2026 AAN President's Award Recipient - Dr. Walter J. Koroshetz

This is Jose Merino, editor-in-chief of the Neurology family of journals. The Neurology podcast provides practical information to neurologists and other clinicians to help them provide better care for their patients. Thanks for listening and have a great week. Hello and welcome. This is Greg Cooper from the Norton Neuroscience Institute in Louisville, Kentucky. Today I have the great pleasure of speaking with Walter Korshets, recipient of this year's President's Award from the AAN. Dr. Korshets, welcome to the podcast. Thank you much, Greg. It's a pleasure to be here. Many of us know you from your work at the NINDS, but if you don't mind, I'd like to start out much earlier and ask you a few questions. What drew you into the field of neurology to begin with? I grew up in Brooklyn and on a rainy day in Brooklyn, what I used to do was go to the library and I remember one day in the library looking around at books and I saw the biggest book I could see and it was a big black book. I took it down just because it was so big and it was a book of psychiatry. I started looking at it, looking at the pages and just became incredibly engrossed by the first chapters which were about how the brain works and came across the idea that, wow, this is real physics here that determines how information is processing in our brain and how all the behaviors we see are determined by that brain activity and I just became completely engrossed with that. I must say I never got past the first chapter which was about ion fluxes across membranes and action potentials and then I got really interested in membrane biology throughout college and even in medical school and of course it was all. As I mentioned stemming from interest in how the brain works, so in medical school I was planning on going into neurology but then I changed my mind because in the 70s there wasn't a great deal of treatments for people with neurologic diseases whereas in medicine there were lots of things that had come online and so I trained in internal medicine first but then when trying to think about a subspecialty of medicine to go into as a fellowship I kept being drawn back into neurology particularly by the writings of a guy named C. Miller Fisher and so I said oh medicines, yeah you can do a lot but boy the future is probably brighter in neurology and so then I went to Mass General and trained in neurology. I feel like we all then oh C. Miller Fisher a bigger debt of gratitude than I realized. What were your initial clinical and research interests once we had you in neurology? After I finished my training I again decided to go through that path I mentioned earlier and start studying membrane biology but this time prior to going through the residency the way to study membrane biology was with lipid bilayers but right as I was leaving this technique called patch clamping came up and that allowed you to actually look at eye and flow across membranes and neurons and so I joined one of the first labs, the David Corey's lab at Mass General which was using this new technique and so I was in the lab doing biophysics and at the same time Dr. Joseph Martin who was the chair neurology at Mass General asked me to join the Huntington's Clinic so I was doing probably a day a week in Huntington's Clinic and the rest of the time in the neurobiology lab. You mentioned a couple important people in your past and certainly well known figures in neurology. I still think sometimes about important mentors I've had in Iowa at Kentucky. Are there other mentors or sources of inspiration you've had along the way? C. Miller Fisher and I would say he was probably the person who had the most impact on my thinking. He was an extraordinary individual and as I mentioned his writings would kind of drew me back into neurology and drew me to Mass General and I ended up with an office next to his for probably a decade so we became intellectually pretty close now close meaning proximity in terms of space but in terms of understanding how the brain works I never got really close to where he was at. I thought he had the best knowledge of how the brain works of anyone I've ever met. He didn't tell you things he basically asked questions and made you think and so he was always trying to train your mind to be a really observant neurologist. He was the one who probably had the greatest influence on me in neurology. That must have been incredible spending all that time in such close proximity. Yes I was very privileged that's true. Now in 2007 you joined the NINDS as deputy director. Tell us what led you to that position. How did you wind up there? I'm afraid I'm going to upset some people out there the answer. That's okay. At that time I was being looked at as a chair in neurology at different places around the country. There was one particular job in the Midwest that looked really interesting and I talked to a friend of mine who had left Mass General to a for a job as a chair in the Midwest and asked him what it was like to move and he said I have a better job for you. That was Dennis Landis. He was a chair at Case Western at the time and his wife was Story Landis who was the head of NINDS and so she was looking for a deputy director and I met with Story and it was just this epiphany that going to NINDS I'd be able to really concentrate on the science and the research and not have to worry about the billing and the RVUs. Basically yeah it was a very kind of gut decision that this would be a good decision for me as opposed to going to be a chair in neurology somewhere. On behalf of the Midwest certainly our loss but the nation's game. In 2015 then you assumed the