When someone experiences a stroke, brain cells are deprived of oxygen and other key nutrients, causing the cells to die and potentially resulting in permanent brain damage, paralysis, long-term disability and even death. The sooner someone gets treatment, the less damage may be done. This is why timely diagnosis and treatment play a critical role in stroke patient outcomes. Time is brain.

Sunnybrook is one of Ontario’s regional stroke centres and home for the North and East Greater Toronto Area Stroke Network. Our dedicated interprofessional stroke team care for patients across the spectrum of stroke recovery, including emergency and inpatient care, rehabilitation and prevention.

We spoke with Dr. Rick Swartz, Neurologist at Sunnybrook and medical director of the North and East Greater Toronto Area Stroke Network, to learn more about stroke and the importance of seeking help as soon as possible.

Recognizing stroke symptoms FAST

The Heart & Stroke Foundation introduced the acronym FAST as a way to remember the key signs of stroke.

• Face: Is the mouth or lower half drooping?
• Arms: Can you raise them both?
• Speech: Is it slurred or jumbled?
• Time to call 9-1-1.

If you or a loved one experience any FAST symptoms, it is important to call 9-1-1 immediately. Don’t try to sleep it off and don’t drive yourself. Calling 9-1-1 is the best way for an ambulance to take you where you need to go for urgent stroke care. The sooner you receive stroke care, the better chance of recovery.

What are the different types of stroke?

There are two types of stroke; ischemic (clot) and hemorrhagic (bleeding). Ischemic stroke is the most common type of stroke and occurs when there is an interference with blood flow to the brain, usually caused by a blood clot or narrowing blood vessels. Hemmorhagic stroke, commonly referred to as a brain bleed, occurs when an artery or vessel ruptures and bleeds into the surrounding brain. A common cause of brain bleeds could be long term high blood pressure or head trauma (traumatic brain injury).

What are some risk factors of stroke?

It is important to know that anyone can experience a stroke, regardless of age, sex or race. However, there are some factors, such as smoking, inactivity, unhealthy weight or diet and alcohol consumption, that can increase your risk of stroke. Many of these risk factors are modifiable, and making small lifestyle changes can help reduce your risk.

Individuals with other health conditions like high blood pressure and cholesterol, diabetes, atrial fibrillation and some forms of cancer are also at a higher risk. These conditions can result in the narrowing of arteries or the formation of clots/blockages, which could interfere with blood flow to the brain.

Your risk of stroke also increases as you age. Women are also at a higher risk, especially those who have experienced menopause or pre-eclampsia.

Stroke and stroke care is different for everyone, and the interprofessional stroke team at Sunnybrook is dedicated to making sure patients with stroke receive the timely and compassionate care they need.

More resources for stroke:

• To learn more about stroke, visit Toronto Stroke Networks.
• Visit our MyCare Stroke Care Pathway to learn more about what stroke care at Sunnybrook looks like.
• Sunnybrook is home to the North and East Greater Toronto Area Stroke Network, learn more about our Regional Secondary Stroke Prevention Clinic.

The post Time is brain: What you need to know about stroke appeared first on Your Health Matters.

This Migraine and Headache Awareness Month, we spoke with Dr. William Kingston, neurologist and director of the Sunnybrook Headache Clinic, to learn more about the symptoms and causes about “the big three” types of headaches and advice on when to seek help.

Tension headaches

A tension headache is the most common type of headache, in that everyone you know, including yourself, has experienced at some point. It is a mild to moderate, non-debilitating headache that usually doesn’t have any other symptoms, like nausea or sensitivity to light, associated with it. Tension headaches are typically a rare reason to go to the doctor.

Tension headaches and migraine are both what we call a primary headache disorder, which means there isn’t an underlying cause that can be seen on a laboratory test or scan.

Migraine

Migraine is the most common reason someone would seek medical attention for a headache. It is also the most common reason you may have a disability associated with a headache. The World Health Organization has recognized migraine as being the second most debilitating condition that exists in terms of years lived with the disability, because migraine can affect people their whole life.

Migraine affects about 12-15 per cent of the population and make up for approximately 10 per cent of primary care and emergency room visits. Despite this, it may take years for someone to receive a migraine diagnosis, with some people actually never receiving one.

Migraines feel different for different people. A migraine could be a headache that lasts up to four hours, and severe enough that it interrupts your daily activities or causes sensitivity, nausea or a loss of appetite. Some people might experience these symptoms every day, others a handful a year. People who suffer from migraine might also develop an aura, which means they might experience visual symptoms like seeing spots. In the hours or days leading up to a migraine, people might experience prodrome, which are symptoms like neck pain, certain food cravings or increased urination.

One of the biggest misconceptions of migraine is that it is a result of a lack of self-care. Migraine is an inherit neurological disease that is influenced, but not caused by of poor self-care. Migraine is a condition that loves routine. Maintaining regular sleep patterns, adequate hydration and exercise has been shown to be really beneficial for people with migraine. It’s not going to be a cure, but it may improve your chances of managing migraine.

Cluster headaches

Cluster headaches are typically shorter, and happen multiple times, or in clusters, every day. These types of headaches occur usually exclusively on one side of the side of the head, behind the eye and around the temple. Cluster headaches are sometimes also referred to as alarm clock headaches, because they may appear at the same time of day or year, so people might be able to predict when a cycle of headaches might start.

