Bringing CNS Members Together to Make Children’s Lives Better

CONNECTING TO...

Deborah Hirtz, MD

Deborah Hirtz, MD

A native New Yorker, Deborah Hirtz attended the University of Chicago, from which she was awarded a B.A. degree with Special Honors in Biology in 1969. She completed medical school at Hahnemann Medical College in 1973. This was followed by a full three-year residency in pediatrics and two years of training in child neurology at the Children’s Hospital National Medical Center, then a year of training in adult neurology at George Washington University Medical Center. She obtained Board Certification in Pediatrics in 1978 and in Neurology with Special Competence in Child Neurology in 1981. From 1981-2007 she served as Consultant in Child Neurology at the Montgomery Country Health Department. She was appointed Consultant in Neurology at the National Children’s Medical Center, Washington, D.C. in 1979, a position she continued to hold until 2003. Between 1979 and 1984 she served as an Expert Consultant in Child Neurology at the Developmental Branch, NINDS, with promotion to Medical Officer, Child Neurology in 1984. She held this position until 1999. Between 1999 and 2007 she served with considerable distinction as Program Director, Clinical Trials, Office of Clinical Research, NINDS, NIH. From 1999 to the present she has been a member of the Medical Staff, Department of Neurology, Children’s Hospital Medical Center, Washington, D.C.

An excellent clinician and scientist, Dr. Hirtz has distinguished herself particularly as an investigator. Her mentor and colleague, Karin Nelson, has characterized her “fierce dedication” to the task of placing the practice of child neurology on as firm a scientific basis as possible. She has undertaken this objective at the NINDS with intelligence, determination and reason that have diverted increasingly rich resources to the underwriting of the studies necessary to achieve this reformation of the way child neurologists do their work. The large number of child neurologists and others that have participated not only in studies but also in workshops and task forces designed to enrich scientific understanding and improve the welfare of children with neurological diseases will be familiar with her determination. The “fierceness” is beneath the surface of an approach to others that is almost enthrallingly captivating. A summons from Dr. Hirtz to participate in the tasks that she envisions has both the logic and the evident importance to make such participation seem the right, the only thing to do.

Reference to just a few of Dr. Hirtz’ endeavors and the associated publications provide evidence for the profound impact she has had on child neurology, neuroscience, and above all the welfare of children. Her most highly cited publication (232 citations) is the report concerning the NINDS workshop on perinatal and childhood stroke (Lynch, Hirtz, deVeber et al, 2002). Stroke in children remained an area of considerable uncertainty and of disappointingly little systematic knowledge. The scope of this conference included what was known about epidemiology, risk factors (maternal, prenatal, perinatal, of postnatal) for either occurence or recurrence, pathophysiology, morbidity, mortality, and potential treatments of childhood stroke. It emphasized the lack of consensus concerning classification, approach to initial evaluation or treatment and of strategies for prevention or for the measurement of outcome with or without treatment. Amongst the attendees, it built a fire that supported the ensuing steps of the initial establishment of a childhood stroke registry to characterize the entities as a basis for ensuing efforts to fill in all the missing information. That fire continues to fuel the effort to make of childhood stroke disorders entities as preventable and treatable as some forms of adult stroke have become.

A second example may be cited from Dr. Hirtz’s evident particular interest in epilepsy. On this subject she similarly shone the bright light and availed the resources of the NINDS. Among the numerous topics of importance that she selected was the subject of the utilization of phenobarbital for the prevention of febrile seizures. The results are reported in the classic report of Farwell, Lee, Hirtz et al, 1990. The carefully designed study of 217 children demonstrated that this approach clearly depressed cognitive performance in at least a transient manner, in some instances outlasting the discontinuation of the drug for at least several months. Moreover, the study demonstrated that there was no clear efficacy in the prevention of seizure recurrence. This study had a considerable impact on practice – especially after the results appeared on the front page of the New York Times. A third example is the effort that Dr. Hirtz invested into the NICHD/NINDS trial demonstrating the efficacy of MgSO4 in reducing risk for cerebral palsy in small very premature infants (Hirtz and Nelson, 1998).

