Research in Neurology - I have a dream!

Dear Researchers at the Neurocenter Bern,

It is my greatest pleasure to write the introduction of this very first research newsletter after my return to Bern. The Neurocenter Bern has a worldwide reputation of excellence in clinical, translational and basic research in neuroscience, and it is therefore a tremendous privilege to be part of this amazing team.

I am very pleased to welcome two principal investigators at the department of neurology. Prof. Bogdan Draganski is the new Extraordinarius for dementia and neurodegenerative disorders and his research focus is the prevention and early diagnosis by using non-invasive neuroimaging methods. Prof. Simon Jung is the new chair of the neurorehabilitation with a strong research focus in vascular diseases. He aims to introduce novel treatment approaches in rehabilitation, including robotics and machine-human interfaces. I am looking forward collaborating with these innovative colleagues.

Combining basic, translational and clinical science under one single roof is one of the main strengths of the research groups at the Neurocenter Bern. In order to foster creativity, innovation and new concepts to prevent and cure diseases of the nervous system, we must further improve the collaboration between the different research groups. The proximity of the research groups is key to exchange new ideas, and I am therefore very pleased, that many clinical and translational research groups not only from neurology, but also from neurosurgery and neuroradiology have moved to the level B of the old “Bettenhochhaus”. I am dreaming that working next door to open-minded researchers from other disciplines will multiply new approaches to understand and treat neurological diseases. It is of utmost importance to further strengthen the connections with the research groups of the ZEN, which will move to the new facilities in the Murtenstrasse 50 in 2025. Regular informal meetings will be launched in mid-August to improve the exchange of ideas among all the different research groups at the Neurocenter Bern.

My dream is to further foster the collaboration between the different groups in order to stimulate innovation and excellence in clinical, translational and basic science at the Neurocenter Bern. May this dream come true!

Prof. Dr. med. Urs Fischer

Dr. med. Bernhard Siepen

What are your main research interest?

My name is Bernhard Siepen, since 03/2020 I am a resident at the Department of Neurology and part of the Bernese ICH research group led by Prof. Dr. med. David Seiffge. Simultaneously, I am pursuing a PhD in Clinical Sciences at the Graduate School for Health Sciences (GHS), University Bern with the project “Deciphering outcomes in intracerebral haemorrhage associated with different types of oral anticoagulants”. My main focus is to determine the influence of different types of anticoagulants on haematoma volume, secondary expansion and outcomes in non-traumatic ICH and to provide thresholds for individual treatment decisions (e.g. the use of reversal agents) based on biological rational (anticoagulant activity). 

Currently, together with PD Dr. med Bastian Volbers and Dr. Shaokai Zheng I am working on a deep learning-based biomedical image segmentation algorithm, which is built for semantic segmentation and relies on supervised learning. Further, together with my PhD supervisor Prof. Dr. med. David Seiffge, I am planning a single centre phase-II randomized controlled trial (MAX-ICH) to assess the feasibility and clinical safety of a maximal care bundle in patients with non-traumatic ICH compared to usual care in a single-center phase II trial. In addition, I will conduct an MRI sub-study to assess MRI surrogate markers for safety (diffusion-weighted imaging lesions) and efficacy (perihaemorrhagic edema volume) in patients enrolled in the MAX-ICH trial.

What do some people get wrong about your research?

Indeed, non-traumatic intracerebral haemorrhage is a devastating disease with high mortality and morbidity and there are very few proven treatments to improve outcome. However, we know that some things work: Anticoagulant reversal, intensive blood pressure reduction, surgical evacuation of haematoma and/or external ventricular drainage, management in an acute stroke unit and long-term blood pressure lowering. Time is brain also counts for ICH!

Bernhard Siepen is a resident at the Department of Neurology, Inselspital University Hospital Bern and PhD student at the Graduate School for Health Sciences (GHS), University Bern. 

1. Andexanet alfa versus non-specific treatments for intracerebral hemorrhage in patients taking factor Xa inhibitors - Individual patient data analysis of ANNEXA-4 and TICH-NOAC. Siepen BM, Polymeris A, Shoamanesh A, Connolly S, Steiner T, Poli S, Lemmens R, Goeldlin MB, Müller M, Branca M, Rauch J, Meinel T, Kaesmacher J, Z'Graggen W, Arnold M, Fischer U, Peters N, Engelter ST, Lyrer P, Seiffge D. Int J Stroke. 2024 Mar 8. https://journals.sagepub.com/doi/10.1177/17474930241230209

2. Intracerebral haemorrhage in patients taking different types of oral anticoagulants: a pooled individual patient data analysis from two national stroke registries. Siepen BM, Forfang E, Branca M, Drop B, Mueller M, Goeldlin MB, Katan M, Michel P, Cereda C, Medlin F, Peters N, Renaud S, Niederhauser J, Carrera E, Kahles T, Kägi G, Bolognese M, Salmen S, Mono ML, Polymeris AA, Wegener S, Z'Graggen W, Kaesmacher J, Schaerer M, Rodic B, Kristoffersen ES, Larsen KT, Wyller TB, Volbers B, Meinel TR, Arnold M, Engelter ST, Bonati LH, Fischer U, Rønning OM, Seiffge DJ. Stroke Vasc Neurol. 2024 Feb 8. https://svn.bmj.com/content/early/2024/02/08/svn-2023-002813

Dr. med. Laura Alva

What are your main research interest?

My name is Laura Alva, I am a dedicated clinician-scientist with a strong clinical and academic interest in the field of movement disorders. In 2021, I joined the research group “Neurophysiology and Adaptive Neuromodulation” led by PD Dr. med. Gerd Tinkhauser, where we focus on the optimization of deep brain stimulation (DBS) for movement disorders like Parkinson’s Disease.

In essence, I am investigating brain-sensing strategies to improve DBS. What do I mean with that? DBS as we apply it in our current routine is characterized by a constant delivery of electrical stimulation to the brain. The disadvantage is that fixed stimulation does not consider the fluctuating nature of Parkinson’s disease symptoms, leading to periods with suboptimal symptom control and stimulation side effects. These problems can be leveraged by the next generation of brain-sense neurostimulation. Novel devices are capable of recording symptom biomarkers from the brain, allowing to adjust the stimulation in real-time according to fluctuating symptoms.

This technology will be transformative for the field of DBS. To guide the process of clinical implementation, I am characterizing neurophysiological symptom biomarkers for movement disorders and establishing a clinical-neurophysiological interrogation framework (1).

What is your motivation to do research?

I am intrigued about applying neurotechnology and novel neuroscientific-based concepts to optimize our patient’s treatment. I find it very enriching working closely with engineering scientists as well as to learn and apply new computational methods. Beyond that, I really enjoy the exchange with our international network and the joint passion to work towards common goals. Overall, academia expands my clinical perspective as a neurologist and I am glad for the opportunity to improve patient’s care from different angles.

Laura Alva is a Clinician-Scientist at the Movement Disorder Centre at Department of Neurology, Inselspital Bern, University Hospital, University of Bern, Switzerland.

1. Clinical neurophysiological interrogation of motor slowing: A critical step towards tuning adaptive deep brain stimulation. Alva, L., Bernasconi, E., Torrecillos, F., Fischer, P., Averna, A., Bange, M., Mostofi, A., Pogosyan, A., Ashkan, K., Muthuraman, M., Groppa, S., Pereira, E. A., Tan, H., & Tinkhauser, G. Clin Neurophysiol. https://doi.org/10.1016/j.clinph.2023.04.013