British Journal of Neurosurgery, October 2014; 28(5): 595–597 © 2014 The Neurosurgical Foundation ISSN: 0268-8697 print / ISSN 1360-046X online DOI: 10.3109/02688697.2014.940844
BIOGRAPHICAL SKETCH
Biographical sketch: Jason Brice Rahul S. Shah1, Marwan Hariz2,3, Tipu Z. Aziz1 & Erlick A. C. Pereira1 1Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford, and Oxford Functional Neurosurgery,
Nuffield Department of Surgery, University of Oxford, Oxford, UK, 2Unit of Functional Neurosurgery, UCL Institute of Neurology & The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, and 3Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
Abstract This article is a biographical sketch of retired British neurosurgeon Jason Brice, who is a pioneer of deep brain stimulation and helped establish the Wessex Neurological Centre. Keywords: deep brain stimulation; epilepsy; tremor; Wessex Neurological Centre
Jason Brice (Fig. 1) was born in 1927. His early schooling was at a two-roomed Church of England school in the North Downs. He started 2 years ahead of his peers and went on to study at the County Grammar School for Boys in Gravesend. Expressing an interest in botany, zoology and biology, he was given the task of teaching himself biology in the school’s laboratory due to a paucity of teachers during the Second World War. It was there he developed an interest in histology and first started dissecting organs carefully to enable their preparation and staining, fondly recalling his copy of The Microtomist’s Vade-mecum: a handbook of the methods of microscopic anatomy.1 At the age of 16, he passed the Higher Schools Certificate examination (replaced by A-levels in 1951) and by a stroke of luck was allocated to attend university rather than become a conscripted coal miner (‘Bevin boy’) or serviceman. Supported by a father who was keen to keep his son away from the front line, he opted for a career as a doctor. Being too young to start a medical school, he stayed on a further year at his own school – mostly tutoring other pupils. Having already gained his first MB on the basis of his Higher Schools Certificate and having won a State scholarship, he entered Guy’s Hospital Medical School in 1944 to start his Second MB. At the end of his first year, he won the Harris prize in anatomy, which – in the wartime absence of enough gold for an actual medal – took the form of £25 and two specimens that he had to dissect – a female pelvis and a human brain. During clinical school he was also strongly influenced by renowned neurologist Sir Charles Putnam
Fig. 1. Jason Brice.
Symonds, whom he would later work with at the National Hospital for Nervous Diseases, Queen Square, London. He completed his MBBS with a junior proficiency prize, and went on to start as a house officer in general surgery and anaesthetics at Joyce Green Hospital in Dartford, Kent followed by neurosurgery under Geoffrey Cureton Knight, when he became set on a career in neurosurgery. He then joined the Royal Air Force medical corps in 1950 as the duty doctor. In 1952, told incorrectly by a Department of Health advisor that he must have completed 2 years as registrar in general surgery before he could start his neurosurgical training, Brice took a general surgery post in Woolwich Memorial Hospital, adjacent to the regional neurosurgical centre at the Brook General Hospital. Already in possession of the primary FRCS, he then did general surgery at the Royal Post-Graduate
Correspondence: Mr. Erlick A. C. Pereira, MA, DM, FRCS, Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford OX3 9DU, UK. Tel: ⫹ 44 (0)-1865-741166. Fax: ⫹ 44 (0)-1865-231885. E-mail: [email protected] Received for publication 7 May 2014; accepted 4 June 2014
595
596 R. S. Shah et al. Medical School, Hammersmith, London. Following a brief spell searching for work, he managed to gain a registrar post at Hammersmith in general surgery. At the time Brice was a keen writer of pantomimes, and set up the rugby club at Hammersmith Hospital – the latter being much to the annoyance of prison guards in the grounds of Wormwood Scrubs Prison where balls could often be found. Despite attempts by his general surgical mentors to dissuade him from a neurosurgical career, he took a registrar post at The Maudsley Hospital under Murray Falconer. Married and expecting his first child, he then became registrar (aka ‘burr hole boy’) to Wylie McKissock at Atkinson Morley’s Hospital. A short time later he was to become McKissock’s senior registrar at the National Hospital for Nervous Diseases and Great Ormond Street Hospital, being told, ‘this may involve you in some social upset, but this is not my concern’. His training continued at pace, and on the return of Lawrence Walsh from Lars Leksell’s group at the Karolinska Institute in Stockholm, McKissock asked Walsh to train Brice in the entire Leksell stereotactic frame method such that he could become the main ‘operating shaker’ performing lesional surgery for Parkinson’s disease. As was the trend during this period, Brice was then sent abroad to Northwestern University, Chicago in 1959 to perform research relating to thalamic nuclei functions. Following that experience he returned to the National Hospital for Nervous Diseases and continued working and undertaking projects for McKissock,2 until he was appointed to his first consultant post in 1965.
