NEUROLOGY

Department of Neurology

DirectorProfessor Stephen Davis 
Deputy Director – Dr Peter Hand 

The Department of Neurology is recognised as one of the strongest in Australia and has international recognition for its work in stroke, epilepsy and multiple sclerosis in particular.

The Department has active laboratory research programs, which augment each of the clinical, specialised programs undertaken by the department alone, and in conjunction with the Department of Neurosurgery.



The specialised clinical programs include: Stroke, Epilepsy, Multiple Sclerosis, Parkinson’s Disease, Movement Disorders, Neuro-ocular disorders, Neurophysiology, Peripheral Neuropathy and specialised programs in neuroradiology and neurovascular.
Professor teaching class Neurology

Stroke Research

The RMH Comprehensive Stroke Centre is the most active in Australia and treats approximately 800 acute stroke patients each year. The Stroke Clinic, headed by Dr Peter Hand, has been a great success. Our major research program underpins the clinical service and involves a team of neurologists, neuroradiologists, MRI physicists, statisticians and research nurses, and is supported by an NHMRC program grant and The Royal Melbourne Hospital Neuroscience Foundation. Patients participating in research trials contribute to world leading programs in primary stroke care and secondary prevention.

Epilepsy Research

The RMH Epilepsy Program conducts a wide range of clinical and basic translational research programs, particularly focused on the areas of new anti-epileptic drug development, brain imaging, neuropsychiatric co-morbidities and evaluating the long-term outcomes of epilepsy and its treatment.  The objectives are to always improve the care and quality of life of patients with newly diagnosed and chronic epilepsy and improve clinical quality feedback and practice.   

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Multiple Sclerosis Research

The Multiple Sclerosis Unit cares for approximately 471 patients with multiple sclerosis per year at The Royal Melbourne Hospital. Apart from the inpatient and outpatient care of patients with multiple sclerosis, the MS Unit has a major commitment to the conduct of randomised clinical trials of new medication and potential therapies for multiple sclerosis. This activity allows our patients access to the latest advances in therapy and keeps medical and nursing staff up-to-date with current trends. Most of the trials also have an MRI component which strengthens our links with the neuro-radiologists and Department of Radiology at The Royal Melbourne Hospital. 

MS Base

Since 2004, The Royal Melbourne Hospital Neuroscience Unit has played a major leadership role in the development and implementation of MSBase (www.msbase.org), the only international web-based MS outcomes database platform for collaborative research. MSBase collects anonymised physician-generated key outcomes data from MS patients worldwide. The MSBase scientific leadership group conducts central, whole dataset outcomes analyses but also allows physicians in individual centres to collaborate with each other in a 'substudy' functionality, which is now hosting ongoing physician initiated multi-centre epidemiological outcomes studies. MS Base has initiated a ‘seen from onset' cohort study, which is the largest study of its kind in the world. 

MOVEMENT DISORDERS

The Movement Disorders research program is focused on clinically relevant research that will lead to improved patient care and to enhance quality of life of patients with Parkinson’s and other movement disorders. Current initiatives include undertaking to investigate the prevalence and impact on quality of life and functioning of pain syndromes in Parkinson’s disease, the role of continuous dopaminergic stimulation in reducing the incidence of the neurobehavioural effects of medications, the development of a deep brain stimulator program for the management of Parkinson’s patients and other movement disorders, and enhanced care of patients with a variety of spasticity disorders.

Clinical Neurophysiology and Peripheral Neuropathy Research

The Department of Clinical Neurophysiology has a major commitment to the conduct of randomised controlled trials of new treatments for a variety of peripheral neuropathies. Particular areas of interest have been the diabetic neuropathies, chemotherapy induced neuropathies and the demyelinating neuropathies. An important role of the department is in the safety monitoring of new drugs (either TGA approved or research related) with potentially neurotoxic side effects. Adverse events such as peripheral neuropathy or optic neuropathy can be identified at a subclinical stage using neurophysiologic techniques. Current initiatives include enhancing the assessment of small fibre neuropathies with utilisation of quantitative sensory testing and development of further tests to evaluate autonomic function.

Neurovestibular and Neuro-ocular Disorders Research

The Ocular Motor and Vestibular Research Laboratory investigates, voluntary and reflexive motor control using the ocular motor system as a model motor system. Taking advantage of the widespread ramifications of control structures within the cerebral hemispheres, the cerebellum and the brainstem, as well as the wealth of literature on the function of various structures, the laboratory is specifically interested in the cognitive processing of information involved in the selection and generation of movements. In particular, we are investigating the competition and resolution of selection processes for willed (top down) processes and reflexive (bottom up) processes. A clinical Service is now being provided with clinical assessment being undertaken within the structure of the Neuro-ophthalmology Clinic with diagnostic services expanding within the Department of Neuro-ophthalmology.
 A main direction of the clinical program remains in the investigation of attention and the influence of cognitive set and cerebral hemispheric disease on fundamental reflexes such as the vestibular reflex, smooth pursuit and saccadic eye movements in normal subjects and patients with extrapyramidal disorders, as well as autism and Asperger’s. We have extended our studies to include establishing a rating scale for motor performance, utilising the unique nature of the ocular motor system in that it utilises substantial parts of motor cortex, has extensively ramified connecting pathways and also utilises a substantial part of brainstem as the ocular motor generator. We are now commencing trials in order to validate its utility in assessing progression in neurological disease. 
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