Cluster headaches have been described as being the most painful condition known to human beings on a pain scale. This can also have significant implications on mental health, as the unmanageable pain interferes with daily living.

Those suffering from cluster headaches receive a diagnosis in an average of five years. Part of this is because cluster headaches have longer periods of reprieve, so by the time they receive care from a specialist, the headaches are gone until the cycle later repeats itself.

When should I seek help for headaches?

Headaches are an extremely common conditions and many times not a cause for concern, but there are a few “red flags” doctors look out for. If you are someone that has never experienced headaches, especially if you are over the age of 40, and have suddenly developed headaches, reach out to your family doctor or general practitioner.  You should also seek help if you experience brand new headaches that wake you from sleep.

Thunderclap headaches are another “red flag” that doctors warn about. These headaches are sudden, painful headaches that reach peak intensity in under a minute. If your headaches are accompanied by other symptoms like fever, nausea, blurred vision or weakness, then it’s time to seek medical attention.

More patient resources and awareness:

• Migraine Canada
• Migraine Awareness Month – Out of Office campaign

The post What you need to know about “the big three” headaches appeared first on Your Health Matters.

Big sister Debbie has always been there for Cindy; this time, as they scurry through hospital corridors, a little late for their first appointment of the day.

Together, the siblings navigate traffic, banter over the long drive from Brantford, and keep on top of appointments. Debbie is a little on edge, given the circumstances. She takes her support role seriously, as she – more than most, due to her career in nursing – understands its importance to patients; her sister, in this case. Cindy, as a result, comes across as laid back and has an energetic spring in her step.

Despite having left early as they always do, the heavy fog and wet morning meant road conditions were heavier than usual. But nothing was going to get in their way…

Cindy is part of a clinical trial, or research study, that is testing an investigative drug therapy for the prevention of Alzheimer’s disease. It is one of many dementia research trials from the Brain Lab in the Dr. Sandra Black Centre for Brain Resilience and Recovery at Sunnybrook Health Sciences Centre.

A volunteer participant for the study, Cindy is required to come in to hospital for regular visits – twice a month in her case, for now. This trip marked a year of visits; expected to continue another four years, for the duration of the five-year study.

Why would someone like Cindy – who shows no symptoms of Alzheimer’s disease – need or want to take that time to participate in such a research study?

When I first heard about this study, I knew right away I wanted to be a part of it. My mother had dementia, Alzheimer’s disease (AD). Seeing mom deteriorate mentally, it was difficult. She would have been in her late sixties, when she started manifesting confusion. She deteriorated; it was tough to see her go downhill. I wanted to learn what my risk was, to see if I could get more information, and what I could do about it”

Cindy Greatex,
clinical trial research participant,
68 years old 

Dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities, with Alzheimer’s being the most common, contributing to about 60 to 70 per cent of dementia cases.

According to the World Health Organization, the illness gets worse over time and mainly affects older people. Having a family history of Alzheimer’s disease – in particular, if a biological parent or sibling has the disease – increases the risk of developing it.

As a part of the study, Cindy had the option to have her genes tested; she didn’t hesitate. The results showed that she has the strongest genetic risk factor for AD – which means she has a 15 times higher risk of developing the brain disorder than the average person.

As a medical doctor, Sunnybrook cognitive neurologist and brain scientist Dr. Sandra Black knows too well the devastating effects that diseases of the brain can have on patients, their quality and length of life, and their impact to families and loved ones.

Recognized internationally for her contributions to the diagnosis and treatment of vascular dementia, Alzheimer’s disease and stroke, Dr. Black has been compassionately providing care to patients and their families for most of her career, while working to advance research into what we know about the brain. This includes leading 88 clinical trials and training 110 trainees – new generations of clinicians and brain scientists, who have gone on to be leaders in cognition, stroke and dementia across the country.

While there are drug therapies available to help treat some of the symptoms of AD or other dementias (once those symptoms have already developed), there are limited medical options to address prevention, before the disease takes hold.

Yet Dr. Black has never been more optimistic.

Never before did we have the option or possibility of altering the pathway in which dementia develops. Now we’re actually looking at the pathology itself that leads to brain cell damage and cognitive decline. This is an emerging field and we’ve learned the sweet spot in preventing or slowing down Alzheimer’s disease is well before symptoms start.

Sandra Black,
Scientific Director, Dr. Sandra Black Centre for Brain Resilience and Recovery,
Sunnybrook Research Institute (SRI) and
Officer of the Order of Canada

She explains how the focus of therapies in their clinical trial research now is to intervene before the toxic processes behind the disease begin to form – a minimum of 10 to 15 years before symptoms kick in and “have a life of their own”, spreading in the brain.

“If we can do that, then you’re going to avoid it (dementia developing). It’s like stroke prevention: you get worked up, and put on prevention therapies, so you don’t have a stroke.”

The comparison should not go unnoticed, considering that she and her colleagues at Sunnybrook’s stroke clinic were one of the first to provide stroke prevention therapies in Canada in the 1990’s.

For the time being, volunteering to participate in a clinical trial is often the best option for patients like Cindy to access therapies that are not yet available “clinically”; in this case, a drug therapy in an effort to prevent or offset the very start of the disease process.

Receiving the drug, however, is not a guarantee as clinical trials are often randomized and blinded, which means volunteer participants are either selected for the drug therapy itself, or a “placebo” instead – the latter usually is just a saline solution – so Cindy and the research team don’t know which group she falls in.

