Early in his medical training, Sarosh Irani, B.M., B.Ch., D.Phil., met a patient who would change the course of his career. The woman, in her mid-30s, arrived at the hospital confused, trembling and wracked by seizures. She was losing her memory and her ability to walk. Yet unlike many with such severe neurological decline, she recovered completely.

Her turnaround came after the clinical team discovered a particular antibody in her blood — proof that her immune system had attacked her brain. When they suppressed that immune response, her symptoms disappeared. The discovery not only changed that woman's life but also opened a window into a new, potentially reversible, facet of medicine — one in which the immune system itself could explain devastating brain diseases.

That revelation propelled Dr. Irani into a field that bridges neurology and immunology, one that continues to expand today from his laboratory at Mayo Clinic in Florida.

A burgeoning field

Dr. Irani's first passion was psychiatry. "I wanted to understand disorders of the mind," he recalls. But he found that the field lacked the molecular footholds that could make its mysteries scientifically tractable. “You couldn't put your hands on the biology,” he says. "There were too many inferences and not enough mechanisms."

He turned to neurology just as scientists were discovering that neurological conditions could, in fact, be autoimmune diseases.

Dr. Irani joined, and subsequently led, the University of Oxford's autoimmune neurology lab, where he helped identify several antibodies that define distinct syndromes — including the antibodies LGI1 and CASPR2, now standard diagnostic markers for treatable forms of various autoimmune neurological conditions.

"What was once a medical curiosity has become a thriving field," says Dr. Irani, who came to Mayo Clinic in 2023. "Twenty years ago, there were no known antibodies affecting the brain. Now we know 20 or 30 such antibodies, and each one represents a potential cure."

Toward Precure

For Irani, these discoveries connect directly to Mayo Clinic's Precure initiative, which aims to predict and prevent disease before symptoms appear. "There are very few examples in medicine where we have a tractable handle on what's causing the disease," he explains. "Here we know the antibodies cause the disease. So the question is simple: How and why are they made? If we can work out causation, we can get close to pre-cure."

His lab is tackling that question through two complementary approaches: exploring patients' genetic predispositions and studying their immune cells. One variant, for example — in an HLA gene involved in presenting proteins to the immune system — appears in more than 90 percent of patients with a particular autoimmune neurological condition.

But genes alone do not tell the whole story. Irani suspects that environmental triggers, such as infections or even medications, act as the final push. "It's likely a multi-hit process," he says. "You need the gene, a misbehaving immune cell and an environmental spark."

His lab is studying patients' own immune cells to trace where this autoimmune process begins. Evidence increasingly points to the periphery, not the brain, as the starting point. That idea is supported by emerging research on the brain's lymphatic drainage system, which helps clear waste and immune molecules.

Early clues to autoimmunity

Recently, Dr. Irani and colleagues showed that biomarkers of neurodegeneration can be detected in the lymph nodes of the neck. These lymph nodes drain byproducts and proteins resulting from brain activity via a network of tiny lymphatic vessels.

Using ultrasound-guided fine-needle aspiration — a quick sampling technique similar to drawing blood — the team measured several proteins including amyloid beta and tau, proteins that build up in Alzheimer's disease, as well as other markers of brain cell health. They found that almost all of these proteins were found in much higher quantities in the lymph nodes than in the blood, especially one called phosphorylated tau (pTau181), which was 266 times more concentrated.

Strikingly, pTau181 levels in lymph nodes decreased with age, suggesting that the brain's ability to clear toxic proteins through lymphatic drainage declines over time — potentially contributing to diseases like Alzheimer's. The discovery also challenges one of medicine's oldest assumptions: that the brain is "immune-privileged" and largely sealed off from the body's immune system.

"This is the first direct evidence that brain proteins accumulate in cervical lymph nodes in living people," says Dr. Irani. "It opens up a minimally invasive way to study how the brain clears waste — and how that process falters with age."

Lymph node aspiration is far less invasive than spinal taps, yet it could offer powerful insight into brain health, aging, and disease progression.

Brain on fire

Dr. Irani's research has come full circle with a new study in The Lancet Psychiatry. The research focuses on patients with autoimmune encephalitis — a condition popularized by the book and movie "Brain on Fire"— whose illnesses often first appear to be psychiatric. The work shows that these patients can be distinguished from others by a simple scoring system based on how rapidly symptoms appear and how they evolve.

