2008 DCNS Annual Report
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Transcript of 2008 DCNS Annual Report
2008 ANNUAL REPORT
Clinical NeurosciencesDEPARTMENT OF
N e u r o l o g y • N e u r o s u r g e r yP h y s i c a l M e d i c i n e & R e h a b i l i t a t i o nE x p e r i m e n t a l N e u r o s c i e n c e s
CONTENTS
.......................................................................................................Message from the Chair! 3
......................................................................................................Administrative Overview! 5
........................................................................................................Departmental Structure! 6
.........................................................................................................................New Faculty! 8
..........................................................Alberta Heritage Foundation for Medical Research! 10
.....................................................................................................2008 Program Updates ! 13
...........................................................................................Adult Hydrocephalus Program! 13
..............................................................................................Alberta Radiosurgery Centre! 14
...........................................................................................................Chronic Pain Centre! 15
...............................................................................................................Epilepsy Program! 16
...........................................................................................Epilepsy Golf Tournament! 20
.................................Calgary Headache Assessment & Management Program (CHAMP)! 21
...........................................................................................Movement Disorders Program ! 23
..............................................................................................Intraoperative MRI Program! 25
................................................................................................Multiple Sclerosis Program! 26
................................................................................................Neuromodulation Program! 30
.........................................................................................................Neuromuscular Clinic! 32
..................................................................................................Neuro-Oncology Program! 35
.......................................................................................Pediatric Neurosurgery Program! 36
....................................................................................Peripheral Nerve Surgery Program! 38
..............................................................................................................Project NeuroArm! 39
..............................................................................................Skull Base Surgery Program! 41
...................................................................................................................Spine Program! 42
....................................................................................Stroke & Neurovascular Programs! 43
.....................................................................................................Urgent Neurology Clinic! 47
....................................................................................................2008 Divisional Updates! 48
....................................................................................................Division of Neurosurgery! 48
.........................................................................................................Division of Neurology! 56
..............................................................Division of Physical Medicine and Rehabilitation! 65
...........................................................................Division of Experimental Neurosciences ! 68
................................................................................................2008 Educational Updates! 72
............................................................................Neurology Residency Training Program! 72
.......................................................................Neurosurgery Residency Training Program! 74
......................................Physical Medicine & Rehabilitation Residency Training Program! 77
..........................................Undergraduate Medical Education in Clinical Neurosciences ! 78
...........................................................................................................Fellowship Program! 79
..............................................................................................................2008 Publications ! 80
.................................................................................................................List of Members! 88
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 2
Message from the ChairExecutive Summary from Dr. Gregory Cairncross,
Department Head
In 2008, the Government of Alberta created a new
leadership structure for health care delivery. Alberta Health
Services now plans and coordinates the provision of health
care across the province. All health
care services fall under the jurisdic-
tion of a single Board which reports
directly to the Minister of Health
and the Premier of Alberta. This
structure promises to eliminate du-
plication of services and barriers to
seamless care for Albertans. Our
Department embraces these
changes toward better care for the
sick.
Throughout 2008, the Depart-
ment of Clinical Neurosciences
provided exemplary neurosurgical,
neurological and rehabilitative care
to the citizens of Calgary and
Southern Alberta. We also provided
emergency services to regions of
Saskatchewan and British Colum-
bia that are close to Calgary. Those
who suffered from stroke, serious
head injuries, spinal disorders, epi-
lepsy, multiple sclerosis, brain infections and a host of
other neurological conditions were cared for skillfully and
compassionately by our expert team of surgeons, physi-
cians, nurses and therapists. It remains an honour for me
to be associated with such an inspiring group of health
care professionals.
As Department Head, I have the unique opportunity to
shape the future of Clinical Neurosciences in Calgary and
beyond through the recruitment of new medical faculty and
2008 was a terrific year.
Dr Eric Smith, a stroke specialist and scientist, joined
us from the Massachusetts General Hospital and Harvard
University. Eric is studying the connection between small
silent strokes, which occur in patients with high blood
pressure and diabetes, and Alzheimer’s disease. He be-
lieves that certain types of dementia may be preventable in
many instances. His research pro-
gram is funded by the National In-
stitutes of Health in the United
States. Eric brings a new area of
research strength to Clinical Neu-
rosciences and its highly regarded
Calgary Stroke Program.
Clinical Neurosciences also played
a pivotal role in the recruitment of
Dr Jennifer Chan, Eric’s wife. Jen-
nifer is a pathologist and clinician
scientist also from Harvard Univer-
sity. She uses molecular genetic
approaches to understand the
causes of brain cancer. This
knowledge will bring us closer to
better treatments for these devas-
tating illnesses. Jennifer is the
newest member of the Clark H
Smith Brain Tumour Centre. The
Centre is located in the new Health
Research Innovation Centre of the
Faculty of Medicine.
Dr Tamara Pringsheim and her husband Dr Jeptha
Davenport were recruited to Calgary from the University of
Toronto, where Tamara, a neurologist, was pursuing post-
doctoral training in movement disorders, and Jeptha, was a
clinical neurologist. Since arriving in Calgary in April,
Tamara has established the first specialized clinic in south-
ern Alberta for children with Tourette’s syndrome. The
Tourette’s clinic is located in the Child Development Centre
adjacent to the new Alberta Children’s Hospital. Tamara is
studying the psychological and genetic underpinnings of
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 3
Dr. Gregory Cairncross
this perplexing neurological disorder, characterized by tics.
Jeptha is a wonderful clinician who works in the Multiple
Sclerosis and Headache Clinics and provides expert neuro-
logical care to patients at the Peter Lougheed Centre. We
are so fortunate to have attracted them to Calgary.
I am especially pleased to have been able to attract to
Clinical Neurosciences, Dr
Sean Dukelow, a physia-
trist and clinician-scientist,
who studies how patients
with stroke can be rehabili-
tated more quickly and
completely. Sean received
his MD and PhD degrees
from the University of
Western Ontario and
trained in Physical Medi-
cine & Rehabilitation at
Queen’s University. As one
of the very few scientists in
the field of Rehabilitation
Medicine, he was highly
sought after by many aca-
demic Departments and
Universities in Canada. I
believe that the emphasis
we have placed on innova-
tion and excellence in
Clinical Neurosciences,
and the extra-ordinary
Stroke Program that we
have built in Calgary over
the past decade, where
two of the main reasons
why Sean and his family chose to move to our City, Univer-
sity and Department. And it only gets better!
Also in 2008, we successfully recruited Dr Shalina
Ousman, a scientist of exceptional accomplishment and
promise. Shalina did her research training at Queen’s,
McGill and the University of California at San Diego before
moving to Calgary. In her laboratory, she is discovering the
molecules in the brain that control inflammation. These
studies are yielding new insights into the causes and future
treatment of Multiple Sclerosis, a progressive neurological
disorder of young adults that is especially common in Al-
berta.
In September, the Rehabilitation Service Task Force,
commissioned by the Calgary Health Region and led jointly
by Ms BettyLynn Morrice and myself, table its final report.
The report made recom-
mendations on organiza-
tional structure, service
integration and academic
enhancement for the Cal-
gary context, and will be
the foundation for Calgary
input to provincial re-
organization of Rehabilita-
tion Care by Alberta Health
Services.
The educational and re-
search missions of Clinical
Neurosciences continue to
thrive and grow. All of the
senior trainees in Neuro-
surgery and Neurology
successfully completed
their Fellowship Examina-
tions of the Royal College
of Physicians and Sur-
geons of Canada.
Once again, the Depart-
ment had a very high rate
of success in research ap-
plications to the Alberta
Heritage Foundation for Medical Research and Canadian
Institutes of Health Research. Nearly 25% of our faculty
members hold an external salary award or research grant
from a provincial or national agency – a remarkable suc-
cess story! I hope you enjoy our 2008 Annual Report and
welcome feedback.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 4
Department of
Clinical Neurosciences
Dr. Gregory
CairncrossHead,
Department of
Clinical Neurosciences
Dr. Gregory
CairncrossHead,
Department of
Clinical Neurosciences
Dr. Rajiv Midha
Division
of
Neurosurgery
Dr. Rajiv Midha
Division
of
Neurosurgery
Dr. Samuel Wiebe
Division
of
Neurology
Dr. Samuel Wiebe
Division
of
Neurology
Dr. John Latter
Division of
Physical Medicine
& Rehabilitation
Dr. John Latter
Division of
Physical Medicine
& Rehabilitation
Dr. Bin Hu
Division of
Experimental
Neurosciences
Dr. Bin Hu
Division of
Experimental
Neurosciences
Executive Assistant
Danielle SikanderExecutive Assistant
Danielle Sikander
Administrative Assistant
Linda Menzies -BurrowsAdministrative Assistant
Linda Menzies -Burrows
Administrative Assistant
Patricia MossAdministrative Assistant
Patricia Moss
Administrative Assistant
Linda JennettAdministrative Assistant
Linda Jennett
Administrative Assistant
Sue NelsonAdministrative Assistant
Sue Nelson
Regional Manager
Stephen JeffersonRegional Manager
Stephen Jefferson
Administrative OverviewCathy Edmond, Director of Serv-
ices
The context for planning and de-
livering services to patients and fami-
lies in 2008 included some significant
capacity challenges, human and finan-
cial resource constraints and the intro-
duction of a major re-organization of
provincial health services. Despite
these circumstances, services in Clini-
cal Neurosciences both expanded and
improved. Physician, nursing and al-
lied health leaders demonstrated
commitment, collaboration and crea-
tivity is achieving a number of suc-
cessful service related achievements.
The expansion of Neurology serv-
ices at the Rockyview Site represents
a key accomplishment. This devel-
opment saw increases to ambulatory
neurology clinics, EEG and EMG visits,
the addition of a second urgent neu-
rology clinic and the introduction of a
neurology admitting service to 8 inpa-
tient beds on Unit 46. The addition of
the second urgent clinic was the first
departmental opportunity to establish
a program on 2 sites. The nursing
staffing model established for this
program is quite unique and includes a
rotational plan that involves existing
staff from Unit 46. It is expected that
this model will allow nurses to en-
hance their understanding of the con-
tinuum of care across settings and
expand their knowledge base in neu-
rological care. Nurse practitioner, Pam
Sweeney, also commenced practice
as part of the team supporting en-
hanced neurological care at the site.
Several quality improvement pro-
jects were completed including those
related to patient flow under the
GRIDLOCC (Getting Rid of Delays that
Limit Our Capacity to Care) Initiative
and those using General Electric Lean
Methodology to improve efficiency
and quality. A number of departmental
leaders and staff had the opportunity
to learn and apply the “Lean” ap-
proach to addressing process im-
provement opportunities. The main
projects included the discharge proc-
ess on Units 111 and 112, admission
to Unit 58 (Tertiary Rehabilitation) and
a project focused upon the Stroke
Prevention Clinic. Although there were
some challenges with applying and
sustaining proposed changes as part
of these initiatives, a number of signifi-
cant outcomes were realized and
those results have been sustained. A
continuous quality management proc-
ess was also established in this year
that provides a systematic method of
monitoring, priority setting and plan-
ning for ongoing quality improvement
in Clinical Neurosciences.
Patient and family involvement
was a continued priority in the plan-
ning, delivery and evaluation of our
services. A growing number of com-
mittees and most initiatives included a
patient or family representative. This
involvement proved invaluable to the
success and quality of the Lean pro-
jects and reinforced our commitment
this important strategy in supporting
patient-centred care in service deliv-
ery.
The ambulatory services man-
agement model was reorganized to
increase staff training and to support
and facilitate management across in-
patient and ambulatory services by
program. An evaluation plan is cur-
rently being developed. In addition, an
ambulatory services re-design project
commenced in late 2008 with a man-
date to improve quality in ambulatory
processes.
A number of ongoing priorities
were established by the Clinical Neu-
rosciences Executive Team in 2008.
These include improvements to the
quality and efficiency of ambulatory
services, continued management of
capacity and demand and the strate-
gic planning process for the develop-
ment of Neuroscience services across
the region with a focus upon the
Rockyview and South Health Campus
Sites.
The Clinical Neurosciences physi-
cians, managers and staff have seen a
number of successes in sustaining,
developing and even enhancing serv-
ices through the complexity of the
healthcare environment in the past
year. I have no doubt that services will
continue to thrive in the current year
with such a committed and talented
team.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 5
Departmental StructureHistory of the Department
Clinical Neurosciences was cre-
ated in 1981 when the Division of Neu-
rosurgery then in the Department of
Surgery and the Division of Neurology
in the Department of Medicine joined
forces to create a new academic De-
partment of the University of Calgary
focused on disorders of the nervous
system. Dr Robert Lee was the first
Head of the Department and Dr Frank
LeBlanc was the first Chief of Neuro-
surgery. Initially, there were two units
one at the Foothills Medical Centre
and the other at the Calgary General
Hospital. Subsequently, neurological
services were consolidated at the
Foothills Medical Centre and a period
of rapid growth ensued with both in-
ternal and external recruitment and
research expansion under the leader-
ship of Dr Tom Feasby (Department
Head and now Dean of the Faculty of
Medicine at the University of Calgary).
Dr Feasby was joined by Dr Garnette
Sutherland (Head of Neurosurgery), Dr
Werner Becker (Head of Neurology)
and Dr Christine McGovern (Acting
Head of Physical Medicine and Reha-
bilitation).
Today, in addition to being an aca-
demic department of the University of
Calgary (U of C), Clinical Neurosci-
ences is a regional clinical department
of the Calgary Health Region (CHR).
Physician members of the Department
of Clinical Neurosciences provide neu-
rosurgical, neurological and medical
rehabilitation services to the citizens of
Southern Alberta, southwestern Sas-
katchewan and southeastern British
Columbia. Clinical Neurosciences now
consists of three clinical divisions,
Neurosurgery, Neurology and Physical
Medicine & Rehabilitation, and one
basic research division, called Experi-
mental Neurosciences. Each division
has a leader and Head – Dr Rajiv
Midha (Neurosurgery), Dr Samuel
Wiebe (Neurology), Dr John Latter
(PM&R) and Dr Bin Hu (Experimental
Neurosciences). Collectively, members
of Clinical Neurosciences are actively
involved in undergraduate and post-
graduate medical education, with
Royal College of Canada approved
residency training programs in Neuro-
surgery, Neurology and Physical Medi-
cine and Rehabilitation. In addition,
many of the subspecialty programs in
Clinical Neurosciences attract clinical
fellows from other Canadian Centres
and abroad. Members of the Depart-
ment also teach clinical skills to ad-
vanced practice nurses and to other
health professionals, and directly su-
pervise graduate students and post-
doctoral research fellows. Clinical
Neurosciences now includes over 70
primary members many of whom are
also members of the Hotchkiss Brain
Institute.
Inpatient and outpatient services,
including neurosurgical services for
adults and children, are provided at
the Foothills Medical Centre and at the
new Alberta Children’s Hospital. Out-
patient and consultation services are
provided at the Tom Baker Cancer
Centre (TBCC), the Rockyview General
Hospital and the Peter Lougheed Cen-
tre. Medical services are also provided
at the Chronic Pain Centre and at the
Fanning Centre. The Department also
provides limited neurological outreach
services to the Chinook and Palliser
Health Regions (Neurology consulta-
tions only). Research programs are
based at the Foothills Hospital, Faculty
of Medicine and Tom Baker Cancer
Centre, especially in partnership with
the Hotchkiss Brain Institute, Southern
Alberta Cancer Research Institute and
the Institute of Maternal and Child
Health.
Throughout its short history, the
Department of Clinical Neurosciences
has had an exemplary record of re-
search accomplishment. Tangible ex-
amples of research success include
two Canadian Foundation for Innova-
tion (CFI) awards, first for the devel-
opment of intraoperative MRI and
more recently for the design and test-
ing of neuroArm, a MRI compatible
robot for micro-neurosurgery, 10 ex-
ternal salary awards, eight from the
Alberta Heritage Foundation for Medi-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 6
cal Research (AHFMR) and two from
the Canadian Institutes of Health Re-
search (CIHR), over 100 major publica-
tions annually and over $10 million in
active research funding. Aided by the
AHFMR, CIHR, Heart & Stroke Foun-
dation of Canada, University of Cal-
gary, Calgary Health Region,
Hotchkiss Brain Institute
and the generosity of Cal-
garians, Clinical Neurosci-
ences has garnered a well
deserved national reputa-
tion for innovation in patient
care, teaching and re-
search.
Structure of the Depart-
ment
Clinical Neurosciences
is one of 20 academic De-
partments of the Faculty of
Medicine and one of 14
Regional Clinical Depart-
ments of the Calgary Health
Region. With regard to Uni-
versity matters, principally
research and education, the
Department Head of Clini-
cal Neurosciences reports
to the Dean of Medicine.
With regard to patient care
and clinical service delivery
issues, the Department
Head of Clinical Neurosci-
ences reports to the Executive Medical
Director of the Northwest portfolio of
the Calgary Health Region and also to
the Chief Medical Officer of the Cal-
gary Health Region. In regard to aca-
demic recruitment, training and re-
search development and support, the
Department Head of Clinical Neurosci-
ences works in concert with the Insti-
tute Directors, especially the Director
of the Hotchkiss Brain Institute. De-
partmental affairs are conducted by
two senior committees: the Academic
Executive Committee, which is chaired
by the Department Head, and by the
Clinical Executive Committee, which is
co-chaired by the Director of Neuro-
science Programs of the Calgary
Health Region and the Deputy De-
partment Head of Clinical Neurosci-
ences, currently the Head of Neuro-
surgery.
Patient care and research occur
seamlessly in Clinical Neurosciences
through the use of multidisciplinary
teams in areas such as Stroke Care,
Epilepsy, Movement Disorders, Spinal
Disorders and many others. The major
care programs and teams and their
medical leaders are summarized in the
attached figure.
Two major challenges face the
Department of Clinical Neurosciences
over the next five to ten years. The first
is the development of a
new strategic plan for Re-
habilitation Services in the
Calgary Health Region that
includes the development
of vibrant, research-
intensive Division of Physi-
cal Medicine and Rehabili-
tation and the second will
be the transition from an
academic and clinical De-
partment consolidated at
the Foothills Medical Cen-
tre and Alberta Children’s
Hospital to a Department
that achieves greater suc-
cess on two sites, the
Northwest (FMC) and
South Health Campuses.
Continued success for
Clinical Neurosciences can
be expected. There is a
strong commitment to pa-
tient care and a palpable
esprit de corps, the latter
most evident at Grand
Rounds, which occur
weekly. The training programs in Clini-
cal Neurosciences are strong, well
managed and heavily subscribed.
Aided by the Hotchkiss Brain Institute
and the “Alberta Advantage”, the
prospect for major recruitment and
significant discovery in Clinical Neuro-
sciences has never been greater. Our
future is bright!
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 7
DirectorNeuromuscular and EMG Lab
Doug Zochodne
Director
EEG & EpilepsyNeelan Pillay
Director
Alberta Radiosurgery Centre& Neuromodulation
Zelma Kiss
Director
Neurosurgery Education
John Hurlbert/John Wong
Director
Peripheral NerveRajiv Midha
Director
Neuro Vascular
John Wong
Director, MRI &
NeuroArm Robotics Garnette Sutherland
DirectorQuality Improvement
And SafetyW. Becker/M. Hamilton
Director
Paediatric NeurosurgeryMark Hamilton
DirectorPaediatric PM & R
John LatterDirector
Stroke ProgramAndrew Demchuk
Director
Stroke Unit
Michael Hill
DirectorMultiple Sclerosis
Luanne Metz
DirectorIBTRC
Gregory Cairncross
Director
SACRI
Peter Forsyth
Director
Headache Program
Werner Becker
DirectorUrgent Neurology
ClinicBill Murphy
Director
Neurology Education
Drs. William Fletcher/David Patry
Director
Therapeutic Brain
Stimulation Program
Bin Hu
Director
Movement Disorders
Oksana Suchowersky
Calgary Spine Program
Jacques Bouchard
& Stephan duPlessis
DirectorALS Clinic
Chris White
Department
Of
Clinical Neurosciences
Clinical Neurosciences
Program Leaders
New FacultyDr. W. Jeptha Davenport
Dr. Davenport graduated
from the University of Illinois
College of Medicine in 1996
after undergraduate studies
in philosophy and
neurosciences." He special-
ized in neurology after com-
pleting an internship at the
Royal Victoria Hospital and
neurology residency in
Montreal at McGill
University." He received his
fellowship in the Royal Col-
lege of Physicians of Can-
ada in 2002 and became a
diplomate of the American
Board of Psychiatry and
Neurology in 2004." He
worked on basic science
studies of pain at the Hospi-
tal for Sick Children under
Dr. Mike Salter before work-
ing in several community
hospitals and in a general
neurology practice in
Toronto." He came to Cal-
gary in the spring of 2008,
working in the headache
group of the Chronic Pain
Centre, the Multiple Sclero-
sis Clinic of the Foothills
Medical Centre,"as well as in
other areas of neurology in
the Department of Clinical
Neurosciences of the Cal-
gary Health Region.
Dr. Sean Dukelow
Dr. Dukelow obtained
his B.Sc. with specialization
in Human Kinetics from the
University of Guelph." He
went on to do his M.D. and
his Ph.D. at the University
of Western Ontario." His
doctoral research, super-
vised by Dr. Tutis Vilis, fo-
cused on using high field
functional MRI to map out
areas of the brain that were
responsive to visual motion
and eye movements." After
completing his doctoral
studies, he continued on to
do his residency in Physical
Medicine and Rehabilitation
at Queen’s University in
Kingston, Ontario." During
his residency and post-
doctoral fellowship at
Queen’s he collaborated
with Dr. Stephen Scott to
develop novel robotic tech-
niques for assessment of
neurologic function in stroke
rehabilitation subjects." Cur-
rent research interests in-
volve further development of
robotic assessment and
treatment tools following
stroke." Clinically his"prac-
tice areas are"stroke reha-
bilitation"and electromyog-
raphy.
Dr. Shalina Ousman
Dr. Shalina Ousman is
an Assistant Professor in the
Department of Clinical Neu-
rosciences at the Hotchkiss
Brain Institute and the Uni-
versity of Calgary. She did
her PhD in Neurosciences at
McGill University followed
by two postdoctoral fellow-
ships at The Scripps Re-
search Institute (Neuro-
pharmacology Department)
and Stanford University
(Department of Neurology
and Neurological Sciences).
She is funded by the Alberta
Heritage Foundation for
Medical Research, Canadian
Institutes of Health Re-
search and the Multiple
Sclerosis Society of Can-
ada. Dr. Ousman is inter-
ested in identifying endoge-
nous protective mecha-
nisms in multiple sclerosis.
Dr. Tamara Pringsheim
Dr Tamara Pringsheim is
a neurologist specializing in
the treatment of Tourette
Syndrome and related
comorbid disorders includ-
ing Attention Deficit Hyper-
activity Disorder and Ob-
sessive Compulsive Disor-
der. She also has an interest
and expertise in the diagno-
sis of movement disorders
in children and adults, as
well as primary headache
disorders. "She completed
her five year residency at
the University of Toronto in
adult neurology, and then a
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 8
Dr. Shalina Ousman
Dr. Sean Dukelow
Dr. Jeptha Davenport
3 year neuropsychiatry and
movement disorders fellow-
ship under Dr Paul Sandor
and Dr Anthony Lang in To-
ronto. "She also did a one
year clinical and research
fellowship in headache at
McGill University. "In addi-
tion to her clinical subspe-
cialty training, Dr Pringsheim
completed a Master degree
in Clinical Epidemiology in
the department of Health
Policy, Management and
Evaluation at the University
of Toronto. "Dr Pringsheim
is the director of the Cal-
gary Tourette Syndrome
Clinic, and is a member of
the Movement Disorders
Program and CHAMP clinic.
Dr. Clare Gallagher
Dr. Gallagher graduated
from the University of Cal-
gary with a PhD in Bio-
chemistry in 1995. After an
industrial post doctoral fel-
lowship in the USA she re-
turned to Canada to attend
medical school at the Uni-
versity of Alberta (2000).
Neurosurgical training was
then undertaken at the Uni-
versity of Calgary and com-
pleted in 2006. A fellowship
in Neurotrauma was com-
pleted at the University of
Cambridge (UK) in 2006-7
and followed with Pediatric
Neurosurgery training at the
University of Texas-
Southwestern (Dallas) in
2007-8. She returns to take
a position at the University
of Calgary with special in-
terest in traumatic brain in-
jury and pediatric neurosur-
gery.
Dr. Gallagher’s research
interests are in the field of
neurotrauma. Both clinical
and basic research projects
are underway. The field of
cerebral metabolism after
traumatic brain injury is be-
ing investigated in the labo-
ratory setting and with brain
injured patients. Neuro-
chemistry and vascular re-
activity is currently being
investigated in both the
adult and pediatric popula-
tion.
Dr. Eric Smith
Dr. Smith was recruited
in 2008 from Massachusetts
General Hospital, where he
was Associate Director of
Acute Stroke Services and
Assistant Professor of Neu-
rology at Harvard Medical
School."His"clinical interests
are vascular cognitive im-
pairment,"cerebral small
vessel disease (including
ischemic white matter dis-
ease and intracerebral hem-
orrhage) and acute stroke
care.
He is the Principal In-
vestigator of a U.S. National
Institute of Health grant to
identify MRI and PET imag-
ing markers of cerebral
small vessel disease and
Alzheimer's disease, and
determine their contribution
to cognitive decline. Another
avenue seeks to identify
predictors of appropriate
medical care for stroke and
the impact of stroke treat-
ments in the “real world”
outside the context of highly
monitored clinical trials. The
data comes from local and
national databases such as
the American Heart Associa-
tion Get With the
Guidelines-Stroke quality
improvement program, of
which"he is a member of
the"Science Subcommittee.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 9
Dr. Eric Smith
Dr. Clare Gallagher
Alberta Heritage Foundation for Medical ResearchOverview
The Department of Clinical Neurosciences is fortunate
to have been able to recruit and nurture bright individuals
who are making substantial contributions to academic
medicine. The following individuals are scholars whose re-
search is supported by the Alberta Heritage Foundation for
Medical Research in 2008.
