Departments

Yale’s Department of Neurology has been at the forefront of cutting-edge clinical care and scientific discovery since it began in 1952. It was Yale scientists who discovered the genes that cause Multiple Sclerosis. Yale housed one of the first epilepsy monitoring units in the country, and one of the first stroke centers at its partner, the Veterans Affairs (VA) Center in West Haven. Today, our team of experienced doctors are committed to understanding and treating the entire spectrum of nervous system diseases. Expert physicians specialize in brain and nerve health for both children and adults. Specialized care is offered in the following areas: Amyotrophic lateral sclerosis (ALS), myasthenia gravis, peripheral neuropathy, neuromuscular disorders Alzheimer’s disease/cognitive disorders Epilepsy and neurophysiology General neurology, headache, pain Multiple sclerosis and neuroimmunology Neurodegenerative disorders Neurocritical care Neurological infections Neuro-oncology Parkinson’s disease and movement disorders Stroke and vascular neurology

At Yale Medicine Neurosurgery, we care for adults and children with neurological disorders of the central and peripheral nervous system. These types of conditions affect the brain, spinal cord, and nerves which send messages from brain to the rest of your body. Our team is comprised of highly trained surgeons, researchers, and clinicians who are all focused on delivering expert care for conditions related to the brain and spine. Each neurosurgeon on our team has extensive training in their respective areas of neurosurgery. Conditions we treat include: All types of primary brain tumors, including gliomas, glioblastomas, and meningiomas Brain and spine trauma Cerebrospinal fluid disorders (such as normal pressure hydrocephalus) Epilepsy Metastatic brain, spine, and spinal cord tumors Movement disorders (including Parkinson's disease and tremors) Neurovascular disease (aneurysms, arteriovenous malformations, ischemic and hemorrhagic stroke, and carotid artery stenosis) Pain disorders (such as trigeminal neuralgia) Pediatric and congenital disorders (including hydrocephalus, craniosynostosis, spina bifida, and congenital spine deformities Peripheral nerve syndromes (such as carpal tunnel syndrome) Pituitary tumors (adenomas) Spasticity (including multiple sclerosis) Spinal disorders (such as herniated disks, stenosis, and scoliosis)

The recurrent seizures that herald epilepsy come from sudden, temporary disturbances in the normal function of the brain’s electrical system. While many people with epilepsy can be successfully treated with anti-epileptic drugs that provide partial or complete control over seizures, many do not respond to medication, or even a combination of multiple medications. As a result, they may experience catastrophic epileptic seizures daily, making any semblance of a normal life impossible. At Yale, we offer promising options for many of these patients. Our experts are world-renowned, specializing in the treatment of new-onset epilepsy in children and adults, as well as medically intractable seizure disorders. Our Epilepsy and Seizure Center was one of the first of its kind, and we continue to lead the way as one of the most advanced and active programs in the world. More epilepsy surgeons around the country received their training at Yale than at any other program in the country. We see both children and adults for second opinions, diagnostic evaluation, and first-time seizures. We provide treatment recommendations for all types and severity of epilepsy or possible epilepsy. Our multidisciplinary team includes epileptologists, neurologists, neurosurgeons, neuropsychologists, neuroradiologists, neuropathologists, and psychiatrists. Nurses, technicians, technical staff, and administrative staff are also key players in patient care.Our neurologists work in collaboration with neurosurgeons and diagnostic radiologists to deliver intensive and innovative therapeutic and diagnostic services for patients with varying forms and degrees of seizures and epilepsy. Specialists perform intensive audiovisual and EEG monitoring for diagnosis and localization of the affected area. We evaluate our patients in phases to precisely coordinate electrophysiology, cognitive testing, medical history, and physical and neurological examination with advanced imaging using MRI, SPECT, and PET techniques.

Movement disorders can be caused by diminished or slowed voluntary movements (hypokinetic) or increased involuntary movements (hyperkinetic).Parkinson’s disease is the most common of these hypokinetic degenerative disorders, but we also treat progressive supranuclear palsy (PSP), multiple system atrophy (MSA) and corticobasal ganglionic degeneration. Our expertise in hyperkinetic disorders includes Huntington’s disease, Tourette’s syndrome, essential tremor, and dystonia. We diagnose and treat all movement disorders, whether they are caused by primary nervous system dysfunction or by strokes or medications. Our team has expertise in tremor disorders, primary and secondary ataxias, gait disorders, restless legs syndrome, and stiff-person syndrome.

