NIELS L. LOW, MD (1916 – 2007)

by Robert S. Rust, MD, MA

Note: The following was published in the Fall 2007 CNS Newsletter in conjunction with the posthumous presentation of the CNS Lifetime Achievement Award at the 36th Annual CNS Meeting in Quebec City. Dr. Low passed away in August 2007.

Low

Niels L. Low was born in his grandmother’s home in Copenhagen, Denmark in 1916. His father, a dermatologist, was away with the troops in World War I at the time of his birth.  His early education was obtained in Carlsbad, Czechoslovakia, although during the summers he returned to Denmark. He studied medicine at Charles University in Prague in order to become a member of the third generation of physicians in his family.  His final year of studies to qualify for his medical degree took place at the Medical College of South Carolina. His MD was conferred in 1940.  A rotating internship at St. Luke’s in Racine, Wisconsin was followed by two years of training in pediatrics at the Medical College of Wisconsin, Marquette Medical School. A student nurse, Mary Margaret Cook, who held an infant upon whom Dr. Low was performing a lumbar puncture, attracted his attention. This attraction became mutual, resulting in a marriage that would last for 64 years. In 1943 Dr. Low joined the Army Medical Corps. For three years he served in the field and station hospitals in England, Belgium, and France. He was discharged at the rank of Captain in 1946, returning home to a son who had been born when he was away at war, Roger Lee Low.

Dr. Low returned to Wisconsin, spending seven years in private practice pediatrics in Racine. In addition, he took charge of the epilepsy clinic and of electroencephalography. Recognizing the need for additional formal training, Dr. Low moved in 1953 to Chicago to assume a fellowship position at the University of Illinois School of Medicine consultation clinic for epilepsy and the associated EEG laboratory. There he received training under Frederic A. and Erna l. Gibbs, an inseparable pair then in their twenty-third year of collaboration in research and clinical care of individuals with epilepsy. Together with Albert Grass in the Putnam/Lennox laboratory at Harvard in the 1930’s they had transformed Hans Berger’s one channel EEG into a three channel model. They had quickly identified the electrographic signature of absence epilepsy and, in so doing, inaugurated American electroencephalography. Two years prior to Dr. Low’s fellowship, Frederick Gibbs and William Lennox had shared the Lasker prize for contributions in epilepsy. Low spent two years acquiring the considerable knowledge and wisdom that the Gibbs team could impart. His experiences in Chicago permitted him to publish three papers: a general review of electroencephalography in children, electroencephalographic findings in breath holding spells, and consideration of electroencephalographic findings in children who had received pertussis immunizations. 

In 1955, Dr. Low was selected to become the first individual to train in child neurology under Sid Carter at the Neurological Institute of New York at Columbia. Carter’s own designation as child neurologist was conferred by the fiat of Dr. Houston Merritt, who had the wisdom to discern not only the need for child neurological specialists, but the capacity Carter possessed to train them. Dr. Carter had been able to arrange funding for Dr. Low’s year of training in cerebral palsies and related conditions from the United Cerebral Palsy Foundation. As would become a pattern in Dr. Carter’s mentor-mentee relationship, an opportunity quickly presented itself for the pair to write an important paper on a topic requiring one – in this case multiple sclerosis in children.

After this year of training, Dr. Low was recruited by Dr. James F. Bosma of the University of Utah Medical School to a position as Associate Research Professor of Pediatrics.  About the same age as Dr. Low, Dr. Bosma was one of the founders of developmental pediatrics. He was also an electromyographer who made important contributions to the investigation of oropharyngeal disturbances including the various dysfunctions manifested by children with severe neurologic disorders. Dr. Bosma played a critical role in the establishment of speech-language and occupational therapies for children. He was a deeply committed advocate for children with chronic illnesses of all sorts. It is likely that in Niels Low he recognized a kindred spirit. These physicians share a productive and lifelong devotion to defining problems, refining care, improving understanding, and ceaselessly advocating for disable children.

Dr. Low’s first Utah paper was a description of the severe mental retardation and some unusual features that he observed in two Utah children who had received no treatment for phenylketonuria. Although the possibility of dietary treatment had been considered in the 1930’s, the first commercially available low phenylalanine diet did not become available until 1958. Moreover, it was not until 1960 that Guthrie (whose own child had mental retardation and whose nephew had PKU) was able to develop a reliable method for identification of PKU in infants prior to the onset of irreversible brain injury. Dr. Low published in quick succession three additional elegant papers concerning EEG abnormalities of PKU, normalizing data for development changes in serum phenylalanine and urine phenylketones and, with Bosma and others, a paper on the effect of their efforts to provide a low phenylalanine diet to children with PKU.

