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Clinical Neurosciences


N e u r o l o g y • N e u r o s u r g e r y Physical Medicine & Rehabilitation Experimental Neurosciences


CONTENTS Message from the Chair!....................................................................................................... 3 Administrative Overview!...................................................................................................... 5 Departmental Structure!........................................................................................................ 6 New Faculty!......................................................................................................................... 8 Alberta Heritage Foundation for Medical Research!.......................................................... 10 2008 Program Updates!..................................................................................................... 13 Adult Hydrocephalus Program!...........................................................................................13 Alberta Radiosurgery Centre!.............................................................................................. 14 Chronic Pain Centre!........................................................................................................... 15 Epilepsy Program!............................................................................................................... 16 Epilepsy Golf Tournament!........................................................................................... 20 Calgary Headache Assessment & Management Program (CHAMP)!.................................21 Movement Disorders Program!...........................................................................................23 Intraoperative MRI Program!.............................................................................................. 25 Multiple Sclerosis Program!................................................................................................ 26 Neuromodulation Program!................................................................................................ 30 Neuromuscular Clinic!......................................................................................................... 32 Neuro-Oncology Program!.................................................................................................. 35 Pediatric Neurosurgery Program!....................................................................................... 36 Peripheral Nerve Surgery Program!.................................................................................... 38 Project NeuroArm!.............................................................................................................. 39 Skull Base Surgery Program!.............................................................................................. 41 Spine Program!................................................................................................................... 42 Stroke & Neurovascular Programs!.................................................................................... 43 Urgent Neurology Clinic!..................................................................................................... 47 2008 Divisional Updates!.................................................................................................... 48 Division of Neurosurgery!.................................................................................................... 48 Division of Neurology!......................................................................................................... 56 Division of Physical Medicine and Rehabilitation!.............................................................. 65 Division of Experimental Neurosciences ........................................................................... ! 68 2008 Educational Updates!................................................................................................ 72 Neurology Residency Training Program!............................................................................ 72 Neurosurgery Residency Training Program!....................................................................... 74 Physical Medicine & Rehabilitation Residency Training Program!...................................... 77 Undergraduate Medical Education in Clinical Neurosciences .......................................... ! 78 Fellowship Program!........................................................................................................... 79 2008 Publications !.............................................................................................................. 80 List of Members!................................................................................................................. 88




Message from the Chair Executive Summary from Dr. Gregory Cairncross, Department Head In 2008, the Government of Alberta created a new leadership structure for health care delivery. Alberta Health Services now plans and coordinates the provision of health care across the province. All health care services fall under the jurisdiction of a single Board which reports directly to the Minister of Health and the Premier of Alberta. This structure promises to eliminate duplication of services and barriers to seamless care for Albertans. Our Department embraces these changes toward better care for the sick. Throughout 2008, the Department of Clinical Neurosciences provided exemplary neurosurgical, neurological and rehabilitative care to the citizens of Calgary and Southern Alberta. We also provided emergency services to regions of Saskatchewan and British Columbia that are close to Calgary. Those Dr. Gregory Cairncross who suffered from stroke, serious head injuries, spinal disorders, epilepsy, multiple sclerosis, brain infections and a host of other neurological conditions were cared for skillfully and compassionately by our expert team of surgeons, physicians, nurses and therapists. It remains an honour for me to be associated with such an inspiring group of health care professionals. As Department Head, I have the unique opportunity to shape the future of Clinical Neurosciences in Calgary and beyond through the recruitment of new medical faculty and 2008 was a terrific year.


Dr Eric Smith, a stroke specialist and scientist, joined us from the Massachusetts General Hospital and Harvard University. Eric is studying the connection between small silent strokes, which occur in patients with high blood pressure and diabetes, and Alzheimer’s disease. He believes that certain types of dementia may be preventable in many instances. His research program is funded by the National Institutes of Health in the United States. Eric brings a new area of research strength to Clinical Neurosciences and its highly regarded Calgary Stroke Program. Clinical Neurosciences also played a pivotal role in the recruitment of Dr Jennifer Chan, Eric’s wife. Jennifer is a pathologist and clinician scientist also from Harvard University. She uses molecular genetic approaches to understand the causes of brain cancer. This knowledge will bring us closer to better treatments for these devastating illnesses. Jennifer is the newest member of the Clark H Smith Brain Tumour Centre. The Centre is located in the new Health Research Innovation Centre of the Faculty of Medicine. Dr Tamara Pringsheim and her husband Dr Jeptha Davenport were recruited to Calgary from the University of Toronto, where Tamara, a neurologist, was pursuing postdoctoral training in movement disorders, and Jeptha, was a clinical neurologist. Since arriving in Calgary in April, Tamara has established the first specialized clinic in southern Alberta for children with Tourette’s syndrome. The Tourette’s clinic is located in the Child Development Centre adjacent to the new Alberta Children’s Hospital. Tamara is studying the psychological and genetic underpinnings of 3


this perplexing neurological disorder, characterized by tics. treatment of Multiple Sclerosis, a progressive neurological Jeptha is a wonderful clinician who works in the Multiple disorder of young adults that is especially common in AlSclerosis and Headache Clinics and provides expert neuro- berta. logical care to patients at the Peter Lougheed Centre. We are so fortunate to have attracted them to Calgary. In September, the Rehabilitation Service Task Force, commissioned by the Calgary Health Region and led jointly I am especially pleased to have been able to attract to by Ms BettyLynn Morrice and myself, table its final report. Clinical Neurosciences, Dr The report made recomSean Dukelow, a physiamendations on organizatrist and clinician-scientist, tional structure, service who studies how patients integration and academic with stroke can be rehabilienhancement for the Caltated more quickly and gary context, and will be completely. Sean received the foundation for Calgary his MD and PhD degrees input to provincial reDr.Gregory Gregory Dr. Cairncross from the University of organization of RehabilitaCairncross Head, Head, Departmentofof Department Western Ontario and tion Care by Alberta Health ClinicalNeurosciences Neurosciences Clinical trained in Physical MediServices. cine & Rehabilitation at Queen’s University. As one The educational and reRegional Manager Executive Assistant of the very few scientists in search missions of Clinical Regional Manager Executive Assistant Danielle Sikander Stephen Jefferson Danielle Sikander Stephen Jefferson the field of Rehabilitation Neurosciences continue to Medicine, he was highly thrive and grow. All of the sought after by many acasenior trainees in Neurodemic Departments and surgery and Neurology Dr.Rajiv RajivMidha Midha Dr.Samuel SamuelWiebe Wiebe Dr.John JohnLatter Latter Dr.Bin BinHu Hu Dr. Dr. Dr. Dr. Division Division Division of Division of Universities in Canada. I successfully completed Division Division Division of Division of of PhysicalMedicine Medicine Experimental ofof of Physical Experimental Neurosurgery Neurology Rehabilitation Neurosciences believe that the emphasis their Fellowship ExaminaNeurosurgery Neurology &&Rehabilitation Neurosciences we have placed on innovations of the Royal College tion and excellence in of Physicians and SurClinical Neurosciences, geons of Canada. Administrative Assistant Administrative Assistant Administrative Assistant Administrative Assistant and the extra-ordinary Administrative Assistant Administrative Assistant Administrative Assistant Administrative Assistant LindaMenzies Menzies-Burrows -Burrows PatriciaMoss Moss LindaJennett Jennett SueNelson Nelson Linda Patricia Linda Sue Stroke Program that we Once again, the Departhave built in Calgary over ment had a very high rate the past decade, where of success in research aptwo of the main reasons plications to the Alberta why Sean and his family chose to move to our City, Univer- Heritage Foundation for Medical Research and Canadian sity and Department. And it only gets better! Institutes of Health Research. Nearly 25% of our faculty members hold an external salary award or research grant Also in 2008, we successfully recruited Dr Shalina from a provincial or national agency – a remarkable sucOusman, a scientist of exceptional accomplishment and cess story! I hope you enjoy our 2008 Annual Report and promise. Shalina did her research training at Queen’s, welcome feedback. McGill and the University of California at San Diego before moving to Calgary. In her laboratory, she is discovering the molecules in the brain that control inflammation. These studies are yielding new insights into the causes and future

Department of Clinical Neurosciences




Administrative Overview Cathy Edmond, Director of Serv- as part of the team supporting enices hanced neurological care at the site. The context for planning and delivering services to patients and families in 2008 included some significant capacity challenges, human and financial resource constraints and the introduction of a major re-organization of provincial health services. Despite these circumstances, services in Clinical Neurosciences both expanded and improved. Physician, nursing and allied health leaders demonstrated commitment, collaboration and creativity is achieving a number of successful service related achievements.

Several quality improvement projects were completed including those related to patient flow under the GRIDLOCC (Getting Rid of Delays that Limit Our Capacity to Care) Initiative and those using General Electric Lean Methodology to improve efficiency and quality. A number of departmental leaders and staff had the opportunity to learn and apply the “Lean� approach to addressing process improvement opportunities. The main projects included the discharge process on Units 111 and 112, admission to Unit 58 (Tertiary Rehabilitation) and The expansion of Neurology serv- a project focused upon the Stroke ices at the Rockyview Site represents Prevention Clinic. Although there were a key accomplishment. This develsome challenges with applying and opment saw increases to ambulatory sustaining proposed changes as part neurology clinics, EEG and EMG visits, of these initiatives, a number of signifithe addition of a second urgent neucant outcomes were realized and rology clinic and the introduction of a those results have been sustained. A neurology admitting service to 8 inpa- continuous quality management proctient beds on Unit 46. The addition of ess was also established in this year the second urgent clinic was the first that provides a systematic method of departmental opportunity to establish monitoring, priority setting and plana program on 2 sites. The nursing ning for ongoing quality improvement staffing model established for this in Clinical Neurosciences. program is quite unique and includes a rotational plan that involves existing Patient and family involvement staff from Unit 46. It is expected that was a continued priority in the planthis model will allow nurses to enning, delivery and evaluation of our hance their understanding of the con- services. A growing number of comtinuum of care across settings and mittees and most initiatives included a expand their knowledge base in neupatient or family representative. This rological care. Nurse practitioner, Pam involvement proved invaluable to the Sweeney, also commenced practice success and quality of the Lean projects and reinforced our commitment !

this important strategy in supporting patient-centred care in service delivery. The ambulatory services management model was reorganized to increase staff training and to support and facilitate management across inpatient and ambulatory services by program. An evaluation plan is currently being developed. In addition, an ambulatory services re-design project commenced in late 2008 with a mandate to improve quality in ambulatory processes. A number of ongoing priorities were established by the Clinical Neurosciences Executive Team in 2008. These include improvements to the quality and efficiency of ambulatory services, continued management of capacity and demand and the strategic planning process for the development of Neuroscience services across the region with a focus upon the Rockyview and South Health Campus Sites. The Clinical Neurosciences physicians, managers and staff have seen a number of successes in sustaining, developing and even enhancing services through the complexity of the healthcare environment in the past year. I have no doubt that services will continue to thrive in the current year with such a committed and talented team.



Departmental Structure History of the Department

Southern Alberta, southwestern Saskatchewan and southeastern British Clinical Neurosciences was creColumbia. Clinical Neurosciences now ated in 1981 when the Division of Neu- consists of three clinical divisions, rosurgery then in the Department of Neurosurgery, Neurology and Physical Surgery and the Division of Neurology Medicine & Rehabilitation, and one in the Department of Medicine joined basic research division, called Experiforces to create a new academic Demental Neurosciences. Each division partment of the University of Calgary has a leader and Head – Dr Rajiv focused on disorders of the nervous Midha (Neurosurgery), Dr Samuel system. Dr Robert Lee was the first Wiebe (Neurology), Dr John Latter Head of the Department and Dr Frank (PM&R) and Dr Bin Hu (Experimental LeBlanc was the first Chief of Neurosurgery. Initially, there were two units one at the Foothills Medical Centre and the other at the Calgary General Hospital. Subsequently, neurological services were consolidated at the Foothills Medical Centre and a period of rapid growth ensued with both internal and external recruitment and research expansion under the leadership of Dr Tom Feasby (Department Head and now Dean of the Faculty of Medicine at the University of Calgary). Neurosciences). Collectively, members of Clinical Neurosciences are actively Dr Feasby was joined by Dr Garnette Sutherland (Head of Neurosurgery), Dr involved in undergraduate and postgraduate medical education, with Werner Becker (Head of Neurology) Royal College of Canada approved and Dr Christine McGovern (Acting Head of Physical Medicine and Reha- residency training programs in Neurosurgery, Neurology and Physical Medibilitation). cine and Rehabilitation. In addition, Today, in addition to being an aca- many of the subspecialty programs in demic department of the University of Clinical Neurosciences attract clinical fellows from other Canadian Centres Calgary (U of C), Clinical Neurosciences is a regional clinical department and abroad. Members of the Department also teach clinical skills to adof the Calgary Health Region (CHR). Physician members of the Department vanced practice nurses and to other of Clinical Neurosciences provide neu- health professionals, and directly supervise graduate students and postrosurgical, neurological and medical rehabilitation services to the citizens of doctoral research fellows. Clinical Neurosciences now includes over 70 !

primary members many of whom are also members of the Hotchkiss Brain Institute. Inpatient and outpatient services, including neurosurgical services for adults and children, are provided at the Foothills Medical Centre and at the new Alberta Children’s Hospital. Outpatient and consultation services are provided at the Tom Baker Cancer Centre (TBCC), the Rockyview General Hospital and the Peter Lougheed Centre. Medical services are also provided at the Chronic Pain Centre and at the Fanning Centre. The Department also provides limited neurological outreach services to the Chinook and Palliser Health Regions (Neurology consultations only). Research programs are based at the Foothills Hospital, Faculty of Medicine and Tom Baker Cancer Centre, especially in partnership with the Hotchkiss Brain Institute, Southern Alberta Cancer Research Institute and the Institute of Maternal and Child Health. Throughout its short history, the Department of Clinical Neurosciences has had an exemplary record of research accomplishment. Tangible examples of research success include two Canadian Foundation for Innovation (CFI) awards, first for the development of intraoperative MRI and more recently for the design and testing of neuroArm, a MRI compatible robot for micro-neurosurgery, 10 external salary awards, eight from the Alberta Heritage Foundation for Medi6


cal Research (AHFMR) and two from the Canadian Institutes of Health Research (CIHR), over 100 major publications annually and over $10 million in active research funding. Aided by the AHFMR, CIHR, Heart & Stroke Foundation of Canada, University of Calgary, Calgary Health Region, Hotchkiss Brain Institute and the generosity of Calgarians, Clinical Neurosciences has garnered a well deserved national reputation for innovation in patient care, teaching and research. Structure of the Department Clinical Neurosciences is one of 20 academic Departments of the Faculty of Medicine and one of 14 Regional Clinical Departments of the Calgary Health Region. With regard to University matters, principally research and education, the Department Head of Clinical Neurosciences reports to the Dean of Medicine. With regard to patient care and clinical service delivery issues, the Department Head of Clinical Neurosciences reports to the Executive Medical Director of the Northwest portfolio of the Calgary Health Region and also to the Chief Medical Officer of the Calgary Health Region. In regard to academic recruitment, training and research development and support, the Department Head of Clinical Neurosciences works in concert with the Institute Directors, especially the Director

of the Hotchkiss Brain Institute. Departmental affairs are conducted by two senior committees: the Academic Executive Committee, which is chaired by the Department Head, and by the Clinical Executive Committee, which is co-chaired by the Director of Neuroscience Programs of the Calgary

Clinical Neurosciences Program Leaders Director ALS Clinic Chris White

Calgary Spine Program Jacques Bouchard & Stephan duPlessis

Director Neuromuscular Director and EMG Lab Doug Zochodne EEG & Epilepsy Neelan Pillay

Director Alberta Radiosurgery Centre & Neuromodulation Zelma Kiss

Director Movement Disorders Oksana Suchowersky

Two major challenges face the Department of Clinical Neurosciences over the next five to ten years. The first is the development of a new strategic plan for Rehabilitation Services in the Calgary Health Region that includes the development of vibrant, researchintensive Division of Physical Medicine and Rehabilitation and the second will be the transition from an academic and clinical Department consolidated at the Foothills Medical Centre and Alberta Children’s Hospital to a Department that achieves greater success on two sites, the Northwest (FMC) and South Health Campuses. Continued success for Clinical Neurosciences can be expected. There is a strong commitment to patient care and a palpable esprit de corps, the latter most evident at Grand Rounds, which occur weekly. The training programs in Clinical Neurosciences are strong, well managed and heavily subscribed. Aided by the Hotchkiss Brain Institute and the “Alberta Advantage”, the prospect for major recruitment and significant discovery in Clinical Neurosciences has never been greater. Our future is bright!

Director Neurosurgery Education John Hurlbert/John Wong


Director Peripheral Nerve Rajiv Midha

Therapeutic Brain Stimulation Program Bin Hu


Director Neurology Education

Drs. William Fletcher/David Patry

Neuro Vascular John Wong

Department Of Clinical Neurosciences

Director Urgent Neurology Clinic Bill Murphy

Director, MRI & NeuroArm Robotics Garnette Sutherland

Director Quality Improvement And Safety W. Becker/M. Hamilton

Director Headache Program Werner Becker


Disorders and many others. The major care programs and teams and their medical leaders are summarized in the attached figure.


Director Paediatric Neurosurgery Mark Hamilton

SACRI Peter Forsyth Director IBTRC Gregory Cairncross Director Multiple Sclerosis Luanne Metz

Director Paediatric PM & R John Latter

Director Director Stroke Program Stroke Unit Andrew Demchuk Michael Hill

Health Region and the Deputy Department Head of Clinical Neurosciences, currently the Head of Neurosurgery. Patient care and research occur seamlessly in Clinical Neurosciences through the use of multidisciplinary teams in areas such as Stroke Care, Epilepsy, Movement Disorders, Spinal



New Faculty Dr. W. Jeptha Davenport Dr. Davenport graduated from the University of Illinois College of Medicine in 1996 after undergraduate studies in philosophy and neurosciences." He specialized in neurology after com-

Toronto." He came to Calgary in the spring of 2008, working in the headache group of the Chronic Pain Centre, the Multiple Sclerosis Clinic of the Foothills Medical Centre,"as well as in other areas of neurology in the Department of Clinical Neurosciences of the Calgary Health Region. Dr. Sean Dukelow Dr. Dukelow obtained his B.Sc. with specialization in Human Kinetics from the University of Guelph." He went on to do his M.D. and

Dr. Jeptha Davenport

pleting an internship at the Royal Victoria Hospital and neurology residency in Montreal at McGill University." He received his fellowship in the Royal College of Physicians of Canada in 2002 and became a diplomate of the American Board of Psychiatry and Neurology in 2004." He worked on basic science studies of pain at the Hospital for Sick Children under Dr. Mike Salter before working in several community hospitals and in a general neurology practice in !

Dr. Sean Dukelow

his Ph.D. at the University of Western Ontario." His doctoral research, supervised by Dr. Tutis Vilis, focused on using high field functional MRI to map out areas of the brain that were responsive to visual motion and eye movements." After

completing his doctoral studies, he continued on to do his residency in Physical Medicine and Rehabilitation at Queen’s University in Kingston, Ontario." During his residency and postdoctoral fellowship at Queen’s he collaborated with Dr. Stephen Scott to develop novel robotic techniques for assessment of neurologic function in stroke rehabilitation subjects." Current research interests involve further development of robotic assessment and treatment tools following stroke." Clinically his"practice areas are"stroke rehabilitation"and electromyography.

rosciences at the Hotchkiss Brain Institute and the University of Calgary. She did her PhD in Neurosciences at McGill University followed by two postdoctoral fellowships at The Scripps Research Institute (Neuropharmacology Department) and Stanford University (Department of Neurology and Neurological Sciences). She is funded by the Alberta Heritage Foundation for Medical Research, Canadian Institutes of Health Research and the Multiple Sclerosis Society of Canada. Dr. Ousman is interested in identifying endogenous protective mechanisms in multiple sclerosis.

Dr. Shalina Ousman Dr. Tamara Pringsheim Dr. Shalina Ousman is Dr Tamara Pringsheim is an Assistant Professor in the a neurologist specializing in Department of Clinical Neu- the treatment of Tourette Syndrome and related comorbid disorders including Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Disorder. She also has an interest and expertise in the diagnosis of movement disorders in children and adults, as well as primary headache disorders. "She completed her five year residency at the University of Toronto in adult neurology, and then a Dr. Shalina Ousman 8


3 year neuropsychiatry and movement disorders fellowship under Dr Paul Sandor and Dr Anthony Lang in Toronto. "She also did a one year clinical and research fellowship in headache at McGill University. "In addition to her clinical subspecialty training, Dr Pringsheim completed a Master degree in Clinical Epidemiology in the department of Health Policy, Management and Evaluation at the University of Toronto. "Dr Pringsheim is the director of the Calgary Tourette Syndrome Clinic, and is a member of the Movement Disorders Program and CHAMP clinic. Dr. Clare Gallagher Dr. Gallagher graduated from the University of Calgary with a PhD in Biochemistry in 1995. After an industrial post doctoral fellowship in the USA she returned to Canada to attend medical school at the University of Alberta (2000). Neurosurgical training was then undertaken at the University of Calgary and completed in 2006. A fellowship in Neurotrauma was completed at the University of Cambridge (UK) in 2006-7 and followed with Pediatric Neurosurgery training at the University of TexasSouthwestern (Dallas) in 2007-8. She returns to take a position at the University !

of Calgary with special interest in traumatic brain injury and pediatric neurosurgery. Dr. Gallagher’s research interests are in the field of neurotrauma. Both clinical and basic research projects are underway. The field of cerebral metabolism after traumatic brain injury is being investigated in the labo-

pairment,"cerebral small vessel disease (including ischemic white matter disease and intracerebral hemorrhage) and acute stroke care. He is the Principal Investigator of a U.S. National Institute of Health grant to identify MRI and PET imaging markers of cerebral small vessel disease and Alzheimer's disease, and determine their contribution to cognitive decline. Another avenue seeks to identify predictors of appropriate medical care for stroke and the impact of stroke treatments in the “real world” outside the context of highly

Dr. Clare Gallagher

ratory setting and with brain injured patients. Neurochemistry and vascular reactivity is currently being investigated in both the adult and pediatric population. Dr. Eric Smith

Dr. Eric Smith Dr. Smith was recruited in 2008 from Massachusetts General Hospital, where he was Associate Director of Acute Stroke Services and Assistant Professor of Neurology at Harvard Medical School."His"clinical interests are vascular cognitive im-

monitored clinical trials. The data comes from local and national databases such as the American Heart Association Get With the Guidelines-Stroke quality improvement program, of which"he is a member of the"Science Subcommittee. 9


Alberta Heritage Foundation for Medical Research Overview The Department of Clinical Neurosciences is fortunate to have been able to recruit and nurture bright individuals who are making substantial contributions to academic medicine. The following individuals are scholars whose research is supported by the Alberta Heritage Foundation for Medical Research in 2008. Dr. Phil Barber! Currently, Dr. Barber is focusing on experimental stroke and the imaging of neuro-inflammation, blood brain barrier breakdown during early ischemia and the neuroprotective properties of resveratrol." His research accomplishments have been recognized by the Heart and Stroke Foundation of Canada with the Henry Barnett Scholarship in 2005 and the University of Calgary Innovator Award." He is funded by the Alberta Heritage Foundation for Medical Research, The Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research (CIHR). Dr. Andrew Demchuk Dr. Demchuk’s primary research interest is in the area of vascular imaging where he is developing imaging guided treatment for stroke and transient ischemic attack. Specific areas he is currently studying include: (1) CT angiography’s detection of ischemic core, thrombus burden and collateral flow; (2) CT angiography’s detection of ongoing bleeding during intracerebral hemorrhage for targeting hemostatic therapy. (3) Transcranial Doppler’s role as a continuous monitoring bedside tool for recanalization during thrombolysis. (4) Transcranial Doppler emboli detection for assessing vulnerability to recurrent stroke after TIA/ minor stroke. (5) Multimodal MRI detected perfusion ab!

normalities and ischemia for predicting vulnerability to recurrent stroke after minor stroke/TIA. These research projects are supported by grants from Heart and Stroke Foundation of Alberta, NWT and Nunavut; CIHR; Canadian Stroke Consortium and NovoNordisk Canada. Dr. Paulo Federico Dr. Federico has received support from Alberta Heritage Foundation for Medical Research as well as the Canadian Institutes of Health Research for the project entitled “Multimodal analysis of the pre-ictal state”. This research involves a functional MRI study, EEG analysis of high frequency oscillations, and near infrared spectroscopy study of blood flow changes during the period leading up to the onset of a seizure. The goal of this project is to identify biomarkers that may predict seizure onset. As a result, we will have a better understanding of how seizures begin and how to anticipate them. This would significantly impact future treatment modalities (e.g., direct the placement and activation timing of implantable devices), which would reduce the suffering and economic burden in a challenging group of persons with epilepsy. Dr. Michael Hill Dr. Hill’s area of research interests include clinical trials in stroke and the use of administrative data for stroke research and surveillance. He has participated in multiple clinical trials, leads the Calgary Stroke Program Clinical Trials Group and is leading 4 large clinical trials as the PI, co-PI or Steering Committee member. He has begun fundamental work on stroke surveillance using administrative data to monitor stroke rates and stroke outcomes. Dr. Hill has been funded by the CIHR, Heart & Stroke Foundation of Alberta/NWT/NU and the NINDS (NIH) since 10


2001. He currently holds the Heart & Stroke Foundation of Alberta/NWT/NU Professorship in Stroke Research and is the Director of the Stroke Unit. Dr. Natalie Jette Dr. Jetté’s research interests are primarily focused on the development of a health services research program in epilepsy."She is studying: (1) quality and appropriateness of care in epilepsy; (2) health resource use and access to care in epilepsy; (3) comorbidities of epilepsy an other health ourcomes; (4) behavioral determinants of health in epilepsy. Her AHFMR funded project consists of the development and application of a new tool which will allow the identification of individuals with focal epilepsy who should be referred for a surgical evaluation. This project has also received national and international funding support from the American Epilepsy Society, the CIHR, the Milken Family Foundation and the Hotchkiss Brain Institute Clinical Research Unit. Dr. Zelma Kiss Dr. Zelma Kiss is a CIHR Clinician Scientist and a Clinical Scholar of the Alberta Heritage Foundation for Medical Research (AHFMR). She directs the regional program in Neuromodulation and her clinical and research interests involve stereotactic and functional neurosurgery. Dr. Kiss’ research interests have focused on the mechanisms of action of deep brain stimulation for movement disorders. Her recent research has extended to the development of Neural Prostheses to restore sensorimotor function. Along with co-leaders in Edmonton, she was recently awarded an AHFMR Interdisciplinary Team Grant on this theme. Dr. Minh Dang Nguyen Dr. Nguyen looks for ways to protect neurons from the damage that occurs with aging and from such disorders as Alzheimer’s disease. Dr. Nguyen’s research focuses mainly on the cytoskeleton (the internal scaffolding) of nerve cells in the brain. Mutations in the cytoskeleton can lead to such neurodegenerative disorders as Frontal Temporal Dementia, Parkinson’s disease and amyotrophic lateral sclerosis. Dr. Minh Dang Nguyen is an AHFMR Scholar and a CIHR New Investigator affiliated with the Hotchkiss Brain !