role of director. Tell us a little bit about that transition. So that really wasn't such a tough transition at all because I came in 2007 as a deputy director and worked hand in hand with Dr. Landis for almost eight years so I did get to learn a lot about how to run the Institute over that time period. The big transition was coming in as a deputy director because you come in with specialty expertise in neurology and then at NINDS you have to cover the entire field of neuroscience which is quite broad and so over those eight years I really tried as hard as I could to broaden my knowledge base and basic science and translational science and clinical trial methodology so I was pretty well prepared in 2014 when I became acting and then again in 2015 when I became the director. You oversaw a lot of major initiatives more than we could really list here but I wonder if you have certain highlights you wouldn't want to share with us. The initiative that is really going to transform neurology and psychiatry is the brain initiative so let me just try and explain a little bit about why I think that. So when we see a patient in the clinic we hear the patient's symptoms, we do the exam and we have this sense of what the problem is and then we have our knowledge of neuroanatomy to try and place it as best we can and then we have that correlation between neuroporthology and neuroanatomy and that's how we make our decisions about what's wrong with the patient and how best to treat it but the big black box in that exercise is that it's actually the circuits that determine the patient's trouble so it's always dysfunction in some neural circuit that's at the bottom of everything whether it's memory and Alzheimer's or motor disturbance and stroke patient and we never had the opportunity to see those circuits in action so the brain is this massive computer stuffed into a small space and it's doing information processing that beats any kind of AI or any other computer and we don't really even understand the rules of how that works but the brain initiative was focused on the circuits and developing the tools to map, monitor and modulate those circuits and the tools that came out are just phenomenal. Many of them are right now in animals only but they're going to move to humans pretty quickly and that's something that we're actually already in the human space helping to treat people with circuit disorders. The brain initiative is basically the equivalent of the human genome project for neuroscience. It is amazing when I think about when you were reading that book that you mentioned on psychiatry in Brooklyn when I was training neurology at that point would be completely unrecognizable to people now and it sounds like this initiative has the potential to do exactly the same thing again. Neurology may be almost unrecognizable in a few years. Am I getting a little carried away there or do you think that's true? You're right about the treatment of disorders and the disorders themselves are not changing but the treatments we have huge potential now to try to fix these circuits or modulate circuits to compensate for circuits that are not working. That's going to have major change in neurology. It already has if you think about deep brain stimulation for Parkinson's now we have with the brain initiative closed loop stimulation where you're actually delivering the stimulus based on you know what the brain activity is. The other thing it's going to bring neurology and psychiatry back together again because in psychiatry the disorders there are also disorders of circuits except there's no pathology that you can see but bringing with these circuit tools I think the approaches are going to be quite similar and so it's good to think about this field of neuropsychiatry. So even now in the brain initiative we've developed technologies that have been quite dramatic in approving say obsessive compulsive disorder or depression using deep brain stimulation and modulating circuits so you can call it psychiatry but it's really neurology. You're speaking my language as someone that trained in behavioral neurology. Yeah. It always did feel that separation between psychiatry and neurology was a bit arbitrary and to your point this brings it back home. I would train at Mass General and some of the older neurologists like Raymond Adams comes from the time when the neurologist and psychiatrists were all trained similarly so it wasn't that long ago so my probably oldest mentor trained in psychiatry neurology. Now he did upset the psychiatrist so they would never let him get bored in psychiatry but he knew a lot of psychiatry and he really thought that was terribly important. Yeah. There is no doubt that it's an exciting time to be in neurology and neurosciences broadly but I'm sure you ran into some frustrations in your time at the NINDS as well. Anything in particular you'd want to share about that? Yeah. So I guess everybody knows that the government is slow and bogged down in many instances so yeah going to NIH you're first impressed with this kind of web of rules that you have to go through to get anything done slowing things down and the initial reaction is you've got to be kidding me this can't be true but it is but then what I realized over time was that the rules in the government at least the ones that I was dealing with were in place to prevent corruption so the NIH was putting was funding projects at 45 billion dollars a year and NINDS we get up to about three billion dollars a year so a lot of money going out the door I realized that if you didn't have this web of rules and regulations there would be some funny stuff going on I can see how it could happen. I was there for 19 