UHN Leads the Way in Women’s Neurology: Closing the Gender Gap in Brain Health
We are living in a new era of medicine, where advancements like robotic surgery and artificial intelligence are reshaping healthcare. Yet, despite these technological leaps, a fundamental gap persists in how we approach brain health: the consistent failure to recognize biological sex as a critical factor in neurological assessment, diagnosis, and treatment.
University Health Network (UHN) is actively working to address this disparity, leading a growing movement to integrate sex-specific considerations into neurological care.
A History of Omission
For decades, neurological research largely overlooked sex as a variable. Dr. Esther Bui, a neurologist and clinician educator at UHN’s Krembil Brain Institute, notes that “up until a few years ago, 80 per cent of human neuroscience research either did not consider or report sex as a biological variable.”1 This historical bias has resulted in a system where treatment protocols and diagnostic criteria are often based on studies primarily conducted on male subjects, potentially leading to misdiagnosis and inadequate care for women.
Recent data underscores the extent of this problem. A 2025 national survey of 1,505 Canadian women, conducted by virtual healthcare platform Maple, revealed that 74 per cent of women feel their health conditions are not taken seriously. 43 per cent reported delays in receiving appropriate treatment, and 35 per cent experienced misdiagnoses or delayed diagnoses.2 These findings highlight a systemic issue of distrust and inequity in healthcare experienced by women.
Why Sex Matters in Neurology
The impact of biological sex extends beyond reproductive health. Dr. Bui explains that “symptoms presentation, medication metabolism, treatment response — these are all shaped by biological sex.” Women are more likely than men to experience atypical symptoms of common conditions like stroke or heart disease, increasing their risk of being under-diagnosed and undertreated.3 This isn’t simply about different anatomy; hormonal fluctuations, genetic factors, and immune responses all contribute to these variations.
The consequences of ignoring these differences are significant. When research excludes or inadequately represents female patients, it creates a fundamental inequity in care. As Dr. Bui asks, “How can we deliver the most effective treatment when the science behind it doesn’t represent every patient?”
UHN’s Pioneering Initiatives
UHN, through the Krembil Brain Institute and the leadership of Dr. Bui, is at the forefront of addressing this gap. The institute, based at Toronto Western Hospital, boasts one of the world’s largest and most comprehensive teams dedicated to preventing and treating brain and spine disorders. Driven by Dr. Bui’s vision, the Krembil Brain Institute is now a global leader in women’s neurology.
Building a New Generation of Experts
Recognizing the need for specialized training, Dr. Bui founded an advanced resident training elective at the University of Toronto (U of T) in 2015, affiliated with UHN. This program educates resident physicians about women’s neurological health, addressing critical gaps in traditional medical education. The program’s reach extends internationally, drawing physicians from around the world.
Building on this success, Dr. Bui established Canada’s first and only one-year accredited Women’s Neurology Fellowship in 2019. This fellowship provides physicians with advanced skills in treating neurological illness through the lens of sex and gender, while also contributing to urgently needed research in the field. Supported by philanthropic contributions from The Earle and Janice O’Born Family Foundation and Jay and Sari Sonshine, the fellowship has already trained Canada’s first women’s neurology fellow and is currently welcoming its sixth cohort.
These educational initiatives tackle fundamental questions often overlooked in traditional neurology training: how to counsel fertility therapy for patients with complex neurological conditions, how to care for pregnant patients with epilepsy, and how to manage stroke during pregnancy.
Canada’s Comprehensive Women with Epilepsy Clinic
UHN is also redefining clinical care with Canada’s most comprehensive women with epilepsy clinic. Epilepsy affects approximately 42 Canadians daily, yet current guidelines largely fail to address the unique needs of female patients.4 Pregnant women with epilepsy face particularly complex challenges, as seizure medications can pose risks to fetal development, creating a difficult balance between managing the mother’s condition and protecting the baby.
UHN’s clinic adopts a multidisciplinary approach, bringing together experts in complex epilepsy, obstetrics, gynecology, fertility medicine, endocrinology, genetics, and women’s mental health. This collaborative model ensures patients receive holistic care tailored to their specific needs.
Music as Medicine: The Lullaby Project
Innovative research at UHN is exploring novel approaches to improve the quality of life for women with neurological conditions. The Lullaby Project, originally developed by Carnegie Hall in New York City, pairs expectant and new parents with professional songwriters to create personalized lullabies for their babies. Dr. Bui recognized the potential of this program to address the often-overlooked emotional and psychological needs of pregnant patients with epilepsy.
Participants in the UHN study are randomly assigned to either a control group or the Lullaby Project. Preliminary results are promising, with a 90 per cent completion rate and qualitative feedback indicating feelings of empowerment and stronger connection to pregnancy. Quantitative data suggests that participation in the Lullaby Project helps stabilize quality of life scores, while scores in the control group trend downward.
Looking Ahead: A Future of Equitable Neurological Care
Dr. Bui’s vision extends beyond research and training. She aims to establish a comprehensive center for women’s neurological health at UHN – a one-stop-shop where patients can receive specialized care from neurologists dedicated to understanding and addressing the unique needs of women.
“I couldn’t be more proud of the work we’re doing at UHN and the University of Toronto,” says Dr. Bui. “We are setting the standard for the world — not only by generating the data that should have existed decades ago, but by translating it into physician training programs and clinical standards.”
UHN’s commitment to women’s neurology represents a significant step towards a more equitable and effective healthcare system, one that recognizes and addresses the biological differences that impact neurological health.
2 Data from the Maple 2025 national survey was referenced in the source article but a direct link to the survey results was not provided.
3 The source article references this claim but does not provide a specific citation.
4 Epilepsy Canada – Facts and Statistics
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