Interview with David L. Felten, M.D., Ph.D.

Why was it important to write Netter’s Atlas of Neuroscience?  What does this publication add to this field? 

I was introduced to Netter’s Atlas of Neuroscience (the first “green” book) as an undergraduate at MIT, recommended by Professor Nauta.  My sentiment always was “I wish there were more.”  As I bought and read scores of neurosciences-related books, I could not find the organization I wanted and needed.  At opposite ends were fascinating compendia written by throngs of investigators discussing “what I do in neurosciences research” and edited by famous researchers; or short-cut summaries that did not provide the scientific framework and understanding needed by students learning neurosciences.  When I was offered the opportunity to revise Netter’s Atlas of Neuroscience (the 1^st revised edition), I jumped at the chance.  It needed a thorough updating of the written material, substantial reorganization, and addition of many new aspects of neurosciences not available when Dr. Netter wrote the last of his revisions. 

I became obsessed with doing the revisions right, within the page limit and new art (mainly from Jim Perkins) allowed through working with the outstanding Elsevier editors, Elyse O’Grady and Marybeth Thiel.  I added many new updated components (e.g. the chemically specific neural systems, brain stem cross sections, new imaging plates, axial and coronal MRIs, and many more).  The 3^rd edition won 3 international book awards (British Medical Association – neurology; International Association of Medical Illustrators; and Wiki – 2^nd on the list of best neurosciences textbooks). 

The 4^th edition of Netter’s Atlas of Neuroscience adds a host of new molecular, cellular, systemic, and clinical plates which provide understanding of the integrated nervous system.  It continues to smoothly integrate both peripheral and central aspects of the nervous system rather than separating them into traditional gross anatomy course components and neuroscience course components.  The neurosciences student now can use this 4^th edition as a single, integrated textbook and atlas, with full cross-sectional anatomical detail, presentation of the major topics in neuroscience, and extensive clinical correlations.  There are hundreds of clinical comments or discussions, either in clinical boxes or integrated into the figure legends, intended to explain why this material is important to diagnosis and care of patients. 

What is the most exciting aspect of Netter’s Atlas of Neuroscience.  What portions are you most excited about?

As I prepared lists and notes about what to include in the 4^th edition of Netter’s Atlas of Neuroscience, the need for several components was conspicuous: 

(1) With many basic sciences and clinical journals extensively emphasizing molecular and genetic approaches to diseases, we need to help students understand new molecular technology, techniques for studying neurons, techniques for establishing animal models of neurological disease, gene regulation and transcription, and many other aspects not known or emphasized at the time of the 2^nd and 3^rd editions. 

(2) Clinically-significant diseases or processes with basic sciences foundations, not previously presented in earlier editions, such as hydrocephalus and shunting, normal pressure hydrocephalus, fetal alcohol syndrome, postnatal environmental influences on granule cell development, and others. 

(3) Chemically-responsive systems of increasing significance in society, such as endogenous cannabinoid systems, and endogenous opioid systems (beta-endorphin, dynorphins, met-enkephalin), including exogenous interactions with these systems. 

(4) Complex integrated sensory and motor interactions for vital autonomic-somatic functions of clinical significance, such as swallowing. 

(5) Mechanisms underlying deep brain stimulation (DBS) for movement disorders, now used extensively. 

(6) Interactions of important limbic forebrain structures not included in previous editions, such as bed nucleus of the stria terminalis (BNST), insular cortex, and prefrontal cortex (both dorsolateral and ventromedial (orbitofrontal) components). 

(7) An entirely new chapter on Global Brain Function and Disorders.  This is a challenging component of the neurosciences, as its complexities are legion; discussions often lead to long and complicated explanations with a multitude of clinical and research data – all of great interest, but difficult to succinctly summarize for the student of neuroscience. It is also a challenge to decide what to include and what not to include.  In order to do this new chapter justice for the 4^th edition, we needed to use the best available Netter Atlas plates and many new illustrations by Jim Perkins, write succinct figure legends with descriptions of the global function/dysfunctions, a summary of what brain structures are involved, and, if known, how they interact in the process.  For the 4^th edition, we have included: 

a. Dementias (Alzheimer’s disease, frontotemporal dementia, dementia with Lewy bodies, vascular dementia, and treatable dementias 

