Clin. Transl. Neurosci., Volume 1, Issue 1 (June 2017) – 16 articles

Neuro-otology and neuro-ophthalmology are clinical fields destined to be combined in a single interdisciplinary center that offers state-of-the-art diagnosis and treatment to patients with vertigo, dizziness, imbalance, eye movements disorders and disorders of the afferent visual pathways. This paper describes the organization of the Oto-Neuro-Ophthalmology (ONO) center at University Hospital Zurich, Switzerland. The ONO center combines physicians and other medical personnel from the departments of neurology, otorhinolaryngology, ophthalmology, and psychiatry as well as dedicated physical therapists. Patients, typically referred to the center by general practitioners or medical specialists, are comprehensively assessed and treated by considering all neurological, otological, ophthalmological, psychiatric and physiotherapeutic aspects of their disorders. Based on the referral, the patient is assigned to a triage examination (duration: 30 minutes; no later than 10 days after referral) or a full examination. The latter includes a complete assessment of the medical history, a bedside examination, a laboratory test battery and imaging procedures. Importantly, the ONO center is partnered by an experimental laboratory dedicated to vestibular and ocular motor research and formed by the academically active members of the ONO center. To justify the collaborative efforts that go into establishing and continuously upgrading an ONO center, outcome measures become increasingly important. Full article

In terms of fundamental, universal scientific progress in the area of “hard sciences” the past century was the one of relativity, quantum mechanics, and solid state/surface physics, whereas the 21st century prospects a focus on genomics/life/brain sciences, computer sciences/artificial intelligence, climate, and extraplanetary research. Among these, neurosciences represent a meta-plane, where new tools and insights provide key contributions to revolutionizing our current understandings. Increasingly, we move toward a quantitative description of various neural phenomena as well as to a new understanding of the nervous system and brain organization/functioning in particular. All this is strongly influencing the way we see the world. From this process, finally yet importantly, we derive large benefits for the cure of diseases as well as the management of an aging society. Full article

Despite more than a century of investigation into the cortical organization of motor function, the existence of motor somatotopy is still debated. We review functional magnetic resonance imaging (fMRI) studies examining motor somatotopy in the cerebral cortex. In spite of a substantial overlap of representations corresponding to different body parts, especially in non-primary motor cortices, geographic approaches are capable of revealing somatotopic ordering. From the iconic homunculus in the contralateral primary cortex to the subtleties of ipsilateral somatotopy and its relations with lateralization, we outline potential reasons for the lack of segregation between motor representations. Among these are the difficulties in distinguishing activity that arises from multiple muscular effectors, the need for flexible motor control and coordination of complex movements through functional integration and artefacts in fMRI. Methodological advances with regard to the optimization of experimental design and fMRI acquisition protocols as well as improvements in spatial registration of images and indices aiming at the quantification of the degree of segregation between different functional representations are inspected. Additionally, we give some hints as to how the functional organization of motor function might be related to various anatomical landmarks in brain morphometry. Full article

Sitem-insel – the Swiss Institute for Translational and Entrepreneurial Medicine in Bern – was created to establish, operate and develop a National Center of Excellence for Translational Medicine. sitem-insel is organized as a non-profit oriented public private partnership. Translational medicine is a new, process-oriented discipline that aims to translate new findings and products emerging from private-sector development and basic research into clinical application. The discipline seeks to professionalize the essential interaction between scientists conducting basic research in the private sector and universities, clinicians, regulatory bodies and investors. The mission of sitem-insel is to create and foster an enhanced environment for translational medicine in Switzerland. The sitem-insel strategy rests on three pillars: (1) The sitem-insel School offers university-level continuing professional development courses taught by university and private-sector lecturers. (2) The sitem-insel Enabling Facilities provide infrastructure to foster cooperation between industrial partners, basic scientists and clinicians on the campus of the University Hospital of Bern (Inselspital) with the ultimate goal to bring novel diagnostic and therapeutic products towards clinical application. (3) The sitem-insel Promoting Services aim to optimize the administrative-regulatory effort along the route from laboratory bench to commercial products. Full article

Schizophrenia is a severe and, at the same time fascinating disorder. It is traditionally defined as a «dissociation» of higher brain functions, which implies a modular organization of the brain up to its highest levels of organization. This short review shows how the study of the disorder is still flawed by fundamentally different definitions of the disorder, and that a consistent naturalistic approach may help to revise the vocabulary of psychiatric disorders, opening the way towards a neurobiologically informed psychiatry. Empirical studies and clinical importance supporting this novel approach are summarized. Full article

The mechanisms regulating the control of consciousness in both spontaneous sleep–wake behaviour and general anaesthesia remain poorly understood and are a fundamental question in neuroscience. The last 30 years have identified numerous molecular substrates and more recently important monoaminergic neuronal substrates. Future work now needs to concentrate on elucidating the convergence of these neuronal circuits to build a unifying mechanism of consciousness control. Full article

Connecting with junior colleagues across the three linguistic regions of Switzerland, knowing the essentials of the Swiss neurology curriculum, conducting research, considering a fellowship abroad, preparing neurological activity in private practice - all these topics are of vital interest for young neurologists. However, keeping up with such essential aspects of neurological training usually turns out quite demanding for residents as individuals. Junior neurologists’ associations help to deal with such issues. In 2014, a group of enthusiastic juniors, encouraged by several senior neurologists, founded the Swiss Association of Young Neurologists (SAYN) within the Swiss Neurological Society (SNS). Here, we describe key missions and activities of the SAYN, its role and interactions within the Swiss and European clinical neuroscience community, and provide an outlook on future challenges and opportunities for young neurologists. Full article