Institute at the University of Calgary. He also holds the Brenda Stafford Chair in Alzheimer Research. Past and present agencies funding his research include the AHFMR, CIHR, Human Frontier Science Program, MS Canada and the ALS USA and Canada society. Dr. Peter Stys Dr. Stys is a neurologist/neuroscientist and a world leader in the detailed study of pathophysiological mechanisms of white matter injury in stroke and trauma. He has extensive expertise in electrophysiological recording methods in myelinated axons, and his team has recently developed confocal, multiphoton and coherent anti-Stokes Raman scattering (CARS) imaging techniques for both fixed immunostained and live myelinated axons and glial cells. Dr. Stys' insights provide a rational basis for devising drug therapy for the acute phases of stroke, spinal cord injury, brain trauma, and neuroinflammatory conditions. Dr. Stys is the recipient of the Dr. Frank LeBlanc Chair in Spinal Cord Research, Canada Research Chair (Tier I) in Axo-glial biology, and Alberta Heritage Foundation for Research (AHFMR) scientist award." His work is supported by a number of important funding partners (in addition to the ones mentioned above), including the Canadian Foundation for Innovation (CFI), CIHR, Multiple Sclerosis Society of Canada, Neuroscience Canada, HBI, Canadian Stroke Network (CSN), NSERC, Alberta Paraplegic Foundation, Adelson Foundation for Medical Research, and the National Institutes of Health (NIH). Dr. Cory Toth In type 1 diabetes, a lack of insulin not only contributes to poor glucose control. It also"starves the brain of a needed growth factor, leading to brain atrophy, loss of white matter, and cognitive decline. Dr. Toth will be studying the impact of deficiency of insulin within the brain upon important pathways and examining methods to shore up these pathways without affecting the rest of the body. His recent AHFMR award will be used to perform this work until 2012, while Dr. Toth's previous work supported by AHFMR led to new discoveries about the impact of insulin deficiency in the brain and its potential replacement through intranasal delivery to access the brain. In addition, AHFMR sponsored work has led to discoveries regarding 11


the AGE-RAGE pathway within the diabetic brain and ongoing JDRF sponsored"work to identify potential therapeutic targets of this pathway as well. Dr. Wee Yong Dr. V. Wee Yong research interests lie in the area of neuroimmunology, neuroprotection and CNS regeneration. His scientific projects have been guided by 4 disorders: multiple sclerosis (MS), spinal cord injury, intracerebral hemorrhage and malignant gliomas. Dr. Yong co-directs the MS Program of the Hotchkiss Brain Institute at the University of Calgary. Dr. Yong currently chairs the Medical Advisory Committee of the Multiple Sclerosis Society of Canada and he sits on the International Advisory Board of the International Society of Neuroimmunology. Dr. Doug Zochodne Dr. Zochodne is a Scientist of the Alberta Heritage Foundation for Medical Research. The Zochodne lab research is been funded by the CIHR, (the current lab is supported by three ongoing CIHR awards), the Canadian Diabetes Association (CDA), National Institutes of Health (NIH USA, PI Dr. Chris Power), the Natural Science and Engineering Research Council of Canada (NSERC, PI Dr. David Cramb), and the Juvenile Diabetes Research Foundation International (JDRFI, PI Dr. Danielle Pacaud). The laboratory has made contributions to the field of experimental diabetic neuropathy and peripheral nerve regeneration. Dr. Zochodne is the team leader of a major ($2.25M) CIHR Regenerative Medicine and Nanotechnology team grant with collaborators at the University of Calgary in Neurosciences and Engineering, the University of Alberta, and the University of Saskatchewan.




2008 Program Updates Adult Hydrocephalus Program Program Director: Dr. Mark G Hamilton Members " Neurosurgeons Dr. Mark G Hamilton Dr Clare Gallagher Dr. Walter Hader

Overview In 2001, the University of Calgary Adult Hydrocephalus Clinic was established with the goal to standardize and enhance the care for patients with hydrocephalus. The population of adult patients with hydrocephalus is increasing as diagnostic and therapeutic techniques improve idenMedical Neurologist and Geriatrician# tification and survival of treated patients. Hydrocephalus Dr. David Hogan patients have typically been assessed and cared for by Dr. David Patry individual physicians in an unstructured and unfocused clinic environment. In 2008 there are 350 patients followed Neuropsychology in the Adult Hydrocephalus Clinic. This population includes Michael King, Ph.D. patients who initially had a diagnosis of hydrocephalus as a child, adults with acute and subacute hydrocephalus, paNurse Practitioner# tients with long-standing overt ventriculomegaly in adults Ron Prince (Inpatient) (LOVA), and patients with idiopathic Normal Pressure Hydrocephalus (iNPH). An audit of all adult patients who have Research Interests undergone treatment of their hydrocephalus over the last Neuroendoscopy treatment and outcome for hydro14 years has been started. cephalus Neuropsychological effects of endoscopic treatment of The University of Calgary Adult Hydrocephalus Prohydrocephalus gram has emerged as a response to the success of the Infections in ventricular catheters and shunts Adult Hydrocephalus clinic. The effort to focus the care of Treatment of idiopathic Normal Pressure Hydrocephaadult patients with hydrocephalus in a specialty clinic replus (iNPH) resented an important development to help foster a better Transition care for pediatric patients with hydrocephaunderstanding of the natural history of patients with unlus treated hydrocephalus, to standardize the investigative Endoscopic management of patients with brain tumors strategies for patients with a potential diagnosis of hydrocephalus and to manage the issues related to problems Grant Support with treatment of hydrocephalus using shunts. Clinical reCodman Corporation search is progressing along these avenues. A Canadian Medtronic Corporation Adult Hydrocephalus Study Group is being established to help advance these objectives nationally.




Alberta Radiosurgery Centre Program Director: Dr. Harold Lau Overview This program, using a Novalis system, the first of its kind in Canada, is a collaborative effort between the Divisions of Neurosurgery and Radiation Oncology, and was originally established as a joint program between the Calgary Health Region and the Alberta Cancer Board. The technology offers focused radiation treatment for diseases of the brain and spinal cord in single daycare sessions, thus obviating the need for lengthy hospital stays associated with standard surgical treatments. By reducing risks of therapy, and ease of returning to normal activities, it results in much higher patient satisfaction. The program has, since its initiation, in 2002 has grown steadily, such that in 2007, 64 patients were treated with stereotactic radiosurgery and another 33 patients treated with fractionated stereotactic radiotherapy. Members Neurosurgery: Drs. Zelma Kiss, Yves Starreveld, John Wong Radiation Oncology: Drs. Alex Chan, Harold Lau, Rob Nordal Medical Physics: Karen Breitman, Drs. Chris Newcomb, David Spencer, Eduardo Villarreal Barajas Nursing: Rhonda Manthey Radiation Therapists: Carol Boyle, Mark Lesiuk, Kim Kraus, Salimah Fazel, Shannon Murland Dosimetrists: Darren Graham, Daphne Walrath, Nathan Wolfe Administration: Brenda Hubley (Interim Program Manager), Jody Derdall Fellows: Dr. Ben Jonker




Chronic Pain Centre Overview The Calgary Health Region Chronic Pain Centre has now completed 8.5 years of operations within the CHR Regional Pain Program. It is now the largest such Centre in Canada and is a leader in interdisciplinary rehabilitation for individuals with chronic pain. Three members of the Division of Physical Medicine and Rehabilitation currently practise at the Chronic Pain Centre: Dr. Pamela Barton, co-founder and former medical director, Dr. Noorshina Virani and Dr. Nwamara Dike. In addition to their strong background in pain management and interdisciplinary rehabilitation, Drs. Barton and Virani contribute specific expertise in clinical biomechanics, while Dr. Dike has shared her expertise from a pain fellowship at Memorial Sloan-Kettering Cancer Centre in New York. Dr. Dike has also participated in the newly inaugurated Chronic Pain Inpatient Consultation Service now available in all of Calgary’s hospitals. The physiatrists work in the Neuromusculoskeletal Program alongside anaesthetists, family practitioners and all members of the rehabilitation teams. They have many patients who are co-managed with the gynecologists and neurologists of the Pelvic Pain and Headache Programs. They also participate in teaching medical students, residents and fellows in family practice, anaesthesiology, psychiatry, physical medicine and rehabilitation and neurology who rotate through the Centre. During 2008, the physiatrists contributed a total of 0.6 FTE, completing 58 new patient assessments and an additional 302 follow up visits on a total of 162 unique patients. Due to their competence in the interdisciplinary management of complex patients, their caseloads carry many of the more complicated patients referred to the Chronic Pain Centre.




Epilepsy Program Overview The overall objective of our team is to be a centre of clinical and academic excellence, and to maximize the full potential of each individual with epilepsy through improved consolidated services, education and research. Patients and families often present with complex needs arising from the impact of this chronic illness on their lives coupled with the experience of change in their disease process and /or response to treatment. The Calgary Epilepsy Program has a unique core of pediatric and adult epileptologists, epilepsy surgeons, EEG technologists, clinical physician assistants, residents, fellows basic scientists, neuroradiologists, neuropsychologists, and nurses providing comprehensive care for epilepsy patients. This team of experts works in collaboration to find the most appropriate treatment for each patient. We are one of the premier epilepsy centres in Canada, and we are developing innovative ways to diagnose and treat epilepsy in children and adults. Epilepsy is much more than seizures. Research by members of our team and others demonstrates that up to 70% of persons with epilepsy suffer from anxiety, depression and other psychological disorders. A similar proportion suffers from cognitive deficits and learning difficulties as a result of the seizures, the medications or underlying

conditions. The risk of death in patients with poorly controlled epilepsy is 5 times higher than in the population. Accidents, social stigma, and disability are well documented in our studies of the Canadian epilepsy population who also use more acute health care resources and allied health services than patients with other common chronic conditions. In addition, our researchers have shown than in Canada, chronic conditions such as hypertension, cancer, stroke, heart disease, gastrointestinal disorders, migraine, allergies, chronic fatigue, diabetes, and psychiatric disorders are significantly more common in patients with epilepsy than in the general population. Service delivery EEG and Epilepsy The Calgary Comprehensive Epilepsy Program provides diagnostic, therapeutic and follow-up services to patients referred with new and uncontrolled seizures. Seven epileptologists contribute to the program. Dr. Neelan Pillay, adult epilepsy program director; Dr. Bill Murphy; Dr. Sam Wiebe, Division Chief of Neurology and Director of the Comprehensive Epilepsy Program; Dr. Paolo Federico; Dr. Nathalie Jette; Dr. Alex Hanson; and Dr. Brian Klassen. Drs. Pillay and Murphy have just completed research sabbaticals at the Brain Research Institute in Melbourne, Australia. The seizure monitoring unit (SMU), staffed by five epileptologists, is the 3rd in-patient service in the division of Neu-

Voxel based relaxometry !



rology, in addition to general neurology and stroke. Our neurophysiology laboratory faces increasing demands for urgent and emergent EEG and for ICU continuous EEG monitoring, a reflection of population growth and changes in practice patterns. Similarly, requests for intra-operative somatosensory and motor evoked potential from spine surgeons and neurosurgeons have increased markedly. The Seizure Monitoring Unit Quality Improvement Team The CEP is committed to providing high quality and safe patient-centered care. A major initiative towards this goal is our Seizure Monitoring Unit (SMU) Quality Improvement (QI) Team. This multidisciplinary team, originally developed with the support of Michael Suddes, previous Neurosciences QI consultant, meets six times a year to monitor and improve quality and safety of care on the fourbed SMU. The team is currently comprised of representatives from EEG technology (Mike Rigby, Erin Phillip), Quality and Safety (Jason Knox), Neurology (Dr. Federico, Dr. Jetté, Dr, Pillay, Dr. Wiebe), Nursing (Barb Seal, Christanne Krassman, Jackie Martini, Robert Cooper, Shelly Mikkelsen, Chris Murray), Psychology (Dr. Macrodimitris, team lead), and a patient representative who is also a former patient of our SMU, Ms. Valerie Gibbons. Initiatives to date include regular assessment of staff and patient experience of the SMU, regular collection of key quality indicators (presently collected by our Clinical Assistants, Dr. Obianyor and Dr. Dhaliwal), staff education and training programs, and the development of a specific protocol and training program for Generalized Tonic-Clonic seizure interventions. The success of our QI program was highlighted at a platform presentation at the December, 2008 American Epilepsy Society meeting in Seattle, Washington. Neurophysiology Laboratory The laboratories at the three adult sites in the city are managed by Mr. Mike Rigby. The main services provided are inpatient and outpatient EEGs. In the past year we had about 20% increase in inpatient EEG requests. On the other hand there was a slight decline in SMU admissions because of more complex patients requiring a lengthier stay in the unit.


The Epilepsy Psychology Program The CEP is committed to providing comprehensive care, which requires addressing the psychological and social needs of patients in addition to their medical issues. Over the past year, Dr. Macrodimitris, our program’s psychologist, and her colleague Dr. Kate Hamilton, have launched a cognitive Behavioral Therapy group program the “CBT Basics II.” The program is run by Dr. Macrodimitris and the Ambulatory Neurosciences Social Worker, Melinda Hatfield, MSW, RSW. Seven patients completed this weekly 10-session structured program for depression

Surgery for refractory epilepsy associated with a lesion involving eloquent cortex after comprehensive pre-operative evaluation

and anxiety disorders. This program will continue to run in 2009 as a multi-center research initiative supported by the Hotchkiss Brain Institute Clinical Research Unit Pilot Project Funding. Dr. Macrodimitris and Dr. Sherman, through support from the Kinsmen Chair in Pediatric Neurosciences, are also developing pediatric epilepsy mental health initiatives, including a group program for adolescents with epilepsy and co-morbid anxiety and depression, and a parent support group for parents of epilepsy patients.



Teaching and training The Comprehensive Epilepsy Program brings together adult and pediatric epilepsy groups during weekly seizure conferences and EEG rounds and monthly journal club. The educational components of the program comprise teaching neurology residents, clinical physician assistants, epilepsy fellows, nurses and EEG technologists. Dr. Adnan Al-Sarawi from Saudi Arabia completed a one-year fellowship in epilepsy and transferred to EMG fellowship in Toronto. Dr. Abdel Hamid Seiam from Egypt will be completing his 2-year epilepsy fellowship in March 2009. Dr. Ayataka Fugimoto, epilepsy surgeon from Japan joined our fellowship program in July for a year. Dr. Harinder Dhaliwal a graduate from the Armed Forces Medical College in India and Dr. Florence Obianyor, a graduate of Premier Medical College, University of Ibadan, have been recruited through the Calgary Clinical Assistant program this year. Dr. Radwa Badawi, EEG/epilepsy fellow from Melbourne, Australia, joined us for an elective during the spring of 2008, and Dr. Jeremy Moeller, senior neurology resident from Dalhousie University, joined us for an elective during the fall.

3. The annual Calgary Epilepsy Program Barbecue took place at the Pioneer Club on Friday June 6, 2008. 4. Second annual Calgary Epilepsy Golf tournament was held on August 21 at Lynx Ridge Golf club. Golf enthusiasts braved the inclement weather and made it a great success. The details are in the separate report appended Research Staff Dr Supriya Save has joined our team as the new Clinical Trial’s Coordinator. Dr. Save has a BSc and PhD degrees in science from Mumbai University, India. She brings expertise in clinical trials and clinical research and is an asset to our team. Research Activities Dr. Federico’s research program uses leading-edge imaging and EEG approaches to better understand the neural and vascular correlates of epilepsy. These studies include using EEG combined with simultaneous functional

Special events 1. The Second Calgary Epilepsy Program Research Retreat was held at the Best Western Village Park, Inn on Friday September 12, 2008. There were 38 participants from all disciplines in this half-day event. 2. The special guest for the annual Mary Anne Lee symposium, held on October 03, 2008 was Dr. Nicholas M. Barbaro, Professor, Department of Neurological Surgery, Vice Chair, Department of Neurological Surgery , Director, Neurosurgical Residency Program, University of California, San Francisco. Dr Barbaro has extensive expertise in the treatment of disorders that are manageable by stereotactic and functional neurosurgical techniques, including epilepsy, Parkinson's disease, and chronic intractable pain syndromes. He is recogDr. Nick Barbaro nized internationally for his work in epilepsy surgery. !

Language fMRI

MRI to better understand the cortical and subcortical circuits underlying the generation of interictal discharges in patients with focal and generalized epilepsy (see Figure). Other projects include fMRI studies of language and motor reorganization in focal epilepsy as well structural MRI stud18


ies of seizure-related structural brain changes. Dr. Federico also has an interest in advanced EEG analytical techniques, including the study of high frequency oscillations in humans and animal models of epilepsy. He currently holds funding from the Canadian Institutes of Health Research and Alberta Heritage Foundation for Medical Research. Dr. Jetté’s research interests are primarily focused on the development of a health services research program in epilepsy. She is studying: (1) quality and appropriateness of care in epilepsy; (2) health resource use and access to care in epilepsy; (3) comorbidities of epilepsy and other health ourcomes; (4) behavioral determinants of health in epilepsy. She is working on the development of an appropriateness rating tool to identify individuals with epilepsy who should be referred for an epilepsy surgery evaluation. She is also working on the development of a national epilepsy surveillance program. Dr. Jetté's research is currently funded by the Canadian Institutes for Health Research (CIHR), the Alberta Heritage Foundation for Medical Research (AHFMR), the American Epilepsy Society, the Milken Family Foundation, the Public Health Agency of Canada, the University of Calgary, and the Hotchkiss Brain Institute Clinical Research Unit. She also holds new investigator awards from CIHR, AHFMR, the American Epilepsy Society and the Milken Family Foundation.

Alberta Medical Services Incorporated Foundation (MSI), the National Institutes of Neurological Disorders and Stroke (NINDS), and the Hotchkiss Brain Institute. In addition to the specific research activities outlined above, our epilepsy program is fortunate to have a strong group of experts who collaborate in various capacities to our research enterprise. These include experts from the areas of Pediatric Epilepsy (Dr. Ismail Mohammed) Neuropathology (Dr. Harvey Sarnat), Neurosurgery (Drs. Walter Hader, Zelma Kiss, Yves Starreveld), Neuropsychology (Drs. Elisabeth Sherman and Lisa Partlo), Psychiatry (Jeremy Quickfall) and Neuroimaging (Drs. James Scott and Chris Molnar). We also enjoy strong collaborations with basic scientists from the Epilepsy and Brain Circuits Program in the Hotchkiss Brain Institute, in particular Drs. Cam Teskey, Jaideep Bains, Quentin Pittman, Michael Collicos and Jeff Dunn.

Dr. Samuel Wiebe’s research focuses on outcome assessment, quality of life, comorbidity, epidemiology, and randomized surgical trials in epilepsy. He is undertaking a multicentre randomized trial of Medical versus Electrical Therapy in Temporal Lobe Epilepsy (METTLE study), and is the PI for a number of planned NIH-supported studies on epilepsy and depression, early refractory epilepsy and neuroprotection. He is developing scales to assess severity of epilepsy and patient satisfaction with therapy. Dr. Wiebe established and leads the Canadian Epilepsy Surgery Study Group (CESSG), a research consortium aimed at facilitating and coordinating collaborative research in all areas related to epilepsy surgery. The group is supported by the Hotchkiss Brain Institute through its Epilepsy and Brain Circuits program, and it is affiliated to the Canadian League Against Epilepsy. Dr. Wiebe is supported by the Canadian Institutes for Health Research (CIHR), the Alberta Heritage Foundation for Medical Research (AHFMR), the !



Epilepsy Golf Tournament The 2nd Annual Epilepsy Golf Tournament was held at Lynx Ridge Golf Club on Thursday August 21, 2008 and despite trying weather was another great success. The tournament continues to grow and this year over 50 brave souls battled rain and cold winds to complete the 18-hole event. Many thanks go out to our hole sponsors and those who made donations of prizes for the event or donations to the program. A special thanks goes out to our many volunteers who helped make this event possible. Proceeds of the tournament will continue to benefit patients by supporting the development of clinical, educational and support programs within the Calgary Epilepsy Programme. Hole Sponsors Johnson & Johnson AMJ Campbell Moving Dr Sam Wiebe# Dr Walter Hader

Donations LaFarge# Magstim# R Anand# Jennifer Buchanan# Jason Cottle# Monty Arun Gaur Walter Hader Sr Nathalie JettĂŠ B Raskin Maureen Robertson Doug Walsh Volunteers Thea Dupras# Kim Ford# Lysa Gallagher Jack Hasna Lisa Partlo Ceri Rawji

Prize Sponsors AMJ Campbell Bernard Florence, Calgary Johnson & Johnson


The Winners!

The Wettest Team!

Frank LeBlanc, Adam Kirton, Ian Stang, Greg Cairncross

Ron Bridges, Tom Feasby, Ed Block, Eric Payne



Calgary Headache Assessment & Management Program (CHAMP) Introduction CHAMP is a multidisciplinary headache management program with 5 neurologists, 3 nursing, 1 occupational therapy, 1 psychologist, 1 kinesiologist, 3 clerical, and 1 research assistant / data analyst team members. Mission Statement Vision: Empowered patients and their families actively engaged in headache self-management. Mission: To reduce the burden of headache related disability carried by patients and their families. Objectives: Deliver care for patients with difficult headache disorders more efficiently and effectively through inter professional teams focused on both medical and behavioral therapies. Contribute to headache care through clinical research and education of health care professionals. Reduce utilization of expensive health care resources such as emergency rooms and inpatient beds through better outpatient management of patients with headache. CHAMP will: Provide patients with a caring and empathetic environment in which to monitor progress towards their functional goals. Encourage patient self reliance and active partnership in their headache care, with an emphasis on self management. Provide access to program services in a timely manner immediately following admission to the program. Serve the headache health care needs of the CHR in conjunction with the headache program of the CHR chronic pain center. Maintain a comprehensive quality management program with appropriate quality indicators and outcome measures. Deliver “best practice� care based on evidence available, with a commitment to develop new evidence where needed. !

Ensure all team members are committed to remain current in terms of best practices in headache care. Involve patients in the design of the program CHAMP offers and in the design of their individualized treatment. Carefully foster communication between patients and staff, and between the members of the inter-professional team to create a forum for the discussion of patient care plans. Work towards following every patient with outcome measures and team discussions so that all are accounted for. Summary of activities The clinical core of the CHAMP program consists of group workshops and one-on-one outpatient visits to physicians and other health care professionals. The nursing component of CHAMP provides additional valuable patient service through telephone follow up and problem solving. The educational session is the entry point for many patients to the CHAMP program, and during 2007, 362 patients and over 200 additional family / friends attended the education sessions which are offered 2 or 3 times a month. There were over 2203 one-on-one patient visits to physicians and other health care professionals. Many patients attended our self management, relaxation, sleep and body works workshops. Education: In addition to continuing medical education programs and teaching directed at University of Calgary residents and medical students, the CHAMP program provided elective rotations to 4 senior University of Alberta Neurology residents in 2007 (Drs. Jickling, Phan, Narasingh, and Jassal), and for one senior neurology resident from the University of Ottawa (Dr. F. Amoozegar). Ms. Khara Sauro, holder of the 2007 Canadian Headache Society National Headache Fellowship, completed her fellowship with CHAMP during 2007. Research activities: CHAMP continues to participate in industry-sponsored multi center clinical trials, and these have included in 2007 trials to evaluate the efficacy of 21


botulinum toxin type A, occipital nerve stimulation, patent Revising the education session to reduce the division foramen ovale closure, and tonabersat in migraine and / or between the medical and behavioral content, and to emchronic daily headache prophylaxis. CHAMP has also ana- phasize more our integrated comprehensive approach to lyzed the properties of two headache outcome measureheadache care. ments, the HIT-6 and the MIDAS, and an abstract has been To review and possibly expand the role of the lifestyle submitted to the Canadian Neurological Sciences Federaassessment in the program. tion annual meeting. In conjunction with Dr Z. Kiss, outTo initiate a formal quality management program for the comes on a CHAMP patient with implantation of a deep CHAMP, complete with a small quality council. This probrain stimulator for the treatment of chronic cluster headgram would include quality improvement education for our ache have been assessed, and an abstract submitted to staff, and the commitment of all staff to identify where the same meeting. processes could be improved, and to contribute to their Quality Improvement: CHAMP has studied program improvement. outcomes. In addition, To focus more on “best an abstract has been practice” through the submitted to the Canadevelopment of more dian Neurological Scistandardized patient ences Federation antreatment processes. nual meeting on the Ensure that all staff CHAMP program and have access to the its outcomes. Several necessary continuing patient focus groups professional education have also been held to in headache managedetermine what imment. provements our paFacilitate intertients think should be professional education made in our program. regarding the care of We are grateful to Jaindividual patients son Knox and Michael through team rounds, CHAMP nursing staff (left to right) Brenda Kelly-Bessler (research Suddes for their assisetc. nurse), Ruth Sutherland and Irene O’Callaghan (clinic nurses). tance with these focus Improve our capacity to groups. meet the needs of the CHR with regard to headache care and reduce our wait times by working to make our patient care processes more Awards efficient. The CHAMP program is extremely pleased that one of Develop further the kinesiology component of CHAMP its members, Ms Irene O’Callaghan, RN, was awarded a as better posture, neck health, and physical conditioning People First Award in the healing hands category by the contribute to headache management. Calgary Health Region. The People First Award is the highest award which the CHR offers. Moving forward A number of action items to improve the program were developed and the program will work on these over the coming year.


Conclusion CHAMP continues to work towards meeting the headache care needs of the CHR, together with the CHR Chronic Pain Center Headache Program and to fulfill its educational and research objectives.



Movement Disorders Program Overview Movement Disorders are diseases that result in involuntary movements such as tremor, dystonia, bradykinesia (slowness) and tics. These disorders cause significant disability in 1/100 Albertans and touch over 30,000 Albertan families. The program provides for a multidisciplinary clinic with a staff of over 20 individuals including specialists in neurology, neurosurgery, psychiatry, nursing, social work, psychology, and physiotherapy, treating over 2000 patients with Parkinson disease, Huntington disease, Tourette syndrome, spinocerebellar ataxia, dystonia, and tremor. We follow approximately 2000 patients with close to 10,000 patient visits per year. We have a large research program involved in developing improvements in treatment of Parkinson disease and related disorders. Research to understand basic mechanisms of disease is coordinated through the Hotchkiss Brain Institute.

ing, Dr Pringsheim completed a Master degree in Clinical Epidemiology in the department of Health Policy, Management and Evaluation at the University of Toronto. She opened the Calgary Tourette Syndrome Clinic in April 2008 at the Child Development Centre adjacent to the Alberta Children’s Hospital. This was joint initiative by the departments of Clinical Neurosciences and Pediatrics at the University of Calgary. The clinic provides consultation and continuing care for children and adults with Tourette Syndrome, as well as other conditions commonly seen in individuals with Tourette Syndrome, such as Attention Deficit Hyperactivity Disorder and Obsessive Compulsive Disorder. The Calgary Tourette Syndrome clinic is the only centre for expertise in Tourette Syndrome in southern Alberta. It will also serve the province of Alberta as well as neighbouring communities in Saskatchewan and British Columbia. The aim is to develop a multidisciplinary team model for the Calgary Tourette Syndrome Clinic, which will include medical expertise, nursing, clinical psychology, and occupational therapy.

