Rendezvous with Dr. Ley Sander

Interviewer: Dr. Rupali Sachdev, Junior Doctor and alumna of Grant   Medical College & Sir JJ Group of Hospitals

Dr. Ley Sander is the Head of the Department and Consultant Neurologist at University College London Queen Square Institute of Neurology in London. He is also the Medical Director at Epilepsy Society, and R&D Director at Stichting Epilepsie Instellingen Nederland.

Professor Sander is an academic neurologist, whose main research interest is in epilepsies, including epidemiology and outcomes, surgical treatment, and genetics.

I had the pleasure of picking his brain for this edition of Lexicon as a part of our series of interviews with Neurologists in the NHS.

Q: Why did you choose to pursue neurology? What excites you about it?

Ans: That’s an interesting question and I am often asked this! I have an interesting story. During my medical school year, I used to work as a paramedic on an ambulance to enhance my grant for certain hours. One of my first encounters as a paramedic was with a person with epilepsy. The dispatcher informed us that we need to aid a lady with epilepsy and when we went there, the lady was demanding diazepam. And I didn’t know anything about epilepsy and why she was after diazepam.

My first thought was that she was a junkie trying to get a fix! I sort of decided that we weren’t there to give her a fix and while I was crawling back into the ambulance, I saw her having an epileptic seizure and then I was completely lost as to what I should do. I just rushed her to the emergency room and halfway through she would wake up. She was clearly unhappy with the outcome and furious about her dog! I didn’t even realize that she had a dog. Once we got to the emergency room, the chief of staff of that shift was not happy that I brought a person with epilepsy who clearly did not want to be there. I was more or less called an idiot. That motivated me to go to the library and get everything out on epilepsy and start looking into it. That’s how I knew I wanted to do neurology and that’s how it all started!

Before that, I wasn’t quite sure what I wanted to be! Did I want to look at the pump – the heart? Or at some point, I was thinking about looking at the body’s software – being a psychiatrist. So my call to neurology was really this encounter with this person and then I decided I was going to be a central computing unit, hardware person!

Q: What an unusual way of getting into neurology! Coming to your life now, can you walk us through a day in your life as a neurology consultant in the NHS?

Ans: So, I’m an academic as well so my life is divided between research and the NHS. Two of my days a week are dedicated to my clinic. I run a very busy epilepsy clinic and I also have my in-patient department. Of course, I have a dedicated team of junior doctors to help me.

If you’re going to do research as a clinician, it’s very important that you keep your eye on the clinic. That’s where the ideas come from. That’s where the questions are going to come to your mind. So, I really enjoy my clinic days; some days more than others because it can be really tiring as well. But, I think at the end of the day, being able to help people is very rewarding.

The rest of the days, I’m into administration since I’m the Head of the department and that means a lot of work but I’m also really keen on my research on what are the outcomes of epilepsy patients. I do a lot of work in the global challenge where I work in resource-constricted settings. So I have projects in India, Africa, and Latin America. That is a rewarding part of being able to help people with epilepsy on the other side of the world.

Q: I see that you’re working with a very diverse group of people when you say that you have projects in India and other parts of the world as well. Where did you get the idea to expand your research globally?

Ans: When I was doing my Ph.D., there was a big question ‘Do seizures beget seizures?’ and there was a concept that if people are not treated promptly after their first seizure, they would progress to chronic epilepsy. So, the only way that we could look into it was by finding a population that had not received treatment for a long period of time.

So, I did my first Ph.D. thesis in Africa and Ecuador, where we were looking at outcomes of people with no treatment, after treatment, and people with a lot of seizures. If the theory at the time was correct, these people would not have had good outcomes after having loads of seizures. But what our research showed was that people would have almost the same outcomes as someone who has just started their journey with epilepsy. I was very proud of that since in some ways it changed the paradigm and put an end to the very prevalent idea of that time that ‘Seizure begets seizure’. As an aspiring Ph.D. student, I was very pleased to see my paper in the Lancet. I got three of my PhD papers into the Lancet and that was my claim to fame for many years!

Q: As you mentioned, you started as a paramedic and that case kick-started your journey into Neurology. In your clinical practice, have you come across any particular case that has stuck with you throughout?

Ans: Yes! Sometimes, we don’t have an interesting case but it’s more of the history behind it. I have had a number of these cases that I can recall. But, one case that I remember was of a man with many years of temporal lobe epilepsy, who never had imaging done. Imaging very quickly revealed that he had a tumor and was successfully operated on and he recently qualified as a physician! He now works as a primary care physician. So, that was one case I couldn’t forget since the person in question ended up being a doctor. But there are other times that I think that we could make a difference. I could tell stories about them all night!

Q: So, for junior doctors like me and for medical students who are just starting out their journey toward neurology, do you have any advice for those of us wanting to follow in your footsteps?

Ans: I think it’s very important that people understand what they’re going into. Medicine is undergoing a major change. We are in the midst of a genomic revolution where we will go from a disease-focused perspective to a more system-focused approach. I think this will increase challenges and probably also make the process more rewarding since we will be able to provide early personalised treatment for people in ten to twenty years.

I think that people need to be prepared for the challenges that are coming ahead and of course, for the people who are starting out, this will be easier than someone like me who has been around for a long time. The way forward will be getting to grips with the basics of genetics which will lead to major changes in neurology. Life itself is a genetic disease that is sexually transmitted with a 100 percent fatality!

Q: You have been in leadership roles throughout your career and is also the head of the epilepsy society. Could you give us an overview of the work done by the Epilepsy Society and your role in it as well?

Ans: The Epilepsy Society is one of the major epilepsy charities in the UK. It is really focused on improving the lives affected by epilepsy. It is not just the person who has epilepsy but also the people around them because every person will have friends, siblings, and parents. So, this is one of the major reasons for the existence of the Epilepsy Society.

It is an advocacy group for providing the best treatment, research, and now, to try and get personalized treatment to people as soon as possible. We are slowly getting there and the Epilepsy Society has done a lot when it comes to encouraging and funding research but also working as an advocacy group for elders and people with epilepsy.

Q: That’s a wrap on our interview with Dr. Ley.

Dr. Ley Sander


Dr. Rupali Sachdev. Junior Doctor and alumna of Grant Medical College & Sir JJ Group of Hospitals.

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