years and there was very rare instances where I thought that something funny was going on that's the main thing you come in you're frustrated by how slow things are but on the other hand it was very good control over corruption I thought. It's actually a bit reassuring. Yeah let me pivot a bit you've been a long-standing member of the AA and tell us about your connection with the AA and and how that may have shaped or informed your career. Early on in my career after residency probably not more than three or four years after residency I got a call from Steve Sergei and Steve was a private practitioner in Florida but he was the head of the what's called the public information committee of the academy and he was looking for people to work on this committee and he's very persuasive guy nice guy and so I said okay I'll help and now is a committee that was doing all the public information and also getting professional information out to the neurologist about what the academy is doing and we had a newsletter that was coming out fairly regularly I thought that it was a really fun group I got to work with private practitioners as well as some academic folks they had some good staff at the end and eventually I became the chair of the committee and then the academy asked us to do some ambitious things one was called the brain matters campaign that was to try to increase awareness of the value of neurology and remember we had in the beginning a video crew that went into Central Park and asked people what is a neurology what's a neurologist and nobody knew and they made up some really weird things so we thought we had a problem and so that was what the brain matters campaign was about and then what happened was so I had moved into the stroke field clinically and then in the early 90s the tpa got approved and required a complete change in how emergency stroke care was delivered across the united states and of course that required neurologists to come in emergently to see people and treat them with thrombolytics which that was a heavy lift as part of the ppic at the time we had had a brain attack campaign to get information out for neurologists and then that morphed into the header was called the in stroke task force which was a task force under the practice committee focused on getting neurology placed well in the space of acute stroke therapies and so through all that time I'd say that the skill set I got doing that was very helpful as I became a director because being a director is heavily about communicating with your staff with the advocacy community with congress with other people at NIH and so I learned a lot about communication while working at the AAN it was actually really good instructive experience you have widely been credited with helping shape our current neuroscience research in the u.s. what gives you hope for the future in neuroscience research there are a couple of things that are pretty inherent developments that really stand to advance a neuroscience neurology going down the road the first of which is there's a circuit in the brain that makes us all want to know how our brains work that has brought a lot of really smart people into neuroscience there's a number of actual Nobel prize winners in other fields who then feel that they want to figure out how the brain works so they switch into neuroscience but if you look at say people going to phd's the greatest number now is in neuroscience so this you swell people try and understand these issues about how the brain works and then those tools that are coming out of this basic science have enabled us to understand basic mechanisms of disease like we never could before and so that also portends the development of lots of therapeutic targets for patients with neurologic disorders the actual bottleneck is the number of neurologists who are interested in careers and research that's really the bottleneck going forward we have this big tsunami of people studying neuroscience coming up with new tools new targets and we have a total of 70 people a year apply for our signature career development awards so that's not going to cut it that's really where the bottleneck is and that hasn't changed in 50 years that's 70 number so I think that this swell of enthusiasm for neuroscience continues to move the needle forward and I just hope that we can do something to engage more neurologists in this path forward would you consider that relatively small number of people going into the field your biggest concern for the future yeah I think that's really where the bottleneck is now the k award is our signature career development award so I'd say we give out probably 35 40 a year so small number get that k award small number apply for that but there are lots of other neurologists who take part in the research advances so if you do a clinical trial you need you know 300 people to do your clinical trial you need 50 or 60 neurologists and so those folks all don't have k awards but they're contributing tremendously so the goal I would hope is that neurology and academic settings and even in private practices can start to take a piece of this research enterprise as we move forward because the more neurologists we have the faster we're going to go so that maybe brings me to another question what should we as individuals in neurology be doing to try to help secure this future everybody can play a role and I said before to get some of these projects going forward you need lots of people so I think in anybody who's certainly with an academic institution to look for opportunities to team up with the people who are full-time researchers they're generally just short of people I know some great places and every time