Growing the Pediatric Neuroimmunology Program at UPMC Children’s Hospital of Pittsburgh

Ariel Heller, MD, MPH, assistant professor of pediatrics and adult neurology joined the Division of Pediatric Neurology at UPMC Children’s Hospital of Pittsburgh in July 2024 as the first fellowship-trained pediatric neuroimmunologist on faculty. She co-directs the pediatric neuroimmunology program and sees patients across the lifespan, with a clinical focus on inflammatory and autoimmune conditions in children and adolescents, with a specific emphasis on the transition from pediatric to adult care.

Background and Training

Dr. Heller earned her medical degree from St. George’s University School of Medicine and then completed a residency in pediatrics and child neurology at the Medical University of South Carolina prior to her fellowship in multiple sclerosis (MS) and neuroimmunology at the University of Pittsburgh School of Medicine and UPMC. Dr. Heller also holds a Master of Public Health degree from Columbia University and a Master of Science degree in Biology from New York University.

Dr. Heller’s dual training in pediatric and adult neurology allows her to care for patients across the age spectrum, supporting the continuity-of-care model she is developing at UPMC Children’s for pediatric patients with neuroimmunology conditions. In addition to her clinical responsibilities at UPMC Children’s, she sees adult neuroimmunology patients one day a week in the multiple sclerosis clinic at UPMC Magee-Womens Hospital.

Dr. Heller cares for pediatric and adult patients across the full range of neuroimmunologic conditions, including MS, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis, and others.

“My dual training in child and adult neurology gives me the perspective of these conditions across the entire lifespan, and that’s important because I have an understanding of what the trajectories are for children diagnosed with chronic neuroimmunologic conditions,” Dr. Heller says. “That plays into how we try to manage and diagnose the conditions in young people, and also how we optimally move younger to adult care eventually.”

Growing the Neuroimmunology Program at UPMC Children’s and Working Toward a Center of Excellence Designation

Dr. Heller co-directs the neuroimmunology program at UPMC Children’s with Levi Shelton, MD, and share a neuroimmunology consult service, alternating coverage on a rotating basis. This clinical dynamic allows Dr. Heller and Dr. Shelton to meet patients during acute hospitalizations and initiate treatment before following them in the outpatient clinic.

A longer-term goal for Dr. Heller and Dr. Shelton is working toward attaining a designation as a formally recognized pediatric center of excellence for neuroimmunologic conditions, one that is modeled on the multidisciplinary and comprehensive structure of the adult UPMC Neuroimmunology and MS Center.

“This project will evolve over time and encompasses creating a dedicated neuroimmunology-trained nursing staff, standardized disability assessments integrated into each clinic visit, templated laboratory and imaging monitoring protocols, and embedded access to social work and psychiatry, among other needs,” Dr. Heller says.

Pediatric-Specific Challenges in Neuroimmunology

When children and adolescents are diagnosed with a neuroimmunologic condition, it can often present dramatically with sudden vision loss, limb weakness, gait disturbance, or seizures.

“These kinds of symptoms have a lot of overlap with other conditions, and because of that getting to the correct diagnosis quickly can be a challenge,” Dr. Heller says. “Sometimes you are dealing with a young child, and they cannot really articulate what they are experiencing, which is different from when I’m dealing with adult patients.”

While conditions like MS have seen substantial advances in disease modifying therapies for use in adults, the same cannot be said for children and adolescents. There is limited current availability of FDA-approved therapies for pediatric patients. For adults with MS, there are more than 20 disease-modifying therapies now available. However, in pediatric MS, only one drug regimen currently has FDA approval, making off-label use of adult therapies somewhat of a standard practice

Transitions in Care: Keeping the Physician, Changing the Location

The move from pediatric to adult care is a recognized risk point for patients with all chronic conditions, including neuroimmunologic ones. Children and adolescents who have spent years building trust with a pediatric provider face potential disruption when that relationship ends, with downstream consequences for medication adherence, follow-up, disease flares, and care engagement at a time they are assuming greater independence and beginning to navigate the world of adult responsibilities.

Dr. Heller’s approach to the transition period is structural. Because she sees both adult and pediatric patients, her pediatric patients can follow her into adulthood without a provider change. The relationship does not end at 18, but the responsibilities change.

“Kids with these chronic conditions hold onto their pediatric provider because they know them and trust them,” Dr. Heller says. “That can sometimes make it difficult for them to develop a sense of autonomy. My goal is to take patients I see in the pediatric clinic and slowly transition them into the adult clinic through a defined and structured approach.”

Transition planning begins at age 14, when patients requiring infusions can start receiving treatment at the adult UPMC Neuroimmunology and MS Center located in UPMC Magee-Womens Hospital. Those visits build early familiarity with the adult environment while Dr. Heller simultaneously shifts communication responsibility to the patient.

“This means messages go directly between me and the patient, appointments are self-scheduled, and clinical information is reviewed by the patient rather than relayed through a caregiver. The goal is that by the time a formal transition to adult care occurs, the environment they are entering is a known quantity – they understand it, they feel safe there, and they know how to be the owner of their own health care needs,” Dr. Heller says.

The dedicated transition clinic that Dr. Heller is creating will officially launch later in 2026. The clinic will provide focused sessions for adolescents and young adults in the transition period, with more frequent follow up appointments early on.

Reproductive health is incorporated into care planning for female patients approaching or who are of childbearing age, including conversations about medication teratogenicity and contraceptive interactions before those issues become urgent.

When patients become pregnant, Dr. Heller makes referrals to the UPMC MS Pregnancy Clinic, directed by Ingrid Loma-Miller, MD, one of the attending physicians at the UPMC Neuroimmunology and MS Center who also trained in pediatric neurology and understands the dynamics of caring for children with neuroimmunologic conditions.

Neuroimmunology Research at UPMC Children’s

One of Dr. Heller’s goals for the pediatric neuroimmunology program is to take part in industry sponsored and multicenter clinical trials. As discussed above, there is lack of approved therapeutics for children in this space, and the only way to effectively close that gap is for more studies to be conducted within pediatric populations.

One of the first clinical trials she will be taking part in at UPMC Children’s is the VOYAGE trial, a clinical study sponsored by Biogen that is evaluating dimethyl fumarate in pediatric MS. Dimethyl fumarate is an oral agent with an established efficacy and safety profile for use in adults with MS. Dr. Heller is serving as the site principal investigator at UPMC Children’s for the VOYAGE study, with enrollment targeted to being in 2026.

In addition to clinical trials of disease-modifying agents in pediatric patients, Dr. Heller’s personal research focus is on social determinants of health and their effect on access to care and clinical outcomes children with neuroimmunologic conditions.

“After we have the transition clinic fully operational, I have plans to examine how socioeconomic factors, including transportation, medication access, and engagement with subspecialty services, shape outcomes for adolescents and young adults managing these conditions across the transition from pediatric to adult care,” Dr. Heller says.

More Information and Patient Referrals

Learn more about the UPMC Children’s Neuroimmunology Program. For patient referrals and consultations, referring physicians should call 412-692-5528.