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All patients are graded in categories of those with the most severe obstruction of the carotid artery, those with middle degree obstruction, and those with very small obstruction. Two weeks ago, following an analysis of the data, we had to stop the trial. We could no longer ethically continue the trial. The upper third of patients, those with severe occlusion, had such remarkable positive results from surgery, we could no longer permit patients not to have surgery. Four hundred thousand physicians were informed overnight that the patients who were in the trial and their own patients, with 70 percent or more obstruction, should now be seriously considered for surgery to prevent stroke. It was unethical to go any further.

PREPARED STATEMENT

I use this as some of the real live examples of the Decade of the Brain and what we have to look forward to in the next 842 years of this remarkable opportunity that the Congress has given the people of the United States.

I would be delighted to try to respond to your questions, sir.
The statement follows:)

STATEMENT OF DR. MURRAY GOLDSTEIN
Each year, more people are hospitalized in the United States with besin

and other neurological disorders than with any other major disease group.

Fortunately, steady progress during years of broad-based support for basic and clinical neuroscience research has brought us to a threshold; a threshold in which knowledge of the brain and nervous system can be turned into

significant benefit for the millions of Americans who live with, or are at

risk for, a neurological or neuromuscular disorder. During the past year, the National Institute of Neurological Disorders and Stroke (NINDS), the

Federal agency with lead responsibility for research and training to understand and treat brain and neuromuscular disorders, announced important

clinical findings which already are having important impact on patients with stroke, spinal cord injury, Parkinson's disease, Gaucher's disease, and febrile seizures. With encouragement from Congress and input from patients,

voluntary groups, and scientists and physicians concerned with nervous system diseases, the National Advisory Neurological Disorders and Stroke Council has

prepared an "Implementation Plan for the Decade of the Brain" that

crystallizes the specific areas ripe for further progress in understanding,

preventing, and treating brain, other neurological, and neuromuscular

disorders.

During the Decade of the Brain, the Institute will emphasize efforts to understand and treat the injured brain and spinal cord--resulting from trauma

or disease. We are beginning to move beyond symptomatic treatment into ways to actually intervene and arrest or even reverse the underlying disease

processes. There exists a window of minutes to days after an initial injury in which damaged nerve cells may be salvaged with timely and appropriate

treatment, and additional, secondary damage prevented. With acute spinal

cord injury we have an eight-hour span during which high doses of

methylprednisolone--costing about $100--can prevent secondary injury and save

the teenager injured in a diving accident from lifelong neurological

disability. This finding was announced in March of 1990. High dose

methylprednisolone is now being rapidly integrated into practice as the

treatment of choice for acute spinal cord injury; treatment by emergency

medical teams soon after an accident is becoming more common.

Plans are

undervay to evaluate whether longer treatment with methylprednisolone or the use of a different steroid may provide even greater benefit. This year, NINDS is establishing a pilot program of regional clinical research centers

fo: head and spinal cord injury. These centers will develop improved

therapies, promote research on restoration and preservation of function after injury, and provide the environment necessary for the recruitment and

training of investigators for research on central nervous system trauma.

The

regional centers will add an important dimension to the NINDS research effort

in 1992 to improve the outcome for many of the estimated 10,000 Americans who

will have a spinal cord injury and the 500,000 who will experience a head

injury.

NINDS scientists and grantees are pursuing other avenues to "tease out" the various chenicıl and cellular events triggered by injury to the nervous system and devise methods to block or enhance nerve cell activity for therapeutic effect. For instance, in stroke patients, damaged nerve cells can spilt out dangerous levels of excitatory anino acids and produce toxic

supercharged molecules of oxygen known as free radicals. The next step is to evaluate promising agents to neutralize these chemicals and prevent the progression of stroke. Research studies are also defining the role of free

radicals in Parkinson's disease and also the damaging interaction between

free radicals and blood vessels in the brain that can result from seizures.

Investigators are pursuing recent evidence that suggests the same mechanism

to secrete excitotoxins my be at work in head injury and aeuro-AIDS.

Greater atteation can now be given to study of the selective vulnerability and degeneration of nerve cell populations. Our laptitute's

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research objective is to prevent brain cell degeneration or arrest it in the very earliest stage of diseases such as Alzheimer's disease and Parkinson's

disease. Aged, nonhuman primates are an important research model for

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Alzheimer's disease, helping to elucidate the development of nerve cell

abnormalities and the deposition of amyloid protein in the plaques

characteristic of this disease.

