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Peter Camfield, MD

Born in England, Peter Camfield moved as a child with his family to Canada, becoming a Canadian citizen in 1954. He obtained his Bachelors Degree in 1966 from Queen’s University, Ontario and then crossed the border to pursue his studies at Harvard Medical School. Quite early in his medical training he was profoundly affected by the lectures of his fellow Canadian, David Hubel and Hubel’s Swedish colleague, Torsten Wiesel. Their now even more detailed and fascinating work on visual system development proved to be as fascinating to Camfield as a few years earlier it had been for Mary Anne Guggenheim. And thus it was that not only were these two remarkable young scientists completing work for which they would be awarded the Nobel Prize in 1981, they had, in addition the distinction (of which they perhaps were unaware) of serving as the initial attractants to neurology and neuroscience of at least two individuals who in time would become some of our finest child neurologist/ neuroscientists. Upon completing medical school in 1970, Dr. Camfield returned to Canada for medical internship at the Royal Victoria Hospital in Montreal. He then recrossed the border to complete his pediatric residency at the University of Michigan.

At the conclusion of residency, Dr. Camfield married Dr. Carol Spooner, establishing a relationship that would greatly enrich his personal and professional life. They spent two months with Patrick Bray and Jack Madsen at the University of Utah and the balance of a year engaged in travel. Dr. Camfield’s training as a child neurologist was then undertaken and completed at McGill University/Montreal Neurologic Institute. At McGill Dr. Camfield’s career development was particularly influenced by many of the extraordinarily distinguished faculty available to him. These now internationally renowned individuals included Fred Andermann and Gordon Watters, whose contributions to child neurology have been recognized by major CNS awards. Also the late George Karpati, a neuromuscular specialist (who had his own ties to Camfield’s ultimate career destination, Dalhousie University); pioneer metabolic/geneticist, Charlie Scriver (six editions ago of his famous textbook); epileptologist/ electroencephalographers David Bloom and the late Pierre Gloor; and epidemiologist, Robert Oseasohn.

With more than 350 listed formal research presentations, invited and honorary lectures delivered over a 37-year interval in North, Central, and South America, Europe, the Caribbean, Far East, Australia, Russia, and elsewhere, Carol Camfield is a similarly prominent co-author or co-presenter. Thirty-five visiting professorships have similarly carried the Camfields throughout the world. The experience of hearing the tandem lectures by the Camfields conveys the sense that their thought processes proceed in perfect tandem with an excellent sense of who should emphasize what. Their visiting professorships entail meetings in an informal setting where they emphasize not only clinical medicine and science, but the importance that young physicians must invest in retaining a balance of work and recreation. They have exemplified the value they have placed not only on high achievement as physicians, researchers, and teachers, but also as a couple sharing all other aspects of the enjoyment of life. Reflections on so rich and productive a scientific relationship carries one’s thoughts back to Pierre and Marie Curie.

Their full-length papers cover a broad range of subjects, amongst which are fifty-three papers considering a very wide range of subjects related to epilepsy, six concerning headache, five on heritable metabolic disorders, and five on movement disorders. Other papers consider syncope, pseudotumor, stroke, learning problems, diseases of muscle and nerve, trauma, SIDS, drooling, and neurological examination. One remarkable thing about all of these papers is how carefully each topic has been selected and how much effort has been expended to gather important, practical, and accurate information. Virtually all of these papers are addressed to an important area of incomplete understanding and virtually all of them provide practical insight as well as direction for further research. Peter and Carol Camfield have a keen eye for what is important and are not the least bit shy about pointing out the inadequacy of general understanding of a wide variety of subjects. The neurological community has benefitted richly from their investigational skills and careful analyses particularly as they are applied to common problems.

The debt of gratitude owed to the Camfields and their collaborators must extend also to the children and adolescents of Nova Scotia who have constituted the stable population base for so many epidemiological and long-term outcome studies – some of which extend for twenty-five years. Included among these studies are some of the best available characterizations of the natural history of various seizure disorders, including febrile, absence, JME, and Rolandic seizures, as well as status epilepticus. These studies provide some of the most reliable information concerning the responsiveness of these disorders to specific medications and the frequency with which medication side effects might be encountered.

The Camfields have provided guidance concerning many other aspects of medication risk and benefit. An over-riding theme in many studies is confirmation of the pre-eminent importance of obtaining a careful and accurate clinical history. They have learnedly encouraged thoughtfulness and observation and have discouraged excessive numbers of tests. They have deeply considered the role of the EEG in evaluation and management of children with epilepsy as well as those without, with due consideration of the manner in which such testing may be misleading or unnecessary. They have similarly considered when anticonvulsants might safely be dispensed with as in the case of benign Rolandic epilepsy. The Camfields have closely considered a wealth of questions concerning learning and behavior in children with epilepsy.

