Forensic Psychiatry; Geriatric Psychiatry; Neurology; Psychiatry; Multiple Sclerosis; Alzheimer Disease / Memory Disorders; Neurodegenerative disorders; Neuropsychology
I direct two UBMD clinics: an outpatient neuropsychology practice at the Buffalo General Medical Center and an inpatient consultation service at the Erie County Medical Center. In addition, I provide services for patients at the Jacobs Multiple Sclerosis Center and the UB Alzheimer’s Disease and Memory Disorders Center. Our clinical mission is to provide compassionate, state-of-the-art care for patients and families affected by a wide range of neurological and psychiatric disorders. Our top-rate neuropsychological services are based on the integration of neurological, psychiatric and imaging findings and structured to meet the needs of our patients and their caregivers. Our neuropsychology service is dedicated to the teaching mission of UB. We support the departments of neurology and psychiatry as well as the rehabilitation services in the orthopaedic, occupational therapy and physical therapy divisions at our UB-affiliated hospitals. Students, residents and fellows have a rich learning experience with us and see a wide range of diseases such as personality disorder, malingering, depression, head trauma, concussion, multiple sclerosis (MS), stroke, dementia, epilepsy and pervasive developmental disorders. Medical students have the opportunity to work with both children and adults during didactics, and they may choose to focus on the evaluation of either patient population based on their clinical focus. My research mission is to employ behavioral psychometrics to understand how cerebral disease affects personality, cognition, and psychiatric stability. Two memory tests I developed, the Brief Visuospatial Memory Test Revised (BVMTR) and the Hopkins Verbal Learning Test Revised (HVLTR), are widely used in neuropsychology, especially in the areas of multiple sclerosis, head injury, and schizophrenia, and they are included in consensus panel test batteries for athlete concussions in the NHL and NFL. I work to develop new tests in order to understand more about the effect of cerebral injuries and disease. I also focus my research in multiple sclerosis (MS) and have conducted several studies on pharmacological treatments for cognitive function in MS patients. I have contributed in noteworthy studies as the lead author on a consensus battery for MS patients (the Minimal Assessment of Cognitive Function in MS), which is a gold standard in the literature, and as a major contributor to the idea that brain atrophy is the primary driver of cognitive impairment in MS, and in particular, deep gray matter atrophy. My major findings also include that personality changes can be assessed in MS patients, are more common in MS dementia, and relate to clinical outcomes, that self-report is not a valid indicator of neuropsychological status in MS, and that Symbol Digit Modalities Test is a reliable and valid marker for cognitive outcomes in clinical trials.
Neurology; Cerebrovascular (Stroke)
I am a neurologist who specializes in the care of patients with stroke and other neurovascular disorders. I am board-certified in internal medicine, neurology and vascular neurology. I care for inpatients at Buffalo General Medical Center, the busiest stroke service in New York State, and for outpatients after their discharge from the hospital. I serve as the neurology medical director at the Gates Vascular Institute, a state-of-the-art facility adjoining Buffalo General Medical Center that specializes in the care of vascular disorders. As a member of several committees, I help develop admission and treatment guidelines for the medical center. Of note, we continue to improve our door-to-tissue plasminogen activator time for those patients who are eligible for this treatment for acute stroke. Our stroke center has been recognized as a Comprehensive Stroke Center by the Joint Commission and received a “Get With The Guidelines Gold Plus” award from the American Heart Association. I am very involved in stroke research and serve as principal investigator on several cutting-edge National Institutes of Health (NIH) and industry-funded clinical trials. My research and publications in this domain include clinical investigation into the diagnosis, treatment and prevention of cerebrovascular disease. In addition to my clinical and research role, I am very involved with the education of medical students, residents and fellows on the neurovascular service. I serve as the program director for the Vascular Neurology Fellowship Program approved by the Accreditation Council for Graduate Medical Education (ACGME) which trains one to two fellows each year. I give several didactic lectures every year to various audiences at different levels of training.
Neurology; Child Neurology; Neurooncology; Oncology
I see patients at the UBMD Neurology clinic on Essjay Road in Williamsville and the UBMD Pediatrics clinic at Women and Children’s Hospital of Buffalo. I also see patients at the Western New York Psychiatric Center once a month. My research has focused on childhood brain tumors. My current research interests include: clinical evaluation of chemotherapy in childhood brain tumors; long-term treatment effects of childhood brain tumors; pharmacokinetics of anticonvulsants; seizure disorders in children and pediatric neurooncology with emphasis on protocol development. I mentor residents throughout their neurology training, supervise and organize weekly professor rounds, oversee a monthly clinical pathologic conference for residents, participate in weekly child neurology rounds and supervise residents weekly in clinic. I also deliver child neurology lectures to third- and fourth-year medical students. I am deeply invested in graduating residents capable of delivering the highest-quality care possible to their patients and in developing in them an understanding of the role of research in medical care. The Department of Neurology’s annual resident‘s research day has been named in my honor. In 2013, my colleague Dr. Patricia Duffner and I created an endowment to help support the teaching and research needs of both the child and adult neurology divisions of the Department of Neurology.
Neurology; Cerebrovascular (Stroke)
I am a board-certified neurologist with subspecialty training in vascular neurology. I evaluate, treat and study diseases that affect the structure and function of the blood vessels supplying the brain. My expertise is in cerebrovascular disease, including both ischemic and hemorrhagic strokes. I practice at the Gates Vascular Institute and Buffalo General Medical Center (BGMC). As part of the stroke team, I assess patients presenting in the emergency room with acute stroke for treatment with tissue plasminogen activator (tPA). I then follow my patients through their entire course of care: I assess them for secondary stroke risk factors and care for them as outpatients at the UBMD Neurology clinic at BGMC. I believe comprehensive care is of utmost importance in serving my stroke patients as they cope with this life-changing event. I work with other health care providers to monitor and continuously improve the process of the acute stroke assessment. Doing so helps ensure that patients receive a prognosis and treatment plan in the most timely and streamlined way possible. I also assess and enroll patients for many different acute stroke clinical trials that are underway at the University at Buffalo. My research focuses on systems-based improvement and the optimization of acute stroke care. My goal is to shorten the length of patients’ hospital stays while improving the outcomes of their medical care. I am also a sub-investigator for several clinical trials in acute stroke care within our cerebrovascular division of the Department of Neurology. I have presented at international and local conferences/meetings such as those of the International Stroke Conference and the local New York State Coverdell Stroke Quality Improvement and Registry Program. I train medical students and residents at the bedside during rounds, and I also lecture and participate in conferences with them. I also train the residents by guiding them through direct care of stroke patients from their initial assessment to their acute care and follow up. My teaching and training is focused on evidence-based medicine, i.e., the conscientious, explicit and judicious use of current best evidence, derived from high-quality research, in directing clinical decision making in the care of my patients.
