Why Stanford Medicine Children’s Health is America’s Leading Training Ground for Child Neurologists

For Release: February 04, 2016

STANFORD, Calif. —“The Stanford University School of Medicine has more students graduating who go into neurology than any other medical school in the country.”

That statement from Paul Fisher, MD, chief of pediatric neurology at Lucile Packard Children's Hospital Stanford and Stanford Medicine Children’s Health, is based on data from the Association of University Professors of Neurology. The AUPN notes that over the past five years, 8 to 14 percent of the School of Medicine’s graduating classes have chosen to pursue postgraduate training in the clinical neurosciences — tops in the nation. “And largely, they’re going into child neurology,” Fisher said.

It’s a success that speaks a synergy of education, innovation, science and care that is unique to Stanford.

“This is really an inspiring culture for the next generation of pediatric neurologists,” said Fisher, the Beirne Family Professor of Pediatric Neuro-Oncology at the Stanford University School of Medicine. “Our physician-scientists see a large number of children, including those with complex diagnoses that are rarely seen elsewhere. This has created a great passion and motivation for students to enter this much-needed specialty.”

Stanford’s bench-to-bedside approach drives advanced care that informs the science of pediatric neurology everywhere, and generates exceptional research opportunities — basic, clinical, and translational research that further encourages the next generation.

“The reason for this success is pretty clear,” Fisher said. “Like our Silicon Valley neighbors, Stanford Medicine is a home for innovation, and this innovation is something future child neurologists want to be a part of.”

Rapid scientific advancements

Pediatric neurologists, neurosurgeons, and neuroscientists at Stanford have been rapidly developing new tools and techniques to help unravel some of the mysteries of the human brain and its neural network, the most complex biological structure on Earth. These advancements include:

• Optogenetics, a tool utilizing genetically encoded molecules inserted in the brains of mice, thus allowing researchers to use light to activate specific neurons. This offers the potential to identify and influence specific brain circuits.
• CLARITY, a process that renders a mouse brain transparent without the need for sectioning. This three-dimensional view can lead to better understanding of the wiring of the human brain.
• Identification of a protein, Neuroligin-3, within the brain that robustly drives tumor growth in the cerebral cortex, a finding that may lead to new treatments for deadly brain tumors.

A national center for childhood concussion

“In partnership with Stanford University, we recently established the Stanford Concussion and Brain Performance Center, which is serving to define the standards for the diagnosis and management of concussions in kids,” said Gerald Grant, MD, director of pediatric neurosurgery and a co-leader of the center with Fisher. “In collaboration with Stanford researchers, the center is driving the development of new technologies to prevent and treat head injuries in children and aggressively rehabilitate children with post-concussive syndrome.”

Related innovations already underway include mouth guards that record accelerometer information about on-the-field cumulative impacts during Stanford Cardinal football games, thus providing researchers with invaluable data about the impact and risks of concussion in young athletes.

“There is growing concern about the risk of concussion, especially in football and soccer, but little is actually known about how repetitive impacts affect the brain, and how this effect can vary based on age or gender,” added Grant, associate professor of neurosurgery at the School of Medicine. “The mouth guards are one component of research into the mechanical forces that cause concussion, which has already revealed that the linear accelerations and forces sustained by the athlete on the football field can be significantly greater than even the forces sustained in a car crash.”

Pediatric Center for Brain Engineering

A powerful new program — the Pediatric Center for Brain Engineering — is bringing together researchers from the Stanford School of Engineering, the Stanford Neurosciences Institute, and Stanford Medicine Radiology to focus on brain disorders and the personalized treatment each case requires. “We benefit from this extraordinary ecosystem at Stanford, one that encourages collaboration and new ways of thinking,” Grant said. “It’s another reason Stanford is so attractive to child neurology and neurosurgery training.”

This center is part of a global scientific effort to map every corner of the brain. Not only does mapping lead to a better understanding of the brain’s complex functions, but it enables surgeons to pinpoint with greater precision those areas that that need protection when kids are undergoing surgery.

