2023 Department of Neurology Annual Report : simplebooklet.com

2023 Annual Report IU School of Medicine Department of Neurology2Communications Manager: Ben Middelkamp Designer: Stephanie JohnsonPhotographer: Tim Yates TABLE OF CONTENTSLETTER FROM THE CHAIR ................................................. 3DEPARTMENT NEWS ..................................................... 4Achievements and Leadership updates ....................................... 4Long Lectureship ........................................................... 5New Faculty Members ...................................................... 675TH ANNIVERSARY ...................................................... 8Department Chairs ......................................................... 8Subspeciality Programs .................................................... 10CLINICAL CARE ......................................................... 14Mobile Stroke Unit ........................................................ 15Alzheimer’s Disease Treatment ............................................. 16ALS Gene Therapy ........................................................ 18Parkinson’s Disease ....................................................... 20Pediatric Epilepsy Program ................................................. 22Duchenne Muscular Dystrophy Therapy ..................................... 23RESEARCH ............................................................. 25LEADS Alzheimer’s Disease Research ....................................... 26Indiana Alcohol Research Center ............................................ 28Neurology Clinical Trials ................................................... 29Neuromuscular Disorders Research ......................................... 30Faculty Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31EDUCATION ............................................................ 33Education News and Fellowships ............................................ 34Residents and Fellows ..................................................... 35FACULTY ............................................................... 36PHILANTHROPY ......................................................... 38

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IU School of Medicine Department of Neurology 2023 Annual Report 3Colleagues,Since joining the Department of Neurology at Indiana University School of Medicine in October 2020, it has been a pleasure for me to watch the continued growth that is reected in this annual report. Our research studies, education program and patient care is regularly recognized at a national level, and I couldn’t be prouder of our talented faculty and trainees who make this happen.Our department celebrated 75 years in 2023, and we’ve dedicated a special section of the report to this rich history. The department has had a strong clinical teaching identity from its inception. Our leading educators in neurology have inspired many medical students at IU School of Medicine to become neurologists. Over the past several decades, our department has been home to nationally recognized clinical and research experts in Alzheimer’s disease and related dementias, neuroinfectious diseases, neuromuscular disorders, stroke, epilepsy, movement disorders, neuroimmunology and neurotoxicology. Our training of general neurologists was recently recognized by the American Academy of Neurology (AAN) with a panel to discuss the training program.We are strong in research in dementias, neuromuscular disorders, epilepsy, movement disorders, neuropsychology, pediatric neurology and stroke. Our department is home to the nation’s most comprehensive longitudinal study of early-onset Alzheimer’s disease as well as innovative investigations in a wide array of therapeutic areas that are supported by federal grants from the National Institutes of Aging, Neurological Disorders and Stroke, and Alcohol Abuse and Alcoholism, as well as the National Science Foundation. Our dynamic subspecialty programs are ranked 18th among all neurology departments in the country, according to the Blue Ridge Rankings. Faculty are also investigators in more than 80 clinical trials in our robust clinical research program.Our education program includes the training of medical students, residents, fellows, PhD candidates and postdoctoral fellows. The IU School of Medicine, one of the largest medical schools in the country, has nine campuses, and the neurology clerkship across all campuses is coordinated through the academic department to ensure the equivalent education in neurology at all sites. This has resulted in the continuation of one of the highest percentages of medical students choosing to go into neurology. Our adult and child residency training programs have grown to match 10 adult neurology residents and 2 pediatric neurology residents a year. We also share support of the neurodevelopmental disability residency program in the Department of Pediatrics. Besides these strong programs, we also have ACGME fellowships in clinical neurophysiology and vascular neurology, and non-ACGME fellowships in neuro-ophthalmology, behavioral neurology and movement disorders. Our faculty clinicians are focused on better understanding neurological conditions in children, adolescents and adults to improve prevention and treatment outcomes for a variety of disorders. In 2023, our clinicians performed more than 45,000 adult patient visits and nearly 14,000 child patient visits. Represented in the academic department are clinical sections in general adult and pediatric neurology, epilepsy, dementia, neuropsychology, headache, movement disorders, multiple sclerosis and neuroimmunology, neuroinfectious disease, neuromuscular disorders, neuro-oncology, neurotoxicology, sleep disorders and stroke. Neurology is housed in a state-of-the-art neuroscience hub, where patients have access to multi-disciplinary clinical care. The site is connected to a neuroscience research building, facilitating collaboration between clinicians and preclinical scientists.We invite you to learn more about our department and distinctive collaborations that uniquely position our faculty and trainees to make a lasting impact in the lives of patients.Sincerely,Laurie Gutmann, MDChair, Department of NeurologyCo-director, IU School of Medicine-IU Health Neuroscience InstituteLETTER FROM THE CHAIRLaurie Gutmann, MDChair, Department of NeurologyCo-director, IU School of Medicine-IU Health Neuroscience Institute

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2023 Annual Report IU School of Medicine Department of Neurology4Lifetime AchievementJohn C. Kincaid, MD, the Kenneth L. and Selma G. Earnest Professor of Neurology, received the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) 2023 Lifetime Achievement Award. The award, given to Kincaid for his lifelong dedication to research, patient care, advocacy, and education, is the highest honor bestowed by AANEM, and is given to members who are recognized as major contributors in the elds of neuromuscular disorders and electrodiagnostic medicine. Kincaid embarked on his professional medical journey at Indiana University School of Medicine, where he completed his medical degree, internship and neurology residency. During his second year of residency, the chair of the department of neurology at the time recognized a need for someone with specialized fellowship-level training in electromyography (EMG). Encouraged by the chair, Kincaid pursued a fellowship in EMG at Mayo Graduate School of Medicine in Rochester, Minnesota, then returned to his roots in Indiana and dedicated his career to the advancement of neuromuscular disorders and electrodiagnostic medicine. Kincaid continues to serve as an attending neurologist for patients with neuromuscular disorders, is in the EMG lab each week, and is involved with education of medical students, neurology and physical medicine and rehabilitation residents, and neurophysiology fellows. He also served as the medical expert for disability cases for the Social Security Administration for 35 years.Medscape Video SeriesMedscape, a website with access to medical information for clinicians and scientists, featured IU School of Medicine faculty and sta and their leading role in researching Alzheimer’s disease. Liana Apostolova, MD, MS, an Indiana University Distinguished Professor and the Barbara and Peer Baekgaard Professor in Alzheimer’s Disease Research, and Jared Brosch, associate professor of clinical neurology, spoke about the complexities of the disease as well as their ongoing research and the few treatment options being investigated and administered at IU.Neuroscience Institute LeadershipThe Neuroscience Institute, a partnership between IU School of Medicine and IU Health, draws on the longstanding national and international reputation of top talent and collaboration at the medical school and health system to further the advancements in disorders of the nervous system. The institute is developing multi-disciplinary centers of excellence to promote patient care, clinical research, bench research and education. Laurie Gutmann, MD, chair of neurology, is a co-director of the institute, alongside Bruce Lamb, PhD and Mitesh Shah, MD. Neurology faculty have a key role in the growth of the Neuroscience Institute. Donna Wilcock, PhD, the Barbara and Larry Sharpf Professor of Alzheimer’s Disease Research, is the director of the Center for Neurodegenerative Disorders. Richard Scheer, assistant professor of clinical neurology, is the interim director of the Center for Neurovascular Disorders.Centers of ExcellenceThe Department of Neurology is home to several centers of excellence and care centers designated by highly regarded foundations and associations. Our specialists are among the top experts in the nation for treating complex neurologic disorders for adults, children and adolescents at clinical care facilities in downtown Indianapolis and the surrounding suburbs. • Parkinson’s Foundation Center of Excellence • Huntington’s Disease Society of America Center of Excellence • Muscular Dystrophy Association (MDA) Care Center • Parent Project Muscular Dystrophy (PPMD) Center of Excellence • ALS Care Center • Epilepsy Level 4 Center • Comprehensive Stroke CenterDEPARTMENT NEWS

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2023 Annual Report IU School of Medicine Department of Neurology6Neurology adds 8 new faculty members in 2023Katie Hutchins, MDAssistant Professor of Clinical NeurologyDr. Hutchins is an adult neurologist specializing in clinical neurophysiology with a focus on epilepsy and EEG. She practices predominantly at Eskenazi Health. She completed her medical degree, residency in adult neurology, and clinical neurophysiology fellowship at IU School of Medicine. Her clinical and research interests are in the elds of global and public health. She is the team leader for the Department of Neurology’s global neurology program, working alongside other universities within the IU-led AMPATH (Academic Model Providing Access to Healthcare) consortium.Makram Obeid, MDAssistant Professor of NeurologyDr. Obeid is a physician-scientist specializing in pediatric epilepsy. He investigates the mechanisms of epileptogenesis in animal seizure models with the goal of discovering novel treatments. Dr. Obeid obtained his medical degree from the American University of Beirut and completed a residency in Child Neurology at Columbia University Medical Center in New York and a fellowship in Pediatric Epilepsy at Boston Children’s Hospital, Harvard. As the director of the Pediatric Comprehensive Epilepsy Program at Riley Children’s Health, he works with a multidisciplinary team to improve the quality of life of children with epilepsy. Dr. Obeid also serves as an investigator in the Stark Neurosciences Research Institute. His laboratory investigates the mechanisms of seizure emergence and the accompanying cognitive and behavioral decits in animals.Patricia Olson, MD, PhDAssistant Professor of NeurologyDr. Olson is a physician-scientist who specializes in headache medicine, with headache fellowship training from the Graham Headache Center at Mass General Brigham and Harvard Medical School. She received her adult neurology residency training from the University of Kentucky College of Medicine. In her headache clinic, Dr. Olson sees a wide range of headache disorders including migraine, cluster headache, trigeminal neuralgia, and post-concussive headache. She has a particular interest in treating refractory headache disorders including refractory migraine. Dr. Olson is also a neuroscientist, earning her PhD at Northwestern University. Her doctoral research focused on dopamine modulation in the basal ganglia, which led to a collaboration with colleagues that yielded a publication in Science. Dr. Olson’s experience in researching neural networks and second-messenger systems informs her approach to and study of various headache conditions.Katie Hutchins, MD Makram Obeid, MDPatricia Olson, MD, PhD Patricia Garcia, PsyDChelsea Schmoll, DOJessica Win, MDErica Weekman, PhDDonna Wilcock, PhD