Neurosurgery in the Wessex region In 1948, the South West Metropolitan Regional Hospital board was responsible for medical care in South West London, Surrey, Hampshire, Dorset, Wiltshire, Isle of Wight and west Sussex. The sole neurosurgical unit serving this vast area with a population of 5 million people was at Atkinson Morley’s Hospital in Wimbledon headed by Wylie McKissock. It quickly became apparent that this arrangement left some patients a considerable distance away from a specialist neurosurgical centre. On the suggestion of McKissock, Stanley Graveson was therefore appointed in 1950 as a consultant neurologist travelling from one district hospital to another doing inpatient and outpatient work, later joined by Peter Robinson in 1956. From 1957, discussions between Graveson, John Revans (Senior Medical Officer of the Wessex Region) and Wylie McKissock led to plans for building a specialist standalone neurosciences centre in Southampton (to be known as the Wessex Neurological Centre) to serve patients in Hampshire, Wiltshire, Dorset and the Isle of Wight.3 Brice was appointed as its first full time consultant neurosurgeon in 1963 and on asking Dr John Revans for a job description, recalls his stern reply, ‘ You are to set up and develop a neurosurgical department of the standard of a university department in a medical school on par with much of the rest of the world.’3 Wessex Neurological Centre (WNC) opened in 1965, and Brice was joined by John Garfield as his senior registrar on secondment from Queen Square (Fig. 2). The first operation in the brand new theatre was planned to be a laminectomy for prolapsed
Fig. 2. Jason Brice operating in the Wessex Neurological Centre.4
intervertebral disc on a Monday afternoon; however, this was delayed by 5 or 6 h by two emergency operations for a large frontal tumour and a ruptured arteriovenous malformation. Playing rugby football in his youth convinced Brice of the benefits of a team approach, hence this was the default for patient management at WNC rather than the hierarchical approach which typified the era – exemplified by everyone from junior nurse to senior registrar becoming an equal target for interrogation during the Monday morning grand round. He was passionate about teaching, which was often dramatic and colourful – for example, to impart a three-dimensional understanding of neuroanatomy to psychiatry registrars he required each person to become a part of the brain: ‘ You, Sir! You’re the choroid plexus.’4 A series of evening lectures given by the consultant staff was also established as part of the training programme for nurses, later becoming the Neurological and Neurosurgical Nursing Course and gained formal accreditation. Brice and Garfield were the only two neurosurgeons at the WNC for a considerable time until John Pickard joined in 1979.
Deep brain stimulation Working with neurologist Lindsay McLellan, who had previously spent some time with Irving Cooper in New York in
Fig. 3. Polygraphs of voluntary movement of the elbow during stereotactic exploration of the target sub-thalamic area. In each polygraph (A–C) the upper trace is biceps EMG, middle trace is triceps EMG and lower trace the angle of the elbow during voluntary flexion and extension through 90°. (A) After insertion of electrode but before stimulation, showing tremor bursts in the EMG and oscillations of elbow angle. (B) Stimulation starts at S. (C) Shows effect continuing after 25 min of continuous stimulation at 100 Hz and at 0.5mA.5
Jason Brice the 1970s, Brice published a study in the Lancet about ‘deep brain stimulation’ in three patients with intention tremor secondary to multiple sclerosis.5 The target for stimulation was the contralateral sub-thalamic area, with all patients having bilateral electrodes inserted. As Fig. 3 shows, after stimulation (S) the oscillations in elbow amplitude (lower trace) became smoother (3B) and the effect was sustained (3C). The electrodes were implanted permanently in two patients who were followed up for 6 months with good therapeutic effect at stimulation frequencies ranging from 75 to 150 Hz. As well as being the first Deep brain stimulation (DBS) for tremor,6 this was also the earliest example of a closed-loop or feedback DBS device – with stimulation triggered by an electrode placed in the deltoid muscle of the appropriate arm on initiation of movement. Brice and McLellan also undertook a double-blind trial of chronic cerebellar cortex stimulation in 12 patients with severe intractable epilepsy which proved it was not effective, adding significant weight to the only other double-blind study of five patients.7–9
Society of British Neurological Surgeons Brice was an active Society of British Neurological Surgeons (SBNS) member since becoming a registrar and had attended most meetings. When he became honorary lecturer in Southampton, he used his university access to print books of abstracts which he would take with him to the meetings and on trips abroad to meetings of the European Association of Neurosurgical Societies. It was his commitment to the society that led him to become SBNS president (1988–90) prior to his retirement in 1992 at the age of 65. He remains immensely proud that following his own tenure, four other neurosurgeons from the WNC have held the
597
office of SBNS president and that he was awarded the SBNS Medal in 2013 for his contributions to British neurosurgery.
