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Collaboration key to understanding brain by Heather Woolwine Public Relations The vast, unexplored depths of the human brain render it one of the most mysterious and complicated organs to care for and understand.   While research scientists and clinicians made great strides in recent years, the collaboration between those treating children afflicted with problems of the brain and scientists trying to understand brain function will determine the length and pace of future strides.   MUSC pediatricians know that treating disease in children is different from treating adults, and in the neurosciences, the mantra is the same.   “When you operate on children, you deal with a smaller anatomy that requires a certain level of delicacy that you don’t necessarily need with adults,” said Sunil Patel, MD, clinical chair of the Department of Neurosciences. “Children can’t always tell us where it hurts or what’s wrong. Fortunately, diagnostic tools have improved during the last few decades and we can turn to CT scans and MRIs to help us pinpoint a problem.”   Offering the only full-service pediatric neurosurgery practice in South Carolina, Patel and his colleagues recently welcomed pediatric neurosurgeon Gerald Tuite, M.D., who will provide neurosurgery care exclusively to children.   “For multiple reasons, there is a national shortage of all pediatric surgical sub-specialists,” said Phil Saul, M.D., Children’s Hospital medical director and Pediatric Cardiology director. “This makes the addition of Dr. Tuite to our hospital even more invaluable.”   Pediatric neurosurgery treats a variety of disorders including brain tumors, hydrocephalus, epilepsy and other seizure disorders, cerebral palsy, craniofacial problems and head trauma cases. To better treat their patients, pediatric neurosurgery participates in numerous multidisciplinary clinics with physicians from other specialties such as plastic surgery and hematology/oncology. “This approach is best for the patients because we can offer them everything they might need within the walls of this hospital,” Patel said. “And it’s all focused on the needs of the child and the family.”   Patel, Tuite, and the other members of the pediatric neurosurgery team know that technology and basic science are at the center of moving forward in patient care, treatment, and safety. The group participates in clinical trials and understands the importance of furthering research for the sake of providing better care for children. Developmental Neuroscience: Prakash Kara, Ph.D.   Kara, a Department of Neuroscience assistant professor and recent recruit from Harvard Medical School, is an integrative neuroscientist with expertise in new in-vivo functional brain imaging and electrophysiological techniques.   His interest lies in baby vision, or how the actual wiring of the brain becomes more precise as babies develop and experience the world around them. “At the level of synapses and neurons, baby brains are not miniature versions of adult brains; they are fundamentally different,” Kara said.   One goal of Kara’s lab in the Charles P. Darby Children’s Research Institute (DCRI) is to understand how neural connections from the eye to brain are formed and refined during postnatal development. He wants to understand how signals from normal, healthy eyes are integrated and processed in the developing brain so that the knowledge gained will translate into better treatments for pediatric blindness.   “The pediatric visual system is sensitive to a variety of congenital and acquired diseases or deprivation of sensory experience through injury,” Kara said. “Vision loss in the pediatric population can go unrecognized, because children are highly adaptive to vision loss and may not have the same visual demands as adults. The loss of vision has a direct neural correlate and we need to understand the mechanisms driving the changes in brain wiring that occur with normal development, deprivation and trauma.”   Complementing much of his work at Harvard involving the first ever simultaneous recordings from the eye/retina, thalamus and cerebral cortex in the adult brain, Kara plans to apply such techniques to decipher functional wiring diagrams for the developing visual system. Beyond mapping connections from the eye to the brain, Kara’s research utilizes advanced imaging techniques to map the function of every adjacent neuron in an entire local network of the brain. A neuron can play a unique role when presented with a subject and visual stimulus, and indeed different groups, or columns, of cortical neurons respond in varying capacities to a range of stimuli. It’s important to understand which columns fire when presented with the stimuli, or more precisely, what patterns they fire in to create normal vision. In the developing brain, the function of some cortical columns is unclear and even the existence of a functional column may not be detected because of older imaging methods’ limitations. The task may seem daunting, but Kara is enthusiastic and upbeat. “We now have the advanced imaging method needed to actually look at thousands of neurons in action, in the intact brain to narrow down and better define the function of an entire cortical processing unit or column, as well as individual neurons,” he said. “We load the neurons in the brain with a special dye that brightens only when neurons are active. A two photon infrared laser allows us to focus much deeper in the brain without damaging the area. In a matter of seconds, this technique brings in images of the hundreds to thousands of brain cells that are working to process a sensory stimulus.”   Kara’s work within the DCRI will have an almost instant impact due to his collaboration on an NSF grant with the Boston Retinal Implant Project. The grant proposes to develop new technologies to improve the design of visual prosthetic devices that will be implanted in the retina of blind human subjects who have lost photoreceptor function.   “When an injury or disease induces massive damage to many receptors and neurons within the eye, there’s no drug or real way to fix it,” Kara said. “But if we’re able to put an electrode array into the retina or optic nerve that would receive a small signal from an outside source, say a pair of glasses with a small camera on it, and provide the appropriate electrical stimulation patterns to that array, we could in a sense restore vision.” One role of Kara’s lab will be to figure out the electrical stimulation patterns that would activate the right sets of cortical neurons and mimic normal vision.   “In the long term, Dr. Kara will work closely with brain and eye specialists in the Children’s Hospital and neurosciences and ophthalmology departments, with the overarching goal of making a difference in the lives of children with visual system dysfunction,” said Bernard Maria, M.D., DCRI executive director. “By bringing together such a diverse group of neuroscience experts, the institute aims to comprehensively address pediatric brain health with every available basic science tool. Our goal is to understand childhood diseases of the brain, from the molecular and cellular mechanisms to a systems level analysis with cutting edge technology.” Welcome Gerald Tuite, M.D., pediatric neurosurgeon From Tampa Bay, Fla., where he served as the Pediatric Neurosurgery Division director at the University of South Florida, Tuite completed his neurosurgical residency at the University of Michigan. Following his residency, he completed a one-year fellowship at Great Ormond Street Hospital for Children at Queen Square in London, where he concentrated on the treatment of craniofacial disorders, spinal anomalies and the surgical treatment of epilepsy. He then spent an additional year at Texas Children’s Hospital and Baylor College of Medicine, where he focused on the treatment of children with brain tumors.   Tuite was drawn to MUSC by the unique combination of strong pediatric clinical, research and teaching opportunities all within the context of an evolving neurosurgical division of the highest caliber. “I believe in the synergy created by bringing the clinical and research aspects of neuroscience under one roof,” he says. “At MUSC, we are in a unique position to make real, enduring changes in the way we care for children with neurological disease through our combined efforts in the neuroscience department.” Friday, Sept. 23, 2005 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. 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