On September 1, Brenda Banwell began work at Johns Hopkins Children’s Center as pediatrician-in-chief and co-director of Johns Hopkins Children’s Center. Banwell joins Johns Hopkins after 12 years at the Children’s Hospital of Philadelphia (CHOP), where she served as chief of the Division of Neurology and co-director for both the Neuroscience Center and the Pediatric Multiple Sclerosis and Neuroinflammatory Clinic. She was also a professor of neurology and pediatrics at the Perelman School of Medicine at the University of Pennsylvania. In her role with the Children’s Center, Banwell will collaborate closely with David Hackam, pediatric surgeon-in-chief, to help manage the hospital’s clinical and research centers.

What inspired you to pursue medicine?

In high school, I had a shadowing opportunity in 11th grade during which I spent a week immersed in two different professions. The first experience was shadowing a senior adviser in a men’s pants company. I discovered that, as a teenager, I didn’t care very much for men’s pants [chuckles]. Then, I spent a week with a surgeon who was a pulmonology expert and a basic scientist. I loved it! I was there every day at 6 a.m., even Saturday and Sunday, and my dad would pick me up at 10 pm. I completely, absolutely loved every minute of it.

Your educational path after 11th grade was a bit unconventional by American standards…

Yes. In Quebec, where I lived during secondary school, after 11th grade, you move into a two-year program known as a CÉGEP (collège d’enseignement général et professionnel). The CÉGEPs are publicly-funded colleges that grant diplomas to enter university. After my first year, I was accepted early to university, so technically I did not earn a high school diploma. Then, after completing two years of undergraduate biology, I was accepted early into medical school, so I don’t have a bachelor’s degree, either. But I assure you that I do hold an M.D.! [laughs] Since I was quite a bit younger than my peers, after earning my medical degree from University of Western Ontario, I pursued some extra opportunities during my medical training: a pediatrics residency at University of Western Ontario, followed by a pediatric neurology residency at University of Toronto — The Hospital for Sick Children, and then a fellowship in neuromuscular research at Mayo Clinic.

I think my nonconventional entry into my medical career has always fostered an acceptance of, and enthusiasm for, people who have different ways of getting to their life goals. It’s a reminder that we can get to where we want to be in different ways. 

Your own children have followed your footsteps into the health professions…

Yes. I have been blessed with an amazing family. My husband and I have been together since we were 18. I have three girls and I’m really proud to say that my eldest daughter is a pediatrics resident, my middle daughter is a pediatric intensive care nurse and my youngest daughter just graduated with a master’s in public health.

When you took your faculty position with University of Toronto — The Hospital for Sick Children, you initially intended to focus on neuromuscular disease in children. What happened to change that?

I was just three months into my first faculty job when I was asked to look after five children living with multiple sclerosis. This was 1999 and at this point, there were a lot of people in the medical community who didn’t believe that MS happened to children. In fact, the official diagnosis criteria excluded children, so there were real barriers to making a diagnosis.

After caring for these five patients, I convinced my division chief to provide support so that I could pursue training in pediatric MS. Eventually, I was able to set up an entire program, which I ran until I left for the Children’s Hospital of Philadelphia in 2012. I also created the Canadian Pediatric Demyelinating Disease Network in 2004. This is a multisite network including all pediatric health care facilities in Canada that has allowed us to better understand diagnosis, treatment and comorbidities of pediatric demyelinating disease.  I also chair the International Pediatric Multiple Sclerosis Study Group and serve as chair of the International Medical and Scientific Board of the Multiple Sclerosis International Federation.

How common is pediatric MS and what is its impact?

It is relatively rare, affecting fewer than 5,000 children and teens in the U.S. Although 1 in 800 Americans suffer from MS, just 5% are believed to experience symptoms before adulthood.

MS is a dysregulated immune response in which the body attacks the brain, the spine and the optic nerve. Every time a child experiences an MS flare-up, there are clinical consequences — damage deep within the brain, for example, or damage to the optic nerve, which can impact vision.

As a clinician-scientist, you have led efforts to investigate the use of neuroimaging to better diagnose and assess the impact of MS on children. Could you explain why neuroimaging is so important?

Imaging of the brain allows us a window into the brain itself, as well as the spine and the optic nerve. Sometimes we find that a child does not have MS, which is fundamentally important because the treatment for MS is much different than for other similar conditions.

When we do make a MS diagnosis, advanced imaging can show us how much injury a child has experienced, which we can measure by changes in brain volume as well as by examining disruption in the brain’s “highways.” This knowledge is vital in guiding our treatment decisions.

How is pediatric MS treated? And could you share how outcomes for young patients have improved over the years?

We have entered into a new era of highly effective therapy. For young patients today, the course of their disease is much, much different than it was compared to the pediatric patients I treated 20 years ago.

Most young patients today get infusions, which are only needed about every six months. Currently, there are about 16 therapies available and many more are expected. Today’s therapies are very targeted, acting on a particular aspect of the immune system, which has really reduced side effects. When I ask my patients how they are managing, they look at me, puzzled, and say, “I feel great! I go to school, and play basketball and play in the band.”

Back when I was starting out, the only available medications reduced MS attacks by just 30% and sometimes kids suffered multiple, damaging attacks before the condition was even diagnosed. Available treatments required these kids to get needles every day or every other day. When I asked how they were doing, they had a long list of problems that made them feel unwell: “I can’t think straight. I’m tired all the time. I’m scared of another relapse.”

In those years, I was running a relapse clinic every week. Today, I no longer need to run a relapse clinic. It’s wildly exciting! Of course, this doesn’t mean the disease is silent. We still have work to do in protecting the brain. Children with MS continue to suffer smoldering inflammation [a mechanism of disease progression]; we haven’t been able to shut that down with current therapies. There is lots of room for innovation in protecting the brain and for providing better emotional and psychological support, since about one-third of pediatric patients with MS experience depression. We need to do better at identifying those with depression and working with them on their emotional health.

Will you be building the program in pediatric MS here at Johns Hopkins Children’s Center?

Yes. By early in the new year, we’ll be getting a new program off the ground, including a clinic for pediatric patients. Dr. Haiwen Chen has joined Johns Hopkins Children’s Center as a pediatric neurologist with fellowship training (at Johns Hopkins and CHOP) in neuroimmune disorders to support the effort. I will also be working in collaboration with physician-scientists in Johns Hopkins’ adult MS program, which is just stellar.

Now that you’ve been on the job for nearly a month, what are your first impressions of Johns Hopkins and the Children’s Center?

The first thing is just how welcoming a place this is. I knew when I took this position that Johns Hopkins has a long history of making faculty members feel welcome and included. It is absolutely a place where collegiality is front and center. I can’t even tell you the number of people who have reached out to me to say, “We’re so glad you’re here!”

A highlight for me was going to the Miracles in Motion 5K event at the Maryland Zoo on September 21 — and seeing more than 1,700 people turn out to support the Children’s Center at this inaugural event.

I saw one young man who had been very recently discharged from the hospital after treatment for severe cancer. When he stood up out of his wheelchair and walked across the finish line, it was absolutely inspirational. Despite everything he had endured, he was here to support other children and families. I felt incredibly grateful to be part of this amazing community at Johns Hopkins.