While many Camfield papers and chapters perform the valuable service of alleviating our anxiety concerning things about which we have known too little, others serve the equally important role of reminding us rather forcefully of the things we think we know that are in fact not yet really so well understood. The scrupulousness with which the Camfields and their associates have refined the boundaries between reliable and unreliable information has greatly assisted the ongoing task of trying to improve the way we do business as neurologists. Among the most highly cited Camfield original full length papers (number of citations in italics in parentheses) are those concerning age-related population-based epilepsy risk up to 15 years of age (85), risk of epilepsy after first unprovoked seizure (118) and factors that worsen an otherwise low risk for mortality from epilepsy (47), risks for seizure recurrence and of medication side effects after onset of treatment (40), and the semiological variability of Rolandic epilepsy (36). Two valuable papers provided an epidemiological foundation for trying a third drug in childhood convulsive epilepsies before opting for invasive management (84).

Another paper richly characterizes the natural history of absence including worrisome associated features (60) psychosocial difficulties (50), and the significant risk for injury, especially on bicycles or in the car (59). The Camfields and associates have carefully investigated the differences in cognition, personality, and school success in individuals with right as compared to left temporal foci (64). They have studied the side effects of phenobarbital in toddlers (162) and have taken a skeptical look at the role of this drug as treatment after first febrile seizure (58). They described valproate-induced pancreatitis (67). An early paper described the occurrence of neonatal stroke in the setting of polycythemia (44). Several papers characterize the social and intellectual development and adaptation of individuals with Tourette syndrome (74). Others demonstrate child migraineurs are not necessarily more anxious than their classmates (38) and that vomiting after head injury is often a migrainous phenomenon (15). They have discerned a changing picture of pseudotumor cerebri (50) and have described the surprisingly benign outcome that may be experienced in the curious entity combining basilar migraine, seizures and severely disordered EEG in adolescents (112).

Sticklers for detail and improvement of care and quality of life, the Camfields and their associates have closely considered the subject of treatment of drooling and the suggestion that an indwelling catheter may simplify blood drawing and lessen pain in the management of intractable epilepsy. They have carefully identified the extent and nature of popular and professional stigmatization of epilepsy. Their approach is exemplified at every CNS meeting, where their thoughtful and valuable questions illuminate considerations of a broad variety of topics in our scientific sessions. Camfield papers have one particular attraction that goes beyond the “bottom line.” Sometimes one must read an entire paper to find out if the methods are adequate and the message is correct. One is never in doubt with a Camfield paper. Nor is it necessarily to enjoy the work of individuals who know how to write well – which they do. The reason to read these papers is to enjoy the fine minds of critical thinkers at work, learning the details of where current knowledge stands, why and how they have approached it, and what remains to be done. Sometimes learning all of this leaves one with an embarrassing sense of what remains to be done and why we are not all pitching in to get on with it. Such is the effect of the Camfields.

Their efforts have extended strikingly into another generation. Daughter Reneé C. Shellhaas, MD, is a child neurologist/epileptologist who was awarded the 2008 Shields Fellowship of the Child Neurology Foundation. Now in her third year on the faculty of the University of Michigan, she has assembled a multidisciplinary team employing amplitude-integrated EEG and near-infrared spectroscopy to study neonatal hypoxic-ischemic brain injury, seizures, and the effects of brain cooling therapy.

Peter Camfield became Acting Chief of Pediatrics at Dalhousie in 1993. He is active in the American Epilepsy Society, including service chairing the Outcome Measures and Annual Course Committees. He is an ad hoc reviewer for 14 journals and member of 5 editorial boards. He was the star of a Sesame Street Short Segment (1976). He is recipient of the Best Clinical Trial Award of the International League Against Epilepsy (1983). He shared with Carol Camfield the prestigious Milken Award of the American Epilepsy Society recognizing their distinguished contributions to clinical investigation. The Camfields also shared the IWK Health Center Research Award in 2005. Peter Camfield was the Bellagio Scholar of the Rockefeller Foundation in 2002, recipient of the Penfield Award of the Canadian League Against Epilepsy in 2003, and of the Epilepsy Canada Pioneer Award in 2003. Dr. Camfield’s non-professional interests, shared with his wife Carol include travel, sailing and skiing.