Acknowledgements The authors would like to thank Jason Brice for his time and comments. We also thank Judith Hope for permission to use photographs from the Wessex Neurological Centre. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Lee AB. The Microtomist’s Vade-mecum: A Handbook of the Methods of Microscopic Anatomy. Philadelphia: P Blackiston’s Son & Co, 1921 2. Brice J, McKissock W. Surgical treatment of malignant extradural spinal tumours. Br Med J 1965;1:1341–4. 3. Brice J, Garfield J, Neil-Dwyer N. Neurosurgery in Southampton and the Wessex region, UK: 1965-2002. Southampton, 2004 [Selfpublished] 4. Hope J. A Portrait of the Wessex Neurological Centre 1965-2005: the First Forty Years. Southampton: Wessex Neurological Centre, 2005 5. Brice J, McLellan L. Suppression of intention tremor by contingent deep-brain stimulation. Lancet 1980;1:1221–2. 6. Blomstedt P, Hariz MI. Deep brain stimulation for movement disorders before DBS for movement disorders. Parkinsonism Relat Disord 2010;16:429–33. 7. Brice J, McLellan DL, Wright GD. Epilepsy, the cerebellum, and cerebellar stimulation. Lancet 1983;2:1500. 8. Wright GD, McLellan DL, Brice JG. A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J Neurol Neurosurg Psychiatry 1984;47:769–74. 9. Van Buren JM, Wood JH, Oaly J, Hambrecht F. Pre-liminary evaluation of cerebellar stimulation of double-blind stimulation and biological criteria in the treatment of epilepsy. J Neurosurg 1978;48:407–16.
Copyright of British Journal of Neurosurgery is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
BIOGRAPHICAL SKETCH
Biographical sketch: Jason Brice Rahul S. Shah1, Marwan Hariz2,3, Tipu Z. Aziz1 & Erlick A. C. Pereira1 1Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford, and Oxford Functional Neurosurgery,
Nuffield Department of Surgery, University of Oxford, Oxford, UK, 2Unit of Functional Neurosurgery, UCL Institute of Neurology & The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK, and 3Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
Abstract This article is a biographical sketch of retired British neurosurgeon Jason Brice, who is a pioneer of deep brain stimulation and helped establish the Wessex Neurological Centre. Keywords: deep brain stimulation; epilepsy; tremor; Wessex Neurological Centre
Jason Brice (Fig. 1) was born in 1927. His early schooling was at a two-roomed Church of England school in the North Downs. He started 2 years ahead of his peers and went on to study at the County Grammar School for Boys in Gravesend. Expressing an interest in botany, zoology and biology, he was given the task of teaching himself biology in the school’s laboratory due to a paucity of teachers during the Second World War. It was there he developed an interest in histology and first started dissecting organs carefully to enable their preparation and staining, fondly recalling his copy of The Microtomist’s Vade-mecum: a handbook of the methods of microscopic anatomy.1 At the age of 16, he passed the Higher Schools Certificate examination (replaced by A-levels in 1951) and by a stroke of luck was allocated to attend university rather than become a conscripted coal miner (‘Bevin boy’) or serviceman. Supported by a father who was keen to keep his son away from the front line, he opted for a career as a doctor. Being too young to start a medical school, he stayed on a further year at his own school – mostly tutoring other pupils. Having already gained his first MB on the basis of his Higher Schools Certificate and having won a State scholarship, he entered Guy’s Hospital Medical School in 1944 to start his Second MB. At the end of his first year, he won the Harris prize in anatomy, which – in the wartime absence of enough gold for an actual medal – took the form of £25 and two specimens that he had to dissect – a female pelvis and a human brain. During clinical school he was also strongly influenced by renowned neurologist Sir Charles Putnam
Fig. 1. Jason Brice.
