From Our Neurons to Yours

How basic science transformed stroke care

• Wu Tsai Neurosciences Institute at Stanford University, Nicholas Weiler, Marion Buckwalter • Season 7 • Episode 9

Share episode

A generation ago, a big clot in the brain meant paralysis or worse. Today, doctors can diagnose clots on AI-enabled brain scans; provide life-saving, targeted medications; or snake a catheter from a patient’s groin into the brain to vacuum out the clot. If they intervene in time, they can watch speech and movement return before the sedatives wear off. How did that happen—and what’s still missing?

In this episode of From Our Neurons to Yours, Stanford neuroscientist and neurocritical care specialist Marion Buckwalter, MD, PhD retraces the 70-year chain of curiosity-driven research—biochemistry, imaging, materials science, AI—behind today’s remarkable improvements in stroke care. She also warns what future breakthroughs are at stake if support for basic science stalls.

Learn More

Buckwalter Lab site

History of Stroke Care:

The uncertain future of federal support for science

We want to hear from your neurons! Email us at at neuronspodcast@stanford.edu or... 

Send us a text!

Thanks for listening! If you're enjoying our show, please take a moment to give us a review on your podcast app of choice and share this episode with your friends. That's how we grow as a show and bring the stories of the frontiers of neuroscience to a wider audience.

Learn more about the Wu Tsai Neurosciences Institute at Stanford and follow us on Twitter, Facebook, and LinkedIn.

Nicholas Weiler:

Welcome to From Our Neurons to Yours, from the Wu Tsai Neurosciences Institute at Stanford University—bringing you to the frontiers of brain science. 

Progress in medicine can sometimes feel frustratingly slow. Research is a painstaking and deliberate process that builds on decades of quiet work in the lab, on building relationships, on deploying new technologies and meticulously planning clinical trials. 

Now, every now and then this slow and steady march of knowledge will lead to a sudden breakthrough. Your metformin, your first ever gene therapy for a terrible disease, but more often it's hard to appreciate just how much progress we've achieved until we take a step back. When we do, we can see once devastating conditions that are now treatable. Patients who can walk out of the hospital who not long ago wouldn't have survived. 

These incredible advances have been driven in large part by 70 years of broad investment in basic curiosity-driven research by federal agencies like the National Institutes of Health, which is the world's largest funder of biomedical research. And the curiosity in research is really important because you never know what's going to lead to the next big breakthrough.

Today on the show, we're going to take a look at one example of how slow and steady progress, people asking just basic questions to try to understand how biology works, has transformed outcomes for patients. Specifically, we're going to take a look at how far we've come in treating stroke. 

Stroke is one of the most common and the most feared neurological events. Basically, it's when something goes wrong with the blood vessels in the brain. Most often there's a clot that blocks blood flow, which is called an ischemic stroke, and less commonly a blood vessel actually ruptures and blood leaks into the brain, which is called a hemorrhagic stroke. In either case, parts of the brain stop getting the oxygen and nutrients they need. Those parts of the brain, if it goes on long enough, eventually die. And depending on where in the brain the damage occurs, a stroke can cause anything from mild confusion to complete paralysis and death.

But today, what was once a wait and see kind of situation has become a race to rescue brain tissue, thanks to new techniques, drugs, and know-how. 

Our guest today is Dr. Marion Buckwalter, a physician scientist at Stanford who studies stroke in the lab and also treats it in the ICU. She's been in this field for decades and she's going to tell us about what's changed, how we got here, and the additional breakthroughs she hopes we'll see in the years and decades to come, so long as we continue investing in the hard work it took to get us here in the first place. And right now, that's not a guarantee, considering the considerable uncertainty around the future of federal funding for basic research. Marion and I will get into that, too. 

I started our conversation by asking Marion to compare the standard of care for stroke today versus what she saw when she was completing her medical training in the early '90s.

Marion Buckwalter:

I think that the care has changed the most, actually, happily for people with the worst kinds of stroke. So often the worst kinds of strokes are the ones where a large clot lodges in a large vessel, so it cuts off blood flow to a large part of the brain. The worst location for that is a left middle cerebral artery stroke, which gets at the language areas so that it makes it so that somebody can't understand words or come up with words and also can't move the right side of their body, so can't walk or move.

