James Simpkins on Stroke

Dana Alliance member James Simpkins, Ph.D., is working on novel treatments that could limit the damage and/or improve recovery from stroke. As a professor and the director of the Center for Basic & Translational Stroke Research at West Virginia University, he operates in a state that has a high rate of stroke. In recognition of Stroke Awareness Month, we asked Simpkins a few questions.james simpkins wvu

Why does West Virginia have a high incidence of stroke?

West Virginians have a very sedate lifestyle. They rank 49th nationally, per person, in exercise. They have a comparatively poor diet, high smoking and drinking rates, and rank in the bottom four or five in states in obesity, heart disease, hypertension, etc.

Also, the folks who show up to a hospital with a stroke often have really severe strokes, likely in part because of the geography of West Virginia. We’re completely within Appalachia, so it’s not uncommon for a 40-mile trip from a person’s home to a hospital to take an hour and a half or two hours. That puts those people close to if not outside the window for tissue plasminogen activator treatment.

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From the Archives: A Neuroscientist Describes His Stroke

At the AAAS/Dana event on sleep last month [see webcast], I was reminded of the time I interviewed sleep expert and Dana Alliance member J. Allan Hobson. At the time, he was excited about his Dreamstage Brain and Sleep Science Museum in East Burke, VT, and he also sold me on his book, From Angels to Neurones: Art and the New Science of Dreaming, which he allowed us to excerpt for a Cerebrum essay. Since then, we’ve talked with him about why we need to sleep to remember.

But his essay that hit me hardest was a more-personal one he wrote for Cerebrum in 2002, “Shock Waves: A Scientist Studies His Stroke.” Hobson had a stroke in 2001, and here describes his recovery in detail, trying to make sense of mysterious changes in his sleep and dreaming. Near-fatal heart failure, bizarre side effects of medications, and other aftershocks followed, and he kept trying to understand developments his doctors often dismissed. “A speculative theoretical bent has always characterized my science,” writes Hobson. “I feel impelled—and pleased—to turn it on myself.”

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Prying Open the Window of Treatment for Acute Stroke

The global burden of stroke is immense and growing, a new report suggests, making it one of the biggest public-health problems worldwide in terms of both death and disability. Experts have called for a three-pronged approach encompassing prevention, acute treatment and recovery/rehabilitation to stem the tide. Yet despite billions of dollars invested in research over the last few decades, little progress has been made in preventing or treating stroke. Perhaps nowhere is this failure clearer than in the emergent treatment of stroke.

The clot-busting drug known as tPA (tissue plasminogen factor) was approved in the U.S. in 1996, and remains the only treatment for acute ischemic stroke (strokes caused by a blood clot or narrowing of a blood vessel–see image). tPA has been shown to be highly effective in sparing brain damage and reducing disability when used appropriately in the right group of patients, but the drug is widely underused.

Brain clot image. nih.gov

Brain clot. Image credit: NIH.gov

That situation is slowly improving–a study published in 2013 found nearly twice as many stroke patients received tPA in 2011 than in 2003. Still, only about 7 percent of stroke patients receive the drug. A growing chorus of experts are saying that’s because of outdated guidelines that are too restrictive in delineating which patients are eligible for tPA therapy.

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Stroke Recovery

Time is of the essence when identifying and treating stroke, but at a recent Capitol Hill briefing we heard about new research that’s showing success in stroke rehabilitation even six months after onset. The briefing, organized by the American Association for the Advancement of Science (AAAS) and supported by the Dana Foundation, was part of a series designed to educate members of Congress and their staffs about issues in neuroscience.

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Tales from the Lab: Plasticity in Response to Injury–a Blessing and a Curse

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Grace Lindsay, a neuroscience graduate student from Columbia University, is guest blogging about neuroplasticity for our “Tales from the Lab” series. This is Grace’s second blog post.

Plasticity is a necessary and powerful force in the developing brain. By adulthood, however, things have mostly settled down. But every now and then, there are events that can upturn the relative stability of the adult brain, forcing a rearrangement of its otherwise consistent connections.

Stroke is one such event. The cutoff of blood to brain tissues leads to the death of neurons, disrupting the neural network in and around the affected region. In a frantic and somewhat messy attempt to salvage what remains, the brain responds by releasing a molecular cocktail to encourage the growth of new cells and of new axons on existing cells, trying to reestablish the lost connections. But this attempt to reconnect is largely random and time sensitive; it rarely is able to restore the brain to the way it was before the stroke. Scientists are studying how to best intervene to enhance the brain’s natural response to injury and improve stroke outcomes.

Facemap

   Photo courtesy of Peter W. Halligan, Cardiff University

But the brain’s natural response to trauma is not always helpful. Take, for example, the problem of “referred phantom sensation.” When a person loses a limb, the cortical area that normally processes sensory signals from that limb no longer receives its normal input. Yet a large fraction of amputees report feeling sensation in their phantom limb on a regular basis. What’s more, some patients actually feel sensation in their phantom limbs in response to being touched in another part of the body. For example, a case study from Oxford University describes how an amputee felt sensation in her amputated right arm when certain parts of the right side of her face were touched. The responses were somatotopically mapped –that is, nearby areas of the face corresponded roughly to nearby areas of the arm (see figure below). It appears that, because it’s lacking its own input, the region assigned to the now-missing limb is overtaken by inputs from another region. In most people, the area of cortex representing the head is located directly next to that representing the arm, so perhaps it is unsurprising that the arm area would be overtaken by head inputs. It’s assumed that plasticity, either in the cortex or the subcortical structures which feed into it (or both), is responsible for this phenomenon. But exactly how–either through the strengthening of existing synapses or the sprouting of new ones into the affected area–is not clear.

 

While this ability of the cortex to rearrange itself can be damaging, it can also be utilized. Prosthetic devices such as cochlear implants rely on it. Over time and use, the brain learns how to properly process inputs it gets from the implant, allowing a person to improve in important areas such as speech perception. The double-edged nature of the brain’s dramatic response to dramatic change can be fully appreciated.

– Grace Lindsay

Grace Lindsay is a first-year Ph.D. student in the Neurobiology and Behavior Program at Columbia University. She got her BS in neuroscience from the University of Pittsburgh in 2011 and then spent a year doing research at the Bernstein Center in Freiburg, Germany. She blogs about all things neuroscience at neurdiness.wordpress.com.

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