Symonds, whom he would later work with at the National Hospital for Nervous Diseases, Queen Square, London. He completed his MBBS with a junior proficiency prize, and went on to start as a house officer in general surgery and anaesthetics at Joyce Green Hospital in Dartford, Kent followed by neurosurgery under Geoffrey Cureton Knight, when he became set on a career in neurosurgery. He then joined the Royal Air Force medical corps in 1950 as the duty doctor. In 1952, told incorrectly by a Department of Health advisor that he must have completed 2 years as registrar in general surgery before he could start his neurosurgical training, Brice took a general surgery post in Woolwich Memorial Hospital, adjacent to the regional neurosurgical centre at the Brook General Hospital. Already in possession of the primary FRCS, he then did general surgery at the Royal Post-Graduate
Correspondence: Mr. Erlick A. C. Pereira, MA, DM, FRCS, Department of Neurological Surgery, The West Wing, The John Radcliffe Hospital, Oxford OX3 9DU, UK. Tel: ⫹ 44 (0)-1865-741166. Fax: ⫹ 44 (0)-1865-231885. E-mail: [email protected] Received for publication 7 May 2014; accepted 4 June 2014
595
596 R. S. Shah et al. Medical School, Hammersmith, London. Following a brief spell searching for work, he managed to gain a registrar post at Hammersmith in general surgery. At the time Brice was a keen writer of pantomimes, and set up the rugby club at Hammersmith Hospital – the latter being much to the annoyance of prison guards in the grounds of Wormwood Scrubs Prison where balls could often be found. Despite attempts by his general surgical mentors to dissuade him from a neurosurgical career, he took a registrar post at The Maudsley Hospital under Murray Falconer. Married and expecting his first child, he then became registrar (aka ‘burr hole boy’) to Wylie McKissock at Atkinson Morley’s Hospital. A short time later he was to become McKissock’s senior registrar at the National Hospital for Nervous Diseases and Great Ormond Street Hospital, being told, ‘this may involve you in some social upset, but this is not my concern’. His training continued at pace, and on the return of Lawrence Walsh from Lars Leksell’s group at the Karolinska Institute in Stockholm, McKissock asked Walsh to train Brice in the entire Leksell stereotactic frame method such that he could become the main ‘operating shaker’ performing lesional surgery for Parkinson’s disease. As was the trend during this period, Brice was then sent abroad to Northwestern University, Chicago in 1959 to perform research relating to thalamic nuclei functions. Following that experience he returned to the National Hospital for Nervous Diseases and continued working and undertaking projects for McKissock,2 until he was appointed to his first consultant post in 1965.
Neurosurgery in the Wessex region In 1948, the South West Metropolitan Regional Hospital board was responsible for medical care in South West London, Surrey, Hampshire, Dorset, Wiltshire, Isle of Wight and west Sussex. The sole neurosurgical unit serving this vast area with a population of 5 million people was at Atkinson Morley’s Hospital in Wimbledon headed by Wylie McKissock. It quickly became apparent that this arrangement left some patients a considerable distance away from a specialist neurosurgical centre. On the suggestion of McKissock, Stanley Graveson was therefore appointed in 1950 as a consultant neurologist travelling from one district hospital to another doing inpatient and outpatient work, later joined by Peter Robinson in 1956. From 1957, discussions between Graveson, John Revans (Senior Medical Officer of the Wessex Region) and Wylie McKissock led to plans for building a specialist standalone neurosciences centre in Southampton (to be known as the Wessex Neurological Centre) to serve patients in Hampshire, Wiltshire, Dorset and the Isle of Wight.3 Brice was appointed as its first full time consultant neurosurgeon in 1963 and on asking Dr John Revans for a job description, recalls his stern reply, ‘ You are to set up and develop a neurosurgical department of the standard of a university department in a medical school on par with much of the rest of the world.’3 Wessex Neurological Centre (WNC) opened in 1965, and Brice was joined by John Garfield as his senior registrar on secondment from Queen Square (Fig. 2). The first operation in the brand new theatre was planned to be a laminectomy for prolapsed
Fig. 2. Jason Brice operating in the Wessex Neurological Centre.4
intervertebral disc on a Monday afternoon; however, this was delayed by 5 or 6 h by two emergency operations for a large frontal tumour and a ruptured arteriovenous malformation. Playing rugby football in his youth convinced Brice of the benefits of a team approach, hence this was the default for patient management at WNC rather than the hierarchical approach which typified the era – exemplified by everyone from junior nurse to senior registrar becoming an equal target for interrogation during the Monday morning grand round. He was passionate about teaching, which was often dramatic and colourful – for example, to impart a three-dimensional understanding of neuroanatomy to psychiatry registrars he required each person to become a part of the brain: ‘ You, Sir! You’re the choroid plexus.’4 A series of evening lectures given by the consultant staff was also established as part of the training programme for nurses, later becoming the Neurological and Neurosurgical Nursing Course and gained formal accreditation. Brice and Garfield were the only two neurosurgeons at the WNC for a considerable time until John Pickard joined in 1979.