"It's a mixture of symptoms — depression, anxiety, psychosis, sleep and eating disturbances — all unfolding over days," he says. "If clinicians recognize that pattern early, we can treat it before irreversible brain injury occurs."

Current therapies for autoimmune encephalitis rely on broad immunosuppression — powerful drugs that quiet the entire immune system and leave patients vulnerable to infection. Dr. Irani envisions a more refined approach that involves the selective silencing of only the harmful immune cells while preserving the rest.

"We want to pick off just the bits causing trouble," he says. "If we can identify exactly what the immune system is attacking, we can teach it tolerance only to that target."

That vision, he believes, could extend to other conditions where the immune system plays a role, potentially informing treatments for dementia, cancer and even common psychiatric disorders. "We're trying to translate these observations to more widespread diseases," he says. "There's enormous potential."

The post Mayo Clinic researcher redefines the brain’s immune connection appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have developed and tested a new 3D surface scanning approach that gives neurosurgeons even greater precision when operating deep inside the brain.  

The system aligns a patient's head, facial features and surgical head frame with brain images, achieving sub-millimeter accuracy — a level of precision that can make a critical difference in delicate procedures. 

In a feasibility study published in the Journal of Neurosurgery, the 3D scanning method proved more accurate than the CT scan typically used during neurosurgery, all while eliminating exposure to radiation.  

Researchers say the approach could make complex procedures, such as deep brain stimulation, drainage and biopsies safer and more efficient, while enhancing patient comfort. Because it integrates with most surgical navigation systems, it may also bring high-precision guidance to operating rooms that don't have a CT scanner. 

How the new 3D approach works 

Using cameras and structured-light scanning, the new system creates high-resolution 3D models of the patient's face and the surgical frame that keeps the head still. It merges these images into a detailed spatial “map” of the patient's position in the operating room. That map is then matched with pre-surgery brain scans, such as MRI or CT images, giving surgeons precise, real-time guidance to reach the exact target in the brain.  

In the study, the system's computer analysis aligned images with an average precision of 0.14 millimeters — compared with about 0.20 millimeters typically achieved with CT scans. The difference is roughly the width of a pencil tip, but in delicate brain surgery, that fraction can be enough to affect accuracy. 

Teamwork behind the breakthrough 

The project combined Mayo Clinic's engineering and surgical expertise. Jaeyun Sung, Ph.D., a Mayo Clinic computational biologist, clinical AI researcher and corresponding author, led the engineering and computational work. Dr. Sung focuses on using engineering and computer science to develop advanced precision medicine tools for patient care.  

"When engineers and neurosurgeons look at the same challenge, we see different details, and that's where breakthroughs can happen," Dr. Sung says. "This is about building the next generation of surgical tools that bring engineering-level, sub-millimeter precision directly into the operating room." 

Kendall Lee, M.D., Ph.D., a Mayo Clinic neurosurgeon, led the surgical integration of the technology and said it could make a real difference for patients and improve his practice.  

"Some of the most important steps in neurosurgery happen before we even begin the operation," Dr. Lee says. "This new 3D scanning method is safe, quick and cost-effective, and it can help us hit the right target more accurately, improving how we care for patients."  

Basel Sharaf, M.D., D.D.S., a Mayo Clinic surgeon and lead author of the study, sees even greater possibilities ahead for the technology.  

"In the future, 3D surface scanning could be as simple as using a smartphone," Dr. Sharaf says. "With advanced AI, the system could adapt in real time, even predicting small shifts in the brain to help surgeons work with greater accuracy and a smoother workflow."  

Next Steps: Advancing automation, AI and clinical validation

The team is now working to add automation and artificial intelligence to help make the process faster and easier to use. They are also testing new hardware and running a larger clinical trial to further evaluate the technique's effectiveness in brain surgery.  

Review the study for a complete list of authors, disclosures and funding.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Tia Ford, Mayo Clinic Communications, newsbureau@mayo.edu 

The post Mayo Clinic researchers develop 3D scanning approach for ultra-precise brain surgery  appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Clinicians typically classify meningiomas — the most common type of brain tumor — into three grades, ranging from slow-growing to aggressive.

But a new multi-institutional study suggests that appearances may be deceiving. If a tumor shows activity in a gene called telomerase reverse transcriptase (TERT), it tends to recur more quickly, even if it looks low-grade under the microscope.

The findings, published in Lancet Oncology, could significantly change how doctors diagnose and treat meningiomas.

