Just a couple of weeks into his new position at Charlotte Hungerford Hospital (CHH), neurologist Hugh Cahill, MD, saw a young female patient who had been experiencing seemingly unusual symptoms. She would have brief spells – about five or more times per day – in which she lost the ability to speak or focus on her surroundings.
Dr. Cahill suspected that she was experiencing seizures, which he says don’t always involve convulsive shaking. After doing a workup that included an EEG (electroencephalogram), a test used to detect irregularities in brain wave patterns, he and his team discovered that the patient, who had indeed been suffering from seizures, had an inherited form of epilepsy.
“We started the seizure medication, which will be life changing for this patient,” says Dr. Cahill. “This is a classic example of why I love being in this field: There are so many treatment options that can have such a powerful impact on people’s lives.”
Neurology: The perfect fit
Dr. Cahill joined the CHH staff – and Hartford Healthcare’s Ayer Neuroscience Institute – on October 1, 2019, after completing his training at Vanderbilt University. Before even considering medical school, Dr. Cahill pursued a PhD in neuroscience at Johns Hopkins University in Baltimore. He spent years studying the visual system and neural networks involved in color vision. “Over time, I moved into more translational projects where I was collecting DNA from humans and interacting with patients.” He liked interacting with patients and decided to apply to medical school.
“Initially, I had very broad interests,” he recalls. “I was focused on the patient-physician interaction and relationship, so was thinking about pediatrics, medical genetics and neurology.” It was at the Joan C. Edwards School of Medicine at Marshall University in West Virginia where Dr. Cahill had influential mentors who were neurologists, that he zeroed in on his current specialty. “With my neuroscience background, it seemed like a perfect fit,” he says.
Dr. Cahill completed his internship and neurology training at Vanderbilt University in Tennessee this past summer. He says he has found that he really enjoys working with the neurology patient population.
“When patients have neurological diseases, it’s different from when patients have diseases of other organs, because your sense of self is so disrupted,” he explains. Whether it’s an inability to control your body, an inability to think, or having your life interrupted by repeated seizures, he says, neurologic conditions change your life in countless ways.
Diagnosing, treating and helping those with neurologic diseases is rewarding, Dr. Cahill says, because the prognosis is good for many of these patients. “It’s just really exciting to be part of their care.”
Indeed, he says, neurology is a thrilling field to be in today. “If you look at the history of medicine, the ‘80s was a very exciting time to be in cardiology, because statins came out, beta blockers came out – all these medications that improved patients’ lives.” Right now, he says, that field is neurology. “Treatments for multiple sclerosis (MS), stroke and headache have all been revolutionized in the last five years,” he says, “and while there are certain areas of neurology, like dementia, that are still undergoing research, and medications haven’t been developed yet, I feel they are just around the corner.”
Migraine goal: Zero per month
Although Dr. Cahill sees general neurology patients for a wide variety of issues affecting the central and peripheral nervous system, including Guillain Barré syndrome and epilepsy, his areas of special interests include migraines, stroke, and multiple sclerosis.
According to Dr. Cahill, about 80 percent of people have had at least one migraine in their life. Some don’t even recognize that their headaches are migraines, which tend to show up as throbbing pain in the front or side of the head and are sometimes accompanied by visual changes or auras. But for many patients, chronic migraines can be debilitating, and can interfere with day-to-day life.
“The goal with migraine treatment is zero days per month with a headache,” says Dr. Cahill, “and we achieve that a lot of the time. That’s because over the last 10 years, there has been an increase in the number of medications that reduce headache frequency.” Most recently, a group of drugs called monoclonal antibodies – medications that mimic the body’s own immune cells – have been approved for migraines.
These medications are prophylactic, that is, they are taken to prevent the onset of the headaches and target the receptor in the brain stem that is thought to be responsible for migraines.
Botox injections for the treatment of migraines has also revolutionized headache medicine, Dr. Cahill says. In addition, there are newer onset medications such as long acting “triptans” that suppress a headache once it has started, he says.
“Whatever your headache frequency, if it is increasing, changing in severity or character, or not able to be controlled with medicine, that’s a reason to come in,” he says.
There are many environmental triggers for migraines, according to Dr. Cahill, including caffeine, alcohol, chocolate, cheese, even chemicals in the environment. He encourages his patients to keep migraine journals, or to use special iPhone apps like “Migraine Buddy” to keep track of what is happening when they get headaches (i.e. what they are eating and what medications they are taking). “With those journals, we can tease out from the data a good game plan to try to reduce headache frequency.”
Multiple sclerosis: A more hopeful outlook
Twenty years ago, notes Dr. Cahill, an MS diagnosis was devastating – there weren’t many medications, and the medications that were available had only a 30 to 40 percent rate of reducing relapse. “Today, newer medicines were shown in a clinical trial to result in a relative reduction in M.S. brain lesions of 89-96% when compared with those in the placebo groups when studied over 24 weeks.” he says.
Just as with migraines, the advent of monoclonal antibodies has also revolutionized the treatment of MS, an autoimmune disease in which the body’s immune system attacks myelin, the lining of the nerve fibers in the brain and spinal cord, forming plaques that impair nerve function. While these medications don’t undo the damage that’s already been done – they are more preventative – researchers are investigating ways to heal MS plaques. Meanwhile, physical therapy and rehab can help patients adapt, and encourage the brain to re-wire and compensate for lost function.
Symptoms of MS include numbness, weakness, double vision, fatigue or un-coordination that comes on over days or weeks, he says.
Stroke: Impressive treatment options
Weakness in the arms or legs can also be a sign of stroke, says Dr. Cahill, as can numbness or slackness in one side of the face, and slurred speech (or any trouble with speech). A stroke occurs when a blood vessel to the brain is suddenly blocked by a clot, depriving the brain tissue supplied by that vessel of oxygen.
“The treatment options for stroke are impressive – if you get to the hospital very quickly,” he says. They include powerful medications to break up the clot that is causing the stroke and surgical retrieval of the clot, also known as thrombectomy. Dr. Cahill sees patients in the hospital who are having active strokes, or sees them post-stroke in an outpatient setting, to make sure they are on the right medications to prevent future events.
“Stroke risk has a lot to do with blood vessel health,” he says. Risk factors for stroke are similar to those for heart disease: smoking, diabetes, high cholesterol, high blood pressure, obesity, and family history.
“When the blood vessels that supply blood to the heart get damaged by atherosclerosis, they cause heart attacks; when the ones that supply blood to the brain get damaged, they cause strokes,” he says. “To prevent stroke, you want to keep blood pressure at normal ranges, keep cholesterol in check, and avoid smoking, because smoking damages blood vessels.” Regular exercise and a heart-healthy diet are also key, he adds.
Connecticut: Coming home
Dr. Cahill, who was born in Washington, DC, but grew up in Hamden, Connecticut, was thrilled to return to this state to practice at CHH, which hasn’t had a neurologist in residence for years. An avid ice-hockey player who played on teams in high school, college, and even at Vanderbilt during his residency, he is eagerly waiting for the pond in front of his house in Harwinton to freeze come winter. His brothers live relatively close by, and he says he has plans to tempt his nieces and nephews with pond hockey.
“I feel like I’ve spent my whole life training, and now I’m back home and able to care for my neighbors and be part of this community,” he says. “It’s an incredible feeling to be back here in Connecticut.”
Lori Miller Kase is a freelance writer living in Simsbury.
Photography by Connecticut Headshots