Isabelle Rapin, M.D. (1927-2017)

By Karen Balaban-Gill, MD and Solomon L. Moshé, MD; Montefiore Medical Center, Einstein College of Medicine

Rapin IIsabelle Rapin was professor emerita in the Saul R. Korey Department of Neurology and Department of Pediatrics at the Albert Einstein College of Medicine.  A longtime colleague and friend, mentor to generations of child neurologists in the US and world-wide, and one of the pioneers in child neurology, Dr. Rapin was born in Lausanne, Switzerland, the eldest of three children, to a Swiss father and American mother.   In an age when it was unusual for women to attend university, let alone attain advanced graduate degrees, the then 10 year old Isabelle decided she wanted to become a physician.  Following completion of secondary school, she attended the University of Lausanne Medical School and was awarded a Swiss Federal Diploma in Medicine in December 1952.  In order to be awarded her doctoral degree (which was not automatically given following the completion of the courses at the end of medical school in Switzerland), Dr. Rapin worked for an additional 6 months period on her thesis describing approaches to lower mortality in traumatic peridural hematomas, which was published in the Swiss Archives of Neurology and Psychiatry in 1955, at which time she received her doctorate in medicine (MD).  While the nervous system fascinated her above all at the University of Lausanne Medical School, it was rotations in la Salpêtrière and at L’ Hôpital des Enfants Malades in Paris that introduced the perspective of child neurology, and cemented her lifelong commitment, prompting her to come to the United States to fulfill this dream.

Determined to be a child neurologist, even though there were no specific training programs or requirements for our specialty until 1956, Dr. Rapin served as an intern in pediatrics at Bellevue Hospital from 1953-1954.  In July 1954, she began her neurology residency at the New York Neurological Institute at Columbia-Presbyterian Hospital, under the tutelage of Dr. Houston Merrit and especially Dr. Sidney Carter, an adult neurologist who was assigned to the task of creating a child neurology program.  During her training, she worked with many of the “greats” of neurology and child neurology, including Drs.  Labe Scheinberg, Robert Katzman, Elliot Weitzman, Eli Goldensohn and Dominick Purpura, who became life long friends and collaborators at Einstein . Surprisingly, although there had never been any female house officers in the years before then, Dr. Rapin was one of three women out of a class of eight neurology residents in her year. After completing three years of neurology training at The Neurological Institute, Dr. Rapin spent a fourth year of residency training in the recently established field of child neurology.  It was during this year of child neurology training that Dr. Rapin became interested in the neurology of children with language and hearing disorders and had her first foray into clinical research.Upon completion of her residency in 1958, Dr. Rapin was recruited by Dr. Saul Korey to the faculty of the fledgling Department of Neurology at the Albert Einstein College of Medicine of Yeshiva University (later the Saul R. Korey Department of Neurology), where she would spend the rest of her prolific academic career, ‘retiring’ in 2012 after more than 50 years. . Even after her retirement, for the next 3 years, Isabelle, organized and ran a biweekly course for the pediatric neurology trainees on neurodevelopmental disabilities

Rapin- 1972 CNS Exec Committee

Nineteen fifty eight was a momentous year for Dr. Rapin. Not only did she found and initially lead the internationally recognized Child Neurology Service and Fellowship Training Program at Einstein, but more importantly she met Dr. Harold Oaklander at a semantics conference, the man to whom she was happily married for over 58 years.  They enjoyed a true equal partnership marriage; she frequently acknowledged that without his encouragement, support and help in caring for their 4 children, she would not have been able to achieve the successes she did in her career.  She frequently told her trainees about how Harold had turned down prestigious job opportunities outside of New York, so that she could continue her career at Albert Einstein College of Medicine and she counseled many of her female trainees about the importance of having a supportive spouse (as well as good childcare!). Dr. Rapin was particularly proud of Harold’s accomplishments; after obtaining his PhD at Columbia University, he focused on the employment practices in Japan, including their life-time employment and avoidance of layoffs, using that knowledge in his role as the proud Founder and Director of the Alliance for the Prevention of Unemployment.

