Dr. Alberto Espay Eyes a Year of Olympic Potential

Man gives presentation

Alberto Espay, MD, leads a session of video rounds for faculty, fellows and residents in the Department of Neurology at the UC College of Medicine. Photo by Cindy Starr / Mayfield Clinic.

For Alberto Espay, MD, the year ahead is going to require a feat of gymnastics. A neurologist at the James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders and a researcher who is leading seven clinical trials, Dr. Espay is attracting global recognition for his wide-ranging talents and is being pulled in all directions. He is in demand as a writer, an editor, a speaker and – somersaulting up onto the balance beam now – as one of those think-on-your-feet professors with a flare for teaching, showmanship and diagnosing complex conditions while hundreds of people watch.

The Gardner Center is part of the University of Cincinnati (UC) Gardner Neuroscience Institute, one of four institutes of the UC College of Medicine and UC Health.

Dr. Espay, who is also Associate Professor and Director of Clinical Research in UC’s Department of Neurology, was recently named one of six assistant editors at the journal Movement Disorders. He will be the Movement Disorders Society’s Ambassador to the Americas, which will take him to Mexico and Argentina later this year. He is co-chairing the second International Conference on Knowledge Gaps in Parkinson’s Disease and Movement Disorders in February near Portofino, Italy; he is chairing the creation of the World Atlas of Movement Disorders, under the sponsorship of the Movement Disorders Society, slated for publication in 2013; and he is starting his third book.

“What drives Alberto is his passion to understand his patients and creatively find solutions for their disorders of movements,” says Joseph P. Broderick, the Albert Barnes Voorheis Professor and Chair of the Department of Neurology and UCNI’s Research Director. “He is an outstanding example of the kind of physicians who are part of the University of Cincinnati Gardner Neuroscience Institute and UC Health.”

Creativity will be set on high alert when Dr. Espay serves as one of 15 professors in the Neuro Bowl at the American Academy of Neurology’s annual meeting in New Orleans in April, and as one of 10 movement disorders experts from around the world in the Video Olympics at the Congress of Movement Disorders meeting in Dublin, Ireland, in June.

“The year is going to present a double gymnastics, as there are two events that are geared toward rapid acumen and are a bit like game shows,” Dr. Espay says. “The Academy of Neurology provides very short vignettes that cover the entire sphere of neurology, while three teams strive to make the correct diagnoses and vie for the title of Neuro Bowl champions. At the Congress of Movement Disorders, two five-member teams assess cases that have been culled from submissions from around the world.”

Some of the movement disorders cases are so difficult, Dr. Espay says, that the treating neurologists may not have known the answer until after the patient had passed away and an autopsy was performed.

“Sometimes the expectations are not that you will come up with the correct diagnosis but that you can rationalize your thought process and approach,” Dr. Espay says. “You are showing the audience how a professor or expert in the field approaches a challenging case, from sifting through all the symptoms to prescribing a diagnostic procedure to narrowing it down to one or two conditions. The team with the greatest diagnostic accuracy or most thoughtful differential wins the Video Olympics trophy.”

Group diagnosis of complex conditions is such a valuable educational tool that Dr. Espay brought the concept of video rounds to the Gardner Center in 2006. Short video clips of patients are shown, and residents and fellows are required to think their way through the subtleties of multiple, inconclusive symptoms.

Dr. Espay, who will be appearing in his third Neuro Bowl and first Video Olympics, recalls watching the Neuro Bowl several years ago and thinking, “There is no way I would ever enjoy being in the panel.” But once invited, with his aptitude and gregariousness, he was a perfect fit.

Less public, but more valuable, is Dr. Espay’s role as assistant editor. His fellow assistants are from Canada, England, Spain and, in the United States, from the University of Pennsylvania and the Mount Sinai School of Medicine. Dr. Espay earned the prestigious position because of his reputation as a prolific peer reviewer (56 papers over the last two years). While he will receive no pay for this work, he says he is honored “to have the civic responsibility.”

In reading research papers, he says, he is looking first and foremost for relevance. “How is this going to change the way I care for my patients, the way I approach my next patient, and does the material change my practice?” he asks. “So many papers confirm facts that we already know. If I would say to you, I have shown that bradykinesia — slowness of movements — improve with the drug levodopa because I’m measuring it with a new fancy device, you haven’t told me anything new about the disease or its treatment.  A study of this sort has low relevance and will probably not meet publication threshold. On the other hand, if you have a device that is going to help patients walk better, that’s a different story altogether. That changes our understanding of disease or how we approach treatment.”

And that, of course, brings Dr. Espay back to his patients. In the end, the research, the publications, the papers with relevant data, the papers with irrelevant data, even the gymnastics, are all about them.

— Cindy Starr

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