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IU School of Medicine Department of Neurology 2023 Annual Report 7Patricia Garcia, PsyDAssistant Professor of Clinical NeurologyDr. Garcia is a clinical neuropsychologist who specializes in the neurocognitive and psychiatric assessment of adult populations. Prior to her appointment at IU School of Medicine, she worked as a sta neuropsychologist and was an adjunct clinical professor of physical medicine and rehabilitation at the Rehabilitation Hospital of Indiana. Clinically, Dr. Garcia evaluates a variety of adult patient populations who present with acquired and neurodegenerative diseases that aect cognition and personality. Her research interests include cognitive aging after a brain injury, neuropsychiatric sequelae following brain lesions and cultural adaptations of psychological/behavioral interventions for neuropsychiatric symptoms in adult populations. She went to Albizu University-Miami campus for her doctoral degree in clinical psychology with a focus in neuropsychology. She completed her residency in neuropsychology at the University of Miami Leonard M. Miller School of Medicine and Jackson Memorial Hospital, where she received extensive training on the neurocognitive assessment of trauma populations, including brain injury and stroke.Chelsea Schmoll, DOAssistant Professor of Clinical NeurologyDr. Schmoll is a neurologist with subspecialty training in neuroimmunology. Dr. Schmoll’s expertise lies in treating various neuro-immunologic disorders including multiple sclerosis, neuromyelitis optica spectrum disorder, MOG antibody associated disease, autoimmune encephalitis and neurologic manifestations of systemic autoimmune and inammatory disease. Dr. Schmoll attended medical school at Marian University College of Osteopathic Medicine in Indianapolis, graduating in 2018. She completed her residency training at IU School of Medicine, graduating in 2022. Following the completion of her residency, Dr. Schmoll completed a one-year transition to practice fellowship in neuroimmunology with IU School of Medicine.Erica Weekman, PhD Assistant Research Professor of NeurologyDr. Weekman focuses her research on hyperhomocysteinemia- induced vascular contributions to cognitive impairment and dementia (VCID), as well as the role of astrocyte end feet in Alzheimer’s disease and VCID. Dr. Weekman obtained her graduate and postdoctoral training at the Sanders Brown Center on Aging at the University of Kentucky. While there, she studied the comorbidity of VCID and Alzheimer’s disease and the eects of this comorbidity on the ecacy of anti-amyloid beta immunotherapies. Her research transitioned to focus on the role of astrocyte end feet and matrix metalloproteinases in hyperhomocysteinemia induced VCID. Her research interests also extend to the eects of VCID and hyperhomocysteinemia on the retina and vision. Dr. Weekman works with Donna Wilcock, PhD, who has multiple projects and research interests relating to amyloid related imaging abnormalities (ARIA) and anti-amyloid beta immunotherapies as well as the role of angiogenic factors like PlGF in VCID.Jessica Win, MDAssistant Professor of Clinical NeurologyDr. Win is a general child neurologist who enjoys seeing children of all ages for concerns not limited to but including headaches, seizures/epilepsy, movement disorders, developmental delay, and neurocutaneous disorders. She is originally from Springeld, Ohio. She went to the University of Cincinnati for medical school, and she completed a Child Neurology Residency in Jacksonville, Florida, with The Mayo Clinic and a Pediatrics Residency with UF-Jacksonville. Dr. Win practiced for the rst three years of her career at Children’s Hospital of Colorado before nding her way back to the Midwest.Donna Wilcock, PhDBarbara and Larry Sharpf Professor of Alzheimer’s Disease ResearchDr Wilcock is a professor of neurology and Director of the Center for Neurodegenerative Disorders in the IU School of Medicine-IU Health Neuroscience Institute. She is also a member of Stark Neurosciences Research Institute and the Indiana Alzheimer’s Disease Research Center. Dr. Wilcock researches the intersection of Alzheimer’s disease and vascular cognitive impairment and dementia. Using mouse models and patient samples, Dr. Wilcock is exploring the role of neuroinammation and dysregulated angiogenesis in VCID. In addition, she has several active projects exploring the underlying mechanisms of beta-amyloid immunotherapy-related ARIA. Her research is funded by the National Institute of Neurological Disorders and Stroke and the National Institute on Aging.

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2023 Annual Report IU School of Medicine Department of Neurology8Alexander Ross, MD (Chair, 1948-1971)Ross began his private practice in neuropsychiatry in Indianapolis in 1940 and was recruited to IU School of Medicine as an assistant professor of neurology by Dr. David Boyd. Boyd, who largely practiced psychiatry, served as the chair of a newly created Department of Neurology and Psychiatry. In 1941, Ross was called into active military duty, serving in Europe during World War II — at which time he ran the only functioning electroencephalography laboratory in the European theater. As a reection of his dedication, service and leadership, in 1945 he was appointed chief of neurology in the division of neuropsychiatry for the United States Army. Following WWII and his military responsibilities, Ross returned to Indianapolis in 1946. Boyd left IU for the Mayo Clinic in 1948, and Alex Ross was appointed Professor and Chair of the Department of Neurology and Psychiatry. Both disciplines grew, but Ross sought to separate the department. In 1952, the university established an independent Department of Neurology. Ross, the only full-time neurology faculty member in 1952, had an immense inuence on the department; residents he trained became future leaders of the department — including Mark Dyken, MD and William DeMyer, MD. Ross was known for his professionalism, his ability to treat patients and trainees with respect and compassion, and for his astute bedside clinical skills. He emphasized the importance of service to others and treasured the opportunity to train and promote the careers of his students, residents and junior faculty. His service-oriented approach to leadership and his attention to the clinical core of neurology have continued to resonate and denes much of what the department has become over time.75TH ANNIVERSARYCelebrating 75 Years of Neurologic Education, Clinical Care and ResearchThe Department of Neurology at Indiana University School of Medicine was established as an independent department in 1952, but its roots go back to 1948 when Alexander Ross, MD, served as the chair of the Department of Neurology and Psychiatry. He was largely responsible for the splitting of the two disciplines and is credited with serving as the leader of neurology at IU School of Medicine for more than two decades. Much of what the Department of Neurology has become can be traced to the vision and philosophy of Ross.William DeMyer, MD, left, collaborates with researchers in a lab at IU School of Medicine.DEPARTMENT CHAIRS

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IU School of Medicine Department of Neurology 2023 Annual Report 975TH ANNIVERSARYMark Dyken, MD (Chair, 1971-1994)Dyken, who trained under Ross, joined the faculty in 1958 and served as chair for 23 years. During that time, the department steadily grew and received recognition for its quality of clinical training for students and residents. Dyken built upon the philosophy of Ross and emphasized the importance of applying scientic methodology to the practice of neurology. Dyken was a champion for prospective controlled clinical trials to establish truth and distinguish what we believe from what we have proven to be true. His expertise in cerebrovascular disease placed IU School of Medicine on the international map regarding advances in the understanding of stroke and stroke management. Dyken was centrally involved with clinical trials of aspirin in demonstrating therapeutic benet in patients with stroke and transient ischemic attack.Jose Biller, MD (Chair, 1994-2003)Biller was the third chair of the department and served in this role for a decade. During this period, he expanded the department and added major subspecialty expertise in movement disorders, neuro-oncology, stroke, epilepsy and multiple sclerosis. Biller was a tireless clinician and remarkable teacher. He led by example. When exploring the department’s acquisition of the private practice group Hoosier Neurology — at the time providing service to Methodist Hospital — there was a need to nd coverage for the holidays, and Biller volunteered to cover the neurology service for Methodist Hospital himself. He was legendary for volunteering to help and invest whatever was necessary for the greater good and benet of the collective. As with his predecessors, Biller emphasized that training and research begins with the patient, and optimal patient care is the backbone of the profession.Robert Pascuzzi, MD(Chair, 2003-2020)As chair, Pascuzzi led the department to meet the institutional needs of merging University Hospital and Methodist Hospital and expanded its clinical footprint. The department also successfully merged and acquired Hoosier Neurology and became the rst clinical department to electively join the clinical service organization called The Indiana Clinic, which later became Indiana University Health Physicians. Under Pascuzzi’s leadership, the department consistently emphasized the commitment for neurological education, and in most years produced the largest number of medical students in the country choosing to train in neurology.Laurie Gutmann, MD(Chair, 2020-present)Gutmann was recruited as chair of the department in October 2020, and she serves in this role today. She has maintained the strengths of the existing department and expanded departmental expertise, emphasized faculty development, provided the leadership for the creation of the IU School of Medicine-IU Health Neuroscience Institute and fueled support and advances in the research mission. Gutmann is nationally recognized for her expertise in clinical trial design.From left to right, Neurology chairs Jose Biller, MD; Alexander Ross, MD; and Mark Dyken, MD.Neurology chairs Bob Pascuzzi, MD and Laurie Gutmann, MD meet up at the American Board of Psychiatry and Neurology.

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2023 Annual Report IU School of Medicine Department of Neurology10NEUROLOGICAL EDUCATION LEADER SPOTLIGHTWilliam DeMyer, MD is the history of neurological education at IU School of Medicine. For decades, he designed and taught the clinical neurology section of the sophomore medical school introduction to clinical medicine course, thereby introducing a plethora of students to the eld of neurology. He wrote a remarkable textbook, “Technique of the Neurological Examination.” He designed and taught the two-month course on clinical neuroanatomy provided to residents in training. DeMyer was the clinician-educator extraordinaire. Much like Ross, he sought no personal attention but dedicated his career to advancing the eld, teaching and promoting the careers of others.NEUROLOGY SUBSPECIALTY PROGRAMSClinical NeurophysiologyDyken gave the responsibility for developing EEG/Epilepsy services to Omkar Markand, MD, a recently appointed faculty member, in 1972. A busy EEG laboratory was already functioning at Riley hospital under the direction of Joseph Green, MD, pediatric neurologist, for several years prior to 1970, serving both adults and children. In the 1970s, not only the EEG fellowship program but also the training of EEG technologists was undertaken after realizing the dire need to have an adequate number of trained EEG technologists for the expanding eld in the state of Indiana. Clinical EEG at IU School of Medicine saw further expansion and progress in the 1990s with the introduction of digital EEG. Evoked potentials in clinical neurology were introduced in 1970s. In 1973, the EEG fellowship program began. Over the next ve decades, the EEG fellowship program has expanded to include training in evoked potentials and electromyography (EMG). Approximately, 100 clinical neurophysiologists — with expertise in EEG and/or EMG — have been trained at IU School of Medicine. The program now has more than 10 board certied clinical neurophysiologists dedicated to the training of future physicians. The one-year fellowship program has established itself as a nationally recognized program enrolling two to three candidates every year.Child NeurologyArthur L Drew, MD was the rst child neurologist at IU School of Medicine and Riley Children’s Health. His tenure as faculty and chief spanned the 1960s and 1970s. DeMyer joined Drew in 1964. The 1970s saw the establishment of Indiana’s rst and only child neurology training program. To date, the program has trained over 30 child neurologists, with the number increasing dramatically in the past 15 years. The program grew from a single annual position to two per year, coinciding with expansion of the neurodevelopmental disabilities training program in the Department of Pediatrics to two residents each academic year. DeMyer and Edward Hodes, MD, PhD from IU Medical Genetics characterized the phenotype of Pelizaeus-Merzbacher disease (PMD). In 1989, their collaboration led to identication of the gene associated with this disorder. For 32 years, Riley Children’s Health has hosted the annual PMD family conference, the largest gathering of families aected with this disorder.After DeMyer stepped down as section chief, he was followed by Bhuwan Garg, MD, Larry Walsh, MD, and the current chief, Christopher Jackman, MD. In 2018-19, the child neurology program split the directorship from the duties of the section chief. This move catalyzed growth in both the clinical and training missions of the section. With this growth, the child neurology section leadership took on a much larger role in the larger neurology department. Today the section consists of 16 faculty, ve APPs, two genetic counselors, seven RNs and 15 additional sta members. This represents more than two-thirds of the child neurologists and 80% of the child neurology advanced practice providers in Indiana.Neuromuscular Disease and EMGDyken was the rst to perform EMGs in the department. He appears to have been self-trained by using information available in textbooks and papers in medical journals. He later wrote several papers on EMG ndings in myotonic dystrophy. Oldrich Kolar, MD, joined the department in 1966 and did EMG studies. He was trained in neurology and neuroimmunology in Europe. In 1978, Dyken approached John Kincaid, MD, who was a second-year resident at the time, about doing a fellowship in EMG after completion of his residency and returning to join the faculty. After residency, Kincaid was accepted into the Mayo Clinic EMG fellowship program for the 1979-1980 term. Following his fellowship in June 1980, Kincaid set up the EMG lab at IU. Two state-of-the-art EMG instruments were purchased. The rst Arthur L. Drew, MD William DeMyer, MD75TH ANNIVERSARYApproximately 100 clinical neurophysiologists — with expertise in EEG and/or EMG — have been trained at IU School of Medicine.