“There has to be this placebo comparison in order for the study to be controlled, in order to validly test for any effects and differences – good or bad – of a drug being studied,” explains Halil Akbulut, clinical research coordinator in the Hurvitz Brain Sciences Program at Sunnybrook.

Without people like Cindy and her study support partner, we wouldn’t make any progress at all. They’re contributing to our understanding.

Cindy will continue to be closely monitored and tested for the duration of the study. Her sister Debbie is her “study partner”. In addition to providing a supportive role to Cindy, Debbie is part of her “team”, sharing any cognitive, physical or emotional changes she observes while outside the hospital setting. Changes to cognition can include thinking processes such as attention, learning and memory, language, remembering, reasoning, and problem solving.

If Cindy’s cognition or overall health declines, she will be pulled from the study. If it’s found that she was on the placebo, she will be offered the drug therapy as part of the agreement as a participant of the study. If she was on the drug arm of the study, she will continue to be offered it, for as long as she and her care team decide to use it.

I’m learning so much through this study, I’m learning how to eat better, how to sleep better, interacting more with people; so it’s giving me a lot of tools that I can put into place now while I’m going through the study, and I know it will make a difference in my life, to a better quality of life.

When asked if she had any advice to offer others who may be considering a clinical trial, Cindy added:

“If there are clinical studies available, sign up. It helps to find out as well genetically whether you have a predisposition – a higher probability of getting the disease – so there’s so many good points about being part of a study. I encourage people to find out if anything is happening in your community – I’m commuting myself – it’s worth the while to do that.”

The post Igniting Discovery: Can we stop dementia in its tracks, before it starts? appeared first on Your Health Matters.

Now, clinical researchers at Sunnybrook think they have a living example to support this theory.

A patient case study with brain network mapping, reported by University of Toronto Psychiatry resident and lead author Dr. Saarah Haque and colleagues, was recently published in the journal Communications Medicine.

The findings from this study provide additional understanding of the causes of substance use disorders and could be helpful for developing new treatments in the future.

Sunnybrook cognitive neurologist and senior author of the paper, Dr. Matt Burke, provides for us a summary of his patient’s case, and helps us to make sense of what it could potentially mean for the direction of research and the treatment of chronic, debilitating, and otherwise “treatment-resistant” alcohol use disorder (AUD).

Dr. Matthew Burke, cognitive neurologist and associate scientist in the Hurvitz Brain Sciences Program at Sunnybrook.

Can you provide for us an overview of the events that led to this case study?

A few years ago, a 42-year-old Toronto woman with chronic AUD (since her early twenties), experienced a traumatic brain injury (TBI) as a result of falling down stairs while intoxicated. She struck her head and lost consciousness, with no memory of the incident.

While in intensive care, brain imaging showed bleeding in in the left frontal lobe of her brain.

A few weeks after her injury, I first met with this patient through my work at Sunnybrook’s Traumatic Brain Injury (TBI) Clinic. She reported a good recovery in many symptoms but still had some insomnia, mild short-term memory difficulties, and loss of smell and taste. Interestingly, she also independently reported a dramatic reduction in her cravings and interest in drinking alcohol – leading to her being abstinent from alcohol for the first time in years.

Keep in mind that before the incident, she didn’t respond well to any treatments. Previous attempts to reduce her alcohol consumption went unsuccessful, despite trying multiple approaches including psychosocial treatments – such as individual counselling and group supports, and pharmacological treatments – where she participated in clinical trials testing medications aimed at minimizing symptoms, such as cravings and a strong urge to drink. But they didn’t work for her.

So, this patient had tried a number of other treatments for her alcohol addiction – with little to no success – and was now suddenly showing signs of remission, after her fall?

That’s correct. You could say her addictive behaviour stopped becoming as much of a problem for her – in a way that was not seen before with clinical treatment.

At a one-year follow-up appointment, she had reported one relapse a few months after the TBI that was triggered by increased workplace stressors, in the context of the COVID pandemic.

After the relapse, she had successfully abstained from alcohol in the four months preceding her one-year follow-up appointment in our clinic (early remission), and she was discharged from the TBI clinic.

How did this incident lead to a research study?

We were obviously fascinated and very happy to learn about the relief she was experiencing from her addiction, albeit it was unfortunately in the context of a TBI with other consequences that can come with such an injury.

We were curious as to whether the damage to the specific brain region seen on the CT scan could be the reason for her marked reduction in cravings and interest in alcohol. In order to do so, we knew we would need to collaborate with previous colleagues at Harvard Medical School to map the brain region and see if it overlapped with regions/circuits previously implicated in remission from addiction.

What did you find?

We were able to trace a focal lesion – damage to tissue created when an object penetrates the skull and directly injures the area. In this case, the location of the lesion was in the orbitofrontal cortex – a part of the brain’s frontal lobe.

This is the same area that previous research in pre-clinical models and humans has been telling us plays a role in addictive behaviour – including the regulation of urges, compulsions, and reward decision-making processes.

We then looked to see what parts of the brain this lesion is connected to in a process called lesion network mapping. This map revealed that the lesion overlapped with previously identified circuits implicated in addiction remission.

What does this tell us?