The program continues to be designated as a Center of Currently, the team includes Dr Tamara Pringsheim (DiExcellence for PD by National Parkinson Foundation (USA). rector of the Calgary Tourette Syndrome Clinic), Dr Bonnie Moshenko-Mitchell (Registered Psychologist), Nancy Labelle (Clinical and Research Nurse), Charmaine Orchard Highlights This year Dr. Tamara and Carolyn Baldwin, Administrative Assistants Pringsheim joined us. Dr Tamara Pringsheim is a neuProgram Staff rologist specializing in the Neurology: Dr. Oksana Suchowersky (Program Directreatment of Tourette Syntor) drome (TS). She completed Dr.Sarah Furtado her five year residency at Dr. Scott Kraft (Neuromodulation) the University of Toronto in Dr. Tamara Pringsheim (Director, Tourette Syndrome adult neurology, and then a Clinic) 3 year neuropsychiatry and Dr. Ranjit Ranawaya (Clinical Director) movement disorders fellowNeurosurgery: Dr. Zelma Kiss (Neuromodulation) ship under Dr Paul Sandor Neurophysiology: Dr. Bin Hu (Research Director) and Dr Anthony Lang in ToNeuropsychology: Dr. Angela Haffenden ronto. In addition to her Psychiatry: Dr. Jeremy Quickfall, Dr. Michael Trew Dr. Tamara Pringsheim clinical subspecialty trainGraduate Students: Aarti Shankar !



Fellows: Dr. Cid Diesta Nurses - Clinical: Karen Hunka, Michelle Zulinick, Robyn Warwaruk, Nancy Labelle Nurses - Research: Lorelei Derwent, Carol Pantella, Mary Lou Klimek Secretarial Support: Sheila Pinkney, Marlene Conrad, D’evan Cooper, Linda Lukindo, Rhiannon D’Haene and Katie Kraft

Autistic Spectrum Disorders, and randomized controlled trials of drug therapy for TS. Grant Support PHAROS – Pilot Huntington At Risk Observational Study (1999-2010) O. Suchowersky (Local PI) National Institutes of Health## $45,000US/yr Multicenter Grant PREDICT-HD Neurobiologic Predictors of Huntington’s disease (2002 – 2008) O. Suchowersky (Local PI) National Institutes of Health $20,000US/yr

From left to right; Carol Pantella, Robyn Warwaruk, D'evan Cooper, Rhiannon DHaene, Dr. Ranjit Ranawaya, Katie Kraft, Karen Hunka, Dr. Oksana Suchowersky, Sheila Pinkney, Dr. Tamara Pringsheim, Nancy Labelle

Fellowship The program offers 1-2 yr clinical fellowships for applicants who have completed neurology residency training in Canada (or equivalent abroad). # Dr. Cid Diesta successfully completed a one year clinical fellowship and has returned to Manila (Philippines) in June 2008. Current Research Interests Neuroprotection for Parkinson disease (PD) Music therapy in PD Identification of genetic factors in PD Neuroprotection for Huntington disease (HD) Abnormalities in reaching in PD Novel treatments in PD, HD, dystonia, and spinocerebellar ataxia. Tourette Syndrome clinic research interests include; creation of a disease specific quality of life instrument for children with TS, defining and measuring rage/explosive anger in children with TS, predicting outcome in TS, identifying factors present early in life which predict resolution of tics in adulthood, understanding the links between TS and !

Cooperative Huntington’s Observational Research Trial (COHORT) (2006-2011) O. Suchowersky (Local PI) HP Therapeutics Foundation, Inc. $8,000US/yr Prospective data collection from HD families.# The effect of music therapy on motor and non-motor symptoms in PD (2006 – 2011) O. Suchowersky (Sub PI)# Canadian Institute of Health Research (CIHR) $26,000/yr NET-PD Neuroprotective PD#(2008-2012) O. Suchowersky (PI)# $75,500US/yr The major goal of this project is to identify drugs to delay disease progression#



Intraoperative MRI Program Program Director: Garnette Sutherland


Overview The year 2008 was an interesting year for the iMRI program. Last year, the program celebrated its 10th year of operation in December. Early this year, the program marked another milestone- treating over one thousand patients in the iMRI suite. The iMRI program successfully raised full funding (~$10M) to allow the Advancing iMRI initiative to occur. The prototype 1.5T iMRI system was upgraded to an IMRIS-Siemens 3T platform based on the world’s first ceiling mounted 3T magnet. The MR system includes high performance gradients and a working aperture of 70cm.

Project Leader"" Garnette Sutherland

Planning for the upgrade began in March 2008 requiring considerable input from CHR Planning and Development, architects from McKay Hlavacek, Ledcor as the lead contractor and various subcontractors. In June of 2008 the iMRI suite was closed and construction was completed by December 2008.

NRC Scientists Boguslaw Tomanek David Hoult Scott King Calvin Bewsky University of Calgary investigators (not inclusive) Alex Greer All members and residents of the Division of Neurosurgery Oliver Bathe Andrew Kirkpatrick Phil Park Andrew Maitland Mark Hudon Carla Wallace Mayank Goyal Will Morish Research Interests Application of iMRI to neurosurgery Whole body application of iMRI technology Molecular imaging Robotics Grant Support Alberta Advanced Education and Technology Western Economic Diversification Calgary Health Trust Significant in-kind support from Alberta Health Services, NRC Institute for Biodiagnostics, and IMRIS




Multiple Sclerosis Program Clinical Highlights Medical Services: Two new neurologists joined the MS Clinical Team in 2008. Dr Dawn Pearson, a cognitive neurologist, joined our MS team in January and Dr Jeptha Davenport, a pain specialist, joined in April. Dr Pearson has been practising neurology in Boston and Dr Davenport has been practising neurology in Toronto. Both Drs Pearson and Davenport spend 30% of their time as MS Clinic physicians. In addition, Dr K Busche increased his time in the MS Clinic from 10% to almost 20%. Electronic Health Record: During 2008 the MS Program (L Metz and research manager Winona Wall) continued to develop the electronic health record (EHR) for the DCNS. After an extensive process of developing system requirements and evaluation of vendors a vendor was selected in June 2007. The choice was Eclypsis, the system supported by the Calgary Health Region. This system will support a continuous inpatient and outpatient record. The choice of this system has, as expected, slowed development of the department EHR as development will in many ways be part of development for the entire Calgary Health Region but linkage with the inpatient system and long term support were believed to be good trade-offs. Development has been further delayed due to changes in the organization of the Alberta !

Health system but the MS clinic will be the first regional clinic to implement the system. This implementation is planned for early 2009. A great deal of work developing the system has taken place during 2008 as decisions that will impact all clinics needed to be made. Start-up of this project in 2005 was supported by a generous donation of 1 million dollars from Teva Neuroscience to

Optic Neuritis

the MS Program of the Hotchkiss Brain Institute (HBI). Alberta MS Program: During 2008 there was further development of an Alberta MS Program led by Dr L Metz. In December, a pilot proposal for a provincial telehealth proposal was submitted to the Alberta Rural development fund. Between June and October regional meetings were held to discuss the current status of mental health services provided to people with MS, to identify gaps, and to develop a plan to move forward. A province-wide MS Mental Health meeting/

education program is scheduled for late June 2009. Preliminary planning to evaluate rehabilitation services for MS has started. A meeting of those providing these services will be held in April 2009. Funding for development of an Alberta MS Program was provided by Jayman Masterbuilt who donated 1 million dollars to the MS Program of the HBI over the period 2007-2011 to develop a Provincial MS Program. Clinic expansion: Clinic expansion is necessary as both clinic space and staffing limit any increase in the number of patients that can be seen per month in the clinic or in OPTIMUS. In addition, our ability to include residents in our clinics has been severely restricted by space limitations. During 2008 planning became more concrete for an MS Clinic site at Rockyview General Hospital. Planning for development of a fully operational site at the South Hospital also started; this clinic site is expected to open in 2011. Research Highlights Translational Research: The Calgary MS clinical and research teams are primarily focused on translational research. Major research activities involve bringing therapies from the laboratory to patients. The following projects represent translational research activities ongoing during 2008.



Minocycline program: We have been leading the translation of minocycline from the Yong lab to the clinic. In 2008 a manuscript describing the final results of a phase IIa trial of minocycline in relapsing remitting MS led by Dr Metz and completed in Calgary was published (funded by CIHR). In 2008 a manuscript describing the results of a phase II Canadian multicentre randomized, doubleblind, controlled trial of minocycline versus placebo in patients starting glatiramer acetate was submitted (study funded by Teva Neuroscience Canada). Recruitment began in 2008 for a phase III randomized controlled trial of minocycline in patients with suspected MS. This study was funded by the MS Foundation of the MS Society of Canada for $4,040,000. The study principal Investigator is Dr Metz; Calgary co-investigators include Drs Yong, Eliasziw, Hill, and Wiebe. Dr Michael Yeung is leading the Calgary site in this trial. The Clinical Research Intelligence Unit of the HBI, led by Dr Wiebe, is managing trial data from across the country. A Brain Repair Team Grant to study “Fine-tuning Inflammation for Neuroprotection and Regeneration in Multiple Sclerosis” was funded by Neuroscience Canada for $1,500,000 over 3 years in late 2007. During 2008 over 60 participants with optic neuritis were enrolled into a follow-up study of optic neuritis by Dr Costello. In early 2009 patients a clinical trial of minocycline versus placebo in optic neu!

ritis will begin. This study aims to (a) determine if the optic nerve can serve as system model to measure neuroprotection and (b) to obtain pilot data on the effects of minocycline on optic neuritis in order to plan phase IIb trials. Meanwhile, basic scientists are working to develop new therapies that may move to the clinic as trials in the future; targets of interest include vitamin D. [Team Leader: Dr VW Yong; Clinical Team: Drs. F Costello and L Metz; collaborators: Dr P Stys (University of Calgary) and Drs C Power and Rivest (Universities of Alberta and Montreal)]. Endogenous Progenitor Cell Repair in MS: Research led by Drs Sam Weise and Wee Yong demonstrated that prolactin stimulates differentiation of oligodendrocyte progenitor cells into functional oli-

godendrocytes, the cells that myelinate nerves. A team grant submitted and awarded in 2008 from the Stem Cell Network for $783,600 over 3 years will support the project: “Endogenous progenitor cell repair in MS”. The goal of the current three-year proposal is to generate both preclinical and clinical (Phase IIa) results to determine whether Phase IIb-III clinical trials of prolactin to stimulate repair in MS are warranted. If the findings are positive, it is envisaged that the Phase IIb-III clinical trials would occur during years 5-7 of the SCN. The first project aims to determine prolactin’s ability to stimulate remyelination within a compromised immune setting that is reminiscent of MS in humans and in the presence of immunomodulatory drugs given to MS patients. The second project asks

In an animal model of multiple sclerosis in mice, as compared to controls (A & B), demyelination and axonal loss are reduced by the combination of glatiramer acetate and minocycline (C & D). 27


whether prolactin regulates the fate of adult human myelin progenitor cells and, again, how is this affected by the presence of immunomodulatory drugs. The third project, a Phase IIa safety and efficacy study of prolactin actions in an optic neuritis subset of MS patients, should provide a clear sense of the potential benefit of prolactin treatment to a larger MS population. Team members include Drs Weiss, Yong, Costello, Metz, and Antel (McGill University). Alpha beta crystalline: Dr Shalina Ousman, who joined our program in April 2008, has been developing humanized monoclonal alpha beta crystalline a molecule that appears to put a break on inflammation in MS. Dr Ousman submitted grants in 2008 to further her research. In the meantime, further laboratory projects are underway funded by start-up funding from an anonymous donor to the HBI. Other basic science development: Mr Hank Swartout donated $1,000,000 over 3 years to the Hotchkiss Brain Institute MS Program to develop the Swartout Neuroprotection and Repair Centre. Funding was increased by $500,000 over 5 years by his colleagues at Precision Drilling. The Swartout Centre includes an EAE Unit to facilitate assessment of potential MS therapies in animal models, a clinical measurement unit to develop models of optic neuritis and corpus callosum function to measure neuroprotection and repair in MS, and !

development of an imaging databank. In 2008 the Swartout EAE Unit supported pilot studies of other potential MS therapies. This research is ongoing. Measurement Research: Evaluating MS therapies requires precise measurement of treatment effects. Classically fairly crude scoring if diseases along with pathology are used in EAE studies. In humans fairly insensitive and fairly variable measures along with MRI measures that focus on lesions are used. To improve the efficiency of EAE studies in vivo imaging would be very useful in accelerating research. In humans, precise in vivo measures of injury, repair, and inflammation within targeted lesions are needed to allow us to test therapies that may be neuroprotective or promote repair. Development of such measures is another focus of our research. The clinical evaluation unit and imaging databank of the Swartout Neuroprotection and Repair Centre will help us achieve these aims. During 2008 an optical coherence tomography machine was purchased and installed in the MS Clinic. This allows precise measurement of the retinal nerve fibre layer, the anterior aspect of the optic nerve. As over 90% of people with MS suffer from optic nerve involvement, and because acute episodes of optic neuritis are usually symptomatic, this provides an opportunity to precisely measure optic nerve integrity to determine the natural history of optic nerve changes and to measure the effects

of optic neuritis. This capacity has been necessary for our success in getting funding for the studies of optic neuritis and to study the natural history of optic nerve changes. During 2008 Dr Fiona Costello led a study in collaboration with Drs Richard Frayne and Brad Goodyear as well as PhD candidate Noorhan Zayed to image the optic nerve during acute optic neuritis and to develop novel optic nerve imaging techniques. This study is funded by the MS Society of Canada ($180, 563). In 2008 Dr Lenora Brown, already an experimental psychologist, completed training in neuropsychology. She is now evaluating measures that aim to develop the corpus callosum as another potential model to evaluate neuroprotection and repair therapies . She is collaborating with Drs Costello and Metz. In 2008 Drs Metz and postdoctoral student Dr Yunyan Zhang continued development of MRI texture analysis as another method of evaluating recovery within lesions. The imaging bank of the Swartout Unit supports this research. The ability to use existing MRI data to evaluate this technique will likely accelerate its development and enhance its value. 2008 was a very good year for recruitment to the MS research program. Drs Shalina Ousman is a neuroscientist whose basic research focuses on MS; in particular preclinical therapy development. She arrived in April 2008.



Education Highlights Weekly MS Clinical Rounds continued through 2008; 30-60 faculty, staff and students attend. The Calgary MS Program continued to host MS Preceptorships. In June 2008 Pavan Ahluwalia completed his MSc research to determine the frequency of vitamin D insufficiency in MS patients and to evaluate methods of dose adjustment. He received a studentship from the MS Society of Canada. He became a medical student at the University of Calgary in August. Dr Yunyan Zhang completed a post-doctoral fellowship in MS Imaging with Dr Metz in June 2008 and went on to undertake an MS Society funded fellowship at the University of British Columbia cosupervised by Drs. David Li and Tony Traboulsee. She received a fellowship stipend and travel support from Teva Neuroscience and submitted Fellowship applications to the MS Society of Canada. The following trainees received national studentships or fellowships from the MS Society of Canada: Pavan Ahluwalia, Yunyan Zhang, Smriti Agrawal, Viktor Skihar, Lorraine Lau, Rowena Cua, Angelika Goncalves DaSilva, Jennifer Hahn. Dr. Jian-Qiang Lu (neuropathology resident), conducted basic science research training within the MS program. Statistics During 2008 there were 3484 patient visits to clinic physicians, over 5000 telephone encounters by clinic nurses, and over 2000 visits to OPTIMUS. There were over 19 !

MS clinical trials ongoing during 2008. Members Physicians Dr. Luanne Metz (Clinic Director) Dr. Michael Yeung (Clinical Trials Unit Director) Dr. Robert Bell Dr. Kevin Busche Dr. Fiona Costello Dr Jeptha Davenport Dr. Dan McGowan Dr. Jean Mah (Pediatric Neurologist) Dr. William Murphy Dr. David Patry Dr Dawn Pearson Non-clinical MS Research Team Dr. Lenora Brown, PhD Dr Jeff Dunn, PhD Dr. Richard Frayne, PhD Dr. Brad Goodyear, PhD Dr Shalina Ousman, PhD Dr. V Wee Yong, PhD Nursing Colleen Harris MN, NP (Clinic Manager) Kathy Billesberger, RN Brenda Buckner, RN Jackie Gaythorpe, RN Janice Hammond, RN Janet Moores, BN, MBA Sharon Peters, BN Lori Tillotson, BN OPTIMUS (Rehab Program) Jutta Hinrichs, BScOT (Program Coordinator) Risha Joffe, PhD (psychologist) Erin Gervais, BScOT Neera Garga, PT Myrna Harden, PT Tara Bramfield, RSW Janice Lake, RN

Clerical Staff Rochelle Lappan Vanessa Rosenzweig Sharon Stadnyk Colleen Selin Joanne Woo Rosalee Thorsen Clinical Research Staff Winona Wall (Research Manager/ clinic IT support) Nicole Anderson Charlotte Caunt Graziela Cerchiaro Michel Dube Shelly Jelinski Shirley Jorge Kathryn Linton Christina Ma Ellen Martin Beth Price Jose Ranawaya Jessie Trufyn Laboratory Research Staff Claudia Silva Yan Fan Hollie Mowbray Michelle Smekal Brooke Verhaeghe Fiona Yong Shuhong Liu Students and postdocs Pavan Ahluwalia Yunyan Zhang, MD, PhD Smitri Agrawal, PhD Lorraine Lau Victor Skihar, MD, PhD Angelika Goncalves DaSilva David Stirling, PhD Rowena Cua Cheryl McCrea, PhD Natalia Liapounova Axinia Doering, PhD Mengzhou Xue, PhD Nourhan Zayed 29


Neuromodulation Program Overview Neuromodulation is the altering / modulation of nervous system function by means of implantable devices or neural prostheses. It includes peripheral nerve, spinal cord and brain electrical stimulation, as well as drug delivery devices. Many conditions are treated including movement disorders, epilepsy, pain, angina, headache, spasticity, urinary incontinence; thereby involves all divisions within the Department of Clinical Neurosciences as well as specialists from other disciplines. Members Neurosurgery: Drs. Mark Hamilton, Zelma Kiss Neurology: Drs. Werner Becker, Scott Kraft, Neelan Pillay, Oksana Suchowersky, Sam Wiebe Physical Medicine and Rehabilitation: Drs. Dan McGowan, Noorshina Virani Pain physicians: Drs. John Clark, Darryl Guglielmin, Geoffrey Hawboldt, John Pereira, Chris Spanswick (Chronic Pain Centre), Dr. Peter Farran (ACH) Urogynecology: Dr. Magali Robert Cardiology: Dr. Jim Stone Gastroenterology: Drs. Christopher Andrews, Phil Mitchell Psychology: Melanie Denheyer, Drs. Angela Haffenden, Michael King, Paul Taenzer Psychiatry: Drs. Jeremy Quickfall, Raj Ramasubbu Nursing: Susan Anderson, Marlene Blackman, Thea Dupras, Colleen Harris, Karen Hunka, Tracy Hyndman, Jackie Martini, Grace Neustaedter, Christine O'Leary, Valerie Sherwood, Tammy Still, Angela Tse, Robyn Warwaruk Research: Drs. Michael Eliasziw, Bin Hu Grant Support Alberta Heritage Foundation for Medical Research Canadian Institutes for Health Research New Initiatives / Highlights Clinical care New procedures performed this year include area 25 subgenual cingulate DBS for the HBI-CRU funded pilot project on refractory depression Ongoing studies include the METTLE study of hippocampal DBS for epilepsy (enrolled 2 new patients) Nursing Neuromodulation Group is going strong, interacts with the Canadian Neuromodulation Society as pertains to database development and guidelines Training/teaching Nurses attend national and international conferences on neuromodulation, presenting at local meetings (e.g. CANN meeting in Feb-08) Clinical fellowship established, with the 3rd fellow (Mr. Ben Jonker from Australia) arriving later in the academic year; previous fellow, Dr. Jean Oropilla presented both a poster and platform presentation at the American Society for Stereotactic and Functional Neurosurgery meeting in Jun-08, published 1 chapter, 1 letter and 1 paper under revision.




Academic activities Members of the team gave invited presentations at the Canadian Neuromodulation Society, American Association of Neurological Surgeons, University of Alberta, University of Minnesota, University of Victoria Poster presentation at CNSF on “Deep brain stimulation for chronic cluster headache”, 2 posters presented at Society for Neuroscience Sue Anderson presented her project on “Nursing time required for a neuromodulation pain program” at the Canadian Neuromodulation Society meeting in Jun-08 Poster at the Neural Interfaces (NIH Neural Prostheses) conference was selected (from a total of 225) as 1of 7 highlighted as a platform presentation The group co-hosted Professor Helen Mayberg as an AHFMR visiting scientist in Apr-08 Mini-symposium in May during an extended Grand Rounds on Mechanisms of Neuromodulation: How electromagnetic stimulation can change nervous system function with world leaders, Professors Alim Benabid, Ronald Tasker and Robert Chen, and local UofC faculty Professors Bin Hu, Brian Bland and Sam Wiebe The GI Research Group hosted Drs. Richard McCallum and Edy Soffer, two world leaders in the field of Gastric Neurostimulation, at a research symposium in Jun-08 Knowledge translation Presentations to the Canada Trigeminal Neuralgia Association and the Parkinson’s Society of Southern Alberta “Hope Conference - Paving Your Path to Wellness” Participation in an advisory capacity to Alberta Health and Wellness through a funded workshop “Innovations in Surgery: Looking to the horizon”

Stereotactic planning for hippocampal deep brain stimulation for epilepsy




Neuromuscular Clinic Area 3 Health Sciences Center 403-944-4415 Members Dr. Keith Brownell (muscle disorders, myasthenia gravis, education) Ms. Roula Simmons (Clinic Facilitator/Coordinator) Dr. Cory Toth (nerve disorders, neuropathic pain, complications of diabetes) Dr. Chris White (ALS clinic director; myasthenia gravis, electrophysiology) Dr. Douglas Zochodne (Director; nerve disorders, regeneration and diabetes) Fellows: Dr. Lawrence Korngut, Dr. Jennifer Bestard Research nurses: Susan Wood, Shefina Mawani Support staff: Jennifer Anderson Social work: Melinda Hatfield and Domenica Smit Vision Within five years, the Neuromuscular Clinic, within the newly constituted Southern Alberta Nerve and Muscle Clinical Program Cluster, will emerge as an internationally recognized model for accessible, evidence based and compassionate care for patients with nerve and muscle disorders. Mission Statement To provide timely, expert and comprehensive consultation and care to patients with neuromuscular disorders. We will achieve this by offering state-of-the-art diagnostic and treatment services, developing specialized clinics, developing cutting-edge research and providing education to health care personnel. Our work will be characterized by a focus on our patients, excellence, collegiality and innovation. Trajectory Development of a five year plan for the Alberta Nerve and Muscle Clinic Cluster “without walls� based at FMC, RGH and the South Hospital The Clinic Cluster would comprise the current Neuromuscular Clinic, ALS Clinic, Neuropathic Pain Clinic, Peripheral Nerve Surgery Clinic with new models: Intake rapid review clinics, myasthenia gravis clinic, neuropathy clinic, and muscle subspeciality clinics focusing on muscular dystrophies and inflammatory myopathies Integration of Nerve and Muscle Clinical Neurophysiology and Rehabilitation within the clinic cluster Recruitment of one additional Neuromuscular Neurologist to our group for each one-two years of the five year plan in order to enhance our service, educational and research goals Integration of the NP (nursing practitioner) role within the Nerve and Muscle Clinic concept Current Strategic Alliances ALS Clinic (Dr. C. White) Peripheral Nerve Surgery Clinic (Dr. R. Midha) !



Neuropathic Pain Clinic (Dr. C. Toth) Neuromuscular Clinic, Alberta Children’s Hospital (Dr. Jean Mah) Clinical Neurophysiology (Drs. White and Zochodne) Regeneration Node (SCNR), Hotchkiss Brain Institute (Drs. Toth, White and Zochodne) 2008 Member Highlights Dr. Brownell worked extensively in medical education in 2008 at undergraduate, graduate, postgraduate medical and postgraduate nursing levels. He served as co-chair of the Physicianship Unit of the Medical Skills Unit and served as the Chair of the Multiple-Mini-Interview Development Committee. Activities included being a small group leader for both the Physicianship and Medical Ethics Unit of the Medical Skills Unit and in the Neuroscience and Aging curriculum. Ms. Roula Simmons pursued work on her Master Degree in Nursing with the goal of becoming a Nurse Practitioner in Neurosciences. With UofC nursing students she facilitated a major research project focused on the analysis of comorbidities in Neuromuscular clinic patients. She also worked extensively on patient education materials for NMC patients (e.g MG group, see below). Dr. Cory Toth served as the Director of the Neuropathic Pain Clinic where he has supervised or initiated five clinical trials in the management of neuropathic pain. He published several high impact papers in 2008 including papers in Diabetes, Neuroscience, PLoS One and Pain. He was awarded a Juvenile Diabetes Research Foundation (JDRF) Innovative operating grant for his work on diabetic complications. He received teaching awards (Gold Star, AMA Honourable Mention) in 2008. Dr. Chris White served as the Site Director for Clinical Neurosciences at Rockyview General Hospital in 2008. His administrative work included Membership on the Departmental Executive Committees, the Division of Neurology ARP committee, the South Hospital Campus Clinical Design Team and the Neurology residency training program. He is the Director of the ALS Clinic. He participated in two multicenter ALS clinical trials and a myasthenia gravis trial. He received the CMSA Letter of Excellence Preceptor award. He is an examiner for the Canadian Society of Clinical Neurophysiology (EMG).

NMC Retreat September 2008: (From left) D. Zochodne, D. Smit, J Bestard, K. Brownell, R. Simmons, C. White, S. Mawani, L. Korngut, S. Wood, and J. Anderson. Absent, C. Toth. !



Dr. Douglas Zochodne served as the Director of the Neuromuscular Clinic and Clinical Neurophysiology and was Co-Leader of the Regeneration Node, Hotchkiss Brain Institute. The Zochodne lab (currently 8 members including PDFs, graduate students and technicians supported by 6 external grants) published work on nerve regeneration and diabetes and renewed a key CIHR operating grant. He authored a text entitled “Neurobiology of Peripheral Nerve Regeneration� (Cambridge Press) published in 2008. The Neuromuscular Clinic facilitates"the Myasthenia Gravis (MG) patient support group, on a bi-yearly basis. The nonprofit MG support Group was initiated in the fall of 2006 and is facilitated by"our"clinic patient care coordinator and social worker. The support group"is dedicated to empowering patients and families to live well in the face of chronic MG through"education, peer support and"community networks."Activities included the organization of a patient and healthcare staff MG education day, and a patient MG identification and alert card.