Dr. Phil Barber!
Currently, Dr. Barber is focusing
on experimental stroke and the
imaging of neuro-inflammation,
blood brain barrier breakdown dur-
ing early ischemia and the neuro-
protective properties of resveratrol."
His research accomplishments
have been recognized by the Heart
and Stroke Foundation of Canada
with the Henry Barnett Scholarship
in 2005 and the University of Cal-
gary Innovator Award." He is
funded by the Alberta Heritage
Foundation for Medical Research, The Heart and Stroke
Foundation of Canada and the Canadian Institutes of
Health Research (CIHR).
Dr. Andrew Demchuk
Dr. Demchuk’s primary research interest is in the area
of vascular imaging where he is developing imaging guided
treatment for stroke and transient ischemic attack. Spe-
cific areas he is currently studying include: (1) CT angi-
ography’s detection of ischemic core, thrombus burden
and collateral flow; (2) CT angiography’s detection of ongo-
ing bleeding during intracerebral hemorrhage for targeting
hemostatic therapy. (3) Transcranial Doppler’s role as a
continuous monitoring bedside tool for recanalization dur-
ing thrombolysis. (4) Transcranial Doppler emboli detection
for assessing vulnerability to recurrent stroke after TIA/
minor stroke. (5) Multimodal MRI detected perfusion ab-
normalities and ischemia for predicting vulnerability to re-
current stroke after minor stroke/TIA. These research pro-
jects are supported by grants from Heart and Stroke Foun-
dation of Alberta, NWT and Nunavut; CIHR; Canadian
Stroke Consortium and NovoNordisk Canada.
Dr. Paulo Federico
Dr. Federico has received support from Alberta Heri-
tage Foundation for Medical Research as well as the Ca-
nadian Institutes of Health Re-
search for the project entitled “Mul-
timodal analysis of the pre-ictal
state”. This research involves a
functional MRI study, EEG analysis
of high frequency oscillations, and
near infrared spectroscopy study of
blood flow changes during the pe-
riod leading up to the onset of a
seizure. The goal of this project is
to identify biomarkers that may
predict seizure onset. As a result,
we will have a better understanding
of how seizures begin and how to anticipate them. This
would significantly impact future treatment modalities (e.g.,
direct the placement and activation timing of implantable
devices), which would reduce the suffering and economic
burden in a challenging group of persons with epilepsy.
Dr. Michael Hill
Dr. Hill’s area of research interests include clinical trials
in stroke and the use of administrative data for stroke re-
search and surveillance. He has participated in multiple
clinical trials, leads the Calgary Stroke Program Clinical
Trials Group and is leading 4 large clinical trials as the PI,
co-PI or Steering Committee member. He has begun fun-
damental work on stroke surveillance using administrative
data to monitor stroke rates and stroke outcomes.
Dr. Hill has been funded by the CIHR, Heart & Stroke
Foundation of Alberta/NWT/NU and the NINDS (NIH) since
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 10
2001. He currently holds the Heart & Stroke Foundation of
Alberta/NWT/NU Professorship in Stroke Research and is
the Director of the Stroke Unit.
Dr. Natalie Jette
Dr. Jetté’s research interests are primarily focused on
the development of a health services research program in
epilepsy."She is studying: (1) quality and appropriateness of
care in epilepsy; (2) health resource use and access to care
in epilepsy; (3) comorbidities of epilepsy an other health
ourcomes; (4) behavioral determinants of health in epilepsy.
Her AHFMR funded project consists of the development
and application of a new tool which will allow the identifica-
tion of individuals with focal epilepsy who should be re-
ferred for a surgical evaluation.
This project has also received national and interna-
tional funding support from the American Epilepsy Society,
the CIHR, the Milken Family Foundation and the Hotchkiss
Brain Institute Clinical Research Unit.
Dr. Zelma Kiss
Dr. Zelma Kiss is a CIHR Clinician Scientist and a Clini-
cal Scholar of the Alberta Heritage Foundation for Medical
Research (AHFMR). She directs the regional program in
Neuromodulation and her clinical and research interests
involve stereotactic and functional neurosurgery.
Dr. Kiss’ research interests have focused on the
mechanisms of action of deep brain stimulation for move-
ment disorders. Her recent research has extended to the
development of Neural Prostheses to restore sensorimotor
function. Along with co-leaders in Edmonton, she was re-
cently awarded an AHFMR Interdisciplinary Team Grant on
this theme.
Dr. Minh Dang Nguyen
Dr. Nguyen looks for ways to protect neurons from the
damage that occurs with aging and from such disorders as
Alzheimer’s disease. Dr. Nguyen’s research focuses mainly
on the cytoskeleton (the internal scaffolding) of nerve cells
in the brain. Mutations in the cytoskeleton can lead to such
neurodegenerative disorders as Frontal Temporal Demen-
tia, Parkinson’s disease and amyotrophic lateral sclerosis.
Dr. Minh Dang Nguyen is an AHFMR Scholar and a
CIHR New Investigator affiliated with the Hotchkiss Brain
Institute at the University of Calgary. He also holds the
Brenda Stafford Chair in Alzheimer Research. Past and
present agencies funding his research include the AHFMR,
CIHR, Human Frontier Science Program, MS Canada and
the ALS USA and Canada society.
Dr. Peter Stys
Dr. Stys is a neurologist/neuroscientist and a world
leader in the detailed study of pathophysiological mecha-
nisms of white matter injury in stroke and trauma. He has
extensive expertise in electrophysiological recording meth-
ods in myelinated axons, and his team has recently devel-
oped confocal, multiphoton and coherent anti-Stokes Ra-
man scattering (CARS) imaging techniques for both fixed
immunostained and live myelinated axons and glial cells.
Dr. Stys' insights provide a rational basis for devising drug
therapy for the acute phases of stroke, spinal cord injury,
brain trauma, and neuroinflammatory conditions.
Dr. Stys is the recipient of the Dr. Frank LeBlanc Chair
in Spinal Cord Research, Canada Research Chair (Tier I) in
Axo-glial biology, and Alberta Heritage Foundation for Re-
search (AHFMR) scientist award." His work is supported by
a number of important funding partners (in addition to the
ones mentioned above), including the Canadian Founda-
tion for Innovation (CFI), CIHR, Multiple Sclerosis Society
of Canada, Neuroscience Canada, HBI, Canadian Stroke
Network (CSN), NSERC, Alberta Paraplegic Foundation,
Adelson Foundation for Medical Research, and the Na-
tional Institutes of Health (NIH).
Dr. Cory Toth
In type 1 diabetes, a lack of insulin not only contributes
to poor glucose control. It also"starves the brain of a
needed growth factor, leading to brain atrophy, loss of
white matter, and cognitive decline. Dr. Toth will be study-
ing the impact of deficiency of insulin within the brain upon
important pathways and examining methods to shore up
these pathways without affecting the rest of the body. His
recent AHFMR award will be used to perform this work un-
til 2012, while Dr. Toth's previous work supported by
AHFMR led to new discoveries about the impact of insulin
deficiency in the brain and its potential replacement
through intranasal delivery to access the brain. In addition,
AHFMR sponsored work has led to discoveries regarding
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 11
the AGE-RAGE pathway within the diabetic brain and on-
going JDRF sponsored"work to identify potential therapeu-
tic targets of this pathway as well.
Dr. Wee Yong
Dr. V. Wee Yong research interests lie in the area of
neuroimmunology, neuroprotection and CNS regeneration.
His scientific projects have been guided by 4 disorders:
multiple sclerosis (MS), spinal cord injury, intracerebral
hemorrhage and malignant gliomas. Dr. Yong co-directs
the MS Program of the Hotchkiss Brain Institute at the Uni-
versity of Calgary. Dr. Yong currently chairs the Medical
Advisory Committee of the Multiple Sclerosis Society of
Canada and he sits on the International Advisory Board of
the International Society of Neuroimmunology.
Dr. Doug Zochodne
Dr. Zochodne is a Scientist of the Alberta Heritage
Foundation for Medical Research. The Zochodne lab re-
search is been funded by the CIHR, (the current lab is sup-
ported by three ongoing CIHR awards), the Canadian Dia-
betes Association (CDA), National Institutes of Health (NIH
USA, PI Dr. Chris Power), the Natural Science and Engi-
neering Research Council of Canada (NSERC, PI Dr. David
Cramb), and the Juvenile Diabetes Research Foundation
International (JDRFI, PI Dr. Danielle Pacaud).
The laboratory has made contributions to the field of
experimental diabetic neuropathy and peripheral nerve re-
generation. Dr. Zochodne is the team leader of a major
($2.25M) CIHR Regenerative Medicine and Nanotechnol-
ogy team grant with collaborators at the University of Cal-
gary in Neurosciences and Engineering, the University of
Alberta, and the University of Saskatchewan.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 12
2008 Program UpdatesAdult Hydrocephalus ProgramProgram Director: Dr. Mark G Hamilton
Overview
In 2001, the University of Calgary Adult Hydrocephalus
Clinic was established with the goal to standardize and
enhance the care for patients with hydrocephalus. The
population of adult patients with hydrocephalus is increas-
ing as diagnostic and therapeutic techniques improve iden-
tification and survival of treated patients. Hydrocephalus
patients have typically been assessed and cared for by
individual physicians in an unstructured and unfocused
clinic environment. In 2008 there are 350 patients followed
in the Adult Hydrocephalus Clinic. This population includes
patients who initially had a diagnosis of hydrocephalus as a
child, adults with acute and subacute hydrocephalus, pa-
tients with long-standing overt ventriculomegaly in adults
(LOVA), and patients with idiopathic Normal Pressure Hy-
drocephalus (iNPH). An audit of all adult patients who have
undergone treatment of their hydrocephalus over the last
14 years has been started.
The University of Calgary Adult Hydrocephalus Pro-
gram has emerged as a response to the success of the
Adult Hydrocephalus clinic. The effort to focus the care of
adult patients with hydrocephalus in a specialty clinic rep-
resented an important development to help foster a better
understanding of the natural history of patients with un-
treated hydrocephalus, to standardize the investigative
strategies for patients with a potential diagnosis of hydro-
cephalus and to manage the issues related to problems
with treatment of hydrocephalus using shunts. Clinical re-
search is progressing along these avenues. A Canadian
Adult Hydrocephalus Study Group is being established to
help advance these objectives nationally.
Members "
Neurosurgeons
Dr. Mark G Hamilton
Dr Clare Gallagher
Dr. Walter Hader
Medical Neurologist and Geriatrician#
Dr. David Hogan
Dr. David Patry
Neuropsychology
Michael King, Ph.D.
Nurse Practitioner#
Ron Prince (Inpatient)
Research Interests
Neuroendoscopy treatment and outcome for hydro-
cephalus
Neuropsychological effects of endoscopic treatment of
hydrocephalus
Infections in ventricular catheters and shunts
Treatment of idiopathic Normal Pressure Hydrocepha-
lus (iNPH)
Transition care for pediatric patients with hydrocepha-
lus
Endoscopic management of patients with brain tumors
Grant Support
Codman Corporation
Medtronic Corporation
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 13
Alberta Radiosurgery CentreProgram Director: Dr. Harold Lau
Overview
This program, using a Novalis system, the
first of its kind in Canada, is a collaborative ef-
fort between the Divisions of Neurosurgery and
Radiation Oncology, and was originally estab-
lished as a joint program between the Calgary
Health Region and the Alberta Cancer Board.
The technology offers focused radiation treat-
ment for diseases of the brain and spinal cord in
single daycare sessions, thus obviating the need
for lengthy hospital stays associated with stan-
dard surgical treatments. By reducing risks of
therapy, and ease of returning to normal activi-
ties, it results in much higher patient satisfac-
tion. The program has, since its initiation, in
2002 has grown steadily, such that in 2007, 64
patients were treated with stereotactic radiosur-
gery and another 33 patients treated with frac-
tionated stereotactic radiotherapy.
Members
Neurosurgery: Drs. Zelma Kiss, Yves Starreveld, John Wong
Radiation Oncology: Drs. Alex Chan, Harold Lau, Rob Nordal
Medical Physics: Karen Breitman, Drs. Chris Newcomb, David Spencer, Eduardo Villarreal Barajas
Nursing: Rhonda Manthey
Radiation Therapists: Carol Boyle, Mark Lesiuk, Kim Kraus, Salimah Fazel, Shannon Murland
Dosimetrists: Darren Graham, Daphne Walrath, Nathan Wolfe
Administration: Brenda Hubley (Interim Program Manager), Jody Derdall
Fellows: Dr. Ben Jonker
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 14
Chronic Pain CentreOverview
The Calgary Health Region Chronic Pain Centre has
now completed 8.5 years of operations within the CHR
Regional Pain Program. It is now the largest such Centre
in Canada and is a leader in interdisciplinary rehabilita-
tion for individuals with chronic pain.
Three members of the Division of Physical Medicine
and Rehabilitation currently practise at the Chronic Pain
Centre: Dr. Pamela Barton, co-founder and former medi-
cal director, Dr. Noorshina Virani and Dr. Nwamara Dike.
In addition to their strong background in pain manage-
ment and interdisciplinary rehabilitation, Drs. Barton and
Virani contribute specific expertise in clinical biomechan-
ics, while Dr. Dike has shared her expertise from a pain
fellowship at Memorial Sloan-Kettering Cancer Centre in
New York. Dr. Dike has also participated in the newly
inaugurated Chronic Pain Inpatient Consultation Service
now available in all of Calgary’s hospitals.
The physiatrists work in the Neuromusculoskeletal
Program alongside anaesthetists, family practitioners and
all members of the rehabilitation teams. They have many
patients who are co-managed with the gynecologists and
neurologists of the Pelvic Pain and Headache Programs.
They also participate in teaching medical students, resi-
dents and fellows in family practice, anaesthesiology,
psychiatry, physical medicine and rehabilitation and neu-
rology who rotate through the Centre.
During 2008, the physiatrists contributed a total of
0.6 FTE, completing 58 new patient assessments and an
additional 302 follow up visits on a total of 162 unique
patients. Due to their competence in the interdisciplinary
management of complex patients, their caseloads carry
many of the more complicated patients referred to the
Chronic Pain Centre.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 15
Epilepsy ProgramOverview
The overall objective of our team is to be a centre of
clinical and academic excellence, and to maximize the full
potential of each individual with epilepsy through improved
consolidated services, education and research. Patients
and families often present with complex needs arising from
the impact of this chronic illness on their lives coupled with
the experience of change in their disease process and /or
response to treatment.
The Calgary Epilepsy Program has a unique core of
pediatric and adult epileptologists, epilepsy surgeons, EEG
technologists, clinical physician assistants, residents, fel-
lows basic scientists, neuroradiologists, neuropsycholo-
gists, and nurses providing comprehensive care for epi-
lepsy patients. This team of experts works in collaboration
to find the most appropriate treatment for each patient. We
are one of the premier epilepsy centres in Canada, and we
are developing innovative ways to diagnose and treat epi-
lepsy in children and adults.
Epilepsy is much more than seizures. Research by
members of our team and others demonstrates that up to
70% of persons with epilepsy suffer from anxiety, depres-
sion and other psychological disorders. A similar propor-
tion suffers from cognitive deficits and learning difficulties
as a result of the seizures, the medications or underlying
conditions. The risk of death in patients with poorly con-
trolled epilepsy is 5 times higher than in the population.
Accidents, social stigma, and disability are well docu-
mented in our studies of the Canadian epilepsy population
who also use more acute health care resources and allied
health services than patients with other common chronic
conditions. In addition, our researchers have shown than in
Canada, chronic conditions such as hypertension, cancer,
stroke, heart disease, gastrointestinal disorders, migraine,
allergies, chronic fatigue, diabetes, and psychiatric disor-
ders are significantly more common in patients with epi-
lepsy than in the general population.
Service delivery
EEG and Epilepsy
The Calgary Comprehensive Epilepsy Program pro-
vides diagnostic, therapeutic and follow-up services to pa-
tients referred with new and uncontrolled seizures. Seven
epileptologists contribute to the program. Dr. Neelan Pillay,
adult epilepsy program director; Dr. Bill Murphy; Dr. Sam
Wiebe, Division Chief of Neurology and Director of the
Comprehensive Epilepsy Program; Dr. Paolo Federico; Dr.
Nathalie Jette; Dr. Alex Hanson; and Dr. Brian Klassen. Drs.
Pillay and Murphy have just completed research sabbati-
cals at the Brain Research Institute in Melbourne, Australia.
The seizure monitoring unit (SMU), staffed by five epilep-
tologists, is the 3rd in-patient service in the division of Neu-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 16
Voxel based relaxometry
rology, in addition to general neurology and stroke. Our
neurophysiology laboratory faces increasing demands for
urgent and emergent EEG and for ICU continuous EEG
monitoring, a reflection of population growth and changes
in practice patterns. Similarly, requests for intra-operative
somatosensory and motor evoked potential from spine
surgeons and neurosurgeons have increased markedly.
The Seizure Monitoring Unit Quality Improvement Team
The CEP is committed to providing high quality and
safe patient-centered care. A major initiative towards this
goal is our Seizure Monitoring Unit (SMU) Quality Im-
provement (QI) Team. This multidisciplinary team, originally
developed with the support of Michael Suddes, previous
Neurosciences QI consultant, meets six times a year to
monitor and improve quality and safety of care on the four-
bed SMU. The team is currently comprised of representa-
tives from EEG technology (Mike Rigby, Erin Phillip), Qual-
ity and Safety (Jason Knox), Neurology (Dr. Federico, Dr.
Jetté, Dr, Pillay, Dr. Wiebe), Nursing (Barb Seal, Christanne
Krassman, Jackie Martini, Robert Cooper, Shelly Mikkel-
sen, Chris Murray), Psychology (Dr. Macrodimitris, team
lead), and a patient representative who is also a former
patient of our SMU, Ms. Valerie Gibbons. Initiatives to date
include regular assessment of staff and patient experience
of the SMU, regular collection of key quality indicators
(presently collected by our Clinical Assistants, Dr. Obianyor
and Dr. Dhaliwal), staff education and training programs,
and the development of a specific protocol and training
program for Generalized Tonic-Clonic seizure interventions.
The success of our QI program was highlighted at a plat-
form presentation at the December, 2008 American Epi-
lepsy Society meeting in Seattle, Washington.
Neurophysiology Laboratory
The laboratories at the three adult sites in the city are
managed by Mr. Mike Rigby. The main services provided
are inpatient and outpatient EEGs. In the past year we had
about 20% increase in inpatient EEG requests. On the
other hand there was a slight decline in SMU admissions
because of more complex patients requiring a lengthier
stay in the unit.
The Epilepsy Psychology Program
The CEP is committed to providing comprehensive
care, which requires addressing the psychological and so-
cial needs of patients in addition to their medical issues.
Over the past year, Dr. Macrodimitris, our program’s psy-
chologist, and her colleague Dr. Kate Hamilton, have
launched a cognitive Behavioral Therapy group program
the “CBT Basics II.” The program is run by Dr. Macro-
dimitris and the Ambulatory Neurosciences Social Worker,
Melinda Hatfield, MSW, RSW. Seven patients completed
this weekly 10-session structured program for depression
and anxiety disorders. This program will continue to run in
2009 as a multi-center research initiative supported by the
Hotchkiss Brain Institute Clinical Research Unit Pilot Pro-
ject Funding. Dr. Macrodimitris and Dr. Sherman, through
support from the Kinsmen Chair in Pediatric Neurosci-
ences, are also developing pediatric epilepsy mental health
initiatives, including a group program for adolescents with
epilepsy and co-morbid anxiety and depression, and a
parent support group for parents of epilepsy patients.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 17
Surgery for refractory epilepsy associated with a lesion in-
volving eloquent cortex after comprehensive pre-operative
evaluation
Teaching and training
The Comprehensive Epilepsy Program brings together
adult and pediatric epilepsy groups during weekly seizure
conferences and EEG rounds and monthly journal club.
The educational components of the program comprise
teaching neurology residents, clinical physician assistants,
epilepsy fellows, nurses and EEG technologists. Dr. Adnan
Al-Sarawi from Saudi Arabia completed a one-year fellow-
ship in epilepsy and transferred to EMG fellowship in To-
ronto. Dr. Abdel Hamid Seiam from Egypt will be complet-
ing his 2-year epilepsy fellowship in March 2009. Dr.
Ayataka Fugimoto, epilepsy surgeon from Japan joined our
fellowship program in July for a year. Dr. Harinder Dhaliwal
a graduate from the Armed Forces Medical College in India
and Dr. Florence Obianyor, a graduate of Premier Medical
College, University of Ibadan, have been recruited through
the Calgary Clinical Assistant program this year. Dr. Radwa
Badawi, EEG/epilepsy fellow from Melbourne, Australia,
joined us for an elective during the spring of 2008, and Dr.
Jeremy Moeller, senior neurology resident from Dalhousie
University, joined us for an elective during the fall.
Special events
1. The Second Calgary Epilepsy Program Research
Retreat was held at the Best Western Village Park, Inn on
Friday September 12, 2008. There were 38 participants
from all disciplines in this half-day event.
2. The special guest for the annual Mary Anne Lee
symposium, held on October 03, 2008 was Dr. Nicholas M.
Barbaro, Professor, Department of Neurological Surgery,
Vice Chair, Department of Neuro-
logical Surgery , Director, Neuro-
surgical Residency Program,
University of California, San
Francisco. Dr Barbaro has ex-
tensive expertise in the treatment
of disorders that are manageable
by stereotactic and functional
neurosurgical techniques, includ-
ing epilepsy, Parkinson's dis-
ease, and chronic intractable
pain syndromes. He is recog-
nized internationally for his work
in epilepsy surgery.
3. The annual Calgary Epilepsy Program Barbecue took
place at the Pioneer Club on Friday June 6, 2008.
4. Second annual Calgary Epilepsy Golf tournament
was held on August 21 at Lynx Ridge Golf club. Golf en-
thusiasts braved the inclement weather and made it a great
success. The details are in the separate report appended
Research Staff
Dr Supriya Save has joined our team as the new Clini-
cal Trial’s Coordinator. Dr. Save has a BSc and PhD de-
grees in science from Mumbai University, India. She brings
expertise in clinical trials and clinical research and is an
asset to our team.
Research Activities
Dr. Federico’s research program uses leading-edge
imaging and EEG approaches to better understand the
neural and vascular correlates of epilepsy. These studies
include using EEG combined with simultaneous functional
MRI to better understand the cortical and subcortical cir-
cuits underlying the generation of interictal discharges in
patients with focal and generalized epilepsy (see Figure).
Other projects include fMRI studies of language and motor
reorganization in focal epilepsy as well structural MRI stud-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 18
Dr. Nick Barbaro
Language fMRI
ies of seizure-related structural brain changes. Dr. Federico
also has an interest in advanced EEG analytical tech-
niques, including the study of high frequency oscillations in
humans and animal models of epilepsy. He currently holds
funding from the Canadian Institutes of Health Research
and Alberta Heritage Foundation for Medical Research.
Dr. Jetté’s research interests are primarily focused on
the development of a health services research program in
epilepsy. She is studying: (1) quality and appropriateness
of care in epilepsy; (2) health resource use and access to
care in epilepsy; (3) comorbidities of epilepsy and other
health ourcomes; (4) behavioral determinants of health in
epilepsy. She is working on the development of an appro-
priateness rating tool to identify individuals with epilepsy
who should be referred for an epilepsy surgery evaluation.
She is also working on the development of a national epi-
lepsy surveillance program. Dr. Jetté's research is currently
funded by the Canadian Institutes for Health Research
(CIHR), the Alberta Heritage Foundation for Medical Re-
search (AHFMR), the American Epilepsy Society, the Milken
Family Foundation, the Public Health Agency of Canada,
the University of Calgary, and the Hotchkiss Brain Institute
Clinical Research Unit. She also holds new investigator
awards from CIHR, AHFMR, the American Epilepsy Society
and the Milken Family Foundation.
Dr. Samuel Wiebe’s research focuses on outcome as-
sessment, quality of life, comorbidity, epidemiology, and
randomized surgical trials in epilepsy. He is undertaking a
multicentre randomized trial of Medical versus Electrical
Therapy in Temporal Lobe Epilepsy (METTLE study), and is
the PI for a number of planned NIH-supported studies on
epilepsy and depression, early refractory epilepsy and neu-
roprotection. He is developing scales to assess severity of
epilepsy and patient satisfaction with therapy. Dr. Wiebe
established and leads the Canadian Epilepsy Surgery
Study Group (CESSG), a research consortium aimed at
facilitating and coordinating collaborative research in all
areas related to epilepsy surgery. The group is supported
by the Hotchkiss Brain Institute through its Epilepsy and
Brain Circuits program, and it is affiliated to the Canadian
League Against Epilepsy. Dr. Wiebe is supported by the
Canadian Institutes for Health Research (CIHR), the Alberta
Heritage Foundation for Medical Research (AHFMR), the
Alberta Medical Services Incorporated Foundation (MSI),
the National Institutes of Neurological Disorders and Stroke
(NINDS), and the Hotchkiss Brain Institute.
In addition to the specific research activities outlined
above, our epilepsy program is fortunate to have a strong
group of experts who collaborate in various capacities to
our research enterprise. These include experts from the
areas of Pediatric Epilepsy (Dr. Ismail Mohammed) Neuro-
pathology (Dr. Harvey Sarnat), Neurosurgery (Drs. Walter
Hader, Zelma Kiss, Yves Starreveld), Neuropsychology
(Drs. Elisabeth Sherman and Lisa Partlo), Psychiatry (Jer-
emy Quickfall) and Neuroimaging (Drs. James Scott and
Chris Molnar). We also enjoy strong collaborations with
basic scientists from the Epilepsy and Brain Circuits Pro-
gram in the Hotchkiss Brain Institute, in particular Drs. Cam
Teskey, Jaideep Bains, Quentin Pittman, Michael Collicos
and Jeff Dunn.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 19
Epilepsy Golf TournamentThe 2nd Annual Epilepsy Golf Tournament was held
at Lynx Ridge Golf Club on Thursday August 21, 2008
and despite trying weather was another great success.
