The complexity of brain signaling and interconnectivity through the central nervous system makes analyzing brain signaling and synchrony a challenge. The neurophysiological mechanisms that underlie seizure onset, spread and termination, and resistance to pharmacological treatment remain largely unknown. Similarly, the physiological underpinnings of movement disorders are inadequately understood.
The Epilepsy Foundation of America estimates that about 1% of the US population has epilepsy and 200,000 new cases are diagnosed each year. This means about 30,000 people in San Diego county live with epilepsy and 2,000 new cases are seen yearly.
About one-third of these patients (over half of them adults) are not controlled with medical therapy. These treatment-resistant patients should be referred to a specialized epilepsy center for evaluation and treatment.
Despite evidence to support its efficacy and safety, epilepsy surgery for refractory seizures remains underutilized nationally and locally. In 2008-09, only 125 patients underwent pre-surgical evaluation for epilepsy at UCSD (the only epilepsy center in San Diego county) and significantly fewer proceeded to epilepsy surgery.
Parkinson’s disease (PD) is the second most common neurodegenerative disease behind Alzheimer’s disease. According to the Parkinson Disease Foundation, PD affects about 2 of 1,000 people and 50,000 new cases are diagnosed each year (6,000 patients in San Diego County, 500 new cases per year).
The prevalence of diseases related to epilepsy and PD/neurodegeneration increases with age, particularly after 65. Therefore, as the age of the general population increases, the need for new and novel treatment will substantially increase over the next decade.
Despite FDA approval of deep brain stimulation (DBS) for idiopathic Parkinson’s disease, essential tremor, and dystonia, only 131 patients with PD received implantations for DBS in San Diego County. UCSD Medical Center performed 24% of these procedures.
A collaborative, broad multidisciplinary team is essential to provide the evaluation, treatment and continuity of care required by these complex patients and to partner the missions of our clinical and research teams to deliver subspecialty care that is unparalleled in San Diego County.
A Center of Excellence in Neural Signaling and Synchrony will foster interactions among various programs, facilitate the development of common resources, facilitate translational research, stimulate the development of new programs, and enhance growth and visibility of UCSD as a clinical neurosciences center.
The unique expertise and multi-disciplinary approach to common neurological diseases and the academic strength of the neurosciences community will position UC San Diego as a regional neuroscience referral center for physicians from local and adjacent counties, and draw self referrals from patients seeking academically oriented programs for evaluation and care.
We propose to develop a program to investigate the mechanisms of neural signaling and synchrony at the basic and translational levels, enhance treatment modalities of functional disease of the nervous system and deliver unparalleled subspecialty care.
The main research goals are to develop and implement innovative techniques to record and analyze biological signals and identify biomarkers of epilepsy.
Potential biological mechanisms to investigate at the pre-clinical stage include cell loss (e.g. hippocampal atrophy), axonal sprouting, synaptic reorganization, gene expression profiles, neurogenesis, altered glial function, inflammatory changes, angiogenesis and altered excitability and synchrony.
Other areas of ongoing clinical research that will be expanded include clinical trials of new antiepileptic drugs and new non-pharmacological therapies such as radiosurgical (gamma-knife) treatment of partial epilepsy, and brain stimulation.
The Center for Neural Signaling and Synchrony will provide excellent opportunities for fellow and resident teaching in the neurology residency program, neurology subspecialty fellowships (such as epilepsy and movement disorders), neurosurgery, neuroradiology, neuropsychology and psychiatry.
It will also be a superb teaching venue in basic and translational research for graduate students in neurosciences, cognitive sciences, biology, engineering and computational sciences.
We aim to enhance existing programs and establish unique interdisciplinary specialty care from the departments of neurosciences, neurosurgery, neuroradiology (including MMIC), psychiatry and neuropsychology, pathology, medicine (cardiology), anesthesiology (rapid response team), pharmacy and nursing.
A Center in Neural Signaling and Synchrony could change the lives of thousands of San Diegans afflicted by brain diseases.