The Department of Neurology’s development as a leader in research, education, and training parallels that of Emory. In 1854, Atlanta Medical College was established and, in 1915, Emory’s board of trustees chartered the Emory School of Medicine, replacing Atlanta Medical College. Andrew Carnegie provided funds to help establish the Emory School of Medicine, as well as Grady Hospital, which continues to be a primary training facility for Emory students and trainees. Dr. W.S. Kendrick was the first chair of Emory’s Department of Medicine. Little is known about how patients with neurologic diseases were cared for during this early period.
Neurology became increasingly recognized as a discipline distinct from medicine and one which was closely related to psychiatry, in part due to practical concerns associated with World War I during which a Division of Neurology and Psychiatry was established by the Surgeon General. Neurology training was done at Grady Hospital by the Grady Department of Neurology and Psychiatry, and neurology was often considered “neuropsychiatry.” The American Board of Psychiatry and Neurology was established in 1934. Until the years following World War II, however, there was little support for formal neurology training at US medical schools, including Emory.
World War II was associated with large numbers of neurologically impaired patients, and in part through the Veteran’s Administration, the importance of neurologic training began to be increasingly appreciated. However, as was common at the time, both the teaching and the practice of neurology generally was done through the departments of medicine or departments of psychiatry, and the practice of neurology was more related to diagnosis than patient management. Nationwide, specialty training and research funding for neurology increased after the National Institute of Nervous Disorders and Blindness, the precursor to the National Institute of Neurological Disorders and Stroke (NINDS), was established in 1947.
The emerging importance of neurology as a distinct medical specialty was formally recognized at Emory in 1958 by the establishment of the Division of Neurology within the Department of Medicine. Herbert R. Karp, M.D. became the first (and only) chief of the Emory Division of Neurology. Also in 1958, NIH awarded a neurology training grant to Dr. Richard B. Wilson. Previously, there had been no formal neurology training to students or residents at Emory.
The Division of Neurology continued to expand formal neurological training opportunities and provide neurologic care with the establishment of an independent neurology service. Based upon the increasing importance and influence of neurology, its status was elevated from a division within the Department of Medicine to an independent department in 1976. Because of his success in leading the neurology division, Dr. Karp was appointed as the first chair of Emory’s Department of Neurology. Dr. Karp recognized the increasing importance of basic research in an academic department, and recruited Robert Kibler, M.D., to develop research as an active component of the department, and also recruited Dale McFarlin, M.D., both specialists in multiple sclerosis.
With the development of computerized axial tomography (CAT) and its application to clinical neurology in the 1970s, the practice of neurology began to subspecialize, and Emory followed that trend.
Dr. Karp left the chairmanship in 1983 to become the first director of medical services at Wesley Woods Geriatric Hospital. Wesley Woods was founded in the 1950s to provide care to senior citizens, and in the 1980s, established a formal relationship with Emory. Dr. Karp was followed as chair by Robert F. Kibler, M.D, who remained in that position for nearly a decade until 1991. Under Dr. Kibler’s leadership, Neurology continued its growth and transformation into a multi-faceted academic department. During this period, research training of residents was increasingly encouraged by providing basic science and clinical research opportunities. Due to increasing demands for neurologic service, Dr. Kibler separated the consult and ward services, a change that also increased the quality of neurologic education. Dr. Kibler championed the first required senior rotation in neurology and neurosurgery for medical students, which was followed by the development of the first independent required neurology rotation.
In the 1980s, MRI scanning became part of standard neurologic practice, which further allowed neurology to differentiate the underlying substrates associated with neurologic disease. A fledgling EEG/epilepsy program that had started in the 1950s by Donald Bickers, M.D. a neurosurgeon, who trained in neurophysiology at the Montreal Neurologic Institute, was expanded by Charles M. Epstein, M.D. to include a surgical arm with the appointment of Roy A.E. Bakay, M.D. as the first epilepsy neurosurgeon at Emory. During this time, subspecialty programs emerged in Movement Disorders, led by Ray Watts, M.D., and a Neurobehavioral Program (subsequently becoming the Cognitive Neurology Program) started by Robert Green, M.D.
Mahlon R. DeLong, M.D. was appointed department chair in 1990. Expanding the existing faculty with members of his research team that moved from Johns Hopkins with Dr. DeLong, Emory quickly became as a leading clinical and research center in movement disorders. At Hopkins, this migration was coined “the hemorrhage to Emory.” The American Parkinson Disease Association designated Emory University as its first Center of Excellence in 1991. During the 1990s, research funding substantially increased as well as number of residents and fellows.
