institute launched the Taking Strides4Stroke: Community Awareness Campaign to educate the community about the signs and symptoms of stroke. The major event and fundraiser, the Taking Strides4Stroke 5K Walk/Run, drew 2,800 participants to Rice University Stadium and raised more than $760,000 in this, its second year.

Funds raised through these activities benefit the Eddy Scurlock Stroke Center at Methodist. Its 18 beds make it the largest dedicated stroke unit in Texas, and its physicians and staff are leaders in all forms of stroke research and treatment.

For example, researchers at the center are applying a new investigational treatment to stroke patients who receive tissue plasminogen activator, or tPA, the only FDAapproved treatment for stroke.

They are studying an investigational drug containing microscopic bubbles that, when combined with saline, may improve the breakdown of blood clots in the brain when combined with an ultrasound and standard treatment. Research shows that ultrasound improves the effects of tPA, which, in turn, improves the rate of blood flow in the brain.

On another front, researchers have teamed with surgeons to offer a surgical solution to epilepsy for people who do not respond to anticonvulsant medication to control their seizures. Doctors have developed advanced techniques and technologies to remove the affected area of the brain, or to implant a nerve stimulator to send bursts of electricity to the brain and control seizures.

“This type of teamwork, or synergy, enables us to team up and advance the knowledge that we have here,” Appel says. “We have one of the best teams in the world.”

Team members at the Neurological Institute have dedicated their lives to finding causes and curesfor some of the most devastating diseases of modern times. Gifted clinicians, teachers and researchers, who have made an impact on the health and lives of innumerable patients, have the future at their fingertips.

Dr. Stanley Appel recently received the 2008 John P. McGovern Compleat Physician Award. This national award, given by the Houston Academy of Medicine, recognizes a physician who embodies exemplary service to humanity and whose career reflects medical excellence, humane and ethical care and commitment to the medical humanities.

Appel holds the Peggy and Gary Edwards Distinguished Endowed Chair for the Treatment and Research of ALS, commonly known as Lou Gehrig’s disease.