The tournament continues to grow and this year over 50
brave souls battled rain and cold winds to complete the
18-hole event. Many thanks go out to our hole sponsors
and those who made donations of prizes for the event or
donations to the program. A special thanks goes out to
our many volunteers who helped make this event possi-
ble. Proceeds of the tournament will continue to benefit
patients by supporting the development of clinical, edu-
cational and support programs within the Calgary Epi-
lepsy Programme.
Hole Sponsors
Johnson & Johnson
AMJ Campbell Moving
Dr Sam Wiebe#
Dr Walter Hader
Prize Sponsors
AMJ Campbell
Bernard Florence, Calgary
Johnson & Johnson
Donations
LaFarge#
Magstim#
R Anand#
Jennifer Buchanan#
Jason Cottle#
Monty Arun Gaur
Walter Hader Sr
Nathalie Jetté
B Raskin
Maureen Robertson
Doug Walsh
Volunteers
Thea Dupras #
Kim Ford#
Lysa Gallagher
Jack Hasna
Lisa Partlo
Ceri Rawji
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 20
The Winners!
Frank LeBlanc, Adam Kirton, Ian Stang, Greg Cairncross
The Wettest Team!
Ron Bridges, Tom Feasby, Ed Block, Eric Payne
Calgary Headache Assessment & Management Program (CHAMP)Introduction
CHAMP is a multidisciplinary headache management
program with 5 neurologists, 3 nursing, 1 occupational
therapy, 1 psychologist, 1 kinesiologist, 3 clerical, and 1
research assistant / data analyst team members.
Mission Statement
Vision: Empowered patients and their families actively
engaged in headache self-management.
Mission: To reduce the burden of headache related
disability carried by patients and their families.
Objectives: Deliver care for patients with difficult head-
ache disorders more efficiently and effectively through inter
professional teams focused on both medical and behav-
ioral therapies.
Contribute to headache care through clinical research
and education of health care professionals.
Reduce utilization of expensive health care resources
such as emergency rooms and inpatient beds through bet-
ter outpatient management of patients with headache.
CHAMP will:
Provide patients with a caring and empathetic envi-
ronment in which to monitor progress towards their func-
tional goals.
Encourage patient self reliance and active partnership
in their headache care, with an emphasis on self manage-
ment.
Provide access to program services in a timely manner
immediately following admission to the program.
Serve the headache health care needs of the CHR in
conjunction with the headache program of the CHR
chronic pain center.
Maintain a comprehensive quality management pro-
gram with appropriate quality indicators and outcome
measures.
Deliver “best practice” care based on evidence avail-
able, with a commitment to develop new evidence where
needed.
Ensure all team members are committed to remain cur-
rent in terms of best practices in headache care.
Involve patients in the design of the program CHAMP
offers and in the design of their individualized treatment.
Carefully foster communication between patients and
staff, and between the members of the inter-professional
team to create a forum for the discussion of patient care
plans.
Work towards following every patient with outcome
measures and team discussions so that all are accounted
for.
Summary of activities
The clinical core of the CHAMP program consists of
group workshops and one-on-one outpatient visits to phy-
sicians and other health care professionals. The nursing
component of CHAMP provides additional valuable patient
service through telephone follow up and problem solving.
The educational session is the entry point for many pa-
tients to the CHAMP program, and during 2007, 362 pa-
tients and over 200 additional family / friends attended the
education sessions which are offered 2 or 3 times a month.
There were over 2203 one-on-one patient visits to physi-
cians and other health care professionals. Many patients
attended our self management, relaxation, sleep and body
works workshops.
Education: In addition to continuing medical education
programs and teaching directed at University of Calgary
residents and medical students, the CHAMP program pro-
vided elective rotations to 4 senior University of Alberta
Neurology residents in 2007 (Drs. Jickling, Phan,
Narasingh, and Jassal), and for one senior neurology resi-
dent from the University of Ottawa (Dr. F. Amoozegar). Ms.
Khara Sauro, holder of the 2007 Canadian Headache Soci-
ety National Headache Fellowship, completed her fellow-
ship with CHAMP during 2007.
Research activities: CHAMP continues to participate in
industry-sponsored multi center clinical trials, and these
have included in 2007 trials to evaluate the efficacy of
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 21
botulinum toxin type A, occipital nerve stimulation, patent
foramen ovale closure, and tonabersat in migraine and / or
chronic daily headache prophylaxis. CHAMP has also ana-
lyzed the properties of two headache outcome measure-
ments, the HIT-6 and the MIDAS, and an abstract has been
submitted to the Canadian Neurological Sciences Federa-
tion annual meeting. In conjunction with Dr Z. Kiss, out-
comes on a CHAMP patient with implantation of a deep
brain stimulator for the treatment of chronic cluster head-
ache have been assessed, and an abstract submitted to
the same meeting.
Quality Improvement: CHAMP has studied program
outcomes. In addition,
an abstract has been
submitted to the Cana-
dian Neurological Sci-
ences Federation an-
nual meeting on the
CHAMP program and
its outcomes. Several
patient focus groups
have also been held to
determine what im-
provements our pa-
tients think should be
made in our program.
We are grateful to Ja-
son Knox and Michael
Suddes for their assis-
tance with these focus
groups.
Awards
The CHAMP program is extremely pleased that one of
its members, Ms Irene O’Callaghan, RN, was awarded a
People First Award in the healing hands category by the
Calgary Health Region. The People First Award is the
highest award which the CHR offers.
Moving forward
A number of action items to improve the program were
developed and the program will work on these over the
coming year.
Revising the education session to reduce the division
between the medical and behavioral content, and to em-
phasize more our integrated comprehensive approach to
headache care.
To review and possibly expand the role of the lifestyle
assessment in the program.
To initiate a formal quality management program for the
CHAMP, complete with a small quality council. This pro-
gram would include quality improvement education for our
staff, and the commitment of all staff to identify where
processes could be improved, and to contribute to their
improvement.
To focus more on “best
practice” through the
development of more
standardized patient
treatment processes.
Ensure that all staff
have access to the
necessary continuing
professional education
in headache manage-
ment.
Facilitate inter-
professional education
regarding the care of
individual patients
through team rounds,
etc.
Improve our capacity to
meet the needs of the
CHR with regard to headache care and reduce our wait
times by working to make our patient care processes more
efficient.
Develop further the kinesiology component of CHAMP
as better posture, neck health, and physical conditioning
contribute to headache management.
Conclusion
CHAMP continues to work towards meeting the head-
ache care needs of the CHR, together with the CHR
Chronic Pain Center Headache Program and to fulfill its
educational and research objectives.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 22
CHAMP nursing staff (left to right) Brenda Kelly-Bessler (research
nurse), Ruth Sutherland and Irene O’Callaghan (clinic nurses).
Movement Disorders ProgramOverview
Movement Disorders are diseases that result in invol-
untary movements such as tremor, dystonia, bradykinesia
(slowness) and tics. These disorders cause significant dis-
ability in 1/100 Albertans and touch over 30,000 Albertan
families.
The program provides for a multidisciplinary clinic with
a staff of over 20 individuals including specialists in neurol-
ogy, neurosurgery, psychiatry, nursing, social work, psy-
chology, and physiotherapy, treating over 2000 patients
with Parkinson disease, Huntington disease, Tourette syn-
drome, spinocerebellar ataxia, dystonia, and tremor. We
follow approximately 2000 patients with close to 10,000
patient visits per year.
We have a large research program involved in develop-
ing improvements in treatment of Parkinson disease and
related disorders. Research to understand basic mecha-
nisms of disease is coordinated through the Hotchkiss
Brain Institute.
The program continues to be designated as a Center of
Excellence for PD by National Parkinson Foundation (USA).
Highlights
This year Dr. Tamara
Pringsheim joined us. Dr
Tamara Pringsheim is a neu-
rologist specializing in the
treatment of Tourette Syn-
drome (TS). She completed
her five year residency at
the University of Toronto in
adult neurology, and then a
3 year neuropsychiatry and
movement disorders fellow-
ship under Dr Paul Sandor
and Dr Anthony Lang in To-
ronto. In addition to her
clinical subspecialty train-
ing, Dr Pringsheim completed a Master degree in Clinical
Epidemiology in the department of Health Policy, Manage-
ment and Evaluation at the University of Toronto.
She opened the Calgary Tourette Syndrome Clinic in
April 2008 at the Child Development Centre adjacent to the
Alberta Children’s Hospital. This was joint initiative by the
departments of Clinical Neurosciences and Pediatrics at
the University of Calgary. The clinic provides consultation
and continuing care for children and adults with Tourette
Syndrome, as well as other conditions commonly seen in
individuals with Tourette Syndrome, such as Attention Defi-
cit Hyperactivity Disorder and Obsessive Compulsive Dis-
order. The Calgary Tourette Syndrome clinic is the only
centre for expertise in Tourette Syndrome in southern Al-
berta. It will also serve the province of Alberta as well as
neighbouring communities in Saskatchewan and British
Columbia. The aim is to develop a multidisciplinary team
model for the Calgary Tourette Syndrome Clinic, which will
include medical expertise, nursing, clinical psychology, and
occupational therapy.
Currently, the team includes Dr Tamara Pringsheim (Di-
rector of the Calgary Tourette Syndrome Clinic), Dr Bonnie
Moshenko-Mitchell (Registered Psychologist), Nancy La-
belle (Clinical and Research Nurse), Charmaine Orchard
and Carolyn Baldwin, Administrative Assistants
Program Staff
Neurology: Dr. Oksana Suchowersky (Program Direc-
tor)
Dr.Sarah Furtado
Dr. Scott Kraft (Neuromodulation)
Dr. Tamara Pringsheim (Director, Tourette Syndrome
Clinic)
Dr. Ranjit Ranawaya (Clinical Director)
Neurosurgery: Dr. Zelma Kiss (Neuromodulation)
Neurophysiology: Dr. Bin Hu (Research Director)
Neuropsychology: Dr. Angela Haffenden
Psychiatry: Dr. Jeremy Quickfall, Dr. Michael Trew
Graduate Students: Aarti Shankar
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 23
Dr. Tamara Pringsheim
Fellows: Dr. Cid Diesta
Nurses - Clinical: Karen Hunka, Michelle Zulinick, Ro-
byn Warwaruk, Nancy Labelle
Nurses - Research: Lorelei Derwent, Carol Pantella,
Mary Lou Klimek
Secretarial Support: Sheila Pinkney, Marlene Conrad,
D’evan Cooper, Linda Lukindo, Rhiannon D’Haene and Ka-
tie Kraft
Fellowship
The program offers 1-2 yr clinical fellowships for appli-
cants who have completed neurology residency training in
Canada (or equivalent abroad). #
Dr. Cid Diesta successfully completed a one year clini-
cal fellowship and has returned to Manila (Philippines) in
June 2008.
Current Research Interests
Neuroprotection for Parkinson disease (PD)
Music therapy in PD
Identification of genetic factors in PD
Neuroprotection for Huntington disease (HD)
Abnormalities in reaching in PD
Novel treatments in PD, HD, dystonia, and spinocere-
bellar ataxia.
Tourette Syndrome clinic research interests include;
creation of a disease specific quality of life instrument for
children with TS, defining and measuring rage/explosive
anger in children with TS, predicting outcome in TS, identi-
fying factors present early in life which predict resolution of
tics in adulthood, understanding the links between TS and
Autistic Spectrum Disorders, and randomized controlled
trials of drug therapy for TS.
Grant Support
PHAROS – Pilot Huntington At Risk Observational
Study (1999-2010)
O. Suchowersky (Local PI)
National Institutes of Health##
$45,000US/yr Multicenter Grant
PREDICT-HD Neurobiologic Predictors of Huntington’s
disease (2002 – 2008)
O. Suchowersky (Local PI)
National Institutes of Health
$20,000US/yr
Cooperative Huntington’s Observational Research Trial
(COHORT) (2006-2011)
O. Suchowersky (Local PI)
HP Therapeutics Foundation, Inc.
$8,000US/yr
Prospective data collection from HD families.#
The effect of music therapy on motor and non-motor
symptoms in PD (2006 – 2011)
O. Suchowersky (Sub PI) #
Canadian Institute of Health Research (CIHR)
$26,000/yr
NET-PD Neuroprotective PD# (2008-2012)
O. Suchowersky (PI)#
$75,500US/yr
The major goal of this project is to identify drugs to
delay disease progression#
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 24
From left to right; Carol Pantella, Robyn Warwaruk, D'evan
Cooper, Rhiannon DHaene, Dr. Ranjit Ranawaya, Katie Kraft,
Karen Hunka, Dr. Oksana Suchowersky, Sheila Pinkney, Dr.
Tamara Pringsheim, Nancy Labelle
Intraoperative MRI ProgramProgram Director: Garnette Sutherland
Overview
The year 2008 was an interesting year for the iMRI
program. Last year, the program celebrated its 10th year
of operation in December. Early this year, the program
marked another milestone- treating over one thousand
patients in the iMRI suite. The iMRI program success-
fully raised full funding (~$10M) to allow the Advancing
iMRI initiative to occur. The prototype 1.5T iMRI system
was upgraded to an IMRIS-Siemens 3T platform based
on the world’s first ceiling mounted 3T magnet. The MR
system includes high performance gradients and a work-
ing aperture of 70cm.
Planning for the upgrade began in March 2008 re-
quiring considerable input from CHR Planning and De-
velopment, architects from McKay Hlavacek, Ledcor as
the lead contractor and various subcontractors. In June
of 2008 the iMRI suite was closed and construction was
completed by December 2008.
Members
Project Leader""
Garnette Sutherland
NRC Scientists
Boguslaw Tomanek
David Hoult
Scott King
Calvin Bewsky
University of Calgary investigators (not inclusive)
Alex Greer
All members and residents of the Division of Neuro-
surgery
Oliver Bathe
Andrew Kirkpatrick
Phil Park
Andrew Maitland
Mark Hudon
Carla Wallace
Mayank Goyal
Will Morish
Research Interests
Application of iMRI to neurosurgery
Whole body application of iMRI technology
Molecular imaging
Robotics
Grant Support
Alberta Advanced Education and Technology
Western Economic Diversification
Calgary Health Trust
Significant in-kind support from Alberta Health Serv-
ices, NRC Institute for Biodiagnostics, and IMRIS
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 25
Multiple Sclerosis ProgramClinical Highlights
Medical Services: Two new
neurologists joined the MS Clinical
Team in 2008. Dr Dawn Pearson, a
cognitive neurologist, joined our MS
team in January and Dr Jeptha
Davenport, a pain specialist, joined
in April. Dr Pearson has been prac-
tising neurology in Boston and Dr
Davenport has been practising neu-
rology in Toronto. Both Drs Pearson
and Davenport spend 30% of their
time as MS Clinic physicians. In
addition, Dr K Busche increased his
time in the MS Clinic from 10% to
almost 20%.
Electronic Health Record: Dur-
ing 2008 the MS Program (L Metz
and research manager Winona Wall)
continued to develop the electronic
health record (EHR) for the DCNS.
After an extensive process of de-
veloping system requirements and
evaluation of vendors a vendor was
selected in June 2007. The choice
was Eclypsis, the system supported
by the Calgary Health Region. This
system will support a continuous
inpatient and outpatient record. The
choice of this system has, as ex-
pected, slowed development of the
department EHR as development
will in many ways be part of devel-
opment for the entire Calgary
Health Region but linkage with the
inpatient system and long term
support were believed to be good
trade-offs. Development has been
further delayed due to changes in
the organization of the Alberta
Health system but the MS clinic will
be the first regional clinic to imple-
ment the system. This implementa-
tion is planned for early 2009. A
great deal of work developing the
system has taken place during 2008
as decisions that will impact all clin-
ics needed to be made. Start-up of
this project in 2005 was supported
by a generous donation of 1 million
dollars from Teva Neuroscience to
the MS Program of the Hotchkiss
Brain Institute (HBI).
Alberta MS Program: During
2008 there was further development
of an Alberta MS Program led by Dr
L Metz. In December, a pilot pro-
posal for a provincial telehealth
proposal was submitted to the Al-
berta Rural development fund. Be-
tween June and October regional
meetings were held to discuss the
current status of mental health serv-
ices provided to people with MS, to
identify gaps, and to develop a plan
to move forward. A province-wide
MS Mental Health meeting/
education program is scheduled for
late June 2009. Preliminary planning
to evaluate rehabilitation services
for MS has started. A meeting of
those providing these services will
be held in April 2009. Funding for
development of an Alberta MS Pro-
gram was provided by Jayman
Masterbuilt who donated 1 million
dollars to the MS Program of the
HBI over the period 2007-2011 to
develop a Provincial MS Program.
Clinic expansion: Clinic expan-
sion is necessary as both clinic
space and staffing limit any in-
crease in the number of patients
that can be seen per month in the
clinic or in OPTIMUS. In addition,
our ability to include residents in our
clinics has been severely restricted
by space limitations. During 2008
planning became more concrete for
an MS Clinic site at Rockyview
General Hospital. Planning for de-
velopment of a fully operational site
at the South Hospital also started;
this clinic site is expected to open
in 2011.
Research Highlights
Translational Research: The
Calgary MS clinical and research
teams are primarily focused on
translational research. Major re-
search activities involve bringing
therapies from the laboratory to pa-
tients. The following projects repre-
sent translational research activities
ongoing during 2008.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 26
Optic Neuritis
Minocycline program: We have
been leading the translation of
minocycline from the Yong lab to
the clinic.
In 2008 a manuscript describing
the final results of a phase IIa trial of
minocycline in relapsing remitting
MS led by Dr Metz and completed
in Calgary was published (funded
by CIHR).
In 2008 a manuscript describing
the results of a phase II Canadian
multicentre randomized, double-
blind, controlled trial of minocycline
versus placebo in patients starting
glatiramer acetate was submitted
(study funded by Teva Neurosci-
ence Canada).
Recruitment began in 2008 for a
phase III randomized controlled trial
of minocycline in patients with sus-
pected MS. This study was funded
by the MS Foundation of the MS
Society of Canada for $4,040,000.
The study principal Investigator is
Dr Metz; Calgary co-investigators
include Drs Yong, Eliasziw, Hill, and
Wiebe. Dr Michael Yeung is leading
the Calgary site in this trial. The
Clinical Research Intelligence Unit
of the HBI, led by Dr Wiebe, is
managing trial data from across the
country.
A Brain Repair Team Grant to
study “Fine-tuning Inflammation for
Neuroprotection and Regeneration
in Multiple Sclerosis” was funded
by Neuroscience Canada for
$1,500,000 over 3 years in late
2007. During 2008 over 60 partici-
pants with optic neuritis were en-
rolled into a follow-up study of optic
neuritis by Dr Costello. In early 2009
patients a clinical trial of mino-
cycline versus placebo in optic neu-
ritis will begin. This study aims to (a)
determine if the optic nerve can
serve as system model to measure
neuroprotection and (b) to obtain
pilot data on the effects of mino-
cycline on optic neuritis in order to
plan phase IIb trials. Meanwhile,
basic scientists are working to de-
velop new therapies that may move
to the clinic as trials in the future;
targets of interest include vitamin D.
[Team Leader: Dr VW Yong; Clinical
Team: Drs. F Costello and L Metz;
collaborators: Dr P Stys (University
of Calgary) and Drs C Power and
Rivest (Universities of Alberta and
Montreal)].
Endogenous Progenitor Cell
Repair in MS: Research led by Drs
Sam Weise and Wee Yong demon-
strated that prolactin stimulates dif-
ferentiation of oligodendrocyte pro-
genitor cells into functional oli-
godendrocytes, the cells that myeli-
nate nerves.
A team grant submitted and
awarded in 2008 from the Stem Cell
Network for $783,600 over 3 years
will support the project: “Endoge-
nous progenitor cell repair in MS”.
The goal of the current three-year
proposal is to generate both pre-
clinical and clinical (Phase IIa) re-
sults to determine whether Phase
IIb-III clinical trials of prolactin to
stimulate repair in MS are war-
ranted. If the findings are positive, it
is envisaged that the Phase IIb-III
clinical trials would occur during
years 5-7 of the SCN. The first pro-
ject aims to determine prolactin’s
ability to stimulate remyelination
within a compromised immune set-
ting that is reminiscent of MS in
humans and in the presence of im-
munomodulatory drugs given to MS
patients. The second project asks
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 27
In an animal model of multiple sclerosis in mice, as compared to con-
trols (A & B), demyelination and axonal loss are reduced by the com-
bination of glatiramer acetate and minocycline (C & D).
whether prolactin regulates the fate
of adult human myelin progenitor
cells and, again, how is this affected
by the presence of immunomodula-
tory drugs. The third project, a
Phase IIa safety and efficacy study
of prolactin actions in an optic neu-
ritis subset of MS patients, should
provide a clear sense of the poten-
tial benefit of prolactin treatment to
a larger MS population. Team
members include Drs Weiss, Yong,
Costello, Metz, and Antel (McGill
University).
Alpha beta crystalline: Dr
Shalina Ousman, who joined our
program in April 2008, has been
developing humanized monoclonal
alpha beta crystalline a molecule
that appears to put a break on in-
flammation in MS. Dr Ousman
submitted grants in 2008 to further
her research. In the meantime, fur-
ther laboratory projects are under-
way funded by start-up funding
from an anonymous donor to the
HBI.
Other basic science develop-
ment: Mr Hank Swartout donated
$1,000,000 over 3 years to the
Hotchkiss Brain Institute MS Pro-
gram to develop the Swartout Neu-
roprotection and Repair Centre.
Funding was increased by $500,000
over 5 years by his colleagues at
Precision Drilling. The Swartout
Centre includes an EAE Unit to fa-
cilitate assessment of potential MS
therapies in animal models, a clini-
cal measurement unit to develop
models of optic neuritis and corpus
callosum function to measure neu-
roprotection and repair in MS, and
development of an imaging data-
bank. In 2008 the Swartout EAE
Unit supported pilot studies of other
potential MS therapies. This re-
search is ongoing.
Measurement Research: Evalu-
ating MS therapies requires precise
measurement of treatment effects.
Classically fairly crude scoring if
diseases along with pathology are
used in EAE studies. In humans
fairly insensitive and fairly variable
measures along with MRI measures
that focus on lesions are used. To
improve the efficiency of EAE stud-
ies in vivo imaging would be very
useful in accelerating research. In
humans, precise in vivo measures
of injury, repair, and inflammation
within targeted lesions are needed
to allow us to test therapies that
may be neuroprotective or promote
repair. Development of such meas-
ures is another focus of our re-
search.
The clinical evaluation unit and
imaging databank of the Swartout
Neuroprotection and Repair Centre
will help us achieve these aims.
During 2008 an optical coherence
tomography machine was pur-
chased and installed in the MS
Clinic. This allows precise meas-
urement of the retinal nerve fibre
layer, the anterior aspect of the op-
tic nerve. As over 90% of people
with MS suffer from optic nerve in-
volvement, and because acute epi-
sodes of optic neuritis are usually
symptomatic, this provides an op-
portunity to precisely measure optic
nerve integrity to determine the
natural history of optic nerve
changes and to measure the effects
of optic neuritis. This capacity has
been necessary for our success in
getting funding for the studies of
optic neuritis and to study the natu-
ral history of optic nerve changes.
During 2008 Dr Fiona Costello
led a study in collaboration with Drs
Richard Frayne and Brad Goodyear
as well as PhD candidate Noorhan
Zayed to image the optic nerve dur-
ing acute optic neuritis and to de-
velop novel optic nerve imaging
techniques. This study is funded by
the MS Society of Canada ($180,
563).
In 2008 Dr Lenora Brown, al-
ready an experimental psychologist,
completed training in neuropsy-
chology. She is now evaluating
measures that aim to develop the
corpus callosum as another poten-
tial model to evaluate neuroprotec-
tion and repair therapies . She is
collaborating with Drs Costello and
Metz.
In 2008 Drs Metz and post-
doctoral student Dr Yunyan Zhang
continued development of MRI tex-
ture analysis as another method of
evaluating recovery within lesions.
The imaging bank of the Swartout
Unit supports this research. The
ability to use existing MRI data to
evaluate this technique will likely
accelerate its development and en-
hance its value.
2008 was a very good year for
recruitment to the MS research pro-
gram. Drs Shalina Ousman is a neu-
roscientist whose basic research
focuses on MS; in particular pre-
clinical therapy development. She
arrived in April 2008.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 28
Education Highlights
Weekly MS Clinical Rounds
continued through 2008; 30-60 fac-
ulty, staff and students attend.
The Calgary MS Program con-
tinued to host MS Preceptorships.
In June 2008 Pavan Ahluwalia
completed his MSc research to de-
termine the frequency of vitamin D
insufficiency in MS patients and to
evaluate methods of dose adjust-
ment. He received a studentship
from the MS Society of Canada. He
became a medical student at the
University of Calgary in August.
Dr Yunyan Zhang completed a
post-doctoral fellowship in MS Im-
aging with Dr Metz in June 2008
and went on to undertake an MS
Society funded fellowship at the
University of British Columbia co-
supervised by Drs. David Li and
Tony Traboulsee. She received a
fellowship stipend and travel sup-
port from Teva Neuroscience and
submitted Fellowship applications
to the MS Society of Canada.
The following trainees received
national studentships or fellowships
from the MS Society of Canada:
Pavan Ahluwalia, Yunyan Zhang,
Smriti Agrawal, Viktor Skihar, Lor-
raine Lau, Rowena Cua, Angelika
Goncalves DaSilva, Jennifer Hahn.
Dr. Jian-Qiang Lu (neuropathol-
ogy resident), conducted basic sci-
ence research training within the
MS program.