New genetic studies, neurochemical studies,

and the development of advanced imaging methodologies are being emphasized to

shed more light on the fundamental cause of Alzheimer's disuse. The long

tera effects of deprenyl and the value of tocopherol--o component of vitamin

E--in combination with deprenyl to treat people with Parkinson's disease are

being evaluated in an ongoing clinical trial. Study of tissues from people

with amyotrophic lateral sclerosis, or Lou Gehrig's disease, has provided a

lead to evaluate the use of branched-chain amino acids for this disease.

One third of the people who will have a stroke this year will become

permanently disabled: stroke is the most common cause of disability requiring

rehabilitation.

The NINDS research effort on stroke will be enriched by a

newly established intramural program.

We also have ongoing clinical trials

to evaluate clot-dissolving agent g--CPA and heparinoids--for their

effectiveness in limiting brain damage from ischemic stroke.

We are working

with a time-frame of only 90 minutes to three hours to determine whether tPA

must be given as an emergency measure in order to be effective.

Studies are

also underway to elucidate risk factors and prevent stroke in those people at

risk for an initial insult or recurrence.

Within the past year, the NINDS

found that aspirin and warfarin were so effective in preventing stroke in

people with atrial fibrillation that as many as 30,000 people could be spared

from a stroke this year, at a potential health care savings of $200 million.

Early results from another, ongoing study have related ethnic differences in

risk factors to differences in stroke type and outcome.

NINDS has revised

and reissued a program announcement to encourage new studies in Blacks, other

minorities, and women to improve our understanding of different risk factors

and types of stroke in various populations.

Intramural scientists using magnetic resonance imaging (MRI) have

evidence that multiple sclerosis (MS) progressively attacks the central

nervous system even when patients may be relatively symptom-free. This finding will change the way many patients are treated, especially in the

early stages of the disease.

In other work, intramural and extramural

investigators are deciphering the immunologic processes related to MS and

exploring new forms of treatment such as the possibility of a T-cell vaccine.

At a minimum, 25 percent of all genetic disorders affect the brain and

rervous system, some estimate that there are neurological consequences in

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neurofibromatosis I (NF-1) gene has been located on chromosome 17; ongoing

research will clarify the gene's normal function and its role in the symptoms

of NP-1 and other di

rders of cell growth such as cancer.

Scientists are

closing in on the genetic basis of some forms of epilepsy. Intramural investigators are refining the optimal dose for enzyme replacement therapy in

Type 1 Gaucher's disease while continuing the development of methods to

repair or replace the defective gene. Dystrophin research has unexpectedly revealed that other genes may be producing proteins that can "pinch hit" for

dystrophin and mitigate the symptoms of muscular dystrophy. Both genetic

linkage studies and studies of cell biochemistry are probing independently the underlying causes of the various types of Batten', disease. In other

studies, researchers are working to isolate and sequence the gene for the

animal model of narcolepsy. While investigators continue work to localize the genetic defect in Huntington's disease (HD), research to determine the physiologic defect and possible therapies has progressed; preliminary efforts

are underway to test the efficacy of a drug called idebenone to protect at

risk brain cells. Transgenic nice are also being developed as a genetic

model for HD--an invaluable tool for the expected wave of new studies once

the gene is found.

An estimated 10 to 15 percent of all children have mild cognitive

deficits or learning disabilities. This year, an estimated 9,000 babies will

develop cerebral palsy and several thousand more babies and children will

have to live with--or die from--the neurological consequences of their

mother's drug abuse.

An ongoing multidisciplinary study to develop,

standardize, and validate a uniform classification system for the diagnosis

of children with higher cortical dysfunctions will facilitate research.

Improved treatments for epilepsy in the pediatric age group are a priority

for the Institute.

As evidenced by the advances and initiatives described here, we cannot separate progress in prevention, treatment, and diagnosis from the importance

of basic neuroscience research. Neurochemistry and neurobiology are

providing important leads to understand cognition and behavior.

NINDS

grantees recently found that one possible mechanism for strengthening long

term neural interactions appears to be the ability of the sending cell in

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