The Clinical Research Center for Brain Sciences at Herzog Hospital

The Next Frontier – The Brain and Cognition

Overview and Philosophy:

Herzog Hospital was established in 1894 as the first psychiatric hospital in the Middle East. Since that time it has expanded to become the third largest hospital in Jerusalem. With 330 beds it focuses today on the care of the full spectrum of geriatric, psychiatric and respiratory diseases. Within the departments the full gamut of neurodegenerative diseases are treated, from the “pure psychiatric” via the dementias to the anoxic and post stroke damage. Over 120 patients of all ages (including children) are dependent on ventilator support due to various diseases such as ALS, stroke, anoxic brain damage, genetic disorders, infectious diseases and assorted others. This spectrum of disease places Herzog in a very special place at the crossroads of psychiatric, neurological, pediatric and geriatric care and has given the hospital a unique opportunity to contribute to the research and development of clinical methods and basic science research in multidisciplinary areas.

Building on this experience, Herzog Hospital has consolidated all of its related research and development under the “umbrella” of The Clinical Research Center for Brain Sciences, to conduct multidisciplinary research focusing on the brain, blending basic and applied clinical sciences with the special patient population available for immediate study.

*The Center has as its primary focus the following areas:

 Neurodegenerative Diseases –we are focusing on the neurodegenerative processes with a special emphasis on Parkinson’s disease and related disorders, drawing on our expertise in neuro-pyschogeriatrics, as well as work that has been ongoing in the hospital looking into the molecular and histopathological level of cerebellar function in Parkinson’s patients. We recently were granted patents for a new medication for Parkinson’s Disease which will be entering phase two clinical trials shortly as well as developing a novel treatment for depression (patent pending). This is a direct outcome of our research into the mono-molecular treatment of schizophrenia thus demonstrating the advantages of clinical and translational research coming together under one roof. We currently manage a rehabilitation program for Parkinson’s patients as part of our rehabilitation outpatients unit and funding has been received to expand the Parkinson program.

 Stroke – researching the process of neuro-rehabilitation. Drawing on our expertise in rehabilitation of stroke patients together with the developing fields of protecting the brain from ischemic damage we aim to reduce the burden of care in the post stroke patients. Our current focus is in the new field of Transcranial Direct and Alternating Current Stimulation which is a growing field in the science of cognition and especially in stroke recovery.

 Anoxic Brain Damage – here too the concepts of neuro-rehabilitation are crucial to reduce the burden of anoxic brain damage. Many of these patients, of whom we currently have many tens, are the “survivors” of “successful” cardiac resuscitation thanks to the advent of the mobile intensive care unit as well as rapid resuscitation in hospitals. We hope to improve their outcome utilizing new technologies.

 Psychiatric Disorders – Herzog Hospital has been a pioneer in the field for 120 years with a heavy investment in basic and applied clinical research. Many of our premier researchers and physicians have gone onto significant achievements in other places. The hospital has been the recipient of many research grants from eminent foundations and agencies such as the NIMH (National Institutes for Mental Health in the US), NARSAD (National Alliance for Schizophrenia and Allied Diseases- now known as the “Brain and Behavior Research Foundation”) and many others. Recent discoveries in the field of mono-molecular therapy of schizophrenia have originated or been confirmed in the hospital and have led, amongst other findings, to the development – as mentioned above – of a novel treatment for Parkinson’s Disease which the hospital has just patented and treatment for depression. These are but two demonstrations of the potential for “cross-pollination” between two areas within a multidisciplinary setting.  Extensive collaborations with centers both in Israel and abroad leverage the work of our Brain Research Center. The proximity to and interface with geriatrics and pediatrics further enables the development of treatments specific to these special and formerly neglected age groups, which are becoming some of the most rapidly developing areas of care with the aging of the population and the increasing prevalence of behavioral disorders in the elderly as well as the survival of severely compromised neonates to childhood.

 ALS – Amyotrophic Lateral Sclerosis is a relatively rare disease which, for reasons as yet unexplained, seems to be on the increase. We currently have a fairly large body of in-patient, ventilator dependent patients with ALS which is enabling the hospital to develop new thinking in the methods of caring for this special patient group.

