Live Well Cincy: Neurology

 Live Well Cincy: Neurology

Local providers are leading revolutionary brain tumor research and sharing advice on recovery from spinal proceduresKevin Michell Advancing Treatment and Recovery

The brand-new building housing the University of Cincinnati’s Gardner Neuroscience Institute has been open for less than a year, but potentially life-changing work is already being accomplished there.

The building houses several UC Health specialty centers within, including the Memory Disorders Center, the Waddell Center for Multiple Sclerosis and the Brain Tumor Center. With many fields of research and care under one roof, the Gardner Neuroscience Institute allows for greater collaboration between specialties as they work together to tackle some of the biggest challenges in maintaining brain health and combating cancer.

Dr. Soma Sengupta is one of a team of physicians and researchers leading the institute’s work on brain tumors and cancer treatment. She is a board-certified neuro-oncologist and associate director of the Brain Tumor Center who works with the multidisciplinary team to study the effects of cancer on the brain and bring in important clinical trials.

“We’re repurposing drugs, very much like other investigators are within this system, and the drug that we’re repurposing will be used to decrease doses of radiation and immunotherapy,” Sengupta explains about one of the Brain Tumor Center’s current initiatives. Radiotherapy and immunotherapy are incredibly helpful in treating cancer and metastases, but each comes with risks and potentially negative side effects. Lowering the doses of either in combination with this repurposed drug can mitigate that risk while providing patients with more reliable tumor treatment.

It’s a bit of a culmination for Sengupta, who has been working on a form of this project since her days at Harvard. This drug, which looks like Valium but was largely ignored because it lacked the level of sedation that Valium offered, actually synergizes well with radiation. The team at the Brain Tumor Center is finishing up their collaborative work with others at Emory University to determine how it interacts with immunotherapy. The results so far are promising and novel, but the process is far from finished with years more research and study ahead. But it’s likely that this will revolutionize brain tumor treatment when it is done.

Sengupta and her partner, Dr. Daniel Krummel, are working with UC’s 1819 Innovation Hub to eventually form their own startup company to facilitate the distribution and use of this repurposed drug. The next step is for Krummel to demonstrate strategies for utilizing the drug compound and the benefits, which may also include helping to reduce the cost of treatment because of how expensive radiotherapy and immunotherapy can be.

“This, in the long run, I think will benefit a lot of patients, especially those who have brain metastases, in reducing the doses of radiation and immunotherapy doses that they might need,” she says.

Sengupta and Krummel are also working with nearby Cincinnati Children’s Hospital Medical Center on the treatment of pediatric brain tumors called medulloblastoma. These rapid-growing and highly malignant tumors form in undeveloped brain tissue, most often in children between the ages of 2 and 6.

“One of the luxuries that we have here is that Cincinnati Children’s is such a powerhouse,” Sengupta says, naming Dr. Maryam Fouladi as one of the people at the pediatric hospital and medical center who serve as an important resource for collaborative study on medulloblastoma.

Sengupta met Dr. Scott Pomeroy, a Cincinnati native and current chair of Boston Children’s Hospital’s neurology department, when she joined the National Institute of Health’s R25 research program some years ago. Pomeroy provided Sengupta an opportunity to look at the sequencing of medulloblastoma and she found an important receptor that allowed for a specific drug compound to work effectively in the cancer cell. That finding has inspired further research and study from others as the receptor is present in a number of cancer strains.

Emory University and Georgia Tech are two schools working closely with the team at Gardner, providing additional research on treatment efficacy and the connection between melanoma and brain metastases.

“When we’re embryos,” Sengupta says about the fundamental connection between the skin and the brain, “it’s from the neural crest cells that the brain evolves and the skin. The melanin pigment comes from those cells, so melanoma is very closely related to brain tumors.”

But the work Sengupta and others are doing goes beyond the front lines of attacking cancer with science and medicine.