Epilepsy; Neurology; Neuromuscular Disorders; Pediatrics
As a pediatric neurologist, my clinical practice focuses on the comprehensive neurologic care of infants, children and adolescents. Having completed fellowship training in clinical neurophysiology, my expertise focuses on the evaluation and management of epileptic and non-epileptic (stress-induced) seizures, as well as neuromuscular disorders, with particular skill in performing electroencephalography (EEG) and electromyography (EMG). I am one of the panel neurologists in the Epilepsy Monitoring Unit at the Women and Children’s Hospital of Buffalo (WCHOB). As a physician for the inpatient and outpatient neurology service, I attend to the needs of patients who present to WCHOB with a variety of neurologic symptoms. In addition to epilepsy and neuromuscular disorders, my clinical interest includes stroke in the young. I am fascinated by the various factors that may predispose infants and children to cerebrovascular ischemia. After an ischemic event, I work closely with the patients and their families to help coordinate long term care and rehabilitation in their road to recovery. I am actively involved in research mentorship and in the teaching of medical students, residents in adult neurology, pediatric neurology, pediatrics, psychiatry and fellows in clinical neurophysiology. I am further interested in autoimmune, demyelinating and infectious processes within the nervous system. After the 2009 influenza A - H1N1 pandemic, I extensively researched the neurologic complications of H1N1 in pediatric patients in Western New York. I compared our results to those of other groups in the global pediatric and neurologic communities. I presented my results at various international medical conferences. I feel fortunate to have participated in and conducted numerous clinical research projects. I have a track record of research, collaboration and publishing in the field of pediatric neurology. I intend to continue blending research with my clinical work, as I feel that both of these are essential for the art of practicing medicine.
Neurology; Cytoskeleton and cell motility; Molecular and Cellular Biology; Molecular Basis of Disease; Molecular genetics; Neurobiology; Signal Transduction; Inherited Metabolic Disorders; Transgenic organisms
My laboratory seeks to understand the molecular basis of myelination and myelin diseases. Myelin is a multi-lamellar sheath that invests large axons and permits rapid conduction of nerve signals. Failure in myelin synthesis and myelin breakdown cause several important neurological diseases, including multiple sclerosis, leukodystrophies and peripheral dysmyelinating neuropathies. In some of these diseases, genetic mutations cause defects in cytoskeletal, adhesion and signaling molecules. I work with a team of undergraduate and graduate students, postdoctoral fellows, technicians, senior scientists and many international collaborators to discover how these molecules normally coordinate cell-cell and cell-extracellular matrix interactions to generate the cytoarchitecture of myelinated axons. We use a variety of approaches, including generation of mice carrying genetic abnormalities, cultures of myelinating glia and neurons, imaging, biochemistry and morphology to understand the role of these molecules in normal and pathological development. By comparing normal myelination to the abnormalities occurring in human diseases, we aim to identify molecular mechanisms that pharmacological intervention might correct. For example, we described how the protein dystroglycan associates with different proteins, some of which impact human neuropathies, depending on a proteolitic cleavage that can be regulated to improve the disease. Similarly, we found that molecules such as integrins and RhoGTPAses are required for glia to extend large processes that will become myelin around axons. In certain neuromuscular disorders, defective signaling pathways that converge on these molecules cause failure to produce or mantain an healthy myelin Finally, in collaborations with scientists and clinicians in the Hunter J. Kelly Research Institute, we are generating transgenic forms of GalC, an enzyme deficient in Krabbe leukodystrophy, to investigate which cells requires the enzyme. Investigating how GalC is handled may help find a cure for this devastating disease.
Neurology; Neurodegenerative disorders; Pathophysiology; Apoptosis and cell death; Cytoskeleton and cell motility; Molecular and Cellular Biology; Molecular genetics; Neurobiology; Protein Folding; Gene Expression; Transcription and Translation; Signal Transduction; Toxicology and Xenobiotics
My research is aimed at finding the cause and a cure for Parkinson’s disease. Parkinson’s disease (PD) is defined by a characteristic set of locomotor symptoms (rest tremor, rigidity, bradykinesia and postural instability) that are believed to be caused by the selective loss of dopaminergic (DA) neurons in substantia nigra. The persistent difficulties in using animals to model this human disease suggest that human nigral dopaminergic neurons have certain vulnerabilities that are unique to our species. One of our unique features is the large size of the human brain (1350 grams on average) relative to the body. A single nigral dopaminergic neuron in a rat brain (2 grams) has a massive axon arbor with a total length of 45 centimeters. Assuming that all mammalian species share a similar brain wiring plan, we can estimate (using the cube root of brain weight) that a single human nigral dopaminergic neuron may have an axon with gigantic arborization that totals 4 meters. Another unique feature of our species is our strictly bipedal movement, which is affected by Parkinson’s disease, in contrast to the quadrupedal movement of almost all other mammalian species. The much more unstable bipedal movement may require more dopamine, which supports the neural computation necessary for movement. The landmark discovery of human induced pluripotent stem cells (iPSC) made it possible to generate patient-specific human midbrain dopaminergic neurons to study Parkinson’s disease. A key problem for dopaminergic neurons is the duality of dopamine as a signal required for neural computation and a toxin as its oxidation produces free radicals. Our study using iPSC-derived midbrain dopaminergic neurons from PD patients with parkin mutations and normal subjects shows that parkin sustains this necessary duality by maintaining the precision of the signal while suppressing the toxicity. Mutations of parkin cause increased spontaneous release of dopamine and reduced dopamine uptake, thereby disrupting the precision of dopaminergic transmission. On the other hand, transcription of monoamine oxidase is greatly increased when parkin is mutated. This markedly increases dopamine oxidation and oxidative stress. These phenomena have not been seen in parkin knockout mice, suggesting the usefulness of parkin-deficient iPSC-derived midbrain DA neurons as a cellular model for Parkinson’s disease. Currently, we are using iPS cells and induced DA neurons to expand our studies on parkin to idiopathic Parkinson’s disease. We are also utilizing the molecular targets identified in our studies to find small-molecule compounds that can mimic the beneficial functions of parkin. The availability of human midbrain DA neurons should significantly speed up the discovery of a cure for Parkinson’s disease.
Neurological Surgery; Neurology
Dr. Fenstermaker graduated from the Northeastern Ohio Universities College of Medicine in 1981. He completed his neurosurgical residency at University Hospitals of Cleveleand and Case Western Reserve University School of Medicine in 1987. Thereafter, he was a NIH Post-Doctoral Research Fellow in Biochemistry and Pharmacology at Case Western Reserve University School of Medicine. Between 1989 and 1995, he was Assistant Professor of Neurological Surgery at Case Western Reserve University School of Medicine and Chief of Neurosurgery at the Cleveland Veterans Affairs Medical Center. Dr. Fenstermaker became certified by the American Board of Neurological Surgery in 1991. Currently, he is Chairman of the Department of Neurosurgery at Roswell Park Cancer Institute and Associate Professor and Director of Neurosurgical Oncology in the Department of Neurosurgery at the State University of New York at Buffalo. He co-directs the Brain Tumor Treatment Center and the new Gamma Knife Center both at Roswell Park. Dr. Fenstermaker's laboratory research program at Roswell Park Cancer Institute concentrates on the molecular oncogenesis of brain tumors. This involves studying the mechanisms by which certain growth factors and their receptors contribute to malignant glioma formation and progression and how these factors may be targeted to selectively kill tumor cells. Dr. Fenstermaker also performs clinical research into local therapies for brain tumors including the effects of intra-operative photodynamic therapy (PDT) on malignant gliomas.