At the Yale New Haven Stroke Center, we offer safe, effective, patient-centered, timely, efficient, and equitable care to patients with strokes. In collaboration with the hospital’s emergency medical service and emergency department teams, we deliver rapid diagnosis and treatment of acute stroke 24 hours each day. Our center is a Joint Commission Primary Stroke Center, a national recognition of our expertise in providing the highest level of care to stroke patients. From prevention to treatment to recovery, we have the most experienced doctors and the latest diagnostic tools, techniques, and treatments. Our patients receive rapid access to treatment by a highly experienced team that includes experts in vascular neurology, endovascular surgical neuroradiology, neurovascular surgery, neurocritical care, physical medicine and rehabilitation, emergency medicine, and other medical subspecialties. Our multidisciplinary team works together to diagnose and determine the most appropriate treatment for our patients. Timely, effective treatment can make a significant difference in quality of life following recovery. We follow best practices to try to preserve brain function and prevent serious injury. Our services include: Dedicated neuro-intensive care unit Stroke consult service with a patient- and family-centered approach to the treatment and rehabilitation of patients with cerebrovascular disease. Specialized stroke clinics for community physician referrals, stroke consults, and for primary and secondary stroke prevention.

Internationally known for clinical excellence and cutting-edge research, we provide promising treatment options for adult and pediatric patients. Our program was one of the nation's first, and has evolved into one of the most active and advanced in the world.Yale is internationally recognized as a leader in innovative treatment for medically intractable and new onset epilepsy. We treat patients in outpatient settings, at a six-bed adult epilepsy monitoring unit, a two-bed pediatric epilepsy monitoring unit, and a technologically advanced operating suite. We are also equipped with state-of-the-art technology for continuous brain and video monitoring of seizures in children and infants. We evaluate patients in phases to precisely determine concordance of electrophysiology, cognitive testing, history, as well as physical and neurological examination with advanced imaging, using MRI, SPECT, and PET techniques. Doctors treat each surgical patient as an individual, determining which procedure or combination of procedures is appropriate.

Yale Cancer Center is Connecticut's only cancer center designated as a Comprehensive Cancer Center by the National Cancer Institute—and one of only 57 in the nation. The significance of this designation has profound implications for those who choose Smilow Cancer Hospital as the place where they will be cared for and receive treatment for their cancer. National Cancer Institute cancer centers are national leaders in cancer research, prevention, detection, and treatment. This provides patients at Smilow Cancer Hospital with novel treatment options and expert care.

Our expert neurosurgeons specialize in utilizing Deep Brain Stimulation, or DBS, to restore function and quality of life in patients with all types of movement disorders, including Parkinson’s disease. We are the only DBS program in the tri-state area capable of performing all types of DBS implantation surgery, including asleep, frame-based, and frameless DBS. Our state-of-the-art operating room suite offers the accuracy of a powerful 3T MRI. Faulty pathway signals in the parts of the brain that control movement are at the root of many movement disorders. Previous surgical methods (such as ablation) destroyed brain tissue to eliminate the problematic signals. Instead, in DBS, the first procedure involves placing an electrode in the brain. Then, in a second procedure, surgeons connect the electrode to a tiny electrical generator implanted in the chest or abdomen. The generator delivers an electrical current to the area of the brain responsible for the symptoms and blocks them. While DBS is not a cure for movement disorders, it can substantially easesymptoms and decrease the number of necessary medications, limiting side effects and improving quality of life. DBS can also be effective for other conditions, including: Tremor:DBS has proven very effective in controlling and eliminating certain types of tremor. DBS is FDA-approved for the treatment of essential tremor and also helpful for a range of other tremor types. Dystonia:Select patients with severe dystonia have found significant benefit with DBS therapy. Patients with DYT1-positive dystonia have had good responses with this FDA-approved treatment. The effectiveness of DBS varies on the primary or secondary nature of the disease. We thoroughly review each patient to determine the potential benefit. Neuropsychiatric disease:Neurosurgery has long used techniques that destroy brain tissue to treat neuropsychiatric conditions. Today, we are exploring and expanding the use of nondestructive neuron-augmentation for psychiatric disorders, including depression and obsessive-compulsive disorder (OCD). DBS has been helpful for select patients with severe OCD. The use of DBS to treat other neuropsychiatric disorders, such as major depressive disorder and Tourette’s syndrome, is currently being studied, with promising results.

