Gowers Researchers: Where Are They Now?

By Sylvia Blair
Epilepsy USA staff
Posted: July 23, 2003

The William R. Gowers Clinical Research Fellowship is awarded annually to a physician-scientist who is embarking on a career in academic clinical medicine and who wishes to undertake a specific project in epilepsy research.

This article takes a look into the research paths of two Gowers fellows, the first recipient in 1986 and a more recent recipient in 2001, to learn how the Gowers award has shaped their career paths and deepened their understanding of epilepsy.

Christopher M. DeGiorgio, M.D.

When Christopher M. DeGiorgio, M.D., received a Gowers fellowship in 1986, he had never done research in epilepsy before. His Gowers-funded study of the neuropathology of status epilepticus, or non-stop seizures, literally started his career in epilepsy.

At the time, DeGiorgio was a fellow at the West Los Angeles Veterans’ Administration Hospital and at the University of California, Los Angeles School of Medicine.

For his project, he studied the brains of people who had died from repetitive seizures. “I performed the first quantified study of neuronal densities, or the number of neurons in the hippocampus,” said DeGiorgio. “I used a grid to count the neurons in the brains of people who died of status epilepticus and of people who died suddenly of other causes.

“I found that in the population that died of status, there was a severe loss of neurons compared to matched and normal controls. This confirmed earlier animal studies,” he continued.

“The significance of my research is that it showed that status causes severe brain injury in humans,” DeGiorgio said.

His research led to the development of a new chemical marker called “neuron specific enolase.” He used this chemical marker to study whether survivors of status sustain brain injury. He found the chemical marker is seriously elevated in survivors of status, again showing that status can cause brain injury.

“The importance of this research is that we learned epilepsy is not a benign condition. Repetitive seizures have serious effects, and we need to be more aggressive in their treatment,” DeGiorgio said.

Today, DeGiorgio is executive vice chairman of UCLA Neurology, Department of Neurology, UCLA School of Medicine.

He is now working on a novel therapy for epilepsy. It is a new form of electrical stimulation to stop seizures called “trigeminal nerve stimulation.” In this therapy, electrical stimulation is applied to a nerve in the face to control seizures.

“We are working on adhesive electrodes and an implantable device that are in the research and development stages. The first patients are reported in the August 2003, issue of the journal Neurology,” DeGiorgio said. “The significance of this treatment is that the patch electrodes are a low-cost, non-invasive new treatment.”

How did receiving the Gowers award shape DeGiorgio’s career in epilepsy? “That first grant gave me confidence in my clinical research, and it gave me exposure to the best epilepsy specialists in the world,” he said.

“In the future, I see the research community putting more emphasis on genetics. I also see promise for more new electrical devices for the control of epilepsy.”

Heidi E. Majors, M.S., M.D.

Although Heidi E. Majors, M.S., M.D., was already doing epilepsy research when she received the 2001 Gowers award, the fellowship allowed her to focus on a special interest — surgery for epilepsy.

At the time, she was a researcher at Johns Hopkins University in Baltimore.

Majors’ project was to study how to precisely pinpoint the area of the brain that is causing seizures before a person becomes a candidate for epilepsy surgery.

“Before we consider a person for surgery, we have to make sure that removing a piece of the brain would not cause problems with other functions, like problems talking or problems with weakness on one side of the body,” said Majors.

“Surgeons map out brain functions by using direct cortical stimulation. They put electrodes on the surface of the brain and pass a small electrical current that turns off part of the affected part of the brain. This lets the surgeon predict what happens if that area is cut out. This is temporary and completely reversible,” Majors said.

“But there is a problem with this method. The stimulation can cause small seizures. We also have a timing issue because electrodes can only stay in so long,” Majors said.

“An alternative is to produce a map of the brain without stimulation by studying brain waves. We know that when brain waves change, certain areas of the brain are being used. So we ask the patient to do a task, and we use the brain wave changes to create a map,” Majors said.

“Before we use this method clinically, we have to prove this method is just as good. My study compared both maps after surgery, to see which map was more accurate,” Majors said.

Today, Majors is assistant professor of Neurology in Residence at the University of California, San Francisco Epilepsy Center.

She is currently researching cognitive functioning in patients before and after epilepsy surgery. Her interest is in “social cognition,” a term that describes facial emotional perception and non-verbal aspects of speech, like tone of voice.

“This is important for interpersonal communication and sensitivity in relationships. We want to know if epilepsy surgery impacts these areas. That’s because most of the research to date has studied surgery’s impact on language and motor skills, but social cognition has not received much attention,” Majors said.

The Gowers award has shaped Majors’ career because she said it gave her more time to pursue her special interests. “Through this experience, I was able to create my own unique niche and take it forward into new directions. Now that I am at the next step of my career, I have written a new grant application to the National Institutes of Health for further funding,” Majors said.

What is the future of epilepsy research, in her opinion? “I’m excited because I believe there will be more large-scale collaborations among scientists to develop large databases of clinical information in search of better treatments,” Majors said.

Gowers fellowships have been supported by grants from Abbott Laboratories since 1986.

About William R. Gowers (1845-1915)

The William R. Gowers Clinical Research Fellowship is named in honor of William R. Gowers, a British physician who was one of a small group of brilliant neurologists who, towards the end of the nineteenth century, led the way to a new understanding of the brain and epilepsy.

His book, Epilepsy and Other Chronic Convulsive Diseases, published in 1881, and his subsequent lectures and writings, are generally cited as marking the beginning of modern concepts of epilepsy, its causes, symptoms and treatment.

In addition to teaching and writing, Gowers spent most of his professional life treating patients in London’s National Hospital for the Paralyzed and Epileptic (now the National Hospital, Queens Square).

He was a clinician, a physician-scientist, a man whose careful observations, supported by data, and principles of patient care and management exemplify the characteristics that the Epilepsy Foundation and Abbott Laboratories hope to cultivate in the recipients of the William R. Gowers Clinical Research Fellowships.