General Neurology; Neurology; Neuromuscular Disorders
Edward J. Fine, MD is Associate Professor of Neurology at State University at Buffalo. He is Board-Certified in Neurology with Extra Qualifications in Clinical Neurophysiology. He specializes in the diagnosis and treatment of patients with neuromuscular disorders primarily and with epilepsy secondarily. Dr. Fine was born in Cincinnati, OH. He graduated cum laude from the Ohio University as a President’s Scholar. He was a Roessler Scholar and a graduate of The Ohio State University Medical School. His internship (PGY I training) was at Albert Einstein Medical School, Bronx, NY in Medicine. His PGY II was in neuropathology. He served Active Duty in the US Navy Medical Corps where he rose from Lt-jg to Commander. He served as Medical Officer to Destroyer Squadron 12 at sea and in the Naval Hospital at Newport, RI. He trained in Neurology at the Albany Medical Center in from 1970-2. He returned to Neuropathology as a Teaching Fellow at Brown University Medical School. Then he became Chief Resident in Neurology at the New Jersey University of Medicine and Dentistry in 1973. He joined and served on the faculty of the Rutgers Medical School (now Robert Wood Johnson, Jr., School of Medicine) in 1973-1978. At Brigham and Women’s Hospitals and Harvard Medical School, he mastered Clinical Neurophysiology from 1978-1979. Then he returned to Rutgers serving as Director of Neurological Services at the Robert Wood Johnson, Jr. Institute of Rehabilitation from 1980-1983. He joined the University at Buffalo in 1983. In 1993 and 1994 he received additional training in human physiology at the NIH-NINDS, Bethesda, MD. Dr. Fine has written 130 peer reviewed articles, book chapters and abstracts. He has published articles related to peripheral neuropathy, vitamin B12 deficiency and motor control. Dr Fine has an academic interest in the history of the neurosciences, serving as President of the International Society of the History of the Neurosciences in 2004 and on the editorial board of the Journal of the History of the Neurosciences from 2003 to present and Chair of Section of History of Neurology, American Academy of Neurology.
Epilepsy; Neurology; Child Neurology
I am a neurologist with added qualifications in child neurology and clinical neurophysiology. I am an attending physician in the Comprehensive Epilepsy Unit at the Women and Children’s Hospital of Buffalo (WCHOB) where I interpret inpatient and outpatient electroencephalograms (EEGs) in neonates, children and adults. I see inpatients at WCHOB, treating a broad range of neurologic conditions and emergencies. My clinical focus is epilepsy, and I have a special interest in caring for disabled adults with epilepsy who have unique quality of life issues. I also care for women with epilepsy, with an emphasis on bone health, reproductive issues and pregnancy. In addition, I manage patients with a wide range of disorders including developmental disorders, headache, tic disorders and Tourette syndrome. My research interests include investigation of techniques to promote neurodevelopment in conditions such as Rett syndrome, a devastating childhood neurodevelopmental disorder. I teach and train medical students, neurology, pediatric, and psychiatric residents and clinical neurophysiology fellows. My teaching activities include delivering core medical student lectures such as the Introduction to the Neurological Examination, Child Neurology and Childhood Epilepsy. It is a privilege to be able to influence medical students, residents and fellows during the formative stage of their careers. My goals are to foster in them an understanding of the full implications of caring for patients and to expose them to intellectual discoveries that will enrich their professional lives and their ability to give their patients the best possible care. In August 2015, I was appointed residency director of the child neurology training program. My focus will be enhancing the overall training experience. I will also lead recruiting efforts as well as efforts to develop clinical and research opportunities for our residents.
I am trained in adult neurology, with expertise in caring for patients with seizures and epilepsy. The core of my practice is diagnosing and caring for patients with epilepsy and facilitating the multidisciplinary care they need. I work frequently with rehabilitation doctors, internists and intensivists, where we advise each other regarding medication and other medical decisions that are needed for the best possible care and treatment outcomes for our patients. I also make an effort to engage family members in the health of my patients. If family members come to the clinic during patient visits and my patients give me permission to talk to spouses, significant others and other family members, I invite these individuals into the exam room. These are opportunities for me to educate families, which in turn helps foster support for my patients and provides an opportunity for family members to be part of the long-term care my patients need. I also work with UBMD Neurosurgery physicians to facilitate appropriate and timely referral of patients who can benefit from epilepsy surgery. I collaborate with my neurosurgical colleagues during joint conferences where, as a team, we make decisions about whether surgery will give our patients the best possible treatment outcome. I read and interpret both inpatient and outpatient electroencephalography (EEG) studies and both Kaleida Health and Erie County Medical Center, where I serve as director of the EEG laboratory. Additionally, I provide medical care at the Comprehensive Epilepsy Unit at the Women and Children’s Hospital of Buffalo (WCHOB), where patients are monitored, evaluated and treated for acute episodes of seizures, epilepsy and other related conditions. As a teacher and mentor, I work closely with medical students and alongside residents and fellows that are training to specialize in adult and pediatric neurology. I teach in our departmental programs that focus on both the acute and long-term care and management of patients with neurological ailments. In working with trainees at all levels, and in all learning settings, I engage everyone in the focused care of patients.
Movement Disorders; Neurology; Parkinson's
I am a movement disorder neurologist, and I care for patients with involuntary movements such as Parkinson‘s disease, tremor disorders and dystonia at our UBMD neurology clinic on Essjay Rd. I manage the care of patients with medication and counseling, and I also perform botulinum toxin (Botox) injections to treat dystonia, blepharospasm, hemifacial spasm, spasticity and certain types of tremors and headaches. I collaborate with UBMD neurosurgeons specializing in movement disorders in order to give patients the best possible and coordinated care. For instance, I refer patients to my neurosurgery collaborators for deep brain stimulation (DBS) when I know this surgical therapy treatment will help my patients. I am also a member of the Parkinson Study Group, an international organization of clinical research centers. My involvement with this group allows me to identify opportunities for my patients to enroll in cutting-edge research studies and clinical trials that could benefit them. I also direct the Menopause Therapy Center at the UBMD neurology clinic on Essjay Rd. I treat peri and postmenopausal women for hot flashes, night sweats and sleeping problems with effective, non-hormonal medications. My research has focused primarily on conducting clinical trials with the goal of finding new treatments for a variety of conditions. These conditions have included hot flashes, chemotherapy-induced nausea, hyperemesis gravidarum, Parkinson‘s disease and concussion. Thus far, my research has shown the drug gabapentin to be an effective treatment for hot flashes in postmenopausal women and to possibly be an effective treatment for nausea and vomiting. Currently, I am conducting two clinical trials in collaboration with faculty in UB’s Department of Obstetrics and Gynecology. We are exploring the effects of gabapentin on prolonging pregnancy in women with preterm labor, and we are comparing the benefit of gabapentin and ondansetron in patients with hyperemesis gravidarum. In addition, I am collaborating with the Buffalo Neuroimaging Analysis Center (BNAC) to assess an MRI imaging modality called diffusion tensor imaging to determine if it can detect changes in cognitive performance over time in patients with Parkinson‘s disease. I teach medical students and residents about movement disorders in classroom settings as well as at the bedside in my outpatient clinic and on inpatient rounds at Buffalo General Medical Center.
