Else Charlotte Sandset is a consultant neurologist in the Stroke Unit of the Department of Neurology at Oslo University Hospital, and chair of the Oslo Stroke Research Group (Oslo, Norway). Her research interests include blood pressure management in stroke patients, and she has contributed to several clinical trials, such as the ongoing ParaNASPP (Paramedic—Norwegian acute stroke prehospital project) study—for which she is the co-principal investigator. Sandset is also the current secretary general of the European Stroke Organisation (ESO). She talks to NeuroNews to discuss her career to date, in addition to several key issues in the neurology field right now.
What initially attracted you to medicine, and the field of neurology specifically?
What initially drew me to medicine was the wide range of opportunities a medical degree provides, from rural general practitioner to business careers. After my internship, I was drawn to stroke because it combines the fields of neurology and internal medicine, and I embarked on my PhD project on blood pressure in acute stroke. In Norway, both internal medicine and neurology care for stroke patients, but—after attending the European Stroke Conference in Stockholm in 2009—it was clear that a future career in stroke was as a neurologist.
Who have your mentors been and how have they impacted your career?
I did my PhD with the late Eivind Berge as my main supervisor. Together, we completed a large, investigator-initiated randomised controlled trial. Eivind was brilliant at creating collaborative networks, which is imperative in order to complete any type of international research, and I am thankful to have had a mentor with this focus. In addition, I have greatly benefitted from working closely with Philip Bath from Nottingham, UK for most of my career. I wrote in the acknowledgement in my thesis that I was thankful for his “contagious enthusiasm for the field of stroke research”, and this still holds true. I also spent a year working with Craig Anderson in Sydney, Australia—briefly interrupted by the birth of my son five months into my stay. Apart from the many benefits of working in a much more global environment, Craig challenged me to focus on what research findings really mean in the clinical setting. We are doing research to improve the care of our patients and this is really what matters! The support of Urs Fischer has been invaluable in my career too. He is always supportive, always finds time for a quick chat when needed and has a strong focus on giving people opportunities. Charlotte Cordonnier is another person who I highly value, and who is a fantastic role model for me when it comes to time management and how to focus your career.
What has your experience been as the secretary general of the European Stroke Organisation?
ESO has always been an organisation where I have felt “at home”. For me, ESO is inclusive, dynamic and forward-thinking. Most initiatives are welcomed as long as you are willing to do the work yourself, and there is a strong focus on the next generation. There is still a lot of inequity when it comes to stroke care in Europe, and in order to further improve care for our patients we need good clinicians and scientists on board. The best way to achieve that is to provide opportunities for growth for junior colleagues and to enable new voices within the organisation. These are two of the core values of ESO, and I think both are important for success as an organisation. This has become even more evident for me as the secretary general. In all areas of my career, I hope I am smart enough to step aside at the right time and let others access the many great opportunities I have received.
How has COVID-19 affected your work at the ESO—and in particular the upcoming ESO conference?
COVID-19 has obviously meant a lot less face-to-face interaction, and we will now host our second virtual conference. I think we all miss discussing the latest trial results over the coffee breaks with random conference participants, so we have worked to create an arena for live networking and discussions—also virtually. I am also worried about how this affects younger colleagues especially, with less abstracts being submitted, very few live platform presentations with questions, and, obviously, less opportunity to network with senior colleagues who may enable visiting fellowships or other career opportunities. There are without a doubt some beneficial aspects as well. The virtual environment has normalised having a family. I do not think we have had a single ESO Executive Board meeting without at least one child showing up—my personal highlight was perhaps my five-year-old Ferdinand dressed up as Kai from Ninjago. As a clinician, I have greatly appreciated the sense of international community and discussions on how to provide adequate stroke care in the pandemic. It became obvious to me during the first wave that, if we do not fight for our stroke patients, no one will!
What do you feel has been the most important development in the field of neurology during your career?
