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Brain Injury Awareness

It wasn’t lost on me when I heard that Dwight Clark, the famed former 49ers’ wide receiver, announced publicly that he had ALS, that the announcement also took place during Brain Injury Awareness Month. Hearing about an ALS diagnosis is deeply saddening, it is a devastating disease, but it did not surprise me to hear that Clark himself acknowledged the development of the disease was most likely linked to his years playing Football. In 1999, after several concussions sent then 49ers star quarterback, Steve Young, to my office for a series of neurological exams, my recommendation that Young retire from football to save his brain health was considered quite controversial.

At the time, many were reluctant to acknowledge the strong connections between head trauma acquired during sport and the development of brain disease. Today, the NFL publicly recognizes that head trauma is much more serious than previously believed, and the public is far more educated about the risks associated with concussions. Despite the progress made, there is still much we need to learn about concussions and brain injury. This is an area of research not only football players should be concerned with; nearly 2 million people suffer a brain injury in the United States every year, most of which are caused by auto and motorcycle accidents, falls, and violent assaults.

The effects of brain injury can be overwhelming; disability, increased aggression, anxiety and depression, or loss of memory or functionality are all common. Many of these symptoms can linger for months, and sometimes years after injury. At Stanford, we have focused our efforts on research that will help us better understand everything from mild concussion to severe injury, to more quickly identify symptoms and improve outcomes.

At our Concussion and Brain Performance Center, our physicians and surgeons including Jam Ghajar, MD, PhD and Gerry Grant, MD are developing a much-needed new brain trauma classification system that will help standardize definitions of concussions, and aid in developing more effective diagnosis and treatment. At the VAPAHS, Stanford neurosurgeons such as Odette Harris, MD, MPH are working with veterans to advance our understanding of how neurosurgical intervention after brain injury can help repair damage and restore function. In addition, our doctors have studied how traumatic brain injury (TBI) specifically affects women. There has been a notable research gap, with much of the studies on TBI focused on men. Having already identified significant ways these types of “invisible injuries” affect men and women’s brains differently, we tailored treatment and policy recommendations specifically for women veterans.

We are currently studying the process of neurogenesis, in hopes we might one day manipulate the process, and repair damage to the brain once thought irreparable. Additionally, we are testing the safety and efficacy of stem cell therapy in increasing mobility for people rendered disabled from traumatic brain injury. Soon, we will be evaluating the use of deep brain stimulation as a potential treatment for TBI.

Those of us who have been studying the neurosciences for decades have been aware of the many connections that exist between head trauma and its long-term implications to brain health. I applaud sports organizations for publicly recognizing the seriousness of concussions, and players themselves talking about the sport and its connection to their brain health, or in some cases donating their brain to scientific investigation. I am encouraged by the military’s commitment to investment into neuroscience research and development of diagnostics and novel therapies. I am hopeful when I see public awareness growing, with the creation of Brain Injury Awareness Month or individuals raising funds for additional research. Football has positive aspects related to participation in a team sport and isn’t going away any time soon, and we certainly can’t eliminate accidents, but the efforts to focus on better understanding and treating brain injury will lead to improved therapeutic options for all of us; athletes, veterans,  you and me.  

Research Matters

Most people rarely consider the impact of disease or injury until they face the unfortunate circumstance of having to seek treatment for themselves or a loved one. By the time someone finds themselves in this predicament, they are hopeful that research and experimentation were long-ago completed, and therapies have been technically perfected and proven effective. The reality is that the journey from basic science research in the lab to its translation into clinical application, can be a long and drawn out process.

Luckily, we scientist-clinicians are aware that the long-awaited discovery we seek will take time and effort, and are motivated by the process. We’ve spent much of our life learning basic science, dedicating years to research, and testing potentially-life saving therapies in clinical trials; all so that one day, when a patient walks into our office seeking that perfected treatment, we’re able to offer it. That laboratory-clinic connection is the foundation to everything we do, and we are keenly aware of the need to focus much of our energies on that less recognized part of our field – the years in the research lab.

