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Head of Division: Associate Professor A. Bryer

Divisional Profile

A general clinical neurology service is operated at Groote Schuur Hospital.  This provides a full range of clinical activities, including in-patients, consultative, and emergency services.  Additionally, there is a clinical neurophysiology laboratory, a dedicated actue stroke unit, and specialised clinics for stroke, myasthenia gravis, HIV neurology, neuro-genetic disorder and epilepsy. 

Areas of research include:

Stroke: A large cohort of stroke patients were followed up for 6 months post incident stroke to determine survival, disability and functional outcomes following their discharge from an acute stroke unit to community-based health care and rehabilitation. Factors predictive of poor outcome were identified. Data from this study are being used to develop a community based model of stroke care. An in-service training program for health care workers involved in stroke care in under-resourced settings is being developed. The new South African National Guideline for the management of acute ischaemic stroke and TIA has been published with substantial input from the GSH/UCT stroke Unit.  A longitudinal study of HIV associated stroke to evaluate the underlying biological mechanisms (specifically endothelial dysfunction and ultrasonographic vascular phenotypes) has been undertaken.

Myasthenia gravis: Clinical and Laboratory-based research projects are focussed on improving therapeutic strategies and increasing understanding of disease pathogenesis.

  1.  Methotrexate vs. azathioprine randomized trial completed.  Presented at NASA and ANA 2010.  Submitted to Neuromuscular Dis. 2011
  2. A Multi-center, Randomized Study comparing Thymectomy to No Thymectomy in Myasthenia Gravis- International study NIH funded.  On advisory committee.
  3. The psychiatric manifestions in thymomatous MG (Dr Freeman, Psychiatry) Complement regulation in MG subjects with DAF promoter SNP and the effect of therapies.  This work done by the Neurology Research Group in partnership with Human Bilogy laboratory.  PI J Heckmann with Dr’s Amaal Abrahams and Sharon Prince.  MSc student Ms J Auret.
  4. TGFb polymorphisms and their association with extraocular muscle MG damage- in collaboration with Dr C Dandara, Human Genetics.

HIV/AIDS: Clinical and Laboratory-based research projects studying the risk factors for developing neuropathy in HIV-infected subjects.

  1. Research collaboration with Endocrine (UCT) and Neurology (Emory University) – longitudinal prevalence study of HIV neuropathy and risk factors at the Crossroads CHC.

Dr Johan van der Watt, received the CIDRI Post Graduate Scholarship award to study inflammation in HIV- associated toxic neuropathy

  1. Dr Chad Centner is studying Pyridoxine & NAT – 2 genotypes as risk factors for HIV- associated neuropathy.
  2. Dr John- Randel Vermaak is studying the incidence of HIV- neuropathy since the cART regimen has changed from d4T to Tenofovir.
  3. Collaboration with Dr’s Todd Hulgan (Vanderbilt University) and Dr P Sinxadi, Pharmacology, UCT to investigate mitochondrial DNA haplotype and susceptibility to HIV- associated toxic neuropathy by examining mitochondrial haplogroups and association with HIV- associated neuropathy in African subjects on d-drugs.
  4. Dr Friedrich Thienemann is performing a retrospective analysis of demyelinating CNS disease in HIV- infected subjects.
  5. Pilot project examining the efficacy and CSF drug penetration of cART in patient with neurological HIV- associated disease.  Dr’s Thienemann, Vermaak and Decloedt (Pharmacology)

Dementia: A longitudinal study of cognitive impairment in the elderly, with an emphasis on the role of inflammation in the pathogenesis of Alzheimer’s disease. The study includes imaging techniques such as magnetic resonance spectroscopy (MRS) of the brain and volumetric MRI analyses of various brain regions.

Neurogenetics: A clinical and counselling service for patients with Huntington disease and familial spinocerebellar ataxia (SCA) with a study to find an appropriate SNP to target for SCA1 gene silencing and to knock down the expression of mutant Ataxin1.

Multi-media teaching: The use of clinical encounter simulations is being explored.

Drug trials:  The division is active in phase 3 drug trials for Parkinson’s disease, epilepsy and multiple sclerosis.


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