R. Brian Sommerville, MD, is an assistant professor of neurology. His areas of specialty include neuromuscular disease, ALS (Lou Gehrig’s disease), muscle disorders, nerve disorders, myasthenia gravis, and electromyography.
Dr. Sommerville sees patients at:
Center for Advanced Medicine, Neuroscience Center, 4921 Parkview Place, 6th floor, Suite C
Barnes-Jewish Hospital, McMillan Building, 517 S. Euclid Ave.
Center 40 Building, 1600 S. Brentwood Blvd., Suite 600
FOR AN APPOINTMENT, PLEASE CALL (314) 362-6981
What happened in the course of your schooling to influence you to choose your specialty?
As a teenager I became interested in the mind/brain dichotomy. It was the 1990s – the “decade of the brain”. By the time I graduated from high school, I was pretty sure I’d be doing something in the neuroscience field.
During college, I figured out that I was going to go to medical school, and by the time I finished college, I was quite certain I was going be a psychiatrist. I was really enchanted with brain imaging at the time, specifically functional MRI. I thought brain imaging was going to change the world as far as how we understand the relationship between the mind and the brain. And I think it’s getting there. But there’s still a long way to go.
I went to medical school at Columbia University in New York City. It was the exposure there to some really brilliant, charismatic people that convinced me to go into neurology instead of psychiatry. Then it was during my neurology residency training here at Washington University that I met Dr. Alan Pestronk, who introduced me to yet a whole new way of thinking about neurology. It was primarily his influence that led me to move into a very different but very accessible part of the nervous system, specializing in peripheral nerve diseases and muscle diseases.
What brought you to Washington University?
Well, 9/11 happened during the first month of my first year of medical school. The psychological aftermath of that kind of hung over our class for the next four years. When it came time for my residency, I was ready for a change of scenery, and applied to Washington University’s program on a lark – I always thought of myself as a creature of the Northeast.
During my interview here, I was blown away by the high quality of the residency program. I also realized St. Louis was a wonderful city to live in, so I decided that Washington University would be a great place to train.
It also worked out very well because my girlfriend at the time (who is now my wife) was also applying for a residency in neurology.
The neurology program here was large enough that we would not necessarily be in each other’s face all day, every day. We trained here simultaneously for four years and then did different fellowships. She now is also on the faculty here, but in the Sleep Medicine division of Neurology.
Which aspect of your practice is most interesting?
One thing I love about neurology, and specifically neuromuscular neurology, is that I get to be a detective of sorts, weaving together different strands of data and trying to synthesize them into a story that makes sense.
The peripheral nervous system is very accessible through a variety of techniques, including the physical examination, nerve conduction testing and EMG, muscle biopsy, skin biopsy, ultrasound, and laboratory testing.
We can generate huge amounts of information about our patients and what’s not working right in their bodies. The fun part of this process is putting it all back together in a way that is meaningful and hopefully helpful to the patient.
This detailed way of thinking was very attractive to me and turned out to be well-suited to my mindset. That’s how I ended up going off on this tangent of neuromuscular disease that is now my career.
What new developments in your field are you most excited about?
A good deal of what we see in the neuromuscular clinic includes genetic or hereditary disorders for which there are no adequate therapies right now. Molecular-based therapies that target specific genetic disorders are going to be the most exciting and interesting development in the course of my career.
In addition, genetic sequencing techniques are getting faster, more comprehensive , and less expensive. We can now rapidly sequence the entire coding portion of a patient’s genome. That’s another new strand of data that helps us understand our patients.
Do you foresee a cure for ALS?
Yes, but it probably won’t be one size fits all. ALS (Lou Gehrig's disease) is actually many different diseases. In the last couple of years, there has been an explosion of knowledge of the underlying genetic determinants of some types of ALS.
Based on what we’re learning from this, it seems like this is something that should be treatable with carefully designed molecular treatments. Certainly I think it’s realistic to expect the development of treatments that can slow down or perhaps stop the progression of the disease once it has started.
Are there new treatments for any other diseases in your specialty?
Yes. We now know a fair amount about the genetic and molecular underpinning of diseases such as myotonic dystrophy, Duchenne muscular dystrophy, and fascioscapulohumeral (FSH) dystrophy. These are all diseases that should be treatable.
The issue is getting the right drug delivered to the right cells and in the right amounts – all in a way that it doesn’t harm the patient. Not an easy task, but doable. The field is slowly getting there.
Where are you from?
I have roots in two very different parts of the country, and I consider them both home. Up until age 12, my family lived in Albuquerque, New Mexico. From age 12 to 18, we lived in a famous little town in upstate New York called Cooperstown – home of the Baseball Hall of Fame. My parents still live there.
Did the baseball bug bite you in Cooperstown?
Ironically, I became more interested in professional baseball after I moved to St. Louis. This is such a great baseball town. Cardinal fever really hit me after I’d been here for a couple of years. I’ve been lucky enough to go to the World Series a couple of different years here at Busch Stadium.
Which particular award or achievement is most gratifying?
I would say that being selected as a National Merit Scholar in high school was a very validating experience for me at a time when I was feeling deep insecurity about my future. That’s still probably the award that I’m happiest about at this point.
As far as career achievements – ask me again in 10 years!
What is the best advice you’ve received?
When I was doing my senior thesis in neurobiology at the Harvard Medical School, I worked under an amazing person named Edwin Furshpan, PhD. He was a very wise and experienced scientist.
I remember once after doing a set of experiments, I was really disappointed in how uninteresting the results seemed. Then he told me, “There is nothing more interesting than the truth”. Those are always good words to live by as a researcher or aspiring scientist. I’ve carried that with me.
What research are you involved in?
Right now we are doing a lot of work in a type of peripheral neuropathy called small-fiber neuropathy. This is a disorder that tends to produce pain, often widespread pain, that is out of proportion to other symptoms or findings on the neurological exam.
Right now we diagnose this principally through skin biopsies where we measure the density of nerve fiber endings within the skin. This disorder is surprisingly common, but it is under-recognized and hasn’t been studied nearly enough.
Many patients with small-fiber neuropathy are initially diagnosed as having fibromyalgia. The diagnostic construct of small-fiber neuropathy not only brings many of these patients into the fold of neurology and neurological disorders, but even more intriguingly raises the possibility that this is a peripherally generated disorder, which is contrary to a lot of the standard thinking about fibromyalgia. We are involved in research pertaining to this hypothesis.
If you weren’t a doctor, what would you like to be doing?
I think I’d be doing something a little bit more creative. As a kid, before the neuroscience bug bit me, I wanted to be an architect. I had a drafting board and loved designing buildings and cars -- that was one of my big hobbies when I was about nine years old. I kind of miss it.