New Neurology Chair Shares Vision for Growth

Developing highly customized multidisciplinary clinics and forming unique collaborative research teams of scientists and clinicians to discover new treatments for neurological disease are top priorities for Benjamin Segal, MD, as he assumes his new role as chair of Ohio State’s Department of Neurology. He also serves as director of Ohio State’s Neuroscience Research Institute and co-director of Ohio State’s Neurological Institute.

Dr. Segal envisions bringing disciplines together in clinics like a neuro-rheumatology clinic focused on patients with rheumatological disorders that have neurological manifestations. Another clinic would specifically evaluate and treat fatigue and sleep disorders in individuals with multiple sclerosis (MS) or Parkinson’s disease.

 He also plans to establish a state-of-the-art biorepository of tissue and fluid samples to facilitate translational neuroscience research efforts across the College of Medicine.

 “We’re in a state of tremendous growth,” he says. “The university has prioritized neurology/ neuroscience as a focus area. We anticipate doubling the faculty, bringing in both renowned scientists and clinicians who can work in concert to move our field forward.”

 He says searches are underway for a director of an Alzheimer’s disease research center and several other subspecialty leadership positions. 

Building on Strengths

 Dr. Segal emphasizes that Ohio State already has a number of assets: “The Department of Neurology is excellent in diagnostics and treatment of the full spectrum of neurological disorders, with highly trained experts in each subspecialty.”

 First-class residency and fellowship programs and robust clinical trial activity also add to Ohio State’s status as a Midwest leader in understanding and treating diseases of the nervous system.

 “We have a particularly broad portfolio of clinical trials in neurocognitive, neuro-oncological and neuromuscular diseases, plus innovative trials in gene therapy for Parkinson’s, Alzheimer’s and Huntington’s diseases, building on a tradition of gene therapy research here at Ohio State.”

 Ohio State’s Neurological Institute encompasses Neurology, Neurosurgery, Neuroscience, Autism, Psychiatry, Behavioral Medicine, and Physical Medicine and Rehabilitation. Collaboration in patient care and research across these disciplines fosters new knowledge and treatment advances, Dr. Segal says. 

Biorepository to Enhance Research

Access to data is a critical component of success, according to Dr. Segal.

 “To enrich and capitalize on translational research that’s already ongoing, we’re building a cutting-edge Ohio State biorepository that will be integrated with a sophisticated database,” Dr. Segal says.

 The biorepository will dramatically expand banks of fluid and tissue samples already in place at Ohio State. The database will allow investigators to locate samples from particular populations of patients for their studies.

 “We’ll use samples from patients with different neurological disorders to foster research on identification of novel biomarkers and therapeutic targets that will hopefully lead to new diagnostic tests and transformative treatment strategies,” Dr. Segal continues.

He notes that this powerful resource will have an additional benefit: “We want to promote collaborations between basic scientists and clinicians to bridge the gap between fundamental work being done at the bench and critical questions being asked at the bedside.”

Customized Multidisciplinary Clinics

Dr. Segal also wants to bring together the expertise of doctors trained in different areas to treat neurologic disease from a holistic perspective. He says this is a unique approach practiced by only a few academic centers across the country and will lead to more accurate diagnoses and more effective management of symptoms.

For example, he has plans to create a neuro-rheumatology clinic at Ohio State for rheumatological disorders like lupus that have neurological manifestations. Rheumatologists and neurologists would work side by side to address conditions like spinal cord inflammation and neuropsychiatric deficits that can occur in that group of patients.

Dr. Segal envisions another clinic to address fatigue and sleep disorders in MS.

As one of the nation’s foremost experts on MS, he notes, “Fatigue is the most common symptom of MS and is not well understood. When a patient comes into the clinic, the doctor often has to address numerous issues: pain, spasticity, imbalance, bladder dysfunction, difficulties with vision and managing medications. It’s challenging to address all of a patients’ needs, including fatigue, in one visit.”

He wants sleep experts and MS experts to work together to help determine if there are comorbid causes, like sleep apnea, contributing to the fatigue, and to develop a comprehensive management plan. If doctors identify a sleep disorder, the patient might need a CPAP machine; if they determine the fatigue is primarily due to MS, the patient may benefit from cognitive neurorehabilitation or certain stimulant medications.

“We want to get the patient proper treatment to improve quality of life and curtail future decline,” Dr. Segal says.

He hopes to develop these and other novel clinics, including:

  • Neurological complications of cancer therapies. “We want to characterize side effects better and determine the mechanism. For example, CART cell-based therapy causes encephalopathy (brain malfunction) and checkpoint inhibitors cause an MS-like demyelinating syndrome. We’re asking, ‘Why do these therapies cause these complications? How can we prevent them?’ This hasn’t been done in a customized clinical setting before.”
  • Parkinson’s disease and fatigue.
  • Neurological diseases that start in childhood and continue into adulthood, like epilepsy, MS and movement disorders.
  • Frontotemporal lobe dementia, which could benefit from neurologists, psychologists, physical therapists and speech therapists working cooperatively.

“Ultimately, we want to offer personalized, customized care by capitalizing on the subspecialty knowledge and experience of doctors from different disciplines at Ohio State to better treat overlapping conditions and syndromes,” Dr. Segal says. “We’ll be able to focus on a particular rare disease, clinical subset or complication of therapy in a very targeted way.”

Disseminating Knowledge

 Additionally, Dr. Segal says, “We’re very committed to education of young doctors and scientists and bringing them together to open lines of communication, which is a necessity for future advancement. We’ll develop educational activities and symposia on molecular and cellular bases of specific neurological diseases. We want scientists to make research more relevant to clinical translation, and to encourage dialogue between clinical neurologists and scientists.”

 Multidisciplinary clinics will expose residents, fellows, researchers and young clinicians to a particular population of patients with a particular symptom complex. They will be able to study a well-defined patient group in a controlled way and collect samples for the biorepository. All of this will lead to an increased understanding of the mechanisms underlying the disease process.

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