Statistics
During 2008 there were 3484
patient visits to clinic physicians,
over 5000 telephone encounters by
clinic nurses, and over 2000 visits
to OPTIMUS. There were over 19
MS clinical trials ongoing during
2008.
Members
Physicians
Dr. Luanne Metz (Clinic Director)
Dr. Michael Yeung (Clinical Trials
Unit Director)
Dr. Robert Bell
Dr. Kevin Busche
Dr. Fiona Costello
Dr Jeptha Davenport
Dr. Dan McGowan
Dr. Jean Mah (Pediatric Neu-
rologist)
Dr. William Murphy
Dr. David Patry
Dr Dawn Pearson
Non-clinical MS Research Team
Dr. Lenora Brown, PhD
Dr Jeff Dunn, PhD
Dr. Richard Frayne, PhD
Dr. Brad Goodyear, PhD
Dr Shalina Ousman, PhD
Dr. V Wee Yong, PhD
Nursing
Colleen Harris MN, NP (Clinic
Manager)
Kathy Billesberger, RN
Brenda Buckner, RN
Jackie Gaythorpe, RN
Janice Hammond, RN
Janet Moores, BN, MBA
Sharon Peters, BN
Lori Tillotson, BN
OPTIMUS (Rehab Program)
Jutta Hinrichs, BScOT (Program
Coordinator)
Risha Joffe, PhD (psychologist)
Erin Gervais, BScOT
Neera Garga, PT
Myrna Harden, PT
Tara Bramfield, RSW
Janice Lake, RN
Clerical Staff
Rochelle Lappan
Vanessa Rosenzweig
Sharon Stadnyk
Colleen Selin
Joanne Woo
Rosalee Thorsen
Clinical Research Staff
Winona Wall (Research Man-
ager/ clinic IT support)
Nicole Anderson
Charlotte Caunt
Graziela Cerchiaro
Michel Dube
Shelly Jelinski
Shirley Jorge
Kathryn Linton
Christina Ma
Ellen Martin
Beth Price
Jose Ranawaya
Jessie Trufyn
Laboratory Research Staff
Claudia Silva
Yan Fan
Hollie Mowbray
Michelle Smekal
Brooke Verhaeghe
Fiona Yong
Shuhong Liu
Students and postdocs
Pavan Ahluwalia
Yunyan Zhang, MD, PhD
Smitri Agrawal, PhD
Lorraine Lau
Victor Skihar, MD, PhD
Angelika Goncalves DaSilva
David Stirling, PhD
Rowena Cua
Cheryl McCrea, PhD
Natalia Liapounova
Axinia Doering, PhD
Mengzhou Xue, PhD
Nourhan Zayed
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 29
Neuromodulation ProgramOverview
Neuromodulation is the altering / modulation of nervous system function by means of implantable devices or neural
prostheses. It includes peripheral nerve, spinal cord and brain electrical stimulation, as well as drug delivery devices.
Many conditions are treated including movement disorders, epilepsy, pain, angina, headache, spasticity, urinary inconti-
nence; thereby involves all divisions within the Department of Clinical Neurosciences as well as specialists from other
disciplines.
Members
Neurosurgery: Drs. Mark Hamilton, Zelma Kiss
Neurology: Drs. Werner Becker, Scott Kraft, Neelan Pillay, Oksana Suchowersky, Sam Wiebe
Physical Medicine and Rehabilitation: Drs. Dan McGowan, Noorshina Virani
Pain physicians: Drs. John Clark, Darryl Guglielmin, Geoffrey Hawboldt, John Pereira, Chris Spanswick (Chronic Pain
Centre), Dr. Peter Farran (ACH)
Urogynecology: Dr. Magali Robert
Cardiology: Dr. Jim Stone
Gastroenterology: Drs. Christopher Andrews, Phil Mitchell
Psychology: Melanie Denheyer, Drs. Angela Haffenden, Michael King, Paul Taenzer
Psychiatry: Drs. Jeremy Quickfall, Raj Ramasubbu
Nursing: Susan Anderson, Marlene Blackman, Thea Dupras, Colleen Harris, Karen Hunka, Tracy Hyndman, Jackie
Martini, Grace Neustaedter, Christine O'Leary, Valerie Sherwood, Tammy Still, Angela Tse, Robyn Warwaruk
Research: Drs. Michael Eliasziw, Bin Hu
Grant Support
Alberta Heritage Foundation for Medical Research
Canadian Institutes for Health Research
New Initiatives / Highlights
Clinical care
New procedures performed this year include area 25 subgenual cingulate DBS for the HBI-CRU funded pilot project
on refractory depression
Ongoing studies include the METTLE study of hippocampal DBS for epilepsy (enrolled 2 new patients)
Nursing Neuromodulation Group is going strong, interacts with the Canadian Neuromodulation Society as pertains to
database development and guidelines
Training/teaching
Nurses attend national and international conferences on neuromodulation, presenting at local meetings (e.g. CANN
meeting in Feb-08)
Clinical fellowship established, with the 3rd fellow (Mr. Ben Jonker from Australia) arriving later in the academic year;
previous fellow, Dr. Jean Oropilla presented both a poster and platform presentation at the American Society for Stereo-
tactic and Functional Neurosurgery meeting in Jun-08, published 1 chapter, 1 letter and 1 paper under revision.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 30
Academic activities
Members of the team gave invited presentations at the Canadian Neuromodulation Society, American Association of
Neurological Surgeons, University of Alberta, University of Minnesota, University of Victoria
Poster presentation at CNSF on “Deep brain stimulation for chronic cluster headache”, 2 posters presented at Soci-
ety for Neuroscience Sue Anderson presented her project on “Nursing time required for a neuromodulation pain pro-
gram” at the Canadian Neuromodulation Society meeting in Jun-08
Poster at the Neural Interfaces (NIH Neural Prostheses) conference was selected (from a total of 225) as 1of 7 high-
lighted as a platform presentation
The group co-hosted Professor Helen Mayberg as an AHFMR visiting scientist in Apr-08
Mini-symposium in May during an extended Grand Rounds on Mechanisms of Neuromodulation: How electromag-
netic stimulation can change nervous system function with world leaders, Professors Alim Benabid, Ronald Tasker and
Robert Chen, and local UofC faculty Professors Bin Hu, Brian Bland and Sam Wiebe
The GI Research Group hosted Drs. Richard McCallum and Edy Soffer, two world leaders in the field of Gastric Neu-
rostimulation, at a research symposium in Jun-08
Knowledge translation
Presentations to the Canada Trigeminal Neuralgia Association and the Parkinson’s Society of Southern Alberta
“Hope Conference - Paving Your Path to Wellness”
Participation in an advisory capacity to Alberta Health and Wellness through a funded workshop “Innovations in Sur-
gery: Looking to the horizon”
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 31
Stereotactic planning for hippocampal deep brain stimulation for epilepsy
Neuromuscular ClinicArea 3 Health Sciences Center 403-944-4415
Members
Dr. Keith Brownell (muscle disorders, myasthenia gravis, education)
Ms. Roula Simmons (Clinic Facilitator/Coordinator)
Dr. Cory Toth (nerve disorders, neuropathic pain, complications of diabetes)
Dr. Chris White (ALS clinic director; myasthenia gravis, electrophysiology)
Dr. Douglas Zochodne (Director; nerve disorders, regeneration and diabetes)
Fellows: Dr. Lawrence Korngut, Dr. Jennifer Bestard
Research nurses: Susan Wood, Shefina Mawani
Support staff: Jennifer Anderson
Social work: Melinda Hatfield and Domenica Smit
Vision
Within five years, the Neuromuscular Clinic, within the newly constituted Southern Alberta Nerve and Muscle Clinical
Program Cluster, will emerge as an internationally recognized model for accessible, evidence based and compassionate
care for patients with nerve and muscle disorders.
Mission Statement
To provide timely, expert and comprehensive consultation and care to patients with neuromuscular disorders.
We will achieve this by offering state-of-the-art diagnostic and treatment services, developing specialized clinics,
developing cutting-edge research and providing education to health care personnel.
Our work will be characterized by a focus on our patients, excellence, collegiality and innovation.
Trajectory
Development of a five year plan for the Alberta Nerve and
Muscle Clinic Cluster “without walls” based at FMC, RGH and
the South Hospital
The Clinic Cluster would comprise the current Neuromuscu-
lar Clinic, ALS Clinic, Neuropathic Pain Clinic, Peripheral Nerve
Surgery Clinic with new models: Intake rapid review clinics,
myasthenia gravis clinic, neuropathy clinic, and muscle sub-
speciality clinics focusing on muscular dystrophies and inflam-
matory myopathies
Integration of Nerve and Muscle Clinical Neurophysiology
and Rehabilitation within the clinic cluster
Recruitment of one additional Neuromuscular Neurologist
to our group for each one-two years of the five year plan in or-
der to enhance our service, educational and research goals
Integration of the NP (nursing practitioner) role within the
Nerve and Muscle Clinic concept
Current Strategic Alliances
ALS Clinic (Dr. C. White)
Peripheral Nerve Surgery Clinic (Dr. R. Midha)
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 32
Neuropathic Pain Clinic (Dr. C. Toth)
Neuromuscular Clinic, Alberta Children’s Hospital (Dr. Jean Mah)
Clinical Neurophysiology (Drs. White and Zochodne)
Regeneration Node (SCNR), Hotchkiss Brain Institute (Drs. Toth, White and Zochodne)
2008 Member Highlights
Dr. Brownell worked extensively in medical education in 2008 at undergraduate, graduate, postgraduate medical and
postgraduate nursing levels. He served as co-chair of the Physicianship Unit of the Medical Skills Unit and served as the
Chair of the Multiple-Mini-Interview Development Committee. Activities included being a small group leader for both the
Physicianship and Medical Ethics Unit of the Medical Skills Unit and in the Neuroscience and Aging curriculum.
Ms. Roula Simmons pursued work on her Master Degree in Nursing with the goal of becoming a Nurse Practitioner
in Neurosciences. With UofC nursing students she facilitated a major research project focused on the analysis of comor-
bidities in Neuromuscular clinic patients. She also worked extensively on patient education materials for NMC patients
(e.g MG group, see below).
Dr. Cory Toth served as the Director of the Neuropathic Pain Clinic where he has supervised or initiated five clinical
trials in the management of neuropathic pain. He published several high impact papers in 2008 including papers in Dia-
betes, Neuroscience, PLoS One and Pain. He was awarded a Juvenile Diabetes Research Foundation (JDRF) Innovative
operating grant for his work on diabetic complications. He received teaching awards (Gold Star, AMA Honourable Men-
tion) in 2008.
Dr. Chris White served as the Site Director for Clinical Neurosciences at Rockyview General Hospital in 2008. His
administrative work included Membership on the Departmental Executive Committees, the Division of Neurology ARP
committee, the South Hospital Campus Clinical Design Team and the Neurology residency training program. He is the
Director of the ALS Clinic. He participated in two multicenter ALS clinical trials and a myasthenia gravis trial. He received
the CMSA Letter of Excellence Preceptor award. He is an examiner for the Canadian Society of Clinical Neurophysiology
(EMG).
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 33
NMC Retreat September 2008: (From left) D. Zochodne, D. Smit, J Bestard, K. Brownell, R. Simmons, C.
White, S. Mawani, L. Korngut, S. Wood, and J. Anderson. Absent, C. Toth.
Dr. Douglas Zochodne served as the Director of the Neuromuscular Clinic and Clinical
Neurophysiology and was Co-Leader of the Regeneration Node, Hotchkiss Brain Institute.
The Zochodne lab (currently 8 members including PDFs, graduate students and techni-
cians supported by 6 external grants) published work on nerve regeneration and diabetes
and renewed a key CIHR operating grant. He authored a text entitled “Neurobiology of
Peripheral Nerve Regeneration” (Cambridge Press) published in 2008.
The Neuromuscular Clinic facilitates"the Myasthenia Gravis (MG) patient support
group, on a bi-yearly basis. The nonprofit MG support Group was initiated in the fall of
2006 and is facilitated by"our"clinic patient care coordinator and social worker. The sup-
port group"is dedicated to empowering patients and families to live well in the face of
chronic MG through"education, peer support and"community networks."Activities included
the organization of a patient and healthcare staff MG education day, and a patient MG
identification and alert card.
2008 Research Funding: Lab based
Number of External Project Grants: 8
External Personnel Awards: 5 (excluding summer studentships)
Canadian Institutes of Health Research (CIHR; 3 grants)
Canadian Diabetes Association (CDA)
Juvenile Diabetes Research Foundation (JDRF)
Natural Sciences and Engineering Research Council of Canada (NSERC)
Alberta Heritage Foundation for Medical Research (AHFMR) [Scientist, Clinical Investigator, Postdoctoral Fellow-
ships, Graduate Studentships, Summer studentships]
National Institutes of Health (NIH)
2008 Research Funding: Clinical trials
Number of Trials: 8
Industry partners: Johnson and Johnson, Talecris, Pfizer, Valeant, Purdue
Juvenile Diabetes Research Foundation (JDRF)
National Institutes of Health (NIH)
Lundbeck and the University of Alberta
ALS Society of Canada
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 34
Dr, Douglas Zochodne
Neuro-Oncology ProgramDirectors
Dr. Greg Cairncross - Medical
Dr. Mark Hamilton - Surgical
Overview
The Neuro-Oncology Program,
spanning multiple Departments, Insti-
tutes and medical disciplines, is dedi-
cated to the care of patients with pri-
mary brain tumours and neurological
complications of cancer. The Program
includes formal Fellowship Training in
the medical and surgical aspects of
Neuro-Oncology and also includes
research activities that span the clini-
cal to basic biomedical continuum.
Members of the Department of
Clinical Neurosciences make a signifi-
cant contribution to the success of the
Neuro-Oncology Program in a number
of important ways. First and foremost,
members provide Neurosurgical and
Neuro-Oncological patient care serv-
ices for adults and children at the
Foothills Medical Centre, Alberta Chil-
dren’s Hospital and Tom Baker Cancer
Centre, oversee the Fellowship Train-
ing Programs in Neuro-Oncology, su-
pervise Graduate Students and pro-
vide senior leadership to the Clark H.
Smith Brain Tumour Centre
(http://www.ucalgary.ca/braintumource
ntre) and Southern Alberta Cancer Re-
search Institute (SACRI;
http://www.sacri.ucalgary.ca) at the
University of Calgary. Members of
Clinical Neurosciences were instru-
mental in establishing the Brain Tumor
Stem Cell Core Facility; Molecular Di-
agnostics Core Facility; Brain Tumor
Tissue Bank and Bio-Repository; Al-
berta Radiosurgery Centre, Neuro-
Oncology Nurse Practitioner Program;
and Advanced Image Processing
Laboratory. The Intraoperative Imaging
Program in the Seaman Family MR
Centre and the highly innovative ro-
botic NeuroArm are other initiatives led
by members of Clinical Neurosciences
that directly enhance the care of pa-
tients by improving surgical therapies
for all types of brain tumor.
A patient care conference (i.e.,
Tumor Board) and clinical trials meet-
ing is held weekly at the Tom Baker
Cancer Centre and every other week
there is informal research and visiting
speaker seminar in the Faculty of
Medicine. Clinical research efforts are
focused on low and high gliomas in
adults and medulloblastomas in chil-
dren. Most clinical trials are conducted
within large National or North Ameri-
can co-operative groups, such as the
National Cancer Institute of Canada –
Clinical Trials Group or the Radiation
Therapy Oncology Group, but
industry-sponsored studies and small
in-house trials are also supported. Ar-
eas of basic research emphasis in-
clude 1) brain tumor stem cell biology,
2) mechanisms of chemotherapy and
radiation resistance in brain tumor, 3)
non-invasive detection of molecular
changes in brain tumor using new im-
aging techniques and 4) development
of experimental therapies for brain tu-
mor including oncolytic viruses, drugs
that block the spread of brain tumor
cells and methods for drug delivery.
Members
Neurosurgeons " "
Dr. Mark G Hamilton
Dr. Betty MacRae
Dr. Yves Starreveld
Dr. Garnette Sutherland
Neuro-Oncologists" "
Dr. Jay Easaw
Dr. Peter Forsyth
Dr. Greg Cairncross ##
Neuro-Pathologists"
Dr Jennifer Chan
Dr Jeff Joseph
Dr David George
Radiation Oncologists
Dr. Rob Nordal
Dr. Alex Chan
Dr Siraj Husain
Nurse Clinician" "
Crystal Tellent
Research Nurse
Annabelle DeGuzman
Neuro-Oncology Fellow
Dr Paula de Robles
Graduate Students
Dr. John Kelly
Michael Blough
Morgan Westgate
Grant Support
Canadian Institute for Health Re-
search
Alberta Cancer Research Institute
Tom Baker Cancer Centre
Hotchkiss Brain Institute
National Cancer Institute of Can-
ada
Alberta Cancer Foundation
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 35
Pediatric Neurosurgery ProgramStaff
Neurosurgeons: Dr Mark G Hamilton (Division Head), Dr
Walter Hader, and Dr Clare Gallagher
Pediatricians: Dr Heather Graham and Dr Keith Jorgensen
Nurse Practitioner: Kelly Bullivant
Nurse Clinicians: Valerie Sherwood and Linda Gill
Overview
Pediatric Neurosurgery is a division of Pediatric Sur-
gery (Department of Surgery) and the members are also
part of the Division of Adult Neurosurgery (Department of
Clinical Neurosciences). There are currently three Pediatric
Neurosurgeons, all of whom participate in adult Neurosur-
gery Programs. Dr. Hamilton is the Head of the Division of
Pediatric Neurosurgery, Dr. Hader and Dr Gallagher are the
other Division members. Dr. Terry Myles, the former Head
of Pediatric Neurosurgery, has recently retired from full-
time neurosurgical practice in Pediatric Neurosurgery.
There are two Pediatricians who work in the Infant Cranial
Screening and Remodeling Clinic. Kelly Bullivant is a full-
time Pediatric Neurosurgical Nurse Practitioner who pro-
vides inpatient and outpatient pediatric neurosurgical care
and two nurse clinicians (Valerie Sherwood and Linda Gill)
who provide outpatient pediatric neurosurgical care.
Clinical Aspects
The Pediatric Neurosurgical Program in comprehen-
sive, offering all aspects of pediatric neurosurgical care
including management of hydrocephalus, brain and spinal
injury, myelomeningocele, other forms of spinal dys-
raphism, refractory epilepsy surgery, spasticity, craniofacial
disorders, and pediatric brain tumor (in conjunction with
the Pediatric Neuro-Oncology Group).
The Pediatric Neurosurgeons provide weekday call at
the Alberta Children’s Hospital (ACH), and with the other
members of the Division of Adult Neurosurgery participate
in nighttime and weekend call schedules.
#
Approximately 210 elective and emergent surgeries
occurred in 2008 at the Alberta Children’s Hospital.
Ninety-seven percent of the surgical patients required inpa-
tient stays. The average length of stay for Neurosurgical
patients was 5 days compared to the average of 2.9 days
for the whole inpatient surgery population. We are able to
offer access to unique treatment modalities such as the
intra-operative MRI theatre for assisting in the surgical
treatment of epilepsy and brain tumor, a comprehensive
neuro-endoscopic program, and the Stereotactic Radio-
surgery Program for selected cerebrovascular malforma-
tions and brain tumors.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 36
Alberta Children’s Hospital
Neurosurgery clinics run every week. Clinics include
General Neurosurgery, Craniofacial Clinic, Infant Cranial
Screening and Remodeling Clinic (Pediatricians), and Mye-
lomeningocele Clinic. Approximately 1700 outpatient visits
occurred in 2008.
Clinical Program Examples
The Adult hydrocephalus Clinic is now in its 6th year at
the Foothills Hospital. This was initiated by Dr Hamilton to
provide transition care for pediatric patients with hydro-
cephalus or tethered spinal cord after age 18 years. This
clinic also coordinates care and assesses adults with un-
treated congenital hydrocephalus and untreated new onset
hydrocephalus. A Hydrocephalus Registry has been estab-
lished, currently with over 100 patients. Care guidelines
have been created. This is a unique Canadian clinic provid-
ing an essential service for patients with two serious
chronic diseases.
A comprehensive Craniofacial Program is coordinated
through ACH. A community-based parent education and
screening program involves Public Health Nurses and
Nurses from ACH. Two Pediatricians coordinate the Infant
Cranial Screening and Remodeling Clinic. Infant patients,
who require Cranial Remodeling Headbands for correction
of positional-related cranial deformities, can have their
head scanned in a state-of-the-art Laser Unit. This allows
creation of a custom treatment headband for each unique
patient. Finally, a monthly Craniofacial Clinic attended by
Dr Mark Hamilton and Dr Don McPhalen from Plastic Sur-
gery evaluates new patients for surgical treatment of
craniosynostosis and provides long-term followup for all
surgically treated children.
An Intrathecal Baclofen pump can be offered to treat
appropriate patients with severe spasticity. These patients
undergo screening by Dr Hader and the Program Nurse
Clinician, Val Sherwood. They must demonstrate a suc-
cessful response to intrathecal injection of Baclofen
through a lumbar catheter. This treatment can provide a
dramatic improvement in quality of life for these severely
affected patients.
Other Activities
The Pediatric Neurosurgical Division members partici-
pate in local and national administrative and educational
functions. They also lead and collaborate in clinical re-
search involving pediatric and adult hydrocephalus, epi-
lepsy and brain tumor. During the last five years, the Divi-
sion of Pediatric Neurosurgery members have published 14
peer-reviewed manuscripts. There are also 4 peer-reviewed
manuscripts in-press, 1 manuscript undergoing peer-
review, 5 book chapters published or in-press and 45 pub-
lished abstracts. In addition, Drs Hamilton and Hader have
collaborated on 8 successful research grant applications
and been local principal investigators for 7 Clinical Trials.
The Pediatric Neurosurgery Division is an active participant
of the Canadian Pediatric Neurosurgery Research Study
Group.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 37
Peripheral Nerve Surgery ProgramProgram Director: Dr. Rajiv Midha
Overview
This program is multi-disciplinary, encompassing clini-
cal and electrodiagnostic services provided by Neurology
and PMR faculty, electrophysiology support and surgical
treatment of patients. The latter consists of state of the art
surgical management of peripheral nerve conditions, such
as complex peripheral nerve injuries, nerve tumors, bra-
chial plexus surgery as well as advanced nerve repair and
nerve transfer techniques. Members have recently
launched a clinical randomized control trial which will be
comparing surgical decompression to best medical man-
agement for ulnar neuropathy at the elbow. Three of the
faculty members (Midha, Toth, Zochodne) within the pro-
gram also have independent basic science research labo-
ratories investigating various facets of peripheral nerve dis-
ease, including neuropathy, nerve injury and nerve regen-
eration. There is considerable collaboration amongst the
principal investigators, of their graduate students and fel-
lows. These individuals are also member of the spinal cord
and nerve regeneration and repair program within the HBI
(The links, http://www.hbi.ucalgary.ca or
http://www.ucalgary.ca/spinalnerve/ have more details for
those interested).
Members
Director & Neurosurgeon:
Dr. Rajiv Midha
Medical Neurologist & Electrodiagnostics:#
Dr. Chris White
Dr. Doug Zochodne
Dr. Cory Toth
Dr. Stephen McNeil
Fellows:
Dr. Bassam Addas 2007-8
Dr. Jacob Alant 2008-9
Intraoperative Electrophysiology Support:
Michael Rigby
Erin Phillip
Research Interests
Experimental nerve injury
Nerve guidance tubes to repair nerve injuries
Growth factors and stem cell therapy to enhance nerve
regeneration
Electrical regeneration interfaces (CIHR Regenerative
Medicine and Nanomedicine Team grant)
Insulin and IGFI effect on nerve injury and diabetic neu-
ropathy
Diabetic neuropathy
Grant Support
Canadian Institute for Health Research (CIHR)
Alberta Heritage Foundation for Medical Research
(AHFMR)
Aegera Therapeutics
Canadian Diabetes Association
National Institute of Health (NINDS)
Pfizer Corporation
Integra Life Sciences
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 38
Local and visiting residents attending the 2008 annual Uni-
versity of Calgary Spine and Peripheral Nerve Surgery
Course
Project NeuroArmProgram Director - Dr. Garnette Sutherland
Overview
In 2008, full engineering sign off for the neuroArm
robotic system was completed. Preclinical studies were
performed and Health Canada, together with University
of Calgary/ Calgary Health Region conjoint ethics board
approvals for clinical application were acquired. The sys-
tem was introduced to neurosurgery in a graded fashion
and has been used on five patients, all with brain tumors.
An index case was selected and the system was intro-
duced to the media. This provided the University of Cal-
gary with considerable international visibility, with articles
appearing in various mediums.
NeuroArm was featured in three documentary series
including the Discovery Channel’s Daily Planet, CBC’s
The Nature of Things with David Suzuki and a documen-
tary from the BBC on medical frontiers entitled Super-
doctors. The system was also featured in a number of
prominent publications such as The London Times, The
Economist, and The Times of India. This also produced a
number of invited speaking engagements to neurosurgi-
cal conferences such as the Society of Neurological Sur-
geons and the Congress of Neurological Surgeons, to
teaching engagements at Dartmouth College and Johns
Hopkins Hospital, and to influential policy-changing con-
ferences as The Conference Board of Canada’s Centre
for Advancing Health Innovations and The Science and
Technology in Society forum in Kyoto, Japan. In this way,
neuroArm innovation and the pathway to that innovation
is shared around the world.
In June of 2008, the operating room that housed in-
traoperative MRI (iMRI) and neuroArm was closed for
renovations and an upgrade from a 1.5Tesla magnet to a
3Tesla platform. This improvement to the imaging capa-
bility of the iMRI will also improve the abilities of the neu-
roArm system. In parallel, neuroArm underwent modifi-
cations to allow full integration into the 3Tesla environ-
ment. Further application of the robotic technology is
slated to begin in January 2009. Related to the neuroArm
project, a new CFI grant entitled MR-PET guided, ro-
botic, molecular characterization of brain tumor for indi-
vidualized therapy was prepared and considered for
round 6 consideration.