Dr, Douglas Zochodne

2008 Research Funding: Lab based Number of External Project Grants: 8 External Personnel Awards: 5 (excluding summer studentships) Canadian Institutes of Health Research (CIHR; 3 grants) Canadian Diabetes Association (CDA) Juvenile Diabetes Research Foundation (JDRF) Natural Sciences and Engineering Research Council of Canada (NSERC) Alberta Heritage Foundation for Medical Research (AHFMR) [Scientist, Clinical Investigator, Postdoctoral Fellowships, Graduate Studentships, Summer studentships] National Institutes of Health (NIH) 2008 Research Funding: Clinical trials Number of Trials: 8 Industry partners: Johnson and Johnson, Talecris, Pfizer, Valeant, Purdue Juvenile Diabetes Research Foundation (JDRF) National Institutes of Health (NIH) Lundbeck and the University of Alberta ALS Society of Canada




Neuro-Oncology Program Directors Dr. Greg Cairncross - Medical Dr. Mark Hamilton - Surgical Overview The Neuro-Oncology Program, spanning multiple Departments, Institutes and medical disciplines, is dedicated to the care of patients with primary brain tumours and neurological complications of cancer. The Program includes formal Fellowship Training in the medical and surgical aspects of Neuro-Oncology and also includes research activities that span the clinical to basic biomedical continuum.

Tissue Bank and Bio-Repository; Alberta Radiosurgery Centre, NeuroOncology Nurse Practitioner Program; and Advanced Image Processing Laboratory. The Intraoperative Imaging Program in the Seaman Family MR Centre and the highly innovative robotic NeuroArm are other initiatives led by members of Clinical Neurosciences that directly enhance the care of patients by improving surgical therapies for all types of brain tumor.

A patient care conference (i.e., Tumor Board) and clinical trials meeting is held weekly at the Tom Baker Cancer Centre and every other week there is informal research and visiting Members of the Department of Clinical Neurosciences make a signifi- speaker seminar in the Faculty of cant contribution to the success of the Medicine. Clinical research efforts are Neuro-Oncology Program in a number focused on low and high gliomas in of important ways. First and foremost, adults and medulloblastomas in children. Most clinical trials are conducted members provide Neurosurgical and within large National or North AmeriNeuro-Oncological patient care servcan co-operative groups, such as the ices for adults and children at the Foothills Medical Centre, Alberta Chil- National Cancer Institute of Canada – dren’s Hospital and Tom Baker Cancer Clinical Trials Group or the Radiation Therapy Oncology Group, but Centre, oversee the Fellowship Trainindustry-sponsored studies and small ing Programs in Neuro-Oncology, suin-house trials are also supported. Arpervise Graduate Students and proeas of basic research emphasis invide senior leadership to the Clark H. clude 1) brain tumor stem cell biology, Smith Brain Tumour Centre ( 2) mechanisms of chemotherapy and ntre) and Southern Alberta Cancer Re- radiation resistance in brain tumor, 3) non-invasive detection of molecular search Institute (SACRI; changes in brain tumor using new im at the aging techniques and 4) development University of Calgary. Members of of experimental therapies for brain tuClinical Neurosciences were instrumental in establishing the Brain Tumor mor including oncolytic viruses, drugs that block the spread of brain tumor Stem Cell Core Facility; Molecular Dicells and methods for drug delivery. agnostics Core Facility; Brain Tumor !

Members Neurosurgeons" " Dr. Mark G Hamilton Dr. Betty MacRae Dr. Yves Starreveld Dr. Garnette Sutherland Neuro-Oncologists" " Dr. Jay Easaw Dr. Peter Forsyth Dr. Greg Cairncross ## Neuro-Pathologists" Dr Jennifer Chan Dr Jeff Joseph Dr David George Radiation Oncologists Dr. Rob Nordal Dr. Alex Chan Dr Siraj Husain Nurse Clinician" Crystal Tellent


Research Nurse Annabelle DeGuzman Neuro-Oncology Fellow Dr Paula de Robles Graduate Students Dr. John Kelly Michael Blough Morgan Westgate Grant Support Canadian Institute for Health Research Alberta Cancer Research Institute Tom Baker Cancer Centre Hotchkiss Brain Institute National Cancer Institute of Canada Alberta Cancer Foundation



Pediatric Neurosurgery Program Staff Neurosurgeons: Dr Mark G Hamilton (Division Head), Dr Walter Hader, and Dr Clare Gallagher Pediatricians: Dr Heather Graham and Dr Keith Jorgensen Nurse Practitioner: Kelly Bullivant Nurse Clinicians: Valerie Sherwood and Linda Gill Overview Pediatric Neurosurgery is a division of Pediatric Surgery (Department of Surgery) and the members are also part of the Division of Adult Neurosurgery (Department of Clinical Neurosciences). There are currently three Pediatric Neurosurgeons, all of whom participate in adult Neurosurgery Programs. Dr. Hamilton is the Head of the Division of Pediatric Neurosurgery, Dr. Hader and Dr Gallagher are the other Division members. Dr. Terry Myles, the former Head of Pediatric Neurosurgery, has recently retired from fulltime neurosurgical practice in Pediatric Neurosurgery. There are two Pediatricians who work in the Infant Cranial Screening and Remodeling Clinic. Kelly Bullivant is a fulltime Pediatric Neurosurgical Nurse Practitioner who provides inpatient and outpatient pediatric neurosurgical care and two nurse clinicians (Valerie Sherwood and Linda Gill) who provide outpatient pediatric neurosurgical care.

Ninety-seven percent of the surgical patients required inpatient stays. The average length of stay for Neurosurgical patients was 5 days compared to the average of 2.9 days for the whole inpatient surgery population. We are able to offer access to unique treatment modalities such as the intra-operative MRI theatre for assisting in the surgical treatment of epilepsy and brain tumor, a comprehensive neuro-endoscopic program, and the Stereotactic Radiosurgery Program for selected cerebrovascular malformations and brain tumors.

Clinical Aspects The Pediatric Neurosurgical Program in comprehensive, offering all aspects of pediatric neurosurgical care including management of hydrocephalus, brain and spinal injury, myelomeningocele, other forms of spinal dysraphism, refractory epilepsy surgery, spasticity, craniofacial disorders, and pediatric brain tumor (in conjunction with the Pediatric Neuro-Oncology Group). The Pediatric Neurosurgeons provide weekday call at the Alberta Children’s Hospital (ACH), and with the other members of the Division of Adult Neurosurgery participate in nighttime and weekend call schedules. # Approximately 210 elective and emergent surgeries occurred in 2008 at the Alberta Children’s Hospital. !

Alberta Children’s Hospital 36


Neurosurgery clinics run every week. Clinics include General Neurosurgery, Craniofacial Clinic, Infant Cranial Screening and Remodeling Clinic (Pediatricians), and Myelomeningocele Clinic. Approximately 1700 outpatient visits occurred in 2008. Clinical Program Examples The Adult hydrocephalus Clinic is now in its 6th year at the Foothills Hospital. This was initiated by Dr Hamilton to provide transition care for pediatric patients with hydrocephalus or tethered spinal cord after age 18 years. This clinic also coordinates care and assesses adults with untreated congenital hydrocephalus and untreated new onset hydrocephalus. A Hydrocephalus Registry has been established, currently with over 100 patients. Care guidelines have been created. This is a unique Canadian clinic providing an essential service for patients with two serious chronic diseases.

gery evaluates new patients for surgical treatment of craniosynostosis and provides long-term followup for all surgically treated children. An Intrathecal Baclofen pump can be offered to treat appropriate patients with severe spasticity. These patients undergo screening by Dr Hader and the Program Nurse Clinician, Val Sherwood. They must demonstrate a successful response to intrathecal injection of Baclofen through a lumbar catheter. This treatment can provide a dramatic improvement in quality of life for these severely affected patients. Other Activities The Pediatric Neurosurgical Division members participate in local and national administrative and educational functions. They also lead and collaborate in clinical research involving pediatric and adult hydrocephalus, epilepsy and brain tumor. During the last five years, the Division of Pediatric Neurosurgery members have published 14 peer-reviewed manuscripts. There are also 4 peer-reviewed manuscripts in-press, 1 manuscript undergoing peerreview, 5 book chapters published or in-press and 45 published abstracts. In addition, Drs Hamilton and Hader have collaborated on 8 successful research grant applications and been local principal investigators for 7 Clinical Trials. The Pediatric Neurosurgery Division is an active participant of the Canadian Pediatric Neurosurgery Research Study Group.

A comprehensive Craniofacial Program is coordinated through ACH. A community-based parent education and screening program involves Public Health Nurses and Nurses from ACH. Two Pediatricians coordinate the Infant Cranial Screening and Remodeling Clinic. Infant patients, who require Cranial Remodeling Headbands for correction of positional-related cranial deformities, can have their head scanned in a state-of-the-art Laser Unit. This allows creation of a custom treatment headband for each unique patient. Finally, a monthly Craniofacial Clinic attended by Dr Mark Hamilton and Dr Don McPhalen from Plastic Sur!



Peripheral Nerve Surgery Program Program Director: Dr. Rajiv Midha Overview This program is multi-disciplinary, encompassing clinical and electrodiagnostic services provided by Neurology and PMR faculty, electrophysiology support and surgical treatment of patients. The latter consists of state of the art surgical management of peripheral nerve conditions, such as complex peripheral nerve injuries, nerve tumors, brachial plexus surgery as well as advanced nerve repair and nerve transfer techniques. Members have recently launched a clinical randomized control trial which will be comparing surgical decompression to best medical management for ulnar neuropathy at the elbow. Three of the faculty members (Midha, Toth, Zochodne) within the program also have independent basic science research laboratories investigating various facets of peripheral nerve disease, including neuropathy, nerve injury and nerve regeneration. There is considerable collaboration amongst the principal investigators, of their graduate students and fellows. These individuals are also member of the spinal cord and nerve regeneration and repair program within the HBI (The links, or have more details for those interested).

Members Director & Neurosurgeon: Dr. Rajiv Midha Medical Neurologist & Electrodiagnostics:# Dr. Chris White Dr. Doug Zochodne Dr. Cory Toth Dr. Stephen McNeil Fellows: Dr. Bassam Addas 2007-8 Dr. Jacob Alant 2008-9 Intraoperative Electrophysiology Support: Michael Rigby Erin Phillip Research Interests Experimental nerve injury Nerve guidance tubes to repair nerve injuries Growth factors and stem cell therapy to enhance nerve regeneration Electrical regeneration interfaces (CIHR Regenerative Medicine and Nanomedicine Team grant) Insulin and IGFI effect on nerve injury and diabetic neuropathy Diabetic neuropathy Grant Support Canadian Institute for Health Research (CIHR) Alberta Heritage Foundation for Medical Research (AHFMR) Aegera Therapeutics Canadian Diabetes Association National Institute of Health (NINDS) Pfizer Corporation Integra Life Sciences

Local and visiting residents attending the 2008 annual University of Calgary Spine and Peripheral Nerve Surgery Course




Project NeuroArm Program Director - Dr. Garnette Sutherland Overview In 2008, full engineering sign off for the neuroArm robotic system was completed. Preclinical studies were performed and Health Canada, together with University of Calgary/ Calgary Health Region conjoint ethics board approvals for clinical application were acquired. The system was introduced to neurosurgery in a graded fashion and has been used on five patients, all with brain tumors. An index case was selected and the system was introduced to the media. This provided the University of Calgary with considerable international visibility, with articles appearing in various mediums.

NeuroArm was featured in three documentary series including the Discovery Channel’s Daily Planet, CBC’s The Nature of Things with David Suzuki and a documentary from the BBC on medical frontiers entitled Superdoctors. The system was also featured in a number of prominent publications such as The London Times, The Economist, and The Times of India. This also produced a number of invited speaking engagements to neurosurgical conferences such as the Society of Neurological Surgeons and the Congress of Neurological Surgeons, to teaching engagements at Dartmouth College and Johns Hopkins Hospital, and to influential policy-changing conferences as The Conference Board of Canada’s Centre for Advancing Health Innovations and The Science and Technology in Society forum in Kyoto, Japan. In this way, neuroArm innovation and the pathway to that innovation is shared around the world. In June of 2008, the operating room that housed intraoperative MRI (iMRI) and neuroArm was closed for renovations and an upgrade from a 1.5Tesla magnet to a 3Tesla platform. This improvement to the imaging capability of the iMRI will also improve the abilities of the neuroArm system. In parallel, neuroArm underwent modifications to allow full integration into the 3Tesla environment. Further application of the robotic technology is slated to begin in January 2009. Related to the neuroArm project, a new CFI grant entitled MR-PET guided, robotic, molecular characterization of brain tumor for individualized therapy was prepared and considered for round 6 consideration.

NeuroArm performing robotic-assisted surgery on live human patient.


During 2008, the research group continued to make progress in the development of cell-specific imaging technology. The project has required collaborations with multiple NRC institutes. Cell and vascular specific single domain antibodies have been successfully attached to nanoparticles based on silicon-coated ferrous oxide. An animal model has been used to show both sensitivity and specificity.



Members Project Leader:# # Garnette Sutherland


MDA Lead Engineers: Tim Fielding Perry Newhook Simon Hu George Feil Andrew Skorupski NRC Scientists: Boguslaw Tomanek Scott King Calvin Bewsky Teodor Veres Roger Mackenzie Danica Stanimirovic Maureen O’Connor Abedelnasser Abulrob University of Calgary investigators (not inclusive): Alex Greer James Larsson Yves Starreveld Yaoping Hu Gail Kopp Chris Macnab

Students: Peter Rizun Jason Motkoski Shawna Pandya David Brandman Residents: Cesar Serrano-Almeida John Kelly Shelly Lwu Atya Alflouse Zhunyu Fu Research Interests Surgical robotics Haptics Surgical simulation Education Grant Support Canada Foundation for Innovation (Infrastructure and Operating) Alberta Advanced Education and Technology (Infrastructure) Western Economic Diversification (Infrastructure) Reach! (Infrastructure and Operating) Alberta Heritage Foundation for Medical Research (Student Support) Canadian Institutes for Health Research (OperatingMolecular Imaging)

Dr. Garnette Sutherland




Skull Base Surgery Program Overview In conjunction with colleagues from the Division of Otolaryngology, the skull base surgery group combines long experience with novel approaches to offer patients the best surgical treatment and long term followup for these challenging lesions. In addition, close ties to both endocrinology, and the Alberta Radiosurgery Centre ensure that the nonsurgical aspects of treatment are equally well dealt with. Endoscopic approaches to pituitary and anterior skull base lesions are also offered when appropriate. Research interests represented within the program include clinical epidemiology, image guidance, robotic surgery, and surgical simulation. Clinical Initiatives Endoscopic Skull Base Surgery Building on the experience gained in endoscopic pituitary tumor resection, extended endonasal approaches to skull base pathology are being used. Esthesioneuroblastomas, olfactory groove and tuberculum sellae meningiomas are all being addressed endoscopically, where


appropriate. Advances in image guidance are being exploited to minimize surgical risk and reduce postoperative morbidity in best serving this patient population. Members Neurosurgeons:# # Dr. Elizabeth MacRae Dr. Garnette Sutherland Dr. Yves Starreveld ENT Surgeons: Dr. Joe Dort Dr. Brad Mechor Dr. Phil Park Intraoperative Electrophysiology Support:# Erin Phillip Michael Rigby



Spine Program Overview The University of Calgary Spine Program is a multidisciplinary program dealing with the care of individuals affected by conditions and diseases of the spine and spinal cord. It encompasses a combined fellowship program offering fellows exposure to Orthopedic Spine and Neurosurgical spinal care. We are now in the 11th year of our official existence and have provided training to 4 fellows per year. Our staff has grown to 6 orthopedic spine surgeons and we are recruiting for an additional neurosurgical spine surgeon to complement the existing 3 neurosurgical spine surgeons. Members Dr Stephan du Plessis (Chairman) - Adult Spine Dr Ken Thomas (Fellowship Director) - Adult Spine Dr Jacques Bouchard - Adult Spine Dr Steve Casha - Adult Spine Dr Roger Cho - Adult Spine Dr Jason Howard - Pediatric Spine Dr Rick Hu - Adult Spine Dr John Hurlbert - Adult Spine Dr David Parsons - Pediatric Spine Dr Paul Salo - Adult spine Dr Ganesh Swamy - Adult Spine Tara Whittaker - Research Nurse Ish Bains - Research Coordinator Emi Sanders - Database Manager Research On the research front the Spine Program has been active in a large number of clinical studies. There are currently 21 clinical trails ongoing within the program. The Odontoid screw study, Minocycline study, Bryan disc study and the Lumbar stenosis study has been going on for a number of years and are in the process of being finalized. The Novartis SCI study, Bioset TLIF and P15 Bone putty studies are new for this year and have started enrolling patients.


The intrathecal morphine study, Cethrin study, Helmet study and the Traumatic SCI predictive index study are in the process of going through the review process. Fellowship Thanks to the efforts of John Hurlbert we were fortunate to have two fellows from Australia this year. Dr Ball from Australia joined us in February and Dr Pope from Australia, Dr Bajammal from Saudi Arabia and Dr Cenic from Ontario started their fellowships in July. Our current fellows have active research projects ongoing and will be presenting their work at the Canadian Spine Society Meeting. New Developments Caleo Health Spine opened its doors in February; this multidisciplinary spine clinic is offering a one stop spine service. Services offered include primary and secondary assessments and treatments by physiotherapists, chiropractors, medical spine physicians as well as surgeons. This facility is geared to provide the full spectrum of spine care and rehabilitation. Spine Referral Project was started in the second part of the year. The goal of this project is to improve access to spine care. The hiring of a medical spine physician has allowed for consistent flow of patients through the outpatient facilities on the 12th floor. This has enabled us to centralize the referral process and by utilize a prioritization tool developed by the spine program. The goal is to provide patients with timely access to appropriate care by the appropriate provider. Spine database expansion is planned for the next year with the goals being the capturing of all data from patients referred for spine care. This will involve a major expansion of our existing database infrastructure and would allow for an electronic web based process to integrate with the spine referral project. The database will be used to capture outcome data form surgical as well as non surgical patients and would provide us with the ability to track outcomes on a long term ongoing basis.



Stroke & Neurovascular Programs Overview The Calgary Stroke Program experienced substantial growth in 2008 with the recruitment of three new stroke faculty members: Dr. Sean Dukelow, Dr. Eric Smith and Dr. Roger Thompson, bringing the program’s total stroke staff/faculty to 60. All three individuals bring unique skill sets to our program which will round out our academic strengths to include stroke recovery, white matter disease/vascular dementia, and basic science/ neuroprotection, respectively. Our program can now has an academic focus that spans the stroke care continuum. The Program has been able to maintain important lead roles with respect to professional and practice development, rehabilitation program facilitation and telestroke coordination and has established two new roles of Knowledge Management Advisor and Patient Experience Strategy Consultant: the first of their kind within the Calgary Health Region. A new Clinical Nurse Educator position, specifically dedicated to Unit 100 has also been established.

several trials where members of our program play significant steering or executive committee roles. Publication activity is steadily accelerating. Grant season was very busy with four faculty members applying for AHFMR junior investigator scholarship awards. Dr. Barber also received his AHFMR Clinical Investigator renewal. Dr. Shelagh Coutts had a very successful grant funding cycle this year. She received a CIHR operating grant

The Calgary Pediatric Stroke Program was established in 2008 by Dr. Kirton at the Alberta Children’s Hospital. This is the only the second such program in Canada. This significantly advances the scope and depth of the Calgary Stroke Program. Research initiatives that are developing from this program include neuroimaging studies, international epidemiology, and mapping of brain plasticity/recovery. The Neurovascular Program was brought under the Stroke Program umbrella significantly advancing the scope and depth of the Calgary Stroke Program and a Neurovascular Clinic which integrates specialist Neurosurgical, Neuroradiological, Neurointerventional and Neurological ambulatory care has been established. Stroke research continues to be a major portion of the program’s work. To date we are involved with over 15 clinical trials directed by Dr. Michael Hill. This includes


Dr. Tim Watson, a Calgary stroke neurologist, pauses for a photo before he and his wife, Doone Watson, rappelled off the Heart and Stroke Foundation building in Kensington. (Leah Hennel, Calgary Herald)



and Pfizer grant for her CATCH study which examines CTA in the minor stroke/TIA population. CATCH is currently recruiting at a brisk pace due to the enthusiasm the entire team has the project. This CIHR funding is Dr. Coutts first major grant as an independent investigator. Dr. Coutts also received pilot funding for her TIA Hotline project with a major grant submission pending. The PREDICT multinational, multicenter observational study coordinated by our program continues to recruit intracerebral hemorrhage patients for acute CT angiography. Preliminary findings demonstrating the dramatic utility of CTA for identifying patients at risk of ICH growth when the “spot sign” is present. This work was presented as a platform by Dr. Demchuk at the International Stroke Conference and European Stroke Conference. PREDICT has spawned the development and successful funding for the STOP-IT randomized Phase 2 clinical trial evaluating recombinant Factor VIIa in Trial in CTA spot sign positive patients. The trial is being coordinated by University of Cincinnati with our program leading the CT scan analysis. The trial was funded by National Institutes of Health SPOTRIAS program. The fellowship program continues to be highly regarded on an international level. To date the Calgary Stroke Program has graduated a total of 28 fellows from 10 different countries. This past year, four fellows left our program: Dr. Mohammed Alzawahmah, moved to London, Ontario to continue a fellowship in Neurocritical Care before returning to a faculty appointment at Royal Military Hospital in Riyadh, Saudi Arabia. Dr. Alex Poppe returned to Montreal, joining the faculty at the University of Montreal CHUM. Dr. Albert Jin has joined the faculty at Queen’s University in Kingston, Ontario, and Dr. Cynthia Herrera returned to Brazil to neurology practice. Dr. Talip Asil joined our program in February of 2008 from Idirne, Turkey. Dr. Nan Shobha joined in May from Bangalore India, Dr. Bijoy Menon in November from Chennai, India. Dr. Dar Dowlatshahi (Ottawa) also joined the fellowship in July. He was successful at obtaining external funding for fellowship through the CIHR and University of Ottawa fellowship award programs. We are continuing to pursue other international links and part!

nerships and hope to establish a formal collaboration with at least one major stroke care provider in the UK in 2009. We have continued to make improvements in clinical services for people affected by stroke right across the continuum. These improvements are aligned with our role as one of two Comprehensive Centres within the overall Alberta Provincial Stroke Strategy (APSS). Our formal Telestroke connection with Drumheller as a Primary Stroke Centre has been established and we continue to provide Comprehensive Stroke Centre support to Lethbridge and Medicine Hat. Around 10% of ischaemic stroke patients receive tPA at the FMC site and we are working to increase this number alongside reducing door to needle time through our HASTE Six Sigma project which is moving from its Analyse to Improvement phase. We believe this to the first application of Six Sigma as an quality improvement process in stroke care in Canada. Working with the team on Unit 112 FMC we have been able to improve our capacity to provide intensive care to hyperacute and acute stroke patients by increasing the number of monitors available to beds on the unit. With the support of Rehabilitation and Specialised Clinical Services we were able to extend a pilot project enhancing acute inpatient therapy to patients on Unit 100 for a full year. A full time Therapy Assistant position has been now funded on a permanent basis and we are looking to secure ongoing funding for more Speech and Language Therapy, in particular with regard to communication interventions, which has been a critical component to the project (which completes at the end of 2008.) Other benefits of this work have included full implementation of the TOR-BSST swallowing screen and having therapy positions dedicated to the acute stroke unit itself. The Stroke Facilitated Discharge and Transition Team has been established through a partnership with Homecare services and Rehabilitation and Specialised Clinical Services. This service will run as a pilot throughout 2009 and will provide home / community based rehabilitation interventions, thereby facilitating early supported discharge from inpatient care units across the city and more 44


comprehensively supporting transition for stroke patients and their families. The Stroke Prevention Clinic maintains a high volume of clinical activity and completed a very successful Kaizen in the summer which resulted in significant improvements in clinic process and our ability to measure the performance of our ambulatory stroke care. Again, we believe this to be first application of LEAN improvement techniques in stroke care in Canada. Learning About Stroke, and Living With Stroke are two new patient education and self management interventions which we be offering to people affected by stroke through our partnership with Regional Chronic Disease Management. These new services will be available in May 2009. Other initiatives designed to address stroke prevention include pilot projects in community awareness of stroke, and community based hypertension detection and management. We have continued to develop our professional development and education profile in 2008 with a wide range of different teaching and learning opportunities provided by physicians and staff associated with the Program. More than 1600 members of Regional staff and physicians attended educational sessions about stroke and stroke care between February and November 2008. Educational resources about stroke are also a major component of a new internal website for the Program which is being launched at the time of writing this report.

Neurovascular Program The Neurovascular Program is a joint collaborative effort of specialists and allied healthcare staff from multiple disciplines (cerebrovascular and endovascular neurosurgery, interventional neuroradiology, and stroke neurology), to combat neurological vascular disease. The past year has seen further academic integration of the Neurovascular Program into the Stroke Program. Shared resources have allowed greater new and continued participation of neurosurgery and radiology in several international stroke studies, such as IMS-3, CREST, ENACT, ALISAH, and CONSCIOUS-2. The program has continued to see growth and expansion in the number of patients with complex cerebrovascular disease. Approximately 500 patients with neurovascular disease are seen yearly in a specialized outpatient clinic for evaluation and follow-up. Currently about 200 patients are treated annually via minimally invasive endovascular means such as endovascular coiling, embolization, and carotid stenting. As well, surgical volumes and expertise in open neurosurgery have been maintained with the availability of specialized procedures such as craniotomy and aneurysm clipping, carotid endarterectomy, resection of vascular malformations, and extracranial-intracranial bypass. An integrated relationship with the Alberta Radiosurgery Centre, which uses focussed radiotherapy techniques unique in Canada, has allowed the non-invasive and safe treatment of patients with complex arteriovenous malformations. In 2008, the outpatient experience of patients with cerebrovascular disease from both clinical and administrative standpoints was consolidated and the weekly Neurovascular Clinic was launched. A joint initiative of specialists from cerebrovascular neurosurgery, interventional neuroradiology, and stroke neurology, this will facilitate the rapid triage and evaluation of patients to expedite and provide high-quality care, and allow further opportunities for teaching and clinical studies. We continue to attract applicants to the endovascular fellowship program from countries worldwide and from multiple disciplines including neurosurgery, radiology, and neurology.




