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Meet Top Doctor 2014: Dr. Mill Etienne

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Dr. Mill Etienne may have spent his youth in Rockland County — the Haitian native is a 1994 graduate of Ramapo High School — but he logged a lot of miles around the globe (and earned a lot of degrees) before returning to settle down at Good Samaritan Regional Medical Center in Suffern. First he got a bachelor’s degree at Yale, then he went on to New York Medical College. He completed his neurology residency and a fellowship in epilepsy at New York Presbyterian Medical Center, before getting a master’s degree in public health from Columbia University.

While still doing his residency, Dr. Etienne joined the Navy. He later went on active duty and became founding director of the Comprehensive Epilepsy Center at Walter Reed National Military Medical Center in Bethesda, Maryland. “It was basically the first comprehensive epilepsy center for the U.S. military, at [one of] the biggest military hospitals in the world,” he notes. “The signature wounds in the wars in Iraq and Afghanistan were head injuries. Since one of the sequela of many head injuries tends to be post-traumatic epilepsy, I thought it was important that the military had a good epilepsy center to address the large number of cases that were developing.”

In 2012, he was hired to set up a comprehensive epilepsy center at Good Samaritan. Epilepsy is the fourth most common neurological problem Americans face — only migraine, stroke, and Alzheimer’s disease occur more frequently. Each year, about 150,000 people will develop the condition. “Previously, a lot of epilepsy patients used to go to Manhattan, Westchester, or New Jersey for treatment, but now they don’t need to,” says Dr. Etienne. “They can stay right here.”

The center focuses on early diagnosis and higher levels of care for patients in the intensive care unit (ICU). “Anyone who is losing consciousness or who has abnormal movement and doesn’t know what it is, we can diagnose and get them the right medication,” the doctor explains. “And we’re doing more EEG monitoring in the ICU and identifying unrecognized seizures in those who are in comas. By treating them, they have better outcomes.” He also treats neurological disorders including dementia, Parkinson’s disease, and neuromuscular disorders. “Traumatic brain injury is another big area; a lot of local athletes — football, lacrosse, and others — have high rates of brain injury.” It’s important they get a neurological evaluation right after a possible concussion to make sure they can safely return to play; they might not even realize they have a concussion, he notes. Dr. Etienne is also an expert in disaster medicine; a particular challenge he has faced was serving as chief ethicist for the medical and rescue response to the 2010 earthquake in Haiti. “One key principle is to respect the communities, cultures, and traditions of that nation. You should not give people treatment they don’t want, or treat them based on U.S. standards.”

For example, after the Haiti earthquake, many people were trapped under buildings. “Their legs were getting infected, and physicians planned to do a lot of amputations. But many of the Haitian people said ‘No, I don’t want that.’ To American doctors this is crazy, but it’s important to respect the patient’s autonomy.”

Since the quake, Dr. Etienne has returned to Haiti on other medical visits. “We’ve been setting up epilepsy and neurology clinics and training Haitian doctors to treat neurological disorders,” he says. “I work with a couple of nonprofits, and we’ve been quite successful in increasing awareness of epilepsy.”

Screening Strategies

“When medications aren’t working, we’re able to offer surgery to some epilepsy patients, and numerous devices have been developed to assist,” Dr. Etienne says. Among them is a device known as the vagal nerve stimulator. “It’s very similar to a cardiac pacemaker. It’s implanted right over your chest wall, with a tiny wire that goes into a nerve in your neck known as the vagus nerve.” From there it sends a gentle electrical pulse into the brain to help control seizures. “There’s also now a device that can be put right inside the brain to regulate seizures.”

Career Rewards

His profession offers plenty of challenges — as well as rewards, Dr. Etienne says. “A lot of neurology patients don’t even realize at first that they are neurology patients. Oftentimes they’re experiencing strange symptoms they don’t quite understand and don’t want to tell anybody about, even their primary care doctor. Sometimes an arm might do movements they can’t control. Sometimes weird thoughts popping into a patient’s head are due to a neurological condition; or if they’re staring off into space, people may think they have attention deficit disorder, when they actually have seizures. So when a neurologist can tell them, ‘I know what this is and how to treat it,’ that’s very rewarding. Patients really appreciate it, and it has a great impact on their lives.”

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