ARTICLE IN BRIEF
Leading neurologists and neuroscientists described research advances at the 100th year anniversary celebration of The Neurological Institute of Columbia University Medical Center and New York-Presbyterian Hospital in September.
In September, The Neurological Institute (NI) of Columbia University Medical Center and New York-Presbyterian Hospital celebrated its 100th year anniversary with a daylong neuroscience symposium and gala dinner for leaders in the field. The NI was the first neurological hospital in North America, and the third in the world, modeled on its European predecessors, The National Hospital at Queen Square in London and the Salpetriere in Paris. It has since been the prototype for all subsequent neurological hospitals across the United States and Canada.
More than a dozen top neurologists and neuroscientists, including two winners of the Nobel Prize in Physiology and Medicine, Eric Kandel, MD, and Richard Axel, MD, described research advances — both basic and clinical — in neurology.
“This centennial ... is an opportunity to honor our legacy of innovation and achievements in neurology and neurosurgery, and to plan the future of the clinical neurosciences at Columbia,” Timothy A. Pedley, MD, Henry and Lucy Moses Professor of Neurology, chairman of the department of neurology at Columbia University College of Physicians and Surgeons, and neurologist-in-chief at New York-Presbyterian/Columbia University Medical Center, said in a statement.
For 16 months Dr. Pedley planned the symposium and gala along with Robert A. Solomon, MD, Byron Stookey Professor and Chief of the Neurosurgery Service, and the former chairmen of the two departments, Lewis P. Rowland, MD, professor of neurology, and Bennett Stein, MD, Byron Stookey Professor Emeritus, as well as Donald O. Quest, professor of neurological surgery.
Established in 1909, the NI of New York was the first specialty hospital in the nation dedicated solely to studying and treating nervous system disorders. Originally on Manhattan's Upper East Side, it was founded by neurologists Joseph Collins, MD (Columbia neurology chair from 1909–1919), Charles Elsberg, MD (Columbia neurosurgery chair from 1909–1937), Joseph Fraenkel, MD, and Pearce Bailey, MD.
Columbia University began sending medical students to the institute in 1921. Four years later, the NI joined Presbyterian Hospital, Babies Hospital, the Squier Urological Clinic, and the New York Orthopaedic Hospital to form the Columbia-Presbyterian Medical Center (as it was then known); they moved their buildings to an adjoining space, spanning an entire city-long block overlooking the Hudson River in an area called Washington Heights. The NI's current building was completed in 1929. (See “Years of Advances at the Neurological Institute.”)
Today, the neurology department is one of the largest in the country, comprising 157 full-time faculty, 11 part-time faculty, 46 postdoctoral fellows, and 36 residents, representing all subspecialties of neurology. In the department of neurological surgery, there are currently 11 full-time members representing all subspecialties and performing over 2,200 neurosurgical operations a year.
A PLACE FOR LEADERS IN THE FIELD
In a series of interviews with Neurology Today, both junior and senior neurologists of the NI described the impact the institute has had on their careers and advances in the field.
H. Houston Merritt, MD, a giant in the field of modern neurology and chair of the department of neurology from 1948 to 1967, produced more than 30 chairmen and chairwomen of American neurology departments, said Lewis P. Rowland, MD, chairman emeritus of the neurology department, and current editor in chief of Neurology Today. Dr. Rowland, one of the most senior members of the department, began his residency at the NI in 1950, two years after Dr. Merritt joined the faculty, and became a close colleague.
He noted that Dr. Merritt edited one of the renowned textbooks in the field, Merritt's Neurology, first published in 1955. [Dr. Rowland became editor of the seventh edition of the textbook, now in its 12th edition with Dr. Pedley as co-editor.]
Dr. Rowland, who was the neurology department chair for 25 years (1973–1998), was cited as a mentor by numerous speakers at the daylong event.
John W. Krakauer, MD, associate professor of neurology and neuroscience and co-director of the NI Motor Performance Laboratory, cited contemporaries at the institute who have made important discoveries in the field.
Among them, he said, Tim Lynch, MD, discovered chromosome 17-linked disinhibition-dementia-parkinsonism-amyotrophy complex; William Dauer, MD, who was a resident with Dr. Krakauer, found that DYT1 dystonia is associated with highly abnormal nuclear membranes; and Scott Small, MD, found that age-related memory loss and Alzheimer disease map onto distinct hippocampal subunit abnormalities. The list goes on, he said.
“The main attraction of the institute has always been the people, especially your contemporaries,” said Dr. Krakauer, who was a resident from 1993 to 1996 and a fellow from 1996 to 1998, before becoming a member of the faculty. “You see them go from first-year residents to full-fledged professors, but we all still see each other as we did when we first met.”
The camaraderie is why multiple experts have remained at the Columbia University for long periods of time or their entire careers. Eric Kandel, MD, who won a Nobel Prize in 2000, has been working at the institute for 36 years.
“It's the most wonderful place — the brain science is the best, and the quality of people is the best,” he enthused. “They are congenial and enjoy working with others, and the level of interaction and collaboration is remarkable,” he said, citing his collaboration with colleagues (and close friends) Richard Axel, MD, and Thomas Jessell, MD.
Along with Dr. Jessell and the late James H. Schwartz, MD, Dr. Kandel published a neuroscience textbook in 1981. Originally designed as a study aid for students so they wouldn't have to take such copious notes during lectures, Principles of Neural Science (first published by Elsevier, currently by McGraw-Hill) will soon be in its 5th edition. The idea emerged because Dr. Kandel recalled that as a student he had disliked the note-taking process.
