Profile written by Robert S Rust, MD, MA
Born in Brooklyn, Steve Ashwal earned his undergraduate degree at New York University, majoring in psychology and chemistry. As a medical student at NYU he decided he would like to take care of children, largely on the strength of two summer electives: the first in child psychiatry service at Great Ormond Street, and the second in Holland, where he was able to see patients with the famous pediatrician Dr. Simon Van Creveld. During his lengthy career, Dr. Van Creveld’s had contributed richly to neonatology, heritable metabolic diseases, childhood blood diseases, and genetics. Returning to New York University, child neurologist Richard Reuben played an important role in attracting Ashwal to child neurology, as would encounters with Sidney Carter and Arnold Gold at Columbia. Dr. Ashwal trained in pediatrics at Bellevue. During his residency he carried out, under the direction of Dr. Philip Brunell, studies of the effects of viral encephalitis and of the recently introduced cancer treatment, cytosine arabinoside.
Dr. Ashwal trained in child neurology at the University of Minnesota. He was greatly influenced by Director Ken Swaiman as well as Larry Lockman, Francis Wright, and by his senior resident, Bhuwan Garg. Attracted to critical care neurology, Dr. Ashwal carried out a study of cerebral death diagnosis in infants, the first of many such studies carried out during his career. Upon graduation, Dr. Ashwal was recruited to the Child Neurology section at the Loma Linda University School of Medicine. He has spent his entire career there, excelling as scientist, clinician, and teacher. Trained by Dr. William Kennedy, Dr. Ashwal has served since 1976 as Co-Director of the Muscular Dystrophy Clinic. He has been particularly active in clinical and research (clinical and bench) aspects of intensive care, both of neonates and of older children, collaborating highly productively with neonatologists, intensivists, radiologists, and others. He became Chief of Child Neurology in1995.
Dr. Ashwal has a remarkable publication record, including 160 original papers and reviews; a large percentage have been published in high impact journals. Fifty-five percent have been cited more than 20 times, 22 per cent more than 50 times, and 7 per cent more than 100 times. Twenty of these papers concern the basic science investigations in which Dr. Ashwal has engaged throughout his career. This work, supported by twelve grants, has characterized factors that account for vascular reactivity and secondary bloodflow disturbances under graded hypoxic-ischemic and other stressful conditions in developing brain. Models have included fetal lamb, pregnant sheep, rat pups and rabbit pups, spontaneously hypertensive rats, hippocampal slice, and isolated arteries. The studies have contributed importantly to the understanding of the reactions of developing brain and its vascular supply during and after varying forms and degrees of hypoxia, hypercapnia, acidemia, and hypotension. He has studied maternofetal hemodynamic interrelationships, vasoregulatory roles of calcium flux and cGMP in vascular endothelium, and the role of nitric oxide within ischemic areas and surrounding tissues. These studies and those evaluating possible treatments of focal ischemic stroke are highly cited.
The remaining 140 papers constitute a cross- section of neurological topics. More than half consider subjects related to intensive care. Twenty-nine well-known papers consider imaging techniques of increasing sophistication ranging from xenon bolus and catheter angiography through CT, scintigraphy, the entire spectrum of MRI, MRA, and proton MR spectroscopy. Among other things, Dr. Ashwal and colleagues have determined the precision with which imaging methods indicate bloodflow, brain death, neonatal and childhood metabolic disturbances, infectious diseases of brain, traumatic shearing forces, and other abnormalities. Careful follow-up has permitted Dr. Ashwal and his collaborators not only to evaluate treatments, but to assess the validity of various imaging changes that may permit more accurate prognostic formulations to be provided in situations where treatment options are being weighed. These studies have included neonatal HIE, drowning, traumatic brain injury, CNS infections, and early childhood cardiac surgery.
