MRC Clinical Academic Research Partnership (*CARP) grant.
Dr Yen Tai, consultant neurologist and movement disorder expert at Charing Cross Hospital, has been awared an MRC CARP grant, to work with Dr Seemungal and team. We will be assaying the impact of spinal cord stimulation on balance function in Parkinson's Disease patients using direct and modelled measures of human postural control. The CARP enables "NHS consultants with a PhD ... to participate in collaborative high-quality research partnerships with established leading biomedical researchers."
BRAIN AND VESTIBULAR GROUP team
Dr Elena Calzolari: Post-Doctoral Research Associate
Ms Mariya Chepisheva: Doctoral Research Fellow
Mr Zaeem Hadi: Research Assistant
Dr Mo Mahmud: Doctoral Clinical Research Fellow
Ms Yuscah Pondeca: Research Assistant
Dr Heiko Rust: Consultant Neurologist and Senior Research Associate
Ms Rebecca Smith: NIHR Clinical (Physiotherapy) Doctoral Research Fellow
If you are interested in working with us, please contact Dr Seemungal.
Barry Seemungal (PhD FRCP) is a neurologist who researches the brain mechanisms of vestibular function and dysfunction, with a focus on vestibular cognition. He was born and raised in Trinidad, West Indies and then studied medicine in Cardiff. He has a strong affinity for general medicine having spent three years as a specialist registrar in internal medicine and endocrinology in Oxford and then trained as a neurologist in London. He completed a PhD in vestibular neurosciences - 'The Mechanisms and Loci of Vestibular Perception' - at the MRC Human Movement and Balance Unit (Institute of Neurology, Queen Square, London) under Profs Adolfo Bronstein and Michael Gresty.
Dr Seemungal was awarded a prestigious Health Foundation & Academy of Medical Sciences and Clinician Scientist Fellowship in 2008. He has current funding as principal investigator from the Medical Research Council UK, NIHR Imperial Biomedical Research Centre and Imperial Health Charity.
He enjoys teaching and training. In 2003, in his first year as a neurology trainee, he held the now historical post of Resident Medical Officer at the Hammersmith Hospital. More recently he has developed an interest in service delivery and is the Trust lead liaison for neurology for the North West London 'STP' (sustainability and transformation plan).
He relaxes by playing football and going on outdoor holidays with his family. He has been a keen photographer since childhood and enjoys the visual arts.
Keywords: Vestibular Perception, Balance, Falls, Vertigo, TBI, Stroke, Dementia, Dopamine, Brain Imaging, Brain Stimulation.
Previous grant funding:
Brain Mechanisms and Loci of Human Vestibular Perception.
A particular theme of our research is the uncoupling of perception and reflex function in the vestibular and ocular-motor system. We have published a brain imaging study which showed that the vestibular cerebellar grey matter is key in modulating sensations of dizziness separate from vestibular ocular reflex responses. In addition, we have demonstrated an extensive white matter cortical network involved in mediating vertigo sensation. These findings in healthy humans were corroborated in a recent human lesion study in which the loci of vestibular perception were probed in acute stroke patients.
Vestibular Mechanisms in neurodegeneration
We are now extending our techniques into understanding the higher-order vestibular contributions to neurodegenerative diseases such as Parkinson's Disease and Alzheimer's Disease. For example, we have shown that the brain mechanisms underlying effects upon balance function with novel deep brain stimulation targets in Parkinson's patients, may be mediated by higher order vestibular mechanisms.
PAST ORGANISED RESEARCH MEETINGS
fens satellite meeting, berlin july 12th 2018.
progress in concussion research.
This meeting provided an overview of the latest research in concussion and mild traumatic brain injury. The meeting inlcuded a pre-meeting evening meeting in a typical Berlin eaterie, with local food and drink.
fens satellite meeting, como 3-4th july 2014.
Brain Plasticity of the vestibular and ocular motior systems.