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IU School of Medicine Department of Neurology 2023 Annual Report 11resident rotation began soon after and the rst EMG fellow was appointed for the 1984-85 year.Pascuzzi joined the faculty in 1985 after an EMG fellowship at the University of Virginia. Margaret Laycock, MD, neurology resident and EMG fellow, joined the department faculty in the summer of 1993 and held a major role in teaching. Loretta VanEvery, MD, neurology resident and EMG fellow in 2003-04, was recruited to the Richard L. Roudebush VA Medical Center after several years in private practice and provided a signicant EMG experience for residents. Cynthia Bodkin, MD, was recruited in 2008 and brought expertise in EMG and sleep medicine. Adam Comer joined in 2017 and added ultrasound to the lab. Since then, Laurie Gutmann, MD and Sara Takacs, MD have joined the section. Marcia Felker, MD and Lisa Smith, MD were child neurology residents who stayed at IU for neurophysiology fellowships and perform most of the pediatric studies currently.Dementia and Alzheimer’s DiseaseIn 1985, Hugh Hendrie, MD, Chair of the Department of Psychiatry, and Martin Farlow, MD, faculty in the Department of Neurology, started an Alzheimer’s disease clinic with a supporting administration, social worker and nurse. Farlow led the rst industry supported trial of a drug that was FDA approved to treat Alzheimer’s disease. He led multiple other trials of medications for Alzheimer’s disease with eventual success and approval of four other symptomatic medications. He thereafter has led and contributed to more than 150 other therapeutic trials. In the early 1990s, the National Institute on Aging funded the IU School of Medicine Alzheimer’s Disease Research Center led by Bernardino Ghetti, MD; Farlow was the leader of the clinical core for this center. Over the following decade, Ghetti and Farlow characterized several families with hereditary neurodegeneration dementias. In the last decade, Liana Apostolova, MD, neurology faculty and a leader in neuroimaging biomarker research, was recruited to lead the clinical core of the Alzheimer’s disease center. She later founded and is the principal investigator of LEADS, the largest NIA grant program to study early-onset Alzheimer’s disease in hundreds of participants across the United States. Jared Brosch, MD and David Clark, MD joined the group, adding further expertise in clinical research and clinical care of people with dementia.NeuropsychologyThe department played a pivotal role in the development of the eld of clinical neuropsychology, as one of the eld’s principal founders, Ralph M. Reitan, PhD, began his independent career at IU. Having completed his doctoral studies with Ward Halstead at the University of Chicago in “biological intelligence,” Reitan was appointed as an assistant professor in the Department of Surgery — three years prior to the formation of the Department of Neurology. It was here that Reitan’s systematic research began one of the two dominant approaches to the clinical assessment of brain and behavior: the Halstead Reitan Neuropsychological Battery. Some of the early instruments developed during that period even bear the Indiana name, as in the Reitan-Indiana Aphasia Screening Test, which was used widely by neuropsychologists and neurologists alike in earlier years. After Reitan’s departure in 1970, direction of the neuropsychology section fell to Kathleen Fitzhugh-Bell, PhD, who had trained with Reitan and become faculty in 1968. Although Fitzhugh-Bell’s interests spanned both children and adults, learning disabilities and children were her special interests. In 1974 she served as president of the Central Indiana Psychological Association. Prior to Fitzhugh-Bell’s retirement in February 1997, David Kareken, PhD began as director of the neuropsychology section. The neuropsychology faculty has grown to 14 — 12 full-time faculty in neurology, and two with joint appointments. Neuropsychologists contribute to all three missions of IU School of Medicine: involved in clinical consultation; the teaching of medical students; clinical neuropsychology resident fellows and neurology residents; and NIH-funded research in Alzheimer’s disease and alcohol use disorders.Movement DisordersThe movement disorders section was started by Eric Siemers, MD in the early 1990s — he transitioned to Eli Lilly in 1999. Joanne Wojcieszek, MD joined in 1995. They were very active in Parkinson’s disease and Huntington’s disease clinical trials, many of which were instrumental in the approval of several drugs for these disorders. They began collaboration with Neurosurgery for the unilateral pallidotomy procedure for Parkinson’s disease.IU is home to a Parkinson’s Foundation Center of Excellence, as well as a Huntington’s Disease Society of America Center of Excellence. The department participated in a 10-year longitudinal Huntington’s disease natural history studies. These provided highly relevant information about the onset and evolution of the disorder. The genetics of Parkinson’s disease has also been a strength. IU was the highest enrolling site identifying 25 sibling pairs with Parkinson’s disease for a study led by Tatiana Foroud, PhD, an IU geneticist, which identied a familial gene.Martin Farlow, MD75TH ANNIVERSARYRalph M. Reitan, PhD, in February 1959, with United Cerebral Palsy of Indiana leaders.

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2023 Annual Report IU School of Medicine Department of Neurology12Elizabeth Zauber, MD joined the group in 2009 and together she and Wojcieszek trained three fellows who became faculty: Annie Baird, MD, Chris James, MD and Brooke Walls, MD. Together they were able to greatly expand the clinical and research oerings including expanding multi-disciplinary clinics and teams. The movement disorders section partners with the Department of Neurological Surgery in treating patients with Parkinson’s disease, essential tremor and dystonia with Deep Brain Stimulation and Focused Ultrasound.Multiple Sclerosis/NeuroimmunologyMultiple sclerosis clinical care and research in the department began with the recruitment of Kolar by Dyken in 1966. Kolar set up a clinical lab for analyzing clinical CSF samples for oligoclonal IgG bands and myelin basic protein levels, which was the state-of-the-art technique to help diagnose multiple sclerosis before MRI. Kolar brought with him a European approach ahead of its time, treating multiple sclerosis patients early and aggressively with then available immunosuppressive drugs, along with daily low dose corticosteroids. He trained a generation of Indiana neurologists in this approach, several of whom disseminated it across the state. The chair at the time, Biller, recruited David Mattson, MD, PhD in 1997 to be the new head of the multiple sclerosis program, focused on multidisciplinary care, experimental therapeutic research and translational research. Mattson built the patient clinical base and re-established IU School of Medicine and IU Health as the tertiary multiple sclerosis referral center for Indiana and surrounding states. Dr. Mattson recruited many experimental therapeutic drug trials to IU, which led to the FDA-approval of many immunotherapies and symptomatic therapies. The section has grown to include Jaison Grimes, MD, Stefanie Rodenbeck, MD, Kyle Coleman, MD, and Chelsea Schmoll, DO.Neuro-OphthalmologyDavid Zauel, MD practiced neuro-ophthalmology, in addition to comprehensive ophthalmology, at IU School of Medicine from 1978-1983. Following a short gap, Valerie Purvin, MD arrived at IU in 1983 and moved to the Midwest Eye Institute in 1987, where she continued to work with residents. She later shared the responsibilities of ophthalmology resident training with Robert Yee, MD, who arrived in 1988 and practiced neuro-ophthalmology in addition to his duties as chair of the Department of Ophthalmology at IU. Yee and Purvin trained many fellows in neuro-ophthalmology. Yee retired his practice in 2011 and continued work at the VA until the mid-2010s. Purvin retired from her clinical private practice in 2013 and has continued as a volunteer faculty member at Eskenazi Health for a half-day every other week since.Following a gap in neuro-ophthalmology at IU School of Medicine in the early 2010s, a neuro-ophthalmology service was again established in 2014 with the arrival of Devin Mackay, MD. After practicing at the Glick Eye Institute in 2014 and 2015 and acquiring specialized equipment, the neuro-ophthalmology service moved to the IU Health Neuroscience Center. The service rapidly grew in patient volume and Melissa Ko, MD joined in 2019, adding expertise in pediatric neuro-ophthalmology in addition to adult neuro-ophthalmology. Ophthalmology and neurology residents train in neuro-ophthalmology with Mackay and Ko and a clinical neuro-ophthalmology elective was established for fourth year medical students in 2018. A neuro-ophthalmology fellowship was established, and the rst fellow will start in 2024.Neuro-oncologyThe neuro-oncology subspecialty in the department includes the diagnosis and management of primary and metastatic CNS tumors, neurological complications of cancer treatment, tumor predisposition syndromes and paraneoplastic syndromes. Edward Dropcho, MD joined neurology faculty in 1995 as the rst neuro-oncologist at IU School of Medicine. He has worked closely with neurosurgeons, radiation oncologists, neuropathologists and neuroradiologists in the multi-disciplinary neuro-oncology team. Stephanie Wagner, MD was a neuro-oncologist and key member of the program from 2010-2015. Kathryn Nevel, MD joined the department in 2018 and has assisted neuro-oncology clinical eorts, inter-disciplinary interactions and teaching.Oldrich Kolar, MD75TH ANNIVERSARYEdward Dropcho, MD meets with a patient at University Hospital.