Clinical Neurophysiology; Developmental Pediatrics and Rehabilitation; Neurology; Pediatrics
I am trained as a pediatric neurologist and am board-certified in both pediatrics and neurology with special qualification in child neurology. My clinical practice focuses on autism spectrum disorders and children with related developmental disabilities. I also completed fellowship training in clinical neurophysiology and have related knowledge of seizures as well as skill in reading electroencephalograms (EEGs) used to diagnose and manage epilepsy. Children with autism and related developmental disabilities often have an increased risk of seizures; my experience in neurophysiology contributes to my clinical acumen in thoroughly evaluating and treating my patients. I am the medical director of the Children’s Guild Foundation Autism Spectrum Disorder Center at Women and Children’s Hospital of Buffalo, a center I helped create and one that is jointly operated by the University at Buffalo and Kaleida Health. The goal of the center is to reach the increasing number of children in need of autism evaluation, diagnosis and treatment. The center is the only one of its kind in Western New York for medically-based, multidisciplinary evaluation and diagnosis of children with autism spectrum disorders. The center takes a team-based approach to evaluation; during a visit, each child is seen by a developmental pediatrician, child neurologist and child psychologist. After the visit, the team discusses the child and determines the diagnosis and/or need for any additional testing or services. The center has a full-time social worker and nurse and offers a monthly parent group, information resources for parents of children diagnosed with an autism spectrum disorder and sessions for new patients that have not yet been diagnosed on the autism spectrum but who may be exhibiting behavioral or developmental issues. Medical students, residents and fellows are welcome to work with me on research projects. I have a particular interest in the neurobiology of autism and conduct research regarding how behavior is affected in autism in the concurrent presence of a seizure disorder. I am also interested in the etiology, screening and evaluation techniques in children with autism. As well, I research epileptiform abnormalities that are seen in patients with autism spectrum disorders. My goal is to find the pattern among children on the autism spectrum who have more risk of an EEG abnormality. My research informs my efforts to promote awareness in, and educate families and medical providers about the approach to caring for a child with these specialized needs.
Neurology; Multiple Sclerosis; Neuroimaging
After completing my Neurology residency at the University at Buffalo, I received the National Multiple Sclerosis fellowship in 2006 and trained at the Jacobs Neurological Institute, Baird MS Center. In 2007, I began fellowship training in Diagnostic Neuroimaging with William Kinkel, MD FAAN one of the founding members of the American Society of Neuroimaging. In 2008, I joined the University at Buffalo, Department of Neurology as an Assistant Professor of Neurology. I am board certified in Neurology with fellowship training in both Multiple Sclerosis/Neuroimmunology and Diagnostic Neuroimaging. In outpatient clinical practice, I evaluate for and treat conditions in neuroimmunology such as Multiple Sclerosis, Neuromyelitis optica (Devic’s Disease), Neurosarcoiodosis and Central Nervous System vasculitis. In addition to this, I provide diagnostic reports of brain and spine MRI’s for the Department of Neurology in the evaluation of all neurologic diseases. While on hospital service, I diagnose and treat all neurologic conditions as well as provide teaching to the neurology residents and medical students in training. My research interests include Multiple Sclerosis, its etiology and treatment, diagnostic neuroimaging and neuroimaging analysis as well as stem cell research. I am currently the site principal investigator for two emerging therapies in multiple sclerosis: Anti-LINGO, the first potential drug for remyelination of damaged nervous system tissue and daclizumab a once a month subcutaneous injection for multiple sclerosis. I also participate in numerous studies of all aspects of Multiple Sclerosis. In neuroimaging, I am involved in the development of advanced MRI techniques for many neurological conditions both for diagnosis and monitoring of disease progression.
Child Neurology; Neurology
Dr. Khalid Kakish, a Board-certified Neurologist with Special Qualifications in Child Neurology and Attending of neurology at Children‘s Hospital of Buffalo, Buffalo Medical CTR and UBMD Neurology clinics , he is also appointed on the faculty of Medicine of University at Buffalo. Dr Kakish has eased the anguish for thousands of patients with wide range of neurological diseases. “My goal is to help patients with neurological conditions live in the most convenient, painless and functional way possible,” he says. “If neurologic conditions are not treated, they continue to get worse, causing physical and psychological impairments.” As a board-certified neurologist, Dr. Kakish deals with all aspects of diseases of brain, nerves and muscles. His practice includes the most updated evidence based knowledge and science for treating children with various neurologic conditions. “We do all we can to make this as easy as possible for our patients,” Dr. Kakish says. Dr. Kakish has a special interest in treating neuro-metabolic conditions, neuro-genetic conditions, Headaches, Migraine, seizure disorders, behavioral and developmental disorders,demyelinating conditions like multiple sclerosis and optic neuritis. He provides a comprehensive neurological evaluation using an onsite diagnostic EEG, EMG, and MRI that makes treatment simple and efficient. Dr. Kakish, a graduate of Baylor college of medicine, served his Fellowship at Texas Children hospital in Houston,Texas. He is a member of The child neurology Society , Texas Medical Association and American academy of neurology. He has written and published several research papers in peer reviewed journals.
Cerebrovascular (Stroke); General Neurology; Neurology
I AM A BOARD CERTIFIED NEUROLOGIST, BOARD CERTIFIED VASCULAR NEUROLOGIST AND RESEARCHER with significant expertise in stroke prevention and treatment from both individual patient and public health perspectives. My broad-based clinical experience in the U.S. and Nepal includes work in trauma centers, comprehensive stroke centers, emergency rooms, acute care / ICU, inpatient, and outpatient settings. My background is ideally suited for positions in hospital administration, stroke centers, health operation and management; and health system management and public health consultancy. MY CURRENT RESEARCH FOCUS explores an area with both a high volume of stroke patients and stroke outcome and risk factors related to stroke. I also collaborate in multi-centric U.S. and worldwide research trials. Past research has been published in peer-reviewed pediatric, neurology, and general medical journals. I SUPERVISE AND INSTRUCT medical students and residents; received multiple commendations for teaching excellence. MY BUSINESS AND MANAGEMENT KNOWLEDGE includes expertise in Finance, Accounting, Business Leadership, Health care strategy and Data Modeling. Fluent in English, Nepali, and Hindi | Basic understanding of Urdu
Child Neurology; Children and Adults; Developmental Neurology; Neurology; Pediatrics
My research was focused originally on using astrocyte cell cultures to shed light upon processes related to astro-gliosis, the key response of developing and mature brain to injury. The laboratory succeeded in modeling many immunochemical features of gliosis in primary brain cell culture. More recently, I have been involved in the clinical care of, and research regarding, children with leukodystrophies. This includes coordinating several clinical research projects in roles as Clinical Director of the Hunter James Kelly Research Institute (HJKRI), and as President of the New York State Krabbe Disease Consortium. Projects include expansion of the World Wide Registry for Krabbe Disease (WWR), a database maintained at HJKRI that now has clinical and genetic information for over 150 affected patients afflicted with this rare disease, and examining ways to involve the WWR in national data-sharing initiatives promoted by the NIH, including the Newborn Screening Translational Research Network (NBSTRN). HJKRI is also conducting long-term follow-up studies of affected children, in conjunction with the Rare Clinical Disease Research Network (RDCRN) examining neuro-developmental parameters before and after therapeutic transplantation. Additional projects include exploration of the genotype/phenotype relationship in Krabbe, including exome and whole genome analyses with collaborators, and participating in research to uncover new biomarkers and to develop novel therapies. I am also the Director of the Headache and Concussion clinics at Children’s Hospital of Buffalo. These clinical leadership roles in Western New York and New York State can facilitate significant recruitment into multi-center research studies.