they train somebody good the person jumps to a pharmaceutical company which is good too but it's been really difficult to man their program so we all have that opportunity no matter what our field is to try and pitch in that space and then also to try to make it less risky for people who are younger as they're coming out of rent and see a fellowship to to engage in what a more full-time research careers whether they're clinical or basic science that's a tricky business because you rely on grants and grants certainly at NIH it's a competitive system so you can't always count on getting your next grant you have to have a backup plan oftentimes you have to have at least two grants one at a phase so you can if one is going to be delayed you still have another one to fall back on neurology is a lot of opportunity there's a lot of philanthropy now in neurology a lot of interest on the private sector particularly for the philanthropy side for helping people make progress in neurologic diseases so I think it's I think it's a fantastic career it's so exciting there are certainly lots of opportunities to get the funding but it's just you just can't guarantee it to yourself that's I think the problem I really wonder based on part of what you said do you see a future where there's greater partnership between let's say the university-based and the non-university-based neurologist or scientist I would hope so now I must say I tried that we tried that at an IDS and it didn't work we started a program to do research in private practices it was really tough maybe we just didn't have enough money to do research in a private practice you really can't interfere with the practice itself and so everything has to be paid for that's anything related to the research number of private practices in that experience I did visit a whole bunch of private practices who were doing research mostly for drug companies for industry and and they were able to recruit patients in that space but the payment was much higher than the government could give so that's why it failed but I would hope that we could do better there I guess the big concern now is that the academic medical centers have become much more kind of corporate and have these large budgets and then they'll run into deficits and so my big worry is that some of these big academic centers which used to be totally existent primarily for their research now that's not true but the worry would be if research falls down lower and lower on there priority list I did talk to somebody who's on the board of directors of a major Harvard hospital 10 years he said research was never mentioned at the board meeting that would be my worry that the academic medical centers become much more corporate and the research falls back yeah understand getting towards the end of our time here what advice would you give to someone maybe just starting their training or just starting their career now yeah a couple of things I would say and I've said them many times to trainees and discussions first of all I'd say that if you think about research it's really the exercise of trying to make things better for your patients and so all neurologists want to do that and so to get into a or train in research or work with team in research could be very fulfilling it's a real antidote for burnout for one thing the second thing I tell a number of trainees if they're interested in research careers to think about a field that they're interested in and then you know to think about what looks like it could be really important to that field maybe in five years and then because as a coming out of say a renzi program you really want to devote about five years to get a skill set that you can bring back into your field to advance the field so I encourage people to think about that as opposed to just there's one other way of doing it which is also to just join a team and just work along the incremental path but it's an opportunity for some people to try and bring something from an area of science back into your field that's really going to be important and then the third one is is don't worry so much what I noticed is a lot of the young people they're doing great work they have a k-award even and they're still worried there's really no reason to worry you're in good shape things are going to work out well for you and so to really enjoy it and feel the sense of the sense of fulfillment that you get for working in this space that is all about getting better treatments for patients or preventing diseases so neurology is so exciting there's so much happening that you really can't lose in neurology if you just have a really calm but enthusiastic approach that's generally the things that I try to get across to the younger folks they got terrific advice just one last question and that's very simply what's next for you I have colleagues in some beautiful places around the country wanting to know if you're recruitable oh yeah definitely I was kind of let go in the end of January and I've been looking for a new full-time job I'm not no intention to retire as I tell people I'm in the money python show I'm not dead yet and we'd really like to contribute more to advancing neurology and the treatments particularly interested in working to get better treatments out for people with these terrible disorders that we work with that's good to hear listen it's been a tremendous pleasure talking with you today Dr. Koroshetz fun great fun for me yeah again I've been speaking with Walter Koroshetz the 2026 recipient of the AAN's president's award thank you all for joining us on the podcast this is Stacy Clark your podcast editor if 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