Interview with Dr. Thomas Koch & Dr. Ramin Eskandari


MUSC Children's Hospital Welcomes Pediatric Neurosciences Specialists

In the summer of 2014, two new specialists in pediatric neuroscience arrived at MUSC Children’s Hospital. Thomas K. Koch, M.D. (above left) was appointed to the position of Division Chief for Pediatric Neurology. Previously, he was Division Chief of Pediatric Neurology at Oregon Health and Science University for 16 years. He has also held clinical faculty positions at the University of California, San Francisco and the University of Maryland in Baltimore. Ramin Eskandari, M.D., MS (above right) was recruited to be the hospital’s pediatric neurosurgeon following his Stanford University fellowship.

PN: What are the pediatric neurological needs in South Carolina?

RE: From a neurosurgery standpoint, hydrocephalus management is the most common need. There is a lot of low or no prenatal care in South Carolina. Babies are born early, have hemorrhages, infections, and undiagnosed anomalies. I’m managing those patients in a different way, using new endoscopic techniques to treat hydrocephalus.

Brain tumors are number two and we’re building that program with pediatric oncology. The third highest need is trauma. I’d argue that pediatric head trauma (from concussions or abuse) and spine trauma are underdiagnosed and the ramifications of not catching them early are underappreciated.

TK: In terms of nonsurgical neurological disorders in children, one of the leading diagnoses nationally is primary headache disorder. This is a spectrum, with migraine as the major component. It accounts for missed days of school, parents missing work, and frequent doctor’s office and emergency room visits. Another major area of need is epilepsy. The number of children with new-onset seizures needing a neurological evaluation exceeds the supply of pediatric neurologists nationally. Many of these children have complex needs, and addressing all of them is crucial for the delivery of comprehensive care. Other major areas of need are cerebral palsy and movement disorders, such as tics and Tourette Syndrome.

PN: Dr. Koch, can you give us a sense of your plans for building the division?

TK: I would like to establish within the division areas of specific strength to serve as regional and national referral centers. An academic medical center needs to serve as a health, healing, and discovery resource for the community, including the medical community. My first order of business is to expand our already comprehensive epilepsy program with the recruitment of additional pediatric epileptologists and the expansion of pediatric neurosurgery.

PN: What are your research interests?

TK: My primary area of interest is headache disorders. I was involved in a study at Oregon Health and Science University looking at the Emergency Department (ED) management of severe headache in children. Some of the preliminary work has already been published. I have discussed this work with our pediatric ED staff here and we are looking into re-evaluating our approach and trying to adopt a standardized protocol.

RE: When I came here I was lucky to have a start-up lab funded, which I’m outfitting, in the Darby Children’s Research Institute, and the basis for my lab research is neonatal hydrocephalus. I’ve been doing that for 12 years and have had some small grants from research institutions. We are looking at the brain and its damage from hydrocephalus. The goal is to predict the point of irreversible damage. At the moment there are few evidence-based and clinical guidelines to guide surgeons as to when to treat pediatric patients with hydrocephalus. In my view, a lot of the deficits that we incur by delaying treatment or not recognizing the failure of treatment occur because we don’t know what the damage is and when it happens. My other research is in epilepsy. I’m working with a postdoctoral investigator who has a fellowship to look at the mapping of epilepsy in pediatric patients. We are using a math model to be able to predict seizures.

I’m also working with a Ph.D. scientist in the Department of Neuroscience to examine malignant brain tumors in children. We’re working on a tissue bank so we have our own tissue to do our research. The goal is to find new targets for therapeutics for malignant brain tumors.

PN: What is it about MUSC Health that attracted you?

TK: MUSC Health’s philosophy to imagine what is possible and to grow and deliver exceptional health care is very exciting. The commitment to build a new Children’s Hospital and Women’s Pavilion underscores that commitment. It makes a clear statement that health care for children and their families is a priority.

RE: The thing that grabbed my attention was the need for pediatric neurosurgery. I felt that I could come here and help many people. But on top of that I felt I would have the support to grow as a surgeon. It appealed to me that there would be a new head of pediatric neurology. As soon as I got here, I began interacting with clinical faculty and neonatology and meeting with intensive care unit physicians and anesthesiologists—it’s all been very collegial and supportive.

TK: Pediatric neuroscience is a major area for an expansion that will enable us to address the health needs of the children of this state and region. I am very happy to have left the Northwest and to now be a part of MUSC Children’s Hospital.