Summary

In the area of Neurosciences at the Clínica Universitaria and the University of Navarra, a combined group of researchers are involved in clincal and basic research in an effort to determine the causes and the most adequate treatments for disorders of the nervous system. These research efforts are intimately linked to the care that is offered to patients treated in the Neurology department of the hospital and to the teaching of Neurosciences in Navarra at all levels.

Objectives

Within the field of the neurosciences, the 3 main research goals of the department are:

1. The diagnosis and treatment of illnesses involving the nervous system using the latest available technology and knowledge, and in close coloboration with other healthcare institutions both within Spain and abroad;
2. The study of the mechanisms, pathogenesis and the treatment of neurological diseases; and
3. The teaching of the Neurosciences at all levels, from undergraduate level to the training of residents:

These objectives are closely integrated such that the medical service offered to the patient benefits from the latest research advances, and that the future generations of doctors learn to care for their patients with a sense of optimism founded on the real hope of an effective cure.

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Research Areas

The clinical service and research efforts coincide in as much as they are centred on the treatment of illnesses that owing to their frequency and the problems they produce, generate serious problems in the area of healthcare in Europe, Spain and Navarra.

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1) Motor disorders and other movement disorders involving the basal ganglia

These illnesses cause a deterioration in the ability of the patient to move freely. Although the patients cognitive abilities often remain intact, the limitation of their motor facilities means that many give the impression of being mentally retarded or of impaired mental capacity. The patients are often unable to work and require intensive care and assistence from their families. The most common of these illlnesses is that of Parkinson's disease, which principally affects patients of  50 years or over, and whose frequency grows in the more elderly. Approximately 20% of patients that show signs of Parkinson's disease also suffer from other motor diseases that require a specialized diagnosis and treatment.

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Parkinson's Disease

There are approximately 70.000 sufferers of Parkinson's in Spain and some 1000 in Navarra alone. A large number of these sufferers, particularly those that have been treated for various years, don't respond to the normal treatments or these treatment have important secondary effects.

The Unit of Motor Disorders in the CUN is specialized in the treatment of these patients. Dr Maria del Rosario Luquin, in colaboration with Dr Miguel Manrique, is studying the possibilty of treating patients by transplanting cells from another part of their own nervous system to replace those affected by the disease, thereby improving their response to the disease. The value of these studies has been recognised by awards from the Spanish Neurology Society (Sociedad Española de Neurología) in 1999.

Dr José Obeso, Co-ordinator of the Unit, is one of the World pioneers in the use of stimulation of the subthalmic nucleus to treat patients that respond poorly to the usual treatments. Along with Dr Maria Rodriguez in the Unit, they have demonstrated the improvement shown by a large proportion of these patients with this new treatment, which when carried out carefully by experienced specialists, is now accepted as an excellent treatment for patients who don't respond to the usual therapy.

The Drs Julio Artieda, Maria Asunción Pastor, y Javier Arbizu employ neurophysiological and advanced neuroimaging techniques such as PET, to aid in the diagnosis of complex cases and to identify the underlying causes of these disorders.

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Other illnesses that lead to motor disorders and restrictions of movement

Other motor illnesses do not behave in the same way as Parkinson's disease but still have serious reprecussions on the health and well being of those affected.  Indeed, movement disorders in ageing people are principally not the result of rheumatism but rather of neurological disfunctions. After Alzheimer, movement disorders are the major cause of chronic disability in people over 65 years of age. Dr. José Masdeu has performed pioneering studies on the diagnosis and treatment of these problems as described in his book "Gait Disorders of Aging," published in the United States, where he was the director of the Neurology department at the New York Medical College.

The Unit includes a group of scientists whose prestige has been gained by mapping the nervous tracts between the basal ganglia and the cerebral cortex, and in studying the signals that are used for the communication between these two areas.  These studies have great importance in helping to define the basis of the distinct neurodegenerative illnesses, and as such, aid in the development of efficient therapies.

Faculty Personnel

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2) Memory disorders

Particularly in elderly people, memory disorders such as Alzheimer's disease and other types of dementia are a primary public health problem. Epidemiological studies, many carried out by Dr Martínez-Lage, have calculated that there are nearly half a million sufferers of Alzheimer's in Spain. This number reaches 675.000 when all the types of dementias are taken into account and some 850.000 patients that suffer isolated memory loss. In Navarra, these numbers equate to 6.000, 8.000 y 11.000 sufferers. This unit is dedicated to the treatment of these patients and to the study of more efficient diagnostic and therapeutic aids. To this end, the unit counts on sophisticated neuroimaging and research techniques including PET and functional magnetic resonance. Dr. Gómez Isla has also developed transgenic animals to experimentally explore the roles of the genes implicated in Alzheimer, with the aim of studying the origin of this illness and defining new strategies for its treatment.

