In memoriam: Dr med. Hansruedi Isler

Abstract

Dr med. Hansruedi Isler (1934–2019)

Within Switzerland, Dr med. Hansruedi Isler has been known as ‘the pope of headache’, which was true for both, patients and fellow physicians.

He was founder (1984) and longtime president of the Swiss Headache Society, and established ‘Headache Neurology’ as a subspecialty in Switzerland, with a significant number of neurologists following suit.

Internationally, Hansruedi Isler has also been well known – for his passion for headache disorders and patient care, but also for publications in his second field of interest, the history of medicine throughout his life.^1,2

His monography and thesis about Thomas Willis who introduced the terms ‘neurologia’ and ‘psychologia’ and developed a 17th-century neuropsychiatric concept was seminal.³ However, for Hansruedi Isler, the dichotomy of body and soul embodied in neurology on the one side and psychiatry on the other side was not a sustainable scientific concept then and now. He extensively published on the history of neurology and discussed the evolving pathophysiological concepts of migraine⁴ and other primary headache disorders⁵ as well as their therapies.⁶

As the founder of the headache clinic (‘Kopfwehsprechstunde’) at the Neurological University Hospital in Zurich 1966, he systematically developed and studied interdisciplinary patient care within and outside the tertiary care headache center.^5,7,8 Together with Colette Andrée he founded and developed the national patient’s organization, ‘Migraine Action’, which has been well received and is active until today.

Some of his concepts reaching outside headache neurology are of importance for current neurological thinking, such as his work on ‘hemicrania epileptica’ together with Heinz Gregor Wieser.⁹

Among others, he published on the emergence of iatrogenic complications of migraine treatment, including medication overuse headache (MOH), recognizing ergots as important substances in this context¹⁰ and laid the clinical foundations for stratified MOH inpatient programs which are state-of-the-art today for the treatment of the most severely affected patients.

Of great importance for the understanding of primary headache disorders was his work on the so-called Swiss cohort study, describing the longitudinal evolution of migraine and non-migrainous headaches over a period of 30 years. The study provided deep insights into the epidemiology and comorbidities of headaches in a ‘normal’ population.^11,12 Furthermore, the longitudinal evolution showed that intraindividually a number of different nosologic entities were fulfilled, partly in sequence, when studied over time, suggesting that primary headaches which are separately classified following International Headache Society criteria might indeed be pathophysiologically related.¹³

Hansruedi Isler was also an exceptional person with multiple interests outside Neurology, a true humanist – with quasi-encyclopedic knowledge, and also multilingual. Nobody really found out the true number of languages he mastered. It is consensus among the authors that this number was certainly above 10, some of us remember to have heard numbers of 15 or even higher. Languages were certainly within his main focus of interest, with the love for the English language in its center. He was one of the sworn circle of the ‘James Joyce Society’ in Zurich, meeting every week to read the author’s last and most difficult work of fiction, ‘Finnegan’s wake’, and when they reached the end, they began anew.¹⁴

One can imagine these sessions where women and men read Joyces’s work loudly with Irish accent – only one or two sentences per hour – and fantasize about their meaning. These must have been spectacular gatherings and from another world of intellect and great knowledge: see NZZ Folio about Hansruedi Isler.

In an interview, his son, Jakob Isler, physician and leading psychiatrist himself, told about Hansruedi Isler as a family man and philanthropist. In the family context, work was seldom a focus of conversations. Nevertheless, Hansruedi was a role model for his son Jakob, took him along to the hospital during duties and impressed him with his clear and concise communication and decision-making processes when confronted with clinical questions.

Books were a common hobby and almost an obsession. An overwhelmingly rich personal library with antique and modern books was the centerpiece of the household and the ideal place for long conversations between father and son.

The period the Isler family spent in Malaysia, with Hansruedi Isler founding the first neurological hospital in Kuala Lumpur (1971–1976), is rich with a multitude of memories for Jakob Isler: with an English speaking tuition, a large number of animals, such as chicken, ducks in a nearby pond, with family weekends spent on the seaside, and artefacts from colonial times such as servants and the tradition of morning and afternoon tea. Altogether, very colourful and personal memories with a father who, while focusing on the charitable activity to build a hospital in a third world country, was very close to his family.

Finally, thinking about Hansruedi Isler cannot happen without mentioning his artistic activities (Figures 1 to 5). While in meetings or at conferences, he could be seen sketching heads or people, in his own style. He also created terracotta sculptures, combining his artistic interest with his passion for headache, often with high symbolic value depicting suffering. One of his drawings can still be found in the Logo of the Swiss Headache Society.