Sixteen papers consider issues related to brain death determination. Sixteen consider traumatic brain injury. Six consider the neurological aspects of cardiac surgery. Eleven consider the definition, clinical aspects, life expectancy, and possible reversibility of the persistent vegetative state. Three consider definition and clinical aspects of the minimally conscious state. Additional papers consider such other topics as metabolic illnesses, brain tumors, neurodegenerative conditions, poisoning, epilepsy, inflammatory diseases, child abuse, diseases of spinal cord, peripheral nerve, anterior horn cell, and muscle. Thoughtful, probing consideration of ethical issues has been a characteristic aspect of Dr. Ashwal’s career, exemplified particularly well in his papers concerning organ donation from anencephalic individuals and those with severe neurologic dysfunction, and probing assessments of the accuracy of braindeath determination. In the “brave new world” of stem cell transplantation, Dr. Ashwal’s sophistication with imagery has permitted him to address important questions regarding how imaging techniques might be employed to monitor the efficacy of this novel form of treatment. Eight grants have supported the clinical investigations of Dr. Ashwal and his colleagues. Dr. Ashwal has participated in supervision of the Doctoral research of eight individuals and the research projects of many physicians. He has trained 14 child neurologists.
Dr. Ashwal’s many responsibilities in the CNS have included service as Secretary-Treasurer, and a particularly successful Presidency. Many important CNS and CNF initiatives were either inaugurated or received a timely boost during his administration. His thirteen-year tenure on the Practice Committee has been marked by an exceptional degree of involvement in the writing of CNS/AAN Practice Parameters. Of particular note were his Co-Chairmanship of the Multi-Society Task force on Persistent Vegetative State (PVS), his active participation in the Aspen Guidelines for the Minimally Conscious State and his service on Task Force 1 to establish criteria to define cardiac death. Dr. Ashwal has been a particularly important organizer and advocate for completion of practice parameters relevant to issues facing both child and adult neurologists. These studies have carefully assessed the quality of available information and have provided direction for important future research. Dr. Ashwal has played a particularly important role in those concerning Concussion, Intracranial Mass Lesions in AIDS, Autism, First Nonfebrile Seizure, Global Developmental Delay, Recurrent Headache, Migraine in Children and Adolescents, Cerebral Palsy, Duchenne Muscular Dystrophy, Infantile Spasms, and Status Epilepticus. Dr. Ashwal has contributed not only his knowledge and judgment, but also his determination, perseverance and tact. The parameter concerning PVS has been cited more than 450 times, that for autism 175, and minimally conscious state parameter 162 times.
Dr. Ashwal’s interest in the history of neurology has been reflected in six papers and in his masterful efforts inspiring and editing Founders of Child Neurology, published in 1990. This very successful book characterized with great detail and interest the development of our subspecialty through the lives and contributions of some of its most notable participants. The achievement required the same set of skills as he manifested in bringing practice parameters to their conclusion, as well as thoughtful prodding, patience (with a discernable limit), encouragement, timely direction, the capacity to enlist collegial responsibility, and the ability to summon excellence. These attributes were displayed again as he assumed co-editorship of Dr. Ken Swaiman’s Pediatric Neurology and have continued through the two editions, the last including the similarly extraordinary editorial skills of Donna Ferriero. Always ranked among the few primary texts for our subspecialty, these editions have rendered it ever better – keeping up remarkably well with our dramatically expanding field. Characteristic of Dr. Ashwal has been the degree to which he has pitched in where needed to bring various chapters to completion. Unaccountably, given his broad and important commitments, Dr. Ashwal has somehow written sixty-five chapters for a wide variety of textbooks.
Dr. Ashwal is an accomplished teacher, known for his capacity to consider clinical problems within a perspective that is enriched by his accomplishments as basic scientist, clinician, medical historian and thoughtful ponderer of moral and ethical questions. He has been in demand as a visiting professor and lecturer throughout the United States, Chile, and Canada (where he received the Preston Robb and John Stobo Pritchard Awards, as well as the John Tibbles Lectureship). He has been similarly much sought after as a lecturer in South America, China, Italy, and Turkey.
Dr. Ashwal is a member of the Board of the International Child Neurology Association. He was a founding member of the Executive Board of the Child Neurology Foundation. He has served as a Board Examiner for twenty years. He has been an NIH Grant Reviewer, ad hoc reviewer for eight journals, and has done yeoman service on three editorial boards. Dr. Ashwal enjoys travel and is a devoted husband, father, and grandfather. Eminently approachable, he is known by all as a person of vision, integrity, and concern for others. He is a person who tirelessly seeks to achieve excellence in multiple arenas, with remarkable success and a laudable record of carrying others along with him in the process.