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IU School of Medicine Department of Neurology 2023 Annual Report 13Neuro-Infectious DiseaseKaren L. Roos, MD, the John and Nancy Nelson Professor Emeritus of Neurology, joined department faculty in 1985 and soon developed neuro-infectious diseases a subspecialty area in the department. Roos was recruited to help in the care of our soldiers returning from foreign wars with neurological infectious diseases. In the beginning of her career, Roos focused on the pathophysiology of the neurological complications of bacterial meningitis working closely with her European colleagues. She was determined in her work that patients not only survive meningitis, but that their survival was meaningful with minimal neurological complications. Roos retired in 2021, and Kyle Coleman, MD, joined the neuroinfectious disease section in 2021.Cerebrovascular DiseaseDyken was a vascular neurologist. He was known both nationally and internationally as an expert on stroke and cerebrovascular diseases and involved in most of the original trials of antiplatelet agents, specically aspirin, in the prevention of ischemic stroke. Biller was also a vascular neurologist. He too was known nationally and internationally as a superb clinician and clinical researcher. The section of vascular neurology continued to participate in many research trials, both regionally and nationally under Biller and a fellow vascular neurologist, Askiel Bruno, MD. Under Biller’s mentorship, and with the help of Bruno, a Stroke/Vascular Neurology Fellowship was established at IU. The fellowship’s rst two graduates were André Durocher, MD and Linda Williams, MD in 1996. Williams established a clinical and research career at the Roudebush VA Hospital in Indianapolis, establishing it as a primary stroke center. The second two graduates of the fellowship were James Meschia, MD and J.D. Fleck, MD in 1997. Fleck rejoined the department in 1999. As medical director of stroke at Methodist Hospital, he helped establish the facility as a Primary Stroke Center in 2007. He was also instrumental in establishing Methodist Hospital as the rst Comprehensive Stroke Center in Indiana in 2014. In addition to Fleck, there have been several vascular neurologists to join the faculty over the last decade. Simona Ivan, MD, who joined the department in 2008, developed the stroke program at the county hospital, Eskenazi Health, and established it as a primary stroke center. Jason Mackey, MD joined the department in 2011. He established the rst Mobile Stroke Unit in Indiana in 2018 and was involved in the BEST-MU trial establishing mobile stroke units as eective tools to administer intravenous thrombolytics more quickly in the eld. Other vascular neurologists to join the department over the past several years include Rick Scheer, MD; Chris Hill, MD; Ann Jones, MD; and Kaustubh Limaye, MD, who is also a neurointerventionalist.NeurotoxicologyThe neuro-toxicology section started in 2011 with the recruitment of Laura Tormoehlen, MD, the nation’s only neurologist-toxicologist. Medical trainees from multiple departments participate in the program. Tormoehlen consults with colleagues around the United States in specialized cases of neurologic poisoning and gives lectures to national and international audiences on neuro-toxicology topics.Innovation in ChemodenervationWell before the FDA approval for botulinum toxin use in cervical dystonia in 2000, the department was on the cutting edge of botulinum toxin use. Eric Seimers, MD and Allison Brashear, MD were both early users to treat a variety of neurologic conditions. Brashear was actively involved in early clinical trials, leading to FDA approval for several neurologic indications, which include cervical dystonia, upper and lower limb spasticity and critical safety studies. IU has also been a pioneer in novel multidisciplinary clinics to perform botulinum toxin injections for rare and unique indications such as when otolaryngologist Edward Weisberger, MD and Kincaid joined together to treat patients with spasmodic dysphonia as far back as the late 1990s. This model multidisciplinary clinic has continued under laryngologist Stacey Halum, MD and neurologist Jay Bhatt, MD.75TH ANNIVERSARYJose Biller, MD, the third chair of the Department of Neurology, assists a patient in the clinic.Allison Brashear, MD

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IU School of Medicine Department of Neurology 2023 Annual Report 15The IU Health Mobile Stroke Unit is saving lives. When patients with acute stroke symptoms are treated on a mobile stroke unit and receive treatment within the rst hour, it nearly doubles the odds of excellent clinical outcome and patients are having less neurologic disability at 90 days, according to research published in the New England Journal of Medicine and Stroke by Indiana University School of Medicine faculty.Jason Mackey, MD, an associate professor of neurology at IU School of Medicine and director of the IU Health Mobile Stroke Unit, served as a principal investigator in a nationwide, multicenter trial on mobile stroke units (MSU), on which the published research is based.“Stroke is a highly time-sensitive condition, so the faster we can treat people, the higher the likelihood that they will do well,” Mackey said. “Treating people faster gives the clot less time to organize and makes it easier to break up.” The study in the New England Journal of Medicine found that patients treated on an MSU were more likely to receive the anti-clotting drug tissue plasminogen activator (t-PA) compared to an emergency medical services (EMS) ambulance. MSUs treated 97.1% patients with t-PA compared to 79.5% patients in the EMS group. MSUs also administered t-PA faster after onset of stroke at an average of 72 minutes compared to 108 minutes in the EMS group.In the Stroke journal article, treatment on the MSU in the rst 60 minutes meant faster on-scene treatment of t-PA and better odds for recovery. In the trial of 941 patients, 599 were treated with a t-PA in MSUs and 342 from EMS. In the MSU group, 33% were treated in the rst 60 minutes, while only 3% of the EMS group were treated in the rst 60 minutes.“ ONE VERY IMPORTANT FINDING IN THIS TRIAL IS THAT WITH MSUS, WE CAN TREAT MANY MORE PEOPLE IN THE FIRST HOUR AFTER STROKE WHEN THE LIKELIHOOD IS HIGHEST THAT THEY WILL DO WELL,” MACKEY EXPLAINED. “‘TIME IS BRAIN’ IS THE MANTRA IN STROKE AND EACH MINUTE THAT GOES BY WITHOUT REPERFUSION IS ASSOCIATED WITH A LOSS OF 2 MILLION NEURONS.”MSU are ambulances equipped with a computed tomography (CT) scanner and staed by one or two paramedics, a CT technologist and a critical care nurse. A vascular neurologist is available on board or via telemedicine. The nationwide, multicenter trial was led by researchers at the University of Texas Health Science Center at Houston (UTHealth) where it began in 2014 when the center acquired the rst MSU in the country. The study was later expanded to six additional sites, including IU Health, and enrolled 1,515 patients over a six-year period. Of the patients enrolled, 1,047 were eligible for t-PA with 617 patients receiving care by an MSU and 430 patients cared for by EMS. Mackey and his research team joined in the last year of the study and contributed 13 patients to the enrollment population. IU Health’s MSU is the only one in the state of Indiana, and one of only 20 MSUs in the United States.“ Showing that these units are eective in helping stroke patients is going to help us build better systems of care for our stroke patients across the country,” he explained. “Right now, most of these units are funded through philanthropy and we need better reimbursement to ensure sustainability—the positive data will help with (Centers for Medicare and Medicaid Services) and other payers.”ADULT NEUROLOGYTreatment on mobile stroke units gives patients better outcomesCLINICAL CARE

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2023 Annual Report IU School of Medicine Department of Neurology16IU administering, leading clinical research on FDA-approved Alzheimer’s drugAbout two years ago, Leo Stenz started to experience memory issues in his day-to-day life. Even though his motor skills were still good—he worked out, ran and played golf—Stenz found himself forgetting the words to say in everyday conversations.“I could see myself losing it sometimes in the middle of a sentence,” Stenz said.When his neurologist, Jared Brosch, MD, associate professor of clinical neurology at Indiana University School of Medicine, diagnosed Stenz with Alzheimer’s disease, he was taken aback, Stenz said. His mother had Alzheimer’s disease for nearly seven years, and he experienced rst-hand her memory and cognitive ability decline while caring for her.Despite this diagnosis, Stenz said he felt hopeful when Brosch told him about a new treatment in clinical trials that was moving toward full approval from the Food and Drug Administration.“It gave me some excitement that something is coming around the corner,” Stenz said.After a series of tests, Stenz qualied for and was the rst patient at IU Health to receive lecanemab, the rst-of-its-kind Alzheimer’s disease treatment. The drug is the rst amyloid beta-directed monoclonal antibody to receive traditional approval from the FDA.Over the past few months, nearly a dozen patients have received the treatment, which is administered through intravenous infusions every two weeks at the IU Health Neuroscience Center in downtown Indianapolis.For nearly a decade, lecanemab has been tested in clinical trials at IU School of Medicine, Brosch said. The drug targets the removal of amyloid plaques in the brain—a hallmark of Alzheimer’s disease. Brosch said lecanemab met all clinical endpoints in phase 2 and phase 3 of the clinical trial and was shown to signicantly reduce amyloid plaques in a person’s brain.While the drug does not stop the disease or lead to cognitive improvement, Brosch said, it does “freeze” a person in their current functional state—potentially three or four more years of independence if the disease is caught early.“That’s a big deal, Brosch said. “That’s a lot of time for a person to be living more independently and traveling and enjoying their grandchildren. It slows the progression to a point where it’s hard to notice that person is progressing while they’re on the drug.”‘THE CUTTING EDGE’For more than 25 years, scientists and pharmaceutical companies have been attempting to develop a treatment for Alzheimer’s disease. Countless drugs have failed in clinical trials, and most of these treatments have tried to target the accumulation of amyloid plaques in the brain. Instead of focusing on people who are in a later and more severe stage of Alzheimer’s disease like failed drugs in the past, lecanemab is geared toward people in early stages of the disease. More than 70% of people treated in the clinical trials of lecanemab could still live independently, Brosch said. They had Alzheimer’s disease, but the disease was at an early and mild stage.“These people are going to primary care clinics, they are in the community, and they are experiencing memory problems, but they might not be telling anyone

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IU School of Medicine Department of Neurology 2023 Annual Report 17about it,” Brosch said. “Those are the people that really benet the most and who we need to get to.”Lecanemab is one of three potential Alzheimer’s disease treatments garnering attention, Brosch said, and IU School of Medicine was a clinical trial site for each of the drugs. These three drugs similarly target amyloid plaques and are intended for early symptomatic Alzheimer’s disease. “It’s exciting that we’ve given that opportunity to our patients to be on the cutting edge,” he said.The FDA approved the controversial drug aducanumab under the accelerated approval pathway in 2021, but it hasn’t received full approval and is now in a phase 4 clinical trial to verify the drug’s clinical eectiveness.An Eli Lilly and Company drug, donanemab, has shown promising results in its clinical trials, Brosch said, and is awaiting a decision for approval by the FDA. “We’ve perceived a benet in all of these drugs,” Brosch said. “It’s incredibly dicult to prove it with a number and a measurement, but in all of these drugs, we feel we’ve seen people do better when they receive these treatments.”‘CHANGING HOW THE DISEASE LOOKS’Donna Wilcock, PhD, the Barbara and Larry Sharpf Professor of Alzheimer’s Disease Research in the Department of Neurology at IU School of Medicine, said those currently receiving lecanemab are patients neurology-based dementia specialists at IU School of Medicine believe will have the greatest benet and lowest risk of side eects from the medicine.The earlier a patient receives the treatment, the greater the benet, Wilcock said.Wilcock is the director of the Center for Neurodegenerative Disorders in the IU School of Medicine-IU Health Neuroscience Institute, which oversees the administration of lecanemab through its Brain Health Program. This wraparound program, Wilcock said, sets patients and their families up with a brain health navigator to schedule appointments and act as a resource.Brosch said this team of neurologists have been prequalifying their patients based on the results from clinical trials. These patients have already had the necessary MRI and PET scans and other screenings needed to qualify them to receive the new Alzheimer’s disease treatment. In addition to the nearly one dozen patients who started receiving the treatment in September, there are at least that many in the pipeline at IU Health. Brosch said the program also is expanding into geriatric clinics to nd qualied patients and is establishing a statewide set of guidelines to refer patients and prequalify them as the drug becomes more known.“It’s certainly hopeful,” Wilcock said. “It’s the best result we’ve had in clinical trials ever for Alzheimer’s disease. It’s the rst disease modifying treatment. We’re not just treating symptoms, we’re changing how the disease looks in the brain, and changing it for the better.”‘END OF THE BEGINNING’While the data from clinical trials of lecanemab are promising, there are still many questions that researchers and physicians at IU School of Medicine are investigating. Brosch said they will need to determine how long to administer the drug to patients. It’s also unclear how much time it takes for amyloid plaques to reaccumulate in the brain once they are reduced by taking lecanemab, Brosch said, and if the drug ultimately alters the trajectory of the disease. In addition to the drug infusion, patients will be given high-quality MRI scans throughout their rst year of treatment.There are also still ongoing phase 3 studies of lecanemab that are analyzing the safety and ecacy of an injection of the treatment rather than an infusion, Brosch said. This would create better access, and potentially lower costs, he said, by allowing people to inject themselves with the drug at home rather than traveling to an outpatient center every two weeks.Brosch said the Dominantly Inherited Alzheimer’s Network Treatment Unit—IU School of Medicine is a site for a clinical trial—is the rst study to combine lecanemab with an anti-tau protein drug. After amyloid plaques form in the brain of Alzheimer’s disease patients, researchers say the protein tau begins to form tau tangles in the brain.IU School of Medicine researchers plan to investigate signatures in the blood of patients receiving the lecanemab to see if there are biomarkers that could predict who will respond well to the drug and who will have adverse eects. The medical school has a strong biomarker program in the National Centralized Repository for Alzheimer’s Disease and Related Dementias (NCRAD) Biomarker Assay Laboratory, Wilcock said, where they can study these biomarkers.Researchers are also hoping to apply machine learning and articial intelligence approaches to MRI clinical scans to study patient outcomes, Wilcock said. “Where we see the eld moving is to a precision medicine approach where we’ll be able to look at blood signatures and be able to identify exactly what changes someone’s brain is going through,” Wilcock said. “The hope is at the same time that we’ll be able to create an arsenal of drugs—like lecanemab—that will be able to specically target these changes. The approval of this drug is not the beginning of the end but the end of the beginning.”ADULT NEUROLOGY