Nicholas Weiler:

Yeah, that would be really ... I mean, one thing that's bringing up, it's sort of helpful to imagine the vasculature in the brain almost like a tree-like structure, where you've got these really large arteries that then branch and branch and branch into smaller and smaller ones. And so if you're blocking the biggest section, that's going to have the largest impact on the brain.

Marion Buckwalter:

That's exactly right. It's just like roots of a tree. So if you could imagine a tree getting water up into the top of the tree from the ground, if you cut away the roots, then the tree doesn't get enough water. Except in humans, a lot of times when the vessels get cut off, it's not like the other side can take over. So sometimes it can, but most of the time it cannot.

Nicholas Weiler:

So you're saying so the left middle cerebral artery is feeding the left side of the brain where there are a lot of language functions and of course the ability to move the right side of the body. And that's one of the most impactful types of stroke that you see in the clinic?

Marion Buckwalter:

Yeah. And one of the reasons it's so impactful is that this is the kind of stroke that makes it so that you can't interact with loved ones and family. You can't understand language, you can't speak, and you also can't walk or feed yourself or do basic bodily functions alone. This is a dreaded kind of stroke. And when I was in training in the early '90s, basically we would do either nothing or we would put people on a blood thinner to try a mild blood thinner to try and prevent another stroke, but there was nothing we could do about that stroke that already happened. And then over time it's transformed itself and we can maybe talk about how that happened, but the way it might happen today is you have symptoms, you call 911. We have a system of primary and secondary stroke centers. So a patient at Stanford might come into the emergency room or they might come into what we call a spoke hospital where the hub, there's a hub and spoke model, so they come into a primary stroke center.

They would get imaging of their brain that would now tell us that the stroke is in process of happening that would be able to detect that there's an area getting not enough blood flow and the brain cells aren't dead yet and could potentially be rescued. If you're at Stanford, we would give you a powerful clot busting therapy. If you were at another hospital, we would do the same thing by telephone after viewing the images online. Either way, you'd get either helicoptered or moved quickly to our angio suite in the hospital where doctors would thread a catheter up the artery in your groin up to your brain and apply either physical pressure or additional chemicals to bust up the clot and pull the clot out. If you get there in time, we can prevent most of that stroke from happening. So sometimes people will end up with no stroke at all, they'll be totally fine, or they'll have mild symptoms instead of the very severe ones that they would've had in the early '90s. It is incredibly dramatic when you see it.

There are still issues where there are people who don't get to treatment in time who have these kinds of strokes. There's also people with smaller strokes that are not as amenable to these kinds of therapies. So about 13% of people are eligible for these therapies. And I would say when we have one of these people come to Stanford, a lot of the time we can make the stroke smaller.

Nicholas Weiler:

Yeah, it's an amazing set of technologies and it must be just so gratifying to you. How does it feel to you as a clinician working with families that you have things that you can actually do?

Marion Buckwalter:

It feels transformative. It's super exhilarating to know in my brain what might've happened to somebody and see them talking and moving and able to walk. It's really special. Not everybody's eligible for therapy, so we still have people where we can't do much, but the fact that we can do something for these people suffering these very large strokes is really amazing. Their families and the patients also see that as well. We're not fundamentally who we are unless we have our brains working.

Nicholas Weiler:

Right. Yeah, I mean, the brain is resilient. The brain is plastic. It can recover a lot, but there's only so much it can do if it loses blood and the cells start dying. Well, I'd love for you to take us through the history of how we got here a little bit and I'd love to look at some of the specific advances we've seen and sort of how they built on one another and how they built on a better understanding of what is actually happening in the brain when a stroke is going on and how we can fix it. It sounded like you mentioned a few different sort of pieces of this, and maybe we can take them one by one. So there are drugs to help break up clots. There's imaging to figure out where a clot is forming and what exactly is going on in the brain. There are techniques for actually going in with this long snake-like device to actually physically remove the clot, which is pretty amazing that we can travel through the blood vessels in almost like Fantastic Voyage style.