"High TERT expression is strongly linked to faster disease progression," says Gelareh Zadeh, M.D., Ph.D., a neurosurgeon at Mayo Clinic and senior author of the study. "This makes it a promising new biomarker for identifying patients who may be at greater risk of developing aggressive disease."

This research was presented at the Society for Neuro-Oncology conference on Nov. 22.

"This is one example of how precision diagnostics of cancer may ultimately improve patient outcomes," says Kenneth Aldape, M.D., Mayo Clinic pathologist and study co-author.

An early warning sign

Meningiomas — tumors of the meninges, the protective tissue that surrounds the brain and spinal cord — are generally considered benign. But a small subset of these tumors has a mutation in the TERT gene, which is linked to faster growth and a shorter time before the tumor returns after treatment.

TERT is the active part of telomerase, an enzyme that maintains telomeres, the protective ends of chromosomes. In most healthy adult cells, TERT is switched off. But if it becomes switched back on, it can fuel cancer development by driving unchecked cell growth.

In this study, the researchers wanted to see whether high TERT expression, even in the absence of the TERT genetic mutation, also predicted worse outcomes. They looked at more than 1,200 meningiomas from patients across Canada, Germany and the U.S., and they found that nearly one-third of them had high TERT expression despite not having the mutation.

These patients had earlier tumor regrowth compared to those without TERT expression, though their outcomes were better than patients with full-blown TERT mutations.

"TERT-positive tumors behaved like they were one grade worse than their official diagnosis," says Dr. Zadeh. "For example, a grade 1 tumor with TERT expression acted more like a grade 2."

Guiding treatment decisions

The findings suggest that testing for TERT activity could help doctors predict which patients are at higher risk for recurrence and may need closer monitoring or more intensive treatment.

"Because meningiomas are the most common primary brain tumor, this biomarker could influence how thousands of patients are diagnosed and managed worldwide," says Dr. Zadeh.

"TERT expression can help us more accurately identify patients with aggressive meningiomas," Chloe Gui, M.D., a neurosurgery resident at the University of Toronto, Mayo Clinic research collaborator and the study's lead author, explains on a podcast hosted by The Lancet Oncology. "This information allows us to offer treatment tailored to the tumor's behavior."

The team is currently investigating ways to incorporate TERT expression into the clinical workflow. The research is part of a larger effort at Mayo Clinic called the Precure initiative, focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions.

Review the study for a complete list of authors, disclosures and funding. 

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post New genetic biomarker flags aggressive brain tumors appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have developed a new, personalized approach to deep brain stimulation (DBS) for people with drug-resistant epilepsy. By mapping each patient's unique brain wave patterns, the method allows physicians to target the precise area in the brain where stimulation is most effective, moving beyond the traditional one-size-fits-all approach.

DBS involves implanting electrodes in the brain to deliver electrical pulses that help prevent and control seizures. While effective, DBS is typically administered with electrodes placed in the same brain region across most patients. Mayo Clinic physician-scientists are now tailoring the treatment to an individual's seizure network before DBS placement.

"Our unique approach aims to tailor neuromodulation for each patient," says Nick Gregg, M.D., a Mayo Clinic neurologist and lead author of a paper published in the Annals of Neurology. "We're moving away from one-size-fits-all to an individualized approach that maximizes seizure network engagement to better modulate abnormal brain wave activity."

Once researchers identify the specific area in the thalamus — a small relay hub deep within the brain — that connects to a patient's seizure network, they can fine-tune stimulation settings for that individual. Because seizures occur infrequently, clinicians analyze erratic brain wave patterns that signal abnormal activity.

"We're trying to disrupt the pathological hypersynchrony and reduce network excitability to lower seizure risk," says Dr. Gregg.

Ten patients received this personalized approach while being evaluated for epilepsy surgery. The next phase of research will follow those who have since received permanent DBS implants using this personalized approach.

"The long-term goal is to quiet the seizure network, so it is eventually forgotten. Reorganizing the neuronal network could move us beyond controlling seizures to actually curing epilepsy."

This research is part of Mayo Clinic's Bioelectronic Neuromodulation Innovation to Cure (BIONIC) initiative, which unites clinical insight with cutting-edge engineering to deliver novel diagnostics and therapies. Through intellectual property development, strategic partnerships and patient-centered trials, BIONIC transforms innovation into impact — advancing care for complex neurological conditions.