Those years spent in the lab can be difficult. Aside from the fact that most research scientists don’t receive the public recognition they probably deserve, finding therapies and cures can take decades, and can sometimes remain elusive beyond a lifetime. As research scientists, we must also learn one of life’s greatest lessons early – repeated failure is necessary, it allows us to learn and grow, and improve. Toiling in the lab is not without some obvious upsides. Discoveries in the lab, when translated to clinical application, can give someone a second chance at life, or at a minimum, teach us something new about the way our body functions that we didn’t know before.

I feel quite fortunate to be in a place where so many people deeply understand the importance of research, and have been extremely proud when those efforts are rewarded with the discovery of new diagnosis and therapy options.

In a very short time, our labs at Stanford alone have made discoveries that will change the way injury and disease are treated in the future. From testing the effects of hypothermia on protecting the brain from damage caused by stroke, to inventing the CyberKnife radiosurgery system for treating brain tumors and other neurologic disorders, to using stem cell transplantation to restore function after neurologic injury, it is incredibly exciting and fulfilling to see how far we have come in just a matter of decades. We are testing the efficacy of using new brain-computer interface technology to allow paralyzed people to communicate, and have successfully shown how using awake brain mapping techniques helps to retain language skills during tumor resection. We study the impacts of genetic changes on conditions like autism so that we can one day prevent its occurrence, and have proven the efficacy of using MRI-guided ultrasound to reduce the severity of chronic tremors. We support over 30 active labs investigating everything from brain injury, degenerative spinal conditions, and deep brain stimulation, to the retina’s role in vision loss, epilepsy, brain tumors, and the effects of stress and aging on the nervous system. My own lab focuses on investigating the pathophysiology and treatment of acute stroke, as well as methods to restore function after chronic stroke. The work my colleagues  achieve in our labs fills me with hope for the future.

While most people tend to consider just the outcome, we scientists are always considering the journey – what basic science understanding are we still lacking that may help us on the road to discovery; what questions must be answered to find better, less invasive modes of diagnosis; and what steps must we still take to find new therapies and cures? The journey can be long and arduous, but in many cases, that journey is what got us hooked on science, and what ultimately allows us to find answers that heal.

Reflection And Gratitude As We Move Into The New Year

As we usher in the New Year, I have spent the last few weeks also reflecting on all of the incredible accomplishments and lessons we learned in 2016.

Our tireless commitment to improve care and outcomes for our patients continued to drive innovation in 2016. We were proud to announce the pioneering of new techniques in stem cell transplantation, innovative treatments for spinal cord injuries, the use of technology to create new means for brain-computer communication, technology that makes brain surgery more safe, and improving our understanding of causes and potential cures for Parkinson's disease.

I was also reminded of the amazing people we serve-patients who despite immense health challenges, fight not only for their own healing and regained strength, but for others like them. For example, 12-year-old Kendall Kemm, who after successful Cyberknife treatment at Stanford for a hemorrhagic stroke caused by a rare defect called AVM, decided to form Kendall's Crusade-a nonprofit aimed to provide financial assistance to families affected by AVM, raise overall awareness of the condition, and support neurosurgery research.

I am also incredibly proud of the many talented and compassionate physicians on our team, whose work continues to make us a world leader. In fact, I'd like to give a special recognition to our own Dr. Laurence Katznelson, Professor of Neurosurgery and Endocrinology. Helping us kick off the New Year right, Dr. Katznelson was selected by the Endocrine Society for their 2017 Outstanding Educator Award which recognizes exceptional achievement as an educator in the discipline of endocrinology and metabolism. Congratulations, Dr. Katznelson!

I was especially excited to share the news this past Fall, of the opening of the Stanford Neurosciences Health Center, a one-of-its-kind outpatient facility that brings together 21 neuroscience sub-specialties all under one roof. The new Center offers patients a unique experience, providing the convenience of one location for all of their diagnostic and treatment needs.

Finally, I was also humbled and thankful to be honored this past year with the prestigious J.E. Wallace Sterling Lifetime Achievement Award in Medicine from the Stanford Medicine Alumni Association. I have dedicated my life's work to advancing science and medicine in Neurosurgery, and was very touched by this recognition.

I continue to be inspired by the community of people I work with every day; our brave patients, committed and passionate surgeons, caring and experienced nurses, innovative researchers, dedicated donors, and visionary students. As we continue together to seek new ways to translate discoveries in our labs into new therapies for our patients, I’d like to wish all of you a happy and healthy New Year, filled with many new achievements in 2017.