Clinical Neurophysiology; Epilepsy; Neurology
I am board-certified in neurology and clinical neurophysiology. My clinical practice focuses on the care of patients with epilepsy. With advanced training, my expertise lies not only in clinical care but also in interpreting electroencephalography (EEG) and performing electrodiagnostic studies, including nerve conduction studies (NCS) and electromyography (EMG). I see outpatients at Buffalo General Medical Center (BGMC) and the UBMD Neurology clinic in Williamsville. I am one of the attending physicians in the epilepsy monitoring unit at the Women and Children’s Hospital of Buffalo. I also attend the inpatient neurology service at BGMC and the Buffalo VA Medical Center (Buffalo VAMC). My research focus is on epilepsy, but I am open to research ideas that address other neurological diseases which can help patient management. My current research is mainly chart review retrospective studies on: 1.) the yield of EEG after new-onset seizures and 2.) potential modifiable factors contributing to the delay of epilepsy surgery. I will participate in a few multicenter studies, including one that aims to determine the main reason for 30-day readmission to the epilepsy monitoring unit. Another is a prospective study for a new medication that might help with super-refractory status epilepticus. I am also interested in conducting retrospective studies on the association between epilepsy and stress. I am the clinical neurophysiology fellowship director. I design training curriculum, interview fellowship applicants and coordinate the scholarly activity of fellows. I feel fortunate to have the opportunity to help fellows develop into successful neurologists specialized in clinical neurophysiology. I am also actively involved in research mentorship and in the teaching of medical students, neurology residents and clinical neurophysiology fellows. With my extensive experience in conducting research with trainees, I am familiar with the needs of residents and fellows and enjoy helping them and providing guidance to them throughout the duration of their training.
Children and Adults; General Neurology; Movement Disorders; Neurodegenerative disorders; Neurology; Parkinson's; Tourette's Syndrome
I received my medical degree from the University of Otago Medical School in New Zealand in 1977 and, following further advanced training in general medicine and Neurology was elected to Fellowship of the Royal Australasian College of Physicians in 1984. On completion of a Neurology residency and fellowship in Movement Disorders at the University of Rochester (1988), I joined the faculty of the Department of Neurology at the University at Buffalo. As a Clinical Professor at UB, I am engaged in patient care and the teaching of students, residents and fellows at the VA Medical Center. I also have a focused Movement Disorders clinic at the Brain and Spine Center (Williamsville, NY). My interests include not only disorders of voluntary movement but also the associated cognitive, behavioral and psychiatric dysfunction commonly accompanying such disorders. Accordingly, I conduct clinical studies in Movement Disorders not only with my Neurology and Neuroimaging colleagues at UB, but have also collaborated on clinical studies in Tourette syndrome with colleagues from the UB Department of Psychiatry, where I have a secondary appointment, and with members of the Division of Developmental and Behavioral Neurosciences. My publications include co-editing a textbook on “Frontal-Subcortical Circuits in Psychiatric and Neurological Disorders” (Guilford Press, 2001). I am an active member of the American Academy of Neurology, the Movement Disorders Society, the Tourette Syndrome Association, the American Neuropsychiatric Association, and the Royal Australasian College of Physicians.
Neurology; Ophthalmology; Neuroophthalmology
I am a neuro-ophthalmologist with a primary clinical interest in optic neuropathy and vasculitis. I see a full range of neuro-ophthalmologic conditions, but I specialize in adult autoimmune optic neuropathy syndromes, diplopia, headache and multiple sclerosis (MS). I am also a board-certified ophthalmologist and conduct vision tests such as visual field testing, ocular coherence tomography (this assesses the health of the retina and optic nerve), sensorimotor examination and prism measurements. I see patients five days a week at UBMD Neurology at Buffalo General Medical Center. My main research interests include preventative treatment trials for autoimmune optic neuropathies and neuroprotection. I present annually at national and international conferences regarding MS and the use of ocular coherence tomography and imaging in my field. I am also involved in the “Hopeful Ways Nicaragua Eye Care Mission Project,” an annual medical mission to Nicaragua to prevent blindness. I work together with a group of medical professionals, local interpreters and Peace Corps volunteers to provide free vision care to over 2,600 patients a year. I am actively involved in training medical students, residents and fellows. I lecture weekly to students in small group sessions as well as larger lecture settings at UB.
Neurology; General Neurology
I am a board-certified neurologist, and I care for patients with a broad spectrum of neurologic conditions. I evaluate patients with new onset of neurologic symptoms such as headache, numbness, weakness, memory loss, confusion, problems with equilibrium, difficulty walking and disturbances in speech and vision. I provide ongoing care for patients with headaches, epilepsy, back pain and a variety of chronic neurologic conditions. I also have extensive experience in caring for adults with developmental disabilities. I see outpatients in the UBMD neurology offices at Buffalo General Medical Center and Essjay Rd. in Williamsville. I also see patients and supervise residents at the Buffalo General Medical Center outpatient clinic. I am deeply invested in the success of our medical students and have distinguished myself in teaching by receiving numerous teaching awards over the course of my career. I am the clerkship director for the required fourth-year medical school neurology module and have served in this role since 1991. I also teach Advanced Medicine, the pre-clinical neuroscience and musculoskeletal modules and the Clinical Practice of Medicine course. I bring to all my teaching and student interactions my keen interest in humanism in medicine. With a master’s degree in medical management and significant experience in hospital environments, I have expertise in measuring and improving quality of care, patient satisfaction and efficiency of care. I also have extensive experience in graduate medical education, risk management, physician compensation models and regulatory and compliance issues in health care.