Faculty and Staff Listing Dr. Andrew Demchuk, Director, Calgary Stroke Program (Emily Collins, Administrative Assistant) Dr. Michael Hill, Director, Stroke Unit (MichelleRae Wright, Administrative Assistant) Dr. Nic Weir, Director, Calgary Stroke Prevention Clinic (Lori Finch, Administrative Assistant) Dr. John Wong, Director, Neurovascular Program (Brent Lester-Satzke, Neurovascular Clinic Coordinator) Dr. Mark Hudon, Head, Neuroradiology Michael Suddes, Program Manager, Alberta Health Services Stroke Neurologists Dr. Phil Barber, Dr. Shelagh Coutts, Dr. Keith Hoyte (Part-time), Dr. Gary Klein, Dr. Peter Stys, (Part-time), Dr. Tim Watson, Dr. Eric Smith# Cerebrovascular Neurosurgery Dr. John Wong, Dr. Garnette Sutherland Interventional Neuroradiology & Endovascular Neurosurgery Dr. Mark Hudon, Dr. William Morrish, Dr. Mayank Goyal, Dr. John Wong Diagnostic Neuroradiology Dr. William Hu, Dr. James Scott, Dr. Carla Wallace, Dr. Kate Bell, Dr. John Lysack, Dr. Rob Sevick Stroke Fellows (2008) Drs. Talip Asil, Mohamed Alzawahmah, Dar Dowlatshahi, Pablo Garcia, Al Jin, Bijoy Menon, Alexander Poppe, Nan Shoba, Nikolai Steffenhagen Interventional Neuroradiology Fellows (2008) Dr. Pranshu Sharma Dr. Muneer Eesa Stroke Research Nurses Karla Ryckborst, Karyn Fischer, Marie McClelland, Carol Kenney# # # #




Urgent Neurology Clinic Staff Director: Dr A. Hanson Nurse Clinician: Janet Warner FMC UNC clerk: Patricia Hammel ( maternity leave coverage - Addie Stowe) RGH UNC Nursing" Staff: rotation every 3 months from Unit 46 (Laura Murdock, Regan Thomson and Vita Mina) RGH UNC"clerk: "Holly Wowk" " FMC Physicians: Drs P. Barber, R.Bell, S. Coutts, T. Feasby, P. Federico, S. Furtado, A. Hanson, J. Kohli, L. Korngut, W. Murphy, T. Watson, and M. Yeung. " RGH Physicians: Dr C. White (RGH" Associate Director), Drs. F. Amoozegar, R. Bell, K. Busche, D. Patry, D. Pearson, " Relief Physicians: Drs K. Brownell, N. Jette Overview 2008 was a busy year for the Urgent Neurology Program, with the opening, in October, of a second site for Urgent Neurology Clinics, at the Rockyview General Hospital. The Rockyview Neurology Planning Committee was comprised of Dr. Chris White, Cathy Edmond, Janice Hagel, Tina McLean, Mike Rigby, Wendy Carruthers, Pam Sweeney, and Janet Warner.

Doctors Busche, Pearson, Patry, and White moved their Urgent Neurology clinic times to the RGH UNC, and Dr. Brownell is the relief doctor for the RGH UNC. Dr. Farnaz Amoozegar, the Headache Fellow, started seeing patients at the RGH UNC in November. The Rockyview Urgent Neurology Clinic opened with a full time clerk, and a nurse rotating through the clinic from the Neurology Floor at the Rockyview. Both staff were oriented at the Foothills Urgent Neurology Clinic. The Foothills site receives all of the Urgent Neurology clinic referrals, and triaging is done by the Program Director, Dr. A. Hanson, with the Nurse Clinician, Janet Warner. The opening of the Rockyview site has split the workload of the Program, so that the staff at Foothills now have a manageable load. Approximately 50% of all referrals received, continue to be inappropriate for the Urgent Criteria of the clinic. The new referral form has resulted in more information being received from referring doctors, but has not decreased the number of inappropriate referrals. Emergency physicians have sent 40% and general practitioners have sent 55%, respectively, of the inappropriate referrals. The Urgent Neurology Program Mandate which includes the inclusion and exclusion criteria was sent to the Dr. R. Anderson, Head of Emergency Medicine, for him to send to all of the ER physicians.

During the planning period, the Mandate of the Urgent Neurology Program was reassessed and updated. New guidelines for the triaging and distribution of referrals were developed. In June, a staff meeting of the Urgent Neurology Clinic was held. A discussion regarding what patients were appropriate to be seen in the clinic was held. Criteria for Inclusion and Exclusion were agreed upon.




2008 Divisional Updates Division of Neurosurgery Academic Neurosurgery in Calgary The Division of Neurosurgery, led by Dr. Raj Midha, is committed to the Faculty of Medicine’s vision for academic medicine in Calgary which is “Creating the Future of Health” and the vision of the Calgary Health Region (CHR) which is, “Our community working together for excellence in health”. Academic neurosurgery in the Calgary Health Region and at the University of Calgary centres around the education, research, clinical and administrative work and service performed by the 14 members of the Division of Neurosurgery in the Department of Clinical Neurosciences. Unlike most other Canadian medical schools Dr. Rajiv Midha and large quaternary level hospitals where neurosurgery would be placed organizationally within a Division of Surgery, Calgary has developed a Department of Clinical Neurosciences which brings together neurologists, neurosurgeons and physiatrists into a single structure which allows for greater coordination of academic and clinical activity across the broad spectrum of brain, spine, nerve, pain, muscle and movement disorders that afflict patients. Clinical Excellence in Neurosurgery Services The Division of Neurosurgery of the Department of Clinical Neurosciences, provides full neurosurgical services for adults and children including Level One Trauma support to the southern half of the province of Alberta as well as the eastern part of British Columbia in the Kootenay Region through the Foothills Medical Centre (FMC) and Al!

berta Children’s Hospital (ACH). The level of clinical service delivered by Calgary’s neurosurgical community is comprehensive, and is built around the qualities of excellence, competence, quality, safety and innovation. The roll-out of the Alternative Relationship Plan for Neurosurgery (in 2001, and renewed in 2008) has fostered a mechanism of timely appropriate transfer of cases to neurosurgical subspecialties and therefore allowing the highest quality of care for each and every patient. General neurosurgical services as well as subspecialty care in complex spinal diseases, skull base surgery, paediatrics, peripheral nerve disease, cerebrovascular and endovascular neurosurgery, epilepsy and functional neurosurgery are provided at the FMC and the ACH sites. Stereotactic radiosurgery is provided in the Tom Baker Cancer Centre, which houses the innovative Alberta Radiosurgery Center (ARC), in collaboration with the radiation oncologists. Dr. Betty MacRae

Dr. Terry Myles

In addition to general neurosurgical call, sub-specialty call coverage is provided for paediatric neurosurgery, spine, and cerebrovascular (including endovascular) surgery. While leading and encouraging the development of innovation in neurosurgery service in Southern Alberta, Divisional Members have continued to deliver core neurosurgical services to the patients in the catchments area. 48


In 2008, at the FMC site, there were approximately 1800 inpatient admissions to neurosurgery and over 5700 outpatient visits to a neurosurgeon office. Neurosurgeons in the CHR performed approximately 2000 procedures in 2008, comprising 1700 procedures in the regular OR, and another 300 procedures in the endovascular, stereotactic radiosurgery ARC unit and ICU settings.

the technique in a patient care setting. Microdialysis is being combined with other multimodality monitoring to determine changes occurring in the brain after injury. These insights into brain neurochemistry will allow us to tailor treatment to each patient and we hope to provide a more coordinated approach to therapy between intensivists and neurosurgery, as well as obtain information that will lead to better treatments in the future.

Below are listed specific examples of excellence in clinical care and innovation, in the various subspecialty areas:

Endovascular Neurosurgery Treatment of vascular diseases of the nervous system has been evolving to less minimally invasive interventions over the past decade. Such treatments are quickly becomLeadership in spine surgery and spinal cord injury The spinal neurosurgery group has embraced minimally ing the standard of care for the invasive techniques for spinal surgery and “bench to bedtreatment of diseases such as side” drug therapies for spinal cord injury and are leading intracranial aneurysms and cathe way in Canada for their aprotid stenosis. With the recruitplication within clinical researchment of the province’s first neucentered trials. Calgary is one of rosurgical endovascular neuroonly two centres contributing to surgeon, Calgary has quickly a national database of spinal become Western Canada’s cord injured patients. This cenleader. For instance, the endotre has successfully launched vascular program treated apand is completing a clinical trial proximately 200 patients annuDr. John Wong in spinal cord injury based on ally. Many of these patients were preclinical work performed at treated with a single day admisthe University of Calgary. We are sion, using minimally invasive approaches (as opposed to also actively involved with two open traditional surgery), and were saved long in-hospital Dr. Stephan DuPlessis other industry initiated clinical stays. In conjunction with our well-known and internationtrials in this disease. The outally recognized Stroke Program, the endovascular program come of this effort will be reduced post surgical lengths of has already become an important partner in stroke restay, and reduced recovery time for patients. search. Traumatic Brain Injury & Neuro-critical Care Basic combined with clinical research is beginning to create an understanding of the complex neurochemistry and physiology of severe traumatic brain injury. Given the advances that have been made worldwide in this area both Drs C. Gallagher and D. Zygun have undergone training in treatment of neurotrauma at the University of Cambridge. As a result the use of intracerebral microdialysis in the investigation and treatment of traumatic brain injury is now underway at Foothills Medical Centre Intensive Care. This means Calgary is the first Canadian centre to routinely use !

Alberta Radiosurgery Centre This program, using a Novalis system, the first of its kind in Canada, is a collaborative effort between the Divisions of Neurosurgery and Radiation Oncology. The technology is capable of offering focused radiation treatment for diseases of the brain and spinal cord in single daycare sessions, thus obviating the need for lengthy hospital stays associated with standard neurosurgical treatments. With our average length of stay of 7.6 days, this alone is a substantial system wide saving in bed days. By reducing risks of therapy, and ease of returning to normal activities, it re49


sults in much higher patient satisfaction. The program, since its initiation in 2002 has grown steadily, and treats dozens of patients yearly with single and fractionated cranial and extracranial radiosurgery. Neuro-Surgical Oncology Program In collaboration with the Department of Oncology at the Tom Baker Cancer Centre, we have established a neurosurgical oncology program under the direction of Mark Hamilton. This subspecialty approach to surgical treatment for patients with malignant brain tumors has helped integrate surgical care into existing neurooncology programs in the region which has facilitated timely access to appropriate surgery. It has also enabled development of a clinical research program in Dr. Mark Hamilton neurosurgical oncology. Since its inception in 2005, several neurosurgically-based clinical trials have been opened, giving neuro-oncology patients in Southern Alberta access to novel therapies such as immunotherapy and convectionenhanced toxin delivery that would otherwise be unavailable. Surgical Epilepsy Program Surgical treatment of epilepsy has been known to provide excellent results in properly selected patients with medically refractory epilepsy. Access to such treatment however remains limited. Tremendous growth of the Calgary comprehensive Epilepsy program, a collaboration of adult and paediatric epilepsy centres, has been possible with addition of a new 4 bed monitoring unit at the FMC and 2 bed unit at the ACH, for the assessment of possible candidates for surgery. Dr. Walter Hader In addition, the recruitment of !

several new epileptologists (including the Division head of neurology) and a recruit (in 2006), of a neurosurgeon who has expertise in epilepsy surgery, has considerably enhanced the program. The volume of cases has steadily increased, and averages approximately 75 cases yearly within the CHR. Peripheral Nerve Program In collaboration with the Divisions of Neurology (neuromuscular program) and Physical Medicine and Rehabilitation, a surgical peripheral nerve program, has been initiated with the recruitment of the Division head in neurosurgery, an established peripheral nerve expert. State of the art surgical management of peripheral nerve conditions is now possible in Western Canada. This program already attracts referral of patients from all of Alberta, and indeed a few select patients from across Canada, and treats approximately 70 patients a year with advanced peripheral nerve surgery. Skull Base Surgery Program In conjunction with colleagues from the Division of Otolaryngology, the skull base surgery group combines considerable experience with standard proven, as well as novel, approaches to offer patients the best surgical treatment and long term follow-up for these challenging lesions. In addition, close ties to both endocrinology and the Alberta Radiosurgery Centre ensure that all aspects of treatment are considered and offered. An emerging strength is the use of minimally Dr. Yves Starreveld invasive endoscopic approaches to pituitary and anterior skull base lesions for appropriate cases. Neuromodulation Program In collaboration with the several other departments and divisions, (Neurology, Cardiology, Anaesthesia/Chronic Pain Centre, Urogynecology, and Gastroenterology). Calgary patients are offered the full range of implantable de50


vices to alter nervous system functioning. While this program started by providing surgery for patients with movement disorders (such as Parkinson’s disease, dystonia and tremor) it has grown to involve treatment of patients with spasticity, epilepsy, chronic migraine, refractory angina, various specific chronic pain conditions and psychiatric disorders. The program has continuously expanded offering new therapies and testing experimental treatments by leading multicentre clinical trials (e.g. Brain 2007). The Division of Neurosurgery Dr. Zelma Kiss continues to lead this program in both hands-on surgery, administrative and academic aspects. This program attracts referral of patients from all across Alberta and eastern BC. Paediatric Neurosciences Program In collaboration with the paediatric neurology Division at the ACH paediatric neurosurgery has lead the way in development of Western Canada’s first paediatric neuroscience unit, within the new children’s hospital (ACH). Technological innovation with the introduction of groundbreaking clinical and research technology, magneto en-

cephalography, which provides a novel way of understanding brain function, will provide paediatric neurosciences with further innovation at the new Children’s Hospital. Robotics Program As a continuation of the highly successful and internationally acclaimed intraoperative MRI neurosurgical program, the development of a MR compatible robot to assist with cranial (and non-cranial) microsurgery is proceeding. This program is on the leading edge (world-wide) of innovation and research, brings together experts (under the leadership of neurosurgery) in robotics, engineering, imaging, haptics and molecular biology. Our partners are the University of Calgary, the Calgary Health Region, and industry. The robotics program technology initiative has the potential to revolutionalize the way that neurosurgery is performed in the future. Creating the Future of Neurosurgical Clinical Service With the addition of the several neurosurgeons over the past 8 years to our faculty, subspecialty neurosurgical care in all major areas is covered, with several new services now being delivered through considerable innovation in care. Two examples of innovation in neurosurgery care are described below: a) Neurosurgery, Physiotherapy and Chiropractic Collaborative Care The Division has met the ever growing clinical challenge to diagnose and treat its rapidly expanding referral base in diseases of the degenerative spine. New referrals to neurosurgeons alone in this area number well over two thousand patients per year. The needs of many of these patients are now addressed through an innovative process of clinical screening, referral and treatment which ensures that the appropriate treatments are provided to the right patients by the appropriate clinician. This new approach involved different groups – specifically physiotherapists and chiropractors – in the process of developing and delivering optimal neurosurgical care for these patients

Dr. Garnette Sutherland, performing live robotic microneurosurgery in the control room using NeuroArm.




In order to help patients with diseases of the degenera- tants Program (CCAP) with the neurosurgical service, is tive spine, an innovative model of spinal care, National now helping manage the medical Spine Clinic, where she Spine Care (NSC), was established. Degenerative spine helps triage patients with dedisease is usually accompanied by severe pain and debiligenerative spinal complaints to tating pain in the lower back or neck most commonly assurgical or medical treatment. sociated with a degenerative spinal disc. NSC offers an Patients are neurologically innovative multi-disciplinary approach to the efficient and evaluated under the supervision effective screening and assessment of patients facilitated of an attending neurosurgeon through the collaboration of the spinal neurosurgeons with a view towards identificaworking with specially trained physiotherapists and chirotion of surgically remediable practors. disease. The clinic provides expedited spinal advice to about This model of interdisciplinary collaboration was de80 patients per month, and has veloped with the full endorsement of the College of Physisignificantly reduced neurosurDr. Salma Yaseen cians and Surgeons of Alberta. Prior to NSC, 90% of degical waiting lists. generative spinal referrals were deemed to be non- surgical patients after assessment by a neurosurgeon. Patients b) Neurosurgery and Nursing Collaboration in the Hosunder the NSC are assessed by spinal neurosurgeon pital Setting A second example of innovation in neurosurgical patrained chiropractic and physiotherapists to assess patients for suitability of assessment by the neurosurgeon. tient care is in the hospital setting, through the development of a Clinical Nurse Practitioner (CNP) program. Patients are therefore more appropriately triaged into a Nurses who are trained through the nurse practitioner program offered by the University of Calgary Faculty of Nursnon surgical spinal therapy program or surgical assessment, where now approximately 85% of those now seen by ing take a third year clinical placement that focuses on the the neurosurgeon are offered ward care of neurosurgical patients, the evaluation of surgery. The result is significantly medical problems in pre- and post-surgical care and the increased throughput of patients, technical and clinical skills related to the care of neurosurgical patients. and resulting decreased waitlists. An average assessment by a physiotherapist or chiropractor Enhancement of all facets of in patient care, pre- and post-surgical education and continuity into the community within the NSC program takes has been possible with the training and implementation of about an hour. Each year about 4 Clinical Nurse Practitioners (CNPs) within the system, 1,500 assessments are being with a 5th now nearing completion of training. done so the use of physiotherapists and chiropractors in the Dr. Steve Casha this innovative care model has c) Neurosurgical Locum Tenens Opportunities freed up about 1,500 hours of The Division of Neurosurgery is now able to offer highly neurosurgeons’ time to be used on more difficult and com- selected individuals, the opportunity to initiate their surgical plex patients, and those actually requiring surgery. career within the Department on a per annum contract basis. Typically newly credentialed by the Royal College of The Division of Neurosurgery has also established a Surgeons, these physicians are well-trained neurosurgeons medical Spine Clinic overseen by Dr. Stephan Duplessis from respected programs who wish to transition from resiand Divisional members within the Foothills Medical Centre dency to full-time staff in a structured and rigorously acasite. Dr. Salma Yaseen, an international medical graduate demic environment. The locum position offers the benefits who has previously completed the Calgary Clinical Assisof quickly adopting a busy general neurosurgical practice !



with administrative and operative resources, with the ready availability of subspecialty neurosurgical advice from Divisional members. Our locum tenens beginning in July 2008, was Dr. Keith MacDougall from the University of Western Ontario. Already a talented surgeon, Dr. MacDougall has taken this opportunity to hone his clinical skills and refine his academic goals. Dr. MacDougall plans further subspecialty training in epilepsy and functional neurosurgery in London Ontario and Australia beginDr. Keith MacDougall ning in 2009. Educating New Physicians and Creating the Neurosurgical Care Team of the Future a) Undergraduate Medical Education The Division of Neurosurgery provides teaching excellence in the University of Calgary Faculty of Medicine to both undergraduate medical students and post graduate trainees in the neurosurgical residency program. Within the undergraduate medical curriculum, Divisional members serve as mentors in Course V: neuroscience and aging course lecture. Division members are involved in undergraduate small group seminars and bedside teaching. Several members of the neurosurgical faculty have received undergraduate and post-graduate teaching awards from the University of Calgary. b) Post-Graduate Medical Education Directed by Dr. John Hurlbert, the University of Calgary Neurosurgical Residency Training Program has continued to excel, and indeed has flourished with an increasing resident complement pool from 2000 (5 residents) to 2008 (13 residents). The Program has now realized a stable complement of residents and has gained approval of 2 PGME funded positions a year.


Resident operating room teaching and technical skill training, critical care unit, emergency room, clinical ward and outpatient experience are provided at the Foothills and ACH sites by neurosurgical faculty member mentors and supervisors. A resident-faculty partnered core curriculum (2 hours weekly, with Dr. John Hurlbert a 3 year cycle) is supplemented by lectures on basic neurosciences, clinical case presentations/discussions and grand neuroscience rounds (at the academic half day). In addition, weekly neuropathology rounds, core surgery seminars, subspecialty rounds, and a visiting professorship program round out the didactic teaching. Formal oral and written neurosurgery examinations are conducted by the neurosurgical team every 3-6 months to evaluate and monitor resident academic performance profiles. Weekly interesting case rounds and bimonthly morbidity and mortality rounds provide an opportunity for open discussion relating to challenges in patient care, including honest discussion of adverse events, ethical standards and medicolegal issues. Finally, quarterly journal clubs enable instruction in reviewing and reading the literature to instill evidence based-best outcome clinical practice. In addition to postgraduate training, the Division of Neurosurgery offers Fellowship training in complex diseases of the spine (several dozen Fellows trained over the past decade), the surgical treatment of epilepsy, functional and stereotactic neurosurgery, endovascular neurosurgery and peripheral nerve surgery. Each of these programs has or is training Fellows, and (given that International Fellows can choose to go anywhere) reflects the maturity and the prominence of these programs. Other Health Professional Education: Medical, Nursing, Physiotherapy, and Chiropractic Calgary’s neurosurgeons have utilized the advanced practice nursing program from the University of Calgary to train clinical nurse practitioners who work with neurosurgery patients in the pre- and post-surgical setting. This 53


training occurs predominantly in the third year of the program in a clinical setting where the advanced practice nurses work closely with neurosurgeons. The Division is pleased to be offering clinical mentorship and guidance to international medical graduates who intend on entering into the Canadian physician workforce. Dr. Bipan Sumbria, a previous general surgeon, is currently enrolled in the two-year Calgary Clinical Assistants Program and is expanding his knowledge base Dr. Bipan Sumbria and clinical repertoire of Western medicine on the neurosurgical wards, emergency department, and in the clinic. The neurosurgeons provide the training to the physiotherapists and chiropractors involved with the clinical assessment services offered through the NSC program. This program received approval from the Alberta College of Physicians and Surgeons and is a successful model of inter-disciplinary cooperation. d) Continuing Medical Education and Public Education Additionally, Divisional Members are involved in various teaching activities targeting the public, and continuing medical education seminars for primary care physicians, emergency physicians and referring doctors. Given their National and International stature, several Members are also prominently involved in the teaching of residents, fellows and their colleagues at Specialty and Sub-specialty meetings.

tient outcomes, is dependent on the excellence in the clinical neurosciences provided by members of the Division of Neurosurgery. The goal of the Division of Neurosurgery is to foster the goals of the HBI and advance the HBI and University of Calgary as a world leading institute for Neuroscience research and translational clinical treatment. Clinical and basic science research is completed by all division members, four of whom run externally funded research programs, and many who play prominent roles in Hotchkiss Brain Institute programs including Neuroarm, Spinal cord and nerve regeneration, Epilepsy and brain circuits, and Movement disorders and therapeutic brain stimulation. As one measure of academic productivity, grant money from National and Provincial agencies awarded to Divisional Members has increased several-fold over the past decade, and was > $2.5 Million in 2007-8. Out of the 10 GFT faculty, 3 have independent operating grant support from CIHR, an extraordinary level of success for a surgical Division in Canada. Another measure is peer reviewed publications, which continue to increase yearly, and are fully documented in the publication section elsewhere in the Annual Report. Fostering the Bio-Science Economy of the Future The research program of members of the Division has a significant focus on technology commercialization and the development of effective partnerships and alliances with interested and committed partners from the private sector. The world’s first MRI-compatible surgical robot is the creation of Calgary neurosurgeon Dr. Garnette Sutherland and his team. Dr. Sutherland has spent the last 7 years leading a multi-disciplinary team of Canadian scientists, in cooperation with MacDonald, Dettwiler and Associates Ltd. (MDA), to design a machine “that represents a milestone in medical technology.”

Creating Knowledge for the Future Research within the Division of Neurosurgery is accomplished through cooperation and close alignment with the Department of Clinical Neurosciences and the Designed to be controlled by a surgeon from a comHotchkiss Brain Institute (HBI) at the University of Calgary. puter workstation, neuroArm operates in conjunction with The goal of the HBI, to be a world leader in Translational Neuroscience and Mental Health research and commitment real-time MR imaging, providing surgeons unprecedented detail and control, enabling them to manipulate tools at a to translating basic science discoveries into improved pamicroscopic scale. Advanced surgical testing of neuroArm !



was completed in 2008, and the first few patients have had neuroArm assisted robotic cranial neurosurgery.

Many Divisional Members have prominent leadership positions at National and International levels. For example, Dr. Hamilton is past President of the Canadian Congress of Developing neuroArm required an international collabo- Neurological Sciences. Dr. Midha is the past President of ration of health professionals, physicists, electrical, softthe (international) Sunderland Society, past President of the ware, optical and mechanical engineers to build a robot American Society for Peripheral Nerves and prior Chair of capable of operating safely in a surgical suite and within the Peripheral Nerve Task Force in organized American the strong magnetic field of the intraoperative MRI envineurosurgery. Dr Hurlbert was recently the Education ronment. Indeed, this past year the 1.5 Tesla intraoperative Committee Chair of the Joint Spine and Nerve Disorders MR has been upgraded to a state-of –the-art 3.0 Tesla sys- Section of AANS/CNS and was the Scientific Program tem. Many other surgical disciplines have and continue to Chair for their meeting in 2007. participate in applying neuroArm to various types of surgical procedures. Summary Administration/Leadership All Divisional Members carry out important administrative duties within the Foothills Hospital, ACH and CHR, and for the purposes herein we will highlight just a few examples.

The Division of Neurosurgery at the University of Calgary continues in its aim towards the development of a world class institution known for excellence in clinical neurosurgery as well as neuroscience education and research.

The Divisional Head, Dr Rajiv Midha, sits on multiple hospital, Departmental and Regional Committees. Dr. Mark Hamilton directs Neurosciences at the ACH, and is the Chair of the important Quality Assurance and Safety Committee of the Department of Clinical Neurosciences. Dr Zelma Kiss provides leadership in the Movement Disorder, Therapeutic Brain Stimulation and Neuromodulation Program. Dr John Hurlbert is the Director of the Residency Training Program, a co-leader of the Spine and nerve regeneration program of HBI, and was previously the director and instrumental in setting up arguably the best multidisciplinary Spinal surgery program (in collaboration with orthopaedic spinal surgery) in Canada. Academic leadership within the Division of Neurosurgery is provided by Dr Rajiv Midha, a surgeon scientist recruited in 2004 to help accomplish the Academic mission. He presently also sits on the executive committee of the Hotchkiss Brain Institute and is a member of the Spinal Cord and Nerve Regeneration Team. Three additional members of the Division of Neurosurgery have leadership roles within 3 research programs within the HBI. For example, Dr. Garnette Sutherland directs the NeuroArm Robotics Program. !



Division of Neurology Overview The Division of Neurology. led by Dr. Sam Wiebe, in the Department of Clinical Neurosciences comprises all 43 neurologists practising within the former Calgary Health Region, in addition to emeriti members and cross-appointees from outside our Region, such as Red Deer and Edmonton. The division provides neurological clinical care to the population of southern Alberta, south-western Saskatchewan and south-eastern British Columbia. The interests, scope of activities and level of specialization varies among members of this large neurological division. Yet, there is a strong spirit of collaboration, which makes this division larger than the sum of its parts. The breadth of scope and depth of expertise enables excellence in clinical care, research, education, and health service delivery models. During the academic year 2007-2008 three new members have joined our division, Dr. Jeptha Davenport, Dr. Tamara Pringsheim, and Dr. Eric Smith. Our new colleagues will strengthen the areas of stroke, movement disorders, multiple sclerosis, headache, and general neurology. This year has also marked a milestone in our Division’s model for delivering neurological services. On September 29, 2008, we opened a second neurology inpatient unit at the Rockyview General Hospital. This unit consists of eight dedicated neurology beds, dedicated neurosciences nurses, and an enlarged presence of neuDr. Sam Wiebe rologists at that site. Two new clinical assistants have been incorporated to the inpatient and outpatient services, as well as a dedicated nurse practitioner. We have also strengthened our links with general Internal Medicine inpatient services. The expansion to the Rockyview Hospital includes a second neurology Urgent Clinic. Under the leadership of Dr Chris White, the new neurology inpatient unit and Urgent Clinic are off to a great start. This development is of particular importance as we cultivate a large outpatient and inpatient neurological unit to occupy the new South Health Campus, currently under construction. Developments in Clinical Research Through collaboration with and support from the Hotchkiss Brain Institute, we have developed a Clinical Research Unit for Neurosciences. The research unit focuses on study design, methodological expertise, research database setup and data management, and data analysis. The unit also provides the opportunity for training in clinical trials and outcome assessment, as well as the ability to undertake small and large-scale, investigator initiated clinical research. The Clinical Research Unit houses a flexible research platform and database, and staff dedicated to study setup and study management. Monthly clinical research rounds address a variety of project-specific questions and provide an excellent learning opportunity for clinical researchers, and mentoring of young clinical investigators. Specialty Programs The Division of Neurology comprises eight specialty programs, each thriving academically through involvement in a broad variety of research areas as well as training of post-doctoral clinical and research fellows (see table). These programs have strong links with basic science researchers through the Hotchkiss Brain Institute, and with health services and population health research through the Department of Community and Health Sciences. !