And then of course we know more about prevention. What can we do to help make it less likely that further strokes will happen? So maybe we could start with the drugs. What are sort of the big breakthroughs in how we can use drugs to break up clots?

Marion Buckwalter:

Okay, so the main drug is tissue plasminogen activator and it's derivative, TNK, which is slightly lower bleeding risk, that we use them both. These are drugs that can actually go in as enzymes and chew up a clot to get it to dissolve.

Nicholas Weiler:

Because a clot is basically ... What is a clot made of exactly?

Marion Buckwalter:

It's made out of proteins in the blood as well as cells called platelets that trigger clotting. They kind of explode their contents and make the blood clot. And everybody's seen that when they cut their skin, for example.

Nicholas Weiler:

Right. It's a scab, basically.

Marion Buckwalter:

Yeah. Reflecting on this, I was just thinking about the amount of time it took to get to a place where we could put this enzyme into a person's body. There was research as far back as the '50s and '60s trying to understand how these different proteins in the blood make a clot, which proteins specifically are important, how clots are broken up in the body. So you could imagine as you heal, normally clots are broken up. And somebody that was funded by NIH probably discovered that and there were decades of work trying to understand what clots were. There were also advances that were funded by federal dollars in how to clone genes, which means being able to take them out of a human cell and maybe put them in a cell culture cell so that you can make protein from that. There were advances in how to make large amounts of these proteins and make them pure enough that you could inject them into a person and know that you're injecting just that one protein and that it was safe.

So all of these things had to happen and then doctors had to understand that clots caused strokes. That took imaging, so CT scans were invented in the ;'70s. Actually, the first work on them was done in England, but a lot of refinements have come from federal dollars here. So it just sort of gives you a flavor that it's not like ... There was a study that happened and finished in 1996 that showed that given this clot busting drug to people within three hours of stroke had a benefit. That single study was also funded by NIH. It was funded by the National Institute of Neurological Disorders and Stroke and it was years in the making. However, it's decades before that, the basic science work, that led to them being able to do that trial. And when you are a researcher, you may spend a lifetime trying different blind alleys or not blind alleys to figure out how things are working.

You need money to do the research to pay for the reagents, to pay for the people to do the work, and you need money that allows you to make some mistakes because you don't know the answer. That's the whole point of research and it does take a very long time.

Nicholas Weiler:

Right. It's a pipeline that sort of gradually evolves over decades to get us to a place where we know enough that we can actually do something impactful for people.

Marion Buckwalter:

There's one more thing I wanted to say about this, too, which is that the people in the early days who were studying blood clotting, they had no idea that they were working on a future cure for stroke. They were curious about how blood clotting worked. And that is true for a lot of basic science, that you don't necessarily know once you figure out how something works how it's going to help.

Nicholas Weiler:

Right, but then when someone is looking at how can I come up with a better treatment for stroke, they can go back and say, "Ah, this person 20 years ago figured out this fundamental thing about how blood clots stick together and there's an enzyme involved that unsticks them. So maybe I can find that enzyme and clone that and turn that into a treatment." But all of that stuff needs to be known in advance if you want a stroke treatment in a shorter timeframe than 30 years.

Marion Buckwalter:

Exactly.

Nicholas Weiler:

Well, you started talking about CT imaging and that when you're doing with these drugs, are the drugs that you were just describing to us, is that something general that'll break up clots anywhere? Because I know that one of the challenges with blood thinners is it also is kind of dangerous because our blood clots for a reason.

Marion Buckwalter:

Yeah.

Nicholas Weiler:

Are these safer and how can you be more specific about targeting a particular clot that's actively forming?

Marion Buckwalter:

So that's a great question, Nick. I think there's a couple different things in there. There's blood thinners that we used to use that just prevent clots from getting bigger and then there's the clot busting drugs. And that's what we're talking about here.

Nicholas Weiler:

Got it.