The Chênevert Family Brain Tumor Center at Smilow Cancer Hospital and Yale Cancer Center is an internationally recognized leader in comprehensive and multidisciplinary clinical care, and a hub of excellence for brain tumor research. Our team of specialists is dedicated exclusively to the care of patients with all types of brain tumors, and has extensive experience with: Primary brain tumors, such as glioblastomas, astrocytomas, oligodendrogliomas, primary CNS lymphomas, and others Brain metastases and leptomeningeal metastases, which originate from other cancers in the body Other primary tumors, such as meningiomas and schwannomas Rare brain tumors including craniopharyngiomas, medulloblastomas, ependymomas pineal tumors, pituitary tumors, and others All types of neurological complications of cancer and their treatments Our expertise covers all critical components for successful care for patients with brain tumors, from comprehensive diagnostic evaluation and state-of-the-art genomic tumor profiling, to innovative treatment options and cutting-edge clinical trials. We treat all patients, whether they are newly diagnosed or have already received extensive treatment. Our expert physicians are readily available to offer second opinions for patients from all over the country, and rapidly accommodate our patients for prompt evaluation and initiation of care. We also offer an extensive program to improve patients’ quality of life before, during, and after treatment, including psychosocial support, rehabilitation for memory impairment, and other resources. Diagnosis Our experts use state-of-the-art technology to diagnose brain tumors with detailed accuracy. Three Tesla MRIs offer highly sophisticated testing, such as functional MRI, MR spectroscopy, and positron emission tomography (PET). Experienced neuroradiologists read all brain scans and evaluate the images for diagnosis. Importantly, all brain tumors that are biopsied or removed at our program undergo whole exome sequencing, the most advanced technique available for tumor characterization, which can target the vulnerabilities of individual tumors. Medical Oncology Many brain tumors require chemotherapy, targeted therapies, or other medical treatments, often combined with radiation therapy and surgery. Our team of neuro-oncologists have extensive expertise in delivering oncology treatments, with a focus on achieving optimal efficacy and safety. Each patient receives an individualized and coordinated treatment plan, taking into consideration the tumor type, molecular and genomic information on the tumor, and the patient’s own needs and choices. Additionally, our patients have access to cutting-edge Yale clinical trials exploring multiple novel strategies to fight brain cancer. Radiation Oncology Established in 1958 as one of the first Radiation Oncology departments in the country, the Yale Department of Therapeutic Radiology has played a foundational role in the national development of

Commonly referred to by one of its brand names, Botox®, Botulinum toxins are widely known as a treatment for wrinkles, but can also help manage dystonia and other movement disorders. Our faculty are skilled in both EMG and non-EMG guided therapies for tremor, spasm, tic disorder, excessive salivation, and hyperhidrosis.

We are dedicated to delivering expert primary and referral services for all disorders of the peripheral nerves and muscles. Our program is supported by the Muscular Dystrophy Association (MDA). As a tertiary referral site for complex neuromuscular conditions, we serve as consultants to general neurologists, internists, and many other specialists. We specialize in: ALS (amyotrophic lateral sclerosis or Lou Gehrig’s disease) Myasthenia Gravis Myopathy (including polymyositis, dermatomyositis, inclusion body myositis) Neuropathy (CIDP, CMT and other inherited neuropathies, Guillain-Barré, diabetic neuropathy) Muscular Dystrophy (including FSH, Duchene, Becker, Limb-Girdle, Myotonic, Oculopharyngeal) Stiff-Person Syndrome and related disorders Our neurologists have advanced training in neuromuscular disease and electromyography (assessing electrical activity in muscle). They have specialized knowledge in the science, clinical evaluation, or clinical management of disorders that affect cells in the central and peripheral nervous systems, muscles, and the junction between them. They offer greater expertise in the origin, mechanisms, diagnosis, and treatment of these disorders than general neurologists. Our electromyographers have expertise in assessing electrical activity in muscle and nerve conduction studies. We are one of the few programs in the Northeast with several electromyographers, who are expert in a specialized technique called single fiber EMG to test for myasthenia gravis. Our neuromuscular group works together as a team that includes medical assistants, clinical nurse coordinators, an MDA coordinator, resident staff, fellows, and attending physicians. Please bring the following items: A copy of your medical records pertaining to your condition, which should include MRIs, nerve conduction studies, and other testing and/or imaging available A current list of all medications and any allergies to medications Name and address of your primary care physician and any other specialists Your first visit will entail a comprehensive evaluation, and you will be asked for a detailed history of your condition. We will complete a thorough neurological examination, after which we will develop a plan of care. We will inform you if additional testing is needed, make recommendations regarding adjustments to current treatment regimens, or refer you to other physicians or consultants. The term EMG is often used to refer to both electromyography and nerve conduction studies. Electromyography is the technique of assessing the health of muscles. Nerve conduction studies assess the health of nerves. Together these techniques are used to investigate and diagnose the entire spectrum of neuromuscular disorders. Our electomyographers use the latest EMG equipment to perform all available specialized EMG techniques, including Quantitative EMG, Blink Reflex, Single Fiber EMG, and others. We use a specialized type of nerve conduction study, called the Jolly

We evaluate and treat all neurological conditions, and make sure patients are seen by appropriate subspecialists within the Department of Neurology to provide the best possible care. The Yale Headache and Facial Pain Center specializes in the diagnosis and treatment of headaches and facial pain in adolescents and adults. The Lumbar Puncture Clinic provides analysis to physicians for conditions related to spinal fluid abnormalities. We perform routine testing of cerebral spinal fluid, as well as more specialized testing for demyelinating disease, neoplasms, inflammatory conditions, and infections. We also provide large-volume spinal taps for the diagnosis of normal pressure hydrocephalus. The Neurology Urgent Access Clinic provides expedited evaluation of patients seen in the emergency room as well as those referred from physicians requiring an urgent assessment.