During 2008, the research group continued to make
progress in the development of cell-specific imaging
technology. The project has required collaborations with
multiple NRC institutes. Cell and vascular specific single
domain antibodies have been successfully attached to
nanoparticles based on silicon-coated ferrous oxide. An
animal model has been used to show both sensitivity and
specificity.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 39
NeuroArm performing robotic-assisted surgery on live
human patient.
Members
Project Leader:# # #
Garnette Sutherland
MDA Lead Engineers:
Tim Fielding
Perry Newhook
Simon Hu
George Feil
Andrew Skorupski
NRC Scientists:
Boguslaw Tomanek
Scott King
Calvin Bewsky
Teodor Veres
Roger Mackenzie
Danica Stanimirovic
Maureen O’Connor
Abedelnasser Abulrob
University of Calgary investigators (not inclusive):
Alex Greer
James Larsson
Yves Starreveld
Yaoping Hu
Gail Kopp
Chris Macnab
Students:
Peter Rizun
Jason Motkoski
Shawna Pandya
David Brandman
Residents:
Cesar Serrano-Almeida
John Kelly
Shelly Lwu
Atya Alflouse
Zhunyu Fu
Research Interests
Surgical robotics
Haptics
Surgical simulation
Education
Grant Support
Canada Foundation for Innovation (Infrastructure and
Operating)
Alberta Advanced Education and Technology (Infra-
structure)
Western Economic Diversification (Infrastructure)
Reach! (Infrastructure and Operating)
Alberta Heritage Foundation for Medical Research
(Student Support)
Canadian Institutes for Health Research (Operating-
Molecular Imaging)
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 40
Dr. Garnette Sutherland
Skull Base Surgery ProgramOverview
In conjunction with colleagues from the Division of
Otolaryngology, the skull base surgery group combines
long experience with novel approaches to offer patients
the best surgical treatment and long term followup for
these challenging lesions. In addition, close ties to both
endocrinology, and the Alberta Radiosurgery Centre en-
sure that the nonsurgical aspects of treatment are equally
well dealt with. Endoscopic approaches to pituitary and
anterior skull base lesions are also offered when appro-
priate. Research interests represented within the program
include clinical epidemiology, image guidance, robotic
surgery, and surgical simulation.
Clinical Initiatives
Endoscopic Skull Base Surgery
Building on the experience gained in endoscopic pi-
tuitary tumor resection, extended endonasal approaches
to skull base pathology are being used. Esthesioneuro-
blastomas, olfactory groove and tuberculum sellae men-
ingiomas are all being addressed endoscopically, where
appropriate. Advances in image guidance are being ex-
ploited to minimize surgical risk and reduce post-
operative morbidity in best serving this patient popula-
tion.
Members
Neurosurgeons:# #
Dr. Elizabeth MacRae
Dr. Garnette Sutherland
Dr. Yves Starreveld
ENT Surgeons:
Dr. Joe Dort
Dr. Brad Mechor
Dr. Phil Park
Intraoperative Electrophysiology Support:#
Erin Phillip
Michael Rigby
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 41
Spine ProgramOverview
The University of Calgary Spine Program is a multi-
disciplinary program dealing with the care of individuals
affected by conditions and diseases of the spine and
spinal cord. It encompasses a combined fellowship pro-
gram offering fellows exposure to Orthopedic Spine and
Neurosurgical spinal care. We are now in the 11th year of
our official existence and have provided training to 4 fel-
lows per year. Our staff has grown to 6 orthopedic spine
surgeons and we are recruiting for an additional neuro-
surgical spine surgeon to complement the existing 3 neu-
rosurgical spine surgeons.
Members
Dr Stephan du Plessis (Chairman) - Adult Spine
Dr Ken Thomas (Fellowship Director) - Adult Spine
Dr Jacques Bouchard - Adult Spine
Dr Steve Casha - Adult Spine
Dr Roger Cho - Adult Spine
Dr Jason Howard - Pediatric Spine
Dr Rick Hu - Adult Spine
Dr John Hurlbert - Adult Spine
Dr David Parsons - Pediatric Spine
Dr Paul Salo - Adult spine
Dr Ganesh Swamy - Adult Spine
Tara Whittaker - Research Nurse
Ish Bains - Research Coordinator
Emi Sanders - Database Manager
Research
On the research front the Spine Program has been
active in a large number of clinical studies. There are cur-
rently 21 clinical trails ongoing within the program. The
Odontoid screw study, Minocycline study, Bryan disc
study and the Lumbar stenosis study has been going on
for a number of years and are in the process of being
finalized.
The Novartis SCI study, Bioset TLIF and P15 Bone
putty studies are new for this year and have started en-
rolling patients.
The intrathecal morphine study, Cethrin study, Hel-
met study and the Traumatic SCI predictive index study
are in the process of going through the review process.
Fellowship
Thanks to the efforts of John Hurlbert we were fortu-
nate to have two fellows from Australia this year. Dr Ball
from Australia joined us in February and Dr Pope from
Australia, Dr Bajammal from Saudi Arabia and Dr Cenic
from Ontario started their fellowships in July. Our current
fellows have active research projects ongoing and will be
presenting their work at the Canadian Spine Society
Meeting.
New Developments
Caleo Health Spine opened its doors in February;
this multidisciplinary spine clinic is offering a one stop
spine service. Services offered include primary and sec-
ondary assessments and treatments by physiotherapists,
chiropractors, medical spine physicians as well as sur-
geons. This facility is geared to provide the full spectrum
of spine care and rehabilitation.
Spine Referral Project was started in the second part
of the year. The goal of this project is to improve access
to spine care. The hiring of a medical spine physician has
allowed for consistent flow of patients through the outpa-
tient facilities on the 12th floor. This has enabled us to
centralize the referral process and by utilize a prioritiza-
tion tool developed by the spine program. The goal is to
provide patients with timely access to appropriate care
by the appropriate provider.
Spine database expansion is planned for the next
year with the goals being the capturing of all data from
patients referred for spine care. This will involve a major
expansion of our existing database infrastructure and
would allow for an electronic web based process to inte-
grate with the spine referral project. The database will be
used to capture outcome data form surgical as well as
non surgical patients and would provide us with the abil-
ity to track outcomes on a long term ongoing basis.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 42
Stroke & Neurovascular ProgramsOverview
The Calgary Stroke Program experienced substantial
growth in 2008 with the recruitment of three new stroke
faculty members: Dr. Sean Dukelow, Dr. Eric Smith and
Dr. Roger Thompson, bringing the program’s total stroke
staff/faculty to 60. All three individuals bring unique skill
sets to our program which will round out our academic
strengths to include stroke recovery, white matter
disease/vascular dementia, and basic science/
neuroprotection, respectively. Our program can now has
an academic focus that spans the stroke care continuum.
The Program has been able to maintain important lead
roles with respect to professional and practice develop-
ment, rehabilitation program facilitation and telestroke
coordination and has established two new roles of
Knowledge Management Advisor and Patient Experience
Strategy Consultant: the first of their kind within the Cal-
gary Health Region. A new Clinical Nurse Educator posi-
tion, specifically dedicated to Unit 100 has also been
established.
The Calgary Pediatric Stroke Program was estab-
lished in 2008 by Dr. Kirton at the Alberta Children’s
Hospital. This is the only the second such program in
Canada. This significantly advances the scope and depth
of the Calgary Stroke Program. Research initiatives that
are developing from this program include neuroimaging
studies, international epidemiology, and mapping of brain
plasticity/recovery.
The Neurovascular Program was brought under the
Stroke Program umbrella significantly advancing the
scope and depth of the Calgary Stroke Program and a
Neurovascular Clinic which integrates specialist Neuro-
surgical, Neuroradiological, Neurointerventional and Neu-
rological ambulatory care has been established.
Stroke research continues to be a major portion of
the program’s work. To date we are involved with over
15 clinical trials directed by Dr. Michael Hill. This includes
several trials where members of our program play signifi-
cant steering or executive committee roles.
Publication activity is steadily accelerating. Grant
season was very busy with four faculty members apply-
ing for AHFMR junior investigator scholarship awards.
Dr. Barber also received his AHFMR Clinical Investigator
renewal.
Dr. Shelagh Coutts had a very successful grant fund-
ing cycle this year. She received a CIHR operating grant
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 43
Dr. Tim Watson, a Calgary stroke neurologist, pauses for a photo before he and his wife, Doone Watson, rappelled off the Heart and Stroke Foundation building in Kensington. (Leah Hennel, Calgary Herald)
and Pfizer grant for her CATCH study which examines
CTA in the minor stroke/TIA population. CATCH is cur-
rently recruiting at a brisk pace due to the enthusiasm
the entire team has the project. This CIHR funding is Dr.
Coutts first major grant as an independent investigator.
Dr. Coutts also received pilot funding for her TIA Hotline
project with a major grant submission pending.
The PREDICT multinational, multicenter observa-
tional study coordinated by our program continues to
recruit intracerebral hemorrhage patients for acute CT
angiography. Preliminary findings demonstrating the
dramatic utility of CTA for identifying patients at risk of
ICH growth when the “spot sign” is present. This work
was presented as a platform by Dr. Demchuk at the In-
ternational Stroke Conference and European Stroke Con-
ference. PREDICT has spawned the development and
successful funding for the STOP-IT randomized Phase 2
clinical trial evaluating recombinant Factor VIIa in Trial in
CTA spot sign positive patients. The trial is being coordi-
nated by University of Cincinnati with our program lead-
ing the CT scan analysis. The trial was funded by Na-
tional Institutes of Health SPOTRIAS program.
The fellowship program continues to be highly re-
garded on an international level. To date the Calgary
Stroke Program has graduated a total of 28 fellows from
10 different countries. This past year, four fellows left our
program: Dr. Mohammed Alzawahmah, moved to Lon-
don, Ontario to continue a fellowship in Neurocritical
Care before returning to a faculty appointment at Royal
Military Hospital in Riyadh, Saudi Arabia. Dr. Alex Poppe
returned to Montreal, joining the faculty at the University
of Montreal CHUM. Dr. Albert Jin has joined the faculty at
Queen’s University in Kingston, Ontario, and Dr. Cynthia
Herrera returned to Brazil to neurology practice.
Dr. Talip Asil joined our program in February of 2008
from Idirne, Turkey. Dr. Nan Shobha joined in May from
Bangalore India, Dr. Bijoy Menon in November from
Chennai, India. Dr. Dar Dowlatshahi (Ottawa) also joined
the fellowship in July. He was successful at obtaining
external funding for fellowship through the CIHR and
University of Ottawa fellowship award programs. We are
continuing to pursue other international links and part-
nerships and hope to establish a formal collaboration
with at least one major stroke care provider in the UK in
2009.
We have continued to make improvements in clinical
services for people affected by stroke right across the
continuum. These improvements are aligned with our role
as one of two Comprehensive Centres within the overall
Alberta Provincial Stroke Strategy (APSS). Our formal
Telestroke connection with Drumheller as a Primary
Stroke Centre has been established and we continue to
provide Comprehensive Stroke Centre support to
Lethbridge and Medicine Hat. Around 10% of ischaemic
stroke patients receive tPA at the FMC site and we are
working to increase this number alongside reducing door
to needle time through our HASTE Six Sigma project
which is moving from its Analyse to Improvement phase.
We believe this to the first application of Six Sigma as an
quality improvement process in stroke care in Canada.
Working with the team on Unit 112 FMC we have
been able to improve our capacity to provide intensive
care to hyperacute and acute stroke patients by increas-
ing the number of monitors available to beds on the unit.
With the support of Rehabilitation and Specialised Clini-
cal Services we were able to extend a pilot project en-
hancing acute inpatient therapy to patients on Unit 100
for a full year. A full time Therapy Assistant position has
been now funded on a permanent basis and we are look-
ing to secure ongoing funding for more Speech and Lan-
guage Therapy, in particular with regard to communica-
tion interventions, which has been a critical component
to the project (which completes at the end of 2008.)
Other benefits of this work have included full implemen-
tation of the TOR-BSST swallowing screen and having
therapy positions dedicated to the acute stroke unit it-
self.
The Stroke Facilitated Discharge and Transition Team
has been established through a partnership with Home-
care services and Rehabilitation and Specialised Clinical
Services. This service will run as a pilot throughout 2009
and will provide home / community based rehabilitation
interventions, thereby facilitating early supported dis-
charge from inpatient care units across the city and more
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 44
comprehensively supporting transition for stroke patients
and their families.
The Stroke Prevention Clinic maintains a high volume
of clinical activity and completed a very successful Ka-
izen in the summer which resulted in significant im-
provements in clinic process and our ability to measure
the performance of our ambulatory stroke care. Again,
we believe this to be first application of LEAN improve-
ment techniques in stroke care in Canada.
Learning About Stroke, and Living With Stroke are
two new patient education and self management inter-
ventions which we be offering to people affected by
stroke through our partnership with Regional Chronic
Disease Management. These new services will be avail-
able in May 2009. Other initiatives designed to address
stroke prevention include pilot projects in community
awareness of stroke, and community based hypertension
detection and management.
We have continued to develop our professional de-
velopment and education profile in 2008 with a wide
range of different teaching and learning opportunities
provided by physicians and staff associated with the
Program. More than 1600 members of Regional staff and
physicians attended educational sessions about stroke
and stroke care between February and November 2008.
Educational resources about stroke are also a major
component of a new internal website for the Program
which is being launched at the time of writing this report.
Neurovascular Program
The Neurovascular Program is a joint collaborative
effort of specialists and allied healthcare staff from multi-
ple disciplines (cerebrovascular and endovascular neuro-
surgery, interventional neuroradiology, and stroke neurol-
ogy), to combat neurological vascular disease. The past
year has seen further academic integration of the Neuro-
vascular Program into the Stroke Program. Shared re-
sources have allowed greater new and continued partici-
pation of neurosurgery and radiology in several interna-
tional stroke studies, such as IMS-3, CREST, ENACT,
ALISAH, and CONSCIOUS-2.
The program has continued to see growth and ex-
pansion in the number of patients with complex cerebro-
vascular disease. Approximately 500 patients with neu-
rovascular disease are seen yearly in a specialized out-
patient clinic for evaluation and follow-up. Currently
about 200 patients are treated annually via minimally in-
vasive endovascular means such as endovascular coil-
ing, embolization, and carotid stenting. As well, surgical
volumes and expertise in open neurosurgery have been
maintained with the availability of specialized procedures
such as craniotomy and aneurysm clipping, carotid en-
darterectomy, resection of vascular malformations, and
extracranial-intracranial bypass. An integrated relation-
ship with the Alberta Radiosurgery Centre, which uses
focussed radiotherapy techniques unique in Canada, has
allowed the non-invasive and safe treatment of patients
with complex arteriovenous malformations.
In 2008, the outpatient experience of patients with
cerebrovascular disease from both clinical and adminis-
trative standpoints was consolidated and the weekly
Neurovascular Clinic was launched. A joint initiative of
specialists from cerebrovascular neurosurgery, interven-
tional neuroradiology, and stroke neurology, this will fa-
cilitate the rapid triage and evaluation of patients to ex-
pedite and provide high-quality care, and allow further
opportunities for teaching and clinical studies.
We continue to attract applicants to the endovascu-
lar fellowship program from countries worldwide and
from multiple disciplines including neurosurgery, radiol-
ogy, and neurology.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 45
Faculty and Staff Listing
Dr. Andrew Demchuk, Director, Calgary Stroke Pro-
gram (Emily Collins, Administrative Assistant)
Dr. Michael Hill, Director, Stroke Unit (MichelleRae
Wright, Administrative Assistant)
Dr. Nic Weir, Director, Calgary Stroke Prevention
Clinic (Lori Finch, Administrative Assistant)
Dr. John Wong, Director, Neurovascular Program
(Brent Lester-Satzke, Neurovascular Clinic Coordinator)
Dr. Mark Hudon, Head, Neuroradiology
Michael Suddes, Program Manager, Alberta Health
Services
Stroke Neurologists
Dr. Phil Barber, Dr. Shelagh Coutts, Dr. Keith Hoyte
(Part-time), Dr. Gary Klein, Dr. Peter Stys, (Part-time), Dr.
Tim Watson, Dr. Eric Smith#
Cerebrovascular Neurosurgery
Dr. John Wong, Dr. Garnette Sutherland
Interventional Neuroradiology & Endovascular Neuro-
surgery
Dr. Mark Hudon, Dr. William Morrish, Dr. Mayank
Goyal, Dr. John Wong
Diagnostic Neuroradiology
Dr. William Hu, Dr. James Scott, Dr. Carla Wallace,
Dr. Kate Bell, Dr. John Lysack, Dr. Rob Sevick
Stroke Fellows (2008)
Drs. Talip Asil, Mohamed Alzawahmah, Dar Dowlat-
shahi, Pablo Garcia, Al Jin, Bijoy Menon, Alexander
Poppe, Nan Shoba, Nikolai Steffenhagen
Interventional Neuroradiology Fellows (2008)
Dr. Pranshu Sharma
Dr. Muneer Eesa
Stroke Research Nurses
Karla Ryckborst, Karyn Fischer, Marie McClelland,
Carol Kenney# # # #
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 46
Urgent Neurology ClinicStaff
Director: Dr A. Hanson
Nurse Clinician: Janet Warner
FMC UNC clerk: Patricia Hammel ( maternity leave
coverage - Addie Stowe)
RGH UNC Nursing" Staff: rotation every 3 months from
Unit 46 (Laura Murdock, Regan Thomson and Vita Mina)
RGH UNC"clerk: "Holly Wowk"
"
FMC Physicians: Drs P. Barber, R.Bell, S. Coutts, T.
Feasby, P. Federico, S. Furtado, A. Hanson, J. Kohli, L.
Korngut, W. Murphy, T. Watson, and M. Yeung.
"
RGH Physicians: Dr C. White (RGH" Associate Direc-
tor), Drs. F. Amoozegar, R. Bell, K. Busche, D. Patry, D.
Pearson,
"
Relief Physicians: Drs K. Brownell, N. Jette
Overview
2008 was a busy year for the Urgent Neurology Pro-
gram, with the opening, in October, of a second site for
Urgent Neurology Clinics, at the Rockyview General Hospi-
tal.
The Rockyview Neurology Planning Committee was
comprised of Dr. Chris White, Cathy Edmond, Janice
Hagel, Tina McLean, Mike Rigby, Wendy Carruthers, Pam
Sweeney, and Janet Warner.
During the planning period, the Mandate of the Urgent
Neurology Program was reassessed and updated. New
guidelines for the triaging and distribution of referrals were
developed.
In June, a staff meeting of the Urgent Neurology Clinic
was held. A discussion regarding what patients were ap-
propriate to be seen in the clinic was held. Criteria for In-
clusion and Exclusion were agreed upon.
Doctors Busche, Pearson, Patry, and White moved
their Urgent Neurology clinic times to the RGH UNC, and
Dr. Brownell is the relief doctor for the RGH UNC. Dr. Far-
naz Amoozegar, the Headache Fellow, started seeing pa-
tients at the RGH UNC in November.
The Rockyview Urgent Neurology Clinic opened with a
full time clerk, and a nurse rotating through the clinic from
the Neurology Floor at the Rockyview. Both staff were ori-
ented at the Foothills Urgent Neurology Clinic.
The Foothills site receives all of the Urgent Neurology
clinic referrals, and triaging is done by the Program Direc-
tor, Dr. A. Hanson, with the Nurse Clinician, Janet Warner.
The opening of the Rockyview site has split the workload
of the Program, so that the staff at Foothills now have a
manageable load.
Approximately 50% of all referrals received, continue to
be inappropriate for the Urgent Criteria of the clinic. The
new referral form has resulted in more information being
received from referring doctors, but has not decreased the
number of inappropriate referrals. Emergency physicians
have sent 40% and general practitioners have sent 55%,
respectively, of the inappropriate referrals. The Urgent
Neurology Program Mandate which includes the inclusion
and exclusion criteria was sent to the Dr. R. Anderson,
Head of Emergency Medicine, for him to send to all of the
ER physicians.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 47
2008 Divisional UpdatesDivision of NeurosurgeryAcademic Neurosurgery in Calgary
The Division of Neurosurgery, led by Dr. Raj Midha, is
committed to the Faculty of Medicine’s vision for academic
medicine in Calgary which is “Creating the Future of
Health” and the vision of the Calgary Health Region (CHR)
which is, “Our community working together for excellence
in health”.
Academic neurosurgery
in the Calgary Health Re-
gion and at the University
of Calgary centres
around the education,
research, clinical and
administrative work and
service performed by the
14 members of the Divi-
sion of Neurosurgery in
the Department of Clini-
cal Neurosciences.
Unlike most other Cana-
dian medical schools
and large quaternary
level hospitals where neu-
rosurgery would be placed organizationally within a Divi-
sion of Surgery, Calgary has developed a Department of
Clinical Neurosciences which brings together neurologists,
neurosurgeons and physiatrists into a single structure
which allows for greater coordination of academic and
clinical activity across the broad spectrum of brain, spine,
nerve, pain, muscle and movement disorders that afflict
patients.
Clinical Excellence in Neurosurgery Services
The Division of Neurosurgery of the Department of
Clinical Neurosciences, provides full neurosurgical services
for adults and children including Level One Trauma support
to the southern half of the province of Alberta as well as
the eastern part of British Columbia in the Kootenay Re-
gion through the Foothills Medical Centre (FMC) and Al-
berta Children’s Hospital (ACH).
The level of clinical service delivered by Calgary’s neu-
rosurgical community is comprehensive, and is built around
the qualities of excellence, competence, quality, safety and
innovation. The roll-out of the Alternative Relationship Plan
for Neurosurgery (in 2001, and renewed in 2008) has fos-
tered a mechanism of timely appropriate transfer of cases
to neurosurgical subspecialties and therefore allowing the
highest quality of care for each and every patient.
General neurosurgical services as well as subspecialty
care in complex spinal diseases, skull base surgery, paedi-
atrics, peripheral nerve disease, cerebrovascular and en-
dovascular neurosurgery, epi-
lepsy and functional neurosur-
gery are provided at the FMC
and the ACH sites. Stereotactic
radiosurgery is provided in the
Tom Baker Cancer Centre, which
houses the innovative Alberta
Radiosurgery Center (ARC), in
collaboration with the radiation
oncologists.
In addition to general neurosur-
gical call, sub-specialty call cov-
erage is provided for paediatric
neurosurgery, spine, and cere-
brovascular (including endovas-
cular) surgery.
While leading and encouraging
the development of innovation in
neurosurgery service in Southern
Alberta, Divisional Members
have continued to deliver core
neurosurgical services to the
patients in the catchments area.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 48
Dr. Terry Myles
Dr. Rajiv Midha
Dr. Betty MacRae
In 2008, at the FMC site, there were approximately 1800 in-
patient admissions to neurosurgery and over 5700 outpa-
tient visits to a neurosurgeon office. Neurosurgeons in the
CHR performed approximately 2000 procedures in 2008,
comprising 1700 procedures in the regular OR, and another
300 procedures in the endovascular, stereotactic radiosur-
gery ARC unit and ICU settings.
Below are listed specific examples of excellence in
clinical care and innovation, in the various subspecialty
areas:
Leadership in spine surgery and spinal cord injury
The spinal neurosurgery group has embraced minimally
invasive techniques for spinal surgery and “bench to bed-
side” drug therapies for spinal cord injury and are leading
the way in Canada for their ap-
plication within clinical research-
centered trials. Calgary is one of
only two centres contributing to
a national database of spinal
cord injured patients. This cen-
tre has successfully launched
and is completing a clinical trial
in spinal cord injury based on
preclinical work performed at
the University of Calgary. We are
also actively involved with two
other industry initiated clinical
trials in this disease. The out-
come of this effort will be reduced post surgical lengths of
stay, and reduced recovery time for patients.
Traumatic Brain Injury & Neuro-critical Care
Basic combined with clinical research is beginning to
create an understanding of the complex neurochemistry
and physiology of severe traumatic brain injury. Given the
advances that have been made worldwide in this area both
Drs C. Gallagher and D. Zygun have undergone training in
treatment of neurotrauma at the University of Cambridge.
As a result the use of intracerebral microdialysis in the in-
vestigation and treatment of traumatic brain injury is now
underway at Foothills Medical Centre Intensive Care. This
means Calgary is the first Canadian centre to routinely use
the technique in a patient care setting. Microdialysis is be-
ing combined with other multimodality monitoring to de-
termine changes occurring in the brain after injury. These
insights into brain neurochemistry will allow us to tailor
treatment to each patient and we hope to provide a more
coordinated approach to therapy between intensivists and
neurosurgery, as well as obtain information that will lead to
better treatments in the future.
Endovascular Neurosurgery
Treatment of vascular diseases of the nervous system
has been evolving to less minimally invasive interventions
over the past decade. Such treatments are quickly becom-
ing the standard of care for the
treatment of diseases such as
intracranial aneurysms and ca-
rotid stenosis. With the recruit-
ment of the province’s first neu-
rosurgical endovascular neuro-
surgeon, Calgary has quickly
become Western Canada’s
leader. For instance, the endo-
vascular program treated ap-
proximately 200 patients annu-
ally. Many of these patients were
treated with a single day admis-
sion, using minimally invasive approaches (as opposed to
open traditional surgery), and were saved long in-hospital
stays. In conjunction with our well-known and internation-
ally recognized Stroke Program, the endovascular program
has already become an important partner in stroke re-
search.
Alberta Radiosurgery Centre
This program, using a Novalis system, the first of its
kind in Canada, is a collaborative effort between the Divi-
sions of Neurosurgery and Radiation Oncology. The tech-
nology is capable of offering focused radiation treatment
for diseases of the brain and spinal cord in single daycare
sessions, thus obviating the need for lengthy hospital stays
associated with standard neurosurgical treatments. With
our average length of stay of 7.6 days, this alone is a sub-
stantial system wide saving in bed days. By reducing risks
of therapy, and ease of returning to normal activities, it re-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 49
Dr. Stephan DuPlessis
Dr. John Wong
sults in much higher patient satisfaction. The program,
since its initiation in 2002 has grown steadily, and treats
dozens of patients yearly with single and fractionated cra-
nial and extracranial radiosurgery.