Two additional programs, Urgent Clinic and General Neurology, are a centrepiece of delivery of neurological care in our region. The Urgent Neurology Clinic has expanded to the Rockyview General Hospital and the General Neurology Programme is developing further. The Division comes together every Friday at Clinical Neurosciences Grand Rounds. In addition, individual programs hold numerous teaching and research sessions throughout the week which provide a rich and valuable source for in depth learning in diverse areas of clinical neurology. Following is a list of ongoing rounds held by each program in addition to the regular resident teaching rounds: Epilepsy Program: Weekly Monday Epilepsy rounds (clinical and/or research) Bi-monthly EEG rounds Monthly Journal Club Headache Program: Weekly CHAMP academic program development rounds Movement Disorders Program: Monthly Unusual Movement Disorder rounds Monthly Journal Club Multiple Sclerosis Program: Weekly MS Clinical Rounds Bi-monthly Journal Club Neuromuscular Program: Monthly neuromuscular rounds Bi-monthly Regeneration Journal Club Weekly lab meetings (D Zochodne) Monthly EMG rounds Neuro-Oncology: Weekly Neuro-Oncology Tumor Board rounds Stroke Program: Weekly Stroke Rounds Weekly Update and Academic Lecture




PROGRAM Calgary Headache and Management Program

Calgary Comprehensive Epilepsy Programme

MEMBERS Dr W Becker, Director Dr K Busche, Dr L Cooke, Dr A Eloff, Dr J Kohli, Dr T Pringsheim Dr S Wiebe, Director Dr N Pillay, Adult Program Director Dr P Federico, Dr A Hanson, Dr N Jette, Dr B Klassen, Dr W Murphy, Dr I Mohamed (Paediatrics)

Calgary Stroke Programme and Stroke Prevention Clinics

Dr A Demchuk, Program Director Dr M Hill, Director Stroke Unit Dr P Barber, Dr S Coutts, Dr K Hoyte, Dr G Klein, Dr E Smith, Dr P Stys, Dr T Watson, Dr N Weir

General Neurology

Dr R Bell, Dr K Brownell, Dr K Busche, Dr J Davenport, Dr A Hanson, Dr M Hill, Dr K Hoyte, Dr B Klassen, Dr G Klein, Dr J Kohli, Dr W Murphy, Dr D Patry, Dr D Pearson, Dr C White, Dr S Wilson, Dr M Yeung

Movement Disorders Programme

Dr O Suchowersky, Program Director Dr R Ranawaya, Clinic Director Dr S Furtado, Dr S Kraft,

Multiple Sclerosis Programme

Dr L Metz, Director Dr R Bell, Dr K Busche, Dr J Davenport, Dr W Murphy, Dr D Patry, Dr D Pearson, Dr M Yeung

Neuromuscular Programme/EMG

Dr D Zochodne, Director Dr K Brownell, Dr C Toth, Dr C White


Dr G Cairncross, Director Dr P Forsyth


Dr W Fletcher, Dr F Costello

Urgent Neurology

Dr Alexandra Hanson and William Murphy, Co-Directors Janet Warner, Coordinator Various Participating neurologists

Fellowship Programs: Post-doctoral clinical and research fellowship programs in our division exist in the areas of epilepsy, epilepsy surgery, EEG, EMG, headache, movement disorders, multiple sclerosis, neuromuscular diseases, neuro-oncology and stroke. During this year our Division trained a total of 22 post-doctoral fellows in the following programs: Epilepsy: Abdel Hamid Seiam, Adnan Al-Sarawi, Ayataka Fujimoto Headache: Farnaz Amoozegar Multiple Sclerosis: Scott Sloka !



Movement Disorders: Cid Diesta Neuromuscular: Lawrence Korngut, Jennifer Bestard, Christine Webber (PhD) Neuro-Oncology: Gloria Roldan, Paula de Robles, Michael Blough (PhD), Morgan Westgate (MSc) Stroke: Talip Asil, Mohamed Alzawahmah, Dar Dowlatshahi, Pablo Garcia, Al Jin, Bijoy Menon, Alexandre Poppe, Nan Shoba, Nikolai Steffenhagen

Dr. Oje Imoukhuede

Residency Program: The neurology training program in our division is highly rated and attracts top candidates from across the country. Under the exemplary leadership of Dr William Fletcher, our training program continues to thrive, with thirteen residents at present and a foreseen expansion of up to five more residents in the upcoming year. The current residents are: R5: Dr. Fatima Abdulla R4: Dr. Mohammed Almekhlafi, Dr. Sameer Chhibber, Senior Resident, Dr. Phillippe Couillard, Dr. Justyna Sarna R3: Dr Claire Hinnell, Dr. Scott Jarvis, Dr. Suresh Subramaniam R2: Dr. Mohammed Alanazy, Dr. Katie Wiltshire R1: Dr. Ahmad Abuzinadah, Dr. Sankalp Bhavsar, Dr. Janel Nadeau Research: Dr. Aylin Reid is taking a research sabbatical during her residency program. Her PhD focuses on long term effects of inflammation and febrile seizures. She will return as an R4 in 2010 to complete her residency.

Dr. Florence Obianyor

Physician Clinical Assistants Program: The Division of Neurology also participates in the Calgary Clinical Assistants Program. Two clinical assistants participate in the general neurology program at the Rockyview General Hospital inpatient unit (Drs. Oje Imoukhuede and Sobia Rajput). Two additional clinical assistants participate in the Epilepsy Programme and Seizure Monitoring Unit at the Foothills Hospital (Drs. Harinder Dhaliwal and Florence Obianyor). These physicians play an important and growing role in our health care services delivery model. Innovations in Health Care Delivery: Division of Neurology is focusing on three new aspects of health care delivery, ie., a central triage system for outpatient services, implementation of an outpatient electronic medical record and booking system, and the development of a formal General Neurology Program. These initiatives are greatly facilitated by our Academic Alternate Relationship Plan (ARP), which supports innovation in health care delivery.

Dr. Harinder Dhaliwal




Neurologists Dr. Samuel Wiebe, Head of the Division of Neurology, is an epileptologist and clinical epidemiologist interested in outcomes research and surgical randomized trials. He is the Director of the Calgary Comprehensive Epilepsy Programme. Dr. Philip Barber is a neurologist specializing in stroke with research interests in blood brain barrier breakdown, stroke in the elderly, inflammation in stroke, and MRI.

Dr. Phil Barber

Dr. Werner Becker has a major interest in headache, and directs the Calgary Headache Assessment and Management Program at the Foothills Hospital and the Headache Program at the Chronic Pain Centre in Calgary." Dr. Robert Bell’s expertise involves the diagnosis and treatment of neuro-inflammatory disease of the Central Nervous System. He is a member of the Multiple Sclerosis Program and is involved in teaching clinicians and researchers.

Dr. Keith Brownell

Dr. Keith Brownell’s clinical interests are in neuromuscular diseases and general neurology." His educational interests currently focus on teaching in the neurosciences, physicianship, professionalism and medical ethics. Dr. Kevin Busche

Dr. Kevin Busche's clinical activities include work in the MS clinic, General and Urgent Neurology and the EMG lab. "He is involved with Undergraduate Medical Education at multiple levels and is the Director of the Office of Faculty Development. Dr. Gregory Cairncross is the Head of the Department of Clinical Neurosciences. He is a neuro-oncologist interested in the genetic basis of glioma and new therapies for brain tumor.

Dr. Fiona Costello

Dr. Lara Cooke, is a neurologist in the Headache Program and is an expert in medical education. She is Assistant Dean of Faculty Development and Medical Education at the University of Calgary. Dr. Warner Becker

Dr. Fiona Costello is a neuro-ophthalmologist and a member of the MS Program. She is developing a research program using the visual pathway as a model of disease to change how MS is followed and treated. Dr. Shelagh Coutts is an academic stroke neurologist. Her research involves using modern imaging techniques to predict outcomes in patients with TIA and minor stroke. Dr. Andrew Demchuk !



Dr. Jeptha Davenport works in the Multiple Sclerosis Clinic, in the Headache Group at the Chronic Pain Centre Holy Cross Site, and at a General Neurology Clinic at the Peter Lougheed Centre. Dr. Andrew Demchuk is a stroke neurologist and the Director of the Calgary Stroke Program. His research interests involve developing targeted treatments for stroke using advanced"acute vascular imaging. Dr. Arnolda Eloff, is a neurologist dedicated to the clinical management of patients with headache in the Calgary Headache Assessment and Management Program. Dr. Arnolda Eloff

Dr. Paolo Federico is an epileptologist in the Calgary Comprehensive Epilepsy Program. His research program uses leading-edge MRI imaging and EEG approaches to better understand the neural and vascular correlates of epilepsy."

Dr. Paulo Federico

Dr. William Fletcher is a neuro-ophthalmologist, Director of the Neurology Residency"Program"and"Chair of"the Neurology"Specialty Committee of the Royal College of Physicans and Surgeons of Canada." " Dr. Peter Forsyth is Associate Director Research Tom Baker Cancer Centre, the Provincial Co-Coordinator for the Terry Fox Research Institute and Director of the Southern Alberta Cancer Research Institute." His research focuses on the molecular genetics of malignant gliomas, and their treatment with experimental therapies." Dr. Sarah Furtado is a neurologist in the Movement Disorders Clinic. She participates in clinical trials for Movement Disorders and in neuroimaging studies for Parkinson's Disease. She participates in the Urgent Neurology Clinic and in the surgical team for Movement Disorders. She is interested in medical education.""

Dr. Sarah Furtado

Dr. Alexandra Hanson

Dr. Michael Hill

Dr. Alexandra Hanson is a clinical neurologist specialising in epilepsy. She also works at the Tom Baker Cancer Centre and is the Director of the Urgent Neurology Clinic.

Dr. Michael Hill is a stroke neurologist who has research interests in clinical trials. He is the Director of the Stroke Unit and is quoted as saying, 'Give the juice'. Dr. Keith Hoyte, has been a clinical neurologist for over 30 years, and consults on all neurological disorders. In addition, he has a special interest in Stroke Prevention. Dr. Keith Hoyte !



Dr. Nathalie Jette is an epileptologist. She is also a CIHR and AHFMR population health investigator, and health services researcher. Her research interests include the study of appropriateness and necessity of medical interventions. Dr. Brian Klassen practises General Neurology, with an interest in Epilepsy, EEG, and EMG." He is"also Neurology Site Leader at the Peter Lougheed Hospital. Dr. Gary Klein is a clinical neurophysiologist active in the EMG clinics and in EEG interpretation. He also participates in the Stroke Program and the general neurology clinic. Dr. Natalie Jette

Dr. Jagdeep Kohli is a community-based neurologist with an interest in headache and EMG. Dr. Scott Kraft is a neurologist who divides his time between the Movement Disorders Clinic and Clinical Informatics. Dr. Luanne Metz, is a neurologist specializing in MS. She is the Director of the Multiple Sclerosis Program. Her research interests include new therapies for MS and the translation basic science research into clinical investigation.

Dr. Brian Klassen

Dr. Luanne Metz

Dr. William Murphy, is neurologist participating in the MS Clinic, Epilepsy, Sleep Disorders and General Neurology Programs. Dr. David Patry is Clerkship Director, Clinical Research Director in the Cognitive Assessment Clinic, UCMG Executive Council Member, and Evaluation Coordinator for the UofC Undergraduate Neuroscience Course. Multidisciplinary clinic participation includes the Urgent, MS, Cognitive and Senior Resident Clinics. Dr. Bill Murphy

Dr. Dawn Pearson is a neurologist with special interests in neurorehabilitation and cognitive change associated with brain injury, including dementia, stroke and trauma. Dr. Neelan Pillay is an epileptologist with expertise in neurophysiology and evoked potentials. He is the Director of the Adult EpiDr. Gary Klein lepsy Program. Following a research sabbatical, his acquired interests are in EEG-fMRI in secondary generalized epilepsy, and in language fMRI reorganization after temporal lobe surgery. Dr. Tamara Pringsheim is the Director of the Calgary Tourette Syndrome clinic, and member of Calgary Headache Assessment and Management Program and the movement disorders programs. !

Dr. Dawn Pearson 62


Dr. Ranjit Ranawaya specializes in Movement Disorders. He is the Director of clinical services of the Movement Disorders Program. Dr. Eric Smith is a stroke neurologist with special interest in stroke, intracerebral hemorrhage and dementia. His research seeks to disentangle the effects of cerebrovascular disease and Alzheimer's disease on cognitive decline.

Dr. Neelan Pillay

Dr. Peter Stys is a neurologist/neuroscientist whose clinical interest is focused on stroke neurology. "He runs a basic science lab where he studies the fundamental mechanisms of axonal and glial injury in a variety of disorders such as spinal cord injury and MS. Dr. Oksana Suchowersky is a neurologist and neurogeneticist specializing in movement disorders, and in adult onset hereditary neurodegenerative disorders. She is Head of the Department of Medical Genetics." Her research"is aimed at"improving treatments for these disorders. Dr. Peter Stys

Dr. Cory Toth is a clinician-scientist who studies clinical and preclinical effects of diabetes upon the nervous system and the impact of neuropathic pain in humans and in animal models.

Dr. Ranjit Ranawaya

Dr. Timothy Watson is a stroke neurologist with interests in the delivery of stroke clinical services in the community. Dr. Nicolas Weir is a stroke neurologist with interests in clinical epidemiology and evidence-based neurology. Dr. Christopher White is the Site Chief of Neurology at the Rockyview Hospital. He is a member of the neuromuscular program and Director of the ALS clinic.

Dr. Cory Toth

Dr. Scott Wilson is a community general neurologist who also provides EMG services.

Dr. Oksana Suchowersky

Dr. Michael Yeung is Director of the Multiple Sclerosis Clinical Trials Research Unit. He is a neurologist in the General Neurology Clinics, Chronic Headache Clinic, and Multiple Sclerosis Clinic.

Dr. Douglas Zochodne is the Director of the Neuromuscular Clinic and of Clinical Neurophysiology for the Calgary Health region. He is an AHFMR Scientist and runs an externally funded research lab addressing peripheral neurobiology. Dr. Tim Watson !



Awards Received by Division Members in 2008 Dr. Kevin Busche: Clinical Adjunct and Research Faculty Teaching Award, ARP merit award for his work in education. Dr. Shelagh Coutts: 2008 Petro Canada Young Innovator Award in Community Health. Dr. Fiona Costello: ARP merit award for her research performance and her novelty in research.

Dr. Nic Weir

Dr. Michael Hill: ARP merit award and Performance Recognition award for his role in research and his outstanding publication record. Dr. Nathalie JettĂŠ: ARP merit award and Performance Recognition award for her outstanding success as a junior clinical and population health investigator. Dr. Luanne Metz: ARP Performance Recognition award for her work in the MS program and for bringing together a translational research program.

Dr. Michael Yeung

Dr. Oksana Suchowersky: Best Doctors of Canada for 2008.

Dr. Chris White


Dr. Chris White: ARP merit award and Performance Recognition award for his outstanding work on the development of the new neurology services the RGH and SHC sites.



Division of Physical Medicine and Rehabilitation Faculty Division Head: Dr. John Latter Staff: Drs. Maryana Apel, Pamela Barton, Nwamara Dike, Sean Dukelow, Denise Hill, Ken Lam, Daniel LeBlond, Christine McGovern, Dan McGowan, Stephen McNeil, Stephanie Plamondon, Perminder Ubhi, Noorshina Virani Overview The Division of Physical Medicine and Rehabilitation is one of four divisions within the Department of Clinical Neurosciences, the Faculty of Medicine, the University of Calgary and the Calgary Health Region. The division provides services for Southern Alberta, South-eastern British Columbia and South-western Saskatchewan. The division’s primary inpatient unit is at the Foothills Medical Centre with amputee patients being treated at Carewest Glenmore Park and stroke patients at Carewest Dr. Vernon Fanning Centre. The division provides consultation services at Dr. John Latter Peter Lougheed Hospital and Rockyview General Hospital, Carewest Glenmore Park and Carewest Dr. Vernon Fanning Centre. Dr. Daniel LeBlond is in Lethbridge and we have had one of our residents rotate through the program in Lethbridge to experience general physiatry in a smaller centre. In-patients are treated on the Tertiary Rehabilitation Unit 58 located in the Special Services Building.


The division members are actively involved in undergraduate medical education and maintain a continued strong presence with residency education. There are several members involved in collaborate research. Clinical Traumatic Brain Injury Rehabilitation" Dr. Christine McGovern, Dr. Stephanie Plamondon, Dr. Nwamara Dike The Brain Injury Rehabilitation Program consists of an inpatient and an outpatient component. This year there were 178 inpatient consultations were performed this year on patients with traumatic brain injury. The number of patients admitted to the inpatient rehabilitation unit, Unit 58, was 67. The median age of the people Dr. Christine McGovern admitted to Unit 58 was 38, with 82% male. Only 16% were not from the Calgary urban area. Based on the Glasgow Coma Scale Score, 69% had sustained severe injuries, 10% moderate, and 21% mild. The median length of stay in acute care prior to transfer was 29 days, and the median length of stay on the rehabilitation unit was 40 days. The majority of patients, 76%, were discharged Dr. Stephanie Plamondon home. In outpatient Brain Injury Clinic, 183 new referrals were seen, and 545 follow-up visits were performed. Patients 65


varied from mild to severe type of injuries, and included both recent and remote injuries. Spinal Cord Injury Rehabilitation Dr. Dan McGowan, Dr. Denise Hill

Dr. Dan McGowan

Dr. Denise Hill

Dr. McGowan and Dr. Hill follow patients who have neurologic impairment resulting from Stroke Rehabilitation spinal cord abnormalities from Dr. Stephen McNeil, Dr. Ken Lam, Dr. Sean Dukelow acute care, through rehabilitation, and in the SCI outpatient It was another busy year for clinics. One hundred and the stroke rehab and spasticity forty-nine patients were seen programs with Dr. Stephen in consultation in acute care. McNeil and Dr. Ken Lam. We Of the 64 patients admitted to of course have also recently the in patient rehabilitation unit added a new physiatrist Dr. with spinal abnormalities esSean Dukelow who will bring a sentially on half were a result significant research compoof trauma. 37 new patients nent to the program. were seen in the outpatient Our spasticity program conclinic and 358 patients were tinues to grow with 90 new seen in follow-up. patients and almost 500 reDr. Stephen McNeil peat injection patients last Dr. Hill presented a review of year. Dr. McNeil was also the sublesional osteoporosis at scientific chair of the 2008 Canadian Botulinum Toxin Conthe Third National Spine Injury ference – Spasticity Section. Conference in Toronto Ontario The stroke rehab program had 190 new inpatient conand has combined her intersults, 16 new outpatient consults and 500 follow up visit. In ests to become the team phy- addition on a weekly basis throughout the year consultasician for Canada’s Paralympic tion and follow up service was provided at the rehab unit at Nordic Ski Team. the Fanning Centre.

Paediatric Rehabilitation Dr. John Latter The Pediatric Rehabilitation Program takes place at Alberta Children’s Hospital as well as Foothills Hospital. Dr. Latter is involved in interdisciplinary clinics. The Spina Bifida clinic saw ninety patients last year. The Pediatric Neuromuscular Clinic saw two hundred children, forty of which were seen by physiatry. The Juvenile amputee clinic has ninety active patients and 43 were seen in clinic in 2008. These clinics run once a month. !

Dr. Latter is a member of the Pediatric Brain Injury Program with both inpatient and outpatient involvement. There were 122 inpatients and 214 outpatient visits with 139 of these seen by physiatry. The Young Adult Rehabilitation Clinic is held weekly out of the Foothills Hospital and this year there were 28 new patient clinic visits and 112 repeat clinic visits.

EMG Dr. Pamela Barton, Dr. Denise Hill, Dr. Ken Lam, Dr. Stephen McNeil, Dr. Stephanie Plamondon, Dr. Noorshina Virani, Dr. Sean Dukelow Amputee Dr. Ken Lam The amputee program is a young and growing program. The goal is to provide comprehensive care to patients with limb loss across the continuum. We provide in66


patient and out-patient services. In 2008 over 100 new patients with limb loss have entered into the program. A joint venture with the Bone and Joint Institute has provided a six bed in-patient program at the Glenmore Park facility. Specialized out-patient rehabilitation is now provided at the new Sheldon Chumir Centre. The program is also dedicated to medical education. Physiatry residents spend a mandatory 3 months with us Dr. Ken Lam during their residency.

The physiatrists work in the Neuromusculoskeletal Program alongside anaesthetists, family practitioners and all members of the rehabilitation teams. They have many patients who are co-managed with the gynaecologists and neurologists of the Pelvic Pain and Headache Programs. They also participate in teaching medical students, resiDr. Noorshina Virani dents and fellows in family practice, anaesthesiology, psychiatry, physical medicine and rehabilitation and neurology who rotate through the Centre.

Chronic Pain Dr. Pamela Barton, Dr. Noorshina Virani, Dr. Nwamara Dike# The Calgary Health Region Chronic Pain Centre has now completed 8.5 years of operations within the CHR Regional Pain Program. It is now the largest such Centre in Canada and is a leader in interdisciplinary rehabilitation for individuals with chronic pain. Three members of the Division of Physical Medicine and Rehabilitation currently practise at Dr. Pamela Barton the Chronic Pain Centre: Dr. Pamela Barton, co-founder and former medical director, Dr. Noorshina Virani and Dr. Nwamara Dike. In addition to their strong background in pain management and interdisciplinary rehabilitation, Drs. Barton and Virani contribute specific expertise in clinical biomechanics, while Dr. Dike has shared her expertise from a pain fellowship at Memorial Sloan-Kettering Cancer Centre in New York. Dr. Dike has also participated in the newly inaugurated Chronic Pain Inpatient Consultation Service now available in all of Calgary’s hospitals.


Dr. Nwamara Dike

During 2008, the physiatrists contributed a total of 0.6 FTE, completing 58 new patient assessments and an additional 302 follow up visits on a total of 162 unique patients. Due to their competence in the interdisciplinary management of complex patients, their caseloads carry many of the more complicated patients referred to the Chronic Pain Centre.

Highlights Dr. Sean Dukelow started with the division on October 1, 2008 with his primary role as a clinical scientist. Clinically he will do some EMG and stroke rehabilitation. The division signed off on its Academic Alterative Relationship Plan as of December 1, 2008. This will allow appropriate stable funding to permit the division to recruit more staff and continue to develop an academic service.



Division of Experimental Neurosciences Overview Division of Experimental Neuroscience (DEN) is the newest division of the department."Translational research in neurological science and medical technology has been a major emphasis of the division since its inception. DEN currently consists of 7 primary and 8 secondary members. Their research areas span from neurodegenerative diseases, movement disorders to multiple sclerosis and medical devices. The research capacity of the division has grown significantly with the creation of Hotchkiss Brain Institute and its disease-focused research programs. An important feature of the division is that almost all its members maintain meaningful and productive collaborations with clinicians or clinician scientists within the department. Together they either hold shared research grant(s) and/or serve as co-supervisors of graduate students working on related research projects. There are over"30 faculty, postdoctoral fellows, graduate students and support staff who are directly involved in DEN. They work in state-of-the-art research facilities including the newly established Boone Pickens Center for Neurological Science and Advanced Technologies." The Division of Neuroscience is rapidly growing, not only in terms of personnel and research support, but in terms of national and international recognition of its research achievements." The divisional members offer graduate studies in both clinical and basic neurosciences, year-round research projects for senior undergraduates and summer research programs. The division also hosts a number of community-oriented educational events." In 2008, DEN members played an increasingly active and leading role in many aspects of academic activities of the department and HBI. These included the mentorship for junior faculties and clinician scientists; development and expansion of different research programs; launching new research initiatives; recruitment and graduate student education. Current Members Head Bin Hu, MD. Ph.D. Sutter Professor in Parkinson’s Disease Research Research: Sensorimotor cueing, deep brain stimulation and devices Primary Members Yong, Wee Ph.D. Professor/AHFMR Scientist/CRC Chair in immunology Research: neuroinflammation and neuroprotection of MS and spinal cord injury. Ousman, Shalina, Ph.D. Assistant Professor Research: neuroprotection in the immune system and potential therapies for MS

Dr. Bin Hu !

Hulliger, Manuel. Ph.D. Professor 68


Research: Spinal Cord and Nerve Regeneration Nguyen, Minh Dang Ph.D. Assistant Professor / AHFMR Scholar / Investigator Brenda Strafford Chair in Alzheimer Research: Cytoskeleton proteins in neurodegenerative disorders and aging. Melvill Jones, Geoffrey (BA, MA, MB BCh (Cantab), FRSC (Canada), FRS (UK) Research Professor Research: Human Neurophysiology, Posture, Gait & Spatial Orientation

Dr. Manuel Hulliger

Tomanek, Boguslaw Ph.D. Research Assistant Professor Research: functional imaging, Neurorobotics and Stroke Zhao, Zonghang MD Research Assistant Professor Research: Mechanisms of ischemic neuronal injury and cell death Block, Edward Senior electrical Engineer Research: Diagnostic and training devices for patients with movement disorders

Dr. Boguslaw Tomanek

Secondary Members Brown, Lenora Ph.D. (Neuropsychology Kim, Sung-Woo Ph.D. (Oncology) Eliasziw, Michael Ph.D. (Population Health) Mitchell, Ross Ph.D. (Imaging) Frayne, Richard Ph.D. (Imaging) Poulin, Marc Ph.D. (Stroke) Goodyear, Brad (Imaging) Tuor, Ursula Ph.D. (Imaging) Haffenden, Angela Ph.D. (Neuropsychology) Whelan, Patrick Ph.D. (Spinal Cord Injury) Achievements: Research

Dr. Zonghang Zhao


Ndel1 and neuroregeneration In 2008 Dr. Nguyen and his collaborators reported an important discovery on the role of Ndel1 in axonal regeneration. Ndel1 is an integrator and stabilizer of the cytoskeleton. It is upregulated in crushed and transected sciatic nerve axons. Lasting in vivo formation of Ndel1/Vimentin complex is associated with robust axon regeneration whereas silencing of Ndel1 by siRNA severely reduced regeneration (see figure below).



Descending reticular network of the temporal lobe Sensory association and parahippocampal cortex in the ventral temporal lobe plays an important role in sensory object recognition, sensory cue processing and control of top-down attention. A commonly held view is that cortical neurons have only one projection target. Contrary to this view, Hu lab discovered that single layer V neurons from the ventral temporal lobe can innervate multiple cortical and subcortical targets. This reticular network may allow large scale synchrony to occur among multiple brain structures during sensorimotor cueing. Matrix metalloproteinase and autoimmune encephalomyelitis Several matrix metalloproteinase (MMP) members contribute to pathology in multiple sclerosis and experimental autoimmune encephalomyelitis (EAE). Dr. Young’s lab has found that MMP-12 transcripts increased with EAE, and protein was localized to a subset of macrophages/microglia. The temporal expression of MMP-12 largely corresponded to that of cytokines, and IL-1! and TNF-" promoted MMP-12 expression in cultured macrophages. They postulate that cytokine — MMP-12 interactions are important in the disease process of EAE.