In 1959, Dr. Rapin published her first pediatric neurology paper, titled ‘The neurologist looks at the nonverbal child’ heralding her intention to forge ways to understand and treat communication disorders. Her pioneer potential was recognized by the National Institutes of Health as she was then awarded her first of many grants launching a research career in the field that would last for the next 58 years.  Indeed, at the time of her death, she was working on a manuscript about congenital blindness and autism. Her early work was focused on event-related potentials in deaf children, which she eventually applied in the diagnosis of deafness in children born following the rubella epidemic of 1964-65.  While working to help deaf children, Dr. Rapin became fascinated by developmental language disorders and autism, leading to her next areas of clinical research and patient care.   As stated by Dr. Mark Mehler, current chair of the Saul R. Korey Department of Neurology, “Isabelle was doing translational research more than 50 years ago, before anyone had coined a term for it or knew what it meant.  She taught all of us who followed the importance of bringing science into our understanding and treatment of (neurological) disorders”. 

Dr. Rapin was one of the first neurologists to consider disorders of higher cognitive functioning, including autism, to be neurologic disorders, and she thus become one of the world’s experts in pediatric communication disorders and autism.  Together with Dr. Dorris Allen, she proposed a new classification system for children with developmental language disorders, and she was one of the first to use the term “autistic spectrum disorder”, recognizing long before the DSM 5, the artificial distinction between autism and “pervasive developmental disorders”.  She collaborated with Dr. Roberto Tuchman, exploring the relationship between epilepsy and autism and with Dr. Ruben Jure, looking at autism in blind children and deaf children.

Dr. Rapin also was interested in neurologic genetic/metabolic diseases of childhood, including inborn errors of metabolism, storage diseases, and peroxisomal and lysosomal disorders, reporting novel findings in many patients with a variety of cerebral diseases including the cherry red spot-myoclonus syndrome, ceroid lipofuscinosinosis and Canavan’s disease.  In 1982, she coauthored a landmark paper describing that microtubule disarray in cortical dendrites is associated with neurobehavioral failure, providing evidence that alterations in dendritic structure of both pyramidal and non-pyramidal neurons may be key in understanding the pathobiological processes leading to neurobehavioral failure. With her vast knowledge and uncanny ability to explain and simplify concepts, she produced a series of chapters for textbooks. In the 19th edition of Rudolph’s Pediatrics, she authored or co-authored 5 different chapters on genetic metabolic disorders, inborn errors of metabolism, peroxisomal disorders, phakomatoses and unclassified progressive nervous system disorders, as well as authoring chapters on cerebral degenerative disorders of childhood in multiple editions of Merrit’s Textbook of Neurology and Swaiman’s Practice of Child Neurology.  In total, over the course of her illustrious career, Dr. Rapin authored nearly 300 papers, books and book chapters, including 10 that were published after her ‘retirement’ in 2012. “Dyscalculia and the calculating brain”, published in August 2016, was her last solo paper and was, as stated by Dr. Steve Roach, “an elegant treatise …. brilliantly reasoned and beautifully written”.

Dr. Rapin was a life-long learner who always kept current with the research and clinical advances in her field.  She felt that “every patient can teach us something we don’t know.  Patients are our teachers”.  Beginning her career before computerized databases existed, she kept a file card database of all patients she saw, listing all of their diagnoses on their file card.  One of the diagnoses she listed was “undiagnosed” and every time a new neurological disorder was reported, she would go though the charts of all “undiagnosed” patients to see if they fit the semiology of the newly reported disorder.  If they did, she would then reach out to the families of those patients and recommend they be seen by a neurologist to evaluate for the disorder.  In this way, she diagnosed a number of girls with Rett syndrome, many years after she had initially evaluated them for their developmental impairments. Dr. Rapin was a pioneer in translational research, , before the term was officially introduced,  emphasizing that neurological disorders are all ‘lifespan disorders’. This concept intertwines adult and child neurologists together in training and practice and brings out the need for better understanding of the evolving dynamic changes in neural substrates for disease pathogenesis, leading to innovative personalized medicine approaches. We, at Einstein have incorporated this in our mission for teaching, clinical activities and research.

