On February 4, 2016, the neurological community lost a founding father of neuroepidemiology, Milton (Meir) Alter. For those of us who had the privilege to work with him, he is remembered as an elegant and scholarly man, a devoted colleague, and family man.
Alter had encyclopedic knowledge, took great pride in sharing information about the fine arts with visitors to his home, and was an avid gardener who tended lovingly to his flock. Born in Buffalo, New York, in 1929, he graduated from the University of Buffalo in 1951 (magna cum laude in psychology) and received a MD degree in 1955 at the same university. Following internship in medicine at the University of Minnesota, and residency in Neurology at the University of Minnesota under the direction of A. B. Baker, MD, a series of fellowship experiences in neuroepidemiology followed at the US National Institutes of Health, University of South Carolina, Dalhousie University in Halifax, Nova Scotia, Canada, Columbia University, and the Hebrew University in Jerusalem, Israel. He became a diplomat of the American Board of Psychiatry and Neurology in 1964 and received a PhD degree from the University of Minnesota in 1966.
Alter worked closely with L. T. Kurland, MD, DrPH, with whom he coauthored his first scientific papers in neuroepidemiology. His stay in Jerusalem kindled his interest in the study of the epidemiology of multiple sclerosis (MS) in a locale with many immigrant populations originating from different areas of the world, including Yemen in the south to Russia and other Northern European countries. The resulting papers were published in lead neurology journals, and pointed to the potential importance of age at the time of immigration, and change of disease susceptibility associated with latitude as possible links in the causation of MS. Alter鈥檚 early studies emphasized other factors such as sun exposure, which is still being discussed today in relation to the role of vitamin D in the pathogenesis of MS.
Another of the important discoveries credited to Alter was the study of Creutzfeldt-Jakob disease (CJD) among Jewish immigrants from Libya and Tunisia. The high frequency of CJD among these groups was originally thought to be due to consumption of scrapie-infected sheep parts, but was later shown to be the expression of a genetic mutation in the prion protein gene. Today, research on the CJD focus continues in Israel. Alter also championed the study of incidence, prevalence, and risk factors for stroke, and also was an early proponent of clinical trials as an important neuroepidemiological tool for understanding stroke.
Alter's important contributions in various fields of neurology are reflected in the large number of peer reviewed published articles, book chapters, and other publications. He was an editorial board member of Annals of Neurology, Archives of Neurology, Neurology, Stroke, and others as well as Founder and Editor-in-Chief of Neuroepidemiology. In 2005, the American Academy of Neurology established a fund in his name for clinical research in stroke and MS. His contributions to the American Academy of Neurology鈥檚 Quality Standards Subcommittee and evidence-based medicine were substantial. He could always be counted on for a thorough, candid, and timely critique of quality issues confronting neurologists.
Alter served as chair of the Department of Neurology at Beilinson Hospital in Israel, a post he maintained for about 1 year (1975-1976). Although he was fluent in Hebrew and loved the country, he returned to the United States where he became chair of the Department of Neurology at Temple University in Philadelphia, Pennsylvania.
For those of us who worked with Alter, he will be remembered as a great neurologic mind, a man of high integrity and sound scientific principles, a perfectionist, and a strong and welcoming mentor. He is survived and will be greatly missed by his wife, Reina, their 5 children and 9 grandchildren, as well as by many colleagues, friends, and students in the United States and all over the world, for many of whom he was an inspiration and trusted colleague.
Corresponding Author: Philip B. Gorelick, MD, MPH, Department of Translational Science and Molecular Medicine, Michigan State University College of Human Medicine, Mercy Health Hauenstein Neurosciences, 220 Cherry St SE, Room H 3037, Grand Rapids, MI 49503 (pgorelic@mercyhealth.com).
Conflict of Interest Disclosures: None reported.