Faculty Spotlight: Lisa Hobson-Webb, MD
Lisa Hobson-Webb, MD, is the subject of this week’s Faculty Spotlight. Hobson-Webb talks about the intellectual challenges of understanding and treating neuromuscular diseases, her pilot trial involving ultrasound to assess peripheral nerve inflammation, and being a Kentucky Wildcats fan in Blue Devil territory.
What are your responsibilities within the Department? What does a typical day for you look like?
One of the best aspects of my work is that every day is different. I have a variety of activities, which means there’s never a boring moment.
Most of my clinical time is spent in the outpatient setting, divided between the Duke Neuromuscular Clinic and the EMG Laboratory. I see patients with a wide range of neuromuscular disorders, including myasthenia gravis, myositis, motor neuron disease and polyneuropathies. I also developed and serve as director of the Duke Neuromuscular Ultrasound Program.
When I’m not in clinic, I am working on research projects. Most of my work is clinically based and involves the use of novel, non-invasive means of assessing neuromuscular health and function. Nerve and muscle ultrasound is a major part of this, but I’ve recently started working with electrical impedance myography (EIM). I also have an interest in the neurologic effects of glycogen storage disorders (e.g. Pompe disease) and do a fair amount of work in myasthenia gravis.
In addition to the clinical and research work, I participate in educational activities, including the Duke SIGN group and lectures for students, residents and fellows. Frequently, I mentor residents and fellows on clinical research projects. I also serve as President for the International Society of Peripheral Neurophysiological Imaging, Chair of the AANEM Professional Practice Committee and as an Editorial Board Member for Clinical Neurophysiology.
What drew you to focus on neuromuscular disease? What do you enjoy most about working in the area?
I worked with a neuromuscular specialist, Dr. Mark Ross, for my first clinical elective in medical school. His ability to use the clinical history and physical examination to diagnose patients really made an impression on me. Through that elective, I also had my first exposure to EMG, which appealed to my love of physics. When I entered neurology residency, I realized that neuromuscular disorders are rare and that patients may have seen several physicians prior to receiving the correct diagnosis. Today, I continue to appreciate the intellectual challenges of the field and enjoy using both clinical and technical skills in my practice.
You recently attended the 2016 AAN conference in Vancouver. What was your most memorable experience at the conference?
There was a really interesting exhibit on modernism at the Vancouver Art Gallery, but you specified AT the conference. On a serious note, I was really impressed by the Frontiers in Neuroscience Plenary Session. There was an excellent talk on the cerebellum’s role in cognition that changed the way I view the brain.
You completed our two-year fellowship program in neuromuscular medicine in 2007. How has your perspective on the field changed since you were a fellow? What do you enjoy most about working with our current fellows?
As a fellow, I thought that neuromuscular medicine consisted of a finite, well-defined set of disorders. I knew that effective treatment was lacking for many conditions, including ALS and idiopathic neuropathies, but did not realize how much remained unknown. Over the last 9 years, I’ve come to realize how little we know about the etiology, pathophysiology and natural course of many neuromuscular disorders. This realization keeps me interested in learning and asking new questions.
One of my favorite parts of working with our fellows is watching them become independent, skilled neuromuscular specialists over such a short period of time. Our program is fortunate to consistently recruit intellectually curious, enthusiastic people who are also fun to work with on a daily basis. I consider the fellows to be colleagues, not “trainees” and hope that I can inspire them to consider academic neuromuscular medicine as a career.
You recently received funding to launch a pilot trial using shear wave dispersion, an ultrasound technique that you’ll use to assess peripheral nerve inflammation. Can you tell me more about this technique? What potential does shear wave dispersion have to improve patient care?
Peripheral nerve imaging is in its infancy compared with CNS imaging. High-resolution nerve ultrasound has given clinicians the ability to easily detect morphological changes in nerve entrapments and neuropathies, but provides no meaningful evidence on the presence of active inflammation within the nerve. Shear wave imaging holds promise for detecting tissue inflammation and early studies on the liver have been successful. Dr. Kathy Nightingale and her colleagues in Duke Biomedical Engineering are pioneers in this field.
The technique relies on shear wave imaging. This uses a specially modified ultrasound system to push a focused, high-energy sound beam into issue. The system then records the propagation of the resultant shear wave through the imaged issue, in this case, nerve. The speed at which this wave propagates and its pattern of dispersion is affected by factors like fibrosis and inflammation. From a patient’s view, this technique would be indistinguishable from a normal ultrasound test.
Being able to non-invasively measure or detect inflammation would aid in diagnosis, reduce the need for nerve biopsy and enable clinicians to monitor treatment response objectively.
What passions or hobbies do you have outside of the Department?
My sons are 5 and 6 years old, so most of my time outside of work is spent with soccer, baseball, swimming and other sports. Aside from being a “soccer mom” minus the minivan, I do enjoy hiking, travel and art.
I also love following the greatest college basketball program in the world – the Kentucky Wildcats. It is a time-consuming, tough duty to represent them here in Duke territory. If there are any other Kentucky fans hiding out in neurology, please let me know!
Hobson-Webb poses with her two sons in Hawaii's Diamond Head monument.