Log in
The capacity for cognitive function may be missed by clinical examination in severely disabled survivors of acquired brain injuries, resulting in individuals being mislabelled as being in the vegetative state (VS). Work from David Menon and John Pickard has shown that functional brain imaging provides a more consistent and less observer-dependent means of detecting and quantifying such cognitive capacity. As a result of this work, the use of functional imaging has been integrated into clinical protocols as the basis for: identifying patients with such covert cognition; prognosticating on outcome; defining a rational framework for patient selection in clinical trials; and exploring the use of brain-machine interfaces to improve communication with such patients.
Powell's work focuses on outcomes after traumatic brain injury. In 1995 she established an innovative community-based multidisciplinary neurorehabilitation service — the Outreach Team — and evaluated it via a randomised controlled trial. The positive findings have informed policy and service developments internationally. In parallel, she developed a new outcome instrument [the BICRO] to evaluate psychosocial functioning; this is now used by clinicians in 10+ countries. The BICRO informed the subsequent development and validation of a cross-cultural instrument for assessing quality of life after brain injury [the QOLIBRI]; Powell was a member of the Steering Group which directed the complex international collaborative QOLIBRI project. The QOLIBRI is now available in many languages, and has been fully validated in six. There are 400+ registered users in over 35 countries, more than 200 being clinical service providers; it is a formally recommended tool for public health services in Finland and the US; and it is being used as an outcome measure in numerous treatment evaluations and prospective studies worldwide.
The Boutelle team has developed a biosensor that uses rapid-sampling microdialysis (rsMD) to detect ischaemia (restricted blood supply to tissue) during surgery and intensive care. The rsMD biosensor is implanted into tissue at risk and provides a real-time readout of chemical markers of metabolism. By 2009, technical improvements researched in the Department of Bioengineering had made the system suitable for routine clinical use. The system has reduced morbidity and mortality by alerting the surgical team to otherwise undetected ischaemia. It has been used by an international consortium of clinical centres to help decide treatment in approximately 100 patients with brain injury. More recently it was adopted by a Portsmouth hospital to monitor cancer patients undergoing reconstruction of the face and jaw; the biosensor detected a failure of perfusion in transplanted tissue in two of the first ten patients, prompting the surgical team to remove otherwise undetected blood clots that could have led to death from septicaemia.
The FLAIR (Fluid Attenuated Inversion Recovery) MRI sequence developed at Imperial College has transformed the sensitivity of clinical neuroimaging for white matter brain lesions. FLAIR has had significant commercial impact with incorporation as a standard imaging sequence offered by all manufacturers on their MRI scanners. The inclusion of FLAIR in routine diagnostic MRI protocols in radiology centres worldwide provides evidence of the continued extensive reach of impact for better healthcare outcomes through improved diagnosis and management. The use of FLAIR has led to more powerful Phase II trial designs for development of medicine for stroke, neuroinflammatory disorders, epilepsy and neuro-oncology based on imaging outcomes.
Research by Professor Karl Friston at UCL has led to the development of Statistical Parametric Mapping (SPM), a statistical framework and software package. By providing a way to analyse signals measured from the human brain in MRI scanners, SPM triggered the creation of an entirely new field of imaging neuroscience. Beneficiaries include: commercial manufacturers who provide imaging equipment; healthcare practitioners and patients, where SPM is used to deliver new treatments; pharmaceutical industries using SPM to deliver clinical trials; the IT industry developing new software based on SPM; and entirely new industries such as neuromarketing that could only have been created once SPM had been invented.
Scientists in the MRC Cyclotron Unit within Imperial College pioneered quantitative Molecular Imaging methods for neuroscience drug development that have since been expanded through collaboration between Imperial and GlaxoSmithKline (GSK) scientists. Human Molecular Imaging has had significant commercial impact with adoption by the major pharmaceutical companies to reduce the risks and costs associated with early drug development. This led directly to the selection of the Imperial Hammersmith Hospital site for the world's first clinical imaging centre embedded in a pharmaceutical company. New GSK investment created new and highly skilled UK employment opportunities first at this GSK Clinical Imaging Centre (CIC) and then Imanova, Ltd., a specialised imaging CRO that was "spun out" from the CIC. Outcomes from studies commissioned by GSK in the CIC and later in Imanova have directly influenced GSK clinical development planning, strategy and drug candidate progression. More recently, outcomes from Imanova are influencing clinical development decisions of other pharmaceutical organisations in similar ways.
Since 2010, infants around the world have been saved from death or severe disability as a result of research conducted by Professor Marianne Thoresen and her team at the University of Bristol. Translational research conducted between 1998 and 2010 by the Thoresen group showed that mild cooling of newborn children who had suffered a lack of oxygen during labour and delivery reduced death and disability by over 50%. Extensive publication on this treatment and practical training for neonatal staff, led by the Bristol team since 2008, has transformed the management of neonatal brain injury. By 2010/11, therapeutic cooling had been adopted as standard treatment throughout the developed world, saving thousands of children from death or severe disability, including cerebral palsy and epilepsy. Therapeutic hypothermia also saves the NHS and UK families about £200 million/year in care and compensation costs.
Recent advances in MRI brain scanning developed at the UCL Institute of Neurology have underpinned major improvements in the surgical treatment of epilepsy. Information about the location of critical brain structures, such as the optic radiation that carries visual signals, and language areas of the brain, are used to identify the risks of neurosurgery in specific individuals. This helps to inform patient choice and to reduce the risk of loss of any part of the visual field or language when performing the surgery. UCL's pioneering use of these imaging techniques during surgery, with correction of the movement of the brain that occurs during surgery, showed that this approach reduced the occurrence of serious loss of vision to zero. This information is now used in epilepsy surgery every week at the National Hospital for Neurology and Neurosurgery and is being rolled out to other centres.
Research by a team at Southampton into amyloid beta protein (A03b2) immunisation to treat Alzheimer's disease has been key to changing the way the global medical community understands and reacts to the disease. The first to observe that A03b2 immunisation clears A03b2 plaques, the team's studies were pivotal in initiating and informing the safe clinical trial development of 40 immunotherapy agents; investments of $3bn by the pharmaceutical industry; and 30 phase II and phase III studies. The research shaped US government policy on new safety measures for clinical trials and played a leading role in the doubling of UK funding to tackle Alzheimer's.
Research conducted at Stirling has improved outcome assessment after traumatic brain injury. Innovative tools, the Glasgow Outcome Scale — Extended (GOSE) and Quality of Life after Brain Injury Scale (QOLIBRI), have made measurement of functional outcome more rigorous, and facilitated the assessment of quality of life after brain injury. The GOSE has specifically impacted practice in clinical trials including those conducted by industry. The QOLIBRI captures the patient's view of life satisfaction after brain injury, and is being used to facilitate communication, as an aid to rehabilitation planning, and in evaluation of progress.