Epilepsy; Multiple Sclerosis; Neurology; Neuropsychology; Pediatrics
As a neuropsychologist with training in both child and adult neuropsychology, my clinical practice focuses on the comprehensive neurocognitive and psychological evaluation of children, adolescents and adults. My primary focus is in pediatric neuropsychology; I see children ages 3 to 18 with a variety of developmental and neurological disorders. I also evaluate adults with developmental disorders and epilepsy. One of my areas of expertise is in pre- and post-surgical assessment, primarily for patients with intractable seizure disorder. As a consultant with our epilepsy unit at Women and Children’s Hospital of Buffalo, I work with patients’ neurologists and neurosurgeons regarding seizure focus, cognitive integrity and prognostic factors related to surgical outcome. I also serve as the primary neuropsychologist for the Pediatric MS Center of Excellence, one of six such centers in the U.S. designated by the National Multiple Sclerosis Society that offers comprehensive, multidisciplinary evaluation and care for children with demyelinating conditions. I provide neuropsychological assessment for the children and conduct research in the center and with collaborating sites within the network. In addition, I have extensive training and experience in assessment and diagnostic clarification for children with neurodevelopmental disorders. In my outpatient clinic at Buffalo General Medical Center, I focus on thorough evaluations of neurocognitive function to provide not only diagnostic clarification, but a better understanding of specific areas of strength and weakness to help guide my patients’ medical treatment, school interventions and other therapeutic interventions. Given findings from the neuropsychological evaluation, I provide specific recommendations to help my patients achieve the greatest degree of success possible. My research interests include understanding neurocognitive functioning in pediatric patients with demyelinating disorders and epilepsy treatment and surgical outcomes. Conducting clinical research allows me to use information from my clinical work to guide research questions, improve understanding of patient populations and provide better care and guidance regarding treatment interventions to my patients. As a teacher, I work with medical residents and psychology graduate students to improve their understanding of neurocognitive functioning and neurocognitive assessment in children and adults with a variety of disorders such as MS, demyelinating disorders, epilepsy, head injury and autism spectrum disorder. I also tailor training if a resident/student has a particular area of interest. In addition, I serve as a mentor for neurology residents and psychology graduate students on research projects and offer more extensive training in neuropsychological assessment and diagnostics. I am also available to work with recently graduated undergraduates and master’s students who would like to gain research experience.
Neurological Surgery; Neurology
I have two major research interests: trophic factors as novel treatments for Parkinson‘s disease and CNS neoplasms. My lab has been characterizing the response to trauma in the caudate nucleus of parkinsonian animals. This work grew out of the observation that tissue grafts for parkinsonism lead to modest behavioral improvement, even when the graft did not survive. We have shown that several trophic factors are present in the caudate of rats after trauma which simulates graft placement. Both brain derived neurotrophic factor and ciliary neurotrophic factor are found in the caudate predictably at intervals after the surgical trauma. Further, there is at least one other, as yet unidentified factor present after trauma in the caudate. We have moved beyond identification to use of BDNF in parkinsonian models. Infusion of BDNF into the dopamine deficient caudate of a hemiparkinsonian rat leads to behavioral improvement and increased tyrosine hydroxylase (TH) staining, the rate limiting enzyme for dopamine synthesis. We are currently working on a delivery system to distribute BDNF, or other macromolecules like trophic factors, in the striatum of primates. The second area of active interest is in two forms of CNS neoplasia: leukemic meningitis and glioblastoma multiforme (GBM). We have created an animal model of leukemic meningitis in the athynic (nude) rat, using a human leukemic cell line. In collaboration with Dr. Steve Greenberg, we are working on a gene therapy approach using a white cell specific promoter and the viral thymidine kinase "suicide" enzyme. We are testing the constructs in vitro and in the nude rat model. In addition, we are working withDr. Greenberg to study the biology of GBM by transfecting human GBM cell lines with genes for vascular growth factors. Basic fibroblast growth factor, transforming growth factor beta, and endothelin-1 are currently being studied. The behavior of the transfected GBM cell lines are characterized in vitro, and after implantation into the frontal lobe of nude rats. By understanding how the transfected genes affect tumor growth, we hope to devise novel treatment strategies, potentially utilizing gene therapy.
I am a neurologist specializing in treating patients who experience headaches, migraines, cluster headaches and post-traumatic headaches. I also care for patients who experience headache during pregnancy and lactation. I use a mixture of lifestyle modification and medications to address my patients’ conditions. I am also experienced in botulinum toxin injections and nerve block injections. After completing my residency, I obtained further specialty training in headache medicine at Harvard Medical School/Brigham and Women’s Hospital. Practicing in Boston’s original City Hospital has equipped me with a wealth of experience and expertise in caring for individuals from diverse cultures and economic backgrounds. I currently see patients at both Buffalo General Medical Center (BGMC) outpatient neurology clinics as well as the UBMD Neurology Main Street clinic in Williamsville, where I continue to care for patients who come from diverse backgrounds. I feel privileged to practice with the UBMD practice plan; the opportunity affords me the clinical time to understand my patients’ individual needs and provide them with the best treatment solutions. I also care for adult inpatients with a wide variety of neurological diseases at BGMC and work as part of a team to provide consultation and inpatient management. My research interests largely mirror my clinical interests, but also include evaluating research integrity and trial registration in the medical literature. Mentoring the next generation of neurologists and headache specialists is one of my major career aims. I take part in mentoring medical students and neurology residents during their rotations at BGMC. My family and I feel fortunate to once again call Western New York home. My goal is to decrease the suffering of individuals in my community who suffer from disabling headaches.
Cerebrovascular (Stroke); General Neurology; Neurology
My clinical practice focuses on vascular disease, predominantly stroke. I am the co-director of the Stroke Center at the Gates Vascular Institute where we treat more stroke patients than anywhere else in New York State. Our team, which includes our vascular neurologists, neuro-endovascular neurosurgeons and the Emergency Department at the Gates Vascular Institute, has been designated a Comprehensive Stroke Center by the Joint Commission and received a “Get With The Guidelines Gold Plus” award from the American Heart Association. These are the highest awards possible in the United States for stroke care. Our Stroke Center team works with first responders to identify signs and symptoms of stroke, and we determine the best treatment protocol and formulate discharge and rehabilitation plans for patients. I then care for my stroke patients at 300 Essjay Rd. in Williamsville to provide continuity of care after hospitalization. I also care for patients recovering from stroke when they have been referred to me by other physicians. I monitor all my stroke patients to prevent a second occurrence of stroke, and I refer them to rehabilitation facilities that help them return to normal daily life. I work with patient families and caregivers as well to help ensure the best possible care for my patients. I am keenly involved in developing techniques, teams and systems that deliver state-of-the-art stroke care to residents of Western New York. In addition to my clinical responsibilities, I am actively involved in medical student and neurology resident teaching. I have an extensive lecture schedule at national and international venues, with a special interest in stroke outreach programs at the local level. I am the principal investigator for numerous trials funded by the National Institutes of Health (NIH) and commercial entities, and I manage the stroke database for UBMD Neurology. I also serve as a flight physician at Metro Life Flight in Cleveland, Ohio, an internationally recognized transport service for critically ill patients. I am qualified in Advanced Trauma Life Support (ATLS), Advanced Cardiac Life Support (ACLS) and Pediatric Advanced Life Support (PALS).
