Neuromuscular Disease and Multiple Sclerosis Research Group
Our major area of interest is in peripheral nerve disease. We undertake detailed studies using neurophysiological techniques that provide novel insights into the causes of peripheral nerve injury that are of highest global prevalence. This includes nerve injury due to diabetes, renal impairment and toxin exposure, particularly chemotherapeutic agents. We also have an interest in understanding the causes of facial nerve and intra-operative nerve injury. Our studies of neuropathy focus on the development of novel biomarkers that can detect nerve injury at an early stage. We are also undertaking a number of clinical trials of neuroprotective agents that may help prevent or treat nerve injury. These strategies have been developed using data generated from our own studies of disease pathophysiology.
Diabetes affects approximately 1.2 million Australians and is frequently complicated by a debilitating form of neuropathy termed diabetic neuropathy. Diabetic neuropathy typically begins with symptoms such as pain, tingling and numbness and can lead to ulceration and in more severe cases amputation. At present there is no cure and standard clinical neurological assessments are unsatisfactory for detecting early changes, at which point neuroprotective therapies could be applied. Our studies have focused on biomarkers of nerve dysfunction in this cohort. We have utilised novel neurophysiological techniques and identified early nerve dysfunction in patients with diabetes in the absence of clinical signs and symptoms of neuropathy. Further to this, our investigations have indicated that in type 1 diabetes, the type of insulin regimen employed may be neuroprotective and that neuropathy development may be a product of more than just average glycaemic control. We are building upon these studies by undertaking a clinical trial in neuroprotective treatments for diabetes in addition to uncovering new therapeutic targets for prevention of complications.
Chronic kidney disease (CKD) is a serious condition that affects 1.7 million Australians. Our studies have demonstrated that nerve injury (neuropthy) occurs in ~80% of CKD patients. We have identified that high levels of potassium cause nerve injury in CKD and that dietary potassium restriction may help prevent neuropathy progression. We also are interested in understanding the effects of renal transplatation on neurological function and the impact of cognitive impairment on functional outcomes in CKD.
Chemotherapy-induced Peripheral Neuropthy
Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect in the treatment of cancer, affecting up to 40% of cancer survivors. This can impose limitations on the patient to perform common ADLs and reduce their quality of life.
Common symptoms of CIPN include:
- Tingling, ‘pins and needles’ or electric shock-like sensations
- Burning sensations, sharp or stabbing pain
- Balance problems
We are currently conducting studies that investigate the impact of CIPN on cancer survivors. These studies utilise new methods and techniques used to assess and diagnose the impact of CIPN, with an emphasis on nerve function, sensation and dexterity.
Facial and intraoperative nerve injury
We have a significant interest in understanding the mechanisms of facial nerve injury due to many different causes, including traumatic and inflammatory aetiologies. We also undertake studies aimed at reducing the impact of intra-operative nerve injury, which occurs as an adverse effect of many surgical procedures. We also work with industry on the advancement of nerve monitoring technology and collaborate broadly with molecular biology and biomedical engineering teams to create new technologies to prevent and treat nerve injury.
We have an extensive programme of clinical research in multiple sclerosis (MS), which is the most prevalent cause of non-traumatic neurological disability in young Australians. We are currently investigating the causes of fatigue in MS and have ongoing studies that explore the potential utility of novel medications for motor fatigue in MS. We are also involved in research that investigates the potential contribution of sleep-disordered breathing to fatigue in MS.
Grants & Funding
2014: National Health and Medical Research Council Career Development Award: ‘Axonal dysfunction in diabetic neuropathy”.
2013: National Health and Medical Research Council Project Grant: ‘Nerve excitability assessment: a novel biomarker for the early detection of diabetic neuropathy’.
2011 National Health and Medical Research Council Project Grant: ‘Neu-Horizons: The neuroprotection and therapeutic use of riluzole for the prevention of oxaliplatin neurotoxicity study’
2011 Baxter Clinical Evidence Council, “Neuroprotective potential of peritoneal dialysis in end-stage kidney disease”
2010 National Health and Medical Research Council Project Grant:‘AUSSPRINT: Australian study of the effects of strict dietary potassium restriction on neuropathy in chronic kidney disease’