The common denominator to all these disorders is the brain. Damage to the brain, be it by genetic, metabolic, infectious, anoxic or other mechanism is responsible for the burden of these diseases. But it is only in the last few years that the integration of the various disciplines across the spectrum of the brain and cognition has started to come together and work in unison.

 Current research:

 Research at Herzog Hospital’s Clinical Research Center for Brain Sciences (CRCBS) focuses on the study of brain and behavior at all levels – neurobiological mechanisms, neurocognitive functions, neuropharmacological processes and novel therapeutic neural-based interventions to improve clinical outcome in severe neuropsychiatric disorders. Research approaches cover most of the experimental methods such as psychological questionnaires, clinical interviews, neurocognitive testing, electro physiological recordings, non-invasive brain-stimulation and novel pharmacological interventions. Although the Center’s overall goal is to develop novel treatments to combat a spectrum of neuro-pathologies, the current research focus is to develop novel diagnostic procedures and treatments for patients suffering from debilitating cognitive, neurodevelopmental and psychiatric disorders including Schizophrenia, ageing-related disorders (Alzheimer’s disease, Parkinson’s disease, Stroke) and Depression.

Some current ongoing and planned research projects in the CRCBS

  • Anxiety treatments – meta analysis
  • Association between physical activity and symptoms in schizophrenia patients
  • Growth patterns of children dependent on chronic ventilation
  • Emotional reactions of families of PVS and unconscious  patients
  • New potential drugs for prevention of cognitive decline in aging and Alzheimer’s disease
  • Understanding changes to the cerebellum in human Parkinson’s disease
  • Religious and spiritual quality of life and Alzheimer’s disease – “Tiferet Zkenim” project
  • Genetic factors in psychiatric disorders (in collaboration with the Hebrew University Faculty of Medicine)
  • D-serine treatment for ADHD

 Electrophysiology and Neurocognition

The electrophysiology lab at the CRCBS focuses on identifying neurobehavioral mechanisms associated with particular EEG patterns and discrete cognitive functions. In doing so, we aim to increase diagnostic sensitivity when attempting to develop new illness-specific treatments to reduce symptom-severity, and improve functional capacity in psychiatric (e.g., schizophrenia patients) and geriatric patients (e.g., dementia patients, stroke patients). In parallel and most importantly, we are developing non-invasive brain stimulation procedures, such as transcranial direct/alternating current stimulation (tDCS/tACS) treatment protocols, that will hopefully enhance cognitive function, reduce symptom severity, and will potentially help patients to function more independently in their community.

Some current ongoing and planned research projects at the Electrophysiology and Neurocognition lab and also with external collaborators include:

  • Transcranial Current Stimulation Treatments of Auditory Hallucinations in Schizophrenia
  • Transcranial Current Stimulation treatment for depressive symptoms in  treatment resistant depression  patients
  • Transcranial Direct Current Stimulation (tDCS) Treatment for motor recovery in acute and chronic stroke patients
  • Transcranial Direct Current Stimulation and D-cycloserine add-on treatment for depressive symptoms in  treatment resistant depression
  • Transcranial current stimulation for Parkinson’s disease
  • Transcranial current stimulation in pediatric intractable epilepsy cases
  • Biofeedback for ADHD and Depression

In the introduction to a recent WHO study on the Global Burden of Disease, Rita Levi-Montalcini, the 1986 Nobel Prize in Medicine, wrote that “In the 19th century and at the beginning of the 20th, brain research belonged to many different areas that differed in methodology and targets: the morphological, the physiological and the psychological. The latter used to consider the brain as a black box where only the input and output were known but not at all the neuronal components and the way they interact with each other. At the beginning of the third millennium, due to prolonged ageing, neurodevelopmental disorders are growing and a much deeper knowledge of the brain is necessary. Scientific and technological research, from molecular to behavioral levels, has  been carried out in many different places but they have not been developed in a really interdisciplinary way. Research should be based on the convergence of different interconnected scientific sectors, not in isolation, as was the case in the past.”

 This is our goal and this is the new horizon which we are following.