Multiple Sclerosis; Neurodegenerative disorders; Neuroimaging; Neurology; Neuroradiology - Radiology; Parkinson's; Radiological Physics; Radiology; Bioinformatics
Magnetic resonance imaging (MRI) is a unique technique for studying the human body since it is non-invasive, does not require ionizing radiation and offers a multiplicity of complementary tissue contrasts. My research seeks to explore the potential of MRI for clinical and pre-clinical imaging and to provide new and improved MRI technology. The goal of this endeavor is twofold: 1.) to contribute deeper insight into the etiology, pathogenesis and potential treatment of neurodegenerative diseases, and 2.) to give clinicians the ability to diagnose diseases earlier and monitor them more accurately. I am currently focusing on understanding MRI contrast mechanisms as well as on developing innovative imaging and reconstruction techniques that improve the sensitivity and specificity of MRI with respect to biophysical properties of brain tissue. Advancements in this field promise to have a substantial impact on our understanding of biophysical and morphological tissue alterations associated with neurological diseases and their treatment. We recently pioneered quantitative susceptibility mapping (QSM), a breakthrough in quantitative MRI. This technique allows for unique assessment of endogenous and exogenous magnetic particles in the human brain such as iron, calcium, myelin or contrast agents. The concept of QSM is fundamentally different from conventional MRI techniques as it involves solving for all imaging voxels simultaneously in large physically motivated equations, a so-called inverse problem. At the Buffalo Neuroimaging Analysis Center (BNAC), we use QSM to explore whether brain iron may serve as an early biomarker for diseases of the central nervous system such as multiple sclerosis and Parkinson’s disease. Other interesting applications of this technique we are investigating include differentiation between hemorrhages and calcifications, detection of demyelination and quantification of tissue oxygenation. I am fascinated by the synergies from combining physical expertise with high-level mathematical, numerical and engineering concepts to advance our understanding of the human brain. Consequently, my research activities are generally interdisciplinary and involve collaboration with clinicians, physicists, computer scientists, technicians and engineers. Student projects typically focus either on the application of techniques or on technical developments. Undergraduate, graduate and doctoral candidates from a variety of disciplines such as neuroscience, physics and mathematics work collaboratively in my lab.
Neurology; Neuromuscular Disorders
As a neurologist with advanced training in the field of neuromuscular disorders, my clinical practice focuses on the care of adults and children with disorders of nerves, the neuromuscular junction and muscle. With specialized training in clinical neuromuscular medicine, my expertise lies not only in clinical care but also in performing electrodiagnostic studies (nerve conduction and electromyography). I am one of the few physicians in the area skilled at performing advanced electrophysiological techniques such as single fiber electromyography. I also perform skin biopsies and chemodenervation (botulinum toxin treatment) at our UBMD Neurology clinic on Essjay Road in Williamsville. As well, I evaluate and treat patients with general neurologic diseases such as headache and seizures. I see outpatients at Buffalo General Medical Center (BGMC), the VA Hospital, the UBMD Neurology Clinic on Essjay and at the Muscular Dystrophy Association clinic at BGMC, where I serve as co-director. I frequently attend on service at BGMC. In addition to my clinical duties, I direct the adult neurology residency training program and train fellows in clinical neurophysiology. I am actively involved in teaching medical students both in the clinical and preclinical years, and I lecture extensively in the medical school and at national and international meetings on topics related to neuromuscular disorders. I serve on a number of committees in the medical school that focus on improving medical and graduate medical education. I am actively involved in both clinical research studies and basic science research in collaboration with physician scientists from multiple disciplines, including neurology. I am most proud of the clinical services that I have developed in our department and the high-quality care that we deliver. It is an honor for me to practice neurology in the Western New York community in which I was raised.
Alzheimer Disease / Memory Disorders; Neurology
I am a board-certified neurologist with specialty training in genetics and cognitive disorders, and I direct the Alzheimer’s Disease and Memory Disorders Center and Translational Genomics Research Laboratory, state-of-the-art facilities specializing in cognitive disorders. Our clinical mission is to provide compassionate, state-of-the-art care for patients and families affected by Alzheimer disease (AD) and other cognitive disorders. Our multidisciplinary approach includes a team of neurologists, neuropsychologists, neuroimagers, social workers and nurses dedicated to the needs of our patients and their caregivers. Our research mission is to employ genetic tools to identify novel risk factors and potential pathways that can be targeted with medications to prevent or modify the course of AD. Our focus is translating discoveries made in the laboratory into improved methods of disease prevention, diagnosis, and treatment. AD is a progressive neurodegenerative disease with high prevalence imposing a substantial public health problem. The heritability of AD is estimated at 60-80 %, forecasting a potential for using genetic biomarkers for risk stratification in the future. The main risk factor of late-onset AD is the APOE4 allele with a population attributable fraction of 0.2-0.3. Several large scale genome-wide association studies (GWAS) using high frequency variants identified nine additional loci with a combined population attributable fraction of 0.31. My laboratory focuses on finding the missing heritability using copy number variation as a genetic marker map. We perform CNV GWAS analysis on case-control datasets and quantitative endophenotypes, such as age at onset and biomarker data. We identified an olfactory receptor CNV association with age at onset of AD. Loss of smell sensation has been associated with AD and other neurodegenerative disorders; we are now applying a novel method, aCGH to study the olfactory subgenome in relation to smell sensation and cognition in normal aging individuals, patients affected by amnestic mild cognitive impairment and mild AD. This multicenter study is ongoing and is funded by the National Institute of Aging. In order to increase the power of association studies, we developed a method to use CNV as a genetic marker map and whole genome gene expression as quantitative trait loci within the same individual using post-mortem human temporal lobe tissue. In a pilot study, we identified a replicable 8 kb deletion association with AD upstream of CREB1. This small deletion harbors a PAX6 transcription factor binding site. We are pursuing iPSC technology to study the effect of this deletion on human neurons. We are also applying the same methodology on a larger set to identify additional signals. Our laboratory also collaborates with the Mendelian Project of Baylor College of Medicine in Houston, Texas. We are studying neurodegenerative dementias with Mendelian inheritance pattern by whole exome sequencing of informative pedigrees. My laboratory performs the data analysis and the follow-up studies for these mutations.
