Brian Moseley, MD, is in his first year at UC as an assistant professor in the Department of Neurology and Rehabilitation Medicine, where he specializes in epilepsy with a strong concentration on research. Here he discusses that research, plus a pleasant surprise heís had as a newcomer to Cincinnati.
How long have you been at UC, and what brought you here?
I just started at UC in July. However, everybody has been so welcoming that it feels like Iíve been here for much longer. When I was looking across the country for the perfect academic epilepsy job last year, UC really stood out above the rest. In addition to the great patient care practiced at all of the UC hospitals and clinics, this institution has a fantastic apparatus in place for clinical research. As part of coming here, the Neurology and Rehabilitation Medicine Department agreed to protect 50 percent of my time for pursuing my research interests. Without existing funding, this is virtually unheard of elsewhere. Such support so early in my career is extremely important and appreciated. It makes me realize how much the staff here cares about mentoring the next generation of physicians.
What is the focus of your research?
Iím an epileptologist, or specialist who cares for patients with seizure disorders. One particular aspect of seizures that I find fascinating is the autonomic effects that seizures can have. For instance, some seizures can cause the heart rate to either speed up too quickly (ictal tachycardia) or slow down inappropriately (ictal bradycardia). Rarely, seizures can even cause the heart to temporarily stop beating (ictal asystole). Seizures can also cause significant drops in oxygen levels in the blood (ictal hypoxemia), sometimes by causing a transient cessation of breathing (ictal apnea).
Iím particularly interested in how such autonomic changes may underlie a phenomenon known as sudden unexpected death in epilepsy (SUDEP). Although rare, SUDEP is the most important direct epilepsy-related cause of death. For reasons we still donít completely understand, people with seizures have a higher risk than those without seizures of dying suddenly and unexpectedly. This can occur following seizures, particularly generalized tonic clonic (aka grand mal) seizures. In the United States alone, SUDEP is estimated to claim nearly 2,000 lives per year. Any knowledge we can shed on the causes of this dreaded phenomenon will hopefully help us to one day prevent it from ever occurring again.
Right now, Iím exploring brain oxygenation changes that occur during and after seizures. Weíll be looking at this in patients with convulsive seizures who are admitted to our Epilepsy Monitoring Unit (EMU) at UC Medical Center. Patients with seizures are admitted to that specialized unit to learn more about their seizures (e.g., where in the brain they may be starting). Such knowledge can potentially allow us to offer them additional antiseizure therapies (such as epilepsy surgery) when antiseizure drugs are not enough to control their epilepsy. The current project will use adhesive pads placed on either side of the forehead to look at brain oxygenation using infrared light. We anticipate that we will see temporary but significant drops in brain oxygenation during and after certain types of seizures (particularly grand mal seizures) that carry the highest risk of SUDEP. If true, our findings may shed more light on the reasons why people die of SUDEP and allow us to design better ways to screen for those at highest risk.
How will your discoveries impact patient care?
Understanding more about the autonomic effects of seizures and how they relate to the risk of SUDEP will hopefully allow us to one day identify people with seizures who are at greatest risk for this dreaded phenomenon. Once we can do that, we will hopefully be able to prescribe individualized therapies to patients to help reduce that risk as much as possible.
The current project involving brain oxygenation will hopefully lead to such discoveries. In addition, after seizures, many patients note temporary but significant problems with memory (postictal amnesia). Following recorded seizures in our EMU, we will be administering a memory test to patients monitored with the brain oxygenation pads. We anticipate that those patients with the highest drops in brain oxygenation will also have the most significant problems on the memory testing. This will suggest a direct link between the two. Equally excitingly, a preliminary study that I did in patients with convulsive seizures suggested that such seizures were reliably preceded by significant increases in brain oxygenation (prior to the drops during the actual seizures). If this is confirmed in our larger study, it may allow us to design new technologies to accurately predict seizures. Such knowledge would allow patients and caregivers to potentially take extra medications to stop seizures before they occur or (at the very least) take precautions to minimize harm should the seizure still happen.
What keeps you motivated to do your research?
When I was in fellowship, I cared for a patient who died from likely SUDEP. It occurred shortly after he underwent epilepsy surgery to try and get rid of his intractable complex partial seizures and grand mal seizures. Unfortunately, based on our current (limited) knowledge of SUDEP, there was truly nothing we could have done back then to prevent this death other than try and get the best control of his seizures possible. Iím hopeful that, by continuing to research this topic, weíll be able to one day find tools (such as the infrared blood flow pads) that help us to identify those at greatest risk of SUDEP. Hopefully, this will also allow us to design interventions tailored to such patients to prevent SUDEP.
What do you like to do in your spare time?
I have to admit that Iím a bit of a foodie. I was worried when I moved here from Los Angeles that I wouldnít be able to indulge this hobby any more. However, Iíve been pleasantly surprised by the number of dining options that Cincinnati has to offer. A friend recently took me to Over-the-Rhine, and I was in foodie heaven. My favorite place thus far has to be Bakersfield (the short rib tacos alone are worth the trip). Iím really looking forward to exploring the rest of what OTR and Cincinnati in general have to offer.