Dr. Gregg's research was supported by the Tianqiao & Chrissy Chen Institute. Review the study for a complete list of authors, disclosures and funding.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Tia Ford, Mayo Clinic Communications, newsbureau@mayo.edu

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ROCHESTER, Minn. — Mayo Clinic researchers have developed a new tool that can estimate a person's risk of developing memory and thinking problems associated with Alzheimer's disease years before symptoms appear. The research, published in The Lancet Neurology, builds on decades of data from the Mayo Clinic Study of Aging — one of the world's most comprehensive population-based studies of brain health.

The study found that women have a higher lifetime risk than men of developing dementia and mild cognitive impairment (MCI), a transitional stage between healthy aging and dementia that often affects quality of life but still allows people to live independently. Men and women with the common genetic variant, APOE ε4, also have higher lifetime risk.

Predicting Alzheimer's disease

Alzheimer's disease is marked by two key proteins in the brain: amyloid, which forms plaques, and tau, which forms tangles. Drugs recently approved by the Food and Drug Administration remove amyloid from the brain and can slow the rate of disease progression for people with MCI or mild dementia.

"What's exciting now is that we're looking even earlier — before symptoms begin — to see if we can predict who might be at greatest risk of developing cognitive problems in the future," says Clifford Jack, Jr., M.D., radiologist and lead author of the study.

The new prediction model combined several factors, including age, sex, genetic risk as associated with APOE genotype and brain amyloid levels detected on PET scans. Using the data, researchers can calculate an individual's likelihood of developing MCI or dementia within 10 years or over the predicted lifetime. Of all the predictors evaluated, the brain amyloid levels detected on PET scans was the predictor with the largest effect for lifetime risk of both MCI and dementia.

"This kind of risk estimate could eventually help people and their doctors decide when to begin therapy or make lifestyle changes that may delay the onset of symptoms. It's similar to how cholesterol levels help predict heart attack risk," says Ronald Petersen, M.D., Ph.D., neurologist and director of the Mayo Clinic Study of Aging, who is a co-author of the study.

The research stands apart because it draws from the Mayo Clinic Study of Aging, a long-running effort in Olmsted County, Minnesota, that tracks thousands of residents over time. The analysis for this study included data from 5,858 participants. Unlike most studies, Mayo researchers are able to continue following participants even after they stop actively taking part, using medical record data — ensuring nearly complete information about who develops cognitive decline or dementia.

"This gives us a uniquely accurate picture of how Alzheimer's unfolds in the community," says Terry Therneau, Ph.D., who led the statistical analysis and is the senior author of the study. "We found that the incident rate of dementia was two times greater among the people who dropped out of the study than those who continued to participate."

The study elevates the significance of MCI, which is the stage targeted by current Alzheimer's drugs that slow but do not stop progression.

While the new tool is currently a research instrument, it represents a major step toward more personalized care. Future versions may incorporate blood-based biomarkers, which could make testing more accessible.

The work was supported by the National Institute on Aging, the GHR Foundation, Gates Ventures and the Alexander Family Foundation.

The research is part of a larger effort at Mayo Clinic called the Precure initiative focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions.

"Ultimately, our goal is to give people more time — time to plan, to act and to live well before memory problems take hold," says Dr. Petersen.

Review the study for a complete list of authors, disclosures and funding.

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Tia Ford, Mayo Clinic Communications, newsbureau@mayo.edu

The post Mayo Clinic scientists create tool to predict Alzheimer’s risk years before symptoms begin appeared first on Mayo Clinic News Network.

November is Epilepsy Awareness Month

PHOENIX — Medication has long been the cornerstone of treatment for people with epilepsy, but it doesn't stop seizures for everyone and may come with significant side effects. New options in use or under development include devices and gene and cell therapies aimed at resetting or rehabilitating the brain circuits that cause seizures, explains Dr. Jonathon Parker, a neurosurgeon at Mayo Clinic in Phoenix and director of the Device-Based Neuroelectronics Research Lab.

The objective is a personalized approach that provides patients with the safest, most effective treatment options for them, Dr. Parker says.

"Epilepsy on its own is very impactful on quality of life. You have these intermittent, unpredictable events or spells — electrical storms in the brain — that can affect your ability to communicate and control your body. Often, people lose consciousness," he says. "It's a really challenging disease to live with."

Medication controls seizures in many patients, but it can come with side effects such as sleepiness, cognitive changes, mood changes and a feeling of mental fogginess, further affecting quality of life, Dr. Parker explains.

