Stroke is the leading cause of adult disability and the second most common cause of death in adults in the developed world. 1 in 6 people worldwide will suffer a stroke during their lifetime.
Clinicians usually distinguish two different types of stroke, ischemic and hemorrhagic. Ischemic stroke occurs when a blood vessel in the brain is blocked. This causes part of the brain that is supplied by that vessel to stop functioning, as the brain depends on adequate supply of blood and oxygen in order for it to function normally. Depending on the part of the brain that is involved, this may cause different symptoms such as weakness, loss of sensation, loss of balance, loss of vision, or speech difficulty. If blood flow is not restored urgently, the part of the brain that is threatened may be permanently damaged, a process known as infarction. In a hemorrhagic stroke, the wall of a blood vessel in the brain becomes fragile and leaky allowing blood to escape from the circulation and into the brain tissue. This causes damage to the surrounding brain.
The stroke research group works to improve acute stroke management and secondary stroke prevention through a variety of research projects, as well as improving the rehabilitation and recovery from stroke. This includes developing new methods for brain imaging, comparing old and new treatment methods and addressing basic questions concerning recanalization (reopening the blocked blood vessel) and reperfusion (restoring blood flow) in ischemic stroke.
Multiple Sclerosis (MS) is a disease of the central nervous system that causes loss of the protective sheath (myelin) around nerve fibres in the brain and spinal cord. On average MS onset occurs at age 32, but in some cases it has been known to start in the teenage years.
The loss of myelin continues over time, progressing at different rates in different people. In some cases, the disease can be severely disabling with symptoms including impaired vision, loss of mobility and impaired cognition.
The MBC-RMH MS research group is committed to understanding the cause of MS, developing predictors of disease progression, and to improve disease-modifying and symptomatic MS treatments to ultimately improve quality of life for patients.
The MBC-RMH Brain Tumour research group sits within The University of Melbourne Department of Surgery (Royal Melbourne Hospital). Research at the Department of Surgery includes clinical and translational research programs involving oncology, trauma, neuro-physiology of vision and cerebrovascular disease, particularly subarachnoid hemorrhage. These are undertaken in collaboration with other departments of the University and international groups including Harvard University, The University of Auckland and The Hebrew University in Jerusalem.
In over 60% of patients with brain tumours, the disease is incurable, with the average life expectancy being less than one year despite the best available treatments. There has been a considerable increase in our understanding of brain tumours at both a cellular and a molecular level, however currently prognosis remains poor.
The Brain Tumour research group investigates the basic molecular and cellular events that lead to the development of brain cancer to identify potential novel targets for biological therapies. This includes studying the role of cell-surface receptors in brain cancer growth and invasion and the intracellular signaling pathways that are altered in cancer development. Particular interest has been in defining the negative regulators of growth signaling pathways and compounds have been identified, which can interact and either positively or negatively regulate the aberrant pathways.
The epilepsies are a common group of chronic neurological conditions that are characterized by recurrent spontaneous unprovoked epileptic seizures. Epilepsy is the second most common serious neurological disorder in the community, with approximately 9% of the population having a seizure at some stage in their lifetime and 3% developing epilepsy. Although much neglected and misunderstood in the past, epilepsy has emerged over the past decade as one of the most dynamic, exciting and rapidly evolving areas of clinical and basic neuroscience research; with much remaining to be discovered.
Epilepsy research at the MBC-RMH is aimed at improving outcomes for patients. Research projects include human clinical trials to assess new and established anti-epileptic medications, to identify potential epilepsy susceptibility genes, and determine individual variability in drug response. There is strong emphasis on applying the knowledge gained in pharmacogenomics research into clinical practice through the development of technology-based testing systems and evaluating the health economics of personalized medicine.
Longitudinal studies investigating clinical outcomes and quality of life following new onset seizures and treatment for epilepsy are currently being conducted in collaboration with the MBC Austin. In addition, collaborations within MBC@RMH have led to cross-disciplinary projects investigating tumour-associated epilepsy, neurodegenerative diseases and psychiatric conditions.
The clinical Epilepsy and Neuropharmacology group based in the MBC@RMH have a strong bidirectional interface with pre-clinical research groups in the Departments of Medicine and Surgery and MBC Parkville, greatly enhancing the capacity for translational research. The group has forged strong and productive collaborations with other university faculties (e.g. engineering), as well as national and international research institutes.
The Movement Disorders research program is focused on clinically relevant research that will lead to improved patient care and enhanced quality of life for patients with Parkinson’s and other movement disorders.
Current initiatives include investigating the prevalence and impact of pain syndromes on quality of life in Parkinson’s Disease, the role of continuous dopaminergic stimulation in reducing the incidence of the neurobehavioral effects of medications, improving the efficacy of deep brain stimulation to treat patients with movement disorders, and enhanced care of patients with a variety of spasticity disorders.
The Neurodegenerative diseases group is led by Prof Colin Masters. In 1984, Beyreuther and Masters were the first to purify and sequence the amyloid constituent of the plaque in Alzheimer’s disease and later isolate the gene encoding the Aβ amyloid peptide. Masters and Beyreuther defined the principal molecular and genetic pathways leading to the current Aβ amyloid theory of causation of Alzheimer’s disease.
More recent research has demonstrated the time-course over which the Aβ accumulates in the evolution of Alzheimer’s disease, using molecular PET- Aβ imaging, allowing the preclinical and prodromal stages to be identified during life. They have also identified some of the genetic determinants that affect the rates of cognitive decline. These insights into the natural history of Alzheimer’s disease will have a major impact on clinical trial design and provide prognostic information for subjects at risk.
Neuroimaging refers to any means of visualizing the brain; its great advantage is that it allows us look at the living brain. Functional neuroimaging, such as PET (positron emission tomography) or fMRI (functional magnetic resonance imaging), allows researchers to identify regions of activity in the brain, whereas structural neuroimaging allows for visualization of the structure of the brain (for example, to compare the brains of healthy and diseased people).
Most neuroimaging studies today are based on some form of magnetic resonance imaging (MRI). The research scanners are similar to the MRI machines you might find in a hospital but sometimes more powerful. One of the great advantages of MR neuroimaging is that, unlike PET or X-rays, it does not expose research participants to potentially dangerous radiation, so MRI studies are considered relatively safe and non-invasive. MRI can also produce high resolution structural images in the scale of millimeters, and fMRI can give information about brain activity in the scale of seconds. The MR signal originates from the response of water-based hydrogen ions (protons) in various settings -- depending on what is around them, a different signal is obtained. In this way, the different signals can then be used to distinguish between different types of tissue in the brain, or between oxygenated and de-oxygenated blood (a proxy for brain activity and the basis of fMRI). The signals obtained from MRI can be analyzed in many different ways, all involving the use of mathematics and statistics. Neuroimaging provides a rich reservoir of information about the brain and helps researchers to test and measure the brain's response to therapeutic interventions.