"Cerebrovascular disease is probably one area in neurology where the greatest advances in treatment and diagnosis have happened over the past few years. "
- Magdy Selim, MD, PhD, Professor of Neurology at Harvard University
In observance of Heart and Stroke Awareness Month in February, we turn our attention to cerebrovascular disease. We asked Magdy Selim, MD, PhD, to share an update on the state of the disease and his own research on the subject. Dr. Selim is a neurologist at Beth Israel Deaconess Medical Center in Boston and Professor of Neurology at Harvard University.
What does the public need to understand about cerebrovascular disease that it often doesn’t?
I don’t think the public really knows when you say cerebrovascular disease what this means, do they? Cerebrovascular disease really includes a large spectrum of diseases or conditions mostly affecting the blood vessels in the brain or the blood vessels that go into the brain. The most common condition is stroke and that’s probably what some people would be familiar with. But it includes a lot more than stroke. It includes bleeding in the brain, sometimes bleeding on the surface of the brain, brain aneurysms, etc. So there are a lot of things that go under cerebrovascular disease.
I think the public needs to understand that it’s more than just a stroke, it’s a condition that affects the blood vessels that supply the brain. That’s one thing. I think people probably don’t know that cerebrovascular disease is probably one area in neurology where the greatest advances in treatment and diagnosis have happened over the past few years. It’s a very hot area in neurology and there’s been a lot of advancements there.
When it comes to stroke, they need to know that time is really important and that the sooner people seek medical help, the better the chances of them receiving better treatments and having better outcomes.
The other thing I think they need to know is that many of the cerebrovascular diseases can be prevented by just lifestyle changes. And probably prevention is better than curing it, right?
What kinds of lifestyle changes can people make to help prevent cerebrovascular disease?
A lot of the problems that lead to stroke are related to smoking, obesity, sedentary life style, high blood pressure, high cholesterol, and sleep apnea, and a lot of these things can be prevented by of course not smoking, exercising, eating healthy, managing weight. These are the important things for people to do.
How are treatment options for cerebrovascular disease different today from 10 years ago?
Well, 10 years ago maybe there were things we didn’t really have treatment for. But the big change has been the technology and the development of devices. So now, for example, the treatment of brain aneurysms is a lot easier and safer than before. We also have a lot of exciting treatments for stroke in order to remove the clot from a blood vessel and to restore blood flow to the brain. I think the major change in the treatment is the increased utilization of technology and the devices, which allow us to provide treatment to conditions that we were unable to do anything about before and to make the treatment safer.
What promising research is poised to change the standard of treatment for cerebrovascular disease?
This is really a difficult question because I just told you that cerebrovascular disease covers a lot of topics and in each area on its own there’s a lot that’s going on there. So, I guess let’s start with what I’m interested in. I am interested in studying bleeding in the brain. There is a lot of research going on in the area of brain hemorrhage. In the last maybe 10 years or so, we have learned a lot about what happens in the brain after a brain hemorrhage and there are a lot of exciting clinical trials going on, a lot exciting research going on to look at how to surgically treat it, how to actually evacuate the blood from the brain and how to reverse the effects of the blood and prevent it from damaging the brain. So that’s in the area of brain hemorrhage. There is a lot also going on in patients who have a different type of stroke where they have a blood clot preventing blood flow to the brain and trying to take the clot out. And the fact that we’re using a lot of devices now which allows us to directly get into the brain opens the window to be able to actually deliver directly into the brain drugs or substances that can help with recovery and to protect undamaged parts of the brain. So there are a lot of exciting areas where there’s been a lot of progress happening.
What work is your lab undertaking to move understanding or treatment for cerebrovascular disease forward?
I don’t really run a lab, I do mostly clinical research. So I’m a clinical trialist. But I do collaborate a lot with the basic researchers and as I mentioned, my interest is in brain hemorrhage and particularly I’m interested in the secondary injury after a brain hemorrhage. So what happens is after a bleeding in the brain, there’s blood and you probably know that red blood cells have hemoglobin in them and that hemoglobin is very rich in iron. So, it turns out that after you have a bleeding in the brain, the red blood cells break down and the hemoglobin and iron leak out and these products are damaging to the brain. So, what I’ve been interested in here is trying to find treatments to how to remove these toxic products from the brain and how to prevent the damage to the brain that happens from these products.
Are there any highlights related to that you’d like to share?
The highlight is that we finished two trials looking into that. We learned a lot from these trials so hopefully we will be able to taking this and move forward to properly expand this work. And we’re also looking at combining this with different surgical ways of removing the blood from the brain. So we’re trying to do it pharmacologically and we’re trying to do it by using devices to actually minimize the toxic of the blood on the rest of the brain.
How has the ANA supported your career or work in this area?
I think what the ANA really does to help us is it provides us a platform to present our research and to bring it to the forefront and make people aware of it.