Silencing Ndel1 by siRNA reduces lesion-conditioned neurite outgrowth in DRG neurons PLoS ONE. 2008; 3(4):

Gaitmeter and movement disorder assessment Recent advances in chip technology has led to a new generation of miniature sensing devices that are particularly suitable for gait and mobility assessment and rehabilitation training in clinical settings. GaitMeter™ is a prototype device developed by our medical device lab. It utilizes miniature triaxial accelerator and gyroscope and system-on-the-chip technology to acquire high frequency gait and mobility data during long distance natural walking. The device, which is equipped with high speed wireless and video connectivity, has significant cost advantage over existing technology. It is currently being tested in several pilot trials. Funding During 2008 DEN members have obtained $1,417,000 external research funding. In addition, >$500,000 was obtained in the form of external PI salary support and studentship/fellowship. Infrastructure Under the leadership of Dr. Bin Hu and with the support of HBI and DCN, over 400 square feet of research and office space has been created at the T. Boone Pickens Center. The new research space has its unique configuration in that animal laboratory is directly across the hall from clinical labs conducting deep brain stimulation and medical device research in humans. Currently the new labs host 5 research projects involving collaborations between basic and clinician scientists.




Recruitment Dr. Shalina Ousman is the newest recruitment of our division. Shalina obtained her Ph.D. from McGill University. She joined MS program as an assistant professor after completing two consecutive postdoctoral training at Stanford University. She is interested in the endogenous protective mechanisms in the immune system and central nervous system and how these mechanisms can be deployed as potential therapies for multiple sclerosis. Welcome Shalina! Training and Education Graduate Student Degree Awarded




Adrien Tennet/Hu, B


Steven Peters/Hu.B


Modulation of High Frequency Oscillations by Sleep-Like Frequencies in the Anesthetized Rat: A Quantitative Analysis

Taylor Chomiak/Hu,B


Posterior Temporal Association Cortex: A Comprehensive in vitro Electrophysiological Study in Rats

Membrane Dynamics of Inferior Colliculus Neurons in the Young Rat

Current Master and Ph.D. candidates and postdoctoral fellows Callie Clark# Lorraine Lau Susobhan Sarkar Gernot Neumayer Camille Belzil # # Dave Stirling Viktor Skihar Smriti Agrawal Rowena Cua Mengzhou Xue Angelika Goncalves DaSilva Gernot Neumayer Axinia Dรถring Susan Park Trina Johnson Hankyu Lee




2008 Educational Updates Neurology Residency Training Program Introduction rosurgery, ophthalmology and emergency medicine The Neurology Residency Program prepares resicompleted neurology rotations in 2007-08. The11th andents to become specialists in neurology during a fivenual Rocky Mountain Basic Science Symposium was year period of study, which includes supervised clinical held at Kananaskis in March, attracting 49 neurology and and research experience and an academic program. The neurosurgery residents from the 4 medical schools in the academic program comprises Prairie Provinces. Guest a weekly academic half-day speakers included Drs. and daily educational rounds Wendy Ziai (Johns Hopkins), Neurology Residents and includes regular seminars Mike Nicolle (U of Western 2008-09 on ethics, communication Ontario) and Raj Midha and skills and evidence-based Greg Cairncross (U of Calmedicine. Evaluation of resigary). The residency program dents and the program ocalso hosted 3 visiting profescurs on a regular basis. The sors in 2008: Drs. Colin Chalk Program Director and Com(McGill), Tom Miller (McMasMohammed Sankalp Bhavsar Fatema Abdulla Ahmad Mohammed Alanazy Abuzinadah Almekhlafi mittee manage all aspects of ter) and Chris Power (U of the program, with the help of Alberta). Reciprocal OSCE a program administrator. All examinations were mounted members of the Division of with the University of Alberta Neurology participate in resiin November. The Amercian dent education. The NeurolAcademy of Neurology Sam Chhibber Philippe Couillard Claire Hinnell Scott Jarvis Bill Fletcher Program Director ogy Program has trained 25 awarded Drs. Philippe Couilneurologists since its inceplard and Sam Chhibber resition in 1981. dent travel scholarships to the AAN meeting in Chicago. The neurology residents voted Dr. Highlights Janel Nadeau Aylin Reid Justyna Sarna Suresh Subramanian Katie Wiltshire In 2008, the Neurology Lara Cooke winner of the A. Program grew to include 13 Keith W. Brownell Neurology residents. Dr. Erin O’Ferrall Teaching Award. Dr. William completed the program in Fletcher was awarded the June, passed the Royal College examinations and 2008 Resident Well-Being Award by the Professional Asstarted a neuromuscular fellowship at McGill University. sociation of Residents of Alberta. Three PGY1 residents joined the program in July: Drs. Janel Nadeau from Calgary, Ahmad Abuzinadah from Residents (2008-09) Saudi Arabia and Sankalp Bhavsar from London, Ontario. Dr. Fatima Abdulla, PGY5 Fifty residents from other disciplines, including internal Dr. Mohammed Almekhlafi, PGY4 medicine, psychiatry, pediatric neurology, physiatry, neu!



Dr. Sameer Chhibber, PGY4 Dr. Philippe Couillard, PGY4 Dr. Justyna Sarna, PGY4 Dr. Claire Hinnell, PGY3 Dr. Scott Jarvis, PGY3 Dr. Suresh Subramaniam, PGY3 Dr. Mohammed Alanazy, PGY2 Dr. Katie Wiltshire, PGY2 Dr. Ahmad Abuzinadah, PGY1 Dr. Sankalp Bhavsar, PGY1 Dr. Janel Nadeau, PGY1 Program Committee (2008-09) Dr. William Fletcher (Program Director) Dr. Fatima Abdulla (until June 2008) Dr. Mohammed Almekhlafi (Chief Resident Jan June 2008) Dr. Robert Bell (Resident Research Director) Dr. Sameer Chhibber (Chief Resident July - Dec 2008) Dr. Lara Cooke Dr. Philippe Couillard (from Sept 2008) Dr. Nathalie Jetté Dr. Claire Hinnell (from Sept 2008) Dr. Jean Mah Dr. David Patry Dr. Justyna Sarna (from Jan 2009) Dr. Samuel Wiebe Dr. Christopher White Dr. Nic Weir

Dr. Mohammed Almekhlafi (right) enjoying snow-related extracurricular activities


Program Administrator Ms. Michelle Mills CanMEDS Co-Ordinators Communication Skills – Drs. Lara Cooke, Dawn Pearson and Justyna Sarna Ethics and Professionalism – Drs. A. Keith Brownell and Philippe Couillard Evidence-Based Neurology – Drs. Samuel Wiebe and Nic Weir Resident Publications (2008) Almekhlafi MA, Hu WY, Hill MD, Auer RN. Calcification and endothelialization of thrombi in acute stroke. Ann Neurol. 200;64:344-8. Almekhlafi MA, Fletcher WA. Levator palpebrae myositis. Neurology 2008;71:1202 Teskey GC, Monfils MH, Flynn C, Young NA, van Rooyen F, Henry LC, Ozen LJ, Henderson AK, Reid AY, Brown AR." Motor maps, seizures, and behaviour. Can J Exp Psychol. 2008; 62: 132-9. Reid AY, Metcalfe A, Williams J, Patten S, Hinnell C, Parker R, Wiebe S, Jetté N." Epilepsy is associated with greater unmet health care needs compared to asthma, diabetes or migraine despite higher health resource use A large national population-based study." Epilepsia (in press). V Puetz, I Dzialowski, M D Hill,"S Subramaniam, P N Sylaja, A Krol, C O’Reilly, M E Hudon, W Y Hu, S B Coutts, P A Barber, T W J Watson, J Roy, A M Demchuk."Intracranial thrombus extent predicts clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the Clot Burden Score."Int J Stroke 2008;3:230-6. S B Coutts, M D Hill, C R Campos, Y B Choi,"S Subramaniam, J C Kosior, A M Demchuk."Recurrent events in TIA and minor stroke: What events are happening and to which patients? Stroke 2008;39:2461-2466. S B Coutts, M Eliasziw, M D Hill, J N Scott,"S Subramaniam, A M Buchan, A M. Demchuk for the VISION study group."An Improved Scoring System for Identifying Patients at High Early Risk of Stroke and Functional Impairment After an Acute Transient Ischemic Attack or Minor Stroke."Int J Stroke. 2008; Feb 3: 3-10. 73


Neurosurgery Residency Training Program Staff Program Director: John Hurlbert Assistant Program Director: John Wong Research Director: Zelma Kiss Program Administrator: Patti Sullivan Number of PGY-1 CaRMS positions per year: 2 Accreditation: Royal College of Physicians and Surgeons of Canada Length of Training: 6 years Mandatory Research: 1 year Overview Education of our postgraduate and undergraduate students remains one of the highest priorities to the Department of Clinical Neurosciences and the Division of Neurosurgery. The teaching faculty consists of a large complement of young and dynamic key opinion leaders representing all subspecialties of Neurosurgery, including vascular, interventional, glioma, skull base, epilepsy, functional, and peripheral nerve interests. In addition the University of Calgary boasts the largest comprehensive Spinal Surgery program in Canada with a total of 8 full time spine surgeons coming from both Neurosurgical and Orthopedic backgrounds. This year there were over 1900 neurosurgical admissions to the Foothills Hospital and Alberta Children’s Hospital, almost all of which underwent a surgical procedure. In addition there were over 5000 visits to Neurosurgery clinics, 400 inpatient consultations, and 700 emergency room consultations. There has been a stellar cast of visiting professors over the past year presenting on topics across the spectrum of Neurosurgery from subarachnoid hemorrhage, meningomyelocele, primary gliomas, to cervical laminoplasty. At each of these events in addition to the clinical and research expertise shared with the entire faculty by the honored guest, the residents received the “inside story” through one-on-one case presentations followed by an evening of relaxed conversation over dinner with the professor. Our guests included: Dr. J. Sampson, Duke University (May, 2008) Dr. R. Dempsey, University of Wisconsin (June, 2008) Dr. H. Nakagawa, Aichi Medical University, Japan (Sept, 2008) Dr. J. Jane, University of Virginia (Sept, 2008) Dr. N. Barbaro, UCSF (Oct, 2008) Dr. R. Dacey, Washington University, St. Louis (Oct, 2008) Dr. H. Rekate, Barrow Neurological Institute Visiting professor Dr. R. Dacey (Madison, WI) guides the residents and Dr. Midha through a neurosurgical tumor case scenario. (Dec, 2008) !



The residents have been continuously involved in research initiatives from the moment they entered the program. Considerable resources are dedicated each year to facilitating this academic activity through faculty participation, existing peer-reviewed grants, project funding from Divisional and Departmental sources, and 12 months of mandatory clinical or basic science research at the PGY-4 level. Resident publications from the past reporting period include: Diaz RJ, Wong JH. Spinal arteriovenous fistula: a treatable cause of myelopathy. CMAJ [accepted for publication May 2008] Diaz RJ, Laughlin S, Nicolin G, Buncic JR, Bouffet E, Bartels U (2007) Assessment of chemotherapeutic response in children with proptosis due to optic nerve glioma. Childs Nerv Syst. 2007Dec 22; [Epub ahead of print]. Gallagher CN, Hutchinson PJA, Pickard JD. Neuroimaging in Trauma. Curr Opin Neurol 2007;20:403-407. Grondin R, Hader W, MacRae E, Hamilton M. Endoscopic versus microsurgical resection of third ventricle colloid cysts. Can J Neurol Sci 2007;34:197-207. Sutherland GR, Kelly JJP. Ceramic aneurysm clips for improved MR visualization. Neurosurgery. 2008 May;62(5 Suppl 2); ONS4005. Chojnacki A, Kelly JJP, Hader WJ, Weiss S. Distinctions between embryonic and adult human PDFGresponsive neural precursors. Annals of Neurology. 2008 (in press). Levy R, Lozano AM, Hutchison WD, Dostrovsky JO. Dual microelectrode technique for deep brain stereotactic surgery in humans. Neurosurgery 2007;60:4 Suppl 2, 277-284. Levy R, Pitout J, Long P, Gill MJ. Late presentation of Cryptococcus gattii meningitis in traveler to Vancouver Island: a case report. Canadian Journal of Infectious Diseases 2007;18:3, 197199. Lwu S, Midha R. Clinical examination of brachial and pelvic plexus tumors. Neurosurgical Focus, Current management of nerve tumors. 2007 June;22:6:E5. Codd PJ, Mitha AP, Ogilvy CS. A recurrent cerebral arteriovenous malformation in an adult: Case report and review of the literature. J neurosurg (accepted, in press) Mitha AP, Wong JH, Lu JQ, Morris WF, Hudon ME, Hu WY. Communicating hydrocephalus after endovascular coiling of unruptured aneurysms. J Neurosurg (accepted in press) Wong JH, Mitha AP, Willson M, Hudon ME, Sevick R, Frayne R. Assessment of brain aneurysms after endovascular coiling using high-resolution magnetic resonance angiography. J Neurosurg. 2007;107(2):283-289. Mitha AP, Scott JN, George D, MacRae ME, Bell RB. Tumefactive demyelinating lesions. Canadian Journal of Neurological Sciences 2007;34(3):362-364. Mitha AP and Ogilvy CS. Comment re: Edner G et al. The Stockholm 20 year follow-up of aneurysmal subarachnoid hemorrhage. Neurosurgery. 2007;60:1023. !



In addition, Friday morning “Neurosurgery School” runs each week for 2 hours after departmental Grand Rounds. The curriculum circumnavigates the neurosurgical universe every two years. Sessions are led by the residents and supervised by the faculty creating a learning environment within the realm of neurosurgical expert. Once monthly interactive CanMeds seminars presented entirely from a neurosurgical perspective round off training of more subjective but nonetheless important roles of Communicator, Collaborator, Advocate, Manager, Scholar, and Professional. Team relationships outside the hospital are of equal importance to the Division of Neurosurgery as within the hospital. In addition to dinners with each of the visiting professors, journal club is hosted by a faculty member every three months. Residents’ Night Out has become a favorite tradition where once every month or two faculty, Clinical Nurse Practitioners, and students get together in a social setting to watch a hockey game, shoot some pool, bowl, drive gokarts, play poker, or just sit around and watch people. Once a year this transforms into an entire day when the Division sets off to the Rocky Mountains for a day of skiing. In summary this year has been characterized by a rich blend of clinical, academic, research, and social activity. For 2009 it only looks better...

Dr. Zelma Kiss (right) finishes her hearty helping of rabbit food while Patti Sullivan (residency program administrator) politely laughs at her joke.




Physical Medicine & Rehabilitation Residency Training Program Program Director Dr. John Latter Residents:" " Drs. Lee Burkholder, Chantel Debert, Darren Gumbs, Arun Gupta, Jaime Yu, Andrew Willmott, Dr. Brian Rambaransingh, Dr. Gentson Leung, Dr. Evan Kwong Program Administrator Linda Jennett In 2008, the University of Calgary Physical Medicine and Rehabilitation Residency Training Program commenced its fifth year. There are now 9 residents in the program. In 2008 we received two residents through the CaRMS match and one resident transferred from another University of Calgary program. The division formally applied for two base positions to commence in 2009 and the division was successful so as of July 2009 there will be two base positions each year. The program has developed a very active academic half day for residents. The Residency Training Committee meets monthly (except July and August) and the Program Director has formal biannual meetings with each resident and informally more frequently. Dr. Evan Kwong Dr. Andrew Willmott The Physical Medicine and (PGY-1) (PGY-2) Rehabilitation Residency TrainDr. Chantel Debert Dr. Brian Ramba(PGY-3) ing Program has residents from ransingh (PGY-2) rheumatology, neurosurgery and neurology and orthopaedic surgery rotating through the program. In September of 2008 we commenced a weekly Senior Medical Resident Clinic under the supervision of Dr. Stephanie Dr. Darren Gumbs Dr. Jaime Yu (PGYPlamondon (PGY-5) 4) Dr. Lee Burkholder (PGY-5)


Dr. Arun Gupta (PGY-5)



Undergraduate Medical Education in Clinical Neurosciences Overview Medical students are taught about the neurosciences in the first course of the second year of the undergraduate curriculum. The course is provided over an eight week period at the beginning of the second year in the three-year curriculum. The neurosciences component of the course is combined with content from geriatrics, otolaryngology and ophthalmology to give ‘Course V – Neurosciences, Aging and Special Senses’. The course is given under the auspices of the Undergraduate Medical Education office of the Faculty of Medicine at the University of Calgary. The neurosciences content in the course begins with a presentation of the functional anatomy and physiology required to approach patients who present with neurological complaints. The remainder of the course covers clinical presentations of neurological illness as well as sessions devoted to specific neurological conditions.

Even the clinical clerks get their hands wet in the operating theatre. Visiting medical Student Teresa Langan (London ON) assists Dr. Raoul Pope (neurosurgical spine fellow) with a complex spinal decompression.


The course is taught by approximately 130 teachers, including 60 from the Department of Clinical Neurosciences. The content of the course is delivered via a combination of lectures, patient presentations, small group seminars and bedside teaching sessions. The course is developed and administered by the Course V Committee, co-chaired by Dr. Kevin Busche from the Division of Neurology. The majority of the course committee members are from the Department of Clinical Neurosciences. The course is always well received by the students and is consistently ranked highly in comparison to the other courses offered in the pre-clerkship curriculum. Course V Committee 2008 Kevin Busche (Co-Chair) Darren Burback (Co-Chair) David Patry (Evaluations Coordinator) Jeff Joseph Paolo Federico Sarah Furtado Gary Klein Cory Toth Walter Hader James Scott Colin Powell Chandrasekaran Sivakumar Karin Verstraten Vivian Hill Beth Lange Daryl Wile Janel Nadeau Tim Ramos



Fellowship Program Overview The Department of Clinical Neurosciences has been fortunate to be able to attract fellows from a wide variety of backgrounds seeking further subspecialty experience. Their presence has enriched the clinical and academic environment for all. Pictured below are some of our recent fellows.

Jacob Alant, Peripheral Nerve Surgery Fellow

Aleksa Cenic, Spinal Neurosurgery Fellow Lawrence Korngut, Neuromuscular Fellow

Sohail Bajammal, Spinal Neurosurgery Fellow

Nan Shobha, Stroke Neurology Fellow

Raoul Pope, Spinal Neurosurgery Fellow

Abdel Hamid Seiam, Epilepsy Neurology Fellow


Paula de Robles, Neuro-Oncology Fellow



2008 Publications 1.

Abdullah AR, Smith EE, Biddinger PD, Kalenderian D, Schwamm LH. Advance hospital otification by EMS in acute stroke is associated with shorter door-to-computed tomography time and increased likelihood of administration of tissueplasminogen activator. Prehosp Emerg Care. 2008;12:426-431.


Addas BMJ, Midha R. Nerve transfers for severe nerve injuries. Spinner R, Winfree C (eds) Neurosurgical Clinics North America, 20: 27-38, Dec 2008. doi:10.1016/


Almekhlafi MA, Fletcher WA. "Levator palpebrae myositis. Neurology. 71:1202, 2008.


Almekhlafi MA, Hu WY, Hill MD, Auer RN. Calcification and endothelialization of thrombi in acute stroke. Ann Neurol. 200;64:344-8.


Alcalay RN, Smith EE. MRI Showing White Matter Lesions and Multiple Lobar Microbleeds in a Patient with Reversible Encephalopathy. J Neuroimaging. 2008


Antel J, Arnold D, Bhan V, Bar-Or A, Bakker J, Bell B, et al." The use of disease-modifying agents in multiple sclerosis—by the Canadian Network of MS Clinics." Can J. Neurol Sci. 2008; 35(2):127-32.


Armstrong L, Graham GE, Schimke RN, Collins DL, Kirse DJ, Costello F, Ardinger HH. The Hunter-MacDonald syndrome with expanded phenotype including risk of meningioma: an update and review. Am J Med Genet A. 2008 Jan 1: 146 (1): 83–92.


Auer RN, Dunn JF, Sutherland GR. Hypoxia and related conditions. In: S Love, DN Louis and DW Ellison (eds), Greenfield’s Neuropathology Eighth Edition. Edward Arnold (Publishers) Limited, London, 1:64-119, 2008.


Becker WJ. Headache progress in Canada over the decades. Headache 2008; 48: 678 – 679

10. Becker WJ, Purdy RA. Medication Overuse Headache In Canada. Cephalalgia 2008; 28: 1218-1220 11. Berg A, Langfitt J, Vickrey B, Wiebe S. “Postoperative Follow-up: Outcome Measurement”. In: Epilepsy. Engel,J.,Jr.; Pedley,T.A. Lippincott Williams & Wilkins, Philadelphia, 2008;Volume II:1929-1937 12. Bristow MS, Poulin BW, Simon JE, Hill MD, Kosior JC, COUTTS SB, Frayne R, Mitchel JR, Demchuk AM (2008). Modeling Infarct Growth in Acute Ischemic Stroke with MR Imaging. J Magn Reson Imaging; 28:837-846. 13. Brown R, Zlatescu M, Sijben A, Roldan G, Easaw J, Forsyth P, Parney I, Sevick R, Yan E, Demetrick D, Schiff D, Cairncross JG, Mitchell R. Detecting Genetic Signatures in Oligodendroglioma Non-Invasively Using MR. Clinical Cancer Research 14: 2357-2362, 2008. 14. Busche K, Morrish WF." Sphenoid Sinus Mucocele – Rupture Causing Brainstem Inflammation and Stroke." Can J Neurol Sci, 34: 381-385, 2008. 15. Brussee V, Guo GF, Dong YY, Cheng C, Martinez JA, Smith D, Glazner GW, Fernyhough P, Zochodne DW. Distal degenerative sensory neuropathy in a long term type 2 diabetes rat model. Diabetes 57(6):1664-73, 2008. 16. Burneo JG, Tellez-Zenteno J, Steven DA, Niaz N, Hader W, Pillay N, Wiebe S. Adult-onset epilepsy associated with dyembryoplastic neuroepithelial tumors. Seizure 2008;17(6):498-504 17. Casha S, Yong W, Midha R. Minocycline administration for nerve repair: a double edged sword. Commentary. Exp Neurol, 213: 245-248, 2008. DOI information: 10.1016/j.expneurol.2008.06.016 18. Cheng C, Webber CA, Wang J, Xu YQ, Martinez JA, Liu WQ, McDonald D, Guo GF, Nguyen MD, Zochodne DW. Activated RHOA and peripheral axon regeneration. Experimental Neurology 212(2):358-69, 2008 19. Chou SH, Smith EE, Badjatia N, Nogueira RG, Sims JR, 2nd, Ogilvy CS, Rordorf GA, Ayata C. A randomized, double-blind, placebo-controlled pilot study of simvastatin in aneurysmal subarachnoid hemorrhage. Stroke. 2008;39:2891-2893. 20. Claassen J, Jetté N, Chum F, Green R, Schmidt M, Choi H, Frontera JA, Connolly ES, Emerson RG, Mayer SA and Hirsch LJ." Electrographic seizures and periodic discharges after intracerebral hemorrhage." Author reply." Neurology." 2008 Feb 14. 21. Costello F, Hodge W, Pan YI, Metz L, Kardon R. Retinal Nerve Fiber Layer and Future Risk of Multiple Sclerosis. Canadian Journal of Neurological Sciences 2008 Sept 35: 482-487. !



22. Costello F, Hodge W, YI Pan, Eggenberger, E, and Kardon R. Retinal Nerve Fiber Layer Changes after Optic Neuritis: A Prospective Study with Optical Coherence Tomography. Mult Scler 2008 Aug;14 (7):893-905 23. Coutts SB, Eliasziw M, Hill MD, Scott JN, Subramaniam S, Buchan, AM, Demchuk AM for the VISION study group). An improved Scoring System for Identifying Patients at High Early Risk of Stroke and Functional Impairment After an Acute Transcient Ischemic Attack or Minor Stroke. International Journal of Stroke. 2008 3(1):3-10. 24. Coutts SB, Hill MD, Campos CR, Choi YB, Subramaniam S, Koisor JC, Demchuk AM; for the VISION study group. Recurrent events in Transcient Ischemic Attack and Minor Stroke: What Events are Happening and to Which Patients? Stroke 2008;39(9):2461-6. 25. Coutts SB, Hill MD, Herrera C, Choi YB, Koisor J, Subramaniam S, Demchuk AM for the VISION Study group (2008). Recurrent events in TIA and minor stroke: What events are happening and to which patients? Stroke. 39:2461-2466. 26. Cucchiara BL, Tanne D, Demscore to predict intracranial stroke. J Stroke Cerebrovasc

chuk AM, Levine SR, Kasner SE. A risk hemorrhage after rt-PA for acute ischemic Dis. 2008 Nov-Dec; IT(6):331-3.

27. Cunningham CJB, Zaamout MF, EEG-fMRI in human epilepsy. ences 2008,35:420-435.

Goodyear BG, Federico P. Simultaneous Canadian Journal of Neurological Sci-

28. Delaney L, Chambers C, Roldan Easaw J. A feasibility study to

G, De Robles P, Cairncross G, Forsyth P, assess the integration of a pharmacist

into neurooncology clinic. J ahead of print]

Oncol Pharm Pract. 2008 Nov 26. [Epub

29. Demchuk AM, Gupta R, Khatri Marr CM, William MA (Eds) ConAmerican Academy of Neurol-

P. “Emerging Therapies.” In: Miller AE, tinuum, Lifelong Learning in Neurology, ogy Vol. 14, Number 6, December 2008.

St. Paul, MN:Lippincott Williams

& Wilkins. 2008:76-93.

30. Demchuk AM, Khan F, Hill MD, for the NINDS rtPA Stroke Study CT for Tissue Plasminogen ActiNINDS rt-PA Stroke Study.

Barber PA, Silver B, Patel S, Levine SR Group. Importance of Leukoaraiosis on vator Decision Making: Evaluation of the Cerebrovasc Dis 2008; 26(2):120-5.

31. Demchuk AM, Khan F, Hill MD, Importance of Leukoaraiosis on cision making: Evaluation of the cular Diseases

Barber PA, Silver B, Patel S, Levine SR. CT for Tissue Plasminogen Activator DeNINDS rt-PA Stroke Study. Cerebrovas2008;26(2):120-125

32. de Robles P, McIntyre J, Kalra Magliocco A, Hamilton M, gene promoter in meningiomas. 2008.