Advanced robotics

In 2016, the team at Packard Children’s is deploying the ROSA Brain robot, becoming the first hospital in Northern California to offer this roboticized surgical assistant. The accuracy with which the robot’s computer brain can guide its robotic arm facilitates 3-D mapping, which helps determine the best trajectory to minimize collateral damage to adjacent brain tissue. Stanford surgeons can also rely on the ROSA to manipulate instruments as thin as a needle during minimally invasive brain surgery, and to decipher the epileptic network and seizure focus in a child with medically refractory seizures.

West Coast Pediatric Epilepsy Initiative

Stanford is launching the West Coast Pediatric Epilepsy Initiative in the summer of 2016. This alliance of children’s hospitals, led by Packard Children's, will interpret EEGs remotely and prioritize certain patients for highly specialized surgical and medical approaches. “Epilepsy is not one diagnosis, but many,” explained Brenda Porter, MD, associate professor of neurology. “There are lots of therapeutic options, but the challenge is to diagnose the disorder correctly and then to identify the best therapy.”

Research led by Porter is focusing on cell signaling abnormalities that lead to epilepsy, as well as improving surgical outcomes. Many of her patients present with difficult-to-treat epilepsy. When appropriate, Porter and her colleagues enroll children in cutting-edge treatment trials with one of the largest, most comprehensive pediatric epilepsy teams on the West Coast.

As the scientific understanding of human genetics continues to mature, Porter predicts the genetic makeup of a patient’s individual disease will one day determine customized treatment for seizures. Also promising are targeted medications, stereotaxic laser surgeries, and implantable devices pioneered by Stanford scientists.

Brain tumor research

Nearly 20 years ago, Fisher started the pediatric brain tumor program at Packard Children’s. The program is now the largest comprehensive center for childhood brain tumor research and care in the western United States, and one of 10 members of the National Cancer Institute’s Pediatric Brain Tumor Consortium (PBTC). As the primary pipeline for bringing new pediatric brain tumor therapies to market, the PBTC supports innovative clinical trials that cannot be completed at any one institution.

Major studies are under way in Stanford labs to understand tumor development. Recently published research by pediatric neuro-oncologist Michelle Monje, MD, PhD, is the first to demonstrate that activity within the brain stimulates growth of high-grade gliomas, an especially deadly group of brain tumors. In addition, through the PBTC, Monje is leading a 10-site patient study using an FDA-approved medication, panobinostat, for treating diffuse intrinsic pontine gliomas. This is a follow-up to her landmark 2015 study, “Functionally-defined therapeutic targets in diffuse intrinsic pontine glioma.” Read about that study here.

Samuel Cheshier, MD, PhD, a pediatric neurosurgeon, and collaborators are looking at the CD47 protein on cancer cells that signals the immune system to ignore those cells. Blocking CD47 could stimulate the immune system to target and destroy those cancer cells. He hopes to move this highly innovative work into trials for children with malignant brain tumors. As chief of pediatric neurosurgery, Grant and collaborators are looking at novel ways to open the blood-brain barrier to treat these tumors, which is a double-edged sword: This barrier protects the brain from harmful substances, although it limits the delivery of targeted chemotherapy for treatment.

The final word

“In the end, all of these programs and initiatives build an environment where learning and discoveries are truly encouraged,” said Fisher, who also noted that medical students train with experts in medical imaging, computer science, genomics, proteomics, stem cells and bioengineering.

“Stanford University, the Stanford School of Medicine and Lucile Packard Children's Hospital represent one of the top academic medical centers in the world, and one of the most diverse. It’s a place where basic, clinical and translational research doesn’t just thrive, but also saves lives – and we’re thrilled to play such an important role in the future of pediatric neurology, neurosurgery, and the neurosciences.”

Authors

Robert Dicks
(650) 497-8364
rdicks@stanfordchildrens.org