Alan Barber
Feature - Upfront
Alan Barber
by Matt Nippert
Alan Barber was once simply a brain man. Now he’s a brain man with a chair. A professor of neurology at the University of Auckland, he also treats victims of stroke – a condition that kills or debilitates 4000 New Zealanders every year. On the first day of his new job as the freshly minted Neurological Foundation Chair of Clinical Neurology, Barber was late for his early morning interview with the Listener.
What kept you? This morning I’ve seen two patients already. One of them came in with Bell’s palsy, that’s where a virus infects the muscles of the face and the face becomes weak – it’s very dramatic and terrifying. The concern was: did this person have a stroke? A stroke is completely different; that’s where you get a blot clot in part of the brain that blocks blood supply, and part of the brain dies and stops functioning. Bell’s palsy has a 90% chance of coming right and is not a big deal. The second patient came in with severe headaches and with numbness and tingling down one side of his body.
I used to get that with migraines. Once my left eye went fuzzy and my right hand went numb during an exam. Well, I would have written you a note to get you out of it. We think this patient had a migraine, but we’re putting him through the scanner just to make sure.
What causes a stroke? Strokes are like heart attacks. In fact, Americans call strokes “brain attacks”, which is a clumsy term, but it does engender that sense of urgency. If you got chest pain you would be convinced you’d had a heart attack, and you’d get yourself into hospital. But strokes aren’t painful, they don’t hurt. One of the problems we face is getting people to the hospital quickly.
Strokes and heart attacks are basically the same disease but with different arteries. Heart attacks occur when the arteries to the heart get gummed up. With stroke, the arteries in your neck that take blood to your brain, gum up – or the little ones in the brain themselves gum up. The usual suspects are smoking, high cholesterol, fatty diet, being overweight, not exercising, having diabetes.
Aside from death and disability, have you seen any patients oddly affected by strokes? You mean like The Man Who Mistook His Wife for a Hat? Oliver Sacks has got a lot to answer for. We do, but it’s pretty rare and distressing. I saw someone who had a stroke that affected the right side of his brain and he completely ignored the left side of space.
He’d make a terrible goalkeeper. An absolutely terrible goalkeeper. Also, when you lifted his arm up he didn’t recognise his left hand as being his own. And while that improved, he does neglect the left side of space – and that’s very difficult to rehabilitate from.
How little do we know about the brain? We know more than we did, but it’s still humbling to realise how much we don’t know. When I’m looking after the hospital ward, there is always a patient that I have no idea about. I find that challenging, it’s very rewarding, and we get there in the end. When I was a junior doctor we were taught that once you’re an infant you don’t get any more brain cells. And when you hit your 40s you start losing brain cells at an increasing rate.
That’s a terrifying thought for boomers. But in the last 10 years, we’ve figured out that isn’t true. Isn’t that amazing? A lot of the research on that has been done by Richard Faull and his team across the road at the medical school. Here at the university they’re trying to find ways of manipulating those brain cells, generating the ones that we want, and getting them to the areas that we want. That’s a long way down the track, but a few years ago this wasn’t even a possibility.
Will your new position see you locked in an ivory tower? Half of my job is seeing patients, and the other half is research and teaching. The research is clinical, so I need access to patients with neurological diseases. My aim is to take the world-class basic neuroscience that happens across the road and translate it into benefits for patients.