Neurology; Child Neurology; Epilepsy
I joined the Department of Neurology and the University at Buffalo in July 1998 with the goal to develop the EEG and pediatric epilepsy program. Prior to that time, I completed residencies in Pediatrics at the University of Tel-Aviv and at Rainbow Babies Case Western University, as well as fellowships in Child Neurology and in Epilepsy and Clinical Neurophysiology at the Cleveland Clinic Foundation. I currently serve as Director of the Division of Child Neurology, the Epilepsy Monitoring Unit as well as the EEG laboratories for Kaleida Health. I was promoted to Professor in Clinical Neurology in March 2014. I serve as the main instructor for EEG and Epilepsy for neurology residents and clinical neurophysiology fellows, and mentored numerous residents and fellows for research projects. The child neurology division was recognized by the “US NEWS and WORLD REPORT” as one of the Top 50 Children’s Hospital in the field of Neurology/Neurosurgery in 2013 and 2011. Our 8-bed epilepsy monitoring unit (EMU) was recognized as a Level IV NAEC level for 4 years in a row (highest possible) by the National Association of Epilepsy Centers (NAEC). The EMU was awarded a $1,000,000 grant by the Cummings Foundation to build a new 12-bed Epilepsy Monitoring Unit in the John R. Oishei Children’s Hospital, Buffalo, NY. My interests in child neurology and epilepsy have focused on management of refractory epilepsy in children, epilepsy surgery and EEG. I am board certified in child neurology, clinical neurophysiology and epilepsy. I read evoke potentials and perform Quality Assurance of EEG‘s at various hospitals in the city of Buffalo. My main research is relate to the diagnosis and management of refractory epilepsy and epilepsy surgery. I have been the site investigator for many Pharma and NINDS sponsored studies on novel anti-epileptic drug therapies, particularly as they relate to pediatric epilepsy, and was the PI of various investigator initiated studies. I am passionate in the education of epilepsy and EEG and guiding medical students, neurology residents and clinical neurophysiology fellows into their careers while promoting the field of epilepsy. Professor of Clinical Neurology State University of New York at Buffalo Medical Director, Child neurology Division Director, Epilepsy Program and Long Term Monitoring Women and Children’s Hospital of Buffalo 219 Bryant Street Buffalo, New York 14222 Phone: (716) 878-7840, Fax: (716) 878-7326 E-mail: email@example.com
Multiple Sclerosis; Neurology
My clinical practice is devoted to the comprehensive care of adults and children living with multiple sclerosis (MS) and other demyelinating disorders. I direct the Jacobs Multiple Sclerosis Center for Treatment and Research at UBMD Neurology; our clinic offers state-of-the-art diagnostic and therapeutic interventions for MS patients and for patients with other autoimmune diseases affecting the central nervous system. We provide a full spectrum of support services to patients including, but not limited to neurocognitive assessment, physical and occupational therapy and social work services that help both patients and families. Additionally, I serve on hospital inpatient service several times a year. I also direct the Pediatric Multiple Sclerosis Center of Buffalo, one of the initial six centers of excellence established by the National Multiple Sclerosis Society. In addition, I serve as executive director of the New York State Multiple Sclerosis Consortium (NYSMSC), one of the largest MS registries in the nation. In support of my patients, I speak to patient and family groups about our MS research and emerging therapies. My team members and I offer special patient programs where we discuss topics such as MS therapies as well as the importance of exercise, nutrition, healthy lifestyle and more specific issues such as reproduction, osteoporosis and aging. My research interests are aimed at better understanding the heterogeneity of MS, identifying predictors of disease progression with a primary focus on genetic and environmental interactions and influences on MS disease phenotype. I am also interested in response to therapy, e.g., influences on physical and neurocognitive status. Pediatric MS, an insufficiently explored subject, is an important area of my clinical and research interests and is part of a well-established national research network via the pediatric MS centers of excellence of the National Multiple Sclerosis Society. More recent foci of my research include understanding the cholesterol link to MS and its influence on the pathobiology of MS, bone health and exercise programs for patients with MS and aging: patient characteristics and biomarkers associated with, and predictive of improved quality of life and/or MS disease stabilization in MS aging. I lecture students and residents on a regular basis. I also mentor five to seven pre-residency candidates and fourth-year medical students per year in clinical rotations and in research project design and implementation.
Neurology; Neuromuscular Disorders
I arrived in January 2012 to assume the role of Chair of the Department of Neurology at Univ. at Buffalo School of Medicine and Biomedical Sciences, the State University of New York. Prior to that time, I served as Professor of Neurology at University of Texas Southwestern Medical School in Dallas, Texas. In September 2004, I was named to the Dr. Bob and Jean Smith Foundation Distinguished Chair in Neuromuscular Disease Research. I also served as Co-Director of the Muscular Dystrophy Association Clinics and Director of the Myasthenia Gravis and Peripheral Neuropathy Clinics at UT Southwestern and was the Clinical Vice Chair for the department in Dallas. My interests in neuromuscular medicine are wide but have mainly focused on myasthenia gravis and other disorders of neuromuscular transmission, as well as peripheral neuropathies. I am board certified both in neurology and neuromuscular medicine. I am also board certified in neurophysiology, and I perform electromyography and nerve conduction studies and monitor intraoperative evoked potentials for spine surgeries and other operative cases. My main research interests include idiopathic and immune-mediated peripheral neuropathies and myasthenia gravis. My research has been sponsored by the National Institute of Health/NINDS, Muscular Dystrophy Association, Myasthenia Gravis Foundation of America, and Food and Drug Administration. I remain actively involved in the training of younger physicians, and have directed neuromuscular medicine and clinical neurophysiology fellowships and neurology residency training programs in the past.
Developmental Neurology; Neurology
My laboratory has a longstanding interest in myelin and its diseases. Myelin surrounds large axons and permits rapid conduction of signals. It is formed by oligodendrocytes in the central nervous system, and Schwann cells in the peripheral nervous system. During development, these cells migrate with the axons that they will myelinate, and depend on those same axons for appropriate signals to survive and differentiate. Myelin-forming glia coordinately express a unique set of genes encoding myelin structural proteins, and enzymes that synthesize myelin lipids-this coordination is in large part transcriptionally-mediated. Given the unique three dimensional transformation of the cell required for myelination, many of the involved proteins include adhesion among their functions. Therefore, our projects include studies of transcriptional regulation, axonal signals to myelinating glia, the role of adhesion in myelination and the characterization of animal models of human demyelinating diseases.
Neurology; Neuroradiology - Radiology; Vascular and Interventional Radiology; Parkinson's; Multiple Sclerosis; Alzheimer Disease / Memory Disorders; Developmental Neurology; General Neurology; Neurodegenerative disorders; Neuroimaging
I direct the Buffalo Neuroimaging Analysis Center (BNAC) and have established the center as a world leader in performing quantitative MRI analysis in neurodegenerative disorders. I also direct the Translational Imaging Center at UB’s Clinical Translational Research Center (CTRC). I strive to extend the boundaries of current knowledge about neurological diseases and disorders through innovative imaging research techniques and the application of bioinformatics resources. My efforts are directed toward advancing technical, basic and translational research at UB which will, in turn, advance patient care. I have secured more than $30 million in research grants for collaborative research projects involving UB investigators as well as national and international collaborators. My research interests include structural and functional quantitative MRI analysis for humans and animals, including lesion/tumor identification and segmentation; perfusion and dynamic contrast-enhanced (DCE) mapping and quantification; fluid flow quantification; functional MRI analysis; diffusion tensor reconstruction and tractography; voxel-wise mapping and image-based group statistical analysis; longitudinal change analysis and tissue/pathology/structure volumetry. I study the application of these techniques in healthy individuals and in patients with various disease states such as multiple sclerosis (MS), stroke, Alzheimer’s disease, Parkinson’s disease, epilepsy, systemic lupus erythematosus and traumatic brain injury. I also concentrate on therapeutic interventions, including therapy directed toward assessing neuroprotective efforts in neurodegenerative disorders as well as the venous function, genetic and neuroepidemiology fields of these diseases. I direct the neurology resident research program. Over a period of two years, I guide third- and fourth-year medical residents through a rigorous assigned scientific research project that is a critical, required part of their training. In addition, I mentor and supervise undergraduate, master’s and doctoral students and MRI fellows. In this role, I help to educate these trainees on clinical MRI use as well as neuroimaging analysis. I also oversee students and fellows conducting research in neurological disorders. One of the most rewarding experiences in my career is helping young physicians and researchers start successful clinical or research careers.