The Centre for Clinical Brain Sciences (CCBS) was established in 2004. It is a multidisciplinary translational "centre without walls" combining basic and applied research to study the causes, consequences and treatment of major brain disorders. Our major disease targets, that straddle the disciplines of Neurology and Psychiatry, include: bipolar disorders, brain cancer, multiple sclerosis, motor neurone disease, prion disease, schizophrenia, stroke and epilepsy.
Exercise After Stroke Pathway wins NHS Lothian Best Innovation prize
The Exercise after Stroke (EAS) pathway in Edinburgh runs in partnership with Edinburgh Leisure and culminates in an in-reach project at the acute stroke unit at the Royal Infirmary of Edinburgh.
The pathway has already achieved the same number of referrals into EAS in six months that are normally received in one year and, more importantly, has already doubled the normal annual numbers taking up exercise in the community with Edinburgh Leisure in just six months. This suggests a four-fold increase in the take up of EAS pathway projected to 12 months, bringing all the evidence-based benefits of increased physical fitness to those individuals. One half of those seen in the ward by a stroke specialist fitness instructor were still exercising in the community three months after the acute intervention. This is a great improvement over previous performance.
The pathway was presented by Mark Smith, Consultant Physiotherapist, at the NHS Lothian Allied Health Professionals Conference at Dynamic Earth on 8th September 2014, and won the prize for the "Best Innovation", which was presented by Mr Brian Houston, Chair, NHS Lothian.
This work has been funded by the Edinburgh and Lothians Health Foundation and has involved multiple key stakeholders.
Conference attendees were also interested in how an in-reach modelmight be replicated with other patient groups such as in orthopaedics or older people's services. The team is looking at ongoing funding opportunities and considering a submission to the Scottish Stroke Improvement Plan Fund as a mechanism for delivering such an in-reach model for stroke in other health boards in Scotland.
£2M for FOCUS: a multicentre randomised trial to establish the effect of Fluoxetine (Prozac) in stroke
Stroke is the major cause of adult disability in the UK, and new treatments are needed to reduce the long-term physical and emotional problems faced by stroke survivors. Selective serotonin reuptake inhibitors (SSRI) are a class of drug that have been used to treat mood disorders for many years. Several small trials have suggested that they might also promote brain recovery when given routinely early after stroke, even in patients without mood disorders.
The FOCUS trial (Fluoxetine or Control under Supervision), which is led by Prof Gillian Mead and Prof Martin Dennis of CCBS, aims to find out whether fluoxetine, a type of SSRI, started at 2-15 days after stroke, and continued for 6 months, improves recovery at 6 months, and whether any benefits persist to 12 months. The start-up phase of FOCUS, funded by the Stroke Association, has demonstrated that a UK multicentre trial is feasible. The FOCUS investigators (G Mead, M Dennis, A House, J Forbes, M MacLeod, S Lewis, G Hankey, M Hackett, C Anderson, D Morales, F Sullivan) have now been awarded £2,088,149 from NIHR Health Technology Assessment over 4.5 years, for the main phase of the trial, which will recruit from up to 120 UK centres and complete recruitment of at least 3000 patients. If Fluoxetine is effective, this simple treatment would be widely applicable throughout the world.
Parallel trials based on the design of FOCUS are being run in Sweden (EFFECTS) led by Erik Lundstrom and Veronica Murray; and Australia (AFFINITY) led by Graeme Hankey and Maree Hackett. The three teams are collaborating closely: e.g., the Data Monitoring Committees of the three trials will share safety data, and when each trial has published its results, the data will be pooled.
For further information, please see www.focustrial.org.uk
Urine test for CJD developed
An international team including researchers from CCBS has published research suggesting that people carrying variant Creutzfeldt-Jakob disease (CJD) could be identified from a urine test.
Variant CJD - which is linked to bovine spongiform encephalophathy (BSE) in cattle - is caused by infectious proteins called prions. Using a new, high-powered technique, the researchers discovered that patients with variant CJD had traces of prions in their urine. The technique, called protein misfolding cyclic amplification (PMCA), was developed at The University of Texas Medical School at Houston. It amplifies minute quantities of abnormal prion protein, enabling highly sensitive detection.