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2023 Annual Report IU School of Medicine Department of Neurology18Neurologists at IU administer rst-of-its-kind FDA-approved gene therapyNeurologists at Indiana University School of Medicine are among the rst clinicians in the nation to administer a groundbreaking gene-based therapy for patients living with a rare form of amyotrophic lateral sclerosis (ALS). The Food and Drug Administration approved tofersen under its accelerated approval pathway in April, making the drug the rst gene-based therapy available for patients with ALS—commonly called Lou Gehrig’s disease—who have a mutation in the superoxide dismutase 1 (SOD1) gene.ALS is a progressive degenerative condition that aects nerve cells in the brain and spinal cord. These cells—motor neurons—carry signals to a person’s voluntary muscles, such as in the arms and legs. ALS mainly impacts a person’s physical control of their muscles.Adam Comer, MD, assistant professor of clinical neurology in the Department of Neurology at IU School of Medicine, administered the therapy to the rst patient at IU Health in October 2023. The treatment is delivered through a spinal injection—like a lumbar puncture— into an area of the spine that surrounds the brain and spinal cord. This results in the medicine owing directly into the central nervous system to have the best eect. “ THE BENEFIT IS LONG-TERM,” COMER SAID. “SO FAR IT APPEARS TO SLOW DOWN THE DISEASE PROGRESSION.”Patients receive three initial doses at two-week intervals followed by doses every month.Of the more than 31,000 patients in the United States living with ALS, according to the Centers for Disease Control and Prevention, this mutation aects about 1- 2% of patients. Comer said past medicines approved for ALS haven’t targeted specic gene variants of the disease. “This is actually trying to x the problem at the genetic level,” Comer said.Cynthia Bodkin, MD, associate professor of clinical neurology, said she had already started the process to fast-track the drug for implementation at IU Health, so that once it received FDA approval patients could receive the therapy as soon as possible.

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IU School of Medicine Department of Neurology 2023 Annual Report 19“We knew we would nd patients who would benet from a treatment like this and potentially change the course of their disease,” Bodkin said.A patient of Bodkin’s received the therapy during the clinical trial phase at another institution. Once he started the trial and returned to Indianapolis, Bodkin was amazed at the lack of decline.“When I saw him back and saw how well he was doing, I cried,” Bodkin said. “He historically should not have been still alive. To see that he was still here was very emotional.”Comer said neurologists at IU treat ALS patients with multiple genetic forms of the neurodegenerative disease. For the past ve years, a genetic counselor in the ALS clinic, located at the IU Health Neuroscience Center in downtown Indianapolis, tests nearly all ALS patients for genetic variants. Recently released national guidelines stated that genetic tests should be oered to all ALS patients, Comer added.“We’ve been ahead of the game. We’ve been counseling our patients and doing genetic testing for patients with ALS for many years so people already know they have this genetic variant,” Comer said.IU School of Medicine neurologists treat about 200 ALS patients at any given time. Recently, they created an ALS repository for clinical research, called NEURO-LinQ, that collects ALS patient blood samples, medication information and other clinical data to study, Bodkin said. Gene therapies targeting neuromuscular disorders is relatively new for neurologists to have available in the clinic. Historically, there has not been treatment for neurological genetic disorders that could change the progression of the disease, Bodkin said. “ IT’S AMAZING THAT WE’RE GIVING GENE THERAPY FOR PATIENTS WITH NEUROMUSCULAR DISORDERS THAT WE HAVEN’T HAD ANY TREATMENT AVAILABLE FOR DURING OUR CAREERS AS NEUROLOGISTS,” BODKIN SAID.ADULT NEUROLOGYAdam Comer, MD, assistant professor of clinical neurology in the Department of Neurology at IU School of Medicine and Cynthia Bodkin, MD, associate professor of clinical neurology“ We’ve been ahead of the game. We’ve been counseling our patients and doing genetic testing for patients with ALS for many years so people already know they have this genetic variant.” – Adam Comer, MD

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2023 Annual Report IU School of Medicine Department of Neurology20TTed Kitchel, the former Indiana University basketball star who won a championship under the late, legendary coach Bobby Knight, straps on some boxing gloves and takes position across from a silent, straight-jawed gure who, by coincidence, is also named Bob.Bob has esh made of rubber, a skeleton of metal, and a face that is imminently punchable. He is, after all, a boxing dummy built to take a beating. And Ted, now 64, is about to give him one.Ted stepped up and hit the machine 100 times. The classmate returned and hit it 101. Tired of triing, Ted unleashed a furry of 210 blows, and it was game over. “Most people who know me know that I’m a little competitive,” Ted said. “I couldn’t let somebody beat me.”That seems to include his real opponent these days, the toughest adversary Ted has ever faced, the foe trying to rob him of his balance and make his right hand—his shooting hand—shake in ways it never did even in the closest games. The adversary he’s trying to defeat—with exercise and fundraisers to support research at IU School of Medicine—is Parkinson’s disease.Ted Kitchel is, in some ways, the quintessential Hoosier. He grew up on a farm in a small town—Galveston, Indiana—where his family grew corn and soybeans. He worked on his jump shot on a hoop in the barn. He led tiny Lewis Cass High School to its rst sectional championship back in the days when big schools and small ones competed for the same title—the way he prefers it. He helped lead the IU Hoosiers to three Big Ten titles and was a key cog on the team that won them a national championship in 1981.Yet Ted’s Hoosier story took an unexpected turn. In 2015, he developed a tremor in his right hand. At rst, he thought it was a side eect of the medications he was taking for blood clots. But the tremors persisted and one of his colleagues at FootJoy, the sports gear company where Ted worked in sales, urged him to see a neurologist in Boston. He went and, in less than 20 minutes, Ted received both a diagnosis and a second opinion: It’s Parkinson’s. That’s how clear the symptoms were.At the time, all Ted knew of Parkinson’s was its impact on Michael J. Fox, the actor whose tremors were by then visible for the world to see. Fox’s case was much more advanced, the doctor said. And Ted found some reassurance learning that, while not curable, Parkinson’s is a disease patients can live reasonably well with for a long time. Still, Ted said, in a low-key assessment of this pivotal moment in his life: “It kind of scares you.”Once back in Indiana, after Ted delivered the news to his wife Kristi and their children, he was connected to doctors at IU, which has been named a Center of Excellence by the Parkinson’s Foundation for its high-quality care. Eventually, he came under the care of Fighting Back: Former IU basketball star Ted Kitchel raising funds for Parkinson’s disease researchBobby King, IU Medicine Magazine

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IU School of Medicine Department of Neurology 2023 Annual Report 21S. Elizabeth Zauber, MD, the center’s director and an associate professor of clinical neurology at IU School of Medicine.In most people, Zauber said, the causes of Parkinson’s disease are not clear. Exposure to certain pesticides and other toxins is believed to be one culprit. For many patients, the suspect seems rooted in genetic factors.IU School of Medicine is conducting Parkinson’s disease research in several areas.Zauber’s research includes clinical trials of new medicines aimed at treating the symptoms of the disease as well as drugs to slow its course, along with studies of the impact of Deep Brain Stimulation and focused ultrasound as treatment for motor symptoms.Tatiana Foroud, PhD, a professor in the Department of Medical and Molecular Genetics and the school’s executive associate dean for research aairs has support from the Michael J. Fox Foundation and the NIH to maintain a biorepository of blood, tissue and other samples. They were collected as part of ongoing research studies seeking to chart the biological and clinical changes across the spectrum of the disease—and to identify early signals of the disease and points where treatments should be directed.Foroud and Zauber are both part of an ongoing research study funded by the Parkinson Foundation that provides free genetic testing and counseling for people with Parkinson’s disease—a service that tells them if they have inherited genetic variants associated with Parkinson’s disease.While there are medications that alleviate the symptoms, there are no treatments proven to slow the course of the disease over time—except maybe one. Exercise hasn’t yet been proven to slow Parkinson’s, but there are some indications that it may do so. Zauber says there even seems to be a dose-dependent eect in reducing the symptoms—the more intense the exercise regimen, the greater the benet.This is the idea that draws Ted twice weekly to the Social of Greenwood, a center for seniors near his home. It’s where he faces o against Bob—and against Parkinson’s.As soon as they learned of their dad’s diagnosis, Ted’s kids—Tyler, Scott and Mackenzie—began scouring the web for information about the disease. They quickly noticed the part about the need to exercise. They also discovered Rock Steady Boxing.Developed in Indianapolis by a patient with Parkinson’s who received some training in boxing, Rock Steady Boxing groups have since spread across the United States and around the world. It employs an assortment of exercises—many boxing-oriented—that include cardiovascular work, balance exercises, stretching and strengthening.Zauber is an enthusiastic believer in Rock Steady Boxing. She sits on the non-prot’s board. And she’s about to begin a research study that aims to nd out precisely which aspects of exercises in the Rock Steady regimen are most eective for Parkinson’s.Wherever that leads, it’s clear Rock Steady gives people like Ted a chance to literally ght back against this chronic illness. “When you are hitting the punching bag,” Zauber said, “you are, in a way, hitting this disease and taking control of your health in a way that can be very empowering for people.”Aside from boxing, Ted is also ghting back against Parkinson’s by raising that kind of awareness—in public speaking and in media appearances.His biggest push—with intense support from his family and close friends—has been an annual golf outing at Valle Vista Golf Club in Greenwood that raises money for Parkinson’s research at IU School of Medicine. The latest golf outing, in August, drew 135 golfers and raised approximately $75,000. Over four years, the event has raised more than $230,000 for research.He kicked o the event by welcoming the golfers and then camped out on the 11th hole, playing the Par 3 with each of the groups passing through. Most of the time, his ball was the best one o the tee.Ted and his family are hopeful the research at IU School of Medicine and other sites advances quickly enough to help him, but they also want it to benet others. And maybe because of his mother’s toughness, because of the thick skin he developed under Knight, and because of his Christian faith, Ted feels well-equipped to face his most formidable foe.“The easiest thing to do is to say ‘Why me? Why do I have the shaking?’ The reason may be that I can handle it better than most people,” Kitchel said. “The good Lord has put it on my shoulders to take care of it and I’ll do the best I can.”ADULT NEUROLOGY

