BICOEE Brain Imaging Center of Economic Excellence

Three Examples of Projects Possible with the Synergy Provide by the BICOEE

1. Improved Understanding of Brain Damage:
   Magnetic Resonance Imaging (MRI) scanners can provide exquisite anatomical views of the human brain in a living person. These scanners are much more safe than the older CAT scanners that exposed people to X-Rays. Instead, the magnetic fields of the MRI scanners are not believed to put people at any risk. MRI scans are being used more and more to assess areas of brain damage following a stroke, and already apparently high-quality images are available at most large hospitals. Given the power of these scanners, it is humbling to realize how rudimentary is our ability to decide a likely outcome or design an optimal rehabilitation regimen based on a patient's scan. A major obstacle to outcome studies is the variability of the human brain, and in order to compare across different patients we need to be able to normalize brain scans. For persons without brain damage this is relatively straightforward, but can be very difficult in the case of those thousands of persons in South Carolina who suffer brain damage following a stroke. Here we show a picture of a person's brain after they had a major ischemic stroke, where a blockage in an artery in the neck stopped blood from flowing, killing a portion of the brain and resulting in the dark area in the top right. On the left is the image that would be seen if it was normalized (put into a common brain space or atlas) by currently available systems, and it looks as though the brain has areas of great distortion (marked by the red arrow). In fact, the brain is not distorted, but the normalization software is being "misled" into drawing the brain this way. The results of a much improved software system, being developed by Professor Rorden (USC) are shown on the right. This is a major improvement, but in order to develop, prove, and market this system, USC simply does not have the number of patients or the clinical expertise. These can be contributed by MUSC, who conversely do not have these specific software skills for developing improved imaging tools of this type.
top
2. Use of Deep Brain Stimulation for Parkinson's Disease (PD)
   

   PD is a common degenerative brain disorder affecting over 1 million people in the U.S., with about 50,000 more people diagnosed each year. And as many other populations around the globe have more people moving into the 50 plus age groups, PD will become more prevalent in these populations too. Initially, most patients with PD respond to medication but commonly after about 5 years the medicines stop working, with few treatment options left. Recently researchers have perfected a method of stimulating the brain that is more invasive than TMS or VNS, but still is much less invasive than traditional brain surgery, where the brain is permanently cut or lesioned. This new technique, called Deep Brain Stimulation, involves inserting a very fine wire (about the width of a human hair) into the brain using precise MRI guidance. Then electrodes on this wire can be stimulated and the part of the brain where the electrode rests is functionally 'off-line'. While the device is transmitting the signal, that part of the brain is 'busy', like your home phone when someone is trying to call in. DBS of three brain regions that act as brakes on movement, is approved for the treatment of Parkinson's Disease. The MUSC BSL and CAIR, because of their track record of combining imaging and stimulation, is currently funded by the NIH to study the effects of DBS in patients with refractory Parkinson's Disease who may also have depression. The BSL, in conjunction with the CAIR, will also perform fMRI studies in these subjects, examining relevant circuitry. This has the opportunity to understand how to use DBS for other diseases like treatment resistant depression. However, MUSC has no real expertise in cognitive neuroscience, and the clinical and imaging expertise needs the expertise of the cognitive neuroscientists at USC. The BICOEE would make this cluster competitive for future funding, and maintain their lead in this area.

   MRI Scan of the Brain in a Stroke Patient with old (left) and new (right) software. Note the non-distortion on the right image

   This example shows how combining the imaging and stimulation technologies at MUSC with the cognitive neuroscience expertise can lead to more advanced work with DBS. However, this formula works even better for another, less invasive form of brain stimulation called TMS.

top
3. TMS to Improve Combat Performance of Pilots
   As we increase our understanding of the human brain and disorders of the brain, more interest is turning to technologies to repair or improve brain functioning. The MUSC BSL has been a pioneer in methods such as Transcranial Magnetic Stimulation or TMS. In TMS a small electromagnet placed on the surface of the head is used to induce a small electrical current in the brain; this small current will stimulate the brain underneath. This method is under investigation as a possible therapeutic technique for clinical depression, chronic pain, and also to temporarily overcome sleep deprivation in Air Force pilots. At present, techniques such as amphetamines are used to attempt to maintain alertness, but these drugs may themselves seriously impair judgment, as a recent investigation of a "friendly fire" tragedy in Afghanistan has shown.

   To fully realize the potential of this approach, two key aspects need to be developed - complete understanding of the psychological and cognitive effects of a particular type of TMS, and a simple method of finding brain locations from the surface of the head. For the first, the expertise of USC in behavioral and cognitive assessment needs to be combined with the medical and technical expertise of the group at MUSC. Drs. Baylis and Rorden at USC are presently developing a simple solution to the second issue.

   A 3D probe can be placed on the surface of the head (left image below), and its location is displayed on a 3D picture of the brain (made from an MRI scan) on a laptop computer (right image below). This is the type of method that could be used under relatively uncontrolled conditions, including conditions of combat. Once again this is an example where combining the expertise at MUSC with that at USC can lead to technological breakthroughs that can lead eventually to the creation of high-tech startup companies to develop and market the new discoveries. MUSC is currently a leader with respect to TMS, and there are many potential opportunities for startup companies building on the 5 current MUSC patents in this area.