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 Main Street in Williamsville. 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, and the International Parkinson and Movement Disorder Society. My involvement with these groups allows me to identify opportunities for my patients to enroll in cutting-edge research studies and clinical trials that could benefit them. 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 and Parkinson‘s disease. 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 conditions that do not respond to more conventional therapies. More recently, I have become interested in the use of lithium carbonate for treating certain symptoms that Parkinson‘s disease patients frequently experience. In addition, I am collaborating with the Buffalo Neuroimaging Analysis Center, the University of California at San Francisco and the University of Pennsylvania to assess MRI imaging modalities called diffusion tensor imaging and quantitative susceptibility mapping to determine if these can more objectively measure brain changes over time in patients with Parkinson‘s disease. Validation of such measures will be essential for identifying ways to slow the progression of symptoms in Parkinson‘s disease. I also 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.
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.
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; 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.