"This is the first time that we have been able to detect prions in the urine of patients with variant CJD. It opens the door to the development of a screening tool for people infected with CJD who do not show any symptoms, which is of particular concern in the UK for securing the safety of our blood supply." Professor James Ironside, National CJD Research & Surveillance Unit, University of Edinburgh.
The disease remains very rare - 229 people have died from variant CJD since it was first identified almost 20 years ago, of which 177 were from the UK. However, it has been estimated that as many as one in 2000 people in the UK could be carrying infectious prions without showing any symptoms.
The findings are published in the New England Journal of Medicine: Prions in the Urine of Patients with Variant Creutzfeldt–Jakob Disease. Moda F, Gambetti P, Notari S, Concha-Marambio L, Catania M, Park K-W, Maderna E, Suardi S, Haïk S, Brandel J-P, Ironside J, Knight R, Tagliavini F, and Soto C. N Engl J Med 2014; 371:530-539August 7, 2014DOI: 10.1056/NEJMoa1404401.
"This could lead to the development of commercial technology for diagnosis as well as to determine the safety of donated blood and urinary products" Claudio Soto, Professor of Neurology, The University of Texas Medical School at Houston.
Dementia experts join forces in global bid to tackle disease
Dementia experts are forming the world's largest research group in the field to tackle the condition. They hope to improve the detection, treatment and ultimately prevention of dementia by looking at the disease in the context of the whole body and not only the brain.
Investigator teams from eight UK universities Å including the University of Edinburgh Å are joining forces with industry experts from pharmaceutical and biotech companies to form the UK Dementia Platform (UKDP).
The team will study data from two million volunteers aged 50 and over who have taken part in existing research projects such as UK Biobank, a long term national health study. Participants in these studies have generously provided a wealth of medical and lifestyle data which experts will examine alongside ongoing genetic studies, brain imaging and tests of mental skills.
Researchers hope to gain a better understanding of who is at risk of developing dementia, possible triggers for the disease, and what might speed or slow its progress. The aim is to identify biological changes and shifts in thinking abilities that are linked to the condition. It is hoped that this could lead to earlier detection and improved monitoring of dementia and will help design better ways of testing new treatments. Looking at the links between development of dementia and other factors Å such as diet or illness Å could also unearth targets for new treatments or new uses for existing drugs. Data from the project will be made available to scientists around the world in a bid to accelerate progress in dementia research and encourage innovation.
The collaboration - which is being led by the Medical Research Council - was announced on 20th June 2014 by Prime Minister David Cameron in a speech at a summit of world health and finance leaders in London. Four of the 14 research leaders who will steer the project are from the University of Edinburgh including scientists from the Centre for Cognitive Ageing and Cognitive Epidemiology, the Alzheimer Scotland Dementia Research Centre, Centre for Clinical Brain Sciences and The Roslin Institute.
Professor Ian Deary, Director of the Centre for Cognitive Ageing and Cognitive Epidemiology, said: "We are delighted that the University has the opportunity to take a leading role in such an important programme of research. Looking at dementia in the context of the whole body is one that we have already taken in our cognitive ageing studies in Edinburgh, and one that we hope will yield significant breakthroughs in this larger setting."
Professor Cathie Sudlow of the Centre for Clinical Brain Sciences, who is also Chief Scientist at UK Biobank, said: "This initiative has the potential to make a significant global impact in the battle against dementia."
Neuroresearchers Fund Awards
Professor Gillian Mead (CCBS) has co-authored a new guideline on physical activity and exercise recommendations for stroke survivors. The guideline discusses the really important issue of inactivity after stroke, and what we can do about it. It has beenCongratulations to two CCBS researchers who have been awarded Neuroresearcher funds. The aim of this fund is to assist in the establishment of new collaborations, bring new techniques to Edinburgh to benefit the community, and enable attendance at high profile techniques-based workshops.