Dr. Hirtz list of publications contains many other examples of her dramatic impact on “the way we do business” – especially her capacity to organize studies that have established other practice parameters under the auspices not only of the NIH/NINDS, but also the Therapeutics and Quality Standards Committees of the AAN, and the practice committees of the AES and the CNS. Dr. Hirtz played an important role in supporting and organizing the effort that led to the publication of two important reports on the efficacy and tolerability of newer antiepileptic medications published in April of 2004. These papers (each now cited more than 170 times) not only provided an evidence-based foundation for selection of drugs for the treatment of newly diagnosed epilepsy, it also identified seizure types and syndromes for which evidence for efficacy and tolerability remained uncertain. Among most important elements of the work of Dr. Hirtz – as is the case with the Karin Nelson/Jonas Ellenberg modus operandi – is the designation not only of “what is” but also “what’s next,” and how one might best go about tackling that next problem. Dr. Hirtz has made it clear that the starting point is to establish where we are – as was achieved in another study – one in which she was first author, having organized the effort to see “how common” are the “common” neurological disorders. She provided the best available data for 12 such conditions – though she pointed out that in many instances the data remains insufficient, despite the fact that millions of individuals are likely affected. This study has been cited at least 172 times since 2007.

Other highly cited answers to important questions in which Dr. Hirtz has played a major role and reported as first author include the prevalence of seizures following childhood immunizations, the natural history of febrile seizures, the risk of recurrence of nonfebrile seizures in children, sleep disturbance as a side effect of phenobarbital, and the practice parameter concerning treatment of a child with a first unprovoked seizure (Hirtz, Berg, Bettis et al, 2003). Other highly cited practice parameters investigations and practice parameters in the organization and establishment of which Dr. Hirtz played a key role include such varied topics as evaluation of global developmental delay, pharmacological treatment of childhood migraine, neuroimaging in the neonate, medical management of infantile spasms, evaluation of recurrent childhood headaches, treatment of women with epilepsy, and many others. Taken as a group, Dr. Hirtz’s 69 publications have been cited 2330 times to date, for an average of 34 citations per paper. Her most common co-authors have been Karin Nelson (27%) and Jonas Ellenberg (17%), but CNS members Steve Ashwal, Schlomo Shinnar, Tracy Glauser, and this year’s Sachs Award designee, Laura Ment, have also been frequent co-authors.

Laura Ment provides the following summary of the work of Dr. Hirtz: “She is the absolute best advocate for the developing nervous system that I know, and I can never thank her enough for her wise advice given over the past many years. Deborah has insight, extraordinary vision and the ability to translate emerging developments in pediatric neurology into the clinical realm. As a community we should be extremely grateful to her.” Alan Leviton emphasized her very effective role behind-the- scenes in “supporting investigators and helping them to achieve goals and avoid pitfalls.” It is very clear that her efforts have played an extraordinary role in organizing, guiding, and financing the substantial improvement in the quality of both the clinical and scientific enterprises of child neurology. Dr. Hirtz’s participation in the CNS has included representation to the Selection and Oversight Committee for the Public Policy Fellowship (2002-present), as well as past and present membership on the Scientific Selection, Research, Nominating and Practice Committees (of the last of which she is currently Co-Chair). She was Chair of the Child Neurology Section of the AAN from 2001-2003. She has been a member of the WHO task force on neonatal seizures since 2007. The NINDS has recognized her distinction with the two NIH Awards of Merit (1993 and 1998), the NIH Director’s Award (2005), the NIMH Director’s Group Award (2006), the NINDS Individual Merit Award (2009), and the NINDS Group Merit Awards (2009).

Dr. Hirtz is happily married to Dr. Daniel Waterman, who is an internist specializing in infectious diseases. His concern for the welfare of others is represented, among other things, by his intermittent medical educational activities in Uganda. The couple have three sons: 35-year- old Benjamin, who is a berry farmer in Vermont, and 31-year-old Andrew and 28-year-old Charles, both of whom are computer experts.