Save the Date
2018 Annual Meeting
January 12-14, 2018
El Conquistador Hotel
Fajardo, Puerto Rico
Dear Members of the American Society for Peripheral Nerve,
It is an honor to serve as your President, especially as a research scientist, not faced with the day-to-day challenges in clinical practice. My contact with patients has been through my long association with distinguished surgical colleagues who have informed me, from the outset of my graduate training in physiology and throughout my research career in neuroscience, of many of the realities of surgical practice in the repair and management of peripheral nerve injuries. Our Society, ASPN, whose membership increases every year and the quality of the presentations at the annual meetings is excellent, is now one of the most important societies for peripheral nerve.
The World War years were the source of much of our understanding and practice in peripheral nerve and, indeed, Sidney Sunderland remains a source of inspiration and knowledge for us all in the clinical and surgical management of peripheral nerve injuries. My PhD supervisor, Gerta Vrbova, a doctor trained in the aftermath of World War II, did not give me a project on nerve regeneration. She told me that nerve regeneration was interesting but her colleague Ernest Gutmann “had done it all”. And indeed, he has done quite a bit, but certainly not all. He had worked during the war with JZ Young from University College, London, an eminent neuroscientist. He came by my poster at the 1978 Society of Neuroscience meeting in St. Louis and commented that ‘this peripheral nerve regeneration is so interesting and important that I should have stuck with it’. His interests had moved to plasticity and learning using the Aplysia, which went on to be the subject and the animal model, respectively, for the studies that won Eric Kandel the Nobel prize in Physiology or Medicine in 2000.
In Edmonton, Lyle Davis, an orthopedic surgeon, with whom Dick Stein and I implanted nerve cuffs to record from nerves and muscles pre- and post-nerve injury over long periods of time (of up to a year a more). Lyle introduced me to a key surgical problem of delayed nerve repair and/or proximal nerve injuries, including brachial plexus injuries, where functional recovery is not expected ‘because the denervated target organs are replaced by fat’. With several talented graduate students, many of whom were either trained as clinicians or went on to train as clinicians, we demonstrated the progressive decline in regenerative capacity of injured neurons and of the regenerative support of denervated Schwann cells with time and distance. Those few nerve fibers that manage to regenerate, become myelinated and they reinnervate many muscle fibers to form large reinnervated motor units. From the time of my first invitation as a speaker at ASPN meetings, I often note these findings, in particular, the ability of regenerating nerves to reinnervate long-term denervated muscles despite their atrophy. Research with other talented graduate students, including those in Toronto supervised by Greg Borschel and myself, noted the difficulties associated with the administration of neurotrophic factors within nerve cuffs and the use of nerve morphology to assess their efficacy. These measures can provide misleading information with the factors also promoting axon sprouting. Moreover, the subtle dose-response effects of the neurotrophic factors should be appreciated in considering how to biologically upregulate them in a natural rather than an artificial manner.
Presently, research that Tom Brushart and I initiated with a graduate student in Edmonton on the efficacy of brief electrical stimulation in accelerating axon outgrowth across injury sites, was translated into clinical studies in collaboration with Ming Chan. Ming has continued with Jerit Olson and Mike Mohart to pursue the application of electrical stimulation. With Greg Borschel, we are also presently involved in this translation in Toronto. I continue to encourage the clinical community to take on multi-centre clinical trials. The key issue is the outcome measure which I believe is the time taken to the very first sign of muscle movement that the patient is instructed to watch for and to inform his/her physician. Of course there will be false positives but that’s fine because the initiation of movement is yet to come.
I relate this ‘history’ as a means to encourage my colleagues, both clinical and basic scientists to ‘read’ the clinical problems that drive the ideas and the progress of nerve research. It has been a privilege for me to be a member of this American Society for Peripheral Nerve and I hope to encourage more neuroscientists interested in peripheral nerve to join our society. I would encourage all these scientists, both clinical and basic, to think ‘outside the box’ so as to continue the vast improvement and management of peripheral nerve injuries and pathology that have evolved over the past 80 years.
We anticipate excellent attendance at the meeting of ASPN in Puerto Rico in January 2018 from the 12th to the 14th, and we eagerly look forward to your contributions at that meeting.
With best wishes,
Tessa Gordon PhD, DSc