Epilepsy is one of the world's most common neurological diseases. Roughly 50 million people have it, global statistics show. It can affect anyone of any age. Possible causes include genetics, brain damage, brain tumors, stroke and other blood vessel diseases, and some infections. Often, the cause of a person's epilepsy remains unknown.

"In up to one-third of patients with epilepsy medications eventually fail to control seizures," Dr. Parker says. In those cases, surgery to remove or ablate the part of the brain causing seizures has typically been the next option explored, he adds. In ablation, laser energy is channeled to disable epileptic tissue.

"However, there has been a paradigm shift and now we have new options to try to electrically rehabilitate abnormal circuitry that's causing seizures, a type of treatment called neuromodulation," Dr. Parker says. "And we're investigating regenerative therapies to try to get to the root cause and repair the brain at the cellular or molecular level rather than remove brain tissue or reset the brain."

Neuromodulation

Using deep brain stimulation techniques, neuroscientists at Mayo Clinic are looking for early signals in the brain to help stop seizures. In their biomarker discovery initiative, a team of researchers assesses how different stimulation patterns affect different parts of the brain.

"We're looking for that brain signal fingerprint that yes, these are the right stimulation settings that are pushing the brain toward a state where seizures are less likely," Dr. Parker says. "For patients having multiple attacks, sometimes per day or per week, if we're able to dramatically reduce them, it allows them to live their life in a much more predictable fashion, easier for them to do the things that they like to do in life without having to live in fear of these uncontrolled neurological attacks."

Deep brain stimulation involves implanting electrodes in the brain that produce electrical impulses to treat certain medical conditions, such as epilepsy. The team includes engineers, clinicians and neuroscientists who analyze the brain's electrical signals and extract meaning for the right settings for an individual patient's deep brain stimulation device.

Neural cell therapy

Dr. Parker and colleagues are studying cell-based therapies to help the brain restore its ability to regulate its electrical activity.

"You can think of epilepsy at some level as a disorder of abnormal regulation of brain neurons. In a healthy brain, some things excite the brain, and some things inhibit the brain. There's a never-ending balance of exciting neurons and quieting neurons down that allows the brain to function normally," he explains.

In people with epilepsy, the brain sometimes loses interneurons, the neurons that slow things down.

"You have this tendency for neurons to get very excited and then draw other neurons into that, creating a rhythmic electrical activity in the brain known as a seizure," Dr. Parker says.

The idea behind cell therapy is to transplant interneurons into the area of the brain affected by epilepsy, the temporal lobe, so the interneurons persist and help to restore the normal balance, he says.

Gene therapy

Dr. Parker is co-leader of a Mayo research team investigating potential gene therapy for epilepsy.

The approach in gene therapy is to look at specific ion channels or proteins in cells that control whether a cell is going to be active or inactive, he explains. In epilepsy, some of those gatekeepers do not work normally.

"They open and close incorrectly, or they stay open or close too long. Neurons get excited, and that excitement spreads in an uncontrolled fashion and a seizure happens," Dr. Parker says.

The team is studying the use of an adenovirus, a common virus in the body, to deliver therapy to reduce the activity of genes in the part of the brain where seizures are coming from, he says. 

"The options that we have are changing," Dr. Parker says. "They're improving year after year."

For more information about innovations in epilepsy care, visit mayoclinic.org.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Innovation in epilepsy care: Alternatives to medication seek to reset, repair brain, expert explains appeared first on Mayo Clinic News Network.

World Heart Day is September 29

ROCHESTER, Minn. — You may have heard of the mind-body connection: the broad concept that  thoughts and feelings, especially those related to stress, can influence physical health. Mohamad Alkhouli, M.D., an interventional cardiologist at Mayo Clinic in Rochester, Minnesota, is researching the relationship between the brain and the heart. Each can have a powerful impact on the other, Dr. Alkhouli explains.

"The mind-heart connection is part of the broader mind-body relationship, but it’s uniquely powerful. Emotional states like anxiety, grief, or even joy can directly influence heart rhythms, blood pressure, and even the risk of heart attacks," Dr. Alkhouli says. "At the same time, the heart sends signals back to the brain through nerves, hormones, and pressure receptors — affecting our mood, attention, and stress levels. So, it’s not just the brain talking to the heart; the heart talks back."

Conditions with a brain-heart connection include spontaneous coronary artery dissection (SCAD) and stress-induced cardiopathy (SICM), also known as broken heart syndrome. Both conditions can result from stress. Dr. Alkhouli has been part of Mayo Clinic research teams exploring aspects of each.