Marion Buckwalter:

The clot busting drugs don't care where the clot is. So when you selected a patient back in the '90s to get the clot busting drug, tPA, you would try and make sure that they didn't have somewhere else that might bleed when you gave them a clot busting drug. It is very short acting, so it only lasts about an hour, but you very carefully try and make sure that people didn't have a bleeding risk. Getting back to the imaging, that's another reason why imaging is really important. I mentioned that 85% of strokes in the US are caused by a blood clot, but 15% are caused by blood vessel breaking. Until we had CT scans, we couldn't tell whether the stroke was being caused by a bleeding vessel or a clot. If someone has a stroke from a bleeding vessel, you don't want to give them a clot busting agent, obviously, because it will make them much worse.

Nicholas Weiler:

Right, because you actually want the vessel to repair itself.

Marion Buckwalter:

Right. You want the clot to keep more blood from getting into the brain if someone's having a bleeding stroke. So if you don't have imaging, you can't know. So back in the '90s, we started to be able to tell quickly and have enough CAT scans or CT scanners that people could get a scan quickly in the emergency room to see if they were having a bleeding kind of stroke. However, back in the nineties when I was first in training as a resident, you couldn't always see the ischemic strokes. You could only see the bleeds because the resolution of the scans wasn't as good. So if you think about a TV show that you ... Maybe you're a little younger than me, but a TV show I might've watched as a kid, we had a black and white TV that was quite small and you didn't have a lot of detail. Whereas now you have a bigger screen and you have all these colors and it's really sharp. When it's sharp, you can start to see all the pixels and you can see where the stroke is starting to happen more easily.

The CAT scans that we were using in the '90s, those CAT scans were looking at tissue damage. So after brain tissue doesn't get blood flow, it starts to swell, sort of like your ankle swells. Not right away when you twist it, but it takes a little time to swell. Same for the brain, so we couldn't see early strokes and we couldn't see blood flow at all. But then as time went on, we developed techniques to look in real time or close to real time at blood flow and how blood flow is happening in the brain. And that was a big advance that was mostly funded by NIH research. Now, we have basically artificial intelligence driven interpretation of those scans. So when we first had those scans, they were great, but they weren't instantaneous.

And now, if someone comes into an outside hospital and they have a stroke and they have a scan that looks at the blood flow, it'll get interpreted by a program that uses artificial intelligence to tell where the blockage in the vessel is, what part of the brain is at risk, and whether somebody would benefit. Basically, if the brain hasn't died yet or probably hasn't died yet, then that's when we would pull the clot out with a catheter.

Nicholas Weiler:

I mean, to go from only being able to kind of see once the tissue is already dying to actually being able to quickly detect a clot that's forming that, if I understood you right, is not 100% blocking the artery yet.

Marion Buckwalter:

Actually, it is completely blocking the artery, but it hasn't killed the brain cells yet.

Nicholas Weiler:

Okay, and are you seeing the clot itself or are you seeing that the brain tissue is starting to get stressed?

Marion Buckwalter:

So what we can see is the actual blood flow. You could imagine if you have a blood drain, you don't have water flowing down the drain. In this case, it's feeding your brain and we can see the part of the brain that isn't getting blood flow. We can see where it is and how big it is. Sometimes we can see the clot itself, but we don't really need to see the clot. We really want to know where is the brain tissue at risk? If blood flow is actually zero, the brain will die relatively quickly, but a lot of times it's not completely zero because there are smaller other channels that blood can get through. And if you can break up the clot in time, you can save all or a lot of the brain tissue that would've died.

Nicholas Weiler:

Got it. And this is with CT imaging primarily?

Marion Buckwalter:

We can do it with either CT or MRI. It's often done with a CT because they're more available in emergency rooms. I think what I was trying to say is also being able to see it immediately was a big advance. So if you were the doctor at Stanford that's deciding whether to have this patient helicopter to Stanford or brought from our emergency room up to our cath lab where they have the catheters to take the clots out, we actually have ... There's an app on your phone where you can see the patient scan nearly instantaneously.

Nicholas Weiler:

Wow.

Marion Buckwalter:

So it gets fed to us and then we have a call with all the doctors involved, including the doctor at the other hospital, and decide what's the best course of treatment for that patient.

