Meningioma is the most common type of primary brain tumour, representing about 27% of all brain tumours. 20-40% of people with meningioma have fits, also known as seizures. These seizures stop people driving or working, and often require long-term anti-seizure tablets which themselves have undesirable side effects. Current treatments mainly suppress seizures rather than tackle what causes them.
Mr Ali Bakhsh has been awarded a Brain Research UK Fellowship to investigate why some meningiomas cause seizures and to develop new treatments to prevent them in patients.
Funded in our second round of fellowship funding, Ali is an outstanding clinician with an excellent research track record whose proposed research has the potential to deliver significant and widely applicable results for patients with meningioma.
Meningioma is typically a slow-growing tumour that forms from the meninges, the layers surrounding the brain and spinal cord. Meningiomas represent about 27% of all brain tumours, and women are affected about twice as often as men. There are 3 grades of meningiomas:
grade 1 - these are slow growing tumours and are the most common type
grade 2 - these can grow more quickly than grade 1. They are sometimes called atypical meningiomas;
grade 3 - these are faster growing tumours and are quite rare.
Treatment depends on whether the meningioma is slow growing or fast growing, and on where the tumour is, the patient’s general health, and the symptoms they might have.
Ali’s previous research work has suggested that, in some meningiomas, an overactive inflammatory response in the tumour and at the tumour-brain boundary irritates nearby brain tissue. However, a deeper understanding of this process is needed to prevent seizures, choose the right treatment at the right time, and reduce emergency hospital visits.
In his fellowship, Ali will study meningioma samples collected from people who had meningioma surgery and, where available, a small sample from the neighbouring brain surface. He will compare patients who had seizures with those who did not, to map where inflammation is most active at the tumour–brain border.
Next, he will recreate the key steps in the laboratory using meningioma cells and human brain cells grown in dishes. He will test whether substances released by the tumour make these brain cells more irritable, by measuring changes in their electrical activity.
Finally, he will try three promising medicines already approved for other illnesses to see whether they can switch down the inflammation signals and return electrical activity towards normal. This will identify the best medicine and the simplest measurements needed to design a small first study in patients.
Ali is a resident neurosurgeon who has taken time out of his clinical training programme to pursue a PhD. As a neurosurgeon in the NHS, Ali has treated many patients with primary brain tumours and has seen the devastating effects of seizures on patients’ quality of life. One patient said to him that their seizures were ‘more trouble than the meningioma ever was’.
Ali’s aim during his PhD is to test his hypothesis about how meningioma brain tumours cause seizures, to improve our understanding of why brain tumours cause seizures and to design new treatments to prevent seizures. He will also consolidate his skills in biochemistry, data analysis, and human-relevant tumour-brain modelling to develop his abilities as a neurosurgeon-scientist.
Ali will be supervised by Professor Michael Jenkinson, who will provide overall scientific leadership and ensure clear clinical translation of Ali’s research to first-in-human studies through his extensive research networks.
Following completion of his PhD, Ali intends to apply for a NIHR Clinical Lectureship and then pursue a clinician-scientist award to establish an independent group focused on brain tumour-related epilepsy.
This research will explain why some meningiomas cause seizures and identify treatable causes rather than symptoms. It could lead to a new approach: preventing seizures by calming tumour-driven inflammation, using medicines that are already in routine use for other conditions. The findings will also support a practical way to estimate an individual patient’s seizure risk, helping doctors tailor monitoring, medication and decisions about surgery.
Ultimately, better seizure control should improve quality of life, reduce emergency admissions and promote safe return to driving and work.
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