Posts Tagged 'education'

Hugh Markus – 2011 Merrill P. Spencer Lecturer

 

Hugh Markus, B.M., B.Ch., D.M., FRCP
Featured Presenter: 6th Annual Merrill P. Spencer, M.D. Endowed Lecture

 

Each spring, The Merrill P. Spencer, M.D. Endowed Lecture is presented in conjunction with the annual Swedish Neuroscience Institute Cerebrovascular Symposium. This year, we are pleased to welcome Dr. Hugh Markus, Professor of Neurology at St. George’s University of London.

Hugh Markus was educated in Medicine at Cambridge and Oxford Universities and then carried out medical jobs in Oxford, London and Nottingham before training in neurology in London. He was senior lecturer and subsequently, reader in neurology at Kings College London before moving to the chair of neurology at St George’s in 2000.

His clinical interests are in stroke, and he is clinical lead for stroke at St George’s Hospital. He is involved in both acute stroke care and outpatient stroke clinics, and runs specialist services for patients with sub cortical vascular disease and genetic forms of stroke.

His research interests are in applying molecular genetic and imaging techniques to investigate the pathogenesis of stroke. Genetic studies are primarily trying to identify genetic causes of sporadic stroke and he is the principal investigator for the Wellcome Trust Case Control Consortium 2 Ischemic Stroke Study, which is performing a large genome-wide association study in ischemic stroke. The imaging techniques he uses are Transcranial Doppler emboli detection and MRI.

His postdoctoral thesis was on emboli detection, which involved experimental studies validating the technique and early clinical studies applying it to patients with a variety of potential embolic sources. He has carried out a number of studies showing that embolic signals predict stroke in carotid artery stenosis, and pioneered the use of the technique to evaluate anti-platelet therapies. He was also principal investigator for the CARESS study. Recently, he finished the Asymptomatic Carotid Emboli Study (ACES) which demonstrated that embolic signals predict risk in asymptomatic carotid stenosis.

The first international conference which Dr. Markus attended was a Transcranial Doppler ultrasound workshop organized by Merrill Spencer, M.D. in the early 1990s.

To register for the 5th Annual Cerebrovascular Symposium: New Therapeutics for Today’s Patient on May 12-13, visit www.swedish.org/cvdregister. Registration for the conference includes the Merrill P. Spencer, M.D. Endowed Lecture.

To attend only the reception and Merrill P. Spencer, M.D. Endowed Lecture on May 12: www.swedish.org/cvdspencer. This is a free CME program. However, pre-registration is required as space is limited.

 

 

 

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PFO closure for migraine

Mark Reisman, MD, Director of Cardiovascular Research and Education

 

Migraine is a primary headache dis­order that causes significant suffering in approximately 13 percent of the popula­tion of the United States. It accounts for an estimated $23 billion in annual cost to the economy through health-care expenses and lost productivity.

Two major features of migraine are migraine aura (MA) and headache. MA occurs in nearly one-third of migraine pa­tients and consists of one or more focal neurological symptoms that develop gradually over 5-20 minutes and persist for less than 60 minutes. MA typically precedes development of migraine headache.

Several years ago single-center retrospective analyses first reported an apparent association between partial or complete relief of migraine symptoms and transcatheter clo­sure of patent foramen ovale (PFO) for secondary stroke prevention (Reisman M, et al., 2005). The fora­men ovale normally serves as a one-way valve in the interatrial septum for physiologic right-to-left shunt in utero. Complete fusion of interatrial septae normally occurs by two years of age. When septae fail to fuse, how­ever, the PFO is a potential tunnel that can be opened by reversal of the interatrial pressure gradient. PFO is the most common form of right-to-left circulatory shunt (RLS).

Studies have shown that as many as 50 percent of individuals with MA will have a PFO, whereas PFO is present in about 25 percent of the general population and in migraineurs without aura (MO). In analy­ses performed by Swedish researchers, MA patients had a larger RLS than patients with MO, despite similar interatrial anat­omy (Jesurum JT, et al., 2007), and were about 4.5 times more likely to have greater than 50 percent reduction in migraine fre­quency following PFO closure (Jesurum JT, et al., 2008). These observations indicated a potential pathophysiological relationship between migraine and PFO.

The mechanism for this potential re­lationship is not understood, but investi­gators have focused on possible interatrial transit of vasoactive chemicals that bypass the pulmonary capillary bed, or on micro­emboli from the venous circulation which might trigger cortical spreading depres­sion and transient regional hypoperfu­sion. Migraineurs may have higher plate­let reactivity (Jesurum JT et al., 2010) or pro-coagulant state (e.g., protein C or S deficiency) than non-migraineurs, possibly resulting in greater load of microemboli in the arterial circula­tion. The brains of migraineurs may be more sensitive to circulatory changes than are the brains of those without migraine. The combination of potential triggers and susceptible neuronal substrate may result in an enhanced risk of MA among pa­tients with PFO.

The Migraine Intervention with STARFlex Technology (MIST) trial was a randomized trial of PFO clo­sure in migraine (Dowson A et al.). The failure of the trial to meet its primary endpoint (cessation of headache) and secondary endpoint (>50-percent re­duction in headache frequency and days) was surprising. Eligibility criteria for the trial may have excluded those patients who were most likely to benefit from PFO clo­sure. For instance, patients were excluded from MIST if they had a history of stroke or hypercoagulability, and subjects had to fit within a narrow range of headache fre­quency. If patients with a greater migraine burden or hypercoagulability were more likely to achieve meaningful reductions in headache frequency and severity, these exclusion cri­teria could have altered the study outcome.

Other trials are in progress or in the pipeline that may better elu­cidate the effect of PFO closure on migraine. The migraine-PFO asso­ciation offers opportunities for col­laboration between scientists and clinicians in both neurology and cardiology. The long-term goals of collaborative trials are improved quality of life and reduced cerebro­vascular sequelae for individuals who suffer from migraine.

 

SNI Fellowship Opportunities

The Swedish Neuroscience Institute (SNI) at Swedish Medical Center in Seattle, Washington, is committed to improving the delivery of neurologic care through evidence-based protocols, research and education.

SNI offers advanced training through five fellowships:

Applications are reviewed as received, with fellowships beginning bi-annually on January 1 and July 1.

For one hundred years Swedish has been the premier health-care provider in the Pacific Northwest and a trusted resource for people when it truly counts. As a high-volume, urban medical center located at the epicenter of the Puget Sound area, Swedish attracts nationally recognized physicians and scientists, and provides a broad population base that enhances the patient care, research and education efforts at SNI.

Applying for an SNI fellowship

You can also email your inquiries to SNIFellowships@swedish.org