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; 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.
Multiple Sclerosis; Neuromuscular Disorders
I evaluate and care for patients who have neuroimmunological disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and other inflammatory- and autoimmune-mediated central and peripheral nervous system disorders. I completed a master's of science degree in clinical and translational investigation to better conduct translational research. My research interests focus on immune-mediated nervous system disorders--specifically, on predictive measures and outcomes research. In addition to participation in several clinical trials, I am actively investigating the prevalence and relationship between MS and neuropathy. I also have a particular interest in the pathophysiology of autonomic nervous system dysfunction in MS and the usefulness of autonomic measurements in developing treatment targets and predictive clinical measures in MS. The goal of my research is to better understand MS and to create better treatments that will positively impact patients' lives. I teach, train and mentor medical students and residents. I like to explore trainees' gaps of knowledge rather than tell them all the answers, a technique that I believe encourages physicians-in-training to think deeply and exhaustively about new areas of learning. I also teach trainees the art of physical exam techniques, which is a special area of interest to me. During medical school, I completed an enrichment program in social medicine and public health that gave me training and research in public health and health disparities. I use what I learned to sensitize medical students and residents to the myriad and complex issues related to the care of patients for whom medical care is often inaccessible.
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.
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.
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; 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.