NeurologyLive® Clinician of the Month Spotlight: Paula Barreras, MD

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As part of our monthly clinician spotlight, NeurologyLive® highlighted rare disease medicine expert Paula Barreras, MD, a physician neurologist and neuroimmunologist at Cedars Sinai Medical Center.

Paula Barreras, MD

Paula Barreras, MD

Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages 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.

Aquaporin-4 antibody-seropositive neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are 2 rare autoimmune diseases that have garnered increased attention of the years. Several in the field have stressed the importance of distinguishing them from the more common neuroinflammatory disease, multiple sclerosis (MS), since treatment and long-term prognoses for all of these diseases greatly differ.1 Research in clinical practice shows that diagnosis of these rare autoimmune conditions can be often challenging, and particularly relies on collaboration of radiological and serological findings.

In a recent conversation with NeurologyLive, Paula Barreras, MD, a physician neurologist and neuroimmunologist at Cedars Sinai Medical Center, discussed her key responsibilities as a neurologist specializing in immune-mediated conditions, and the ways she balances clinical work, research, and education in her role. She also spoke about her typical day as a neurologist, from reviewing patient MRIs to conducting consultations and balancing research and advocacy for patients. Additionally, she talked about her motivations to pursue neurology and how she finds personal fulfillment in her role, particularly in building long-term relationships with patients and contributing to advancements in neuroimmunology.

Clinical Facts on NMOSD

  • Approximately 15,000 patients in the US are estimated to be living with NMOSD and the median age of onset is 39 years of age.
  • Women are about 2 to 8 times more likely to develop NMOSD than men.
  • Patients of African and Asian descent have severe attacks at onset more frequently compared to those of Caucasian descent.
REFERENCES
1. Navigating NMOSD. About NMOSD. Accessed January 24, 2024. https://nmosd.com/understanding-nmosd/about-nmosd

NeurologyLive: What are some of the main responsibilities you have in your role as a neurologist at your clinic? 

I specialize in immune mediated conditions affecting the brain and the spinal cord like MS and other rare neuroimmunological disorders. I have special expertise in spinal cord disorders including NMO, MOGAD, transverse myelitis and neurosarcoidosis.

I wear many hats in my role as a neuroimmunologist.

Clinically, I do initial consultations after patients first present with neurological symptoms and second opinions on diagnosis and treatment plans. I also do follow up visits. Since these disorders are rare and some of the MRI and spinal fluid features can overlap, there is frequent misdiagnosis before patients come to the clinic. A big part of my role is guiding the initial evaluation to reach the correct diagnosis and re-evaluate if the initial treatment plan was correct. Most neurologists are familiar with MS but are not as well versed in the less frequent disorders like NMO, MOGAD, neurosarcoidosis, so a big part of what I do is providing education to my patients and colleagues on these disorders. I help my patients understand their condition and the various treatment options to prevent future inflammatory attacks and choose the best treatment plan for their lifestyle.

My other big role is being a researcher. I focus on understanding how the immune system and nervous system interact to cause these disorders and on identifying factors that can help us differentiate early on between these conditions to improve the diagnosis accuracy and predict outcomes so we can provide better information to patients.

I also spend time training medical students, neurology residents and neuroimmunology fellows, I do this in the inpatient service and in the clinic and I really enjoy being part of training the next generation.

Could you describe a typical day in your work as a neurologist at your clinic

On a typical clinic day, I start early with a good coffee and review the MRIs of my patients for the day. While we receive the radiology reports on the MRIs I like to verify the findings myself. I usually review the records in the days prior to the appointment and review some of the key findings again right before seeing the patients. After MRI and record review, I start seeing patients at 8 am, usually new consults in the morning and follow up patients in the afternoons. Each patient is different so there is never a “typical” or usual patient. I like to take my time with patients and try to provide as much information as I can. After seeing patients I spent time doing clinical notes, responding to patient messages and renewing prescriptions. When I am not seeing patients, I spend a lot of time advocating for my patients to coordinate their care, reviewing results and researching strategies to improve their quality of life. The rest of my time I divide between my research and education activities like giving talks or teaching the neurology residents in the inpatient service.

What motivated you to pursue a career in neurology, and when did you make this decision? 

I made the decision to study the brain early in high school. I think the brain is what makes us who we are and studying the brain is a way to understand ourselves and the world better. I was very interested in mathematics then and the brain networks and complexity fascinated me. I really like the puzzle solving in neuroimmunology, putting the pieces together in a logical way to understand how the immune system and nervous system interact. I love seeing patients and being part of their journey and in neurology I get to meet people and form long term relationships with them.

What do you find most rewarding about your work as a neurologist at your clinic

The personal relationships with my patients are the most important part of my job. I get to meet wonderful inspiring people every day and really get to know them over the years.

There are many rewarding aspects of being a neuroimmunologist. I enjoy the challenge of difficult rare cases, I get to see interesting imaging and presentations and learn a lot from my patients everyday.

I find it rewarding when we finally solve the puzzle and we reach a final diagnosis.

I am excited to practice in a time where I can offer multiple treatment options to patients and actually make a difference in their prognosis. 

I also enjoy to practice in an academic environment with a lot of smart and stimulating colleagues that do research and are in the top of their fields, these interactions help me to continue to grow as a physician and scientist.

What are some of the biggest challenges you face in your role? 

With rare disorders there are many unknowns so in my practice I must deal with a lot of uncertainty. It is challenging when there are no clear answers to some of the questions my patients have but this motivates me to continue working in my research.

Is there something that you wish more patients and clinicians at your clinic understood about the field?

I want patients to know that even if these disorders are not curable, they are treatable and there is always something that can be done to improve symptoms or quality of life. There have been amazing advancements in the field in the last decade with multiple therapies now available foMS, NMO, MOGAD and sarcoidosis that did not exist before.

For clinicians, I would like them to know that the spinal cord is as complex and interesting as the brain, and the disorders that affect the spinal cord need careful analysis of MRI features and clinical profile to reach the final diagnosis beyond just the label of “transverse myelitis” which is often given prematurely. Also important to recognize the “invisible” symptoms of neuroimmunological disorders such as fatigue, pain, brain fog, or exercise intolerance. These invisible symptoms are often overlooked but they can significantly impact quality of life and should be taken seriously.

In addition to your work as a neurologist, what hobbies or interests do you have outside of the clinic? 

I love science fiction literature and movies, enjoy traveling and spending time with my husband and baby daughter. Recently we have been visiting national parks and hiking.

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Over the years, the Siegel Rare Neuroimmune Association (SRNA) has been a bridge for patients with rare neuroimmunological disorders and the clinicians and researchers with interest in these disorders. In December 2023, the organization offered a 1-day virtual conference to attend for patients with these disorders who speak Spanish. In a recent interview with NeurologyLive, Barreras, who was among those who organized the event, spoke about the patient-clinician relationship for Spanish-speaking individuals with neuroimmune disorders and the ways the clinical community can improve care for this population.

Transcript edited for clarity. Click here for more coverage on NMOSD.

REFERENCES
1. Mewes D, Kuchling J, Schindler P, et al. Diagnosis of Neuromyelitis Optica Spectrum Disorder (NMOSD) and MOG Antibody-Associated Disease (MOGAD). Diagnostik der Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) und der MOG-Antikörper-assoziierten Erkrankung (MOGAD). Klin Monbl Augenheilkd. 2022;239(11):1315-1324. doi:10.1055/a-1918-1824
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