Neuro-Surgical Oncology Program
In collaboration with the Department of Oncology at
the Tom Baker Cancer Centre, we have established a neu-
rosurgical oncology program
under the direction of Mark
Hamilton. This subspecialty
approach to surgical treatment
for patients with malignant brain
tumors has helped integrate
surgical care into existing neuro-
oncology programs in the region
which has facilitated timely ac-
cess to appropriate surgery. It
has also enabled development
of a clinical research program in
neurosurgical oncology. Since
its inception in 2005, several
neurosurgically-based clinical trials have been opened, giv-
ing neuro-oncology patients in Southern Alberta access to
novel therapies such as immunotherapy and convection-
enhanced toxin delivery that would otherwise be unavail-
able.
Surgical Epilepsy Program
Surgical treatment of epilepsy has been known to pro-
vide excellent results in properly selected patients with
medically refractory epilepsy.
Access to such treatment how-
ever remains limited. Tremen-
dous growth of the Calgary
comprehensive Epilepsy pro-
gram, a collaboration of adult
and paediatric epilepsy centres,
has been possible with addition
of a new 4 bed monitoring unit
at the FMC and 2 bed unit at the
ACH, for the assessment of
possible candidates for surgery.
In addition, the recruitment of
several new epileptologists (including the Division head of
neurology) and a recruit (in 2006), of a neurosurgeon who
has expertise in epilepsy surgery, has considerably en-
hanced the program. The volume of cases has steadily in-
creased, and averages approximately 75 cases yearly
within the CHR.
Peripheral Nerve Program
In collaboration with the Divisions of Neurology (neu-
romuscular program) and Physical Medicine and Rehabili-
tation, a surgical peripheral nerve program, has been initi-
ated with the recruitment of the Division head in neurosur-
gery, an established peripheral nerve expert. State of the
art surgical management of peripheral nerve conditions is
now possible in Western Canada. This program already
attracts referral of patients from all of Alberta, and indeed a
few select patients from across Canada, and treats ap-
proximately 70 patients a year with advanced peripheral
nerve surgery.
Skull Base Surgery Program
In conjunction with colleagues from the Division of Oto-
laryngology, the skull base surgery group combines con-
siderable experience with stan-
dard proven, as well as novel,
approaches to offer patients the
best surgical treatment and long
term follow-up for these chal-
lenging lesions.
In addition, close ties to both
endocrinology and the Alberta
Radiosurgery Centre ensure that
all aspects of treatment are con-
sidered and offered. An emerging
strength is the use of minimally
invasive endoscopic approaches
to pituitary and anterior skull base lesions for appropriate
cases.
Neuromodulation Program
In collaboration with the several other departments and
divisions, (Neurology, Cardiology, Anaesthesia/Chronic
Pain Centre, Urogynecology, and Gastroenterology). Cal-
gary patients are offered the full range of implantable de-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 50
Dr. Walter Hader
Dr. Yves Starreveld
Dr. Mark Hamilton
vices to alter nervous system functioning. While this pro-
gram started by providing surgery for patients with move-
ment disorders (such as Parkinson’s disease, dystonia and
tremor) it has grown to involve
treatment of patients with spas-
ticity, epilepsy, chronic migraine,
refractory angina, various spe-
cific chronic pain conditions and
psychiatric disorders. The pro-
gram has continuously ex-
panded offering new therapies
and testing experimental treat-
ments by leading multicentre
clinical trials (e.g. Brain 2007).
The Division of Neurosurgery
continues to lead this program in
both hands-on surgery, adminis-
trative and academic aspects. This program attracts refer-
ral of patients from all across Alberta and eastern BC.
Paediatric Neurosciences Program
In collaboration with the paediatric neurology Division
at the ACH paediatric neurosurgery has lead the way in
development of Western Canada’s first paediatric neuro-
science unit, within the new children’s hospital (ACH).
Technological innovation with the introduction of ground-
breaking clinical and research technology, magneto en-
cephalography, which provides a novel way of understand-
ing brain function, will provide paediatric neurosciences
with further innovation at the new Children’s Hospital.
Robotics Program
As a continuation of the highly successful and interna-
tionally acclaimed intraoperative MRI neurosurgical pro-
gram, the development of a MR compatible robot to assist
with cranial (and non-cranial) microsurgery is proceeding.
This program is on the leading edge (world-wide) of inno-
vation and research, brings together experts (under the
leadership of neurosurgery) in robotics, engineering, imag-
ing, haptics and molecular biology. Our partners are the
University of Calgary, the Calgary Health Region, and in-
dustry. The robotics program technology initiative has the
potential to revolutionalize the way that neurosurgery is
performed in the future.
Creating the Future of Neurosurgical Clinical Service
With the addition of the several neurosurgeons over the
past 8 years to our faculty, subspecialty neurosurgical care
in all major areas is covered, with several new services now
being delivered through considerable innovation in care.
Two examples of innovation in neurosurgery care are de-
scribed below:
a) Neurosurgery, Physiotherapy and Chiropractic Col-
laborative Care
The Division has met the ever growing clinical chal-
lenge to diagnose and treat its rapidly expanding referral
base in diseases of the degenerative spine. New referrals
to neurosurgeons alone in this area number well over two
thousand patients per year. The needs of many of these
patients are now addressed through an innovative process
of clinical screening, referral and treatment which ensures
that the appropriate treatments are provided to the right
patients by the appropriate clinician.
This new approach involved different groups – specifi-
cally physiotherapists and chiropractors – in the process of
developing and delivering optimal neurosurgical care for
these patients
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 51
Dr. Zelma Kiss
Dr. Garnette Sutherland, performing live robotic micro-
neurosurgery in the control room using NeuroArm.
In order to help patients with diseases of the degenera-
tive spine, an innovative model of spinal care, National
Spine Care (NSC), was established. Degenerative spine
disease is usually accompanied by severe pain and debili-
tating pain in the lower back or neck most commonly as-
sociated with a degenerative spinal disc. NSC offers an
innovative multi-disciplinary approach to the efficient and
effective screening and assessment of patients facilitated
through the collaboration of the spinal neurosurgeons
working with specially trained physiotherapists and chiro-
practors.
This model of interdisciplinary collaboration was de-
veloped with the full endorsement of the College of Physi-
cians and Surgeons of Alberta. Prior to NSC, 90% of de-
generative spinal referrals were deemed to be non- surgical
patients after assessment by a neurosurgeon. Patients
under the NSC are assessed by spinal neurosurgeon
trained chiropractic and physiotherapists to assess pa-
tients for suitability of assessment by the neurosurgeon.
Patients are therefore more appropriately triaged into a
non surgical spinal therapy program or surgical assess-
ment, where now approximately 85% of those now seen by
the neurosurgeon are offered
surgery. The result is significantly
increased throughput of patients,
and resulting decreased wait-
lists. An average assessment by
a physiotherapist or chiropractor
within the NSC program takes
about an hour. Each year about
1,500 assessments are being
done so the use of physiothera-
pists and chiropractors in the
this innovative care model has
freed up about 1,500 hours of
neurosurgeons’ time to be used on more difficult and com-
plex patients, and those actually requiring surgery.
The Division of Neurosurgery has also established a
medical Spine Clinic overseen by Dr. Stephan Duplessis
and Divisional members within the Foothills Medical Centre
site. Dr. Salma Yaseen, an international medical graduate
who has previously completed the Calgary Clinical Assis-
tants Program (CCAP) with the neurosurgical service, is
now helping manage the medical Spine Clinic, where she
helps triage patients with de-
generative spinal complaints to
surgical or medical treatment.
Patients are neurologically
evaluated under the supervision
of an attending neurosurgeon
with a view towards identifica-
tion of surgically remediable
disease. The clinic provides ex-
pedited spinal advice to about
80 patients per month, and has
significantly reduced neurosur-
gical waiting lists.
b) Neurosurgery and Nursing Collaboration in the Hos-
pital Setting
A second example of innovation in neurosurgical pa-
tient care is in the hospital setting, through the develop-
ment of a Clinical Nurse Practitioner (CNP) program.
Nurses who are trained through the nurse practitioner pro-
gram offered by the University of Calgary Faculty of Nurs-
ing take a third year clinical placement that focuses on the
ward care of neurosurgical patients, the evaluation of
medical problems in pre- and post-surgical care and the
technical and clinical skills related to the care of neurosur-
gical patients.
Enhancement of all facets of in patient care, pre- and
post-surgical education and continuity into the community
has been possible with the training and implementation of
4 Clinical Nurse Practitioners (CNPs) within the system,
with a 5th now nearing completion of training.
c) Neurosurgical Locum Tenens Opportunities
The Division of Neurosurgery is now able to offer highly
selected individuals, the opportunity to initiate their surgical
career within the Department on a per annum contract ba-
sis. Typically newly credentialed by the Royal College of
Surgeons, these physicians are well-trained neurosurgeons
from respected programs who wish to transition from resi-
dency to full-time staff in a structured and rigorously aca-
demic environment. The locum position offers the benefits
of quickly adopting a busy general neurosurgical practice
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 52
Dr. Salma Yaseen
Dr. Steve Casha
with administrative and operative resources, with the
ready availability of subspecialty neurosurgical advice
from Divisional members. Our locum tenens beginning in
July 2008, was Dr. Keith Mac-
Dougall from the University of
Western Ontario. Already a tal-
ented surgeon, Dr. MacDougall
has taken this opportunity to
hone his clinical skills and refine
his academic goals. Dr. Mac-
Dougall plans further subspe-
cialty training in epilepsy and
functional neurosurgery in Lon-
don Ontario and Australia begin-
ning in 2009.
Educating New Physicians and Creating the Neurosur-
gical Care Team of the Future
a) Undergraduate Medical Education
The Division of Neurosurgery provides teaching excel-
lence in the University of Calgary Faculty of Medicine to
both undergraduate medical students and post graduate
trainees in the neurosurgical residency program.
Within the undergraduate medical curriculum, Divi-
sional members serve as mentors in Course V: neurosci-
ence and aging course lecture. Division members are in-
volved in undergraduate small group seminars and bedside
teaching.
Several members of the neurosurgical faculty have re-
ceived undergraduate and post-graduate teaching awards
from the University of Calgary.
b) Post-Graduate Medical Education
Directed by Dr. John Hurlbert, the University of Calgary
Neurosurgical Residency Training Program has continued
to excel, and indeed has flourished with an increasing resi-
dent complement pool from 2000 (5 residents) to 2008 (13
residents). The Program has now realized a stable com-
plement of residents and has gained approval of 2 PGME
funded positions a year.
Resident operating room teach-
ing and technical skill training,
critical care unit, emergency
room, clinical ward and outpa-
tient experience are provided at
the Foothills and ACH sites by
neurosurgical faculty member
mentors and supervisors.
A resident-faculty partnered core
curriculum (2 hours weekly, with
a 3 year cycle) is supplemented
by lectures on basic neurosci-
ences, clinical case presentations/discussions and grand
neuroscience rounds (at the academic half day). In addi-
tion, weekly neuropathology rounds, core surgery semi-
nars, subspecialty rounds, and a visiting professorship
program round out the didactic teaching. Formal oral and
written neurosurgery examinations are conducted by the
neurosurgical team every 3-6 months to evaluate and
monitor resident academic performance profiles. Weekly
interesting case rounds and bimonthly morbidity and mor-
tality rounds provide an opportunity for open discussion
relating to challenges in patient care, including honest dis-
cussion of adverse events, ethical standards and medico-
legal issues. Finally, quarterly journal clubs enable instruc-
tion in reviewing and reading the literature to instill evi-
dence based-best outcome clinical practice.
In addition to postgraduate training, the Division of
Neurosurgery offers Fellowship training in complex dis-
eases of the spine (several dozen Fellows trained over the
past decade), the surgical treatment of epilepsy, functional
and stereotactic neurosurgery, endovascular neurosurgery
and peripheral nerve surgery. Each of these programs has
or is training Fellows, and (given that International Fellows
can choose to go anywhere) reflects the maturity and the
prominence of these programs.
Other Health Professional Education: Medical, Nursing,
Physiotherapy, and Chiropractic
Calgary’s neurosurgeons have utilized the advanced
practice nursing program from the University of Calgary to
train clinical nurse practitioners who work with neurosur-
gery patients in the pre- and post-surgical setting. This
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Keith MacDougall
Dr. John Hurlbert
training occurs predominantly in the third year of the pro-
gram in a clinical setting where the advanced practice
nurses work closely with neurosurgeons.
The Division is pleased to be
offering clinical mentorship and
guidance to international medi-
cal graduates who intend on
entering into the Canadian phy-
sician workforce. Dr. Bipan
Sumbria, a previous general
surgeon, is currently enrolled in
the two-year Calgary Clinical
Assistants Program and is ex-
panding his knowledge base
and clinical repertoire of West-
ern medicine on the neurosurgi-
cal wards, emergency department, and in the clinic.
The neurosurgeons provide the training to the physio-
therapists and chiropractors involved with the clinical as-
sessment services offered through the NSC program. This
program received approval from the Alberta College of
Physicians and Surgeons and is a successful model of
inter-disciplinary cooperation.
d) Continuing Medical Education and Public Education
Additionally, Divisional Members are involved in various
teaching activities targeting the public, and continuing
medical education seminars for primary care physicians,
emergency physicians and referring doctors. Given their
National and International stature, several Members are
also prominently involved in the teaching of residents, fel-
lows and their colleagues at Specialty and Sub-specialty
meetings.
Creating Knowledge for the Future
Research within the Division of Neurosurgery is ac-
complished through cooperation and close alignment with
the Department of Clinical Neurosciences and the
Hotchkiss Brain Institute (HBI) at the University of Calgary.
The goal of the HBI, to be a world leader in Translational
Neuroscience and Mental Health research and commitment
to translating basic science discoveries into improved pa-
tient outcomes, is dependent on the excellence in the clini-
cal neurosciences provided by members of the Division of
Neurosurgery. The goal of the Division of Neurosurgery is
to foster the goals of the HBI and advance the HBI and
University of Calgary as a world leading institute for Neuro-
science research and translational clinical treatment.
Clinical and basic science research is completed by all
division members, four of whom run externally funded re-
search programs, and many who play prominent roles in
Hotchkiss Brain Institute programs including Neuroarm,
Spinal cord and nerve regeneration, Epilepsy and brain cir-
cuits, and Movement disorders and therapeutic brain
stimulation.
As one measure of academic productivity, grant money
from National and Provincial agencies awarded to Divi-
sional Members has increased several-fold over the past
decade, and was > $2.5 Million in 2007-8. Out of the 10
GFT faculty, 3 have independent operating grant support
from CIHR, an extraordinary level of success for a surgical
Division in Canada. Another measure is peer reviewed pub-
lications, which continue to increase yearly, and are fully
documented in the publication section elsewhere in the
Annual Report.
Fostering the Bio-Science Economy of the Future
The research program of members of the Division has
a significant focus on technology commercialization and
the development of effective partnerships and alliances
with interested and committed partners from the private
sector.
The world’s first MRI-compatible surgical robot is the
creation of Calgary neurosurgeon Dr. Garnette Sutherland
and his team. Dr. Sutherland has spent the last 7 years
leading a multi-disciplinary team of Canadian scientists, in
cooperation with MacDonald, Dettwiler and Associates Ltd.
(MDA), to design a machine “that represents a milestone in
medical technology.”
Designed to be controlled by a surgeon from a com-
puter workstation, neuroArm operates in conjunction with
real-time MR imaging, providing surgeons unprecedented
detail and control, enabling them to manipulate tools at a
microscopic scale. Advanced surgical testing of neuroArm
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 54
Dr. Bipan Sumbria
was completed in 2008, and the first few patients have had
neuroArm assisted robotic cranial neurosurgery.
Developing neuroArm required an international collabo-
ration of health professionals, physicists, electrical, soft-
ware, optical and mechanical engineers to build a robot
capable of operating safely in a surgical suite and within
the strong magnetic field of the intraoperative MRI envi-
ronment. Indeed, this past year the 1.5 Tesla intraoperative
MR has been upgraded to a state-of –the-art 3.0 Tesla sys-
tem. Many other surgical disciplines have and continue to
participate in applying neuroArm to various types of surgi-
cal procedures.
Administration/Leadership
All Divisional Members carry out important administra-
tive duties within the Foothills Hospital, ACH and CHR, and
for the purposes herein we will highlight just a few exam-
ples.
The Divisional Head, Dr Rajiv Midha, sits on multiple
hospital, Departmental and Regional Committees. Dr. Mark
Hamilton directs Neurosciences at the ACH, and is the
Chair of the important Quality Assurance and Safety Com-
mittee of the Department of Clinical Neurosciences. Dr
Zelma Kiss provides leadership in the Movement Disorder,
Therapeutic Brain Stimulation and Neuromodulation Pro-
gram. Dr John Hurlbert is the Director of the Residency
Training Program, a co-leader of the Spine and nerve re-
generation program of HBI, and was previously the director
and instrumental in setting up arguably the best multi-
disciplinary Spinal surgery program (in collaboration with
orthopaedic spinal surgery) in Canada.
Academic leadership within the Division of Neurosur-
gery is provided by Dr Rajiv Midha, a surgeon scientist re-
cruited in 2004 to help accomplish the Academic mission.
He presently also sits on the executive committee of the
Hotchkiss Brain Institute and is a member of the Spinal
Cord and Nerve Regeneration Team. Three additional
members of the Division of Neurosurgery have leadership
roles within 3 research programs within the HBI. For exam-
ple, Dr. Garnette Sutherland directs the NeuroArm Robotics
Program.
Many Divisional Members have prominent leadership
positions at National and International levels. For example,
Dr. Hamilton is past President of the Canadian Congress of
Neurological Sciences. Dr. Midha is the past President of
the (international) Sunderland Society, past President of the
American Society for Peripheral Nerves and prior Chair of
the Peripheral Nerve Task Force in organized American
neurosurgery. Dr Hurlbert was recently the Education
Committee Chair of the Joint Spine and Nerve Disorders
Section of AANS/CNS and was the Scientific Program
Chair for their meeting in 2007.
Summary
The Division of Neurosurgery at the University of Cal-
gary continues in its aim towards the development of a
world class institution known for excellence in clinical neu-
rosurgery as well as neuroscience education and research.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 55
Division of NeurologyOverview
The Division of Neurology. led by Dr. Sam Wiebe, in the Department of Clinical Neurosciences comprises all 43 neu-
rologists practising within the former Calgary Health Region, in addition to emeriti members and cross-appointees from
outside our Region, such as Red Deer and Edmonton. The division provides neurological clinical care to the population
of southern Alberta, south-western Saskatchewan and south-eastern British Co-
lumbia. The interests, scope of activities and level of specialization varies among
members of this large neurological division. Yet, there is a strong spirit of collabo-
ration, which makes this division larger than the sum of its parts. The breadth of
scope and depth of expertise enables excellence in clinical care, research, educa-
tion, and health service delivery models.
During the academic year 2007-2008 three new members have joined our division,
Dr. Jeptha Davenport, Dr. Tamara Pringsheim, and Dr. Eric Smith. Our new col-
leagues will strengthen the areas of stroke, movement disorders, multiple sclerosis,
headache, and general neurology.
This year has also marked a milestone in our Division’s model for delivering neuro-
logical services. On September 29, 2008, we opened a second neurology inpatient
unit at the Rockyview General Hospital. This unit consists of eight dedicated neu-
rology beds, dedicated neurosciences nurses, and an enlarged presence of neu-
rologists at that site. Two new clinical assistants have been incorporated to the
inpatient and outpatient services, as well as a dedicated nurse practitioner. We
have also strengthened our links with general Internal Medicine inpatient services. The expansion to the Rockyview
Hospital includes a second neurology Urgent Clinic. Under the leadership of Dr Chris White, the new neurology inpatient
unit and Urgent Clinic are off to a great start. This development is of particular importance as we cultivate a large outpa-
tient and inpatient neurological unit to occupy the new South Health Campus, currently under construction.
Developments in Clinical Research
Through collaboration with and support from the Hotchkiss Brain Institute, we have developed a Clinical Research
Unit for Neurosciences. The research unit focuses on study design, methodological expertise, research database setup
and data management, and data analysis. The unit also provides the opportunity for training in clinical trials and outcome
assessment, as well as the ability to undertake small and large-scale, investigator initiated clinical research. The Clinical
Research Unit houses a flexible research platform and database, and staff dedicated to study setup and study manage-
ment. Monthly clinical research rounds address a variety of project-specific questions and provide an excellent learning
opportunity for clinical researchers, and mentoring of young clinical investigators.
Specialty Programs
The Division of Neurology comprises eight specialty programs, each thriving academically through involvement in a
broad variety of research areas as well as training of post-doctoral clinical and research fellows (see table). These pro-
grams have strong links with basic science researchers through the Hotchkiss Brain Institute, and with health services
and population health research through the Department of Community and Health Sciences.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 56
Dr. Sam Wiebe
Two additional programs, Urgent Clinic and General Neurology, are a centrepiece of delivery of neurological care in
our region. The Urgent Neurology Clinic has expanded to the Rockyview General Hospital and the General Neurology
Programme is developing further.
The Division comes together every Friday at Clinical Neurosciences Grand Rounds. In addition, individual programs
hold numerous teaching and research sessions throughout the week which provide a rich and valuable source for in
depth learning in diverse areas of clinical neurology. Following is a list of ongoing rounds held by each program in addi-
tion to the regular resident teaching rounds:
Epilepsy Program:
Weekly Monday Epilepsy rounds (clinical and/or research)
Bi-monthly EEG rounds
Monthly Journal Club
Headache Program:
Weekly CHAMP academic program development rounds
Movement Disorders Program:
Monthly Unusual Movement Disorder rounds
Monthly Journal Club
Multiple Sclerosis Program:
Weekly MS Clinical Rounds
Bi-monthly Journal Club
Neuromuscular Program:
Monthly neuromuscular rounds
Bi-monthly Regeneration Journal Club
Weekly lab meetings (D Zochodne)
Monthly EMG rounds
Neuro-Oncology:
Weekly Neuro-Oncology Tumor Board rounds
Stroke Program:
Weekly Stroke Rounds
Weekly Update and Academic Lecture
DEPARTMENT OF CLINICAL NEUROSCIENCES
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PROGRAM MEMBERS
Calgary Headache and Management ProgramDr W Becker, Director
Dr K Busche, Dr L Cooke, Dr A Eloff, Dr J Kohli, Dr T Pringsheim
Calgary Comprehensive Epilepsy Programme
Dr S Wiebe, Director
Dr N Pillay, Adult Program Director
Dr P Federico, Dr A Hanson, Dr N Jette, Dr B Klassen, Dr W Murphy,
Dr I Mohamed (Paediatrics)
Calgary Stroke Programme and
Stroke Prevention Clinics
Dr A Demchuk, Program Director
Dr M Hill, Director Stroke Unit
Dr P Barber, Dr S Coutts, Dr K Hoyte, Dr G Klein, Dr E Smith,
Dr P Stys, Dr T Watson, Dr N Weir
General Neurology
Dr R Bell, Dr K Brownell, Dr K Busche, Dr J Davenport, Dr A Hanson,
Dr M Hill, Dr K Hoyte, Dr B Klassen, Dr G Klein, Dr J Kohli,
Dr W Murphy, Dr D Patry, Dr D Pearson, Dr C White, Dr S Wilson,
Dr M Yeung
Movement Disorders Programme
Dr O Suchowersky, Program Director
Dr R Ranawaya, Clinic Director
Dr S Furtado, Dr S Kraft,
Multiple Sclerosis Programme
Dr L Metz, Director
Dr R Bell, Dr K Busche, Dr J Davenport, Dr W Murphy, Dr D Patry,
Dr D Pearson, Dr M Yeung
Neuromuscular Programme/EMGDr D Zochodne, Director
Dr K Brownell, Dr C Toth, Dr C White
Neuro-OncologyDr G Cairncross, Director
Dr P Forsyth
Neuro-Ophthalmology Dr W Fletcher, Dr F Costello
Urgent Neurology
Dr Alexandra Hanson and William Murphy, Co-Directors
Janet Warner, Coordinator
Various Participating neurologists
Fellowship Programs:
Post-doctoral clinical and research fellowship programs in our division exist in the areas of epilepsy, epilepsy sur-
gery, EEG, EMG, headache, movement disorders, multiple sclerosis, neuromuscular diseases, neuro-oncology and
stroke. During this year our Division trained a total of 22 post-doctoral fellows in the following programs:
Epilepsy: Abdel Hamid Seiam, Adnan Al-Sarawi, Ayataka Fujimoto
Headache: Farnaz Amoozegar
Multiple Sclerosis: Scott Sloka
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Movement Disorders: Cid Diesta
Neuromuscular: Lawrence Korngut, Jennifer Bestard, Christine Webber (PhD)
Neuro-Oncology: Gloria Roldan, Paula de Robles, Michael Blough (PhD), Morgan Westgate
(MSc)
Stroke: Talip Asil, Mohamed Alzawahmah, Dar Dowlatshahi, Pablo Garcia, Al Jin, Bijoy Me-
non, Alexandre Poppe, Nan Shoba, Nikolai Steffenhagen
Residency Program:
The neurology training program in our division is highly rated and attracts top candidates
from across the country. Under the exemplary leadership of Dr William Fletcher, our training
program continues to thrive, with thirteen residents at present and a foreseen expansion of up
to five more residents in the upcoming year. The current residents are:
R5: Dr. Fatima Abdulla
R4: Dr. Mohammed Almekhlafi, Dr. Sameer Chhibber, Senior Resident, Dr. Phillippe Couillard,
Dr. Justyna Sarna
R3: Dr Claire Hinnell, Dr. Scott Jarvis, Dr. Suresh Subramaniam
R2: Dr. Mohammed Alanazy, Dr. Katie Wiltshire
R1: Dr. Ahmad Abuzinadah, Dr. Sankalp Bhavsar, Dr. Janel Nadeau
Research: Dr. Aylin Reid is taking a research sabbatical during her residency program. Her
PhD focuses on long term effects of inflammation and febrile seizures. She will return as an
R4 in 2010 to complete her residency.