Nicholas Weiler:

Yeah, that's a great point, to get the treatment fast enough, because it's not enough to just have a treatment. But basically as soon as the patient starts experiencing symptoms, there's a clock ticking, right?

Marion Buckwalter:

Yeah. So this software that I'm talking about was developed at Stanford. Dr. Albers, who was the leader on the study and who's the head of the stroke center here, had the idea that if people had low blood flow, those would be the people that would benefit from pulling the clot out. And he applied for NIH funding to fund a trial to study that and he ended up doing three different trials. The first few of them sparked other trials, other multi-center trials, some funded in the US, some international, that showed that basically having this program and this knowledge of where there was tissue at risk was the key for identifying who would benefit. We were talking earlier about bleeding in the brain. If the brain tissue has already died, you could potentially make it worse by breaking up a clot because when the brain tissue dies from lack of blood flow, you lose the blood vessels as well as all the other cells, not just the neurons.

And so providing more blood flow back into a dead area, you can actually get bleeding because the blood vessels are weakened. And so early studies without this sort of magic AI platform failed to show a benefit because they were treating some people who wouldn't benefit and actually got worse. And so it allowed us to select the people that would actually benefit from the therapy.

Nicholas Weiler:

And the AI here is sort of taking the imaging data and trying to ...

Marion Buckwalter:

And processing it to show the doctor in a simple way this is the part of the brain. It literally colors the brain tissue, like this part of the brain is likely dead and this part around it. So a small area is likely dead and a larger area around it is going to die if you don't open up that vessel. If the tissue has already died in the area with low blood flow, that person would not benefit from the therapy and so we don't give it to them. It's kind of magical.

Nicholas Weiler:

It's incredibly magical. I mean, it's something we've talked about on the show a lot, that to do something meaningful for the brain is challenging because it's inside the skull. And you don't want to be opening up the skull, but now we've got these tools. CT is based on X-rays and MRI is based on magnets. And it's incredible that we can get this really fine resolution to be able to feed the data into the AI algorithm to figure out what parts of the brain are in what status and get it to the doctor over the internet and our mobile networks through satellites and back down and make a decision really quickly. We were talking about the clot busting drugs, but the other thing you mentioned was this amazing ability to actually put this tiny sort of snaking device in through an artery in the groin and actually get all the way up to the clot in the brain.

Marion Buckwalter:

Yeah.

Nicholas Weiler:

That sounds like a crazy thing to do. How did that come about?

Marion Buckwalter:

That's a great question. Actually, a lot of catheters were pioneered in taking care of heart attacks. So this happened maybe the '80s and '90s. I'd have to double check the dates, but by the time I was in medical training, it was pretty established that you could put a catheter in the heart and open up a blocked vessel. The heart is a little more forgiving than the brain. You don't have to get to it as quickly, but it's similar where time matters. So if a blood vessel in the heart is blocked and you have a heart attack, people learned how to open them up and put in stents, but translating it to the brain was a challenge. Brain blood vessels are a lot more delicate than heart blood vessels. They're a lot more elastic. They have to be to deliver blood flow. I'll take this little step to the side. I was also reflecting on how this is a podcast on the brain, but we're talking about blood vessels and blood clots, but actually the brain is very metabolically demanding.

It really needs its blood flow. The brain is about 2% of body weight and it gets 20% of the oxygen that you bring in and 15% of the blood flow that comes from your heart goes to the brain. The body recognizes the brain is important, but the issue is it needs to be very high flow, the blood in the brain, because there's not enough room. If you had a proportional amount of blood volume, your head would be way too big and you wouldn't be able to walk around. And so what you need is you need this fine-tuned system where you have these very elastic, delicate vessels that can expand and contract depending on what part of the brain you're using at the time. So this is the basis of functional MRI you probably know.

Nicholas Weiler:

Right, so it's actually figuring out where there's more blood flow or less blood flow to interpret what parts of the brain are more active or less active.