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2023 Annual Report IU School of Medicine Department of Neurology22Home to Indiana’s only Level 4 Epilepsy Center, the pediatric epilepsy program in the Department of Neurology at Indiana University School of Medicine and Riley Children’s Health oers a comprehensive approach to improve the quality of life of children with epilepsy. Makram Obeid, MD, an assistant professor of neurology and a physician-scientist, is the director of the epilepsy program at Riley Children’s Health. The multi-disciplinary team of epileptologists, neurosurgeons, neuroradiologists, neuropsychologists, geneticists and dieticians provide leading-edge, personalized care to manage the full spectrum of epileptic conditions.Epilepsy is the most common neurological disorder in children in the United States, and it can have several causes. Some are genetic and others are caused by brain lesions and injuries. According to the Centers for Disease Control and Prevention, 470,000 children have epilepsy.The program oers state of the art diagnostic modalities and treatments for seizures with a special attention to potential accompanying developmental, behavioral, or learning disturbances, Obeid said. The team has the most advanced services and technologies, such as functional imaging and magnetoencephalography (MEG), and particularly excels at oering surgical and non-surgical interventions to children with refractory epilepsy.Once a physician has established an epilepsy diagnosis with the child, the rst step in treatment is typically controlling seizures through medication, Obeid said. If medications don’t work, the physicians will perform addition tests to see if the child needs other treatments and interventions, including epilepsy surgery conducted by IU neurosurgeons.There are multiple surgical options to treat epilepsy, which include laser ablation, surgical resection and neuromodulation—vagus nerve stimulation (VNS), responsive neurostimulation (RNS) and deep brain stimulation (DBS).“Our program oers children with epilepsy a unique medical home with personalized care using the most advanced diagnostic and treatment modalities and personalized treatments based on genetic testing,” Obeid said. “Through a robust communication plan, referring providers have direct access to a nurse coordinator to stay informed throughout the entire care process.”In addition to the program’s robust clinical care, the epilepsy team is heavily involved in preclinical and clinical research, Obeid said. Research eorts include investigating the mechanisms of status epilepticus and epileptogenesis in animal seizure models to discover molecular targets for novel treatments. They also conduct clinical research on medication trials, device trials, patient outcomes and reporting their surgical data to national databases.Pediatric epilepsy program growing at IU Neurology

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IU School of Medicine Department of Neurology 2023 Annual Report 23TThe little boy didn’t know what all the fuss was about, other than he was getting some important medicine.But there he was last week, making history at Riley Children’s Health.Paul, a kindergartner from northern Indiana, is the rst patient in the state to receive a new drug therapy that could stop the debilitating and deadly eects of Duchenne muscular dystrophy.DMD, which typically presents in boys in preschool to school-age years, is a serious genetic muscle disease that often results in patients losing the ability to walk by the age of 10 to 12, according to Dr. Laurence Walsh, Riley pediatric neurologist.It is caused by a lack of dystrophin, a protein needed to hold muscles together. Without that protein, muscles begin to deteriorate, leading to paralysis, heart/lung failure and early death.Riley is the rst hospital in Indiana to administer the newly approved gene infusion therapy to attack DMD, which gives Paul’s parents, Paul Sr. and Lindsey, hope for his future. (The family asked that their last name be withheld.)“We believe the timing of everything, from diagnosis to approval for the therapy to the date of the infusion, was divine intervention,” Lindsey said, adding that she and Paul Sr. hope their son has the chance at a more normal life, maybe even playing a little soccer someday.“We want him to be able to run like other kids,” Paul Sr. said, as his son watched nurse Anna Busald prepare the rst of four syringes that would pump hope and healing through an IV into the little boy.“I’m gonna take my medicine now,” young Paul announced. “I can’t wait!”The next 90 minutes passed without a hitch, Busald switching out the syringe infusions every 20 minutes and monitoring Paul’s blood pressure, while he focused on a sticker book and a doctor kit and ate a lunch of chicken strips and smiley-face fries.When the beep sounded to signify the treatment’s end, a crowd gathered around Paul’s room to clap and cheer.He grinned and said, “That was so fun!”Even though Paul likes to wrestle with his dad, dance and take walks, his mom began noticing he was regressing in skills he had learned as a toddler. He couldn’t run, couldn’t jump with both feet and walked on his tiptoes, signs often linked to DMD. That’s when she sought out dierent therapies and was eventually connected with Riley for the shattering diagnosis of Duchenne muscular dystrophy.“If I hadn’t followed up earlier when he was missing milestones, I still might not have known,” she said.Since that diagnosis this past spring, things have moved really fast, Lindsey said, thanks to an intense eort by Katelyn Webb, nurse navigator, who has devoted the past few months to coordinating the treatment and getting prior authorization through insurance for the $3 million therapy.Timing was critical because the drug is only approved for use in children 4 to 5 years old. Paul turned 6 just ve days after his treatment, so it was the best birthday present possible for his mom and dad.It’s been a labor of love for Webb, a former bedside nurse, who also spent a great deal of time calming the fears of Paul’s parents.“ THIS IS LIFECHANGING. I FEEL LIKE WE’RE MAKING HISTORY HERE, SO I’M PROUD TO BE A PART OF IT,” WEBB SAID. “IT’S BEEN A LOT TO NAVIGATE, BUT PAUL WAS AT THE TOP OF MY MIND ALL THE TIME.”Riley patient makes history with gene infusion therapy for DMDMaureen Gilmer, Riley Children’s HealthCHILD NEUROLOGY

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2023 Annual Report IU School of Medicine Department of Neurology24“ Our mission has always been to provide the best possible care to the patients and families we serve. Being able to oer this therapy underscores our commitment to giving our patients a chance at a brighter future.”– Mara Nitu, MD Chief Medical Ocer, Riley Children’s HealthAfter more than 30 years in pediatric neurology, Dr. Walsh is thrilled to be able to oer a promising gene therapy treatment for patients with DMD, calling it a “ray of hope” for children and their families.“ IT’S A VERY EXCITING TIME,” DR. WALSH SAID. “THIS IS A DISEASE I’VE BEEN HELPING FAMILIES THROUGH FOR THREE DECADES, AND IT’S PRETTY NEAT AT THIS POINT TO HAVE SOMETHING LIKE THIS TO OFFER THEM.”While its use is currently restricted to kids ages 4 and 5, he expects it to be expanded to other children if it continues to live up to its promise.“Until recently, we’ve never really had a treatment that promises to change the trajectory of the disease to a signicant degree,” Dr. Walsh said. “We don’t yet know the long-term benet, but we know that it has done better than anything else that has come before it.”The hope now is that it gives kids more time while even better therapies are tested.“It’s incredibly exciting after all this time to be on the cusp of these gene therapies that I think will make huge dierences in children’s lives,” he said.Riley Chief Medical Ocer Dr. Mara Nitu agrees, saying it is an honor to be the rst children’s hospital in Indiana to provide gene infusion therapy for the disease. “Our mission has always been to provide the best possible care to the patients and families we serve. Being able to oer this therapy underscores our commitment to giving our patients a chance at a brighter future.”Paul will return to Riley weekly for the next few months so his care team can monitor his overall health, including his liver function.From the clinical trials, Dr. Walsh said children who have received the therapy begin to separate themselves from their untreated peers over the next two years in terms of preserved level of function or improvement in function.“I would hope to see those same benets in Paul over the same time period.”

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2023 Annual Report IU School of Medicine Department of Neurology26Liana Apostolova, MD, has been on a 5-year quest to better understand a form of Alzheimer’s disease that strikes people early—before age 65. Her lab’s rst-of-its-kind Longitudinal Early-onset Alzheimer’s Study (LEADS) now has 700 participants. The research is producing valuable insights—and even more questions.“There is so much more we can learn,” said Apostolova, the associate dean of Alzheimer’s disease research and the Barbara and Peer Baekgaard Professor of Alzheimer’s Disease Research at Indiana University School of Medicine. “Unraveling the mysteries of early onset Alzheimer’s disease is very uplifting and motivating.”More than 6 million Americans are living with Alzheimer’s. Just 6 percent of them are under the age of 65. In this younger subset, the disease progresses nearly ve times faster than it does in people with late-onset disease.Early-onset Alzheimer’s was a largely neglected population for research until Apostolova and her team launched LEADS. Now LEADS has IU’s largest grant, with nearly $80 million in total funding primarily from the National Institute on Aging. “A LARGE EFFORT LIKE THIS WAS MUCH NEEDED SO WE CAN MAKE LARGE-SCALE DISCOVERIES AND HAVE THE POWER TO UNRAVEL NEW GENETIC SIGNALS AND NEW THERAPEUTIC AVENUES,” APOSTOLOVA SAID.Since the early 2000s, Apostolova has delved into developing imaging techniques and genetic biomarkers for Alzheimer’s disease, becoming a leading national expert. She is a frequent speaker at national and international conferences and has co-authored hundreds of publications.Alzheimer’s & Dementia, the journal of the Alzheimer’s Association, recently published a special issue devoted entirely to LEADS—a validation of their work’s impact.“We’re really proving to the world how enormously prolic we are,” Apostolova said.When LEADS launched in 2018, Apostolova’s team at IU consisted of 10 people. Since then, her team has tripled.The number of U.S. data collection sites has increased from 14 to 18, and ve international sites have been added—Buenos Aires, Barcelona, London, Amsterdam and Lund (Sweden). Apostolova’s co-principal investigators on the project include Gil Rabinovici, MD, University of California–San Francisco; Brad Dickerson, MD, Massachusetts General Hospital and Harvard Medical Leading the Way: LEADS enters its fth year — and has more insights to shareBy Laura Gates, IU Medicine MagazineNEUROLOGY RESEARCH

