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LONDON, ON - The ability of humans to use language may also be what puts us at the unique risk of developing psychosis, a subset of mental illness characterized by changes in emotions, impaired functioning, and a disconnection from reality. 

Difficulties with communication – both the ability to use language and to comprehend what others are saying – are some of the earliest symptoms. New research from Western University and Lawson Health Research Institute has shown that this may be because in patients with psychosis parts of the brain not meant to process language are trying to perform this complex job. Like a small airport trying to handle all the air traffic from a big hub like Pearson International Airport, some brain regions may be overloaded in psychosis.  

“The language system seems to be key to understanding this illness,” said Dr. Lena Palaniyappan, the Tanna Schulich Chair in Neuroscience and Mental Health at Western’s Schulich School of Medicine & Dentistry and Scientist at Lawson and Robarts Research Institute. “We don’t yet fully understand how the disorganization of language takes place in patients affected by psychosis.” 

Embarking on a mission to find out, Dr. Palaniyappan worked with a team of imaging scientists at Robarts to perform MRI scans on the brains of patients with acute psychosis. Patients were recruited from the Prevention and Early Intervention Program for Psychoses (PEPP) at London Health Sciences Centre, a flagship clinic that supports young individuals from a very early stage of psychosis. 

The team divided the patients into two groups – those with severe language disturbances, and those whose language symptoms were less pronounced. They found that both groups had weakening of connectivity, or ‘hubness,’ in the part of the brain generally associated with language -- the superior temporal area. The group with more severe language symptoms also showed an emergence of higher hubness in some unexpected regions of the brain that may be compensating for some of the lost connectivity elsewhere. 

“This finding led us to believe that the language problems may occur because the main hubs that are supposed to conduct language are now retired, and so these peripheral hubs, which have no business of orchestrating language as their main function, are picking up the job and aren’t doing it very well,” said Dr. Palaniyappan. 

The researchers hope that by understanding how language becomes disorganized in psychosis, the data can inform new interventions to focus on strengthening the language systems in the brain to reduce or delay psychotic symptoms.  

Using ultra-high-field magnetic resonance imaging at Robarts Research Institute, they were able to look at the entire brain of patients with acute psychosis. Instead of homing in on one specific area, the team looked at 3-D pixels of the brain (voxels) to get a full picture of what was happening in the whole brain and how different areas were interacting. 

Using the airport analogy, Palaniyappan said that if they had only looked at the language area it would have been like only walking into one airport, and not understanding how the reduced traffic in that airport was influencing the air traffic at other surrounding airports. 

“We went in without any expectations, and searched the whole brain,” said Palaniyappan. “This unique approach allowed us to get a picture of the forest rather than a picture of the tree.” 

The study was funded through an early-career foundation grant from the Canadian Institutes of Health Research and was supported by PEPP. 

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LONDON, ON – A new study published in The Lancet Oncology suggests that a very precise, high-dose form of radiotherapy called stereotactic ablative radiotherapy (SABR) may be a new treatment option for patients with inoperable kidney cancer. Lawson Health Research Institute was one of 12 participating centres from around the world with patients recruited from London Health Sciences Centre’s (LHSC) London Regional Cancer Program (LRCP). 

The analysis, among the first to look at the long-term impact across multiple centres, included 190 patients with primary renal cell carcinoma, the most common type of kidney cancer. It found SABR to be effective and safe with a low rate of cancer recurrence and acceptable impact on renal function. Five years after treatment, kidney function was largely maintained and only 5.5 per cent saw their cancer return in the treated kidney.

SABR directs highly accurate and intense radiation to eradicate tumours while limiting the impact on surrounding tissues. The treatment is offered to patients who are unable or unwilling for various reasons to have surgical treatment.

Previous studies on the use of SABR for primary renal cell carcinoma have been encouraging, but this publication represents the first report of long-term follow-up from a large, international group of patients. 

“This study suggests that the positive outcomes seen in our prior studies are long-lasting,” says Dr. Rohann Correa. “It shows that this non-invasive treatment is worthy of further clinical study in patients with kidney cancer.”

Dr. Correa, a Lawson Scientist and Radiation Oncologist at LHSC, says this study was the result of many years of international collaboration.

“The International Radiosurgery Consortium of the Kidney (IROCK) brought together global experience with this completely non-invasive, pioneering way to treat localized kidney cancer,” Dr. Correa explains. “Our study has shown that at five years, this technique appears to be safe and effective, giving us confidence to launch clinical trials that provide patients access to this promising treatment.”

The study was led by Dr. Shankar Siva, a Radiation Oncologist at the Peter MacCallum Cancer Centre in Australia. Dr. Siva and Dr. Correa’s teams are part of the collaborative IROCK group whose members include Surgical Oncologists and Radiation Oncologists from around the world. The team at Lawson and LHSC was a key contributor to this high-profile study, with local patients participating in the study and all international data housed and analyzed through Lawson.