Physician Clinical Assistants Program:
The Division of Neurology also participates in the Calgary Clinical Assistants Program. Two
clinical assistants participate in the general neurology program at the Rockyview General
Hospital inpatient unit (Drs. Oje Imoukhuede and Sobia Rajput). Two additional clinical assis-
tants participate in the Epilepsy Programme and Seizure Monitoring Unit at the Foothills Hos-
pital (Drs. Harinder Dhaliwal and Florence Obianyor). These physicians play an important and
growing role in our health care services delivery model.
Innovations in Health Care Delivery:
Division of Neurology is focusing on three new aspects of health care delivery, ie., a central
triage system for outpatient services, implementation of an outpatient electronic medical re-
cord and booking system, and the development of a formal General Neurology Program.
These initiatives are greatly facilitated by our Academic Alternate Relationship Plan (ARP),
which supports innovation in health care delivery.
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Florence Obianyor
Dr. Harinder Dhaliwal
Dr. Oje Imoukhuede
Neurologists
Dr. Samuel Wiebe, Head of the Division of Neurology, is an epileptologist and clinical epide-
miologist interested in outcomes research and surgical randomized trials. He is the Director of
the Calgary Comprehensive Epilepsy Programme.
Dr. Philip Barber is a neurologist specializing in stroke with re-
search interests in blood brain barrier breakdown, stroke in the
elderly, inflammation in stroke, and MRI.
Dr. Werner Becker has a major interest in headache, and directs
the Calgary Headache Assessment and Management Program at
the Foothills Hospital and the Headache Program at the Chronic
Pain Centre in Calgary."
Dr. Robert Bell’s expertise involves the diagnosis and treatment of
neuro-inflammatory disease of the Central Nervous System. He is
a member of the Multiple Sclerosis Program and is involved in
teaching clinicians and researchers.
Dr. Keith Brownell’s clinical interests are in neuromuscular dis-
eases and general neurology." His educational interests currently
focus on teaching in the neurosciences, physicianship, profes-
sionalism and medical ethics.
Dr. Kevin Busche's clinical activities include work in the MS clinic,
General and Urgent Neurology and the EMG lab. "He is involved
with Undergraduate Medical Education at multiple levels and is
the Director of the Office of Faculty Development.
Dr. Gregory Cairncross is the Head of the Department of Clinical
Neurosciences. He is a neuro-oncologist interested in the genetic
basis of glioma and new therapies for brain tumor.
Dr. Lara Cooke, is a neurologist in the Headache Program and is
an expert in medical education. She is Assistant Dean of Faculty
Development and Medical Education at the University of Calgary.
Dr. Fiona Costello is a neuro-ophthalmologist and a member of
the MS Program. She is developing a research program using the
visual pathway as a model of disease to change how MS is followed and treated.
Dr. Shelagh Coutts is an academic stroke neurologist. Her research involves using mod-
ern imaging techniques to predict outcomes in patients with TIA and minor stroke.
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Andrew Demchuk
Dr. Phil Barber
Dr. Kevin Busche
Dr. Fiona Costello
Dr. Keith Brownell
Dr. Warner Becker
Dr. Jeptha Davenport works in the Multiple Sclerosis Clinic, in the Headache Group at the
Chronic Pain Centre Holy Cross Site, and at a General Neurology Clinic at the Peter
Lougheed Centre.
Dr. Andrew Demchuk is a stroke neurologist and the Director of the Calgary Stroke Program.
His research interests involve developing targeted treatments for stroke using ad-
vanced"acute vascular imaging.
Dr. Arnolda Eloff, is a neurologist dedicated to the clinical man-
agement of patients with headache in the Calgary Headache As-
sessment and Management Program.
Dr. Paolo Federico is an epileptologist in the Calgary Comprehen-
sive Epilepsy Program. His research program uses leading-edge
MRI imaging and EEG approaches to better understand the neu-
ral and vascular correlates of epilepsy."
Dr. William Fletcher is a neuro-ophthalmologist, Director of the
Neurology Residency"Program"and"Chair of"the Neurology"Spe-
cialty Committee of the Royal College of Physicans and Surgeons
of Canada."
"
Dr. Peter Forsyth is Associate Director Research Tom Baker Can-
cer Centre, the Provincial Co-Coordinator for the Terry Fox Re-
search Institute and Director of the Southern Alberta Cancer Re-
search Institute." His research focuses on the molecular genetics
of malignant gliomas, and their treatment with experimental
therapies."
Dr. Sarah Furtado is a neurologist in the Movement Disorders
Clinic. She participates in clinical trials for Movement Disorders
and in neuroimaging studies for Parkinson's Disease. She partici-
pates in the Urgent Neurology Clinic and in the surgical team for
Movement Disorders. She is interested in medical education.""
Dr. Alexandra Hanson is a clinical neurologist specialising in epi-
lepsy. She also works at the Tom Baker Cancer Centre and is the
Director of the Urgent Neurology Clinic.
Dr. Michael Hill is a stroke neurologist who has research interests in clinical trials. He is
the Director of the Stroke Unit and is quoted as saying, 'Give the juice'.
Dr. Keith Hoyte, has been a clinical neurologist for over 30 years, and consults on all
neurological disorders. In addition, he has a special interest in Stroke Prevention.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 61
Dr. Alexandra Hanson
Dr. Keith Hoyte
Dr. Michael Hill
Dr. Sarah Furtado
Dr. Paulo Federico
Dr. Arnolda Eloff
Dr. Nathalie Jette is an epileptologist. She is also a CIHR and AHFMR population health in-
vestigator, and health services researcher. Her research interests include the study of appro-
priateness and necessity of medical interventions.
Dr. Brian Klassen practises General Neurology, with an interest in Epilepsy, EEG, and EMG."
He is"also Neurology Site Leader at the Peter Lougheed Hospital.
Dr. Gary Klein is a clinical neurophysiologist active in the EMG
clinics and in EEG interpretation. He also participates in the
Stroke Program and the general neurology clinic.
Dr. Jagdeep Kohli is a community-based neurologist with an in-
terest in headache and EMG.
Dr. Scott Kraft is a neurologist who divides his time between the
Movement Disorders Clinic and Clinical Informatics.
Dr. Luanne Metz, is a neurologist specializing in MS. She is the
Director of the Multiple Sclerosis Program. Her research interests
include new therapies for MS and the translation basic science
research into clinical investigation.
Dr. William Murphy, is neurologist participating in the MS Clinic,
Epilepsy, Sleep Disorders and General Neurology Programs.
Dr. David Patry is Clerkship Director, Clinical Research Director in
the Cognitive Assessment Clinic, UCMG Executive Council
Member, and Evaluation Coordinator for the UofC Undergraduate
Neuroscience Course. Multidisciplinary clinic participation in-
cludes the Urgent, MS, Cognitive and Senior Resident Clinics.
Dr. Dawn Pearson is a neurologist with special interests in neu-
rorehabilitation and cognitive change associated with brain injury,
including dementia, stroke and trauma.
Dr. Neelan Pillay is an epileptologist with expertise in neurophysi-
ology and evoked potentials. He is the Director of the Adult Epi-
lepsy Program. Following a research sabbatical, his acquired in-
terests are in EEG-fMRI in secondary generalized epilepsy, and in
language fMRI reorganization after temporal lobe surgery.
Dr. Tamara Pringsheim is the Director of the Calgary Tourette Syndrome clinic, and
member of Calgary Headache Assessment and Management Program and the movement
disorders programs.
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Luanne Metz
Dr. Bill Murphy
Dr. Dawn Pearson
Dr. Brian Klassen
Dr. Gary Klein
Dr. Natalie Jette
Dr. Ranjit Ranawaya specializes in Movement Disorders. He is the Director of clinical services
of the Movement Disorders Program.
Dr. Eric Smith is a stroke neurologist with special interest in stroke, intracerebral hemorrhage
and dementia. His research seeks to disentangle the effects of cerebrovascular disease and
Alzheimer's disease on cognitive decline.
Dr. Peter Stys is a neurologist/neuroscientist whose clinical inter-
est is focused on stroke neurology. "He runs a basic science lab
where he studies the fundamental mechanisms of axonal and
glial injury in a variety of disorders such as spinal cord injury and
MS.
Dr. Oksana Suchowersky is a neurologist and neurogeneticist
specializing in movement disorders, and in adult onset hereditary
neurodegenerative disorders. She is Head of the Department of
Medical Genetics." Her research"is aimed at"improving treat-
ments for these disorders.
Dr. Cory Toth is a clinician-scientist who studies clinical and pre-
clinical effects of diabetes upon the nervous system and the im-
pact of neuropathic pain in humans and in animal models.
Dr. Timothy Watson is a stroke neurologist with interests in the
delivery of stroke clinical services in the community.
Dr. Nicolas Weir is a stroke neurologist with interests in clinical
epidemiology and evidence-based neurology.
Dr. Christopher White is the Site Chief of Neurology at the Rocky-
view Hospital. He is a member of the neuromuscular program and
Director of the ALS clinic.
Dr. Scott Wilson is a community general neurologist who also
provides EMG services.
Dr. Michael Yeung is Director of the Multiple Sclerosis Clinical
Trials Research Unit. He is a neurologist in the General Neurology
Clinics, Chronic Headache Clinic, and Multiple Sclerosis Clinic.
Dr. Douglas Zochodne is the Director of the Neuromuscular Clinic and of Clinical Neuro-
physiology for the Calgary Health region. He is an AHFMR Scientist and runs an externally
funded research lab addressing peripheral neurobiology.
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Oksana Suchowersky
Dr. Peter Stys
Dr. Ranjit Ranawaya
Dr. Neelan Pillay
Dr. Cory Toth
Dr. Tim Watson
Awards Received by Division Members in 2008
Dr. Kevin Busche: Clinical Adjunct and Research Faculty Teaching Award, ARP merit award
for his work in education.
Dr. Shelagh Coutts: 2008 Petro Canada Young Innovator Award in Community Health.
Dr. Fiona Costello: ARP merit award for her research perform-
ance and her novelty in research.
Dr. Michael Hill: ARP merit award and Performance Recogni-
tion award for his role in research and his outstanding publica-
tion record.
Dr. Nathalie Jetté: ARP merit award and Performance Recogni-
tion award for her outstanding success as a junior clinical and
population health investigator.
Dr. Luanne Metz: ARP Performance Recognition award for her
work in the MS program and for bringing together a transla-
tional research program.
Dr. Oksana Suchowersky: Best Doctors of Canada for 2008.
Dr. Chris White: ARP merit award and Performance Recognition award for his outstanding
work on the development of the new neurology services the RGH and SHC sites.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 64
Dr. Michael Yeung
Dr. Nic Weir
Dr. Chris White
Division of Physical Medicine and RehabilitationFaculty
Division Head: Dr. John Latter
Staff: Drs. Maryana Apel, Pamela Barton, Nwamara
Dike, Sean Dukelow, Denise Hill, Ken Lam, Daniel LeBlond,
Christine McGovern, Dan McGowan, Stephen McNeil,
Stephanie Plamondon, Perminder Ubhi, Noorshina Virani
Overview
The Division of Physical Medicine and Rehabilitation is
one of four divisions within the Department of Clinical Neu-
rosciences, the Faculty of Medicine, the University of Cal-
gary and the Calgary Health Region. The division provides
services for Southern
Alberta, South-eastern
British Columbia and
South-western Sas-
katchewan. The divi-
sion’s primary inpatient
unit is at the Foothills
Medical Centre with
amputee patients be-
ing treated at Carew-
est Glenmore Park and
stroke patients at
Carewest Dr. Vernon
Fanning Centre. The
division provides con-
sultation services at
Peter Lougheed Hos-
pital and Rockyview
General Hospital, Carewest Glenmore Park and Carewest
Dr. Vernon Fanning Centre.
Dr. Daniel LeBlond is in Lethbridge and we have had
one of our residents rotate through the program in
Lethbridge to experience general physiatry in a smaller
centre.
In-patients are treated on the Tertiary Rehabilitation
Unit 58 located in the Special Services Building.
The division members are actively involved in under-
graduate medical education and maintain a continued
strong presence with residency education. There are sev-
eral members involved in collaborate research.
Clinical
Traumatic Brain Injury Rehabilitation"
Dr. Christine McGovern, Dr. Stephanie Plamondon, Dr.
Nwamara Dike
The Brain Injury Rehabili-
tation Program consists of an
inpatient and an outpatient
component. This year there
were 178 inpatient consulta-
tions were performed this
year on patients with trau-
matic brain injury. The num-
ber of patients admitted to
the inpatient rehabilitation
unit, Unit 58, was 67. The
median age of the people
admitted to Unit 58 was 38,
with 82% male. Only 16%
were not from the Calgary
urban area. Based on the
Glasgow Coma Scale Score,
69% had sustained severe
injuries, 10% moderate, and
21% mild. The median length
of stay in acute care prior to
transfer was 29 days, and
the median length of stay on
the rehabilitation unit was 40
days. The majority of pa-
tients, 76%, were discharged
home.
In outpatient Brain Injury Clinic, 183 new referrals were
seen, and 545 follow-up visits were performed. Patients
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 65
Dr. John Latter
Dr. Christine McGovern
Dr. Stephanie Plamondon
varied from mild to severe type of injuries, and included
both recent and remote injuries.
Spinal Cord Injury Rehabilitation
Dr. Dan McGowan, Dr. Denise Hill
Dr. McGowan and Dr. Hill fol-
low patients who have neuro-
logic impairment resulting from
spinal cord abnormalities from
acute care, through rehabilita-
tion, and in the SCI outpatient
clinics. One hundred and
forty-nine patients were seen
in consultation in acute care.
Of the 64 patients admitted to
the in patient rehabilitation unit
with spinal abnormalities es-
sentially on half were a result
of trauma. 37 new patients
were seen in the outpatient
clinic and 358 patients were
seen in follow-up.
Dr. Hill presented a review of
sublesional osteoporosis at
the Third National Spine Injury
Conference in Toronto Ontario
and has combined her inter-
ests to become the team phy-
sician for Canada’s Paralympic
Nordic Ski Team.
Paediatric Rehabilitation
Dr. John Latter
The Pediatric Rehabilitation Program takes place at
Alberta Children’s Hospital as well as Foothills Hospital.
Dr. Latter is involved in interdisciplinary clinics. The Spina
Bifida clinic saw ninety patients last year. The Pediatric
Neuromuscular Clinic saw two hundred children, forty of
which were seen by physiatry. The Juvenile amputee clinic
has ninety active patients and 43 were seen in clinic in
2008. These clinics run once a month.
Dr. Latter is a member of the Pediatric Brain Injury Pro-
gram with both inpatient and outpatient involvement.
There were 122 inpatients and 214 outpatient visits with
139 of these seen by physiatry.
The Young Adult Rehabilitation Clinic is held weekly out
of the Foothills Hospital and this year there were 28 new
patient clinic visits and 112 repeat clinic visits.
Stroke Rehabilitation
Dr. Stephen McNeil, Dr. Ken Lam, Dr. Sean Dukelow
It was another busy year for
the stroke rehab and spasticity
programs with Dr. Stephen
McNeil and Dr. Ken Lam. We
of course have also recently
added a new physiatrist Dr.
Sean Dukelow who will bring a
significant research compo-
nent to the program.
Our spasticity program con-
tinues to grow with 90 new
patients and almost 500 re-
peat injection patients last
year. Dr. McNeil was also the
scientific chair of the 2008 Canadian Botulinum Toxin Con-
ference – Spasticity Section.
The stroke rehab program had 190 new inpatient con-
sults, 16 new outpatient consults and 500 follow up visit. In
addition on a weekly basis throughout the year consulta-
tion and follow up service was provided at the rehab unit at
the Fanning Centre.
EMG
Dr. Pamela Barton, Dr. Denise Hill, Dr. Ken Lam, Dr.
Stephen McNeil, Dr. Stephanie Plamondon, Dr. Noorshina
Virani, Dr. Sean Dukelow
Amputee
Dr. Ken Lam
The amputee program is a young and growing pro-
gram. The goal is to provide comprehensive care to pa-
tients with limb loss across the continuum. We provide in-
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 66
Dr. Denise Hill
Dr. Dan McGowan
Dr. Stephen McNeil
patient and out-patient services. In 2008 over 100 new pa-
tients with limb loss have en-
tered into the program. A joint
venture with the Bone and
Joint Institute has provided a
six bed in-patient program at
the Glenmore Park facility.
Specialized out-patient reha-
bilitation is now provided at
the new Sheldon Chumir Cen-
tre. The program is also dedi-
cated to medical education.
Physiatry residents spend a
mandatory 3 months with us
during their residency.
Chronic Pain
Dr. Pamela Barton, Dr. Noorshina Virani, Dr. Nwamara
Dike#
The Calgary Health Region
Chronic Pain Centre has now
completed 8.5 years of opera-
tions within the CHR Regional
Pain Program. It is now the
largest such Centre in Canada
and is a leader in interdiscipli-
nary rehabilitation for individu-
als with chronic pain.
Three members of the Division
of Physical Medicine and Re-
habilitation currently practise at
the Chronic Pain Centre: Dr.
Pamela Barton, co-founder and
former medical director, Dr. Noorshina Virani and Dr. Nwa-
mara Dike. In addition to their strong background in pain
management and interdisciplinary rehabilitation, Drs. Bar-
ton and Virani contribute specific expertise in clinical bio-
mechanics, while Dr. Dike has shared her expertise from a
pain fellowship at Memorial Sloan-Kettering Cancer Centre
in New York. Dr. Dike has also participated in the newly
inaugurated Chronic Pain Inpatient Consultation Service
now available in all of Calgary’s hospitals.
The physiatrists work in the
Neuromusculoskeletal Pro-
gram alongside anaesthetists,
family practitioners and all
members of the rehabilitation
teams. They have many pa-
tients who are co-managed
with the gynaecologists and
neurologists of the Pelvic Pain
and Headache Programs.
They also participate in teach-
ing medical students, resi-
dents and fellows in family
practice, anaesthesiology,
psychiatry, physical medicine and rehabilitation and neu-
rology who rotate through the Centre.
During 2008, the physiatrists
contributed a total of 0.6 FTE,
completing 58 new patient
assessments and an additional
302 follow up visits on a total
of 162 unique patients. Due to
their competence in the inter-
disciplinary management of
complex patients, their
caseloads carry many of the
more complicated patients
referred to the Chronic Pain
Centre.
Highlights
Dr. Sean Dukelow started with the division on October
1, 2008 with his primary role as a clinical scientist. Clini-
cally he will do some EMG and stroke rehabilitation.
The division signed off on its Academic Alterative Rela-
tionship Plan as of December 1, 2008. This will allow ap-
propriate stable funding to permit the division to recruit
more staff and continue to develop an academic service.
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Dr. Pamela Barton
Dr. Nwamara Dike
Dr. Noorshina Virani
Dr. Ken Lam
Division of Experimental NeurosciencesOverview
Division of Experimental Neuroscience (DEN) is the newest division of the department."Translational research in neu-
rological science and medical technology has been a major emphasis of the division since its inception. DEN currently
consists of 7 primary and 8 secondary members. Their research areas span from neurodegenerative diseases, move-
ment disorders to multiple sclerosis and medical devices. The research capacity of the division has grown significantly
with the creation of Hotchkiss Brain Institute and its disease-focused research programs. An important feature of the di-
vision is that almost all its members maintain meaningful and productive collaborations with clinicians or clinician scien-
tists within the department. Together they either hold shared research grant(s) and/or serve as co-supervisors of gradu-
ate students working on related research projects.
There are over"30 faculty, postdoctoral fellows, graduate students and support staff who are directly involved in DEN.
They work in state-of-the-art research facilities including the newly established Boone Pickens Center for Neurological
Science and Advanced Technologies." The Division of Neuroscience is rapidly growing, not only in terms of personnel
and research support, but in terms of national and international recognition of its research achievements." The divisional
members offer graduate studies in both clinical and basic neurosciences, year-round research projects for senior under-
graduates and summer research programs. The division also hosts a number of community-oriented educational events."
In 2008, DEN members played an increasingly active and leading role in many aspects of academic activities of the
department and HBI. These included the mentorship for junior faculties and clinician scientists; development and expan-
sion of different research programs; launching new research initiatives; recruitment and graduate student education.
Current Members
Head
Bin Hu, MD. Ph.D.
Sutter Professor in Parkinson’s Disease Research
Research: Sensorimotor cueing, deep brain stimulation and devices
Primary Members
Yong, Wee Ph.D.
Professor/AHFMR Scientist/CRC Chair in immunology
Research: neuroinflammation and neuroprotection of MS and spinal cord in-
jury.
Ousman, Shalina, Ph.D.
Assistant Professor
Research: neuroprotection in the immune system and potential therapies for
MS
Hulliger, Manuel. Ph.D.
Professor
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 68
Dr. Bin Hu
Research: Spinal Cord and Nerve Regeneration
Nguyen, Minh Dang Ph.D.
Assistant Professor / AHFMR Scholar / Investigator Brenda Strafford Chair in Alzheimer Re-
search: Cytoskeleton proteins in neurodegenerative disorders and aging.
Melvill Jones, Geoffrey (BA, MA, MB BCh (Cantab), FRSC (Canada), FRS (UK)
Research Professor
Research: Human Neurophysiology, Posture, Gait & Spatial Orientation
Tomanek, Boguslaw Ph.D.
Research Assistant Professor
Research: functional imaging, Neurorobotics and Stroke
Zhao, Zonghang MD
Research Assistant Professor
Research: Mechanisms of ischemic neuronal injury and cell death
Block, Edward B.sc
Senior electrical Engineer
Research: Diagnostic and training devices for patients with movement disorders
Secondary Members
Brown, Lenora Ph.D. (Neuropsychology
Kim, Sung-Woo Ph.D. (Oncology)
Eliasziw, Michael Ph.D. (Population Health)
Mitchell, Ross Ph.D. (Imaging)
Frayne, Richard Ph.D. (Imaging)
Poulin, Marc Ph.D. (Stroke)
Goodyear, Brad (Imaging)
Tuor, Ursula Ph.D. (Imaging)
Haffenden, Angela Ph.D. (Neuropsychology)
Whelan, Patrick Ph.D. (Spinal Cord Injury)
Achievements: Research
Ndel1 and neuroregeneration
In 2008 Dr. Nguyen and his collaborators reported an important discovery on the role of
Ndel1 in axonal regeneration. Ndel1 is an integrator and stabilizer of the cytoskeleton. It is
upregulated in crushed and transected sciatic nerve axons. Lasting in vivo formation of
Ndel1/Vimentin complex is associated with robust axon regeneration whereas silencing of
Ndel1 by siRNA severely reduced regeneration (see figure below).
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 69
Dr. Boguslaw Tomanek
Dr. Manuel Hulliger
Dr. Zonghang Zhao
Descending reticular network of the temporal lobe
Sensory association and parahippocampal cortex in the ventral temporal
lobe plays an important role in sensory object recognition, sensory cue proc-
essing and control of top-down attention. A commonly held view is that corti-
cal neurons have only one projection target. Contrary to this view, Hu lab dis-
covered that single layer V neurons from the ventral temporal lobe can inner-
vate multiple cortical and subcortical targets. This reticular network may allow
large scale synchrony to occur among multiple brain structures during senso-
rimotor cueing.
Matrix metalloproteinase and autoimmune encephalomyelitis
Several matrix metalloproteinase (MMP) members contribute to pathology
in multiple sclerosis and experimental autoimmune encephalomyelitis (EAE).
Dr. Young’s lab has found that MMP-12 transcripts increased with EAE, and
protein was localized to a subset of macrophages/microglia. The temporal ex-
pression of MMP-12 largely corresponded to that of cytokines, and IL-1! and
TNF-" promoted MMP-12 expression in cultured macrophages. They postu-
late that cytokine — MMP-12 interactions are important in the disease process
of EAE.
Gaitmeter and movement disorder assessment
Recent advances in chip technology has led to a new generation of miniature sensing de-
vices that are particularly suitable for gait and mobility assessment and rehabilitation train-
ing in clinical settings. GaitMeter™ is a prototype device developed by our medical device
lab. It utilizes miniature triaxial accelerator and gyroscope and system-on-the-chip tech-
nology to acquire high frequency gait and mobility data during long distance natural walk-
ing. The device, which is equipped with high speed wireless and video connectivity, has
significant cost advantage over existing technology. It is currently being tested in several
pilot trials.
Funding
During 2008 DEN members have obtained $1,417,000 external research funding. In addition, >$500,000 was ob-
tained in the form of external PI salary support and studentship/fellowship.
Infrastructure
Under the leadership of Dr. Bin Hu and with the support of HBI and DCN, over 400 square feet of research and office
space has been created at the T. Boone Pickens Center. The new research space has its unique configuration in that
animal laboratory is directly across the hall from clinical labs conducting deep brain stimulation and medical device re-
search in humans. Currently the new labs host 5 research projects involving collaborations between basic and clinician
scientists.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 70
Silencing Ndel1 by siRNA reduces
lesion-conditioned neurite outgrowth in
DRG neurons PLoS ONE. 2008; 3(4):
Recruitment
Dr. Shalina Ousman is the newest recruitment of our division. Shalina obtained her Ph.D. from McGill University. She
joined MS program as an assistant professor after completing two consecutive postdoctoral training at Stanford Univer-
sity. She is interested in the endogenous protective mechanisms in the immune system and central nervous system and
how these mechanisms can be deployed as potential therapies for multiple sclerosis. Welcome Shalina!
