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Novel methods of measurement developed by Marek Czosnyka, Peter Hutchinson, David Menon and John Pickard have provided new insights into the pathophysiology of brain injury, led to commercial applications, and influenced patient care in terms of improved outcome for clinical trials. Multimodality brain monitoring of intracranial pressure (ICP), brain oxygen and microdialysis; PET/MRI imaging of critically ill patients; and computerised CSF infusion tests for shunt function in hydrocephalus have each impacted on the clinical practice and the ability to evaluate novel treatments and interventions in brain injury. This work has led directly to the establishment of a National Institute for Health Research (NIHR) Health Technology Cooperative for Brain Injury.
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.
Up to 10% of stroke patients experience persistent hemispatial neglect, a lack of perception of space in one half of their visual field, despite their eyesight functioning properly. University of Glasgow researcher Dr. Monika Harvey has led the development of a vision rehabilitation method that was implemented by German stroke units (2011) and applied to over 60 stroke patients. In July 2011 Harvey formulated content for an advanced training module called `Vision after Stroke', a Scottish Government supported online training resource for stroke healthcare professionals provided by the Stroke Training and Awareness Resources (STARs) Project. In just eight months since launch (December 2012) the module series has had 17 473 unique visitors nationally and internationally with `Vision after Stroke' the second most popular module in Scotland. To date, 152 healthcare professionals have successfully completed the `Vision after Stroke' module certificate.
Computed tomography (CT) and Magnetic Resonance Imaging (MRI) have revolutionised the practice of medicine by providing improved diagnostic accuracy resulting in improved clinical management and outcome. The evidence-based medicine approach developed by Professor Dixon and his team contributed to the timely evaluation of these technologies. Several of his studies proved improved outcome measures, including reduced mortality, shorter in-patient stay and enhanced diagnostic confidence. Examples include: CT of patients with acute abdominal problems and possible large bowel disease; CT for suspected pulmonary embolism; MRI for lumbar spine disease; MRI for knee and shoulder problems. These informed radiological guidelines adopted across Europe.
Research at the University of Nottingham has defined the clinical phenotype and management of lymphangioleiomyomatosis, a rare and often fatal multisystem disease affecting 1 in 200,000 women worldwide. The group has led the development and evaluation of new therapies and diagnostic strategies which are now part of routine clinical care. The research has underpinned the transformation of this previously under recognised and untreatable disease into a condition recognised by respiratory physicians, with international clinical guidelines, patient registries, clinical trials, specific treatments and a UK specialist clinical service.
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.
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.
Congenital myasthenic syndromes (CMS) are inherited neuromuscular disorders caused by defects at neuromuscular junctions, which are often a result of acetylcholine receptor gene mutations. A subset of CMS patients (around 14% in the US and Europe) have limb-girdle myasthenia (LGM). This disease can be highly disabling with symptoms including increasing weakness of skeletal muscles. As a result of collaborative work between Newcastle and Oxford, it was determined that many LGM patients have a mutation of the Dok-7 gene (unrelated to the acetylholine receptor), and do not, therefore, respond to standard CMS treatments. Since then, a number of additional mutations have been discovered, and genetic testing is now available for the majority of known LGM-causative genes. Crucially, Dok-7 patients, and those with other non-receptor related mutations, can now be diagnosed accurately and treated effectively, with ephedrine and salbutamol (in the US, albuterol). This significantly improves these patients' quality of life by enabling them to walk and breathe unassisted.
Dialysis has revolutionised the management of End Stage Kidney Disease (ESKD), but the benefits of this invasive, demanding treatment may not be clear-cut for elderly, frail patients with other serious comorbidities. University of Hertfordshire and East and North Hertfordshire NHS Trust researchers have led the development of Conservative Management, an alternative to dialysis for some patients, providing multidisciplinary support and careful symptomatic management until death. The research shows that quality of life is maintained, survival may not be significantly compromised, and preferred place of death is more often achieved than for counterparts on dialysis. Conservative Management programmes have been adopted across the UK and elsewhere, influencing the care of many patients.
Based on his research at the UCL Institute of Cognitive Neuroscience, Professor Paul Burgess invented and co-invented several cognitive tests (known as the Hayling and Brixton Tests, and the BADS and BADS-C assessment batteries) which are used to detect dysfunction of the frontal lobes of the brain. These were developed for commercial production by Burgess and are now produced and marketed by the largest test publisher in the world (Pearson Assessment). There are versions in several different languages, and they are used in clinics worldwide to diagnose problems in a wide variety of patients with neurological, psychiatric and developmental problems. The tests are now administered around the world to around 55,000 patients per year.