This meeting focused on the brain plasticity in the vestibular and ocular motor systems. The speakers were from a variety of backgrounds including electrophysiology, pharmacology, optogenetics, computational modelling, scientific studies of human brain function as well as clinical studies. (Conference webpage).
LAB TO BEDSIDE EXAMPLES
How the brain adapts to repeated pirouetting.
We showed that the brain adaptation in dancers that enable them to suppress dizziness following a pirouette involves changes in the vestibular cerebellar grey matter. We aim to translate these findings in developing a new therapy (dance-based therapy) for chronic dizzy patients together with colleagues from Kings College London and University College London. A modified version of this therapy may be used for rehabilitating other neurological conditions such as stroke and traumatic brain injury.
TURBOCHARGING REHABILITATION WITH DOPAMINE.
In this study, we address the issue of whether dopamine activation improves visual perception despite increasing sensory noise in the visual cortex. We show specifically that dopamine D1 (or combined D1/D2) receptor activation enhances the cortical signal-to-noise-ratio to boost perceptual performance. Together with the previously reported effects of dopamine upon brain plasticity and learning (Wolf et al., 2003; Hansen and Manahan-Vaughan, 2014), our results suggest that combining rehabilitation with dopamine agonists could enhance both the saliency of the training signal and the long-term effects on brain plasticity to boost rehabilitation regimens for brain injury.
Dr Yuliya Nigmatullina
Dr Shamim Quadir
NIHR Research MSc
Dr Hena Ahmad
Dr Diego Kaski
Previous visiting and fixed term researchers:
Tom Cronin. Clinical Research Fellow (current - neurology academic clinical fellow Newcastle).
Hannah Streat: Visiting researcher (Engineering undergraduate, Cambridge University).
Recent Project students (including MSc & BSc)
Raymond Fu, Bilal Abou-El-Ela Bourquin, Matt Sargeant, Emiko Sykes, Joy Arthur, Crystal Yang, Jay Kotecha, Hetvi Bhatt.
Dr Anil Bharath - Imperial (BRC Stroke Project)
Ms Deborah Bull - Kings (Dance therapy study)
Prof John Golding - Univ Westminster (Dance therapy study).
Prof Danilo Mandic - Imperial (BRC Stroke Project)
Dr Luca Passamonti - Cambridge (US Military mTBI and chronic vestibular disability study)
Dr Marousa Pavlou - Kings (Dance therapy study).
Prof Simon Schultz - Imperial (Dopamine modulation of visual perceptual function)
Prof David Sharp - Imperial (MRC TBI vestibulopathy study)
Prof Jeff Staab - Mayo Clinic (US Military mTBI and chronic vestibular disability study)
Prof Dominic Straumann - ETH, Zurich (Imbalance in concussion)
Prof Mark Wilson - Imperial (MRC TBI vestibulopathy study)
Dr Eric Viirre - UCSD, San Diego (diagnosis in dizziness)
SELECTED RECENT PUBLICATIONS
Yousif N, Fu RZ, Abou-El-Ela Bourquin B, Bhrugubanda V, Schultz SR, Seemungal BM. Dopamine Activation Preserves Visual Motion Perception Despite Noise Interference of Human V5/MT. J Neurosci. 2016 Sep 7;36(36):9303-12. [OPEN ACCESS].
Kaski D, Quadir S, Nigmatullina Y, Malhotra PA, Bronstein AM, Seemungal BM. Temporoparietal encoding of space and time during vestibular-guided orientation. Brain. 2016 Feb;139(Pt 2):392-403. [OPEN ACCESS].
Yousif N, Bhatt H, Bain PG, Nandi D, Seemungal BM. The effect of pedunculopontine nucleus deep brain stimulation on postural sway and vestibular perception. Eur J Neurol. 2016 Mar;23(3):668-70. [OPEN ACCESS]
Nigmatullina Y, Hellyer PJ, Nachev P, Sharp DJ, Seemungal BM. The neuroanatomical correlates of training-related perceptuo-reflex uncoupling in dancers. Cereb Cortex. 2015;25:554-62. [OPEN ACCESS].
