Entre Nous with Guy Rouleau, Director of the Montreal Neurological Institute and Hospital – The Neuro
By Neale McDevitt
Guy Rouleau, the new Director of the Montreal Neurological Institute and Hospital, can pinpoint exactly when he became interested in the brain. “July 1980,” said Rouleau. “I was an intern and did a rotation in neurology at the Montreal General Hospital. I was fascinated.”
Rouleau, who has filled the void at the helm of The Neuro left by David Colman’s untimely death in June 2011, said certain “inherent limitations’ also helped steer him toward the neurosciences. “I’m very bad with my hands so there was no way I could be a surgeon,” he said with a laugh. “And I’m not very visual so I couldn’t be a dermatologist or anything where you had to be very good at pattern recognition.
Instead, he gravitated toward neurology because “it was very abstract and complex.” Taking up the challenge, Rouleau has spent the last 30 years deciphering the brain’s abstractions and bringing new understanding to its complexities.
“I study the genetic basis of brain diseases,” he said. “I try to find the genes and the mutations in the genes that predispose people for certain brain diseases. Once we’ve identified the gene I try to figure out what is the biology of how this causes a brain disease.”
Rouleau’s landmark achievements are his contributions to the identification of more than 20 disease-causing genes and his discovery of new mutational mechanisms. Over the last 20 years, Rouleau and his team have focused on identifying genes causing such neurological and psychiatric diseases as autism, amyotrophic lateral sclerosis (Lou Gehrig’s Disease), hereditary neuropathies, epilepsy and schizophrenia, as well as providing a better understanding of the molecular mechanisms that lead to these disease symptoms.
Why did you choose to come to The Neuro?
Firstly, I’m a neurologist and a neuroscientist. This is an ideal place for me to be. The Neuro’s mission fits perfectly with what my ambitions are and what I like to do.
I had been director of research at the CHU Ste-Justine Research Centre for seven years and I was looking for the next challenge. These positions open up every 5-10 years and in 10 years it will be too late for me so the timing was perfect, the place was perfect and it fits exactly with what I love doing.
What is your vision for The Neuro?
The Neuro has a long tradition of bringing together clinical research and basic research – from bedside to bench and from bench to bedside. It is something that everybody talks about now but The Neuro was built on that long before it was fashionable. It is something we already do very well but we need to focus on how we can do better. That’s the first priority.
Secondly, we live in a very competitive world. In the 1930s there weren’t too many neurology institutes in the world. Now there are quite a few along with many neuroscience institutes. Given the stiff competition around the world, The Neuro needs to focus on its strengths.
What are those strengths?
The Neuro combines a world-leading research centre with a specialized hospital that delivers the highest quality of care for patients with neurological disorders. One of the Neuro’s great strengths is fostering research that is clinically relevant. We are very good at bringing clinical questions to the bench then bringing the answers back to the clinic.
I think we are very strong in basic transversal technologies, such as brain imaging. In addition to work that ranges from understanding cellular function to complex neuronal networks, The Neuro excels in the understanding and treatment of a wide range of diseases including epilepsy, multiple sclerosis, neurodegenerative diseases and oncology.
What is the Neuro’s reputation worldwide?
Our reputation is excellent.
I have not worked at The Neuro since 1985 but every time I give a talk or attend a conference anywhere in the world, people always say “You’re from Montreal, you must be from The Neuro.” Such is the reputation of The Neuro!
The question facing us now is: what is the next frontier?
The Neuro didn’t build its reputation on all neurological diseases. It has been very strong on some specific neurological diseases and it made a huge mark in the world. We need to continue to focus on those diseases where we will continue to make our mark.
Where can the Neuro improve itself? Are there areas that need shoring up?
Shoring up isn’t really a concept here at The Neuro because we’re so strong in so many areas. It’s about building on strengths, helping people to be productive and being excellent in all spheres. We have to be excellent in everything we do.
One way we can get even stronger is to ensure that our people are supported to the best of our capabilities independent of the field they are in. It doesn’t matter what areas we choose to focus upon, everyone in this place needs full support.
The Neuro’s integrated model – from bench to bedside and bedside to bench. How important is it?
The integrated model – in which our hospital and research institute are integrated – isn’t found in too many other places. Yes, a lot of other institutions want to replicate this model or have created something that partially resembles it, but to have it working at the extent that The Neuro does is very rare. It’s our sweet spot, if you want.
We’re in an era where medical research is booming. The integrated model is important because the amount of positive changes in treatments and patient care is not keeping pace.
You need to have this mix of research and clinical activity, to help the research focus on the relevant clinical questions. Then you see the research results being picked up, understood and applied by clinicians quickly and appropriately. Key people in this mix are the physician scientists, those individuals who can understand and be understood in both the research and clinical worlds. One of the strengths of The Neuro is that we have many such clinician scientists.
But it’s an extremely difficult system to replicate, which is why there are so few institutions like The Neuro.
The model also fits perfectly with what our funders want, whether it is the Government of Canada or the Government of Quebec. It is what our donors want, it’s what everybody wants. Most importantly, it is what we want to be doing, which is to improve patient care.
It seems like diseases like Parkinson’s and Alzheimer’s are increasingly in the news. Why is this?
People talk more and more about brain diseases for the simple reason that more and more people are affected and dying from them.
A lot of people don’t realize this but the overall morbidity from brain diseases globally is greater than that of heart disease and cancer combined.
Why is that?
The cardiologists are doing a fantastic job, so mortality from heart problems is decreasing. The average lifespan of a person is increasing. Sure people are still dying of heart problems but instead of dying at 50 they die at 80.
But if you aren’t dying of heart disease, or if you are dying much later, your chances of developing something like cancer or brain disease increase. Cancer mortalities are increasing simply because we have an aging population and an increasing number of people are developing neurodegenerative diseases because they are living longer.
How close are we to a significant breakthrough in Parkinson’s or Alzheimer’s research?
This notion of scientific breakthroughs is more suited for the days of Banting and Best. It’s not the same any more. Now there are incremental advances – significant, but incremental, advances. We’ve seen some significant incremental advances in many neurological diseases over the past 20 years and things are accelerating.
When will that translate into concrete changes in care? I think we’ve already seen some significant changes. For example, when I was a resident there was no treatment for multiple sclerosis. Since then we’ve seen the development of a series of treatments and the outcome in MS is much better than it ever was before.
In regards to neurodegenerative diseases like Parkinson’s and Alzheimer’s, however, we’ve not done as well. But I think there will be things coming up in the next few years. It will be a slow process, but it is coming.