Statue of Hippocrates in University of Calgary Health Sciences Centre

S, Roldan G, Cairncross G, Forsyth P, Easaw J. Methylation status of the MGMT Cancer Genet Cytogenet 187: 25-27,

33. Drabycz S, Mitchell JR, “Texture Quantification of Medical Images Using a Novel Complex Space-Frequency Transform” The International Journal of Computer Assisted Radiology and Surgery, DOI: 10.1007/s11548-008-0219-4, 2008 34. Fallah A, Grochmal J, Lu J-Q, diFrancesco L, Khalil M, Clark A, Midha R. Nodular fasciitis presenting in the obturator nerve and gracilis muscle. Peer Reviewed Letter. Can J Neurol Sci, 35(1):111-114, March 2008. 35. Federico P, Alqahanti S, Myers RP. Possible new clinical sign of hyperammonemia. Canadian Medical Association Journal 2008: 178:326. 36. FitzMaurice E, Wendell L, Snider R, Schwab K, Chanderraj R, Kinnecom C, Nandigam K, Rost NS, Viswanathan A, Rosand J, Greenberg SM, Smith EE. Effect of statins on intracerebral hemorrhage outcome and recurrence. Stroke. 2008;39:2151-2154. 37. Fletcher WA. Eye signs in patients with parkinsonism: do they predict the development of multiple system atrophy?" Nature Clin Pract Neurol. 4:540-1, 2008




38. Forsyth PA, Roldan G, George D, Wallace C, Palmer C, Morris DG, Cairncross G, Vallee Matthews M, Markert J, Gillespie GY, Coffey M, Thompson B, Hamilton M. A phase I trial of intratumoral (i.t.) administration of reovirus in patients with histologically confirmed recurrent malignant gliomas (MGs). Molecular Therapy. 16: 627-632, 2008. 39. Frohman EM, Costello F, Stuve O, Calabresi P, Miller DH, Hickman SJ, Sergott R, Conger A, Salter A, Krumwiede KH, Frohman TC, Balcer L, Zivadinov R. Modeling axonal degeneration within the anterior visual system: implications for demonstrating neuro-protection in multiple sclerosis. Arch Neurol. 2008 Jan; 65(1): 26 – 35 40. Giannini C, Burger PC, Berkey BA, Cairncross JG, Jenkins RB, Mehta M, Curran WJ, Aldape K.Anaplastic oligodendroglial tumors: refining the correlation among histopathology, 1p 19q deletion and clinical outcome in Radiation Therapy Oncology Group trial 9402. Am J Surg Pathol 18: 360-369, 2008. 41. Giovannoni G, Barbarash O, Casset-Semanaz F, King J, Metz L, Pardo G, Simsarian J, Soelberg Sørensen P, Stubinski B; on behalf of the Rebif® New Formulation Study Group. Safety and immunogenicity of a new formulation of interferon beta-1a (Rebif® New Formulation) in a Phase IIIb study in patients with relapsing multiple sclerosis: 96-week results. Multiple Sclerosis Mult Scler. 2008 Aug 28. [Epub ahead of print] 42. Goodman AD, Brown TR, Cohen JA, Krupp L, Shapiro R, Schwid SR, Cohen R, Marinucci LN, Blight AR for the Acorda-F202 Study Investigators. Dose comparison trial of sustained-release fampridine in multiple sclerosis. Neurology. 2008 Oct 7;71(15):1134-41. Epub 2008 Jul 30 43. Gorlia T, van den Bent MJ, Hegi ME, Mirimanoff RO, Cairncross G, EisenhauerE, Belanger K, Brandes AA, Allgeier A, Lacombe D, Stupp R. Nomograms for predicting survival of patients with newly diagnosed glioblastoma multiforme: a prognostic factor analysis of EORTC/NCIC trial 26981-22981/CE.3. Lancet Oncol 9: 29-38, 2008. 44. Green TL, Mansoor A, Newcommon N, Stephenson C, Steward E, Madden B, Hill MD. Reliability of Point-of-Care Testing of INR in Acute Stroke: a comparison with hospital laboratory testing. Can J Neurol Sci 2008; Jul;35(3):348-51 45. Greer AD, Newhook P, Sutherland GR. Human-machine interface for Robotic Surgery and Stereotaxy. IEEE/ ASME Transactions on MRI Compatible Mechatronic Systems 13: 355-361, 2008 46. Greenberg SM, Grabowski TJ, Gurol ME, Skehan ME, Nandigam RNK, Becker JA, Garcia-Alloza M, Prada C, Frosch MP, Rosand J, Viswanathan A, Smith EE, Johnson KA. Detection of isolated cerebrovascular beta-amyloid with Pittsburgh compound B. Ann Neurol. 2008;64:587-591. 47. Hader WJ, Walker RL, Myles TM, Hamilton MG. Complications of endoscopic third ventriculostomy in previously shunted patients. Neurosurgery 63 [ONS Suppl 1]: ONS170–ONS177, 2008 48. Hauck LJ, White C, Feasby TE, Zochodne DW, Svenson LW, Hill MD Incidence of Guillain-Barré syndrome in Alberta, Canada: an administrative data study. J Neurol Neurosurg Psychiatry. 2008 Mar; 79(3):318-20 49. Hegi M, Murat A, Migliavacca E, Gorlia T, Lambiv W, Shay T, Hamou M-F, Diserens A-C, Luca R, Wick W, Kouwenhoven M, Hainfellner J, Heppner F, Dietrich P-Y, Zimmer Y, Macdonald D, Guha A, Merlo A, Cairncross G, de Tribolet N, Janzer R-C, Domany E, Delorenzi M, Stupp R. Self-renewal signature" and high EGFR expression associated with resistance to chemoradiotherapy inglioblastoma. J Clin Oncol 26: 3015-3024, 2008. 50. Holland CM, Smith EE, Csapo I, Gurol ME, Brylka DA, Killiany RJ, Blacker D, Albert MS, Guttmann CR, Greenberg SM. Spatial distribution of white-matter hyperintensities in Alzheimer disease, cerebral amyloid angiopathy, and healthy aging. Stroke. 2008; 39:1127-1133 51. Hurlbert J, Hamilton MG. Methylperednisolone for acute spinal cord injury: 5-year practice reversal. Canadian Journal of Neurological Sciences 35: 41-45, 2008. 52. Iloreta A, Sarna J, Sharma P, Klein G. Radiologic findings in a patient with spinal cord dysfunction.Can J Neurol Sci (Suppl 1) May 2008 p S89 53. Jetté N, Marson AG, Hemming K, Hutton JL. Topiramate add-on for drug-resistant partial epilepsy." Cochrane Database Syst Rev." Cochrane Database Syst Rev. 2008 Jul 16;3:CD001417. 54. Jette N, Patten S, Williams J, Becker W, Wiebe S. Comorbidity of migraine and psychiatric disorders- a national populationbased study. Headache 2008; 48: 501 – 516. 55. Jetté N, Quan H, Faris P, Dean S, Li B, Fong A and Wiebe S." Health resource use in epilepsy:" disparity between aboriginals and non-aboriginals." Epilepsia." 2008 Apr;49(4):586-93." Epub 2007 Dec 28. !



56. Jetté N, Williams J, Patten S, Becker W and Wiebe S." Psychiatric comorbidities in migraine patients – a population based study." Headache." 2008 April;48(4):501-516." Epub 2007 Dec 7. 57. Jovin TG, Demchuk AM, Gupta R. “Pathophysiology of Acute Ischemic Stroke.” In: Miller AE, Marr CM, William MA (Eds) Continuum, Lifelong Learning in Neurology, American Academy of Neurology Vol. 14, Number 6, December 2008. St. Paul, MN:Lippincott Williams & Wilkins. 2008:29-44. 58. Kawchuk G, Gian SJ, Hurwitz EL, Wynd S, Haldeman S, Hill MD. Spatial distribution of vertebral artery dissections in cases associated with and without cervical manipulation. J Neurol 2008; 255(3): 371-377 59. Kemp SWP, Walsh S, Midha R. Growth factor and stem cell enhanced conduits in peripheral nerve regeneration and repair. Neurol Res, 30(10): 1030-1038,

December 2008.

60. Khatri P, Hill MD, Palesch Y, A, Martin R, Mauldin P, Dillon C, Broderick J for the IMS III Investional Management of Stroke

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72. Murphy BD, Fox AJ, Lee DH, Sahlas DJ, Black SE, Hogan MJ, Coutts SB, Demchuk AM, Goyal M, Aviv RI, Symons S, Gulka IB, Beletsky V, Pelz D, Chan RK, Lee TY. White matter thresholds for ischemic penumbra and infarct core in patients with acute stroke: CT perfusion study. Radiology. 2008;247(3):818-825. 73. Murphy W." VNS Therapy. CJNS July 2008 Vol 35 No 3, pp 278-279. 74. O'Connor P, Devonshire V; Canadian Network of MS Clinic (Patry DG). The use of disease-modifying agents in multiple sclerosis-by the Canadian Network of MS Clinics. 75. Can J Neurol Sci. 2008 May;35(2):127-32. English, French"" 76. Patten SB, Williams JVA, Lavorato DH, Modgill G, Jetté N and Eliasziw M." Major depression as a risk factor for chronic disease incidence: longitudinal analyses in a general population cohort. J Hosp Psych." 2008 Sept-Oct;30(5):407-13 77. Patten SB, Williams JV, Metz L. Antidepressant Use in Association with Interferon and Glatiramer Acetate Treatment in Multiple Sclerosis. Mult Scler. 2008 Apr;14(3):406-11. Jan 31 [Epub ahead of print 78. Polman C, Kappos L, Freedman MS, Edan G, Hartung HP, Miller DH, Montalbán X, Barkhof F, Selmaj K, Uitdehaag BM, Dahms S, Bauer L, Pohl C, Sandbrink R; for the BENEFIT investigators**. Subgroups of the BENEFIT study: Risk of developing MS and treatment effect of interferon beta-1b. J Neurol. J Neurol. 2008 Apr; 255(4):480-7. 79. Polman CH, Reingold SC, Barkhof F, Calabresi PA, Clanet M, Cohen JA, Cutter GR, Freedman MS, Kappos L, Lublin FD, McFarland HF, Metz LM, Miller AE, Montalban X, O’Connor PW, Panitch H, Richert JR, Petkau J, Schwid SR, Sormani MP, Thompson AJ, Weinshenker BG, Wolinsky JS. Ethics of Placebo-Controlled Clinical Trials in Multiple Sclerosis: A Reassessment. Neurology 2008 Mar 25; 70(13 Pt2): 1134-40. 80. Potucek RK, Kemp SWP, Syed NI and Midha R. Peripheral nerve injury, repair and regeneration. In: Strategies in Regenerative Medicine: Integrating Biology with Materials Design, ed. Matteo Santin, Springer, 2008, ISBN 978-0-387-74659-3. 81. Pringsheim T, Davenport WJ, Dodick D. Evidence Based Review: Acute Treatment and Prevention of Mentrually Related Migraine Headache. Neurology 2008:70:1555-1563. 82. Pringsheim T, Lang A, Kurlan R, Pearce M, Sandopr P. Understanding Disability in Tourette Syndrome. Development Medicine and Child Neurology, 2008 Oct 24, Epub ahead of print. 83. Pringsheim T, Marras C, Pimozide for tics in Tourette Syndrome (Protocol). Cochrane Database of Systemaatic Reviews 2008: Isue I, Art. No: CD006996. DOI: 10.1002/14651858. CD006996. 84. PRoFESS Study Group. Telmisartan to prevent recurrent stroke and cardiovascular events. N Engl J. Med. 2008 Sep 18;359(12):1225-37. 85. PRoFESS Study Group. Effects of aspirin plus extended-release dipyridamole versus clopidogrel and temisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial: a double-blind, active and placebo-controlled study. Lancet Neurol. 2008 Oct; 7(10):875-84. 86. Puetz V, Dzialoski I, Hill MD, Subramaniam S, Sylaja PN, Krol A, Hudon M, , Hu WY, Coutts SB, Barber PA, Watson T, Roy J, Demchuk AM for the Calgary CTA study group (2008). Intracranial thrombus extent predicts the clinical outcome, final infarct size and hemorrhagic transformation in ischemic stroke: the clot burden score. "International Journal of Stroke. 3:230-236 87. Puetz V, Gahn G, Becker U, Mucha D, Mueller A, Weir NU, Wiedemann B, von Kummer R. AJNR 2008;29:273-280 Endovascular therapy of symptomatic intracranial stenosis in patients with impaired regional cerebral blood flow or failure of medical therapy. 88. Puetz V, Sylaja PN, Coutts SB, Hill MD, Dzialowski I, Mueller P, Becker U, Urban G, O’Reilly C, Barber PA, Sharma P, Goyal M, Gahn G, von Kummer R, Demchuk AM (2008). Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion. Stroke;39:2485-2490. 89. Reid A, Jetté N, Quan H, Hill M and Wiebe S." Using administrative databases for research in epilepsy:" Validation of ICD-9 and ICD-10 epilepsy codes." Neuroconnections Symposium." Banff, AB, January 2008 (chapter in meeting book). 90. Roldán G, Brasher P, Vecil , Senger D, Rewcastle B, Cairncross G, Forsyth P*, Hamilton M. Population-based study of medulloblastoma: outcomes in Alberta from 1975 to 1996. Can J Neurol Sci 35:210-5, 2008.




91. Roldan G, de Robles P, Cairncross JG. Searching for a new treatment for anaplastic oligodendroglioma. In: New Treatment for Brain Cancer (International Oncology Updates Series). Ed. C Bala#á Quintero. Permanyer, Barcelona, Spain, 2008, pp 1127. 92. Roldan G, Li H, Brasher P, Vecil G, Senger D, Rewcastle B, Cairncross G, Forsyth P, Hamilton M. A population-based study of Medulloblastoma: Outcomes in Alberta from 1975-1996. Canadian Journal of Neurological Sciences 35: 210-215. 2008 93. Roldán G, Scott JN, George D, Easaw J, Yan E, Parney I, Cairncross G, Forsyth P. Leptomeningeal disease from oligodendroglioma: a clinical and molecular analysis. Can J Neurol Sci 35: 204-209, 2008. 94. Rosenthal ES, Schwamm LH, Roccatagliata L, COUTTS SB, Demchuk AM, Schaefer PW, Gonzalez RG, Hill MD, Halpern EF, Lev MH (2008). Role of Recanalization in Acute Stroke Outcome: Rationale for a CT Angiogram-Based "Benefit of Recanalization" Model. AJNR. Am J Neuroradiol ;29:1471-1475. 95. Rost NS, Smith EE, Chang Y, Snider RW, Chanderraj R, Schwab K, FitzMaurice E, Wendell L, Goldstein JN, Greenberg SM, Rosand J. Prediction of functional outcome in patients with primary intracerebral hemorrhage: the FUNC score. Stroke. 2008;39:2304-2309. 96. Rubin ZA, Wiebe S. “Social Issues: Issues in Health Outcomes Assessment. In: Epilepsy. Engel,J.,Jr., Pedley,T.A. Lippincott Williams & Wilkins, Philadelphia, 2008;Volume III:2267-2275 97. Sauro KM, Becker WJ. Multhe Canadian healthcare set-

tidisciplinary treatment of headache in ting. Can J Neurol Sci 2008;35: 46 –

56 98. Saposnik G, Fang J, O’Donon behalf of the Investigators Network (RCSN) for the (SORCan) working group. hospital care and Stroke Mor99. Saposnik G, Hill MD, O’Donon behalf of the investigators Network for the Stroke OutWorking Group. Comparing and 1-year fatality after Aug;39(8):2318-24

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100.Saqqur M, Tsivgoulis G, Molina CA, Demchuk AM, Garami Z, Barreto A, Spengos K, Forteza A, Mikulik R, Sharma VK, Brunser A, Martinez P, Montaner J, Kohrmann M, Schellinger PD, Alexandrov AV; CLOTBUST-PRO Investigators. Design of a PROspective multi-national CLOTBUST collaboration on reperfusion therapies for stroke (CLOTBUST-PRO). Int J Stroke. 2008 Feb;3(1):66-72. 101.Sarna JR, Iloreta A, Sharma P, Klein G. Neuroimaging features of cerebellar venous infarct: a case report and review of literature. Can J Neurol Sci (Suppl 1) May 2008 p S105 102.Schmahmann JD, Smith EE, Eichler FS, Filley CM. Cerebral white matter: neuroanatomy, clinical neurology, and neurobehavioral correlates. Ann N Y Acad Sci. 2008;1142:266-309. 103.Sherman E, Griffiths SY, Akdag S, Connolly MB, Slick DJ, Wiebe S. Sociodemographic correlates of health-related quality of life in pediatric epilepsy. Epilepsy & Behaviour 2008;12(1):96-101. 104.Sijben AE, McIntyre JB, Roldán GB, Easaw JC, Yan E, Forsyth PA, Parney IF, Magliocco AM, Bernsen H, Cairncross JG. Toxicity from chemoradiotherapy in older patients with glioblastoma multiforme. J Neuro-Oncol 89: 97-103, 2008. 105.Smith EE, Vijayappa M, Lima F, Delgado P, Wendell L, Rosand J, Greenberg SM. Impaired visual evoked flow velocity response in cerebral amyloid angiopathy. Neurology. 2008;7:1424-1430. 106.Smith EE, Egorova S, Blacker D, Killiany RJ, Muzikansky A, Dickerson BC, Tanzi RE, Albert MS, Greenberg SM, Guttmann CR. Magnetic resonance imaging white matter hyperintensities and brain volume in the prediction of mild cognitive impairment and dementia. Arch Neurol. 2008; 5: 4-100.




107.Smith EE, Dreyer P, Prvu-Bettger J, Abdullah AR, Palmeri G, Goyette L, McElligott C, Schwamm LH. Stroke center designation can be achieved by small hospitals: the Massachusetts experience. Crit Pathw Cardiol. 2008;7:173-177. 108.Speechley KN, Sang X, Levin S, Zou GY, Eliasziw M, Smith ML, Camfield C, Wiebe S. Assessing severity of epilepsy in children: preliminary evidence of validity and reliability of a single-item scale. Epilepsy Behav 2008;13:337-342. 109.Sutherland CS, Hill MD, Kaufmann AM, Silvaggio J, Demchuck AM, Sutherland GR. Recombinant Factor VIIa plus Surgery for Intracerebral Hemorrhage. Can J Neurol Sci 35:567-572, 2008. 110.Sutherland GR, Kelly JJP, Boehm DW, Klassen JB. Ceramic aneurysm clips for improved MR visualization. Neurosurg 62 [ONS Suppl 2]: 400-406, 2008. 111.#Sutherland GR, Newhook P, Feil G, Fielding T, Greer AD, Latour I. An image-guided MR compatible surgical robot. Neurosurgery 62: 286-293, 2008 112.Sutherland GR, Tyson RL, Auer RN. Truncation of the Krebs Cycle During Hypoglycemic Coma. Medicinal Chemistry 4:379-385, 2008. 113.Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM; VISION Study Group. When to expect negative diffusion weighted images in stroke and transcient ischemic attack. Stroke 2008:39(6):1898-1900 114.Sylaja PN, Coutts SB, Krol A, Hill MD, Demchuk AM for the VISION Study Group (2008). Diffusion weighted MRI negative stroke and TIA-when to expect it? Stroke; 39:1898-1900. 115.Sylaja PN, Puetz V, Dzialowski I, Krol A, Hill MD, Demchuk AM. Prognostic Value of CT Angiography in Patients with Suspected Vertebrobasilar Ischemia. J Neuroimaging. 2008 Jan; 18 (1):46-49 116.Tellez-Zenteno JF, Hunter G, Wiebe S. Injuries in people with self-reported epilepsy: a population-based study. Epilepsia 2008;49:954-961 117.Tellez-Zenteno JF, Wiebe S. Long-term seizure and psychosocial outcomes of epilepsy surgery. Curr Treat Options Neurol. 2008;10:253-259. 118.Tomsick T, Broderick J, Carrozella J, Khatri P, Hill MD, Palesch YY, Khoury J, for IMS II Investigators. Revascularization results in IMS II, AJNR 2008; Mar;29(3):582-587 119.Toth C. Epidemiology of Neurological Sports Injuries, Neurologic Clinics, February 2008, 26(1):1.31. 120.Toth C. Neuroepidemiology of Sports Injury, Trauma and Neurology, 2nd edition, Oxford Press, London, Chapter 25, 479-524 121.Toth C. Peripheral Nerve Injuries in Sports and Recreation, Neurologic Clinics, February 2008, 26(1): 89-113. 122.Toth C, Au S. A prospective identification of neuropathic pain in specific peripheral neuropathy syndromes and response to pharmacological therapy. Pain 2008 Sep 15;138(3):657-66. 123.Toth C, Lee HK, Samuels BA, Shim SY, Liu WQ, Martinez J, Xu Y, Ayala R, Wang J, Zochodne D, Tsai L and Nguyen MD. Ndel1 promotes axon regeneration via intermediate filaments, PLOS One, 2008 Apr 23;3(4):e2014. 124.Toth C, Martinez JA, Chen YY, Diggle J, Fang Q, Ramji N, Hoke A, Zochodne DW. Local erythropoietin signalling enhances regeneration in peripheral axons, Neuroscience, 2008;154(2):767-83 125.Toth C, Rong LL, Yang C, Martinez J, Song F, Ramji N, Brussee V, Liu W, Durand J,Nguyen MD, Schmidt AM, Zochodne DW. RAGE and experimental diabetic neuropathy. Diabetes. 2008 Apr; 57(4):1002-17. 126.Toth C, Shim SY, Wang J, Jiang Y, Neumayer G, Liu W-Q, Martinez J, Zochodne D, Nguyen. MD. Ndel1 promotes axon regeneration via intermediate filaments. PLoS ONE 3(4):e2014,2008 127.Viswanathan A, Patel P, Rahman R, Nandigam RN, Kinnecom C, Bracoud L, Rosand J, Chabriat H, Greenberg SM, Smith EE. Tissue microstructural changes are independently associated with cognitive impairment in cerebral amyloid angiopathy. Stroke. 2008;39:1988-1992 128.Wang LM, Rahn JJ, Lun X, Sun B, Kelly JP, Weiss S, Robbins SMR, Forsyth PA*, Senger DL*. Intramembrane Proteolysis of the p75 Neurotrophin Receptor (p75NTR) is required for Glioma Invasion. PLoS Biol., 6: 2496-2511, 2008. . 129.Webber CW, Xu YQ, Vanneste KJ, Martinez JA, Verge VM, Zochodne DW. Guiding adult mammalian sensory axons during regeneration. Journal of Neuropathology and Experimental Neurology 67(3): 212-22, 2008 130.Weir NU, A neurological letter from Calgary, Canada. Practical Neurology 2008;8:128-132 131.Weir NU. An update on cardioembolic stroke. Postgraduate Medical Journal 2008;84:133-142 132.Weir NU, Dennis MSA triumph of hope and expediency over experience and reason?JNNP 2008;79:852 !



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List of Members Geographic Full-Time Academic Staff! Barber Becker Brownell Cairncross Casha Cooke Coutts Demchuk Dukelow Feasby Federico Fletcher Forsyth Gallagher Hader Hagen Hamilton Hill Hu Hulliger Hurlbert Jette Kiss Latter Metz Midha Nguyen Ousman Parney Smith Starreveld Stys Suchowersky Sutherland Toth Wiebe Wong Yong Zochodne


Philip Werner Keith Gregory Steven Lara Shelagh Andrew Sean Tom Paolo William Peter Clare Walter Neil Mark Michael Bin Manuel R. John Nathalie Zelma John Luanne Rajiv Minh Dang Shalina Ian Eric Yves Peter Oksana Garnette Cory Samuel John Wee Douglas


! Assistant Professor Professor Professor Professor Assistant Professor Assistant Professor Assistant Professor Associate Professor Assistant Professor Professor Assistant Professor Professor Professor Assistant Professor Assistant Professor Professor Associate Professor Associate Professor Professor Professor Associate Professor Assistant Professor Associate Professor Professor Professor Professor Assistant Professor Assistant Professor Assistant Professor Assistant Professor Assistant Professor Professor Professor Professor Assistant Professor Professor Assistant Professor Professor Professor

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Major Clinical Staff!! Barton Bell Busche Costello Davenport Dike Du Plessis Eloff Furtado Hanson Hoyte Klassen Klein Kraft Lam MacRae McGovern McGowan Murphy Patry Pearson Pillay Plamondon Pringsheim Ranawaya Virani Weir White Yeung Watson

Clinical Staff!! Hill Kohli McNeil Ubhi Wilson

! Pamela Robert Kevin Fiona Jeptha Nwamara Stephan Arnolda Sarah Alexandra Keith Brian Gary Scott Kenneth Elizabeth Christine Daniel William David Dawn Neelan Stephanie Tamara Ranjit Noorshina Nicolas Christopher Michael Timothy

Clinical Associate Professor Clinical Associate Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Associate Professor Clinical Assistant Professor Clinical Associate Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Associate Professor Clinical Associate Professor Clinical Associate Professor Clinical Associate Professor Clinical Associate Professor Clinical Assistant Professor Clinical Associate Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Associate Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Associate Professor Clinical Assistant Professor Clinical Assistant Professor

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Denise Jagdeep Stephen Perminder Scott

Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor Clinical Assistant Professor

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Francis Robert Terence

Professor Emeritus Professor Emeritus Professor Emeritus

Neurosurgery Neurology Neurosurgery


Professor Emeritus LeBlanc Lee Myles




2008 Visitors & Highlights January


• 1st annual Spine & Peripheral Nerve Anatomy & Surgery Course • Dr. Colin Chalk, Neurology, McGill University • Dr. Lorne Zinman, Neurology, University of Toronto

• Dr. Thomas A. Miller, Physical Medicine & Rehabilitation, University of Western Ontario • Dr. Marc del Bigio, Pathology, University of Manitoba



• Dr. Susan Fox, University of Toronto • Douglas Cheyne, PhD, Medical Imaging, University of Toronto • Dr. Helen Mayberg, Psychiatry and Neurology, Emory University School of Medicine

• Dr. John H. Sampson, Division of Neurosurgery, Duke University



• Dr Alim-Louis Benabid, Professor Emeritus, Universitaire Joseph Fourier, Grenoble, France • Robert Chen, Division of Neurology, University of Toronto • Ronald R. Tasker, Professor Emeritus, Division of Neurosurgery, University of Toronto

• Charles Taylor Memorial Lecture: Dr. Robert J. Dempsey, Department of Neurological Surgery, University of Wisconsin • Dr. Nina Paleologos, Professor of Neurology, Northwestern University



• Welcome new resident housestaff

• 2nd annual Epilepsy Golf Tournament



• Dr. Hiroshi Nakagawa, Aichi Medical University, Japan • Dr. John Jane, Department of Neurological Surgery, University of Virginia

• Mary Anne Lee Memorial Lecture: Dr. Nicholas M. Barbaro, Department of Neurological Surgery, University of California at San Francisco • Dr. Ralph Dacey, Department of Neurosurgery, Washington University – School of Medicine • Dr. David Mcdonald, Sloan-Kettering Institute



• Dr. Chris Power, Department of Medicine, University of Alberta • Dr. Eric C. Holland, Department of Neurosurgery, Surgery, Neurology & Cancer Biology for Genetics, Memorial Sloan Kettering Cancer Center, New York • Dr. Sandra E. Black, Brill Chair in Neurology, University of Toronto

• Dr. Michael Schlossmacher, Division of Neurosciences – OHRI, University of Ottawa • Dr. Harold L. Rekate, Chief of Paediatric Neurosciences, Barrow Neurological Institute, Phoenix • Annual Christmas Rounds - a departmental tradition!

2008 DCNS Annual Report  

2008 annual report for the Department of Clinical Neurosciences, University of Calgary / Alberta Health Services.

2008 DCNS Annual Report  

2008 annual report for the Department of Clinical Neurosciences, University of Calgary / Alberta Health Services.