Dr. DeLong and team that included Jerry Vitek, M.D., Ph.D., Thomas Wichmann, M.D., Roy Bakay M.D. (Neurosurgery) and others established Emory University as a worldwide leader in in functional neurosurgery, and in particular pallidotomy, and subsequently developed deep brain stimulation (DBS) for the treatment of advanced Parkinson’s Disease. DBS is currently a widely use standard treatment option for Parkinson’s Disease as well as a growing list of other neurological, such as essential tremor and primary dystonia when symptoms are not adequately managed with traditional medical therapies. The Movement Disorders program grew into what is arguably the largest dedicated group of subspecialists in the world, now lead by Dr. Stewart Factor. Over the past decade, Emory recruited Helen Mayberg, M.D., Robert Gross, M.D., Ph.D., and Nick Boulis, M.D. to join the team and expand the applications of DBS and functional surgery to depression, epilepsy, ALS, and other conditions.
Basic neuroscience research in the Department of Neurology also grew considerably, starting in the 1990s, together with a dramatic expansion of neurosciences across Emory University. This growth established Emory among the top ten NIH-funded Departments of Neurology, which continues to the present. The Center of Neurodegenerative Disease (CND) was established in 2001 under the leadership of Allan Levey, M.D., Ph.D., Tim Greenamyre, M.D., Ph.D. from a philanthropic $3 million gift from an anonymous donor as well as institutional support and housed in the newly constructed Whitehead Research Building. With a broad mission to expand team science, over the past ten years the CND helped recruit and integrate at least 18 basic and clinical scientists from several departments and units in the School of Medicine, the Rollins School of Public Health, and Yerkes National Primate Research Center, to investigate degenerative disease mechanisms in conditions such as Parkinson’s, Alzheimer’s Disease, ALS, stroke, and others. Core facilities to facilitate cutting edge research were also developed successfully. The new faculty who joined the CND acquired many individual grants, established several NIH-funded Center grants (e.g., Parkinson’s and Alzheimer’s Disease Research Centers), core facility grants, and training grants, returning approximately $60 million in funding to advance neurodegenerative disease research activities at Emory. Emory was awarded the first national Parkinson’s Disease Center of Excellence funded by the American Parkinson’s Disease Association, as well as the Huntington Disease Center of Excellence by the Huntington Disease Association. The Emory ALS Center was established in 1997 to provide comprehensive care for people and families with ALS and related motor neuron diseases. Emory is now recognized nationally as an ALS referral center by both the Muscular Dystrophy Association (MDA) and the ALS Association, and was the first center to test stem cells in patients with ALS. Jonathan Glass, M.D. is the director of the ALS Center. Emory University was designated an Alzheimer Disease Research Center (ADRC) with initial funding by the National Institute of Aging in 2005 in recognition of its commitment to excellence in research and clinical care of patients with Alzheimer’s disease. Dr. Allan Levey serves as the Center Director for the Emory ADRC.
The Stroke Program, with its primary location at Grady Hospital, was started following the recruitments of Marc I. Chimowitz, M.D. and Barney Stern, M.D., and has made numerous contributions to patient management including therapies designed to minimize risk of recurrent stroke, and the landmark study demonstrating that the administration of TPA within the first few hours of stroke reduces mortality and morbidity. The Stroke program presently coordinates the Paul Coverdell Coverdell Acute Stroke Registry to improve stroke care across Georgia.
Allan Levey, M.D., Ph.D. assumed leadership of the Neurology Department as Chairman in 2003, and the department has continued to grow in its clinical and research presence whether measured by patient visits, grant funding, or by published research. The clinical practice now provides care for tens of thousands of patients annually across many locations, including ambulatory and hospitalized patients at The Emory Clinic practices, Emory University Hospital, Emory University Hospital at Midtown, Grady Memorial Hospital, the Atlanta VA Hospital, The Wesley Woods Geriatric Hospital, and Children’s Healthcare of Atlanta.
To accommodate the various teaching, clinical, and research missions of the University, the Neurology Department is presently composed of multiple programs. Programs include Balance, Cognitive, Epilepsy, Movement Disorders, Neuromuscular Disease, Neuropsychology, Restorative Neurology, Sleep, and Stroke. Faculty with joint or secondary appointments in Neurology and other departments including Pediatrics, Psychiatry, Rehabilitation Medicine, Ophthalmology, Hematology-Oncology participate in additional programs for Pediatric Neurology, Depression, Rehabilitation, Neuro-ophthalmology, Pain, and Neuro-oncology. Through each program, Emory Neurology strives to be a leader in training, research, and clinical care.