Broken heart syndrome often is sparked by stressful situations and extreme emotions; it briefly interrupts the way the heart pumps blood. People experiencing it may have sudden chest pain and think they're having a heart attack.

The tools typically used to screen for heart attacks cannot identify when broken heart syndrome is actually the cause of a patient's chest pain. In most cases, invasive coronary angiography is required to differentiate SICM from myocardial infarction due to coronary obstruction. Mayo research found that a novel technology called magnetocardiography, which measures magnetic fields generated by the heart, can help identify broken heart syndrome. 

Another Mayo study suggests that SCAD, a type of heart attack that often results from physical or emotional stress, can be a secondary event instigated by broken heart syndrome.

In broken heart syndrome, the heart's temporary weakening doesn't happen evenly: Some parts of the heart fail to contract well, while others work harder to compensate, Dr. Alkhouli says. This uneven motion creates twisting forces on the heart muscle. 

"Because the coronary arteries, the main blood vessels that supply blood to the heart, sit on top of the heart, they can be stretched or stressed at the junctions between these overactive and underactive areas during broken heart syndrome," he explains. "In some cases, this stress may cause a tear in the artery wall, what we call SCAD."

A question still to be answered is why some people develop broken heart syndrome after emotional trauma while others do not, Dr. Alkhouli notes.

Emotional stress also can increase the risk of other heart conditions, such as:

• High blood pressure, also known as hypertension.
• Heart disease.
• Atrial tachycardia.
• Bradycardia.

"What fascinates me most is how deeply intertwined our emotional and cardiovascular systems are, and how much we still don't understand," Dr. Alkhouli says. "Could we one day 'rewire' this connection for healing, using therapy, neuromodulation (alteration of nerve activity at targeted sites in the body by electrical or chemical means), or even digital tools? At Mayo Clinic, we're exploring these questions, and we're beginning to see the heart and brain not as separate organs, but as a single, dynamic network."

That network works in both directions. Dr. Alkhouli is part of Mayo's Heart Brain Clinic, where cardiologists and neurologists work together to evaluate patients who may have neurological symptoms that can be attributed to a cardiac event.

In these patients, the heart and brain are closely linked, such as strokes caused by clots that form in the heart, known as cardioembolic strokes. The causes of a transient ischemic attack, a short period of stroke-like symptoms, may include a blood clot that moves from another part of the body, such as the heart, to an artery that supplies the brain. The heart condition atherosclerosis, the buildup of fats, cholesterol and other substances in and on the artery walls, can also lead to a transient ischemic attack.  

More research is needed to better understand how to harness the mind-heart connection for disease prevention and healing. There are steps you can take now for your mental health that will benefit your heart, and things you can do for your heart health that will benefit your brain, Dr. Alkhouli says.

"The good news is that what's good for your mind is often good for your heart, and vice versa," he explains. That includes:

• Managing stress.
• Getting quality sleep.
• Staying socially connected.
• Practicing mindfulness or prayer.

"All have measurable benefits for heart health," Dr. Alkhouli says. "Likewise, regular physical activity, a heart-healthy diet and controlling blood pressure and cholesterol can boost mood and cognitive function. It's a powerful feedback loop: Caring for one supports the other."

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post The brain-heart connection: Mayo Clinic expert explains powerful tie that works both ways appeared first on Mayo Clinic News Network.

Before the sun rises at his home near Orlando, Florida, Rakesh Parekh, M.D., is already making the most of the day. He reviews patient notes and exercises before joining his wife, Tejal Parekh, in preparing their children for school. Time means a great deal to Dr. Parekh.

In 2020, he was diagnosed with amyotrophic lateral sclerosis (ALS) after muscle weakness began to affect his movement. ALS is a nervous system disease that affects nerve cells in the brain and spinal cord. Worsening over time, ALS affects control of the muscles needed to move, speak, eat and breathe.

Watch: Dr. Rakesh Parekh's story

Journalists: Broadcast-quality video pkg (2:16) is in the downloads at the end of the post. Please courtesy: "Mayo Clinic News Network." Read the script.

"You get this diagnosis, and, you know, within three to five years, you're no longer," says Dr. Parekh.

He was familiar with the disease long before his own diagnosis.

"My father lived with ALS," says Dr. Parekh. "I know time is of the essence."

