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UrduDr. Liewluck is currently a consultant for the Department of Neurology at the Mayo Clinic in Rochester, Minnesota. He also holds the title of associate professor of neurology there. Prior to this, he was an assistant professor in the Department of Neurology at the University of Colorado School of Medicine.
Dr. Liewluck was first honored with an award by AANEM in 2011 when he was named the recipient of AANEM’s Junior Member Recognition Award. “AANEM has given me an opportunity to join a number of committees since the very beginning of my career,” says Dr. Liewluck. “This is almost unheard of in any other organization. It shows me that AANEM really helps to support the young physicians joining our exciting field of NM and EDX medicine!”
Dr. Liewluck was first introduced to the field of myology (the study of muscles) by Dr. Tumtip Sangruchi, the former chair of the Department of Pathology at Mahidol University in Thailand. He later met Dr. Ichizo Nishino, the director of the Department of Neuromuscular Research at the National Center of Neurology and Psychiatry of Japan, where Dr. Liewluck completed his research fellowship. In 2002, Dr. Liewluck and Dr. Nishino chatted over a meal in Thailand.
“I shared with him that I was thinking about going into neurology residency instead of anatomical pathology,” Dr. Liewluck explains. “However, I was discouraged by the fact that many of the neurological diseases were incurable. He told me to look at it as more reason to go into neurology, to help discover the cures. That was the start of my journey into NM medicine.”
Dr. Liewluck has several specialties of study. He is board certified in neurology, neuromuscular medicine, and clinical neuromuscular pathology. He graduated medical school from Faculty of Medicine Siriraj Hospital, Mahidol University in Thailand (where he met Dr. Sangruchi, his first mentor).
He then went onto complete two different research fellowships; one through the Department of Pathology at Mahidol University, and the other in NM research at the National Center of Neurology and Psychiatry of Japan. Dr. Liewluck continued his education in the United States by completing residency in neurology at the University of Miami Miller School of Medicine followed by two separate fellowships in NM disorders (muscle disorders), and clinical neurophysiology (EMG). Both took place at Mayo Clinic in Rochester.
During his fellowships at Mayo, Dr. Liewluck had the incredible opportunity to work under the directorship of Dr. Andrew G. Engel, the ‘father of the field of myology.’ “I still remember sitting in the microscope room reviewing muscle biopsy slides with him during the first couple months of the fellowship,” Dr. Liewluck reflects. “During this time, I also had the opportunity to meet Dr. Margherita Milone, my mentor and friend, who has taught me so much about the clinical aspect of myology.”
Dr. Liewluck explains that the research, which won this award, developed from a patient that Drs. Milone and Engel shared during his fellowship in 2010. The patient had centronuclear myopathy and fatigable weakness, along with decrement on repetitive nerve stimulation (RNS).
“As a fellow, I was involved in trying to find the molecular basis of the patient’s phenotype,” Dr. Liewluck recalls. “That was the time that we still used Sanger’s sequence technique and analyzed one gene at a time. The underlying genetic defect remained unknown after checking all known centronuclear myopathy genes.”
It was later discovered that some hereditary myopathies, not only centronuclear myopathy, may have coexisting NM transmission defects, and patients may respond to acetylcholine esterase inhibitor (AChEl).
“Although only a small proportion of myopathy patients in our cohort had decrement, they did improve to a certain degree with AChEl,” concludes Dr. Liewluck. As for the original patient in question, Dr. Milone identified the pathogenic variants in the GMPPB gene nearly a decade later.
“The take home point is that a coexisiting NM transmission defect should be considered in patients with certain hereditary myopathies or acquired myopathies,” says Dr. Liewluck. “Although it is uncommon, pharmacological treatment of a coexisting defect of NM transmission in these patients could improve their quality of life when we still do not have the cure for their myopathies.”
Dr. Liewluck loves one thing in particular about his career ¬- watching growth. “I enjoy seeing patients improving with the course of treatment that I recommend. I also love working with fellows and watching their progression during their 2 years of training.”
Over the years, Dr. Liewluck has learned that listening to the patients, and treating trainees with respect is key to being successful in the field. “I believe that patients know themselves best,” he explains. “As a physician we need to be a good listener and extract the relevant information from the patients.”
He remembers one story in particular of a 19-year-old who came to Mayo Clinic with an outside diagnosis of limb-girdle muscular dystrophy. The patient was first seen locally at age 11 for progressive proximal weakness dating back to age 4 or 5. Her parents had first noticed she had difficulty rising up from the floor. The patient in question was adamant that she did not have muscular dystrophy based on the genetic testing that had been done.
After listening to his patient, Dr. Liewluck was able to discover that the patient in fact had anti-HMGCR antibody-mediated necrotizing autoimmune myopathy (NAM), presenting with unusual phenotype of chronic slowly progressive weakness resembling muscular dystrophy. She responded to immunomodulatory therapy but was left with residual weakness. The incomplete response to treatment could be due to extensive fibrofatty replacement of certain muscles as she was untreated for over a decade since her onset of weakness.
Over the course of his career, he has authored over 84 articles and continues to give lectures both nationally and internationally. “I would like to thank the coauthors and the Mayo Clinic team of certified nerve conduction technologists,” Dr. Liewluck relays. “Without them, this paper would not be completed. I am also very grateful to my parents, Nikorn and Supawadee, my wife, Eriko, and my two children, Saya and Sota, who support me throughout my career. It is challenging to balance the roles of a son, a husband, a father, and a physician, but they make it all possible.”
Dr. Liewluck will be awarded with the 2021 Scientific Impact Award at the upcoming annual meeting in Aurora, Colorado.
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About AANEM
The American Association of Neuromuscular & Electrodiagnostic Medicine (AANEM) is a nonprofit membership association dedicated to the advancement of neuromuscular (NM), musculoskeletal (MSK), and electrodiagnostic (EDX) medicine. For more information about AANEM, visit www.aanem.org or find us on Facebook and Twitter.