Deep brain stimulation Working with neurologist Lindsay McLellan, who had previously spent some time with Irving Cooper in New York in
Fig. 3. Polygraphs of voluntary movement of the elbow during stereotactic exploration of the target sub-thalamic area. In each polygraph (A–C) the upper trace is biceps EMG, middle trace is triceps EMG and lower trace the angle of the elbow during voluntary flexion and extension through 90°. (A) After insertion of electrode but before stimulation, showing tremor bursts in the EMG and oscillations of elbow angle. (B) Stimulation starts at S. (C) Shows effect continuing after 25 min of continuous stimulation at 100 Hz and at 0.5mA.5
Jason Brice the 1970s, Brice published a study in the Lancet about ‘deep brain stimulation’ in three patients with intention tremor secondary to multiple sclerosis.5 The target for stimulation was the contralateral sub-thalamic area, with all patients having bilateral electrodes inserted. As Fig. 3 shows, after stimulation (S) the oscillations in elbow amplitude (lower trace) became smoother (3B) and the effect was sustained (3C). The electrodes were implanted permanently in two patients who were followed up for 6 months with good therapeutic effect at stimulation frequencies ranging from 75 to 150 Hz. As well as being the first Deep brain stimulation (DBS) for tremor,6 this was also the earliest example of a closed-loop or feedback DBS device – with stimulation triggered by an electrode placed in the deltoid muscle of the appropriate arm on initiation of movement. Brice and McLellan also undertook a double-blind trial of chronic cerebellar cortex stimulation in 12 patients with severe intractable epilepsy which proved it was not effective, adding significant weight to the only other double-blind study of five patients.7–9
Society of British Neurological Surgeons Brice was an active Society of British Neurological Surgeons (SBNS) member since becoming a registrar and had attended most meetings. When he became honorary lecturer in Southampton, he used his university access to print books of abstracts which he would take with him to the meetings and on trips abroad to meetings of the European Association of Neurosurgical Societies. It was his commitment to the society that led him to become SBNS president (1988–90) prior to his retirement in 1992 at the age of 65. He remains immensely proud that following his own tenure, four other neurosurgeons from the WNC have held the
597
office of SBNS president and that he was awarded the SBNS Medal in 2013 for his contributions to British neurosurgery.
Acknowledgements The authors would like to thank Jason Brice for his time and comments. We also thank Judith Hope for permission to use photographs from the Wessex Neurological Centre. Declaration of interest: The authors report no declarations of interest. The authors alone are responsible for the content and writing of the paper.
References 1. Lee AB. The Microtomist’s Vade-mecum: A Handbook of the Methods of Microscopic Anatomy. Philadelphia: P Blackiston’s Son & Co, 1921 2. Brice J, McKissock W. Surgical treatment of malignant extradural spinal tumours. Br Med J 1965;1:1341–4. 3. Brice J, Garfield J, Neil-Dwyer N. Neurosurgery in Southampton and the Wessex region, UK: 1965-2002. Southampton, 2004 [Selfpublished] 4. Hope J. A Portrait of the Wessex Neurological Centre 1965-2005: the First Forty Years. Southampton: Wessex Neurological Centre, 2005 5. Brice J, McLellan L. Suppression of intention tremor by contingent deep-brain stimulation. Lancet 1980;1:1221–2. 6. Blomstedt P, Hariz MI. Deep brain stimulation for movement disorders before DBS for movement disorders. Parkinsonism Relat Disord 2010;16:429–33. 7. Brice J, McLellan DL, Wright GD. Epilepsy, the cerebellum, and cerebellar stimulation. Lancet 1983;2:1500. 8. Wright GD, McLellan DL, Brice JG. A double-blind trial of chronic cerebellar stimulation in twelve patients with severe epilepsy. J Neurol Neurosurg Psychiatry 1984;47:769–74. 9. Van Buren JM, Wood JH, Oaly J, Hambrecht F. Pre-liminary evaluation of cerebellar stimulation of double-blind stimulation and biological criteria in the treatment of epilepsy. J Neurosurg 1978;48:407–16.
Copyright of British Journal of Neurosurgery is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
