As part of our monthly clinician spotlight, NeurologyLive® highlighted expert Gary Hisch, MD, pediatric neurologist at Cleveland Clinic, who oversees programs for neuromuscular disorders such as for patients with spinal muscular atrophy.
Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages to manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.
Spinal muscular atrophy (SMA), a progressive neuromuscular disease, impacts motor nerve cells in the spinal cord and affects the muscles used for activities such as breathing, eating, crawling, and walking. Thousands of patients are born with SMA but it also has significant impacts on both pediatric and adult patients of all ages from all backgrounds. Although there are several approved treatments for SMA, including nusinersen (Spinraza; Biogen), there has yet to be a cure.
For SMA Awareness Month—August 2023—Gary Hisch, MD, pediatric neurologist at Cleveland Clinic, recently discussed his role as a neurologist and seeing patients in the neuromuscular field, including those with SMA. He described his multifaceted role in diagnosing and managing neurological disorders in both children and adults. He also spoke about the aspects of neurology that make it akin to solving a mystery according to his clinical perspective. Additionally, he emphasized the significance of nomedical factors in impacting patients' well-being and treatment outcomes.
As a pediatric neurologist, I see children (and some adults) with various neurological symptoms and disorders, such as seizures, developmental delays, headaches. In particular, I lead our programs in neuromuscular disorders, spina bifida, and neurofibromatosis. We even counsel pregnant women who are found to have a fetus with a neurological concern, and some adults who have rare neurogenetic disorders. I also love working with trainees – fellows, residents, and medical students.
I may start the day with a meeting or teaching conference, followed by seeing patients in the outpatient clinic. Sometimes, I oversee residents and fellows in their patient care activities. Some weeks, I work primarily in the inpatient setting, working with a team of trainees and seeing patients in the emergency room and the intensive care units. Throughout the month, I also give teaching lectures.
I love working with children, so I was already inclined to be in pediatrics. Neurology was one of the first rotations I did in medical school. I found the field fascinating. It’s like solving a mystery and putting together various pieces of evidence: the clinical symptoms, neurological exam, and various tests and studies. We talk about “localizing the lesion” -- where in the nervous system the problem might be. Then we think about what disorder may be affecting that part of the nervous system.
I enjoy helping people maximize their developmental potential and feeling good about themselves. Many neurological disorders involve disabilities, physical and/or cognitive. I think it’s important to have a thorough understanding of a patient’s history, circumstances, and experiences. Some of my patients are now technically no longer pediatric, but I still very much enjoy seeing them, watching them grow, and hearing about their lives in their transition to adulthood.
There are many problems that affect our children, but that we struggle to fix. Neurology is known for being diagnostically interesting, but some of our therapeutic options are limited. Genetic disorders, stroke, and autism are but a few of the disorders that can profoundly affect children and families, and yet we sometimes have no specific treatments or cures. Additionally, beyond their medical problems, there are additional burdens of caregiving, stress, finances, coping, and mental health that magnify the medical issues.
Neurology is a very complex field in which the role of the brain, mind, stressors, coping, and mood – all affect our symptoms, severity, function, and abilities. We often underestimate how all these medical and external factors can affect our well-being. Sometimes, there is not a medication or procedure that can easily fix a problem. Other modalities (physical therapy, exercise, relaxation/stress management strategies, healthy lifestyles) can be equally important.
I enjoy spending time with my family, fitness and exercise, and learning more about our community and society.
Transcript edited for clarity.