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IU School of Medicine Department of Neurology 2023 Annual Report 27School; and Maria Carrillo, PhD, of the Alzheimer’s Association.“This is all launching from IU,” Apostolova said proudly. “It’s very exciting. We’re launching much more in-depth analysis of the genetic data with a larger scale of samples assembled around the world.” Apostolova has the daunting task of directing it all. She insists it isn’t “work”—it’s a fullling vocation that brings her joy.“I’m in awe of how hard she works to keep the LEADS study running smoothly, and how she nds the time and energy to constantly try to build and expand on it, not just to advance research, but also to provide more services and benets to study participants and their families,” said Kelly Nudelman, PhD, a geneticist working on LEADS and an assistant professor of medical and molecular genetics at IU School of Medicine.The progress can’t be measured merely in numbers. Apostolova is reminded of that each week as she meets with real people living with this memory-robbing disease.All of them enrolled in LEADS knowing their contributions likely wouldn’t be able to help them but could help provide solutions for future suerers of early-onset Alzheimer’s.For a few of them, however, there is some hope now.In July, the FDA gave full approval to the rst drug shown to slow cognitive decline in Alzheimer’s patients in the early stages of disease. Lecanemab, from drugmakers Eisai and Biogen, is an anti-amyloid drug that helps clear the plaques in the brain associated with Alzheimer’s. Apostolova presented positive ndings from the Phase 3 clinical trial for a similarly working drug from Eli Lilly (donanemab) at the 2023 Alzheimer’s Association International Conference in Amsterdam in July.“It’s a dream come true for us to be able to do something to help our patients,” Apostolova said.It’s unknown whether this type of drug will benet early-onset patients as much as the larger population of Alzheimer’s patients over age 65. That’s something LEADS will be evaluating in patients who qualify for a clinical trial.Since the underlying pathology for each Alzheimer’s patient is unique, personalized medicine is key.One surprising nding from LEADS has been the low rate of early-onset Alzheimer’s caused by an inherited genetic mutation, previously thought to be the main cause of Alzheimer’s disease in people younger than age 65. Among LEADS participants, just one percent have gene mutations causing the autosomal dominant form of the disease.“We have learned early-onset Alzheimer’s disease is most often sporadic,” Apostolova said.Because Alzheimer’s disease is more prevalent in Black and Hispanic populations, the LEADS team has actively focused on recruiting diverse participants with supplemental funding from the Alzheimer’s Association.There is still much to learn and a long way to go before medical science can predict and prevent Alzheimer’s from developing in those at risk. What Apostolova knows is that the disease looks and behaves dierently in people who develop symptoms before age 65.“I believe our unique cohort will be of great interest to pharmaceutical companies,” she said. “These individuals hold unknown facts and potential hints for nding cures for Alzheimer’s.”More than 6 million Americans are living with Alzheimer’s. Just 6 percent of them are under the age of 65. RESEARCH

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2023 Annual Report IU School of Medicine Department of Neurology28A multi-disciplinary team of Indiana University researchers is focusing their eorts on a growing public health concern: binge and “high-intensity” drinking—extreme drinking behaviors that are increasingly prevalent among college-age adults.The researchers, who are part of the Indiana Alcohol Research Center, recently received a ve-year, $8.65 million grant renewal from the National Institute on Alcohol Abuse and Alcoholism to support this work.Established in 1987, the Indiana Alcohol Research Center (IARC) is housed at Indiana University School of Medicine and led by director David Kareken, PhD, a professor in the Department of Neurology. The center’s broad mission is to study the behavioral and neurobiological risks for alcohol use disorder.“The IARC begins its eighth consecutive funding cycle by continuing its long tradition of multi-disciplinary collaboration across animals and humans to better understand the neurobiological and behavioral risks for developing alcohol use disorder,” Kareken said. “We believe that our combined diverse methods and perspectives are best suited to studying a problem of both great importance and complexity.”Cristine Czachowski, PhD, a professor of psychology at the School of Science at IUPUI, and Christopher Lapish, PhD, a professor of anatomy, cell biology and physiology at IU School of Medicine, serve as the center’s deputy director and scientic director, respectively.“The center provides researchers like me—those studying rodent models of behavior—valuable interactions with colleagues (and friends) who work on the clinical side,” Czachowski said. “The crosstalk between disciplines, and across many departments, keeps us at the top of our game with regard to the latest ndings and focused on the human experience of alcohol use disorder.”Working as a team across basic and clinical research, center faculty will work to determine how inherited and acquired behavioral and neurobiological vulnerabilities predispose people to more intense patterns of drinking, with a particular emphasis on factors that lead to faster initial rates of drinking and a proclivity for sustained high intake.“Our ability to measure how brain function is altered in alcohol use disorder is rapidly improving,” Lapish said. “This is true for humans and rodent models of the disorder. Our hope is that we can nd similarities across the species, which, in turn, will facilitate new treatments.”The researchers will also work with the community, schools, health care providers and state policy makers in providing education about the science, prevention, and treatment of alcohol use disorder.This funding renewal is the Indiana Alcohol Research Center’s eighth consecutive ve-year grant from the National Institute of Alcohol Abuse and Alcoholism since its founding. Over the past three decades, center researchers and their collaborators have played key roles in studying alcohol use disorder heritability—showing diering genetic and environmental inuences across the disorder’s developmental timeline.Their animal and human research models are also used worldwide in alcohol-related research. Center researchers conceived, and continue to rene, the “Computer-assisted Alcohol Infusion System,” an intravenous alcohol administration research method that permits exquisite experimental control over an individual’s level of alcohol exposure—a technique employed in human research laboratories around the world. The center’s animals—rats and mice selectively bred by the IARC to prefer alcohol—are similarly used throughout the world to help understand inherited risk.IU researchers receive $8.6M NIH grant renewal to study alcohol use, binge drinking

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2023 Annual Report IU School of Medicine Department of Neurology30The Indiana University School of Medicine Department of Neurology is helping lead the development of novel therapies for neuromuscular disorders, specically ALS, muscular dystrophy, myotonic dystrophy and myasthenia gravis. Researchers produce new and personalized treatment options for patients with neuromuscular disorders. From the HEALY ALS Platform Trial and a long-standing muscular dystrophy practice to the development of the latest medications for myasthenia gravis and the rst trials for myotonic dystrophy, our physician researchers are at the forefront of improving care and creating options for patients with neuromuscular disorders.“These studies allow our department to oer clinical trials and potentially therapeutic drugs or devices to people who otherwise would not have access to them,” said Laurie Gutmann, MD, chair of the Department of Neurology.ALSThe HEALY ALS Platform Trial is allowing more patients faster and wider access to clinical trials as well as the opportunity to be screened for multiple studies at once. By oering the HEALY trial in Indianapolis, patients from around the Midwest can join this trial and avoid traveling long distances for care. Access for All in ALS (ALL ALS) consortium is a competitive, NIH-funded network of 30 sites in the United States. The Biospecimen Exchange for Neurological Disorders (BioSEND) at IU School of Medicine will serve as the biorepository for the consortium, of which IU School of Medicine is a site. BioSEND sta will provide sample collection kits and training to research sites, and the biospecimens collected will be shipped to us for processing and storage. Basic scientists at IU School of Medicine are collecting blood samples to monitor for dierent biomarkers associated with the development of ALS in the ALS Biomarker Study. By understanding these biomarkers, scientists hope to be able to better predict the development, cause and prognosis of ALS. Some of these studies are moving into Phase 1 at clinical trials.MYASTHENIA GRAVISMyasthenia gravis clinical trials are among the most active neuromuscular studies at IU School of Medicine. Through several clinical trials for this autoimmune condition, scientists have been at the forefront of developing FDA-approved medications to treat myasthenia gravis, including an infusion therapy and a complement inhibitor. Both are approved for patients with antibodies targeting the most common antibody that causes myasthenia gravis.MUSCULAR DYSTROPHYResearchers have been working on several clinical trials for muscular dystrophy as well as the investigation into the cause of this disease, including the role of blood vessel epicardial substance protein in the development of muscular dystrophy and atrophy. MYOTONIC DYSTROPHYThough it is the most common muscular dystrophy that begins in adulthood, myotonic dystrophy is a relatively rare neuromuscular disease aecting about one in 2,100 people globally. IU School of Medicine has been involved in the rst clinical trials for this hereditary muscle disease, which are studying the excessive daytime sleepiness caused by myotonic dystrophy as well as underlying disease itself.Contributing writer: Sally WintersCLINCAL RESEARCH FEATURE: NEUROMUSCULAR DISORDERS

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IU School of Medicine Department of Neurology 2023 Annual Report 31Investigating early-onset Alzheimer’s diseaseThe laboratory of Liana G. Apostolova, MD, MS investigates the characterization of early symptomatic and pre-symptomatic stages of Alzheimer’s disease and on the development and validation of sensitive imaging and genetic biomarkers for Alzheimer’s disease and other dementing disorders. The lab works with data from several high prole Alzheimer’s disease studies, including the Longitudinal Early Onset Alzheimer’s Disease Study (LEADS) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). The lab also works with datasets from the Imaging and Genetic Biomarkers for Alzheimer’s Disease Study (ImaGene).Novel biomarkers for neurodegenerative disordersThe laboratory of Jerey Dage, PhD is focused on the discovery and development of biomarkers to aid in the understanding of neurodegenerative disorders. Dr. Dage has more than 20 years of experience in drug discovery and early clinical development. He has successfully led research groups in diverse areas such as analytical chemistry, stem cell biology and translational science with broad impact across therapeutic areas. Dr. Dage has led the discovery and development of phosphorylated tau as a novel blood biomarker for Alzheimer’s disease clinical trials—proven useful for identication of Alzheimer’s disease pathology and risk of cognitive decline.CLINICAL RESEARCHMolecular cell biology of neurodegenerative disordersThe laboratory of Yansheng Du, PhD, has a long-term goal to elucidate molecular mechanisms which are responsible for the neuronal death and inammation in neurodegenerative/neuronal injury disorders, which include Alzheimer’s disease, Parkinson’s disease, stroke and ALS. Research conducted in the molecular cell biology laboratory can provide valuable information that may lead to the development of preventive and therapeutic approaches to these disorders. The lab also studies pathogenic mechanisms underlying neurodegenerative disorders and hypertension; animal, adipose stem cells and cellular models for the mechanistic and therapeutic studies; and drug and therapeutic development.

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2023 Annual Report IU School of Medicine Department of Neurology32Investigating the mechanisms of epileptogenesisThe laboratory of Makram Obeid, MD, investigates the mechanisms of epileptogenesis in immature animal seizure models. The primary goal is to identify molecular targets for novel treatment strategies that can prevent seizures and the accompanying neurodevelopmental behavioral decits. Conditions studied in the laboratory using age-tailored animal models include hypoxic seizures in rodent pups and limbic status epilepticus and post-traumatic epilepsy in peri-adolescent rodents. The laboratory employs a variety of electrophysiological, behavioral, and molecular techniques, such as continuous long-term EEG recordings in our rodent epilepsy monitoring unit, behavioral testing and histological studies.Advancing the understanding of dementia and Alzheimer’s diseaseThe laboratory of Donna Wilcock, PhD is focused on vascular contributions to cognitive impairment and dementia (VCID) and neuroinammation in VCID and Alzheimer’s disease. The lab takes a multi-faceted approach that ranges from primary cell cultures and multiple mouse models to human biospecimens including plasma, cerebrospinal uid and brain tissue. The Wilcock lab is advancing the understanding of multi-etiology dementia that one day will contribute to a precision medicine approach to treat dementia. They have research projects studying both mechanism and treatment of VCID and Alzheimer’s disease, and funded by National Institute of Neurological Disorders and Stroke and the National Institutes of Health.Neuropsychology alcohol studies The laboratory of David Kareken, PhD uses functional MRI to understand the human brain’s reward system in studies of alcohol use disorder and obesity. Research in this laboratory is funded by the National Institute of Alcohol Abuse and Alcoholism at the NIH. The lab has several studies on alcohol use disorder and its risks. Much of lab’s current work examines brain activity during human operant eort to obtain alcohol, salience network activity in response to intense stimulation from primary reward, and — in collaboration with scientists at Purdue University and Indiana University’s School of Public Health, Bloomington — dynamic brain network reconguration during mental state transitions.

