Alfred Health Life: Leading brain research

Blood test to detect brain injury

Researchers at The Alfred are on track to develop a blood test which will determine the severity of brain injury in patients with head trauma.

No such test currently exists, however, lead researcher Professor Biswadev Mitra said it would enable faster, more accurate diagnosis and treatment plans for patients.

The development is possible thanks to National Trauma Research Institute (NTRI) research that revealed the level of a particular bio-marker present in a patient’s blood directly correlates to severity of brain injury.

By measuring the level of the bio-marker, known as micro-RNAs, it is possible to determine how severely the patient’s brain is affected and what the impact will be for that patient.

Professor Mitra said the test would be particularly useful for less severe brain injuries, when it could be difficult to determine whether a patient would suffer concussion.

"For heart attack patients, we’re able to measure the levels of troponin and know immediately how severe their heart attack is, and how to treat them," Professor Mitra said.

"For patients with TBI, it is a more speculative diagnosis – there’s no definitive test to show the severity of the brain injury."

Professor Mitra said the diagnostic test would also provide clarity for family members, particularly if the patient is unconscious.

Study co-ordinator, Jack, standing in the Neuroscience Clinical Trials Unit.

Solving neurology's greatest riddles

With more than 40 clinical trials underway, The Alfred’s neurology research group is one of the fastest growing in Australia – nurturing promising new therapies and giving hope to patients looking for answers.

When Jack Germaine joined the Epilepsy Research Group, he did so with the intent of helping to grow The Alfred’s research profile in an area he knew well. Now, 18 months on, the research program has expanded beyond epilepsy, adding clinical trials into movement disorders such as Parkinson’s disease, PSP and essential tremor, headache and migraines, dementia, and neuro-trauma, including concussion.

"The Alfred is the only hospital in Australia with a specialist unit able test the most innovative first-in-disease treatments and therapies in neurology, in the safety of a ward setting. This enables clinical care and research to work together."

“Because our purpose-built clinical trials unit is embedded within the neurology ward, it allows patients to be admitted, trial new drugs, and receive intensive 24-hour monitoring and the care they need. New treatments can be tested here first, with studies involving novel therapies only available at The Alfred,” Mr Germaine said.

The Alfred’s current trials into epilepsy and Parkinson’s disease enrol participants from all over the country. Mr Germaine said one particular patient was experiencing six seizures a month, severely impacting his quality of life.

“We placed him in a number of studies, with little success, before trialling him on a new drug that has helped him remain seizure-free for six months. It’s the longest he’s ever been seizure-free, and he’s now in his 80s. He’s really happy,” he said.

"The best bit about my job is getting a trial running and then seeing patients improve. Even if a new therapy - drug or device - doesn’t have an impact, our patients know they are receiving the best care and trying the latest treatment possible."

Brain stimulation could treat fibromyalgia

Fibromyalgia sufferers have been offered a ray of hope after a trial using magnetic brain stimulation showed preliminary positive results.

The trial, led by Monash Alfred Psychiatry Research Centre (MapRC) senior research fellow Bernadette Fitzgibbon, used theta-burst stimulation (TBS) to target areas of the brain responsible for the the modulation of pain.

TBS is a type of transcranial magnetic stimulation (TMS), which is being used increasingly to treat medication-resistant depression. It works by delivering magnetic bursts to stimulate electrical activity in parts of the brain.

While the exact cause of fibromyalgia is not known, Dr Fitzgibbon believes it relates to parts of the brain becoming over-sensitized – and TBS appears to restore these changes.

“Fibromyalgia is a chronic pain disorder but there are very few treatment options available,” Dr Fitzgibbon said.

“We know that chronic pain is an experience that is manifested in the brain. This trial has shown in preliminary analysis that TBS has positive effects in reducing fatigue for fibromyalgia patients as well as how the brain is functioning. It’s really early days but we’ve had fantastic feedback from participants and we’re hopeful this trial will reveal something really important in relation to chronic pain.”

Symptoms of fibromyalgia include chronic, widespread pain, fatigue, altered mood and sleep, and cognitive difficulties. It affects roughly four per cent of the population.

Alison Ottrey checks Olivia's VNS in the Epilepsy Clinic.

Finding relief for Olivia

Olivia was 20 years old when she had her first seizure. It was the tonic-clonic kind, with loss of consciousness and convulsions, and it was a “bizarre, surreal experience” like nothing she’s ever felt before.

Olivia was diagnosed with a rare form of autoimmune encephalitis, which four years on has resulted in lasting epilepsy. Each week, Olivia endures up to three seizures which leave her feeling exhausted.

The Neurology team at The Alfred have been working with Olivia to try and find some relief from the seizures, which can come on at any time.

Loud noise, fatigue and emotional upheaval can trigger her, and for Olivia, her epilepsy is resistant to medication.

Recently, Olivia had a Vagal Nerve Stimulator (VNS) implanted, which has provided her some piece of mind. The VNS is an implant that prevents seizures by sending regular, mild pulses of electrical energy to the brain via the vagus nerve. Patients can swipe a magnet over the implant to stimulate and extra burst of energy if they feel a seizure coming on.

“If I’m going out with a friend I know to swipe the implant and I might not have a seizure,” Olivia said. “In the past, I wouldn’t go to loud cafes or out with friends because it might trigger me.”

The Alfred neurology team is running a number of clinical trials, specialised monitoring and new surgical procedures to find new treatment options for patients like Olivia, whose lives are severely affected by epilepsy that is resistant to medication.

“I’m really hopeful. I don’t know if epilepsy can be stopped but I’m really happy to try anything new, especially if it could help other people like me,” Olivia said.

Patient turns mentor following traumatic brain injury

In July 2017, a traumatic brain injury left Mark unable to move or communicate. After 18-months of care and support from Alfred Health staff, along with his own strength and determination, the 48-year-old is active and social, and has been invited back to hospital to mentor other patients.

Mark was playing a regular game of doubles tennis when he collided with his partner and fell hard onto the court. He was rushed to The Alfred where the neurosurgical team saved his life. The accident left Mark with a severe traumatic brain injury (TBI) and he was transferred to the Acquired Brain Injury (ABI) Rehabilitation Centre at Caulfield Hospital, where he spent the next year recovering.

“When Mark first arrived in the ABI Unit he was unable to walk or communicate effectively – he was in post-traumatic amnesia (PTA), common among patients with a brain injury, so he had difficulty forming new memories,” said Jacinta Sadler, Senior Clinician and Social Worker.

The ABI Unit at Caulfield Hospital is Victoria’s first purpose-built centre of excellence in brain injury rehabilitation. The statewide service opened in 2014 to treat patients from early stages of injury, through rehabilitation to recovery. It also plays a leading role in research and teaching ABI rehabilitation the wider community.

Before his accident, Mark was confident in social settings but he temporarily lost these skills following the TBI. With his care team, Mark created goals for his recovery.

“I just kept it simple - it’s not about quick results and I had to take a step back and trust those around me to help,” Mark said.

"The journey has been a long one, with lots of pot holes, but I’m feeling the best I’ve felt since the accident. It’s a realisation that you need to appreciate what you’ve got, and who you’ve got around you," Mark said.

RELATED NEWS: Federal Minister for Health, the Hon. Greg Hunt visited our Intensive Care Unit last month to announce $50 million in research funding to develop models that will better predict recovery outcomes after a traumatic brain injury, nurture new technologies and identify the most effective care and treatments. MORE