Advancing Women's Neurology through education, research and advocacy
Women’s Neurology is an emerging medical subspecialty that focuses on neurological conditions across a woman’s lifespan with key periods being preconception, pregnancy, postpartum and transitional midlife period (pre-menopause and post-menopause)1.
Women have important sex and gender-specific considerations, yet there are gaps in training that neurologists receive specific to this population. Furthermore, research shows that men and women respond differently to pain medications and an increasing number of studies suggest that the fundamental biology of pain and pain relief differs between the sexes. Such important differences extend to epilepsy, cognition, headache, multiple sclerosis, neurodegenerative diseases and stroke.
Since 2012, Dr. Esther Bui has worked as a neurologist and epilepsy specialist focusing on women's neurological health. She is also an assistant professor and clinician educator within the Department of Medicine at the University of Toronto (U of T).
“Although we understand there are differences between the male and female brain, our existing neurological treatments are heavily-based on the male brain research model,” says Dr. Bui.
In 2016, the National Institutes of Health (NIH) established a policy mandating the inclusion of sex as a biological variable in research design, analyses and results reporting. This recognition stems from the understanding that overlooking sex as a biological factor undermines the transparency and applicability of research findings. Similarly, in 2021, the Canadian Institutes of Health Research (CIHR) underscored related policies and the importance of integrating sex (and gender) into health research when appropriate2.
When sex as a biological factor is integrated into data, it can change our understanding of the biology of a neurological disease, yet the intersectional aspects of such findings are multiplied by social determinants of health, such as gender. Therefore, it’s important to understand why research in all neurology-related conditions can improve care and outcomes, as well as emphasize how sex differences can impact the success of interventions.
In 2015, Dr. Bui founded an advanced training elective program at U of T for resident physicians to learn more about women's issues in neurology. Since then, physicians across Canada, the United States and Europe have come to participate in the program.
“When I joined the University Health Network (UHN), I met Dr. David Tang-Wai, our Department Divisional Director of Neurology at U of T. He is a champion and ally in advancing sex and gender-informed neurology education,” says Dr. Bui.
In 2019, she founded Canada's first and only one-year accredited Women's Neurology Fellowship alongside co-director Dr. Aleksandra Pikula, a vascular neurologist with expertise in women’s brain health, as well as an associate professor, clinician investigator and JS Sonshine Chair in stroke prevention and brain health at UHN. The fellowship allows trainees to acquire advanced skills in the treatment of neurological illness through the lens of sex and gender, as well as contribute to the growing clinical research in this field. The first Canadian women’s neurology specialist, Dr. Ginette Moores, graduated in 2021 and is currently establishing Canada’s first obstetrical neurology program at U of T.
“I have presented our program at the American Academy of Neurology and the European Academy of Neurology’s Diversity, Equity & Inclusion Panel in 2023,” says Dr. Bui. “U of T should be really proud of what we've accomplished with shared passion, commitment and collaboration. We're leading the way and the world is watching.”
Two years ago, Dr. Pikula and Dr. Gillian Einstein, a cognitive and women’s brain health neuroscientist at U of T, began hosting Women’s Brain Health Rounds at the university in an effort to bridge the knowledge gap between clinical and basic science while bringing together national and international clinicians, researchers, trainees and fellows to discuss relevant topics around women’s brain health and aging.
“This is becoming a network of transdisciplinary global connections – from neurology and neuroscience all the way to anthropology, endocrinology, sociology, and creative aspects of brain functions and expressions, even extending into health and social policies, global climate change and brain capital,” says Dr. Pikula.
One, among many disorders, that highlights the need for a targeted approach to treatment is epilepsy. A Canadian study on neurologists’ and neurology residents’ knowledge of issues related to pregnancy for women with epilepsy demonstrated that less than half of physicians correctly identified adverse outcomes for most anti-seizure medications3.
“Due to concerns around new medications causing complications during pregnancy, pregnant women have often been excluded from clinical trials. Some women may even stop taking their epilepsy medication when they become pregnant, which may be dangerous and life threatening,” Dr. Bui says.
“This drives home a message: more advocates for women’s health are needed at the table in establishing standards for clinical practice, education and research. As this field grows, pregnancy will hopefully become an inclusion criterion for future research.”
Drs. Bui and Pikula stress that their work is fundamentally about improving patient care and the education of upcoming trainees interested in expanding this area of expertise within neurology and beyond. As our understanding of the role sex and gender play in clinical and basic science evolves, our ability to offer more precise treatments that are influenced by these variables will increase, benefitting all. Therefore, it’s imperative that men, women and non-binary advocates be invited to the table to be allies and collaborators in this work.
“The future of women’s neurology is bright,” says Dr. Pikula. “Although we’re seeing more clinical and scientific data confirming the need for us to study women’s neurology, we’re also seeing minimal dedicated funding for such initiatives. It takes a village to make an expert in women’s neurology, but it takes numerous villages to sustain it.
To learn more about women’s neurology, you can visit Dr. Esther Bui’s website (www.estherbui.com), follow her on X at @WomensNeurology or follow Dr. Aleksandra Pikula on X at @WomensBrain_MD.
Click here for more information on Women's Brain Health Rounds 2024.
1 Thornton HF, LaHue SC, Bove R, Waters J, O'Neal MA, Bui E. Emerging Subspecialties in Neurology: Women's Neurology. Neurology. 2024 Jan 9.
2 Anello M, Pikula A, Bui E. Women’s Neurology: Why We Need a Subspecialty for Half the Population. Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques. 2023.
3 Roberts JI, Metcalfe A, Abdulla F, et al. Neurologists’ and neurology residents’ knowledge of issues related to pregnancy for women with epilepsy. Epilepsy Behav. 2011.