This case study provides us with information that we normally would never be able to ethically do – in that you would never intentionally disrupt or create injury to one’s brain – for obvious reasons, unless there is very specific evidence indicating a measured controlled way for healthcare practitioners to do so that is proven to show therapeutic benefit with minimal risk.

An example of this includes some of the proven therapies offered in medicine and research for some other brain conditions, where non-invasive or minimally-invasive brain therapies have shown to carefully and precisely create either some form of connection disruption, or in some cases, produce a controlled lesion or “injury” to very specific parts deep within the brain to create a therapeutic effect.

In this case, this unintentional TBI appeared to somehow, by fluke, disrupt a brain connection in perhaps a specific way and/or in a critical spot, that contributes to, or is responsible for, this patient’s AUD.

To the best of our knowledge, there have been no published reports of focal lesions resulting in remission of isolated alcohol use disorder (without the use of more than one drug).

What is the take home message?

We describe a patient with longstanding alcohol use disorder who reported reduced cravings and stopped drinking alcohol following a traumatic brain injury that damaged part of her left frontal lobe.

We performed analyses on this damaged brain region and found that this area overlaps with previously-identified brain connections involved in substance use disorders.

Our findings provide additional understanding of the causes of substance use disorders and could be helpful for developing new treatment strategies.

How unusual is this case?

This is a fairly extraordinary situation. I would say there are probably a handful of other cases I have seen where patients report a paradoxical improvement of pre-existing symptoms (e.g. low mood) after a major head injury.

When I was previously working down at Harvard Medical School, I was involved in research that collected such rare lesion cases from the medical literature and combined them with brain network mapping – and they garnered unexpected media attention, probably in part due to the unusualness of these cases.

Does this mean a potential treatment for alcohol addiction? What are the next steps?

Not yet. But it does shine a new light in this area of research and highlights how changes to brain circuits may impact complex behaviours (the crux of neuropsychiatry).

Our findings suggest that potentially just disrupting this brain network could possibly facilitate remission, however, the intersection of brain injury and AUD is complicated and requires more study.

Importantly, we couldn’t control for other possible factors that could have been potential contributors to alcohol remission in our patient. This includes negative psychological associations with alcohol (given that the trauma occurred in the context of alcohol intoxication), less social interaction, the role of psychiatric factors, such as depression or post-traumatic stress disorder, or reduced exposure to triggers for alcohol use in the context of a recovery from TBI.

We therefore need to do more research and proceed with caution in further investigating any potential treatment looking to modulate the brain circuit implicated in our article.

The post Brain injury paradoxically alleviates alcohol addiction in Toronto woman: Q&A with Sunnybrook neurologist Dr. Matthew Burke appeared first on Your Health Matters.

The Sunday Scaries can occur when we feel overwhelmed about the week ahead. Whether it’s a big presentation or many small tasks, these feelings of stress and anxiety can negatively affect our mood.

We sat down with Dr. Karen Wang, psychiatrist in Sunnybrook’s Hurvitz Brain Sciences program, to better understand the Sunday Scaries and learn some practical tips for easing feelings of anxiety ahead of a new work week.

Why do people experience the Sunday Scaries?

Though there is no clinical diagnosis for “Sunday Scaries”, about eight per cent of the Canadian population will experience an anxiety disorder where worrying becomes a normal part of their everyday life.

One such condition is Generalized Anxiety Disorder. Generalized Anxiety Disorder involves intense, persistent worrying often leading to catastrophic thinking, where someone anticipates the worst-case outcome. This inability to control one’s thought patterns can have a negative impact on day-to-day activities.

Another reason someone may experience the Sunday Scaries is due to past workplace incidents that have negatively affected their feelings of safety and enjoyment at work. These incidents may include workplace injury, previous harassment, burnout or even difficult interpersonal work relationships.

Weekend habits also play a key role in contributing to the Sunday Scaries. For many, the weekends are a time to let loose, often resulting in altered sleep schedules and increased alcohol or substance use. Disrupted sleep and ongoing substance use can then lead to increased feelings of stress and anxiety over time.

What are some at-home strategies for decreasing stress?

1. Set personal boundaries

The weekends are often a time for family and friends, but for some, these gatherings can also be emotionally draining, especially if there are unresolved conflicts or tensions. Spend time with family and friends but also be mindful of how these interactions may be affecting your overall mental wellbeing.

2. Make a list of your tasks

We often feel stressed and anxious when we have many tasks to do but no plan in place to complete them. Spend a few minutes on the weekend to preview your upcoming week and identify the priority tasks that have to be completed.  Making a list of tasks and when you plan to complete them can help you visualize your work schedule, preventing you from feeling overwhelmed.

3. Add some fun to your Monday

Many people dread Mondays because it means a return to work. By regularly adding an enjoyable activity such as a dance class, music lesson, exercise, or social gathering after work, you have something positive to look forward to. It also starts to build positive associations in our minds about Monday.

4. Practice Mindfulness

Mindfulness practices can be a great way to reduce stress and anxiety. Meditation apps or online videos can be useful to access mindfulness practices on the go. Taking a moment to disconnect and focus on the present moment can reduce feelings of stress and anxiety, helping us think more clearly about the upcoming week.

5. Think of what you’re grateful for

Try practicing gratitude on a daily basis by writing down five things you are grateful for. By taking a moment to reflect on the things we are grateful for, we remind ourselves that there are so many things that can bring us joy outside of work.