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2023 Annual Report IU School of Medicine Department of Neurology34Evan Templeton, MD, assistant professor of clinical neurology, received the Trustee Teaching Award from IU School of Medicine in 2023. Liana Apostolova, MD, an IU Distinguished Professor and the Barbara and Peer Baekgaard Professor of Alzheimer’s Disease Research, received the 2023 Alvin S. Bynum Faculty Mentor Award. The award, handed down to faculty in each school at IU Indianapolis by the Chancellor, requires testimonials from mentees and a strong track record of excellent mentors.Tami Hall, neurology clerkship coordinator, received the American Academy of Neurology (AAN) Clerkship Program Coordinator Recognition Award.Jerliyn Summay, MD, MA, PGY4 for Child Neurology, and Shaney Pena, MD, PGY4 for Adult Neurology, each received a Residency Research Scholarship (iDREAM Scholars) at IU School of Medicine. The iDREAM (Incentivizing Diverse Recruitment for Equity in Academic Medicine) programs aim to enhance representational diversity among the physician workforce to better reect the diversity of the populations they teach and serve by identifying and retaining residents from backgrounds underrepresented in medicine. The goal of the program is to create a pathway for residents from backgrounds historically underrepresented in medicine to be able to be considered for an early faculty recruitment through the iDREAM Early Incentive Program. The Neurology Clerkship continues to receive high satisfaction scores by IU School of Medicine medical students. The program is led by Joanne Wojcieszek, MD, clerkship director, and Devin Mackay, MD, assistant clerkship director, who both inspire many medical students to pursue a career in neurology.NEUROLOGY EDUCATION NEWSNeurology FellowshipsThe Department of Neurology oers four accredited fellowship programs:Behavioral Neurology and Neuropsychiatry Fellowship Director, Liana Apostolova, MDThis UCNS-accredited Behavioral Neurology & Neuropsychiatry fellowship program prepares clinical experts in cognitive and behavioral neurology and neuropsychiatry. This two-year clinical fellowship provides a broad exposure to a variety of conditions seen in the outpatient behavioral neurology and neuropsychiatry clinics with a focus on dementing illnesses.Clinical Neurophysiology Fellowship Director, Dragos Sabau, MDThis ACGME-accredited clinical neurophysiology fellowship provides trainees an opportunity to learn the entire range of neurophysiology techniques, including EEG, EMG, intraoperative neurophysiology monitoring and sleep studies. Three positions are oered each year. Two positions focus on EEG and epilepsy; the remaining position focuses on EMG and neuromuscular disorders.Neuro-ophthalmology Fellowship Director, Devin Mackay, MDThis AUPO-accredited neuro-ophthalmology fellowship bridges the knowledge and clinical care gap between the specialties of neurology and ophthalmology. The one-year fellowship oers an opportunity for trainees to learn about vision disorders involving the brain and cranial nerves. The fellowship will welcome its rst fellow in 2024.Vascular Neurology Fellowship Director, Ann Jones, MDThis ACGME-accredited vascular neurology fellowship provides advanced training in the contemporary care of all vascular neurological conditions, including ischemic and hemorrhagic stroke. The one-year fellowship will welcome its rst fellow in 2024.

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IU School of Medicine Department of Neurology 2023 Annual Report 35Neurology Residents and FellowsAdult Neurology ResidentsPGY 4Joseph A Frazee, DOMarina E. Giovannini, DOAlexis N. Kaiser, MDSarah J. Mace, DOGail J. Ocana, MD, PhDShaney N. Pena, MDRusty Reed, MDSumeet Toor, MDPGY3Haley L. Basinger, MD, MSCameron Duner, MDJohn W. Fanta, MDJohn L. Flach, DOThomas O. Keneld-Kelleher, DODaniel R. Kotfer, MDXyryl Chriscella Pablo, MDWeston B. Wright, MDPGY2Amanda Arand, DO, MSOlivia M. Cummings, MDAshli B. Elrod, MD, MSBryan R. Hyatt, MDUsama K. Khan, MDIsaac Lamb, MDIshi Nalamolu, DOPhalgun C. Narla, DOMadison G. Ott, MDPGY1 Aislin M Betts, MDNeck Henthorn, MDFatiha Iqbal, DOArjun Kumar, MDMackenzie C. Langdon, DO, MSErica N. Lumpkin, DO, MSKelli J. Manikowski, DO, MSHussein Moussa, MDMaham Nadeem, MDAlaina M. Singer, MDChild Neurology ResidentsPGY5Spencer W. Eberhard, DOPGY4Grace E. Eib, DOJerilyn M. Summay, MD, MAPGY3Jaskiran Kaur, MDPerry Grin, MDKabir Sheikh, DOPGY2Jonathan Go, DOPGY1Emily B. Matney, MDClaire V. Weaver, MDEDUCATIONNeurodevelopmental Disabilities ResidentsPGY6Florence F. Sun, DOPGY5 Kristin D. Fauntleroy-Love, MBBS, MA PGY4Kayleigh D. Avery, MDPGY3Sarah Fine, DO, MPH PGY2Laxhmi Ramjit, DOIndigo D. Yeager, DOPGY1Kaitlyn H. Cocuzzo, MD, MSNaomi E. Samuel, MDNeurology FellowsKathryn H. Kleine, DOMariah R. Ozkir, MA,MDLauren Schmidt, MD

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2023 Annual Report IU School of Medicine Department of Neurology36Adult Neurology Faculty FacultySergiu Abramovici, MDRobert J. Alonso, MDLiana G. Apostolova, MD, MSJay R. Bhatt, MDCynthia L Bodkin, MDJared R. Brosch, MDPaul F. Bustion, MDDavid G. Clark, MDKyle J. Coleman, MD, MSAdam D. Comer, MD, MScRobin Conwit, MDEdward J. Dropcho, MDMartin R. Farlow, MDJames T. Fesenmeier, MDJames D. Fleck, MDWhitney E. Gauen, MDJaison A. Grimes, MDLaurie Gutmann, MDMichael A. Hans, MDDavid W. Harvey, MDChristopher J. Hill, MDKatie Hutchins, MDC. Simona Ivan, MDChristopher W. James, MDAnn M. Jones, MDJ. Alex Karel, MDAlison Kostandy, MDJohn C. Kincaid, MDMelissa Ko, MDKaustubh Limaye, MDDevin D. Mackay, MDJason S. Mackey, MD, MSOmkar N. Markand, MDDavid H. Mattson, MD, PhDKathryn Nevel, MDPamela K. O’Dea, MDPatricia A. Olson, MD, PhDRyan T. Overman, MDRobert M. Pascuzzi, MDRachel M. Pfeier, MDStefanie J. Rodenbeck, MDSadia Saba, MDDragos Sabau, MDVicenta Salanova, MDRichard V. Scheer, MDChelsea D. Schmoll, DOSara M. Takacs, MDEvan J. Templeton, MDLaura M. Tormoehlen, MDLinda S. Williams, MDJoanne M. Wojcieszek, MDS. Elizabeth Zauber, MDChild Neurology FacultyRobert B. Blake, MDSusan C. Conrad, MD, MSCelanie K. Christensen, MD, MDSarah Isis R. Delima, MDMarcia V. Felker, MDChristopher T. Jackman, MDBittu D. Majmudar-Sheth, MDAaron McLaughlin, MDDerryl J. Miller, MDMatthew A. Miller, MDAshley A. Moeller, MDMakram Obeid, MDLisa H. Smith, MDDeborah K. Sokol, MD, PhDLaurence E. Walsh, MDJessica Win, MDSarah E. Wing, MDNeuropsychology FacultyElizabeth L. Begyn, PhDJana B. Dykstra, PhDAnne-Marie N. Fleckenstein, PhDPatricia Garcia, PsyDDustin Hammers, PhDEmily J. Kalscheur, PhDDavid A. Kareken, PhDKate Kingery, PhDSarah A. Koch, PhDBrenna C. McDonald, PsyDTy Owens, PhDAngelina Polsinelli, PhDChristopher C. Stewart, PhDNeurology Basic ScientistsJe Dage, PhDYansheng Du, PhDMario Dzemidzic, PhDHuiying Gu, MS, BMNaazneen Khan, PhDAnn E. Kosobud, PhDErica M. Weekman, PhDDonna M. Wilcock, PhD

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2023 Annual Report IU School of Medicine Department of Neurology38Support the work of the Department of NeurologyThe future of education, research and clinical care in neurology is bright at IU School of Medicine. Founded in 1948, the department has always had a strong clinical teaching identity. IU has been recognized as a model among medical schools in the United States for encouraging interest in the eld of neurology with the highest percentage of students choosing this specialty. Department faculty include nationally and internationally recognized experts, and research funding is strong, especially in the areas of Alzheimer’s and dementia.Gifts from alumni, patients and friends helps us to support our basic science and clinical research advancement, helps train our residents and fellows with latest in neurological technology and techniques in clinical care and recruitment of neurology specialists. When you make a gift to the IU School of Medicine Department of Neurology, you enable our team to provide the most advanced care and conduct groundbreaking research and make a dierence in our community. Two recent funds to the department showcase its breadth of expertise.IU Health FoundationA recent $1.5 million gift established the Kennedy Homan and Koorsen Family Fund for Neuro-ophthalmology and Neuroimmunology at IU Health Adult Academic Medical Center. When Kennedy Homan was quite young, she was diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease, also known as MOGAD. It’s a rare inammatory disease that attacks the fatty substance protecting nerve bers in the optic nerves, brain and spinal cord. Five years ago, IU recruited Melissa Ko, MD, a neuro-ophthalmologist who specializes in the kinds of rare neurological diseases Kennedy faced. She continues to be Kennedy’s doctor, while treating other adult and pediatric patients and training the next generation of specialists. The family’s gift recruits and supports the highly specialized physicians who work with the complexities of neuro-ophthalmology and neuroimmunology. Additionally, the Koorsen family are longtime supporters of neuroscience care at IU Health.IU FoundationTed Kitchel, a former IU basketball star, lives with Parkinson’s disease and sees S. Elizabeth Zauber, MD, a movement disorders specialist at IU, which has been named a Center of Excellence by the Parkinson’s Foundation for its high-quality care. Kitchel set up the Ted Kitchel Parkinson’s Disease Research Fund to support research at IU School of Medicine aimed at understanding Parkinson’s disease, easing its symptoms, and nding treatments. Kitchel takes part in a boxing-oriented exercise regimen, called Rock Steady Boxing, designed to help people with Parkinson’s maintain balance, coordination and strength. He also hosts an annual golf event in Greenwood to raise money for Parkinson’s research at IU School of Medicine.

2023 Department of Neurology Annual Report

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