The CCBS awardees were:
Mark Hughes, who was awarded £870 towards a visit to Charlottesville, USA to learn a new technique (trans-cranial magnetic resonance-guided focused ultrasound) as a potential new surgical approach to treating conditions such as Parkinson's.
Lynsey Hall, who was awarded £500 towards the costs of attending the Wellcome Trust Advanced Course in Genetic Analysis of Multifactorial Diseases in Cambridge in July.
We would also like to offer our congratulations to the other six winners.
Physical Activity and Exercise Recommendations for Stroke Survivors
Professor Gillian Mead (CCBS) has co-authored a new guideline on physical activity and exercise recommendations for stroke survivors. The guideline discusses the really important issue of inactivity after stroke, and what we can do about it. It has been published in Stroke, doi: 10.1161/STR.0000000000000022.
Causes of depression in spotlight with £4.7m funding boost
People suffering from clinical depression, and those at risk from the condition, could benefit from a major medical research initiative that is being led by Prof Andrew McIntosh (Psychiatry, CCBS). The Stratifying Resilience and Depression Longitudinally (STRADL) project has been awarded £4.7million from the Wellcome Trust to study the condition in new ways in the hope of developing better treatments. In addition to CCBS researchers from Psychiatry, the project involves the Centre for Cognitive Ageing and Cognitive Epidemiology (CCACE), the Institute for Genetics and Molecular Medicine (IGMM) and brain imaging facilities in Edinburgh and at the University of Aberdeen.
Over the next five years, the scientists will study groups of people who have known depression risk factors. These include family history of low mood, diseases like heart disease and diabetes and early life problems such as low birth weight or childhood psychological trauma. Researchers will then use memory, reasoning and mental speed tests as well as brain imaging to find out whether specific subgroups of patients correspond to specific disorders. Prof McIntosh said: "For many people, the symptom of low mood is the most understandable of reactions to loss or stress, yet we remain ignorant of its causes and mechanisms. This means that progress in discovering new and more effective treatments is slow. This Wellcome Trust grant will enable us to make significant progress with this common and disabling condition."
Prestigious Award for CCBS Researcher Dr Jon Stone
Congratulations to Dr Jon Stone on being awarded the Jean Hunter Prize for Nervous Diseases by the Royal College of Physicians of London for his work on Functional Disorders. Former awardees include Dame Kay Davies, Prof Doug Tunrbull, Prof John Newsom Davies, Dame Pam Shaw and Sir Simon Wessely, so Jon is in magnificent company! Jon will be presented with his award on 27th May. Read Jon Stones profile on the Clinical Neurosiceneces Website
Launch of the world's biggest study of cognitive function
A third of a million adults in the UK are to be invited to take part in the world's biggest study of cognitive function. The trial aims to predict which factors may increase the risk of developing dementia.
All the participants will be part of UK Biobank, and previously gave DNA samples and lifestyle information. They will be asked to do a series of memory and reasoning tests online.
Professor Cathie Sudlow (CCBS) is Chief Scientist of UK Biobank. Cathie described the project on radio and TV news bulletins on Friday 2nd May.
Coverage on the BBC Radio 4 Today programme (1hr 34min in) [available until 8th May 2014]
Stroke recovery chances step up with exercise
Regular exercise can speed recovery for stroke survivors and may reduce their risk of having another stroke. Professor Gillian Mead (CCBS) has been researching the benefits of exercise on stroke recovery for more than 10 years. She will be speaking about her research at a public event on Tues 15th April as part of the Edinburgh International Science Festival.
Prof Mead's findings reveal that a structured physical training plan - including aerobic, strength and balance training - can help stroke survivors to become more mobile, improve their balance and reduce their disability. She is currently investigating whether breaking up long periods of sitting or lying - so-called 'sedentary' behaviour - with short periods of movement might help to bring down the risk of having another stroke.
Professor Mead said: "We're working with fitness experts to determine the best 'exercise prescription' for stroke survivors. It's also important that we understand more about the factors that put patients off from taking part in exercise programs, and how we can motivate them to take advantage of the benefits."