Initially working with a care team closer to home, Tejal and Dr. Parekh were determined to find a way forward to preserve his quality of life and possibly help others, including their children, who have a chance of inheriting the gene mutation. The couple began messaging physicians, researchers and friends around the world. That's when they learned about the work of Dr. Bjorn Oskarsson, a Mayo Clinic neurologist.

"Dr. Oskarsson was recommended to us by a friend, and it was like finding a diamond in the rough," says Tejal Parekh.

A personalized approach

Dr. Oskarsson and colleagues at Mayo Clinic have spent their careers looking for answers and options for people diagnosed with ALS. A multidisciplinary care team met with Dr. Parekh in May 2021 and began tests to determine the best way forward.

"We worked with our outside partner to develop an individualized treatment made just for him," says Dr. Oskarsson.

The therapy aims to stop protein production by targeting the gene mutation and halting the progression of the disease. After nearly two years of testing and preparations, Dr. Parekh's first treatment was an injection in his spine in April 2024.

"He is the first person in the world to have received this treatment," says Dr. Oskarsson.

He would repeat the trip from Orlando to Jacksonville for the next two months, then placed on a three-month dosage.

"More than just ourselves, this would be a step forward for all the other people getting diagnosed with ALS; it would be something for them, hope," says Tejal.

One year after treatment started, the results are exciting to the Parekhs and Dr. Oskarsson.

"This is something that is truly new, and one day we will get there for everyone," says Dr. Oskarsson. "And when that happens, there's nothing that compares. It's a beautiful thing."

Back home, Dr. Parekh reflects on how this treatment has changed his outlook. His 25 years working in healthcare did not prepare him for what it would be like to receive care, let alone a therapy that may benefit his children one day.

"Not only has it made an impact on our lives, but honestly, it's made an impact on the way I practice because I realize now what patients need beyond healthcare," says Dr. Parekh.

The post (VIDEO) Florida dad receives first-in-world ALS treatment appeared first on Mayo Clinic News Network.

When Dr. Bobby Mukkamala found himself on the other side of the exam table, he relied on the cutting-edge surgical techniques at Mayo Clinic to get him back to his professional work. 

While presenting at a professional meeting, Dr. Bobby Mukkamala, normally an eloquent speaker, began speaking incoherently for about 90 seconds. 

"Given my age of 53 at the time, I thought it was a 'senior moment,'" says Dr. Mukkamala, an otolaryngologist and head and neck surgeon from Flint, Michigan. 

His colleagues suspected he was having a stroke and convinced Dr. Mukkamala to go to a nearby emergency department for evaluation. Doctors suggested he may have had a transient ischemic attack, or ministroke. They recommended an MRI when he returned home.

That scan revealed something far more serious: a brain tumor. His journey as a patient had begun — and it would ultimately lead him to Mayo Clinic. 

Finding the right brain cancer care

After sharing the news with his family, Dr. Mukkamala tapped into his professional network. "Within a week of my diagnosis, I had half a dozen Zoom calls with neurosurgeons around the country," he says. "They were all wonderful with similar but slightly different perspectives on how to approach my case."

One call, however, stood out — his conversation with Dr. Ian Parney, (pictured here) a neurosurgeon at Mayo Clinic in Rochester, Minnesota and member of Mayo Clinic Comprehensive Cancer Center.

Dr. Parney knew the tumor was large, complex and near critical speech areas in the brain. "It was important to Dr. Mukkamala to protect those areas," says Dr. Parney.   

Unlike other surgeons who recommended two brain surgeries, Dr. Parney recommended a single awake craniotomy with speech mapping. During the procedure, the patient answers questions, and brain activity is monitored. This helps surgeons avoid damaging parts of the brain responsible for speech. His extensive experience — about 200 similar brain tumor procedures per year — gave hope to Dr. Mukkamala that the single operation was the best choice.

"Dr. Parney spent time answering every question we had," Dr. Mukkamala says. "That is what healthcare should be. As soon as we got off the call, my wife and kids said, 'That's it. That's where you're going.'"

Using advanced surgical techniques to guide care

In December 2024, Dr. Mukkamala underwent an awake craniotomy with speech mapping. The surgical team also used an intraoperative MRI. This advanced imaging technique provides real-time, high-resolution MRI scans while the surgery is in progress. 

"We do an MRI during the procedure to get the most accurate image so that we can remove the tumor safely," says Dr. Parney. Integrating functional imaging into image-guided systems in the operating room is a technique that Dr. Parney's team develops and tests to improve patient safety. He also correlates these techniques with novel strategies such as intraoperative electrophysiological mapping (using electrodes or electrical simulation to identify and preserve functions) and fluorescence-guided resection.

