Obituary - Robert Surtees

Robert's death came as a deep shock to everybody who knew him. His life was cut short in his early fifties. He leaves behind his wife and two sons as well as his parents and three sisters with their families.

Robert grew up in the Lake District, his parents being general practitioners. His school career started in a two-classroom village school. After a few years his talents were recognised and he was sent to Stamford school. For his medical studies he was admitted to Edmond Hall, University College Oxford where he graduated as Bachelor of Medicine and Surgery in 1980. His first professional goal was to become an adult endocrinologist. As part of his training programme he had to work on a pediatric ward and this experience convinced him to become a pediatrician. When he informed his supervisor about his decision this person stood up and exclaimed: “What? … a pediatrician? That's scandalous! We have invested three years of training in you and now you are going to become a social worker?!?” Although Robert was sent to neonatology for the very first part of his training and found the abrupt change in the size of his patients quite challenging, he was steadfast in his conviction and completed his pediatric training in Stoke-on-Trent, Birmingham, Manchester and London (United Kingdom). His work in Great Ormond Street Hospital for Sick Children and the Institute of Child Health in London began in October 1986. His Ph.D. on the biochemical exploration of the single carbon transfer pathways in cerebrospinal fluid (CSF) and their role for demyelination in subacute degeneration of the spinal cord and brain as well as in HIV-infected patients and those with haemophagocytic syndromes and other acquired conditions with demyelination was completed in 1992. This work comprised the development of new chromatographic assays as well as the establishment of age-related reference values in CSF of all age groups. In 1993 Robert was awarded the Ronnie Mac Keith Prize of the British Pediatric Neurology Association for his work. In 1995 he was elected Fellow of the Royal College of Physicians (F.R.C.P.). In addition to his qualification as pediatrician he was registered as a neurologist in 1996 (specialist registry General Medical Council).

Robert's special interests in pediatric neurology were neurometabolic diseases, especially those comprising extrapyramidal movement disorders and leukodystrophies as well as white matter disorders of infectious, neoplastic and toxic origin. He covered these complex areas as a clinician and as a researcher with an excellent reputation. To look after these patients and to counsel their parents is a very difficult and sometimes stressful task since many of them suffer from a neurodegenerative disorder and overall only a few patients respond to medication. His research activities were diverse as witnessed by the approximately 70 peer-reviewed original articles, 10 reviews as first or sole author, 11 reviews as co-author and 6 book chapters that he wrote. He was a member of the Editorial Boards of Pediatric Neurology, Neuropediatrics and the European Journal of Pediatric Neurology as well as a Section Editor of Current Opinion in Neurology.

The highest impact of his research can be found in his work on CSF analyses in children. This work paved the way for greater understanding of the pathophysiology and therapeutic strategies in genetic and acquired extrapyramidal movement disorders and in demyelinating diseases, especially those related to disorders of cobalamin, pterin, folate, biogenic amines' and nitric oxide metabolism. For example Robert investigated the pathogenetic background of the fact that survivors of acute leukaemia in childhood often develop cognitive defects and demyelination. He could show marked effects of treatment upon tetrahydrofolate concentrations in CSF and substantiated the expansion of folinic acid rescue therapy in children with leukaemia. Studies to clarify the role of nitric oxide and its toxic metabolites in treated acute leukaemia have been underway. Cerebral malaria was another field of acquired disorders in which Robert was pursuing research projects in. In his studies quinolinic acid - a known agonist of the excitatory NMDA glutamate receptors - was found to be greatly increased in patients with cerebral malaria and the degree of this correlated with the outcome. Furthermore, central nervous system nitric oxide, which is known to attenuate NMDA glutamate receptor related excitotoxic mechanisms, was found to be reduced. Apart from an explanation for the severe cerebral involvement in cerebral malaria, these findings suggest further studies with respect to the application of selective NMDA receptor blockers as a neuroprotective part of the treatment of cerebral malaria.

Robert was awarded a Chair of Pediatric Neurology at UCL Institute of Child Health and Great Ormond Street Hospital in 2002. In 2004 he took over the position as Head of the Department of the Neurosciences Unit at the Institute of Child Health.

His clinical advice and his presentations on scientific as well as on clinical topics were very much appreciated on countless occasions. One particular episode, that took place during the European Academy of Childhood Disability International Meeting in Dublin in 1996, magnificently illustrates Robert's stunning capacities. What happened was the following:

Robert was supposed to give a lecture on the “Neurochemistry of movement disorders” which he duly started with the slide projector still used in those days when suddenly a complete power cut extinguished sound and vision in the auditorium. After quite a while of first bemused and then increasingly worried efforts of the organisers to get restarted, manual lifting of the shutters revealed that this part of the City was without energy; traffic lights were out and the auditorium was told that the whole building was without electricity. In pure daylight Robert calmly took a piece of chalk and drew a stunningly complex picture of the brain nuclei, their excitatory and inhibitory pathways, and explained what was known and unknown with respect to the corresponding diseases. The resulting work of art might have served as a computer matrix, and still every step was clear and logical as he went along. He was about to finish his lecture, precisely keeping to time, when with a sudden click the power circuit came back.

It is hard to come to terms with his sudden loss. The sole consolation might be that Robert presumably did not suffer for a long period of time. Maybe the best way we can honour his memory is by continuing the work he loved so much and thereby contributing to the wealth of knowledge Robert has passed on to us.