See coverage on the BBC news website: http://www.bbc.co.uk/news/uk-scotland-edinburgh-east-fife-27023739
Congratulations to Katie McGoohan
Congratulations to Katie McGoohan (Masters of Nursing in Clinical Research student at the University of Edinburgh), who has been awarded a prestigious Stroke Association Postgraduate Fellowship for nurses to do a PhD. Katie will be co-supervised by Rustam Al-Shahi Salman (CCBS) and Sheila Rodgers (Nursing Studies). Her clinical research project will be based with the Stroke Research Group and will focus on the participants in LINCHPIN, a clinico-radio-pathological case control study of the causes of intracerebral haemorrhage. This study is part of the Research to Understand Cerebral Haemorrhage (RUSH) programme that is led by Prof Al-Shahi Salman.
Can the damaged brain repair itself? Siddharthan Chandran's TED talk now online
The talk that CCBS Director Siddharthan Chandran gave at TEDGlobal last year is now available to view online at here... In this short talk, Siddharthan explores how it might be possible to heal damage from degenerative disorders such as MS and motor neurone disease (ALS).
Video overview of the Human Brain Project featuring Prof Seth Grant
The Human Brain Project (HBP) is the world's largest neuroscience project (https://www.humanbrainproject.eu/en_GB) aiming to generate data, infrastructure and resources for the research community, develop new clinical tools and train students. The University of Edinburgh is highly involved in the project with CCBS Professor Seth Grant, one of the architects of the HBP, leading the work on the molecular and cellular programs. The HBP also includes Prof Siddharthan Chandran and computational scientist Prof Douglas Armstrong (Informatics). A video has been developed providing an overview of the project with Seth making an appearance halfway through. Watch it here: http://ec.europa.eu/programmes/horizon2020/en/news/human-brain-project-video-presenting-flagship-project.
Statistical analysis plan for the third International Stroke Trial (IST-3); part of a 'thread' of reports of the trial. Sandercock P, Lindley R, Wardlaw J, Whiteley W, Murray G; ST-3 collaborative group. Int J Stroke. 2012 Apr;7(3):186-7. doi: 10.1111/j.1747-4949.2012.00782.x.
Recognition of mental incapacity when consenting patients with intracranial tumours for surgery: how well are we doing? Kerrigan S, Dengu F, Erridge S, Grant R, Whittle IR. Br J Neurosurg. 2012 Feb;26(1):28-31. Epub 2011 Aug 4.
Mutant induced pluripotent stem cell lines recapitulate aspects of TDP-43 proteinopathies and reveal cell-specific vulnerability. Bilican B, Serio A, Barmada SJ, Lumi Nishimura A, Sullivan GJ, Carrasco M, Phatnani HP, Puddifoot CA, Story D, Fletcher J, Park I-H, Friedman BA, Daley GQ, Wyllie DJA, Hardingham GE, Wilmut I, Finkbeiner S, Maniatis T, Shaw CE and Chandran S. PNAS 2012; published ahead of print March 26, 2012, doi:10.1073/pnas.1202922109/
Effects of a mis-sense DISC1 variant on brain activation in two cohorts at high risk of bipolar disorder or schizophrenia. Whalley HC, Sussmann JE,Johnstone M, Romaniuk L, Redpath H, Chakirova G, Mukherjee P, Hall J,Johnstone EC, Lawrie SM, McIntosh AM. Am J Med Genet B Neuropsychiatr Genet.2012 Apr;159B(3):343-53. doi:10.1002/ajmg.b.32035. Epub 2012 Feb 15.
Untreated clinical course of cerebral cavernous malformations: a prospective, population-based cohort study. Salman RA, Hall JM, Horne MA,Moultrie F, Josephson CB, Bhattacharya JJ, Counsell CE, Murray GD,Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP; for the Scottish Audit of Intracranial Vascular Malformations (SAIVMs) Collaborators. Lancet Neurol. 2012 Mar;11(3):217-224. Epub 2012 Jan 31.