Boldness based on deep understanding has marked Hopkins’ approach to nervous system disorders since the very beginning, when Harvey Cushing, the father of neurosurgery, attempted surgery for brain tumors at the turn of the 20th century. Studies he’d made of the brain’s circulation and of the way it reacts to injury let him whittle the going mortality, in a few short years, from nearly100 percent to less than 10 percent.
A half-decade later, when Hopkins neurologists and neurosurgeons came to understand that strokes, brain surgery and nerve-severing accidents present such distinct problems that only specialized intensive care can save patients, they went out on a limb to start the first true NCCU—neuro critical care unit—in the country. Today, strengthened by unusually quick melding of fundamental and clinical research, the treatment of major insults to the nervous system at The Johns Hopkins Hospital has led to mortality rates that are either the lowest or among the lowest anywhere.
That same approach colors the way any nervous system illness is dealt with at Hopkins, from chronic neurodegenerative diseases like multiple sclerosis, Parkinson’s, Alzheimer’s and Lou Gehrig’s (ALS) to drug-resistant epilepsy to nerve damage brought on by certain chemotherapies or diabetes.
Neurosurgeon Henry Brem’s frustration with recurring malignant brain tumors led first to research into their behavior then to studies of a novel local approach to treatment. Now, by placing chemotherapy-saturated, biodegradable wafers at the site of tumor surgery in the brain, he’s helped thousands worldwide live longer without the notorious side-effects of whole-body chemotherapy. He also has opened the way for local brain tumor therapy in general, rejuvenating the field.
A fine understanding of neurotransmitter chemistry in the synapses of patients with ALS—a result of a decade in the laboratory—led neuroscientist Jeffrey Rothstein to Riluzole, the sole drug to extend life for patients with that disease. Neurologist Peter Calabresi’s studies of white blood cell behavior in autoimmune illness have led to ways of damping down internal cellular switches. So far, they work astoundingly well in pilot trials for MS patients. The recent history of medical research (see list below) is a testimony to neurology’s ability to translate research to therapy.
For all this historical and current success, something far better is in the works for patients with neurological illnesses. So far, their treatment has, for the most part, come more slowly than for other body areas because of the fragile, protected nature of brain and nerve tissue itself and because nervous system cells have been notoriously difficult to study in the lab.
Now, however, the use of new technology at Hopkins is changing much of that. For the first time, our neurologists, neuroscientists and neurosurgeons can imagine blocking disease or damage at its source. They’ve begun recruiting the immune system into an ally against disease and they’re laying the groundwork to re-activate long shut-off embryonic pathways so they can repair the body.
You can see the beginnings of this in neurologist Doug Kerr’s animal studies using stem cells to form new neural bridges across injuries in the spinal cord or in Ahmet Hoke’s use of growth factors to regrow the myelin insulation in wounded nerves—a holy grail of MS research. Kati Andreasson has discovered one way nerve cells respond once the insults of stroke or more chronic disease strike; she’s close to finding how to magnify it. Dan Drachman has “re-booted” the immune system to quell effects of myasthenia gravis. And Ted and Valina Dawson are painstakingly mapping the body’s neuroprotective pathways, identifying key points where drugs or other approaches could block the relentless progress of Parkinson’s and other chronic diseases.
These advances aren’t happening in a piecemeal way. Along with the new hope of truly meaningful research have come smarter, savvier ways of working across departments and disciplines. In the last decade, Hopkins scientists have created the Johns Hopkins Institute for the Brain Sciences, the Institute for Cellular Engineering (ICE), the Baltimore Huntington’s Disease Center, Project RESTORE which aims for new therapies for MS, the Robert Packard Center for ALS Research, the Parkinson’s Disease and Movement Disorders Center and the Morris K. Udall Parkinson’s Disease Research Center of Excellence. Their pioneering work brings hope for some of humanity’s most devastating neurological diseases.
These innovations will join the list of neurological science discoveries already part of Hopkins' history:
1972 - Identification of the sites where heroin and other opiates act in the brain, a discovery important for the treatment of drug addicts and for screening and developing non-addictive pain-killers. |
1987 - Identification of the brain receptor for cocaine, a key step in developing treatments for cocaine addiction.
1989 - Discovered how the brain "hears" - how bioelectrical signals from the inner ear to the brain are encoded - findings important for understanding the hearing process as well as how the brain operates.
1990 - Induced apparently normal human brain cells to multiply in the test tube, opening the possibility that such cells could be used in treating neurological diseases.
1996 - Developed an effective new treatment for brain tumors using biodegradable polymer implants.
1997 - Genetically engineered mice to grow Herculean muscles, a finding with implications for treating muscular dystrophy and other muscle-wasting diseases.
1997 - Confirmed that a gene related to manic-depressive disorder is located on chromosome 18.
1998 - Provided the first reliable evidence of genetic susceptibility to schizophrenia.
1998 - Identified genetic mutations involved in more than half of all cases of inherited ALS, speeding development of a diagnostic test and earlier treatments.
1999 - Discovered a genetic "switch" that can temporarily quiet firing nerve cells, a finding with implications for treating epilepsy, severe pain, and heart rhythm disturbances.
1999 - Identified a new and unusual nerve transmitter in the human brain, as well as its biological source, work that promises to hasten drug treatments for stroke.
2000 - Used stem cell grafts to restore movement to limbs of paralyzed animals, a major advance in efforts to overcome paralysis in humans.
2000 - Identified a key enzyme in the brain that produces a molecular hallmark of Alzheimer' s disease.
Douglas Kerr, M.D., Ph.D. and Adam Kaplin, M.D., Ph.D. on Neurology