Training and Education
Graduate Student Degree Awarded
NAME/SUPERVISOR DEGREE PROJECT TITLE
Adrien Tennet/Hu, B M.Sc Membrane Dynamics of Inferior Colliculus Neurons in the Young Rat
Steven Peters/Hu.B M.ScModulation of High Frequency Oscillations by Sleep-Like Frequencies
in the Anesthetized Rat: A Quantitative Analysis
Taylor Chomiak/Hu,B Ph.D.Posterior Temporal Association Cortex: A Comprehensive in vitro
Electrophysiological Study in Rats
Current Master and Ph.D. candidates and postdoctoral fellows
Callie Clark#
Lorraine Lau
Susobhan Sarkar
Gernot Neumayer
Camille Belzil # #
Dave Stirling
Viktor Skihar
Smriti Agrawal
Rowena Cua
Mengzhou Xue
Angelika Goncalves DaSilva
Gernot Neumayer
Axinia Döring
Susan Park
Trina Johnson
Hankyu Lee
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 71
2008 Educational UpdatesNeurology Residency Training ProgramIntroduction
The Neurology Residency Program prepares resi-
dents to become specialists in neurology during a five-
year period of study, which includes supervised clinical
and research experience and an academic program. The
academic program comprises
a weekly academic half-day
and daily educational rounds
and includes regular seminars
on ethics, communication
skills and evidence-based
medicine. Evaluation of resi-
dents and the program oc-
curs on a regular basis. The
Program Director and Com-
mittee manage all aspects of
the program, with the help of
a program administrator. All
members of the Division of
Neurology participate in resi-
dent education. The Neurol-
ogy Program has trained 25
neurologists since its incep-
tion in 1981.
Highlights
In 2008, the Neurology
Program grew to include 13
residents. Dr. Erin O’Ferrall
completed the program in
June, passed the Royal College examinations and
started a neuromuscular fellowship at McGill University.
Three PGY1 residents joined the program in July: Drs.
Janel Nadeau from Calgary, Ahmad Abuzinadah from
Saudi Arabia and Sankalp Bhavsar from London, Ontario.
Fifty residents from other disciplines, including internal
medicine, psychiatry, pediatric neurology, physiatry, neu-
rosurgery, ophthalmology and emergency medicine
completed neurology rotations in 2007-08. The11th an-
nual Rocky Mountain Basic Science Symposium was
held at Kananaskis in March, attracting 49 neurology and
neurosurgery residents from the 4 medical schools in the
Prairie Provinces. Guest
speakers included Drs.
Wendy Ziai (Johns Hopkins),
Mike Nicolle (U of Western
Ontario) and Raj Midha and
Greg Cairncross (U of Cal-
gary). The residency program
also hosted 3 visiting profes-
sors in 2008: Drs. Colin Chalk
(McGill), Tom Miller (McMas-
ter) and Chris Power (U of
Alberta). Reciprocal OSCE
examinations were mounted
with the University of Alberta
in November. The Amercian
Academy of Neurology
awarded Drs. Philippe Couil-
lard and Sam Chhibber resi-
dent travel scholarships to the
AAN meeting in Chicago. The
neurology residents voted Dr.
Lara Cooke winner of the A.
Keith W. Brownell Neurology
Teaching Award. Dr. William
Fletcher was awarded the
2008 Resident Well-Being Award by the Professional As-
sociation of Residents of Alberta.
Residents (2008-09)
Dr. Fatima Abdulla, PGY5
Dr. Mohammed Almekhlafi, PGY4
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Neurology Residents2008-09
Sam Chhibber
Mohammed
Almekhlafi
Philippe Couillard Scott JarvisClaire Hinnell
Suresh SubramanianAylin Reid Katie Wiltshire
Bill FletcherProgram Director
Justyna SarnaJanel Nadeau
Sankalp BhavsarFatema Abdulla Ahmad
Abuzinadah
Mohammed
Alanazy
Dr. Sameer Chhibber, PGY4
Dr. Philippe Couillard, PGY4
Dr. Justyna Sarna, PGY4
Dr. Claire Hinnell, PGY3
Dr. Scott Jarvis, PGY3
Dr. Suresh Subramaniam, PGY3
Dr. Mohammed Alanazy, PGY2
Dr. Katie Wiltshire, PGY2
Dr. Ahmad Abuzinadah, PGY1
Dr. Sankalp Bhavsar, PGY1
Dr. Janel Nadeau, PGY1
Program Committee (2008-09)
Dr. William Fletcher (Program Director)
Dr. Fatima Abdulla (until June 2008)
Dr. Mohammed Almekhlafi (Chief Resident Jan -
June 2008)
Dr. Robert Bell (Resident Research Director)
Dr. Sameer Chhibber (Chief Resident July - Dec
2008)
Dr. Lara Cooke
Dr. Philippe Couillard (from Sept 2008)
Dr. Nathalie Jetté
Dr. Claire Hinnell (from Sept 2008)
Dr. Jean Mah
Dr. David Patry
Dr. Justyna Sarna (from Jan 2009)
Dr. Samuel Wiebe
Dr. Christopher White
Dr. Nic Weir
Program Administrator
Ms. Michelle Mills
CanMEDS Co-Ordinators
Communication Skills – Drs. Lara Cooke, Dawn
Pearson and Justyna Sarna
Ethics and Professionalism – Drs. A. Keith Brownell
and Philippe Couillard
Evidence-Based Neurology – Drs. Samuel Wiebe and
Nic Weir
Resident Publications (2008)
Almekhlafi MA, Hu WY, Hill MD, Auer RN. Calcifica-
tion and endothelialization of thrombi in acute stroke.
Ann Neurol. 200;64:344-8.
Almekhlafi MA, Fletcher WA. Levator palpebrae my-
ositis. Neurology 2008;71:1202
Teskey GC, Monfils MH, Flynn C, Young NA, van
Rooyen F, Henry LC, Ozen LJ, Henderson AK, Reid AY,
Brown AR." Motor maps, seizures, and behaviour. Can J
Exp Psychol. 2008; 62: 132-9.
Reid AY, Metcalfe A, Williams J, Patten S, Hinnell C,
Parker R, Wiebe S, Jetté N." Epilepsy is associated with
greater unmet health care needs compared to asthma,
diabetes or migraine despite higher health resource use -
A large national population-based study." Epilepsia (in
press).
V Puetz, I Dzialowski, M D Hill,"S Subramaniam, P N
Sylaja, A Krol, C O’Reilly, M E Hudon, W Y Hu, S B
Coutts, P A Barber, T W J Watson, J Roy, A M
Demchuk."Intracranial thrombus extent predicts clinical
outcome, final infarct size and hemorrhagic transforma-
tion in ischemic stroke: the Clot Burden Score."Int J
Stroke 2008;3:230-6.
S B Coutts, M D Hill, C R Campos, Y B Choi,"S
Subramaniam, J C Kosior, A M Demchuk."Recurrent
events in TIA and minor stroke: What events are happen-
ing and to which patients? Stroke 2008;39:2461-2466.
S B Coutts, M Eliasziw, M D Hill, J N Scott,"S
Subramaniam, A M Buchan, A M. Demchuk for the VI-
SION study group."An Improved Scoring System for
Identifying Patients at High Early Risk of Stroke and
Functional Impairment After an Acute Transient Ischemic
Attack or Minor Stroke."Int J Stroke. 2008; Feb 3: 3-10.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 73
Dr. Mohammed Almekhlafi (right) enjoying snow-related ex-
tracurricular activities
Neurosurgery Residency Training ProgramStaff
Program Director: John Hurlbert
Assistant Program Director: John Wong
Research Director: Zelma Kiss
Program Administrator: Patti Sullivan
Number of PGY-1 CaRMS positions per year: 2
Accreditation: Royal College of Physicians and Surgeons of Canada
Length of Training: 6 years
Mandatory Research: 1 year
Overview
Education of our postgraduate and undergraduate students remains one of the highest priorities to the Department
of Clinical Neurosciences and the Division of Neurosurgery. The teaching faculty consists of a large complement of
young and dynamic key opinion leaders representing all subspecialties of Neurosurgery, including vascular, interven-
tional, glioma, skull base, epilepsy, functional, and peripheral nerve interests. In addition the University of Calgary boasts
the largest comprehensive Spinal Surgery program in Canada with a total of 8 full time spine surgeons coming from both
Neurosurgical and Orthopedic backgrounds. This year there were over 1900 neurosurgical admissions to the Foothills
Hospital and Alberta Children’s Hospital, almost all of which underwent a surgical procedure. In addition there were over
5000 visits to Neurosurgery clinics, 400 inpatient consultations, and 700 emergency room consultations.
There has been a stellar cast of visiting professors over the past year presenting on topics across the spectrum of
Neurosurgery from subarachnoid hemorrhage, meningomyelocele, primary gliomas, to cervical laminoplasty. At each of
these events in addition to the clinical and research expertise shared with the entire faculty by the honored guest, the
residents received the “inside story” through
one-on-one case presentations followed by an
evening of relaxed conversation over dinner
with the professor. Our guests included:
Dr. J. Sampson, Duke University (May, 2008)
Dr. R. Dempsey, University of Wisconsin (June,
2008)
Dr. H. Nakagawa, Aichi Medical University, Ja-
pan (Sept, 2008)
Dr. J. Jane, University of Virginia (Sept, 2008)
Dr. N. Barbaro, UCSF (Oct, 2008)
Dr. R. Dacey, Washington University, St. Louis
(Oct, 2008)
Dr. H. Rekate, Barrow Neurological Institute
(Dec, 2008)
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 74
Visiting professor Dr. R. Dacey (Madison, WI) guides the residents and
Dr. Midha through a neurosurgical tumor case scenario.
The residents have been continuously involved in research initiatives from the moment they entered the program.
Considerable resources are dedicated each year to facilitating this academic activity through faculty participation, exist-
ing peer-reviewed grants, project funding from Divisional and Departmental sources, and 12 months of mandatory clini-
cal or basic science research at the PGY-4 level. Resident publications from the past reporting period include:
Diaz RJ, Wong JH. Spinal arteriovenous fistula: a treatable cause of myelopathy. CMAJ [accepted for publication
May 2008]
Diaz RJ, Laughlin S, Nicolin G, Buncic JR, Bouffet E, Bartels U (2007) Assessment of chemotherapeutic response in
children with proptosis due to optic nerve glioma. Childs Nerv Syst. 2007Dec 22; [Epub ahead of print].
Gallagher CN, Hutchin- son PJA, Pickard JD. Neuro-
imaging in Trauma. Curr Opin Neurol
2007;20:403-407.
Grondin R, Hader W, MacRae E, Hamilton M. En-
doscopic versus microsurgi- cal resection of third ventri-
cle colloid cysts. Can J Neurol Sci
2007;34:197-207.
Sutherland GR, Kelly JJP. Ceramic aneurysm
clips for improved MR visu- alization. Neurosurgery. 2008
May;62(5 Suppl 2); ONS400- 5.
Chojnacki A, Kelly JJP, Hader WJ, Weiss S. Distinc-
tions between embryonic and adult human PDFG-
responsive neural precur- sors. Annals of Neurology.
2008 (in press).
Levy R, Lozano AM, Hutchison WD, Dostrovsky
JO. Dual microelectrode technique for deep brain
stereotactic surgery in hu- mans. Neurosurgery
2007;60:4 Suppl 2, 277-284.
Levy R, Pitout J, Long P, Gill MJ. Late presentation of
Cryptococcus gattii menin- gitis in traveler to Vancouver
Island: a case report. Cana- dian Journal of Infectious
Diseases 2007;18:3, 197- 199.
Lwu S, Midha R. Clinical examination of brachial and
pelvic plexus tumors. Neurosurgical Focus, Current management of nerve tumors. 2007 June;22:6:E5.
Codd PJ, Mitha AP, Ogilvy CS. A recurrent cerebral arteriovenous malformation in an adult: Case report and review
of the literature. J neurosurg (accepted, in press)
Mitha AP, Wong JH, Lu JQ, Morris WF, Hudon ME, Hu WY. Communicating hydrocephalus after endovascular coiling
of unruptured aneurysms. J Neurosurg (accepted in press)
Wong JH, Mitha AP, Willson M, Hudon ME, Sevick R, Frayne R. Assessment of brain aneurysms after endovascular
coiling using high-resolution magnetic resonance angiography. J Neurosurg. 2007;107(2):283-289.
Mitha AP, Scott JN, George D, MacRae ME, Bell RB. Tumefactive demyelinating lesions. Canadian Journal of Neuro-
logical Sciences 2007;34(3):362-364.
Mitha AP and Ogilvy CS. Comment re: Edner G et al. The Stockholm 20 year follow-up of aneurysmal subarachnoid
hemorrhage. Neurosurgery. 2007;60:1023.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 75
In addition, Friday morning “Neurosurgery School” runs each week for 2 hours after departmental Grand Rounds.
The curriculum circumnavigates the neurosurgical universe every two years. Sessions are led by the residents and su-
pervised by the faculty creating a learning environment within the realm of neurosurgical expert. Once monthly interac-
tive CanMeds seminars presented entirely from a neurosurgical perspective round off training of more subjective but
nonetheless important roles of Communicator, Collaborator, Advocate, Manager, Scholar, and Professional.
Team relationships outside the hospital are of equal importance to the Division of Neurosurgery as within the hospi-
tal. In addition to dinners with each of the visiting professors, journal club is hosted by a faculty member every three
months. Residents’ Night Out has become a favorite tradition where once every month or two faculty, Clinical Nurse
Practitioners, and students get together in a social setting to watch a hockey game, shoot some pool, bowl, drive go-
karts, play poker, or just sit around and watch people. Once a year this transforms into an entire day when the Division
sets off to the Rocky Mountains for a day of skiing.
In summary this year has been characterized by a rich blend of clinical, academic, research, and social activity. For
2009 it only looks better...
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 76
Dr. Zelma Kiss (right) finishes her hearty helping of rabbit food while Patti Sulli-
van (residency program administrator) politely laughs at her joke.
Physical Medicine & Rehabilitation Residency Training ProgramProgram Director
Dr. John Latter
Residents:" "
Drs. Lee Burkholder, Chantel Debert, Darren Gumbs, Arun Gupta, Jaime Yu, Andrew Willmott, Dr. Brian Rambarans-
ingh, Dr. Gentson Leung, Dr. Evan Kwong
Program Administrator
Linda Jennett
In 2008, the University of Calgary Physical Medicine and Rehabilitation Residency Training Program commenced its
fifth year. There are now 9 residents in the program. In 2008 we received two residents through the CaRMS match and
one resident transferred from another University of Calgary program. The division formally applied for two base positions
to commence in 2009 and the division was successful so as of July 2009 there will be two base positions each year.
The program has developed
a very active academic half day
for residents.
The Residency Training
Committee meets monthly (ex-
cept July and August) and the
Program Director has formal
biannual meetings with each
resident and informally more
frequently.
The Physical Medicine and
Rehabilitation Residency Train-
ing Program has residents from
rheumatology, neurosurgery and
neurology and orthopaedic sur-
gery rotating through the pro-
gram.
In September of 2008 we
commenced a weekly Senior
Medical Resident Clinic under
the supervision of Dr. Stephanie
Plamondon
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 77
Dr. Evan Kwong
(PGY-1)
Dr. Lee Burkholder
(PGY-5)
Dr. Darren Gumbs
(PGY-5) Dr. Jaime Yu (PGY-
4)
Dr. Brian Ramba-
ransingh (PGY-2)
Dr. Andrew Willmott
(PGY-2)Dr. Chantel Debert
(PGY-3)
Dr. Arun Gupta
(PGY-5)
Undergraduate Medical Education in Clinical NeurosciencesOverview
Medical students are taught about the neurosciences
in the first course of the second year of the undergradu-
ate curriculum. The course is provided over an eight
week period at the beginning of the second year in the
three-year curriculum. The neurosciences component of
the course is combined with content from geriatrics, oto-
laryngology and ophthalmology to give ‘Course V – Neu-
rosciences, Aging and Special Senses’. The course is
given under the auspices of the Undergraduate Medical
Education office of the Faculty of Medicine at the Univer-
sity of Calgary.
The neurosciences content in the course begins with
a presentation of the functional anatomy and physiology
required to approach patients who present with neuro-
logical complaints. The remainder of the course covers
clinical presentations of neurological illness as well as
sessions devoted to specific neurological conditions.
The course is taught by approximately 130 teachers,
including 60 from the Department of Clinical Neurosci-
ences. The content of the course is delivered via a com-
bination of lectures, patient presentations, small group
seminars and bedside teaching sessions.
The course is developed and administered by the
Course V Committee, co-chaired by Dr. Kevin Busche
from the Division of Neurology. The majority of the course
committee members are from the Department of Clinical
Neurosciences.
The course is always well received by the students
and is consistently ranked highly in comparison to the
other courses offered in the pre-clerkship curriculum.
Course V Committee 2008
Kevin Busche (Co-Chair)
Darren Burback (Co-Chair)
David Patry (Evaluations Coordinator)
Jeff Joseph
Paolo Federico
Sarah Furtado
Gary Klein
Cory Toth
Walter Hader
James Scott
Colin Powell
Chandrasekaran Sivakumar
Karin Verstraten
Vivian Hill
Beth Lange
Daryl Wile
Janel Nadeau
Tim Ramos
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 78
Even the clinical clerks get their hands wet in the operating
theatre. Visiting medical Student Teresa Langan (London ON)
assists Dr. Raoul Pope (neurosurgical spine fellow) with a com-
plex spinal decompression.
Fellowship ProgramOverview
The Department of Clinical Neurosciences has been fortunate to be able to attract fellows from a wide variety of
backgrounds seeking further subspecialty experience. Their presence has enriched the clinical and academic environ-
ment for all. Pictured below are some of our recent fellows.
DEPARTMENT OF CLINICAL NEUROSCIENCES
! 79
Aleksa Cenic, Spinal
Neurosurgery Fellow
Raoul Pope, Spinal
Neurosurgery Fellow
Sohail Bajammal,
Spinal Neurosurgery
Fellow
Abdel Hamid Seiam,
Epilepsy Neurology
Fellow
Lawrence Korngut,
Neuromuscular Fel-
low
Nan Shobha, Stroke
Neurology Fellow
Jacob Alant, Periph-
eral Nerve Surgery
Fellow
Paula de Robles,
Neuro-Oncology Fel-
low
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107.Smith EE, Dreyer P, Prvu-Bettger J, Abdullah AR, Palmeri G, Goyette L, McElligott C, Schwamm LH. Stroke center designa-
tion can be achieved by small hospitals: the Massachusetts experience. Crit Pathw Cardiol. 2008;7:173-177.
108.Speechley KN, Sang X, Levin S, Zou GY, Eliasziw M, Smith ML, Camfield C, Wiebe S. Assessing severity of epilepsy in chil-
dren: preliminary evidence of validity and reliability of a single-item scale. Epilepsy Behav 2008;13:337-342.
109.Sutherland CS, Hill MD, Kaufmann AM, Silvaggio J, Demchuck AM, Sutherland GR. Recombinant Factor VIIa plus Surgery
for Intracerebral Hemorrhage. Can J Neurol Sci 35:567-572, 2008.
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112.Sutherland GR, Tyson RL, Auer RN. Truncation of the Krebs Cycle During Hypoglycemic Coma. Medicinal Chemistry
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List of MembersGeographic Full-Time Academic Staff! ! !
Barber Philip Assistant Professor Neurology
Becker Werner Professor Neurology
Brownell Keith Professor Neurology
Cairncross Gregory Professor Neurology
Casha Steven Assistant Professor Neurosurgery
Cooke Lara Assistant Professor Neurology
Coutts Shelagh Assistant Professor Neurology
Demchuk Andrew Associate Professor Neurology
Dukelow Sean Assistant Professor Physiatry
Feasby Tom Professor Neurology
Federico Paolo Assistant Professor Neurology
Fletcher William Professor Neurology
Forsyth Peter Professor Neurology
Gallagher Clare Assistant Professor Neurosurgery
Hader Walter Assistant Professor Neurosurgery
Hagen Neil Professor Neurology
Hamilton Mark Associate Professor Neurosurgery
Hill Michael Associate Professor Neurology
Hu Bin Professor Scientist
Hulliger Manuel Professor Scientist
Hurlbert R. John Associate Professor Neurosurgery
Jette Nathalie Assistant Professor Neurology
Kiss Zelma Associate Professor Neurosurgery
Latter John Professor Physiatry
Metz Luanne Professor Neurology
Midha Rajiv Professor Neurosurgery
Nguyen Minh Dang Assistant Professor Scientist
Ousman Shalina Assistant Professor Scientist
Parney Ian Assistant Professor Neurosurgery
Smith Eric Assistant Professor Neurology
Starreveld Yves Assistant Professor Neurosurgery
Stys Peter Professor Neurology
Suchowersky Oksana Professor Neurology
Sutherland Garnette Professor Neurosurgery
Toth Cory Assistant Professor Neurology
Wiebe Samuel Professor Neurology
Wong John Assistant Professor Neurosurgery
Yong Wee Professor Scientist
Zochodne Douglas Professor Neurology
DEPARTMENT OF CLINICAL NEUROSCIENCES
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Major Clinical Staff! ! !
Barton Pamela Clinical Associate Professor Physiatry
Bell Robert Clinical Associate Professor Neurology
Busche Kevin Clinical Assistant Professor Neurology
Costello Fiona Clinical Assistant Professor Neurology
Davenport Jeptha Clinical Assistant Professor Neurology
Dike Nwamara Clinical Assistant Professor Physiatry
Du Plessis Stephan Clinical Assistant Professor Neurosurgery
Eloff Arnolda Clinical Assistant Professor Neurology
Furtado Sarah Clinical Assistant Professor Neurology
Hanson Alexandra Clinical Assistant Professor Neurology
Hoyte Keith Clinical Associate Professor Neurology
Klassen Brian Clinical Assistant Professor Neurology
Klein Gary Clinical Associate Professor Neurology
Kraft Scott Clinical Assistant Professor Neurology
Lam Kenneth Clinical Assistant Professor Physiatry
MacRae Elizabeth Clinical Associate Professor Neurosurgery
McGovern Christine Clinical Associate Professor Physiatry
McGowan Daniel Clinical Associate Professor Physiatry
Murphy William Clinical Associate Professor Neurology
Patry David Clinical Associate Professor Neurology
Pearson Dawn Clinical Assistant Professor Neurology
Pillay Neelan Clinical Associate Professor Neurology
Plamondon Stephanie Clinical Assistant Professor Physiatry
Pringsheim Tamara Clinical Assistant Professor Neurology
Ranawaya Ranjit Clinical Associate Professor Neurology
Virani Noorshina Clinical Assistant Professor Physiatry
Weir Nicolas Clinical Assistant Professor Neurology
White Christopher Clinical Associate Professor Neurology
Yeung Michael Clinical Assistant Professor Neurology
Watson Timothy Clinical Assistant Professor Neurology
Clinical Staff! ! !
Hill Denise Clinical Assistant Professor Physiatry
Kohli Jagdeep Clinical Assistant Professor Neurology
McNeil Stephen Clinical Assistant Professor Physiatry
Ubhi Perminder Clinical Assistant Professor Physiatry
Wilson Scott Clinical Assistant Professor Neurology
Professor Emeritus
LeBlanc Francis Professor Emeritus Neurosurgery
Lee Robert Professor Emeritus Neurology
Myles Terence Professor Emeritus Neurosurgery
DEPARTMENT OF CLINICAL NEUROSCIENCES
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DEPARTMENT OF CLINICAL NEUROSCIENCES
2008 Visitors & HighlightsJanuary• 1st annual Spine & Peripheral Nerve Anatomy
& Surgery Course
• Dr. Colin Chalk, Neurology, McGill University
• Dr. Lorne Zinman, Neurology, University of
Toronto
February• Dr. Thomas A. Miller, Physical Medicine & Re-
habilitation, University of Western Ontario
• Dr. Marc del Bigio, Pathology, University of
Manitoba
March• Dr. Susan Fox, University of Toronto
• Douglas Cheyne, PhD, Medical Imaging, Uni-
versity of Toronto
• Dr. Helen Mayberg, Psychiatry and Neurology,
Emory University School of Medicine
April• Dr. John H. Sampson, Division of Neurosurgery,
Duke University
May• Dr Alim-Louis Benabid, Professor Emeritus,
Universitaire Joseph Fourier, Grenoble, France
• Robert Chen, Division of Neurology, University
of Toronto
• Ronald R. Tasker, Professor Emeritus, Division
of Neurosurgery, University of Toronto
June• Charles Taylor Memorial Lecture: Dr. Robert
J. Dempsey, Department of Neurological Sur-
gery, University of Wisconsin • Dr. Nina Paleologos, Professor of Neurology,
Northwestern University
July
• Welcome new resident housestaff
August• 2nd annual Epilepsy Golf Tournament
September• Dr. Hiroshi Nakagawa, Aichi Medical University,
Japan
• Dr. John Jane, Department of Neurological
Surgery, University of Virginia
October• Mary Anne Lee Memorial Lecture: Dr. Nicho-
las M. Barbaro, Department of Neurological
Surgery, University of California at San Fran-
cisco
• Dr. Ralph Dacey, Department of Neurosurgery,
Washington University – School of Medicine
• Dr. David Mcdonald, Sloan-Kettering Institute
November• Dr. Chris Power, Department of Medicine, Uni-
versity of Alberta
• Dr. Eric C. Holland, Department of Neurosur-
gery, Surgery, Neurology & Cancer Biology for
Genetics, Memorial Sloan Kettering Cancer
Center, New York
• Dr. Sandra E. Black, Brill Chair in Neurology,
University of Toronto
December• Dr. Michael Schlossmacher, Division of Neuro-
sciences – OHRI, University of Ottawa
• Dr. Harold L. Rekate, Chief of Paediatric Neu-
rosciences, Barrow Neurological Institute,
Phoenix
• Annual Christmas Rounds - a departmental
tradition!