In addition to her extremely productive academic achievements, Dr. Rapin was a most outstanding teacher, as well.  She took great pleasure in teaching students, residents and junior and senior faculty to think critically.  Over the course of her career, she helped train over 100 child neurology residents, as well as scores of adult neurologists, as well.  Many of those 100 child neurology trainees specifically choose to train at Einstein in order to have the opportunity to be taught by her, and some credit their decision to become child neurologists to her influence.  Not only did she teach her trainees clinical neurology, she also educated them in research, critically reviewing literature, preparing lectures and writing manuscripts.  Dr. Rapin mentored many academic child neurologists at various stages of their careers and provided particular encouragement to women in training at a time when  women were very much a minority in the field. Dr. Pongsakdi Visudhiphan, a child neurology resident at Einstein from 1967-70, credits Dr. Rapin with helping him “to set a foundation for modern pediatric neurology training and better care system for all child neurological problems in Thailand”.  

In addition to her trainees at Einstein, Dr. Rapin helped educate many more child neurologists, neurologists and pediatricians in the US and around the world, giving over 550 presentations and invited lectures, including endowed lectures, as visiting professor, symposium organizer or lecturer at universities, hospitals, scientific meetings and postgraduate courses.  As stated by Dr. Kenneth Mack, “the breadth and depth of her knowledge was exceeded only by her collaborative spirit and her unfailing willingness to engage younger colleagues in conversation who sought her wise counsel at Einstein Medical Center or at any number of national and international meetings”

Dr. Rapin received many awards in recognition of her contributions as an outstanding teacher and scholar, being an early recipient of the CNS’s Hower Award in 1987 and giving the Frank Ford Memorial Lecture at the International Child Neurology Association in 1990. She was awarded the Albert Einstein College of Medicine Pediatric Teaching Award in 2002, the Einstein Medical Student teaching award in 2009, the lifetime achievement award from the International Society for Autism Research in 2008, given to an individual who has made a “significant fundamental contributions to research in autism spectrum disorders that have had a lasting impact on the field” and the American Academy of Neurology Presidential Lifetime Achievement Award in 2010.

Dr. Rapin was a founding member of the Child Neurology Society and International Child Neurology Association and served on the Executive Boards of both societies, as well as the American Academy of Neurology, the International Neuropsychology Society and the American Neurological Association.  She served as Secretary-General of the International Child Neurology Society form 1979-1982 and Vice President from 1982-1986, in addition to serving as first Vice President of the ANA from 1981-1982. Dr. Rapin served on National Advisory Boards for the NINCDS, NIH, March of Dimes, Canavan Foundation and the National Alliance for Autism Research (NAAR) and served on the editorial board for numerous journals, including as Editor of the International Review of Child Neurology from 1983 - 2008.

In 2006, Einstein hosted an International Symposium on Autism in her honor, featuring most of the international authorities in the field and her colleagues who continue her work. To commemorate her mentorship contributions, the department of Neurology at Einstein has designated the Rapin Award which is given annually to neurology trainees with distinguished scholarly activities who most embody her spirit of biomedical inquiry. Also in recognition of her distinctive authority on communication disorders, Einstein has created an annual conference in Dr. Rapin’s honor.

Aside from child neurology, Dr. Rapin enjoyed spending time with her family and gardening in their Dutch Stone house in Coxsackie, NY, which she and her husband spent decades restoring.  She leaves behind her loving husband of 58 years and their 4 children, Dr. Ann-Louise Oaklander, MD-PhD, an adult neurologist at the Massachusetts General Hospital, Dr. Christine Oaklander, PhD, an independent art historian and private art consultant, Stephen Oaklander a retired music executive and recording studio owner who owns a saw mill, creating cabinets and furniture and Peter Oaklander, an electronics engineer, as well as 4 grandchildren.

Dr. Rapin died after a brief bout of pneumonia on May 24, 2017, surrounded by her family. While we mourn Dr. Rapin's passing, we should all celebrate how fortunate we were to know her and to be taught and mentored by her, and we should celebrate the wonderful contributions she made to the field of child neurology for over a half a century. Throughout the years, Dr. Rapin guided us all to be the best we can be as thinkers and doers, teachers and pupils, assistants or leaders and, most importantly, human beings. With her amazing energy, sharp mind and knowing smile, she molded child neurology worldwide and changed our discipline forever.