The implementation of endovascular therapy worldwide is by far the most important development during my career. Stroke is now established as one of the most time-urgent medical emergencies. Apart from stroke, advances in the treatment of multiple sclerosis have been a game-changer in neurology as well.
Besides your own work, what is the most interesting piece of neurology research you have seen in the past year?
It was a bit further back than the past year, but Adrian Parry-Jones’ “Bundle of Care” approach to the treatment of intracerebral haemorrhage (ICH)—published in the Annals of Neurology in 2019—really caught my attention. We are currently working on a similar protocol to implement in my hospital, and we have a long way to go to improve care for ICH patients.
What is the most significant unmet need in the field right now?
Without a doubt, treatment of ICH is a key unmet need. It is one of the most devastating types of stroke and, currently, we are nowhere near the treatment options we have for ischaemic stroke. Also, stroke being a very heterogenous disease. We need to identify more individualised treatments; in the acute setting, and in rehabilitation and secondary prevention.
Throughout your career, what work have you undertaken to improve the representation of women in the neurology field?
I have been involved in the Women Initiative for Stroke in Europe (WISE). As a scientist, I find it difficult to make statements without having the numbers. In 2018, we published a paper showcasing the number of women in all core activities in ESO. In addition, I have organised Women in Stroke Leadership workshops. Finally, by taking on senior roles within the organisation, you automatically become a role model, and you have an obligation to promote and sponsor good women within the community. As a role model, I think it is important to show that it is possible to be a mother, a clinician and a scientist. You do not fall off the face of the earth because you have children.
How would you assess the issue of gender differences in stroke and stroke care right now—why is this an important area, and what do you think needs to be done to address this?
The majority of evidence in cerebrovascular and vascular medicine in general is generated from white, middle-aged, middle-class men. Generalisability of treatment effects and potential differences in treatment effects is an issue. To address this, we need to ensure representative inclusion of both sexes in trials, and we need a better understanding of why women are underrepresented in most clinical trials.
What advice would you give to people embarking on a career in the field of neurology?
Number one: get involved in clinical research! Understanding and knowing the evidence provides confidence in your clinical decision-making, and also when you treat beyond evidence-based medicine. Number two: there are lessons to be learned from everyone you meet. Always focus on the strong traits of your mentors, seniors and colleagues, and learn from them and incorporate them in your own practice. Number three: find an early interest in neuroradiology. You will spend a lot of your career looking at images of the brain.
What are your interests outside of the field of medicine?
Very few things beat a day with perfectly tuned sails on a sailboat, either on a family trip with my husband and five-year-old son, or more rough sailing with my husband either in a regatta or just for fun. I also find cooking extremely relaxing, and I tend to provide friends and colleagues from around the world with pictures of favourites including sourdough bread and a variety of sweet rolls. Hopefully, I will be able to serve them all the real stuff soon enough! Irrespective of activity, I (nearly) always listen to music and I pretty much enjoy every genre depending on my state of mind. I am quite sure some of my papers should have had the soundtrack as a disclosure—especially when I revert to German and Swedish “Schlagers”, or Eurodance from the late 90s and early 00s!
- 2018–present: Senior consultant, Department of Neurology, Stroke Unit, Oslo University Hospital, Oslo, Norway
- Senior researcher, Norwegian Air Ambulance Foundation, Lørenskog, Norway
- 2000–2006: MB, BCh, BAO, Royal College of Surgeons in Ireland, Dublin, Ireland
- 2008–2012: PhD, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Thesis title: “Blood Pressure Lowering Treatment in Acute Stroke”
- 2019: Specialist in Neurology, The Norwegian Directorate of Health, Oslo, Norway
- 2015–2016: Visiting fellow, The George Institute for Global Health, Sydney, Australia
- 2019–present: Secretary general, European Stroke Organisation (ESO)
- 2020–present: Chair, Oslo Stroke Research Group, Oslo University Hospital, Oslo, Norway
- 2021: Chair, ESO Guidelines on Blood Pressure Management in Acute Ischaemic Stroke and Intracerebral Haemorrhage