Marion Buckwalter:

Yeah. And so what this means when you get back to somebody having a stroke is that the brain dies much more quickly when it doesn't have blood flow because it's so dependent on the glucose and the oxygen that the blood carries to the brain. But then also the vessels themselves are very delicate and so you have to have good imaging. Again, the imaging in this case is done in real time where the doctors who do this that are called neuro-interventionalists take a catheter and shoot a little bit of dye so they can watch where the catheter goes. And so over time, those catheters had to be developed that were delicate enough that they didn't tear the blood vessels in the brain and then they had to develop ways to get the clot out. There are devices that kind of grab the clot now and pull it out.

There's also suction devices that they can use and then they can also deliver a higher concentration of one of those clot busting drugs, TNK or tPA that we talked about earlier. But this time, instead of giving it to the whole body, they can deliver it right to the clot itself. And that's a lot more effective at limiting the exposure of the rest of the body to the clot buster and also in delivering a higher dose to the clot itself. And when they're doing the procedure, they're shooting dye slowly up so that they can see the shape of the vessel and they can actually see where the vessel is blocked and they can see when they're successful in breaking up the blood clot.

Nicholas Weiler:

So what were the advances that needed to happen before you could move from doing this in the heart to moving this in the brain?

Marion Buckwalter:

They basically had to make devices that were a lot more delicate. And then to actually pull the clot out, they had to figure out. If you picture a really delicate blood vessel with a clot at the middle, they had to get the clot out without damaging the blood vessel walls. So if you damage the blood vessel walls, you could cause a rupture. There were some earlier attempts. There was a very cool one when I was an early attending, so maybe this would be the early 2000s, but there was like a corkscrew you would take out a wine bottle cork, but that by necessity had a little bit of a pointed edge and then they developed technology to suck on the clots and actually pull them out. So it's material science was necessary for that to make things that are just smaller and more delicate, but that you can still manipulate through a tiny little catheter that goes up into these blood vessels that are quite small.

Nicholas Weiler:

Yeah, and I know that these techniques and technologies are still continuing to evolve. I know Renee Zhao, for example, here at Stanford is doing work on even more advanced techniques for pulling clots out and getting them out in a way that doesn't damage the blood vessels. So you've taken us through this journey from back in the '90s when there was very little you can do to now when there's a lot we can do. What are some of the limitations, I guess, or some of the areas where we still need more progress? You were talking about how we've gotten better at quickly treating some of the worst kinds of strokes, which is great to be able to help the people who would be most impacted by a stroke, but what are some of the areas where we are still trying to figure out how we can get help to people fast enough to save their brains?

Marion Buckwalter:

Well, I think that you can separate that into two parts, so one is preventing the stroke. So essentially, the therapies we're talking about now are preventing the stroke at the very, very last moment. And we've also had a lot of advances in how to prevent strokes ahead of time, like taking medications for high blood pressure, high cholesterol, high blood sugar. All of those medications prevent strokes. The other issue is that when people have strokes, if there's no one there to see them, they may not be able to call for help. There's always going to be people that have a stroke that don't get to the hospital in time to rescue the tissue. There have been some advances there. There's actually some cool studies using smartwatches. You may know that the Apple Watch now has this thing where it can call 911 if you fall. So something like that might identify somebody with a large stroke.

There's also people with smaller strokes, and they may have either no symptoms or just very mild symptoms and they may ignore them. So symptoms of stroke would be weakness on a part of the body or the face, slurred speech, problems with balance, problems with vision. It's very important that people understand that those are emergencies and that they should call 911 because if they do have a larger stroke or a threat of a larger stroke, they want to be at a hospital. So there's a lot of public health work on that, educating people on stroke, and that's also NIH funded. The second side of that I think you're about to ask about is after the stroke happens, what can you do? We talked a little bit about plasticity and there's a lot of people at Stanford working on therapies to try and make the brain recover better after stroke. There's people working on implants.

Dr. Henderson has a big project on people who can't speak and trying to help them speak through an implant. And then my work is focused on long-term cognitive consequences of stroke, so stroke doubles your risk of having dementia. It also causes post-stroke fatigue, which is kind of similar to post-COVID fatigue. And we're trying to understand the biological basis of this and I think we'll talk about that in the future at some point.