In Dr. Mukkamala's case, as part of the speech mapping, Dr. Nuri Ince, a professor of neurosurgery and biomedical engineering at Mayo Clinic, provided a novel electrocorticography technique that showed critical areas of function without requiring direct cortical stimulation (electrical signals to the brain's outer layer), as is usually necessary.

Dr. Parney and his colleagues were able to remove more than 90% of Dr. Mukkamala's tumor without damaging the speech areas. Six weeks after surgery, he was once again speaking professionally and confidently to large groups.

Coordinating multidisciplinary cancer care

Dr. Mukkamala's cancerous brain tumor was a low-grade IDH-mutant astrocytoma. This type of brain tumor arises from astrocytes (a type of glial cell in the brain) and carries a mutation in the IDH (isocitrate dehydrogenase) gene. 

After surgery, Dr. Mukkamala met Dr. Ugur Sener, a neuro-oncologist at Mayo Clinic, who prescribed a new targeted drug to treat any remaining cancerous cells. The less toxic therapy allowed Dr. Mukkamala to avoid chemotherapy and radiation, which are standard treatments for brain cancer that can cause side effects such as fatigue and nausea. 

"We've built one of the largest brain tumor practices in the world here at Mayo," Dr. Parney says. "We have the right resources and the right teams in place to provide cutting-edge therapies and holistic care."

Bringing new 'tumor wisdom' to the bedside

While his life today looks much like it did before his diagnosis, Dr. Mukkamala says his perspective is forever changed by his experience. "I used to be more science than emotion, but I've learned there's room for both," he says. 

Dr. Mukkamala was alone when he received the news that he had cancer, much like most of his patients were when he delivered hard news. "It never occurred to me before that it was a problem to share a diagnosis when a patient was alone," Dr. Mukkamala says. He now tries to ensure his patients have support. 

It's one of the many lessons he attributes to "tumor wisdom." "My brain may be a little smaller," says Dr. Mukkamala, "but I think it's happier and wiser."

The post How advanced surgical skills returned a physician to the podium after brain cancer appeared first on Mayo Clinic News Network.

On this week's episode of Tomorrow's Cure, we explore brain-computer interfaces (BCIs), cutting-edge technologies that create direct communication pathways between the human brain and external devices. Once considered science fiction, BCIs are now transforming lives. 

The podcast episode features Dr. Jonathon Parker, epilepsy and functional neurosurgeon, assistant professor of neurosurgery and neuroscience, and director of the Neuroelectronics Research Lab at Mayo Clinic; and Dr. Allen Waziri, neuroscientist and neurosurgeon, and CEO and co-founder of iCE Neurosystems. Together, they discuss the science behind BCIs, current medical applications and the transformative possibilities they hold for the future.

BCIs offer groundbreaking possibilities in the treatment of neurological disorders, with the potential to restore mobility, communication and independence to people affected by severe neurologic injuries or conditions. Already, this technology is enabling users to control prosthetic limbs and digital interfaces through brain activity.

"The brain is a piece of hardware; the brain-computer interface is another piece of hardware we are connecting to the brain," says Dr. Parker. "We are used to communicating through speech, movement, understanding other sensory inputs, right? So this is digitizing those inputs to solve a problem." 

"BCIs, for several decades, is the translation of those electrical potentials that are coming off of the brain into something that we can understand on a computer side that will then functionalize whatever device — a robotic arm, a cursor on a screen, drive a wheelchair, so on and so forth," says Dr. Waziri.

BCIs are being used to assist people with neurological injuries that impair speech or movement. However, experts believe this technology has far greater potential. Beyond restoring motor function, BCIs could pave the way for continuous neurological monitoring and new forms of intervention, opening doors to transformative applications in brain health.

Dr. Parker emphasizes the broader clinical implications of the technology. "When delivered to clinicians so they can just monitor the brain signals overtime, (it) could have tremendous impact for epilepsy, depression, Alzheimer's — these conditions which are affecting huge swaths of our population. That's the future of this technology," he says. 

Don't miss this thought-provoking conversation on the evolving science of BCIs and the remarkable innovations that could redefine human-machine interaction. Listen to the latest episode of Tomorrow's Cure, and explore the full library of episodes and guests at tomorrowscure.com.

The post Tomorrow’s Cure: Mind meets machine — the future of neurological care appeared first on Mayo Clinic News Network.