One of the most meaningful experiences of working at the NI is interacting with the great neurologists of modern history, noted newer faculty members and residents. Rebecca Traub, MD, co-chief resident of neurology, said that during her weekly conference with senior faculty, she found herself describing a patient who had a mitochondrial myopathy, Kearns-Sayre syndrome, described by Dr. Rowland in 1977 and 1988. “That is the type of experience at Columbia that is truly unique,” Dr. Traub said.
[Dr. Rowland noted that other NI faculty, Salvatore DiMauro, MD, and Eric Schon, MD, conducted key laboratory research on MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke. Darryl DeVivo, MD, and Michio Hirano, MD, joined the team on the first MELAS paper and led subsequent papers, he added, noting that Dr. Hirano also came to the fore with mitochondrial neurogastrointestinal encephalomyopathy (MNGIE) and used bone marrow transplantation for treatment.]
LASTING MEMORIES AT THE NI
Other experts at the symposium recalled the moments — humorous, poignant — that have stayed with them since originally impacting them in their younger days.
“As a resident, on ward rounds with pediatric neurology head Dr. DeVivo, I recall having to use every ounce of willpower to avoid laughing out loud when a young patient bit Dr. DeVivo's hand,” said Dr. Krakauer. “He took it very well, remaining unflappable,” Dr. Krakauer said, noting it impressed upon him the need to remain cool in such situations.
“The librarian, Amy Lopatt, used to leave cookies for me with the books I had requested to read when I was ‘on call,’” said Richard Mayeux, MD, Sergievsky Professor of Neurology, Psychiatry, and Epidemiology and co-director of the Taub Institute of Research on Alzheimer's Disease and the Aging Brain. “I couldn't sleep well so I read and the cookies helped!”
Dr. Mayeux, who trained in neurology between 1974 and 1977, and joined the Columbia faculty in 1979, has stayed on, he said, because of the opportunity to work on neurodegenerative diseases with his colleagues in pathology. “I did not train in CT or MRI, but CT was introduced here around 1973–74. It was basically limited to polaroid slices,” he said, adding that brain imaging has been a major advance.
“I would hope that neurologists at the Neurological Institute will integrate themselves with the ever-changing landscape of neuroscience, genetics, and molecular biology,” Dr. Mayeux said, of the future of the institute. Biological markers and genetic analysis should continue to be combined with traditional epidemiology in clinical studies to investigate the origins and effects of neurologic diseases.
In July, Dr. Mayeux was honored with the Henry Wisniewski Lifetime Achievement Award in Alzheimer's Disease Research by the Alzheimer's Association.
The NI will continue to be at the vanguard of academic neurology as long as it continues to support young, talented faculty, Dr. Krakauer said, because that “is the only way to stay innovative and interesting.”
Indeed, one of the younger faculty members, Christopher Hess, MD, co-chief resident at the New York-Presbyterian Hospital/Columbia University Medical Center, described changes in the residency program that have improved both the residents' quality of training and patient care. In 2007 the program was expanded to include ten adult and two pediatric junior residents per year, he said. He said the change allowed for increased outpatient and subspecialty exposure for residents and has paved the way for a research pathway for those interested in a career as a physician-neuroscientist. “Residents have more time now to develop and complete research projects during their residency under the guidance of faculty mentors,” he said.
The Neurological Institute, now led by Dr. Pedley, has spawned generations of mentors in the field, several faculty members told Neurology Today. “We are not celebrating a building, but the programs and people that this institution symbolizes,” said Dr. Pedley.
Years of Advances at the Neurological Institute
Research and advances at the Neurological Institute (NI) have often been responsible for major shifts in the field. Groundbreaking accomplishments include: the first successful removal of a herniated intervertebral disc (in the 1920s by Charles A. Elsberg, MD, a founder of the NI who established the first neurosurgery service there); the first use of the anticonvulsant diphenylhydantoin (Dilantin) to treat epilepsy (discovered in the 1930s by Tracy J. Putnam, MD, and H. Houston Merritt, MD); the launch of one of the first electroencephalography laboratories in the US to study the diagnostic value of brain waves (in the 1930s by Paul F.A. Hoefer, MD); and the development of the independent field of neuroradiology and the first use of radiation on an open wound (in 1930s by Cornelius Dyke, MD).
The model of child neurology as a separate subspecialty within American medicine originated at the NI, with Bernard Sachs, MD (of Tay-Sachs disease), becoming the first chief of pediatric neurology at the NI in 1933. Sidney Carter, MD, who became chief in 1951, was awarded the first NIH Pediatric Neurology Training Grant, founded the first training program in child neurology, and was one of the founders of subspecialty board certification in pediatric neurology by the American Board of Psychiatry and Neurology.
Additional milestones include: the establishment of one of the earliest Neurological Intensive Care Units in the country by Matthew Fink, MD (1960s); development of an embolization treatment for malformations of blood vessels in the brain (in 1968 by Sadek Hilal, MD); the awarding of the first NIH Training Grant to support development of neurological clinician-scientists (in the 1970s by Lewis P. Rowland, MD, and updated by Timothy A. Pedley, MD); the first use of botulinum toxin to prevent involuntary movements by investigators of movement disorders (1970s); the mapping of genes for Huntington disease, spinal muscular atrophy, levodopa-responsive dystonia (1990s); and the development of deep hypothermic cardiac arrest to improve surgery for cerebral aneurysms (in 1990s by Robert A. Solomon, MD).