b. Alzheimer’s disease distribution and pathology 

c. Neuropsychiatric disorders (schizophrenia, major depressive disorder and bipolar disorder, panic and anxiety disorders, post-traumatic stress, obsessive-compulsive disorder) 

d. Neural foundations of addictive behavior 

e. Traumatic brain injury (TBI) and chronic traumatic encephalopathy (CTE) 

f. Aphasias, brain areas involved, and their clinical characteristics 

g. Non-dominant hemispheric disorders 

h. Memory processing 

i. Coma and its differential diagnosis 

j. Aging processes in the nervous system 

I believe that topics 3 (cannabinoids and opioids), 6 (limbic structures of great behavioral importance), and 7 (new chapter on global brain function), are the most significant and exciting components for students seeking current information about timely and interesting neurosciences topics. 

 Who will find the greatest value from Netter’s Atlas of Neuroscience and why? 

Any student undertaking a journey through the nervous system, especially medical students (who need to know enough to either treat or refer patients with nervous system involvement), but also including any health-care professionals, whether students or practitioners, will find the organization, outstanding illustrations (Frank Netter, Jim Perkins, others), succinct but understandable figure legends, and many clinical comments and considerations, to be the most compact and understandable way to comprehend the scope of nervous system components, interactions, functions, and clinical applications.  It is not an endless and complicated compendium, nor is it a simplistic dick-and-jane beginner text.  It is intended to be a guide book and road map from the most straightforward to the most complex aspects of neuroscience.  The three-part organization of overview-regional-systemic makes this possible.  The Student Consult component provides greater details online for those who want more, while not burdening the majority of students who want to “cut to the chase” and learn the most useful and important components for achieving success in course work. 

I have heard feedback from high school and college students, non-medical professionals who have curiosity about the brain, and others, that they greatly enjoy the illustrations and commentary.  A remarkably wide range of people are fascinated with the brain and how it works.  As the British Medical Association award and review noted- the Atlas is above all else, beautiful, is scholarly, and truly does Frank Netter justice. 

What ideas, practices, or procedures do you hope students will take away from Netter’s Atlas of Neuroscience? 

The 4^th edition of Netter’s Atlas of Neuroscience is directed at understanding basic scientific foundations for the application of neurosciences principles to the practice of medicine.  It also provides an integrative understanding of the brain, its many components and interactions, and important functional and behavioral applications.  It is intended to allow the student to walk away with: (1) an excellent understanding of the basic features of the nervous system (its major components, the ventricular system, its vasculature, development); (2) regional components of the nervous system (essential for diagnosis of where a neurological problem is and what it might be); (3) systemic components of the nervous system (essential for interpreting the neurological exam, which is carried out systemically); and (4) global aspects of brain function and dysfunction, which likely encompass extensive regional and systemic aspects of brain function.  This Atlas is NOT about practices, procedures, how to carry out detailed clinical exams and diagnostic tests, extensive clinical details and data, what dosages of drugs to use, etc.; those topics are best found in more detailed clinical neurology and neurosurgery texts. 

What problems do you hope future generations will be able to solve? 

The new topics noted in components 3, 6, and 7, above, provide several goals. 

We need to know more about the mechanisms by which opiates alter brain function, both for appropriate therapeutic use, and for addressing the scourge of opioid addiction, especially from drugs such as fentanyl, and their destruction of human life.  The understanding of cannabinoids, especially their “reverse transmitter” mechanisms, may lead to revealing the neural foundations of some of the useful clinical applications (anti-nausea, pain treatment, anti-inflammatory, perhaps anti-tumor benefits, anti-stress effects), separate from the more cognitively-altering effects or behavioral impairment (e.g. impaired driving). 

Better understanding of the interactions of many of the limbic structures and prefrontal cortex are critical to dealing with cognitive impairment, rage behavior, amotivational states, addictive behaviors, neuropsychiatric disorders, and other troubling behaviors in our society.  The interaction of drugs (both licit and illicit) can provoke even further unwanted interactions of these brain systems. 

From the perspective of global neurological functions and disorders, our society needs to get a better grip on identifying the dementias early enough to gain a foothold in preventive strategies – the economic consequence of not doing so is both budget-breaking and laden with human tragedy.  Depression and suicidal behavior are accelerating, as is the associated stress and its negative consequences, especially with the isolation and fear from COVID – perhaps a consequence that is as bad or worse than the disease for many.  Traumatic brain injury continues, both in athletes and in military personnel – better life saving emergency care has led to more devastating, sometimes lifelong injuries. 

