Bethany J. Transcript

Hi, thanks for having me today. I’m Bethany Johnson Kerner. I’m a pediatric neurologist at University of California, San Francisco. I became interested in neurology, actually probably looking back as a elementary school student. I unfortunately had a grandfather with Alzheimer’s disease and it’s once you meet somebody with dementia, it’s really striking to see how some of, many of the neurological diagnoses change people’s identities, change their behavior, change their personality, and change how they think.

And that sparked my interest in how the brain works. And I studied chemistry and undergraduate, but didn’t wanna be a chemist, so I did some research for a time in neuroscience, and then ultimately went to medical and graduate school at Columbia University after school, after college. And I did research there in stem cells, so a lot of basic science research on neurological disease models and how we can alter disease pathways.

And then I did my residency in child neurology at UCSF here in California, and throughout the course of residency really realized how, despite how much I love science and research, my passion is really getting to work with kids and families. There’s so much immediate care that needs to be delivered, questions that we can answer, accommodations that we can help people with, and that’s been a really satisfying part of my career.

I think a lot of people don’t hear about pediatric neurology as a medical specialty. Many people never meet a pediatric neurologist, but because of my graduate school work in disease models, which involved a disease model of a childhood neurologic illness, that’s how I got introduced to the field, and it’s been a really great career.

Pediatric neurology, I think the first question I get from family is, what do you treat? And it’s a big range of conditions. A large group of what we see is headache. Headaches are very common and children get headaches as well, and so there’s a lot we can do for, to treat pediatric headache. We also treat children with epilepsy. So unfortunately people have seizures with or without fevers in childhood, and we can help diagnose and manage those.

We also treat children with developmental differences, so whether that’s developmental delay, autism, helping to provide diagnostics along the path, and I got interested in traumatic brain injury mostly after my residency training, in a large part because I was seeing large amounts of people being referred to neurology for head injury and head injury questions, but we hadn’t really received any specific training about that and didn’t really feel qualified to hold space for those concerns.

And so I actually founded and direct our pediatric neuro recovery clinic at UCSF that we started in 2021 to have a dedicated clinic space and training and time to be able to address the needs of families coming through with questions after head injury, and that’s been really satisfying. I enjoy being a general pediatric neurologist with some subspecialty expertise, ’cause a lot of our patients coming through may have seizures or epilepsy after their head injury, or may have sleep problems, learning problems, headaches, and I think my background as a generalist is a strength in that regard and that I can pull from those different assets of my training.

We work closely with our adult neurology colleagues. There’s also an adult neurology neuro recovery program, rather, here at UCSF, and it’s fun to get to work together. Recovery is always very multidisciplinary, and so I love getting to work with my colleagues from physical, occupational, speech therapy, neuropsychology. I’m often talking to educators out in the community, school nurses.

It’s a, it’s just really a, a team effort. I would say day to day for me looks like seeing patients in the clinic. And you know, usually most of the care we provide is one-on-one medical care. It involves, you know, history taking—how, you know, what happened with the head injury, how has the head injury changed the day to day for people, how has that impact been manifesting, deciding together with families next steps, you know, do we need some head imaging? Do we need any laboratory work? Do we need any EEG to look for any sign of seizures? And then making a plan together for next steps.

And I think one of the most important things I do is usually provide a letter for support in school, with a lot of head injury being an invisible injury, and so ensuring that parents and educators and the child can also be on the same page about what are the current changes from the injury and what sort of expected for the future, what are reasonable accommodations to help support recovery as much as possible.

So that’s kind of what day-to-day looks like, seeing patients, doing a lot of individual treatment plans. I also do a little bit of research as well, so I haven’t fully hung up my research hat from my graduate school days. And a study that we have right now, which is really great, is trying to meet a need for cognitive changes after head injury.

As you may know, you know, one in three kids will have persistent symptoms after a concussion, and the majority of those are cognitive, and there isn’t really easy ways to get assessed or to intervene on those cognitive changes. And so we’ve partnered with a lab at UCSF called Neuroscape, which developed a software platform to help treat ADHD Attention deficit disorder, and has been shown to have benefits for real world functioning, not just in the video game, as well as durability.

And so we have a study right now where kids, eight to 16 year olds, one to 12 months post head injury can participate. And it involves playing a game from home. It’s fully remote. People are paid for their time. It is a commitment of about 30 sessions, but the goal there is to see can we actually monitor attention and how it changes over time and can we intervene potentially on attention through this mindfulness intervention.