There are several unique features of the concept of advanced intraoperative imaging modalities with CT (computed tomography), MRI (magnet resonance imaging) and DSA (digital substraction angiography) inaugurated in one operating tract. For the first time, there is the opportunity to switch from postoperative to intraoperative imaging – when the surgeon can not only check the result of surgery but improve it – but in general, that is, for all specialties, at least theoretically. Intraoperative imaging is a broad term with many technologies already in routine use today, such as image intensifier, ultrasound, fluorescence technologies, and soon. Using intra-operative CT, MRI, and DSA is not indisputable. Does the benefit justify such immense costs, both in building and in maintenance? To evaluate the clinical benefit and possible drawbacks of these technologies and if there's a substantial benefit for the patients. Also, this is a review of literature to evaluate the evidence and clinical impact of advanced intraoperative imaging in neurosurgery. There is one prospective randomized trial showing that intraoperative MRI increases the extent of resection. In spine surgery, there are several randomized trials showing that pedicle screws are inserted more accurately when image guidance is used. However, there is no RCT comparing navigation with intraoperative CT-updated navigation. Several prospective studies are showing that intraoperative DSA is able to identify vascular remnants or vessel occlusions in case of aneurysm-, arteriovenous malformation-and arteriovenous fistula-surgery. A fair comparison of the benefit of these new technologies must take into consideration that other methods of intraoperative imaging or image guidance already exist. Hence, there are some patients in whom the use of the more advanced technologies makes a personal, individual difference that may affect quality of life and survival. We have to differentiate between (1) the best diagnostic procedure and (2) the term “standard of care.” Advanced intraoperative imaging is a gold standard in terms of imaging but not a standard of care. Full article

Stroke has become an absolute emergency that is treated by additional endovascular means or by replacing pharmacological options. Modern neuroradiological techniques such as computed tomography (CT) allow us to examine multiple parameters of the diseased brain. These focused on the parenchyma and hemodynamics for pretherapeutic decisions. However, it has become evident that the clot is the current target for interventional measures. Clot length is established as a marker for recanalization. The dense artery sign is known as an acute CT sign of stroke that is readily visible on acute nonenhanced CT. The rationale behind our study was to study if clot density might represent clot vulnerability or resistance to treatment. We conducted a prospective study of all consecutive stroke patients admitted to our hospital over 1 year, who presented with signs of acute middle cerebral artery stroke within the therapeutic window, and who underwent either intravenous or combined intravenous and intra-arterial thrombolysis. All patients were evaluated with a complete stroke CT protocol, transcranial color-coded duplex sonography monitoring, and clinical evaluation with the National Institutes of Health Stroke Scale (NIHSS) score. We measured clot length using planimetry on unenhanced CT and measured Hounsfield units in the clots on the same images. A total of 31 patients were included in the study (19 men, 12 women, aged 35–90 years). We found that patients with a longer clot on the unenhanced CT had a higher NIHSS score, confirming previous literature. However, we found that patients with a lower clot density recanalized to a more marked degree and had a better clinical outcome. Patients who did not recanalize had a higher clot density (49 Hounsfield units) than those who did recanalize (23 Hounsfield units). Overall, measuring the clot seems to be an important additional parameter to be taken into account. In our study, CT clot density seems to correlate with clinical outcome and recanalization. The higher density seems to represent a higher red blood cell content. This is evidence that clot composition could play a much more important role in acute stroke than thought until now and characterizing it with imaging may help in choosing the adequate treatment modality. Higher density seems to reflect erythrocyte content. Therefore, patients with a longer and denser clot may necessitate direct thrombectomy. Full article

This is a viewpoint on future developments opportunities and risks for the healthcare of neurological patients. The discipline started with the method of clinical pathologic correlations which has discovered most of the major neurological diseases in the first half of the last century. In the second half research in our field was merged with the one of basic neurosciences currently labeled as translational neurosciences. This period began with the development of neurophysiology and imaging techniques which allow characterizing the status of the nervous system in health and disease. Later molecular, genetic and many other techniques gained importance for our field. These tools improving the understanding of pathogenesis and diagnosis have been instrumental, but the importance of our field came to the attention of the general population only when new therapies were developed based on these advances. This lead to the establishment of neurological departments both at University level and in general hospitals. This ongoing process has made neurology nowadays the third largest discipline for patient care alongside with internal medicine and surgery in many places. No need to say that further specialization within neurology is needed but the discipline as a whole must operate as an entity to make sure that patient care and subspecialist development run in harmony and neurologists can still also practice as general neurologists. The European Academy of Neurology is supporting these efforts. In the future the best strategy to help neurological patients will be to even increase the research to understand neurological diseases and to develop new therapies. Full article

Medical doctors should be studying in the future not only about the “alleviation of physical and mental pain and suffering” but also about the “restoration of social functioning of their patients. Medical professionals are urged to carry their culture of helping and caring as contributions to society. They also assume responsibility for the careful use of available resources and their equitable distribution. Central values of medicine are respect for human dignity, respect for self-determination and autonomy, the primacy of patient welfare, the principle of noninjury, and solidarity. Questions of values deal with particularly complex areas of personal identity, because values are causes and reasons for decisions and actions. The potential damage of medical interventions is not automatically justified by the desire to help. The ratio between benefit and risks of medical measures must always be critically appreciated. The professional medical ethic is the basis for the contract between medicine and society with three basic principles: primacy of patient welfare, respect for the rights of self-determination (autonomy) of patients (informed consent), and promoting social justice in health care (solidarity). From these principles, normative values are derived, indispensably connected with medical responsibilities and obligations. Development of these values is discussed in the light of the philosophical background of the dignity of the individual person and the process of decision-making. Full article