Manoj Menezes, MBBS FRACP
Peripheral neuropathy research
My training in paediatrics and paediatric neurology has had a very clinical focus, with only a recent, but very enjoyable and interesting, foray into clinical research. After completing my undergraduate medical degree at Bangalore University, I trained in general paediatrics (M.D. Paediatrics) in Baroda, in North India. After arriving in Australia in 2005, and briefly considering training in neonatology, I completed my FRACP exams in 2007, followed by training in general neurology (SCH) and neurogenetics (CHW). I had the opportunity to undertake post-fellowship neuromuscular training at NHNN, Queen Square and GOSH, and since my return in early 2012, have been employed as a part-time Staff Specialist at CHW while also undertaking a PhD. In addition to clinical neurology, my specific clinical interests include childhood neuromuscular disease, specifically inherited neuropathies.
Interview by Russell Dale
Please tell us about your PhD
My PhD attempts to describe the clinical and neurophysiological characteristics of peripheral nerve involvement in children with mitochondrial disease. As part of the PhD, I have been investigating a group of children with Brown-Vialetto-Van Laere syndrome, a fatal neurodegenerative disorder due to mitochondrial dysfunction, and mutations in a neuronal riboflavin transporter. I am investigating the effect of oral riboflavin supplementation, and have had some promising results.
What got you in to neuropathy research?
I realised very early in my neurology training, after working with Dr Heather Johnston in the SCH neuromuscular clinic, that I wanted to train in neuromuscular medicine. Prof. Kathryn North gave me the opportunity to train in neuromuscular medicine as part of the Neurogenetics Fellowship at CHW, and suggested I work with Prof. Robert Ouvrier in peripheral neuropathy (some of the best advice I have ever received). Doing the peripheral neuropathy clinics with Prof. Ouvrier was an education not only in the science of neurology and peripheral neuropathy, but the art of examining a patient and dealing with the family. Prof. Ouvrier had already set up a large cohort of patients with inherited neuropathy, excellent research collaborations and a well-resourced neuropathy management clinic and I have been fortunate to continue the neuropathy service at CHW.
Where do you hope neuropathy research and management will be in 10 years time?
While I hope we could have an single intervention that reverses the deterioration seen with all inherited neuropathy, it would be realistic to say that this may take a little longer. Neuropathy research is currently focussed on understanding the genetic basis and pathophysiological mechanisms of inherited neuropathy, and perfecting our ability to measure the effects of interventions in clinical trials. I hope that by 2024, we will have gene-specific interventions that modify the course of disease, and are involved in large multicentre trials investigating drugs and interventions that can stop and reverse the effects of nerve degeneration.
You got a Churchill fellowship, tell us about that, and what it allowed you to do
I received a Churchill Fellowship in 2011, allowing me to travel to the UK to study the assessment and avenues to achieving a diagnosis in children with inherited neuromuscular disease and peripheral neuropathy. The fellowship allowed me to attend adult neuropathy clinics at the National Hospital for Neurology and Neurosurgery, Queen Square (run by Prof. Mary Reilly, one of the international leaders in inherited neuropathy research) and paediatric muscle clinics at GOSH. The most important part of this was the opportunity to meet and establish collaborations with researchers at these centres of research excellence in neuromuscular disease – these collaborations have been essential for all my subsequent research. The fellowship gave me the opportunity to be part of a group that includes people specialised in areas like law enforcement, agriculture, fire-fighting, finance, music, etc, and the share experiences much beyond the field of medicine.
If a trainee comes to ask you about doing paediatric neurology research, what 2 pieces of advice would you give them?
1. Choose Peripheral Neuropathy Research – you’ll love it. On a more serious note, even if your training, and career, have a clinical focus, pick an area of neurology research that really interests you and persist at it. Often clinical needs and patient care will need to come first, but it is great to have a focus that you can nurture, build networks in, and something to challenge you in a long, and usually busy, career.
2. Go overseas, even if it has to be for a short period, to a centre of research excellence. One can now get the best clinical training in paediatric neurology in Australia, and overseas fellowships are often hard work with poor accommodation, little or no family support and often poorly rewarding financially. However, beyond the clinical expertise, you learn new approaches, see interesting patients, meet new researchers, and establish collaborations that will, hopefully, last a lifetime.
What is your favourite thing to do in Sydney?
Watch a good action movie, lots of blood, gore and fights, and preferably no storyline. Best way to de-stress.