“One of the things that I have found to be seriously lacking in the world of cancer is survivorship,” she says, mentioning the work of her colleague Michelle Kirschner at the Barrett Cancer Center. Kirschner, Sengupta and Dr. Rhonna Shatz—who has earlier worked with UC’s College-Conservatory of Music to examine the effects of music on delaying or combating the onset of dementia—are opening a neurocognitive clinic for brain tumor patients. There, they want to help survivors with memory treatment, psychiatric input on neurocognitive therapies and employing others using integrated medicine, which includes bringing in members of the schools of music and the arts.

“So that’s also another thing that will be completely novel in its making—there aren’t any programs like it in existence,” explains Sengupta. “There are elements of it but not the whole thing.”

While there has been a lot of research into the neurodegenerative side of brain treatment, much is still not understood about why some patients who receive high doses of radiation therapy exhibit negative cognitive effects more than others. There is hope that recovery can be improved through stimulating other parts of the brain through music and art. Sengupta points out that her patients with the best recoveries tend to be people with a background in these interests.

Sengupta has only been at the Gardner Neuroscience Institute since July, but already her work and that of her colleagues are putting the center on the map by bringing together a vast amount of research and studies being conducted here in the city and at other facilities. There is a lot to be done on many different fronts, ranging from research and collaboration with neurosurgeons and neuro-oncologists to setting up trials and applying for NIH funding. But the work being done at the Gardner Neuroscience Institute is of monumental importance and the efforts of Sengupta and many others are helping medical science provide patients with more hope and optimism that they can beat brain cancer and metastases, recover from them and go on to live happy, normal lives.

Improving Spine Procedure Recovery

Mayfield Brain & Spine has been a leader in spine care and surgery for over 80 years and continues to offer cutting-edge medical treatment and therapy. But spine procedures require patients to seriously commit to the process of recovery

One very important aspect of this is weight management. Patients with a body mass index of 40 or higher have a much higher risk of complications after spinal procedures. Those can include delayed healing from the surgery, knock-on effects that can arise from compensating for decreased spinal strength initially after surgery and extra stress being placed on spinal constructs because of being overweight. That last element can be catastrophic and can lead to major problems beyond a protracted or failed recovery from the procedure.

Patients who are undergoing elective surgery are sometimes referred to clinics or counselors to help with weight loss, weight management and improving nutrition.

“It’s a difficult thing because oftentimes patients with these conditions have significant pain, which is debilitating,” says Dr. Zachary Tempel, a neurosurgeon with Mayfield, “so trying to encourage them to be active is sometimes difficult.”

That can be compounded by depression that can arise with the inability to be as active, mobile or able as the patient used to be, which makes a good support system—from the physicians and specialists to the patient’s family and friends—all the more important.

But it’s not just weight management that can make spinal procedure recovery more complicated and drawn out. Diabetes and smoking have similar effects, as Tempel describes, placing those patients at a higher risk of wound complications, infections and bone fusion.

Recovery in normal circumstances varies depending on the surgery, but often takes between six weeks and three months, though it can also take six months or more for the bone to fuse.

“In patients who are smokers or diabetic or overweight, that process can take a much more prolonged period of time—more than a year,” Tempel explains. “And what’s worse is when that [bone] fusion process just doesn’t occur because of the patient’s inability to heal. When that happens, then you’re talking about salvaging an operation.”

Tempel points out the extended recovery period isn’t the biggest problem, it’s the likely need for additional, more complex surgeries to fix what has gone wrong during recovery.

But that doesn’t mean that there aren’t paths to successful procedures in these cases. In fact, Mayfield is particularly adept at helping patients prepare for spinal surgery through referrals to organizations that help with weight loss or smoking cessation and walking them through what their responsibilities are to meet expectations and goals of the procedure.

Tempel points out that Mayfield’s staff contains professionals across many disciplines who can provide comprehensive care and guidance for spinal health. Mayfield Brain and Spine uses its expertise and the top advancements in the field to help those needing spinal procedures receive the care they need and a smooth recovery in order to enjoy their lives afterward.