6. Try disconnecting

For many people, work doesn’t simply end on Friday and pick back up on Monday. Many of us carry our work into the weekend, preventing us from completely disconnecting. Avoid looking at work emails on the weekend or endlessly scrolling social media so you can relax and be present.

What should you do if you are still struggling with stress?

If you are not seeing any improvement in your stress level after making lifestyle changes, consider speaking to your doctor. Your doctor will be able to assess your symptoms and recommend an appropriate treatment plan to help you better manage stress and anxiety.

The post Sunday Scaries: Here’s how to manage stress ahead of a new work week appeared first on Your Health Matters.

The human brain is an extraordinarily complex organ responsible for our thoughts, memory, breathing and so much more. Its intricate networks, made up of billions of neurons working together, make our actions possible. Neurodegenerative diseases like Alzheimer’s and Parkinson’s disease can impact the patterns of these cells’ activity, and being able to map these networks and the cellular activity within them can inform potential treatments for these conditions.

Scientists have recently developed powerful microscopy systems and molecular techniques that create three-dimensional images of cells to study brain function and activity in detail. However, these images are exceptionally large and complex (with trillions of pixels), making it very difficult to detect changes in network activity patterns.

To address current gaps, a group of researchers in the Hurvitz Brain Sciences Research Program, in collaboration with teams in the United States and Europe, developed the AI-based Cartography of Ensembles (ACE) pipeline, a software that identifies patterns of brain cell activity in large volumes of brain data. A study describing the ACE pipeline architecture and its application in complex neuroscience problems was recently published in Nature Methods. ACE was designed using cutting-edge deep learning algorithms and trained on more than 30,000 3D images curated from microscopy images.

“ACE is capable of analyzing a wide variety of microscopy images, meaning researchers can use the pipeline to gain new insights into how specific populations of cells in different regions of the brain respond to disease,” says Ahmadreza Attarpour, the first author of the study and PhD candidate at SRI and the University of Toronto. “ACE goes beyond traditional methods relying on brain maps that divide the brain into pre-defined regions based on their coarse structural differences.”

Our novel pipeline acts as a detective, pointing out cell activity and patterns that would be otherwise difficult for even highly trained professionals to identify.”

The tool has the potential to accelerate discoveries in neuroscience because of its ability to help researchers accurately identify patterns of activity in specific cell groups and networks within every region of the brain. Researchers can monitor these patterns to better understand how neurological diseases affect brain activity and how treatments may normalize these activity patterns.

“Using ACE, scientists can evaluate the effects of experimental drugs on a particular population of cells across the brain or identify novel targets for neuromodulation therapies,” adds Dr. Maged Goubran, scientist in the Hurvitz Brain Sciences Research Program and Physical Sciences Platform and co-senior investigator of the study.

“ACE provides a powerful tool for mapping brain function and circuitry, paving the way for breakthroughs in neuroscience research and, ultimately, improved patient outcomes,” explained Dr. Bojana Stefanovic, senior scientist and director of the Physical Sciences Platform at SRI and co-senior investigator of the study.

The post AI in Action: Monitoring cellular brain networks appeared first on Your Health Matters.

With no cure for the disease, scientists around the world are conducting research that is leading to breakthroughs in the diagnosis, progression and prevention of Alzheimer’s. Dr. Julie Ottoy, scientist in the Hurvitz Brain Sciences Program, is one of the many researchers at Sunnybrook Research Institute, studying the pathophysiology of Alzheimer’s and what impacts it has on patient outcomes.

Dr. Ottoy’s interest in researching the causes and progression of Alzheimer’s disease started from her personal experiences. Like many Canadians, she has seen firsthand how the disease can impact the lives of family members and friends. Her experiences with her own loved ones and conversations with individuals with lived experience have played a pivotal part in shaping her work.

They remind me time and again that the research we do is about people, their families and their futures.

Dr. Ottoy’s research is working to answer some of the most fundamental questions surrounding Alzheimer’s. Who is most likely to develop Alzheimer’s? In what cases does the disease progress faster? Can we detect changes in the brain before symptoms appear?

Her work specifically focuses on better understanding mixed dementia. This is when Alzheimer’s disease occurs alongside vascular brain damage, which occurs when the blood vessels in our brain are affected and the blood flow to the brain is disrupted. Although mixed dementia is common, it’s not fully understood, making diagnosis and treatment challenging.

Using advanced neuroimaging techniques, like PET and MRI scans, blood-based biological markers, computational biology and AI-based analysis tools, Dr. Ottoy’s research focuses on two overarching themes:

• Mechanisms: To better understand how changes in our blood vessels and immune system contribute to brain changes seen in Alzheimer’s and mixed dementia.
• Biomarkers: To investigate novel biological markers that can aid researchers and clinicians in predicting the progression of these disorders in their early stages.

Her research looks for signs of vascular damage on brain scans, patterns of inflammation and the presence of toxic proteins that form into amyloid plaques and tau tangles. By combining this information, researchers can group patients into more specific subgroups based on the biological changes driving their disease, in turn driving more targeted intervention.

Photo illustration. Kevin Van Paassen/Sunnybrook Health Sciences Centre.

“Alzheimer’s is a very heterogeneous disease, meaning there is a number of different contributing factors and causes for the disease,” explains Dr. Ottoy. “By identifying different subgroups of patients using biomarkers, we are a step closer to creating more tailored treatments that match the individual needs of each patient more closely.”

