We are living in a new era of medicine. Robots are lending helping hands in the operating room, artificial intelligence (AI) is empowering clinicians to more accurately predict patient risk and outcomes, and we have seen drones fly organs to transplant patients faster than ever. Yet, despite these technological advancements, there remains a simple but critical gap in how we approach brain health: the failure to recognize sex as a biological factor.
University Health Network (UHN) has made it a priority to close that gap.
“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 said Dr. Esther Bui, neurologist and clinician educator, University Health Network (UHN). “Because of this, the way we assess, diagnose and treat female patients is rooted in a fundamental bias which has serious consequences for women’s health.”
A 2025 national survey of 1,505 Canadian women, published by virtual health care platform, Maple, found that 74 per cent of women feel their health conditions are not taken seriously. Additionally, 43 per cent report delays when it comes to getting the proper treatment for their conditions, and 35 per cent have experienced misdiagnoses or delayed diagnoses.2
“Symptoms presentation, medication metabolism, treatment response — these are all shaped by biological sex,” said Dr. Bui. “In fact, women are more likely than men to experience atypical symptoms of common diseases such as stroke or heart disease, placing them at risk of being under-diagnosed and under treated.3
“When female patients are omitted or sex is not considered in research, we create a fundamental inequity in care. We need to ask ourselves, ‘How can we deliver the most effective treatment when the science behind it doesn’t represent every patient?’”
Dr. Bui and her team at UHN are stepping up to change this reality.
Leading the World in Women’s Neurology
Dr. Esther Bui is a neurologist and clinician educator at UHN’s Krembil Brain Institute and an associate professor at the University of Toronto (U of T), where she is working to inform women’s neurological care through sex and gender-specific data.
Based at Toronto Western Hospital, the Krembil Brain Institute is home to one of the world’s largest and most comprehensive teams of physicians and scientists dedicated to preventing and treating disorders of the brain and spine. Driven by Dr. Bui’s leadership, the Krembil Brain Institute is now leading the world in the field of women’s neurology.
“The opportunity we have at UHN is unprecedented,” she noted. “Re-imagining neurological care for women begins with educating the next generation of physicians.”
Building the World’s First Accredited Women’s Neurology Training Program
In 2015, Dr. Bui founded an advanced resident training elective at U of T, affiliated with UHN, to teach resident physicians about women’s neurological health. Today, the program draws physicians from around the world, closing educational gaps and extending the impact of this training far beyond Canada.
But she didn’t stop there.
In 2019, Dr. Bui founded Canada’s first and only one‑year accredited Women’s Neurology Fellowship, which gives physicians advanced skills in treating neurological illness through the lens of sex and gender, while contributing to urgently needed research in this growing field. She currently co-directs the program with Dr. Aleksandra Pikula, and through the generous philanthropic support of The Earle and Janice O’Born Family Foundation and Jay and Sari Sonshine, the Fellowship has trained Canada’s first women’s neurology fellow and is now welcoming its sixth.
Dr. Esther Bui
UNIVERSITY HEALTH NETWORK
These educational opportunities are designed to address long-unanswered questions such as: How do we counsel fertility therapy for complex neurological patients? How do we care for pregnant patients with epilepsy? What happens when a patient experiences a stroke during pregnancy?
Most neurologists graduate with limited training in these areas. And as Dr. Bui emphasizes, this knowledge gap extends beyond pregnancy.
“Not all of our female patients become pregnant, but all will go through perimenopause and menopause at some point,” she noted. “Understanding neurological health across the entire life course, not just during reproductive years, is essential, and is something that didn’t exist until now.”
Canada’s most comprehensive women with epilepsy clinic
In addition to leading groundbreaking work in education, Dr. Bui is redefining real‑world care through Canada’s most comprehensive women with epilepsy clinic at the Krembil Brain Institute.
Every day, an average of 42 Canadians are diagnosed with epilepsy, yet in 50 to 60 per cent of cases the cause remains unknown. And although women make up half of all patients, only six per cent of current epilepsy guidelines specifically address women’s health.4
“While most experience stability, for some, epilepsy can worsen during pregnancy. Combined with the significant impact seizure medications can have on the developing fetus, it creates a very difficult situation,” said Dr. Bui. “It’s a condition where you can’t simply stop your medication, yet you worry about the risks of fetal exposure, such as spina bifida or heart defects. It’s an incredibly frightening position to be in.”
UHN’s women with epilepsy clinic is unique for its multidisciplinary model, bringing together experts in complex epilepsy, obstetrics, gynecology, fertility medicine, endocrinology, genetics, and women’s mental health. This allows patients to receive care that reflects the full complexity of their conditions.
“It’s about challenging the status quo of care and taking innovative approaches to medicine that is tailored to women’s unique needs,” said Dr. Bui.
One of the clinic’s most prominent studies — the Lullaby Project — is doing exactly that.
The Lullaby Project – Music as Medicine for Pregnant Patients with Epilepsy
Originally created at New York City’s Carnegie Hall, the Lullaby Project pairs new and expecting parents and caregivers with professional artists to create bespoke lullabies for their babies, supporting parental health, aiding childhood development, and strengthening the bond between parent and child. The program came to Toronto in 2017 through Massey Hall and Roy Thomson Hall.
When Dr. Bui connected with an educator at Roy Thomson Hall, she began exploring how this model could be embedded into her clinic as proof of concept for music as medicine in epilepsy, and potentially for other chronic conditions such as depression and anxiety.
“One of the unique challenges of caring for pregnant patients with epilepsy is that in the efforts to manage seizures during pregnancy, stress and quality of life often go unaddressed.” said Dr. Bui. How can we more holistically support our pregnant patients and create a safe space for them to heal and thrive. That’s what the Lullaby Project is exploring.”
Participants from the women’s epilepsy clinic are randomly assigned to a control group or paired with a singer‑songwriter for a 10‑week process, meeting weekly until their lullaby is complete. This multidisciplinary model relies heavily on the essential support provided by nurse practitioner Keriann Tingling, alongside neuropsychologist Dr. David Gold and research analysts Sabrina Chan and Sharon Ng, who together closely follow each participant.
The results have been striking: an unexpectedly high completion rate, with 90 per cent of participants finishing the study and creating a lullaby for their child. Qualitative feedback highlights feelings of empowerment and stronger connection to pregnancy and to others.
Quantitatively, measures of quality of life specific to epilepsy show a downward trend in the control group, while participants in the Lullaby Project maintain stable quality of life scores. Because the measure captures stress, worry and broader social and behavioural aspects of health, this stabilization is a promising and meaningful trend.
Looking to the future
The goal for Dr. Bui and her team is to build a true one‑stop‑shop for women at UHN — a place where patients can see a neurologist who understands women’s health needs and is dedicated to this area of care.
“I couldn’t be more proud of the work we’re doing at UHN and the University of Toronto,” said 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.”
Under Dr. Bui’s leadership, UHN is not just advancing women’s neurology. It is redefining what equitable, evidence‑based neurological care can look like for women today, and for generations to come.
1 Ref: Mamlouk GM, Dorris DM, Barrett LR, Meitzen J. Sex bias and omission in neuroscience research is influenced by research model and journal, but not reported NIH funding. Front Neuroendocrinol. 2020;57:100835. doi:10.1016/j.yfrne.2020.100835