Innovations in Review 2023

Neurology and Neurosurgery

Our neurologists and neurological surgeons work in pursuit of innovative treatments for complex neurological disorders that affect the brain and spine. Physicians and surgeons from Columbia and Weill Cornell Medicine are always on the forefront of new therapies and technologies for debilitating neurological conditions, striving to restore brain health and improve patients’ quality of life.

Neurology and Neurosurgery
Neurology and Neurosurgery

New Gene Therapy Holds Promise in Parkinson’s Disease

For years, NewYork-Presbyterian surgeons have been pioneering the use of gene therapy and deep brain stimulation in patients with Parkinson’s disease. Last year, Drs. Michael Kaplitt (Weill Cornell Medicine) and Gordon Baltuch (Columbia), two leaders in the field, launched a novel randomized study of an innovative gene therapy—adeno-associated virus-glutamic acid decarboxylase (AAV-GAD)—that shows promise for controlling Parkinson’s disease symptoms in people whose motor function remains impaired despite medication. AAV-GAD is an investigational gene therapy designed to deliver the GAD gene to the subthalamic nucleus (STN) to increase GABA production. This protocol may result in the normalization of motor circuits and improve symptoms without the side effects associated with existing therapies.

Top Left: AAV-GAD is delivered directly to the subthalamic nucleus via catheter infusion. Bottom Right:AAV-GAD is an investigational gene therapy designed to deliver the GAD gene to the STN to increase GABA production

Source of Hidden Consciousness Found in “Comatose” Patients

Neurologists have identified brain injuries that may underlie hidden consciousness, or cognitive-motor dissociation (CMD): the phenomenon by which brain-injured patients are unable to respond to verbal commands despite being able to hear and comprehend them. The team at NewYork-Presbyterian/Columbia, led by Dr. Jan Claassen, showed that brain structures related to arousal and command comprehension in CMD patients were intact, suggestive of injuries in the circuits that relay information from the brain to muscles. This novel discovery may lead to a new screening protocol for CMD using brain-imaging techniques.

Brain MRI scans of two CMD patients

Pushing the Boundaries of Spine Surgery with TLIF

Dr. Ibrahim Hussain, a neurological spine surgeon at Och Spine at NewYork-Presbyterian, performed the first 3D-navigation-guided endoscopic transforaminal lumbar interbody fusion (TLIF) in New York City. This innovative procedure for treating lumbar degenerative pathologies relies on 3D navigation to map a trajectory that avoids nerve injury and helps customize the size of the implant. A collapsed interbody “cage” is expanded after placement inside the disc space under endoscopic visualization. In contrast to open TLIF and minimally invasive TLIF, 3D endoscopic TLIF requires a smaller incision, minimal bone and muscle dissection, and less sedation, resulting in a faster and less painful recovery.

Preoperative and postoperative X-rays

Facial-Nerve Massage Offers Relief for Hemifacial Spasm

Currently, microvascular decompression (MVD) addresses hemifacial spasm by relieving neurovascular compression along the centrally myelinated portion of the facial nerve. While in a large number of patients, MVD completely relieves spasms with a low occurrence of morbidity, there remains a segment of patients who cannot be cured with revision MVD despite sufficient vascular decompression. NewYork-Presbyterian/Columbia neurosurgeon Dr. Raymond Sekula, Jr., served as senior author on a study investigating the outcomes and complications of facial-nerve massage in patients who had previously undergone MVD but continued to have spasms. The study found that after massage, durable and at least partial relief of spasms with a relatively low complication rate was observed in most patients.

Facial nerve massage for treatment of hemifacial spasm refractory to MVD; arrowhead points to the dissector used to massage the facial nerve

Discovery of Potential Trigger for MS Offers New Hope

Multiple sclerosis (MS) is known to require an environmental trigger for lesion formation, but the identity of that trigger has long eluded scientists. Suspecting that the gut microbiome may play a role, NewYork-Presbyterian/Weill Cornell Medicine neurologist Dr. Timothy Vartanian led a collaborative novel research effort that used highly sensitive polymerase chain reaction (PCR) detection to show that people with MS were more likely to harbor, and have a greater abundance of, epsilon toxin—producing strains of the C. perfringens bacteria within their gut microbiomes compared to healthy controls. This discovery holds promise for the development of new treatments that could halt MS by neutralizing epsilon toxin—offering hope to people who suffer from the disease.

Epsilon toxin in multiple sclerosis