Another area of her research investigates how well different brain regions connect with one another. The abnormal buildup of tau, one of the toxic proteins in Alzheimer’s disease, leads to cognitive decline in Alzheimer’s disease. Some studies suggest the way brain regions connect with each other is a key mechanism for the spreading of tau. Dr. Ottoy’s work studies these highly-connected regions and tau epicentres, to predict where the tau will build up next.

By studying the interface between the vascular system, immune cells and the spread of Alzheimer’s-specific toxic proteins throughout the brain, scientists can identify novel treatment targets, determine the best time and approach for disease intervention and develop new biomarkers that can inform future clinical trials and potential treatments. Understanding immuno-vascular contributions to dementia is important because both vascular and immune factors are modifiable.

With the advent of disease-modifying treatments, we are closer than ever in meaningfully slowing the progression of Alzheimer’s disease.

Today’s research lays the groundwork for larger-scale initiatives, including multi-site collaborations, like Toronto’s first 7-Tesla MRI, housed at Sunnybrook and part of the Toronto Neuro-Immunology/Imaging Consortium (TONIIC), a multi-site collaborative research initiative focused on neuroimmunology and neuroimaging for diseases such as Alzheimer’s. These research efforts will deepen understanding of disease mechanisms and aid in identifying new biomarkers and therapies.

“My hope is that these advancements will drive the development of combination treatment strategies that reach the clinic and accelerate progress toward precision medicine for neurodegenerative diseases.”

Dr. Ottoy’s research in immune-vascular contributions to dementia is funded by the Alzheimer’s Association and BrightFocus.

The post Understanding the causes and progression of Alzheimer’s disease: Scientist spotlight on Dr. Julie Ottoy appeared first on Your Health Matters.

The 7T MRI scanner is part of the Toronto Neuro-Immunology/Imaging Consortium (TONIIC), a multi-site collaborative research initiative focused on neuroimmunology and neuroimaging for diseases such as stroke, multiple sclerosis and cancer. TONIIC is made up of hospital and academic institutions across Toronto, including Sunnybrook, Baycrest, SickKids, University Health Network (UHN), Centre for Addiction and Mental Health (CAMH), Unity Health Toronto (St. Michael’s Hospital) and the University of Toronto’s Temerty Faculty of Medicine. Although construction of the facility is still underway, 7T MRI will soon transform the way Toronto researchers see, understand and study novel approaches for diagnosing, monitoring and treating the brain.

The scanner, manufactured by Siemens Healthineers, is one of only three clinical 7T systems in Canada. Getting the scanner here from Europe was a multi-stage effort. It was flown to Chicago on one of the few heavy-lift planes equipped to transport the 7T magnet. From there, it was transported by road the rest of the way to Toronto. The 7T MRI scanner was maintained on route with liquid helium to keep its inner core extremely cold. This minimized the amount of additional liquid helium that will be needed to fill the magnet in Toronto during installation, when electric current will be applied to achieve the ultra-high magnetic field strength of 7T.

The 7T magnet arriving at Sunnybrook Health Sciences Centre.

Dr. Kâmil Uludağ and Dr. Simon Graham, senior scientists in the Physical Sciences and Hurvitz Brain Sciences Program at Sunnybrook, are both harnessing 7T MRI technology to explore fundamental methodological research and to advance clinical applications of MRI. The focus of Dr. Uludağ’s work is integrating MRI techniques into clinical research for conditions such as brain tumors, depression, OCD, neurodegeneration and Alzheimer’s disease. Dr. Graham’s work focuses on the applications of MRI of brain activity in healthy individuals as well as patients suffering from stroke, Alzheimer’s Disease, brain cancer and traumatic brain injury, as well as improving the use of MRI and other associated medical devices.

We spoke with them to learn more about the power of 7T MRI and its potential to revolutionize research, care and outcomes for patients living with brain conditions.

How does an MRI work?

An MRI scanner is a type of diagnostic tool crucial for informing the diagnosis and treatment of many diseases, including brain conditions such as cancer, dementia, Parkinson’s disease, multiple sclerosis (MS) and amyotrophic lateral sclerosis (ALS).

When patients enter an MRI scanner, they’re exposed to a strong magnetic field that causes the magnetic hydrogen nuclei of water molecules in the body to align in one direction — like the earth’s magnetic field moves a compass needle. Electromagnetic waves are then sent through the body, causing the magnetism of the hydrogen nuclei to swing out of alignment, and then realign again. This reaction, which can be slightly different for healthy and diseased tissues in the body, is recorded and an image is created.

How is the 7T MRI different from other MRIs?

There are different strengths of MRIs, which are measured in Tesla (T) — the unit of measurement representing the strength of the magnetic field, which is usually set at either 1.5T or 3T for hospital MRI scanners.

The 7T MRI has a higher magnetic field than the 3T or 1.5T MRI, which permits higher resolution imaging. This results in a more detailed and less grainy image, enabling scientists and clinicians to see previously invisible features of the brain.

Many brain conditions like cancer or dementia, start in extremely small parts of the brain and later grow and expand to other parts of the brain and body. Many brain conditions may also appear similar on MRI scans performed at lower field strengths, making diagnosis difficult. With higher resolution and more detailed images, clinicians will have the ability to detect disease earlier, and with greater accuracy. This will enable existing treatments, and new treatments under development, to be applied earlier towards improved patient outcomes.