These papers, in which Dr. M.D. Armstrong also played an important role, represented more than considerations of a single metabolic disease. They represented important fuel for increasing interest in that era in mental retardation as a preventable illness. The quest to identify such opportunities became an important objective to which rising support for public health initiatives to help children could be directed. The work of Low and others concerning the severe effects of a potentially treatable disease provided the impetus for mass screening trials of the Guthrie test. The success of this phase and the demonstration of the effectiveness of dietary treatment if begun soon enough after birth produced in 1963 a national consensus to “Test Every Newborn for PKU.”  “The rest,” as they say, “is history.” Dr. Low’s additional publications based on his experiences in Utah included studying the utility of the sedative Suvren in treatment of brain injured children, a study of childhood polyneuritis, and papers on the effects of treating infantile spasms with dietary manipulations and with corticosteroids. During their years in Utah, Dr. and Mrs. Low were blessed with the birth of a daughter, Judith Ann Low.

In the meantime, a certification route for child neurology had been established in 1957.Sid Carter promptly established at the Neurological Institute the first NIH-supported child neurology training program. Low returned as the inaugural recipient of this fellowship, which entailed two additional years fellowship training, including a year of adult neurology. He may have been the first trainee to pass the formal requirements for ABPN certification in neurology with special qualifications in child neurology.  He successfully completed the formal certifying examination at The Neurological Institute in December of 1960. In order to do so, he had had to walk several miles from his home in New Jersey through a blizzard. An invitation to joint the Columbia University faculty followed, making Dr. Low the first of what would be an impressive collection of select individuals that were retained by Carter after they had completed their training with him. 

At Columbia, Dr. Low and Charles Poser described pathological abnormalities in children who had experienced infantile spasms.  He reported the effects of phenytoin treatment with Mel Yahr, and published a study of EEG findings in individuals with juvenile delinquency. In 1961 Dr. Low translated, edited, and published Foix’s The Encephalogram of the Normal Child. In 1962 he and Sid Carter published a description of the emerging discipline of pediatric neurology. In 1965, with Drs. J.W. Correll and Jim Hammill, Dr. Low published report of childhood brain tumors. In 1966 he and Dr. Correll published a paper on head pain due to leptomeningeal cysts. With Abe Chutorian and Arnold Gold in 1968 he published the results steroid treatment of non-infantile myoclonic epilepsy of children. Since his work in Utah, Dr. Low had been an early and forceful advocate of the utility of these medications in myoclonic epilepsies. Subsequent publications considered the management aspects of children with chronic neurologic illnesses such as cerebral palsy, spinal muscular atrophies, mental retardation, and progressive myoclonic epilepsy. With physiatrist Dr. J.A. Downey he edited a book on rehabilitation of children with chronic disabling illnesses that ran through two editions. 

Dr. Low achieved the rank of Professor of Pediatrics in 1989. For many years he had been in charge of the Child Neurology Clinic. He was one of several members of the faculty who consulted on children with chronic neurological conditions at the Blythedale Children’s Hospital. Until his mandatory retirement from Columbia at age 65 Dr. Low was a popular teacher of students and residents in both clinics and wards. Trainees also joined him on his trips to Blythedale. They recall him as unfailingly kindly to children and their parents, a highly experienced and practical clinician. If the question of the relationship of mild head injury to an ensuing neurologic complaint were raised on rounds, his response was likely to be “Every childhood neurologic disease is preceded by a head bump.” He emphasized the importance of understanding and acquiring excellence in managing common disabling conditions of children in addition to the more exotic rarities. His trainees found him to be what Isabelle Rapin and Arnold Gold, have termed a “no-nonsense teacher.” He had the combination of extensive experience, excellent judgment, a dry wit, and a quick and tidy mind. To these he also added unfailing concern and kindness.  For these and other attributes he was a valued participant in the storied monthly nocturnal clinicopathological case conference with beer and pretzels on the 14th Floor of the Neurological Institute. 

Dr. Low lectured throughout the United States and internationally. He was active in national and international pediatric and neurological societies including the Child Neurology Society.  He was elected to the ANA in 1965.He was a founding member of the International Child Neurology Association and in 1975 succeeded John Stobo Pritchard, becoming the second President.  He served on the Board of the American EEG Society. So much appreciated were his services at Blythedale that in 1981, after his mandatory retirement from Columbia at 65, he was appointed Medical Director and Chief of Pediatrics.  He joined his old mentor, Sid Carter, who had retired from Columbia to become Chief of Neurology there in 1978. Low remained at his Blythedale post for eight years and even after that retained a part-time position there for a few more years. 

He enjoyed gardening, travel (especially to Denmark) stamp collecting, and reading history, Danish and German Literature, and listening to classical music. The only devotion that exceeded his devotion to child neurology was that he maintained for his wife, his son and daughter, five grandchildren--namesake Niels, Cassell, Maria (now an MD, which would have delighted him), Sarah and Dorothy)--and four great grandchildren--Bo, Poppy, Jake and Heath. His children remember his encouragement of study and of open-mindedness, his kind-heartedness and capacity to trust and relate with children. Dr. Low died peacefully at age 90 in his home in Tenafly, New Jersey, on August 20, 2007.  There is no doubt that the recognition of his “Lifetime Achievement” in child neurology is a tribute that he would deeply appreciate as do his wife and family who shared his important life.