So really excited to get to contribute to all the research that’s going on with TBI right now, and it’s excited to see what’s, you know, in the future, everything from supplements, brain stimulation, some of the tools, like I mentioned, you know, software platforms, in addition to increased awareness about head injury for teachers and coaches. And there’s still a lot we have to improve for care after head injury, but I think we’re on the right path as far as recognition, as well as recognition of need for more treatments.

I think one thing that I’d like to share, the perspective from where I sit, is how many different medical providers help manage concussion and the differences among those groups. So the first group of medical providers are primary care providers, and there’s a fair amount of variability in the comfort that primary care may have with concussion.

Sometimes I see very clearly in the chart that, oh, this is a primary care provider who really feels comfortable, like you’re saying, Sean, with that like gradual return to learn and return to play. And then others just may not have received that in their training. And I think as a consumer, it’s just always good to be aware of, you know, what that variability entails, and to, you know, just ask that provider, you know, I need something that’s maybe a little bit more structured. If they’re maybe giving you a little bit of like a, oh, you’re fine, you know this, just go back to your sports and activities, it’s okay to say, well, is there any testing I should be doing? Or, you know, can you give me a detailed sort of way to do this?

Then there are orthopedists. So at many clinics and medical centers, concussion and head injury often lives within the Department of Orthopedics, which you might think, well, that’s strange, like, why would a bone specialist be doing head injury? But the reason is because they have such deep training in sports medicine and concussion is such an important part of sports medicine, and I would say there really are experts in sideline recognition and assessment of concussion, as well as early adopters of technology tools to assess, monitor concussion.

So in our sort of local ecosystem, they use impact testing, sort of standardized brain testing, cognitive testing, which is really great, and they’re very good at airing on the side of caution when it comes to return to play. And they have a lot of deep relationships with the local sports teams, which is great.

The third group of medical providers might be what are called PM&R Doctors, physical Medicine and Rehabilitation Specialists, and they tend to deal with people who have had more severe head injury. Think somebody who’s maybe spent a couple of weeks in the hospital after a head injury, say from a car accident, and they’re really outstanding, especially in managing motor problems that people develop after a head injury, like weakness or difficulty with coordination, getting back to basic functions day to day, like showering, bathing, dressing, things like that. That’s really where they excel.

And then there’s neurology in our clinic. And this can look differently in different places, but often what we’re seeing is people who are many months out from their head injury, but still having clusters of symptoms, physical, emotional, cognitive, and so sometimes our approach is a little bit different than those other groups.

But I think as a consumer potential patient, I think it’s just helpful to know all those different medical providers that can participate and how their approaches may vary. And what I generally educate my families on is it has to feel like the right fit for you. There isn’t a one size fits all treatment of concussion. So especially if you don’t see your symptoms getting better, if it doesn’t give you enough detail, if you don’t feel like you’re getting the answers that you’re looking for, it’s always fair to say like, well, who else in my area could I, you know, get more information from? And I think just recognizing that lots of different medical providers have expertise in this and have different approaches.

Well, I wanna give a couple pieces of advice, if that’s okay, just ’cause it’s hard to give just one. But I would say is, I think one of the things you mentioned, that social connection is so important.

I think it’s great that there’s more awareness of concussion. But I think people don’t realize the next phase, which is how many people can have lingering symptoms. So, you know, establishing that social connection, not feeling socially isolated, recognizing that you’re unfortunately a good company. You know, a lot of people have long-term symptoms and that there’s treatments out there and communities out there to be supportive of that.

I think trying to balance pushing yourself and patience. You know, healing takes time and there’s a lot we don’t understand about how the brain heals. So I think, as somebody personally who’s recovered from surgeries, it can take time. And I think being patient, thinking on the order of potentially months to years.

What I usually advise people is however long your symptoms have lasted, they’ll probably, you know, last at least that long. Doesn’t mean that they won’t get better during that time, but just to set realistic expectations and not be discouraged by that.

I think prioritizing what you’re gonna do with your recovery time is really important. We all only have so many hours in a day, and it can be overwhelming all the advice that’s out there, but just picking one or two things. And I think the one intervention that’s has a lot of good evidence behind it for concussion, but that can be easy to not act on, is movement.

So I think as much as possible, taking brain breaks, you know, moving your body, clearing your head. A lot of the research we have in neurology for cognitive protection for a whole range of disorders has to do with like light exercise. So this isn’t necessarily running a marathon, but it’s getting outside, getting sunshine, getting fresh air, taking those movement breaks, thinking about exercise as medicine.

And that’s something that can be hard, easier said than done, but can be very beneficial.