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Professor Alexander's work on diffusion magnetic resonance imaging (MRI) modelling and processing has had significant and lasting impact on medical practice. In particular, neurosurgical support systems rely on his work to map the major connection pathways in the brain, helping the surgeons avoid damaging them during intervention. Specific examples are in epilepsy, where, since 2010, surgeons perform about one operation per week using these systems, and brain tumour resection, where surgeons in Milan have since early 2013 been using a similar system based on UCL's latest microstructure imaging techniques. The key impact is on patients, whose likelihood of permanent post-operative deficits in, for example, visual, verbal or motor skills, is significantly reduced.
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 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.
Epilepsy is one of the most common neurological diseases. It is characterised by apparently unpredictable seizures that severely affect the quality of patients' life. In this case study we demonstrate how our research has derived commercial impact within the medical technology industry, as well as impact on researchers and practitioners in neuroscience and medical science. Mathematical research carried out at the Institute of Pure and Applied Mathematics (IPAM) at the University of Aberdeen has led to a threefold impact. First, our research shaped the development, implementation and validation of a new software platform, called EPILAB, containing a vast number of sophisticated algorithms targeting seizure prediction together with novel statistical tools to evaluate prediction performance. Second, our research resulted in commercial impact through the development of a new automatic long term monitoring device, called LTM-EU, by one of our industrial collaborators, Micromed (Italy). Third, a direct consequence of our research is the compilation and commercial exploitation of the world's largest epilepsy database of its type, which enables novel studies into seizure prediction in epilepsy.
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.
Professor Malcolm Young and colleagues at Newcastle University developed new mathematical and computational tools with which they could analyse large amounts of data on connections in the brain and produce models of how the brain is organised. Young realised that those research tools could also be used to analyse networks of proteins involved in disease processes and predict their susceptibility to drugs and in 2003 he set up the medicines discovery company e-Therapeutics to exploit the technology. The company listed on the AIM of the London Stock Exchange in November 2007 and in May 2013 became the eighth largest company in the biotechnology/pharmaceutical sector listed on the index, with a market capitalisation of over £90 million.
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.
Theoretical and computational methods for optimising the design of gradient and shim coils with arbitrary shapes and topologies were developed in collaboration with Magnex Scientific as part of a CASE award (2004-07). The resulting software was licenced to Agilent (who now own Magnex Scientific), for whom it has opened up new market opportunities in the supply of novel magnetic resonance imaging systems, leading to £3.4M sales since 2009. The software has also been used by Paramed Medical Systems to improve their `open' magnetic resonance imaging systems, which are optimised for orthopaedic imaging, allow vertical subject posture, and facilitate image-guided treatment, as well as offering a better patient experience. Our work has thus resulted in impact in the economy and healthcare.
Alzheimer's disease is the most common form of dementia, with a cost to society estimated at €177 billion per annum across Europe, according to the European Collaboration on Dementia (EuroCoDe) project funded by Alzheimer Europe. Data-based modelling of network structures is a modern approach to study and understand many diseases including dementia. Research carried out at the Institute of Pure and Applied Mathematics (IPAM) at the University of Aberdeen has led to the development, implementation, and testing of novel mathematical algorithms to infer network structures by means of observations of their dynamics. The results of our research have been implemented as part of a software package now offered by the Netherlands-based company BrainMarker to researchers and practitioners across Europe in an online `pay-per-click' platform (section 5.c1 and 5.c4). As such our research generated impact on clinical practitioners in addition to commercial impact.
The clinical research of the UCL Unit of Functional Neurosurgery has led to improvements in the operative technique of Deep Brain Stimulation (DBS) with clear and demonstrable impact on patient outcomes with respect to efficacy, safety, and adverse event profiles. Our published data have been described by an independent editorial as a new "Benchmark for Functional Neurosurgery". Our Unit's excellent safety record has led to an ever-growing number of referrals, has allowed us to trial DBS for new indications, and has prompted visits from a succession of international specialists who seek to learn and disseminate our practice in their centres.