Unit of Functional Neurosurgery
The research strategy of the Unit is clinical and patient-centred, with the primary objective being to improve further the outcome of Functional Neurosurgery and the quality of life of the patients. The approach is multidisciplinary and involves neurology, neurosurgery, neuropsychology, neurophysiology, neuropsychiatry and neurogenetics.
The principal research aims are:
- To better understand how DBS works and what it affects;
- To improve the imaging and accuracy of existing brain targets;
- To expand DBS to the treatment of other disorders of the brain;
- To evaluate novel surgical and non-surgical therapies which do not involve electrical brain stimulation.
• Accuracy of image guided functional stereotaxis and accuracy of stereotactic targeting using higher Tesla MRIs as well as interventional MRI
• Electric field simulation in deep brain stimulation; impact on effects and side effects of DBS
• High Tesla (9.4T) MRI imaging of midbrain following implantation of DBS Electrodes
• Pathophysiology of brain plasticity in Parkinson’s and dystonia
- The relationship between candidate genetic polymorphisms, the development of dyskinesias in PD and the response to DBS (measured clinically and using fMRI and rTMS).
- Pathophysiology of speech and brain plasticity in PD and dystonia.
• Neuropsychology: Current research strategies focus on five main issues:
- Investigation of cognitive safety of surgical therapy.
- Surgical therapy as a method of gaining access to or modulating the function of deep brain structures, such as the STN or GPi, and investigating their role in movement, cognition and emotion.
- Modulatory influence of dopamine on response selection under conflict and learning.
- Application of experimental findings to improve motor function eg investigation of virtual reality glasses as a mobility aid in PD.
- Impact of movement disorders on psychosocial functioning and quality of life of patients, carers and children and how surgical interventions influence these.
• New DBS applications and new brain targets for DBS
- Multicentre (UK) study using DBS for Tourette’s syndrome is about to start.
- European Multicentre study (Queen Square only UK centre) of subgenual cingulum DBS for depression (planned).
- Posteromedial hypothalamic DBS for cluster headache (funding obtained) - PPN DBS in Parkinson’s disease.
• Existing therapy
- PD Surg multicentre UK study of surgery versus medical treatments.
- Pallidal DBS in Dystonia.
- Pallidal DBS in pediatric populations (planned).
- Intraduodenal delivery of levodopa in a European multicentre trial.
• Cell therapies for advanced Parkinson’s disease
- Collaboration involving UK, Sweden, Germany, US, Canada. Phase I/II clinical trial to validate an optimised protocol for dopamine cell transplantation in patients with moderately severe Parkinson’s disease (PD). Submitted MJF