Topics and Speakers Timothy A. Pedley, MD
| ||||||
Synopsis
Neuroscience, Dr Timothy A. Pedley declares, stands at a threshold. In this, the final lecture of the course, Dr Pedley provides an overview of where clinical neuroscience is today and what future advances lie just over the horizon. The most promising trend, he argues, is the integration of neuroscience across the entire spectrum, from molecular biology to clinical trials and the care of patients. Data derived from basic neuroscience and applied to disease-oriented laboratory research has begun to yield results in the clinical arena. Dr Pedley offers illustrations of exciting advances in select fields that are already changing the future of neuroscience.
Brain imaging techniques are now able to capture physiological and metabolic processes. Sophisticated imaging enables research into how the brains of patients with neurological and psychiatric conditions differ from brains in the normal population, as well as enabling the quantification of those differences. This has tremendous potential to reshape clinical research. In addition to these studies of pathological abnormalities, functional imaging now allows examination of how the brain changes when engaged in specific activities. Functional mapping has also been applied to clinical settings. In patients with epilepsy, cortical stimulation with implanted electrodes can now be accomplished post-operatively with fMRI as a guide.
Animal models, Dr Pedley argues, are absolutely crucial to research. They permit research into the basic mechanisms of disease but also serve as models for testing new interventions and treatments. Advances in developing animal models have opened up new opportunities for research. Some studies with animal models use genetic mutants that resemble certain human disorders. Another cutting-edge technique is to create transgenic animals by insertion or deletion of genes, yielding animals that mimic the symptoms of human disorders such as schizophrenia.
Genetics is at the core of new developments in neurology and psychiatry. Although some neurological disorders have been found to have a single gene mutation, far more common are disorders with complex genetic-environmental interactions. A critical focus of research will be to continue working toward teasing out how the genetic substrate affects vulnerability to other factors, such as environmental ones.
Since many neurological diseases are characterized by cell death and neurodegeneration, another critical field of research will be to study the mechanisms whereby cell death occurs in the nervous system. In certain neurodegenerative disorders, certain cell populations are targeted for cell death leaving others unharmed. For example, Parkinson's disease attacks dopaminergic neurons. Research into the mechanisms of this cell death may yield important implications for targeted therapeutics.
Given the prominent role cell death plays in neurological disease, research into treatments focuses on neurogenesis as a cell replacement strategy. Dr Pedley describes current work on harnessing adult stem cells for neural regeneration. Research into neurogenesis offers exciting hope for restoring function in brains damaged by injury, stroke, or inherited neurodegenerative disease.
Another critical arena for neurology is the prevention of neurological disease by treating while the patient remains asymptomatic. Dr Pedley advocates a dramatic paradigm shift, one that moves from rehabilitation to restoration of function.
In conclusion, Dr Pedley praises the growing rapprochement between neurology and psychiatry. Following years of mutual distrust, the fields are moving closer together as the intersecting biological and psychological factors common to all brain disorders come to light. Schizophrenia, long thought to be purely psychological, has been shown to have heritable components. Similarly, neurological diseases thought to be exclusively biological, such as Huntington's disease, have been found to exhibit major behavioral aspects, such as depression or psychotic behavior.
The inseparability of mind and brain lies at the heart of the new integration in neuroscience. As neurology and psychiatry recognize the common underlying neurobiology of all brain disorders, their collaboration will fuel advances in clinical therapeutics.
