Doris Leung, MD, a 2011 AAN and AAN Foundation Clinical Research Training Fellow, likes solving mysteries — both in and outside of the lab. An avid reader of adventure and detective novels, Dr. Leung brings her appetite for the unknown to the clinical problems she studies in her research.
After earning her medical degree from Duke University School of Medicine, Dr. Leung completed her neurology residency at the Stanford University Hospital in 2009. Currently, Dr. Leung is a clinical research fellow at the Kennedy Krieger Institute's Center for Genetic Muscle Disorders.
Dr. Leung's AAN fellowship proposal, aims to use advanced techniques in MRI to develop new ways of examining and monitoring patients with progressive muscle weakness due to facioscapulohumeral muscular dystrophy (FSHD).
Starting with the “magical quality” of neurology, which first attracted her to the specialty, Dr. Leung spoke to Neurology Today about her motivations and research in neuromuscular medicine.
WHAT WAS YOUR RESEARCH QUESTION?
My research will involve the use of new techniques in magnetic resonance spectroscopy to evaluate skeletal muscle in patients with FSHD.
We are hoping to use this technique to develop quantitative biomarkers that can be used to monitor disease progression in clinical trials. Right now this project is still in the planning stages, and we hope to start enrolling patients in the summer.
WHY DID YOU CHOOSE THIS SPECIFIC PROJECT?
What I really like about this project is that it addresses a present need in the field of muscular dystrophy research. When I was doing background research, I was surprised by how much literature on muscle spectroscopy is already available.
In the 1980s, there were quite a few papers published on magnetic resonance spectroscopy in muscular dystrophy, but it never really became part of routine clinical care or a common clinical research biomarker. There are some technical reasons for this, but I also think that the demand for imaging biomarkers wasn't as urgent then.
There have been several major advances in defining the mechanism of FSHD recently, and this has really improved the prospects for treatment options for the disease in the foreseeable future. We need reliable and practical biomarkers to monitor disease progression if we want to generate useful clinical data, and I think that MR imaging and spectroscopy may be a non-invasive way to address that need.
WAS THERE A PARTICULAR CASE OR PATIENT THAT INSPIRED YOUR INTEREST IN THE RESEARCH QUESTION?
I remember at one point in my clinical neurophysiology fellowship, I read an EMG text that said we could EMG any muscle in the body if we had a long enough needle — which is true, but it sounds kind of ominous, doesn't it?
The point I decided to take away from that instance is that there are limitations to any single diagnostic test, particularly in muscle diseases, where the examination, electrophysiology, and even muscle biopsy can only get you so far. Muscle imaging is really just beginning to establish its role in neuromuscular neurology, and I'm interested in how we can incorporate it into our armamentarium of diagnostic tools to make us better neurologists.
DO YOU HAVE A MENTOR WHO HAS INFLUENCED YOU?
My mentor for this project is Dr. Kathryn Wagner, director of the Center for Genetic Muscle Disorders at the Kennedy Krieger Institute. Her dedication to her patients and her research in muscle disorders is truly inspiring to me and to everyone that works with her. From the beginning, she has helped me develop the goals of my project and forge the partnerships I would need to complete it. The opportunity to work with her has been a real privilege.
WHY DID YOU CHOOSE TO GO INTO NEUROLOGY?
Neurology was my first clinical rotation in medical school. I don't think I seriously considered neurology before that, and I don't think I ever seriously considered any other specialty afterward. The neurologists I worked with on my rotation really loved what they did, and their enthusiasm was what motivated me the most — and the cases we saw were fascinating, as well.
One time, we were able to localize a lesion because the room was extremely warm and we noticed giant beads of sweat on the patient's forehead that stopped exactly at the midline. It was all perfectly logical, of course, but there is also a magical quality about these kinds of cases, which I love.
WHY DID YOU CHOOSE TO FOCUS ON NEUROMUSCULAR MEDICINE?
I really enjoy the multidisciplinary approach to medicine, and neuromuscular medicine in particular has given me many opportunities to work with — and learn from — other specialists. The clinics I've trained in are able to provide patients with immediate access to physical therapy, occupational therapy, speech therapy, nutrition, social work, nursing care, genetic counseling, and equipment specialists in a way that really consolidates and enhances their care. Working with these teams has also made me a better physician in more ways than I can count.
ON A MORE PERSONAL NOTE, TO LET OUR READERS KNOW SOMETHING ABOUT YOU OUTSIDE OF YOUR RESEARCH, COULD YOU TELL US WHAT BOOKS ARE ON YOUR READING LIST RIGHT NOW?
The last two books I've read are Apollo 13 by Jeffrey Kluger and James Lovell and Murder at the Vicarage by Agatha Christie. No one who knows me would find this surprising, but I almost always read the endings of books first. I just have to know what happens! •
AAN Clinical Research Training Fellowships are funded by the AAN, the AAN Foundation, and the AAN Foundation Corporate Roundtable, and provide $55,000 per year for two years, plus $10,000 per year for tuition to support formal education in clinical research methodology at the fellow's institution or elsewhere. More than 70 training fellowships have been awarded through the program since its inception in 1996. For more information about the program, visit http://bit.ly/egrG8L