Seemungal BM, Guzman-Lopez J, Arshad Q, Schultz SR, Walsh V, Yousif N. Vestibular activation differentially modulates human early visual cortex and V5/MT excitability and response entropy. Cereb Cortex. 2013 Jan;23(1):12-9. [OPEN ACCESS].
Seemungal BM. The cognitive neurology of the vestibular system. Curr Opin Neurol. 2014 Feb;27(1):125-32.
(Consensus paper) Lempert T, Olesen J, Furman J, Waterston J, Seemungal B, Carey J, Bisdorff A, Versino M, Evers S, Newman-Toker D. Vestibular migraine: diagnostic criteria. J Vestib Res. 2012;22(4):167-72. [OPEN ACCESS].
GUIDELINES AND TOOLS FOR DOCTORS
- Online tools to help General Practitioners to manage the dizzy patient - Click Online tool.
- Help for hospital doctors dealing with acute vertigo - WHEN DOES A PATIENT WITH ACUTE VERTIGO NEED A BRAIN SCAN?
Taken from Seemungal. Current Opinions in Neurology, 2007:
Acute brain imaging (ideally MRI) is mandatory if there are one or more of the following in a case with acute persisting vertigo:
- Hyperacute onset vertigo (seconds) that persists.
- Acute vertigo with a normal head impulse test.
- Acute vertigo with new onset headache (especially occpital).
- Acute vertigo with any central signs, inlcuding gait or truncal ataxia.
- Acute vertigo and deafness without a typical Meniere's history.
Member of NHS England Strategic Clinical Network for Neurology (London) - I was involved in the neurology 'common conditions' working group (click for the report published in December 2016). The aim of this working group was to rebalance the referral pattern between the community and acute hospitals for common neurological conditions. One model involves a fully integrated service linking the community and the acute hospital. For example, for dizziness, the hospital team would train and support a community team to see the majority of dizzy patients. More complex and/or acute vertigo cases (e.g. potential strokes) would be seen by the hospital team.
Member of Association of British Neurologists Acute Neurology Advisory board.
Member of the Barany Society Vestibular Migraine Workign Group - involved in the working group that published the first classification for vestibular migraine.
Registered expert on the European Research and Innovation database.
Expert review of the United Kingdom ‘NICE’ guidelines for vertigo & dizziness.
FENS Satellite meeting - Chaired a European conference on Brain Plasticity in the Vestibular system (‘FENS’ Satellite conference – 2014).
This includes masterclasses on managing dizziness at the Royal College of Physicians, at BMJ Masterclasses in India and at the 1st and 2nd European Academy of Neurology (EAN) meetings in Berlin (2015) and Copenhagen (2016).
Participates in the Trust acute neurology rota. Provides an acute vertigo service with colleagues (Prof Adolfo Bronstein) at Imperial Healthcare NHS Trust. Together, they provide an acute vertigo service to the Trust A&E's, Hyperacute Stroke Unit at Charing Cross and the Major Trauma Unit at St Mary’s Hospital.
et al., 2015, Temporoparietal encoding of space and time during vestibular-guided orientation, Brain, Vol:139, ISSN:0006-8950, Pages:392-403
et al., 2013, The Neuroanatomical Correlates of Training-Related Perceptuo-Reflex Uncoupling in Dancers, Cerebral Cortex, Vol:25, Pages:554-562
et al., 2012, Vestibular Activation Differentially Modulates Excitability and Response Entropy in Human V5/MT and Early Visual Cortex., Cerebral Cortex, Vol:23, ISSN:1047-3211, Pages:12-19
Guzman-Lopez J, Silvanto J, Seemungal BM, 2011, Visual motion adaptation increasesthe susceptibility of area V5/MT to phosphene induction by transcranial magnetic stimulation, Clinical Neurophysiology
Seemungal BM, 2007, Neuro-otological emergencies, Current Opinion in Neurology, Vol:20, ISSN:1350-7540, Pages:32-39