What a Difference 50 Years Make!

Stefan M. Pulst, MD, Dr. med

Professor and Chair, Department of Neurology

The Department of Neurology turned 50 on June 28th, 2015. A neurologist training in 1965 would hardly recognize today’s neurological practice and research. We can imagine joining the team in the neurology library in the newly built hospital on a hot day in July 1965 with the air conditioning not yet ready to kick in. Dr. Ted Ajax is the ward attending, sitting around a small table with two male residents. The light box on the wall illuminates a pneumencephalogram, an invasive and painful procedure, which replaces the spinal fluid in the cerebral ventricles with air. In a few minutes one of the residents would rise from his chair and replace the “pneumo” with an angiogram of the same patient, another invasive and potentially dangerous procedure, but the only ways to image the brain in 1965.

It was inconceivable at this point in time that just a few years later the first grainy pictures of the brain obtained by computed tomography would revolutionize imaging and neurologic practice. Multiple sclerosis was untreatable in 1965 and George Cotzias’ seminal trial of L-DOPA in Parkinson patients was still 2 years away. The identification of the first Alzheimer gene would take another 20 years, and a patient with an acute stroke would more often than not be admitted to internal medicine.

Propelled by basic and translational neuroscience using novel imaging, genetic and molecular tools, and improved methods in clinical trials, the change in neurological practice and treatment has been breath-taking. To recognize the technological innovation in neurological patient care, the ensuing pages highlight some of the diverse research that is currently conducted in the Department of Neurology at the University of Utah and showcase the neurologists leading these projects.  The breadth of these projects – ranging from disease gene discovery and molecular approaches to treatment, to novel imaging methods and innovative exploration of the most common neurological disorders such as neuromuscular diseases and stroke – is astonishing.

The Department of Neurology at the University of Utah is only one of two neurology departments west of the Mississippi that is a member of both NeuroNext and StrokeNet, the two clinical trial networks that were recently funded by the National Institute of Neurological Disorders and Stroke. These clinical translational efforts are paired with a department-wide biosampling core that obtains and purifies biological samples from patients admitted to the Neurology wards or seen in the outpatient clinic. Combined with precise clinical characterization and continued follow-up of our patients, this sample resource empowers clinical and discovery research, and recently contributed to the identification of a new gene for ALS.   

It is notable that the founding year of the Department of Neurology coincided with the creation of Medicare under the leadership of President Johnson, a program that provided healthcare to people older than 65 regardless of income or medical history. Now 50 years later, we are witnessing another milestone. In June 2015, the Supreme Court upheld a key part of the Affordable Care Act that provides health insurance subsidies to all qualifying Americans, thus expanding access to healthcare for millions of previously uninsured individuals in the US. With an estimated 2.5 million increase of the Utah population by 2050 and a disproportionate increase of the senior population, we will need to train a sufficient number of neurologists to bring the expected technological and treatment advances to all Utahns.

The Department of Neurology has proven in the past that it can rise to this challenge. Who could have imagined that 6 attending neurologists and 5 residents in 1965 would grow to more than 60 neurology faculty members, 25 residents and 10 fellows by 2015?  I am certain that similar growth and expansion will be possible in the next 50 years. It is difficult to imagine the practice of neurology 50 years from now, and I will refrain from this temptation as it will only produce amusement for those future neurologists who are not even born in 2015. But what I do know is this: neurologists will still remain at the forefront of academic investigative medicine with a great enjoyment for teaching students about the brain and its disorders.  I am certain that future neurologists will love their profession as much as we do today.  

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