What are some use cases for the 7T MRI?

The new 7T MRI will be used to help researchers advance the way many brain disorders are detected, diagnosed and monitored. It has the potential to support timelier diagnosis of conditions that appear small in the brain but have a big impact on an individual’s health, like brain lesions or microbleeds. The higher field strength produced at the 7T will make these conditions more visible on scans.

Researchers will also be using the 7T to help support the development of precision treatments, such as more precise targeting in MR-guided focused ultrasound, deep brain stimulation or improved radiation therapy treatment for patients with cancer. Cancer tissue can be hard to distinguish from other types of pathologies after radiotherapy and the 7T can provide more insight on how a patient’s cancer reacts to the treatment.

In other research, 7T MRI will be used to monitor treatments and disease progression. The images will give scientists a more detailed look at how new procedures and drugs impact the progression of different neurodegenerative conditions like Alzheimer’s or Parkinson’s disease.

How will the 7T MRI advance patient care and outcomes in the city?

Moving the 7T magnet into its new facility next to the Garry Hurvitz Brain Sciences Centre.

The ultra-high magnetic strength of 7T MRI will result in images of the brain with more detail than ever before, enabling researchers to get a closer look and better understanding of how disease impacts the brain, ultimately supporting earlier detection and diagnosis of disease and more personalized and precise treatments.

The new 7T will have a significant impact on patients across the entire city. Although the scanner is located at Sunnybrook, as part of the TONIIC research network, it will support research and advance discoveries in medical imaging of the brain throughout Toronto.

Support for the 7T MRI scanner and TONIIC is provided by the Canada Foundation for Innovation (CFI) and the Ontario Research Fund.

The post Behind the research: Toronto’s first 7-Tesla MRI appeared first on Your Health Matters.

The new Hurvitz Centre features 47 private inpatient beds, 26 outpatient exam rooms and is home to:

• the Harquail Centre for Neuromodulation, one of the world’s first to offer a complete range of neuromodulation strategies to influence brain circuitry;
• the Murphy Family Centre for Mental Health, providing compassionate and comprehensive inpatient care for youth and adults; and
• the Yuval & Lori Barzakay Brain Health Clinic, where research directly impacts outpatient care in stroke, memory, ALS, traumatic brain injury and more; and
• Ontario’s first circadian sleep centre, with sleep rooms dedicated to round-the-clock testing.

We spoke with Dr. Nir Lipsman, who started his role as Chief of the Hurvitz Brain Sciences Program in July of this year to learn more about what the future holds for brain health care at Sunnybrook.

Q: Brain sciences is a vast field. What made you decide this was what you wanted to focus on?

 A: I’ve always been interested in the brain; it’s been a common thread throughout my education, going back to undergrad, and even before. I’m fascinated by human behaviour and the different ways it can go wrong. The original plan wasn’t to do neurosurgery, I was going to be a psychiatrist, but realized and was inspired by neuroscientists in the field, that you can approach diseases of the brain from many different directions. The interaction and collaboration between different disciplines, coming together in service of our patients and their families, is what made me pursue neuroscience.

 Q: You’ve been in your new role for a few months now. As Chief, what are some of your goals for the Hurvitz Brain Sciences Program?

 A: The last two chiefs, Ken Shulman and Anthony Levitt, did an outstanding job in growing the program. Ken put a stake in the ground that we are a neuroscience centre, and Anthony took it to new heights in terms of philanthropy and growth. My goal is to build on those accomplishments in big ways. We want to foster a sense of common purpose, ensure that the care we give to our patients is excellent, and that the science we do is impactful and world-leading. My goal is to take a ‘big tent’ approach to neuroscience, and include all the amazing work happening in this space within the program. This will include, I hope, getting everyone together to share ideas and learn about what’s happening. I would love for the Hurvitz program to be a destination for top clinical and research talent, recruiting and retaining the best and brightest. This means investing in the infrastructure, as we are doing, but also fine-tuning our goals: to conduct more clinical trials, rapidly translate pre-clinical work to practice, and ensure that patients get the care they need, when they need it, whether in hospital or outside. In fields like dementia, stroke and mood & anxiety, I’d love to see us continue being world leader and set the national and global agendas for care and prevention.

 Q: In a few months, your team will be moving into the new Garry Hurvitz Brain Sciences Centre. What excites you about the new space and how will it change the way patients are treated at Sunnybrook?

 A: The Hurvitz Centre is the first big infrastructure project at Sunnybrook in years, and it’s an incredible building. Not only the brick and mortar, the expanded beds, clinical spaces and meeting rooms. It’s much more than that. The building embodies everything we strive to do in neuroscience: bring together the brightest minds, from all brain disciplines, under one roof and focus on a common problem. In this case tackling nothing less than changing how we understand and treat the most common brain disorders. So no more running across floors to meet with collaborators; no more questions about where brain science ‘lives’ at Sunnybrook. Bringing people together is what’s always excited me about academic medicine, and that’s what the building represents. It also happens to be a beautiful place to walk through and work.

 Q: Brain sciences is a field that’s always changing. If you were to give advice to someone considering your field of study, what would you tell them?