Depression can be attributed, in a grand part, to biochemical disturbances in the brain. Dr Del Río's team is collaborating in the development of more efficient medications to treat this all-to-common problem.

Faculty Personnel

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3) Tumours of the Brain and Spinal cord

Although not as frequent as other disorders of the nervous system, tumours often affect younger people and their consequences may remain with them throughout the rest of their lives. Some tumour types are so malignant that they may prove to be fatal in a question of weeks if not treated appropriately. In the CUN there is an excellent programme for tumour treatment directed by Dr. Antonio Burgarolas that has attained worldwide prestige. The oncology unit is comprised of neurosurgeons, neuroradiologists and neuropathologists who collaborate intimately with  Dr. Burgarolas group and with gene therapy groups, and that has a depth of experience in treating patients with tumours that affect the nervous system.

In the CUN, the treatment of tumours in the nervous system benefits from the use of the latest therapeutic and diagnostic techniques including PET, a technique particularly useful in distinguishing the degree of malignancy in cases of relapse, and radiosurgery that provides a non-invasive treatment for tumours that previously could only be treated surgically.

Medical Personnel in the Unit

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4) Epilepsy

There are 380,000 people with chronic epilepsy in Spain and 5,000 in Navarra. Approximately 70% of these patients can be adequately treated with medication whilst the remaining sufferers require alternative treatments, two of which require the close collaboration of neurologists and neurosurgeons. In many cases, following a detailed study of brain function and the location of the focal origin of the epilepsy, surgical extirpation can successfully remediate the attacks. However, in other patients, Vagal nerve stimulation with portable modules permits the patient to exert a greater control over their epileptic attacks. The doctors in this unit have worked in the best centres in the USA, France and UK, and have at their disposition the most advanced techniques to treat patients with this disease.

Medical Personnel in the Unit

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5) Multiple Sclerosis

Fifty Seven thousand Spaniards, of which some 750 are Navarros, suffer from Multiple Sclerosis a progressive disease of the nervous sytem that until recently had no cure. There are now four drugs that can be used to delay the progression of the disease. Remissions that can produce serious effects such as blindness or paralysis of the arms or legs, can also be treated. In the CUN and in collaboration with other departments, research into immunological treatments is being carried out in order to continue improving our treatment of this disease. 

Medical Personnel in the Unit

Dr. Purificación de Castro	Dr. José Masdeu
Dr. Michel Idoate	Dr Pablo Villoslada
Dr. José Manuel Martínez-Lage	Dr. José Luis Zubieta

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6) Neuromuscular disorders

This heterogeneous group of illnesses can give rise to back or neck pains, pins and needles in the arms or legs, loss of strength or difficulties in moving. Some of these illnesses only respond in a limited manner to treatment such as Ameliotrophic-Lateral Sclerosis (ALS), whereas others can be treated more successfully such as autoimmune neuropathies. The success of the treatment depends on the rapid and accurate diagnosis of the illeness for which various neurophysiological techniques as well as biochemical and immunological tests are used. In some cases, it may be necessary to analyse muscle or nerve biopsies.

Medical Personnel in the Unit

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7) Cerebrovascular illnesses

Cerebral Strokes are the third most common cause of death in men and the second in women. In Navarra, approximately 1,000 people suffer from strokes each year, of which some 30% are fatal in the short term and a large part of the remaining cases result in severe disabilities in their victims. This service is centred above all on the prevention of strokes in conjunction Dr. Javier Diez whose research deals with risk factors in vascular diseases, another of the principal lines of study in the CUN.

Medical Personnel in the Unit

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8) Sleep disorders

Whilst they don't share the mortality of some of the diseases mentioned above, somnolence or insomnia are common yet little studied problems that interfere with the productivity in the workplace and the homelife of a great many people. The correct diagnosis and treatment of these problems often requires a study of sleep patterns performed in a laboratory where the brainwaves and other parameters can be studied in the sleeping patient.

Medical Personnel in the Unit

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Other research areas

1) Cerebral integration

This line of research is aimed at elucidating how the diverse brain functions are integrated to maintain the functional harmony throughout the human brain. These studies take advantage of current neurophysiological techniques and have led to the development of novel tchniques for neuroimaging.

Faculty Personnel

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2) Information technology in Neurociences

The explosion of the information available in neurociencias requieres that this information is readily assessible to and reaches those that need it. Neuroscientists and above all doctors that care for patients with neurological problems will benefit form some of the iniciatives that are being developed in this section. One example is the THyNK project ("The Hypertext Neurological Knowledge-base"), a project in which hundreds of neurologists around the world are colaborating.