It is my fondest hope that some of these devastating problems can be addressed with both preventive strategies and better treatment approaches.  I look forward to our next generations of students, both in the clinic and at the research bench or computer, to say “Oh, so that’s how it works,” and then move forward to greater insight.  I feel that if the 4^th edition can inspire such outcomes, even to a small degree, it will be a true success.  One brilliant thought or idea can lead to incredible progress.   

Anything else I would like to say?

Way back, as an undergraduate at MIT, using the Netter Atlas of Neurosciences as an introductory learning tool, little did I think I would end up spending countless hours and effort to significantly contribute to new editions, now leading to this 4^th edition.  It is both an honor and a privilege to do so, and has added great joy to my life.  I have been able to learn from the two great masters – Dr. Netter from his incomparable and informative illustrations, and Dr. Nauta from his wonderful organization and insights of the brain. 

David L. Felten, M.D., Ph.D. is currently based in Canandaigua, NY.  He is working half-time as Associate Dean of Clinical Sciences, and Professor of Neuroscience, at the University of Medicine and Health Sciences (UMHS), headquartered in NYC.  He counsels medical students on strategies and approaches for passing board examinations in basic sciences (Step 1) and clinical sciences (Comprehensive Clinical Sciences Exam, CCSE; and Step 2 Clinical Knowledge, CK), and the NBME subject exams in the Core Clinical Clerkship subjects.  Helping students to achieve competency and understanding in the basic and clinical sciences to qualify for a life of medical practice as an M.D. is highly rewarding to him, and provides insight into the challenges of students from a wide range of backgrounds and cultures. 

His educational background includes a B.S. degree from MIT in Cambridge MA, an M.D. from the University of Pennsylvania School of Medicine, and a Ph.D. in Anatomy from the University of Pennsylvania Institute for Neurological Sciences in the School of Medicine.  At MIT, he had the privilege of spending extensive time and study in the neuroanatomy laboratory of Institute Professor Walle J.H. Nauta, M.D., Ph.D., a world renowned researcher and truly outstanding teacher.  His graduate Neuroanatomy course was inspirational, and provided his foundation in the organization of the nervous system.  Professor Nauta took a three-part approach – Overview, Regional Neuroscience, Systemic Neuroscience, with multiple insightful subcomponents – which is the organizational framework for Netter’s Atlas of Neuroscience, including this 4^th Edition.  He has spent his entire professional life pursuing and refining this framework, now expanding it to new components for the 4^th Edition.  Dr. Felten expresses that it is an honor to preserve and expand the organization and insights of this wonderful mentor, scientist, and teacher. 

His career has included a significant research presence at Indiana University School of Medicine (Professor), University of Rochester School of Medicine (Professor, then Chair and Endowed Chair, and Director of the Markey Charitable Trust Institute), Seton Hall University (Dean of Graduate Medical Education), and William Beaumont Health System (Vice President for Research, Medical Director of the Research Institute, Founding Associate Dean for Research at the Oakland University William Beaumont School of Medicine).  His research career has centered around the discovery of bidirectional direct connections between the nervous system and the immune system, resulting in a leadership role in establishing the new and exciting field of neural-immune communication (brain, behavior, and immunity).  This has led to over 200 peer-reviewed publications, extensive national and international invitations as organizer or keynote speaker at symposia and research societies, and many research awards. 

Dr. Felten was awarded a John D. and Catherine T. MacArthur Foundation Prize Fellowship (labeled “genius award” by the press), two simultaneous MERIT Awards by NIH (National Institute of Aging, National Institute of Mental Health), many other federal grants and foundation grants, two nominations for a Lasker Prize (with Robert Ader, Ph.D., submitted by George Engels, M.D.), many research fellowships, and a Robert Wood Johnson Teaching Scholar Award.  He organized, directed, and taught medical neurosciences courses for decades, and helped to develop the clinical correlations components of the University of Rochester School of Medicine double helix curriculum.  This has led to many teaching awards.  However, he considers the opportunity to author and revise Netter’s Atlas of Neuroscience the greatest honor of his career. 

Get your copy of Netter’s Atlas of Neuroscience, 4th Edition here!