 A: Embrace the complexity; lean into the challenges that the brain represents. We have never known more about the brain than at this moment, and we haven’t scratched the surface of that understanding. Adapt quickly, and be open to new opportunities; you never know what tools or instruments you’ll be using in 5, 10, or 15 years, so develop skills that can be universally applied: good clinical practice, compassionate care, judicious and sound science. Find a team you love to work with and understand that the most exciting discoveries are made at the edges of disciplines, where people find common ground.

 Q: Is there anything else you’d like to add?

 A: I’m incredibly grateful for the team I have the privilege of working with on a daily basis, from the Foundation to SRI. This includes Anne Marie McLeod, our Operations Director who keeps things running efficiently, and Ru Taggar and our senior leadership, who are laser focused on growth that is sustainable and impactful. The Hurvitz building, and within it the Harquail Centre and Barzakay Clinic, wouldn’t be possible without the incredible generosity of our donor community. The goal really is improving the lives of our patients, current and future, and I cannot be more excited for what’s ahead.

The post The future of brain health at Sunnybrook: a conversation with Dr. Nir Lipsman appeared first on Your Health Matters.

Nearly 10 years later, the same group of researchers is once again approaching a new breakthrough, this time with the potential to bring the technology to more patients and more clinics, and to revolutionize the treatment options for many neurological and brain diseases.

The team, led by Dr. Kullervo Hynynen, vice president of research and innovation and senior scientist at SRI, as well as the Temerty Chair in Focused Ultrasound Research, has developed a powerful new ultrasound device specifically designed to open the blood-brain barrier to allow helpful agents — such as chemotherapy, antibodies, stem cells or gene therapy to reach the brain. However, unlike the current focused ultrasound device, the new technology operates without the need for real-time MR imaging – a costly hurdle for delivering focused ultrasound to the brain.

At Sunnybrook, focused ultrasound is most commonly used to treat essential tremor, a neurological disease that causes tremors which can severely affect a person’s quality of life. Dr. Nir Lipsman, chief of the Hurvitz Brain Sciences Program, Harquail Chair in Neuromodulation and senior scientist at SRI, explains that the technology used for this indication is called high-intensity focused ultrasound, which uses ultrasound waves to target tissue and create lesions deep within the brain, without the need for a scalpel or incisions.

The new technology in development, meanwhile, is low-intensity focused ultrasound, which Lipsman says, “is used to open the blood-brain barrier and deliver all kinds of therapeutics to the brain.”

The technology behind the low-intensity focused ultrasound is currently undergoing clinical trials at Sunnybrook’s Harquail Centre for Neuromodulation – to be housed within the new Garry Hurvitz Brain Science Centre – and has the potential to provide new treatments and therapies for brain cancers, Alzheimer’s disease, Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS).

Drs. Hynynen and Lipsman shared some of the latest developments and most promising potential of the next-generation helmet.

Drs. Kullervo Hynynen and Nir Lipsman

How could this next-generation helmet change the way focused ultrasound is used to treat brain diseases?

Lipsman: One of the conditions we are most interested in is brain cancer. Currently, the entire procedure across all of our trials is done inside the MRI for real-time imaging. There are some indications where that’s very important, but there are other indications where real-time imaging may not be as critical. The next-generation helmet means we may be able to do the procedure outside of the MRI environment, saving time and money, and making the procedure more comfortable for patients. The idea is over time to develop a safer, more streamlined, and effective procedures for accessing critical brain circuits, and that’s where the new technology will really shine.

Hynynen: Taking the procedure out of the MRI would make it a more accessible form of treatment. We would do an initial scan of the patient’s head to be able to create a rapid prototype of the helmet that is customized to the patient, and subsequent treatments could be done without real-time imaging. Being out of the MRI means no associated costs, and by bringing costs down it increases capacity significantly.

How is the next-generation helmet different from the existing technology?

Hynynen: The current focused ultrasound technology works really well for precise single ‘dose’ treatments, like treating tremors or what you might think of as ‘surgery’ treatments. But for treating brain cancer or Alzheimer’s, which require multiple treatments, it becomes prohibitive in its current state using real-time MRI. By taking the treatment out of the MRI, we can perform any number of treatments. It’s taking it to the next level – it becomes a real treatment for things like brain cancer and Alzheimer’s.

What would a treatment visit look like for someone using this new technology?

Hynynen: The patient would get the initial MRI scan, and from that a customized helmet would be created. Then, the patient would come in for treatment, get the helmet and transducers on. We would infuse drug and infuse the microbubbles that help us open the blood-brain barrier, and with very controlled modulation we would open the blood-brain barrier to deliver the therapy. The treatment can be precisely customized for each patient to the area of the disease while the intact blood-brain barrier is protecting the rest of the brain.

Lipsman: An aspirational goal would be to do with focused ultrasound what we do in a chemotherapy clinic or a dialysis centre. It would be an outpatient procedure where patients come in, get the procedure, and leave in a more streamlined, comfortable process. Ultimately, we hope to use focused ultrasound at every stage of the brain cancer treatment journey. This can include immediately after surgery, when patients undergo chemotherapy and radiation or it might be at the time of a recurrence, and in order to enhance the effect of other treatments. The idea is to match, as much as possible, novel treatments to our patient’s specific conditions.

This technology development is generously supported by the Weston Family FUS Initiative and our incredible donor community.

The post Behind the Research: How a next-generation helmet could revolutionize focused ultrasound appeared first on Your Health Matters.