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Neurology in Israel — A View from Jerusalem's Hadassah Hospital

ARTICLE IN BRIEF

  • ✓ Dr. Tamir Ben-Hur, chair of the department of neurology at Jerusalem's Hadassah University Hospital, highlights the accomplishments of Israel's leading academic medical center as the neurology department celebrates its 70th anniversary.

You might expect that for Tamir Ben-Hur, MD, PhD, chair of the department of neurology at Jerusalem's Hadassah University Hospital, one of the biggest challenges of running his department and providing care to patients would be the constant threat of war and terrorism. After all, his hospital, located in Ein-Kerem, is one of Hadassah Medical Center's two hospitals, which together consist of more than 1,000 beds. The department has frequently cared for the victims (as well as the perpetrators) of terror attacks, and hosts a regular one-week “Mass Casualty/Terror Workshop” on crisis medicine.

But to Dr. Ben-Hur, the Hebrew University-educated neurologist who has run Hadassah's neurology program since 2005 and served on its faculty for 10 years, terrorism and war take a back seat to other clinical, scientific, and financial challenges facing his department, and neurology in Israel in general.

“Terrorism is always something people ask about, but I wouldn't rank it as our most important challenge. In spite of living in a country that is always struggling, the drive to do good clinical work and good research always exists,” he said. “Even in the worst of times, life has continued here at the hospital, almost as usual. We have tried to keep things normal, and I think we succeeded in doing that.”

In February 2002, the BBC described the hospital as a place “where there is no distinction between Arabs and Jews.” Dr. Ben-Hur said, “Even the visitors here seem to obey the unwritten rules of coexistence. This is something that is completely normal for us.”

Normal for them, perhaps, but unusual enough that in 2005, the Hadassah Medical Organization was a candidate for the Nobel Peace Prize.

Medical Achievements and Goals

Dr. Ben-Hur is proud of that distinction, but he'd prefer to talk about his department's medical achievements and goals for the future. Hadassah's department of neurology is known for a strong focus on neuroimmunology in general, and multiple sclerosis (MS) in particular, as well as prion diseases, stroke, and stem cell research.

Figure

The seventieth anniversary of the neurology department at Hadassah University Hospital, seen here, drew leaders in the neurology field from all over the world.

“For many years we have had a strong research program in degenerative diseases and particularly prion diseases such as Creutzfeldt-Jakob (CJD),” he said. “It's a rare disease around the world, but in Israel among the Jewish population, it's more prevalent, especially among Jews of Libyan origin.” In fact, the largest cluster of familial CJD in the world is found in Israel. In 2002, Hadassah created the Agnes Ginges Center for Human Neurogenetics, dedicated to the study of prion diseases and other neurodegenerative disorders in Israel.

On the MS front, Hadassah neurologists have been involved in developing several immunomodulatory approaches to MS therapy. They have also focused on developing the science of stem cell transplantation in neurological diseases. From this work and together with the Hadassah Human Embryonic Stem Cell Research Center, founded in 2003, they hope to proceed into clinical studies.

Embryonic Stem Cell Research

Israel has been spared the controversy that has hobbled embryonic stem cell research in the U.S. “According to the Jewish faith, the embryo is only considered viable after 40 days from gestation, and provided it is still in the womb,” said Dr. Ben-Hur. “Therefore, religious groups support stem cell research because of the hope that this will save lives in the future. By law, we are allowed to use in-vitro-fertilization derived embryos, and there is wide support from the government, all religious groups, and the public in general.”

There are a few caveats: the embryos must have been kept for seven years before use; the couple must both agree to the donation, planning no future children, and have no commercial or other claims on the research; and the embryos must have otherwise been intended to be destroyed. The law limits use of the embryos to medical and research purposes, and bars human cloning

Stroke Research

Stroke research — basic, clinical, and translational — is also a top priority for the neurology program at Hadassah, where former Israeli prime minister Ariel Sharon received care after suffering two strokes in December 2005 and January 2006. The hospital is now building a state-of-the-art stroke center. In 2006, Hadassah scientists along with researchers at the University of Pennsylvania, reported that they had modified the function of tissue plasminogen activator (tPA), using a binding peptide, to maintain tPA's capability to preserve tissue viability after brain injury without adding to the risk of cranial hemorrhaging. Clinical trials in humans are the next step.

Building that stroke center, and other state-of-the-art centers for epilepsy and cognitive neurosciences, is much more of a daily challenge than worries about bombings, war, or terrorism, said Dr. Ben-Hur. “Israel doesn't have the same resources for funding and financial support for medical care that America does, so it's always a struggle to get the money to get things going,” he said.

Changes in the Field

More broadly, not just for Hadassah's neurologists but for Israeli neurologists and the field in general, he points to the need to address major changes in the field over the last decade.

“Neurology is a profession that has changed its face very rapidly and significantly,” says Dr. Ben-Hur. Today, especially but not only with stroke, neurology is a much more active field in terms of treatment than it was in past years. People see us as we were 20 or 30 years ago and don't appreciate that today, neurological cases are much more treatable.

“Society and the systems that pay for medical services need to appreciate that the field has changed, and we need more manpower to deal with those changes, such as neurologists available 24 hours to care for emergency cases,” Dr. Ben Hur said. We have become a much more urgent field of medicine.

“Another challenge is to get funding to develop the systems and technological infrastructure that we need to develop the future of neurology,” he said. That infrastructure will primarily be concentrated in the major cities of Jerusalem, Tel Aviv, and Haifa, where most resources are. “Since Israel is small, most people are close enough to one of the major centers to receive the care they need,” he added.

Planning for the future of the field, said Dr. Ben-Hur, is the challenge he spends much of his time thinking about — a preoccupation that makes his professional life not that different from the chairs of neurology at any American academic medical center. “Terrorism is not something that governs our life,” he says. “We keep our focus on developing good medicine and good science, despite any security or political problems.”

Celebrating Seventy Years of Neurology at Hadassah

In June 2007, Hadassah's Department of Neurology, the first of its kind in the region, celebrated its 70th anniversary with a symposium for world leaders— including three Nobel laureates — in the field. The department was established in 1937 by Lipman Halpern, who immigrated to Jerusalem from Berlin.

Participants from Australia, Austria, Canada, Germany, Greece, Israel, Italy, Poland, Scotland, Sweden, Turkey, United Kingdom, and the U.S. shared their perspectives and knowledge about neurological diagnosis, treatment, and research.

During the symposium, professor Oded Abramsky, MD, who served as head of the department of neurology for 18 years, from 1988 to 2005, was honored. Dr. Abramsky has also served as the dean of the Hebrew University-Hadassah Faculty of Medicine, chief scientist of the Israeli Ministry of Health, and chaired the National Medical Research Organization from 1987 to 1992. Currently, Dr. Abramsky serves as the chairman of the Israel National Council for Research and Development. He is also one of few non-Americans to be elected to the U.S. Institute of Medicine of the National Academy of Sciences.

Dr. Abramsky was one of the first scientists to establish the field of neuroimmunology and to demonstrate immune pathogenesis in various neurological diseases of the central nervous system, peripheral nervous system, and muscle. Some of his most important research achievements include demonstrating that myasthenia gravis is an autoimmune disease against the acetylcholine receptor at the neuromuscular junction, and identifying a significant improvement in the course of multiple sclerosis (as in other autoimmune diseases) in pregnant women during the second half of gestation.

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