Researcher

My Expertise

peripheral neuropathy, multiple sclerosis, neuromuscular disease

Fields of Research (FoR)

Neurology and Neuromuscular Diseases, Neurosciences, Peripheral Nervous System

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Biography

Our goals

We have a specific interest in peripheral neuropathy that occurs in the context of diseases of high global prevalence including diabetes, kidney failure, obesity and cancer. Our research is patient focused and interdisciplinary. We have a diverse range of expertise in areas such as neurology, neurophysiology, vision science, metabolic medicine and mathematical modelling.

Our novel multidisciplinary program of research in multiple...view more

Our goals

We have a specific interest in peripheral neuropathy that occurs in the context of diseases of high global prevalence including diabetes, kidney failure, obesity and cancer. Our research is patient focused and interdisciplinary. We have a diverse range of expertise in areas such as neurology, neurophysiology, vision science, metabolic medicine and mathematical modelling.

Our novel multidisciplinary program of research in multiple sclerosis (MS), focuses on exploring the basis of common MS symptoms such as vision changes, fatigue and sleep disturbance. We have recently commenced studies to develop new ways of monitoring inflammation in MS patients,  analysing the impact of disease modifying treatments through confocal imaging of the cornea in people with MS and analysis of neuropeptide levels in the tear film.

Our vision science programme has recently expanded to migraine, focusing on ocular surface changes. In the world, migraine is the eighth leading cause of disability years lost, and the leading cause of disability days lost among people under 50. The crosstalk between migraine processes and those affecting the ocular surface is not well understood, but physiological pathways may overlap. To better monitor and manage chronic migraine, we aim to expand our understanding of the connection between ocular surface disease and migraine.

Research strengths

  • Neurophysiology and nerve excitability assessment.
  • Corneal confocal microscopy and tear neuropeptide assays.
  • Peripheral nerve ultrasound

Our results

  • Clinical trial demonstrating a neuroprotective effect of dietary potassium restriction in kidney disease.
  • Discovery of diagnostic role of nerve ultrasound in diabetic neuropathy.
  • Clinical trial demonstrating benefit of potassium channel blockers on walking distance in multiple sclerosis.
  • Clinical study demonstrating that diabetic neuropathy can influence both the corneal nerves and the neuropeptides they release into the tear film.
  • Clinical study demonstrating that the neurotoxic effects of chemotherapeutic drugs are also evident in the cornea and tear film.

 

PERIPHERAL NEUROPATHY RESEARCH

Our major area of interest is in peripheral nerve disease. We undertake detailed studies using neurophysiological techniques that provide novel insights into the causes of peripheral nerve injury that are of highest global prevalence. This includes nerve injury due to diabetes, renal impairment and toxin exposure, including chemotherapeutic agents. Our studies of neuropathy focus on the development of novel biomarkers that can detect nerve injury at an early stage. We are also undertaking a number of clinical trials of neuroprotective agents that may help prevent or treat nerve injury. These strategies have been developed using data generated from our own studies of disease pathophysiology.

Diabetic neuropathy

Diabetes affects approximately 1.2 million Australians and is frequently complicated by a debilitating form of neuropathy termed diabetic neuropathy. Diabetic neuropathy typically begins with symptoms such as pain, tingling and numbness and can lead to ulceration and in more severe cases amputation. At present there is no cure and standard clinical neurological assessments are unsatisfactory for detecting early changes. Our studies have focused on biomarkers of nerve dysfunction in this cohort. We have utilised neurophysiological and morphological techniques to identify early nerve dysfunction in patients with diabetes. Further to this, our investigations have indicated that in type 1 diabetes, the form of insulin administration may have an impact on neuropathy development. We are building upon these studies by undertaking a clinical trial of neuroprotective treatments for diabetes in addition to uncovering new therapeutic targets for prevention of complications.

Neuropathy in chronic kidney disease

Chronic kidney disease (CKD) is a serious condition that affects 1.7 million Australians. Our studies have demonstrated that nerve injury (neuropathy) occurs in ~80% of CKD patients. We have identified that high levels of potassium cause nerve injury in CKD and that dietary potassium restriction may help prevent neuropathy progression. 

Chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a major side effect in the treatment of cancer, affecting up to 40% of cancer survivors. This can impose limitations on the patient to perform common ADLs and reduce their quality of life.

Common symptoms of CIPN include:

  • Numbness
  • Tingling, ‘pins and needles’ or electric shock-like sensations
  • Burning sensations, sharp or stabbing pain
  • Balance problems

We are currently conducting studies that investigate the impact of CIPN on cancer survivors. These studies utilise new methods and techniques used to assess and diagnose the impact of CIPN, with an emphasis on nerve function, sensation and dexterity.

MULTIPLE SCLEROSIS RESEARCH

We have an extensive programme of clinical research in multiple sclerosis (MS), which is the most prevalent cause of non-traumatic neurological disability in young Australians. We are currently investigating the causes of fatigue in MS and have ongoing studies that explore the potential utility of novel medications for motor fatigue in MS. We are also involved in research that investigates the potential contribution of sleep-disordered breathing to fatigue in MS. 

Broad Research Areas:
Neurology, Neuroscience, Clinical Research, Diabetes, Renal Disease, Multiple Sclerosis, Cancer

Qualifications:
MBBS, PhD, FRACP

Specific Research Keywords:
Neurology, Neurophysiology, Ion Channels, Corneal Confocal microscopy, Cancer, Multiple Sclerosis, Renal Disease, Diabetes and Endocrinology

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Location

(1)Prince of Wales Clinical School, Edmund Blacket Building,Prince of Wales Hospital, Avoca Street, Randwick
(2)Department of Neurology, Prince of Wales Hospital, Sydney Ph: (02) 93822414;


Contact

+61 2 9382 2414
93822428

Research Activities