Nicholas Weiler:

Yeah, I'm looking forward to having that conversation when that research is ready. We've been having back channel conversations about that. Marion's got some very exciting stuff coming up that I'm looking forward to talking about on the show. So just to take this back to the big picture, for anyone who knows someone who's had a stroke, or has experienced a themselves, or is it risk, how would you think about the impact that our investments in just fundamental curiosity-driven research have impacted something very practical? How quickly can we get help to a patient?

Marion Buckwalter:

Yeah. I mean, I think this is the kind of thing that's really priceless. When you see the articles about how every dollar of NIH investment gives you $2.46 of benefit or something less, there's a couple different estimates there, as I'm sure you know, they're talking about economic impact. But if you are one of these people who ends up a functioning member of society instead of either dead or in a nursing home unable to communicate with your family, that's really priceless. You would give probably anything to not have that giant stroke. So I think it's hard to put a dollar amount on it, but the impact is really tremendous. It means that person, instead of having a stroke, can have a job and they can be with their kids and be with their grandkids and their loved ones. And it means their loved ones don't spend time taking care of them. Stroke is the number one cause of permanent disability in the US. And you may know that if somebody has reached the age of 25, then they have a one in four chance of having a stroke in their lifetime.

Nicholas Weiler:

Really? Wow.

Marion Buckwalter:

Yeah, it's really high.

Nicholas Weiler:

It's something that will likely affect very many of us.

Marion Buckwalter:

Yeah. And when I give a talk, for example, I'll often ask people in the room to raise their hand if they know somebody personally who's had a stroke. And most people raise their hands and I would love there to be a world where people didn't raise their hands when I asked that question.

Nicholas Weiler:

Well, just to close this out, I'm sure that listeners are wondering what can we do? What should we be thinking about given these challenges and uncertainty that are facing investments in fundamental research here in the United States right now? Do you have anything that you'd like to say to listeners about how they should think about this, what those threats really look like?

Marion Buckwalter:

Yeah. I would say not just in neurologic disease, but in pretty much every disease they're in a kind of a similar place to stroke. I mean, stroke is a terrible disease, but there's many other terrible diseases that have seen big advances due to basic science research. These are things that really impact our lives not just in monetary ways, but in really personal ways. You can't get to be my age, I'm 59, without having family members and friends who have died of diseases, or who are suffering from diseases now, or who are going to. The money that our government has put into these cures, we're not done. We really need more. That's really true for neurologic diseases, as I'm sure you have talked about on your podcast, but it's true for many other diseases as well. And so I think all of us as citizens of the US should care about that.

These are global problems and scientists often work as teams that include international collaborators. Just like doctors, scientists really want to help everybody that comes in front of them. And so I think support by our government of international research can actually really help not just people here, but people all over the world. But the converse is also true, that our cooperation and our collaborations with others also help. So I think that's something else people should understand.

Nicholas Weiler:

Science is sort of this beautiful global network. And even in times when there's international tension, I mean, often scientists are still trying to find ways to collaborate to find answers to these fundamental problems that are so difficult to tackle with just one small group here and there. We need the expertise that comes from everywhere. Marion, thank you so much for coming on the show. I'm really looking forward to having you back to talk more about some of the exciting research coming out of your lab. I know we've been talking about some really cool stuff that you've got going on, so I really look forward to having you back to talk more about this important work.

Marion Buckwalter:

Thank you, Nick. It's been great to be here.

Nicholas Weiler:

Thanks again so much to our guest, Dr. Marion Buckwalter. She's a professor of neurosurgery and of neurology and neurological sciences at Stanford Medicine. To read more about her work and the progress in stroke care, check out the links in the show notes. If you're enjoying the show, please do subscribe and share with your friends. That's what helps us grow as a show and bring more listeners to the frontiers of neuroscience. We'd also really love to hear from you. We'd love to hear what you are loving or what's not working for you on the show in a comment on your favorite podcast platform or by sending us an email directly at neuronspodcast@stanford.edu. From Our Neurons to Yours is produced by Michael Osborne at 14th Street Studios with Sound Design by Morgan Honaker. I'm Nicholas Weiler. Until next time.