Departments

The Pediatric Movement Disorders Program was established to evaluate and treat children with dystonia, chorea, myoclonus, tremor, motor tics, stereotypies, and other paroxysmal disorders of movement. Dr. Nigel Bamford works closely with the Yale Child Study Center , the Yale Comprehensive Movement Disorders Program , and the Department of Neurosurgery to enhance clinical evaluation and available treatments. The clinic is located at Yale New Haven Hospital.

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.

We evaluate, diagnose, and manage children and young adults with problems involving the brain, spinal cord, peripheral nervous system, and muscular systems. Our highly trained physicians offer child-friendly, family-centered care and are experts in treating nervous system disorders including: Epilepsy and seizures Learning disabilities, including developmental delay, cerebral palsy, and dyslexia Headaches and migraines Migraine and other pain syndromes Movement and paroxysmal disorders Multiple Sclerosis and white matter disease Muscular Dystrophies, Guillain-Barre syndrome, and other nerve and muscular disorders Spinal cord disorders, including myelomeningocele and spinal muscular atrophy Stroke and other cerebrovascular disorders Our special services include: Comprehensive epilepsy evaluation, including inpatient combined electroencephalogram (EEG) to measure electrical activity in the brain and video monitoring for epilepsy Evaluation and management of full-term and premature infants with potential nervous system problems

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 cover all of the components critical to successfully managing patients with brain tumors. This includes comprehensive evaluation and diagnosis, genomic profiling of the tumor, leading-edge treatment options, follow-up, and psychosocial support. We welcome newly diagnosed patients as well as those who have already received extensive treatment elsewhere, along with patients in need of second surgeries or follow-up biopsies. We work closely with other Yale Medicine brain tumor doctors to provide a comprehensive, multidisciplinary approach that is patient-focused. Using advanced microsurgical techniques, including intraoperative neurophysiological monitoring and awake craniotomy (when appropriate), our brain tumor surgeons strive to achieve the maximum extent of tumor removal while preserving neurological function. Often, what is often deemed "inoperable" by some surgeons is considered operable at Yale with successful outcomes. We are the only hospital in the region to have MRI and angiography capabilities in our operating room. Yale New Haven Hospital also banks all tumor samples and performs genomic profiling to better understand tumor mutations. We use this information to help direct postsurgical therapy. Our state-of-the-art neurosurgical operating rooms in Smilow Cancer Hospital are the only in the regionto offer intraoperative MRI, intraoperative angiography, stereotactic surgical guidance, and operative brain mapping to precisely pinpoint brain tumors during surgery.These technologies, combined with our surgical expertise allow for the best in surgical care for patients. A team of experts dedicated to caring for patients with brain tumors, including specialized brain tumor surgeons, radiation oncologists, neuroradiologists, medical neuro-oncologists, neuropathologists, and other specialists meets weekly to arrive at the most advanced and appropriate treatment plan for each individual. Yale is one of the few centers capable of offering even more personalized and precise oncologic care, when appropriate, based on the genetic makeup of the individual’s tumor. Inquiries from referring physicians or directly from patients or their families are welcome. All inquiries are handled expeditiously by our team of experienced patient coordinators. Their role includes ensuring that appropriate appointments are made in a timely fashion, and coordinating with the various medical specialists involved in each treatment plan. New patients with brain tumors are usually seen within two or three days. Our patient coordinators also act as patient advocates, communicating with the various medical specialists contributing to the treatment plan. Through Yale’s strong tradition of and commitment to research, practitioners are well acquainted with the most advanced treatment methods and have access to clinical trials. Patients also benefit from the specialized resources at Smilow Cancer Hospital and Yale New Haven Hospital, such as an advance

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.

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.

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.

The Yale Pediatric Neuromuscular Program is Connecticut’s only pediatric multidisciplinary program and one of the only five in New England supported by the Muscular Dystrophy Association (MDA). Families of children with muscular dystrophy or other childhood neuromuscular disorders see a multidisciplinary team that includes a neurologist, pediatric cardiologist, pediatric pulmonologist, pediatric orthopedic surgeon, neuromuscular geneticist, pediatric physical and occupational therapist, pediatric psychologist, pharmacist, social worker, dietitian, and care coordinator. There is easy access to other relevant subspecialties such as endocrinology, gastroenterology, and general surgery. Here is a short list of various neuromuscular disorders seen in our clinic: Duchenne and Becker Muscular Dystrophy Spinal Muscular Atrophy Myotonic Dystrophy Limb Girdle Muscular Dystrophies Congenital Myopathies Congenital Muscular Dystrophy Metabolic Myopathies Mitochondrial Myopathies Dermatomyositis Myasthenia Gravis Congenital Myasthenic Syndromes Charcot Marie Tooth Disease CIDP and related disorders Other motor neuron disorders Spastic Paraplegia Arthrogryposis The program offers comprehensive diagnostic evaluations by a fellowship-trained and board-certified pediatric neuromuscular specialist and a neuromuscular geneticist, both with experience in pediatric neuromuscular diseases. State-of-the-art, comprehensive genetic testing, muscle biopsy, pediatric EMG (with or without sedation), and other diagnostic tools are available. We are the only center in the state that offers sedated pediatric EMG. Basic diagnostic imaging, pulmonary function tests, and echocardiography occur on-site. Cardiac MRI is available for our patients on the main campus. The state-of-the-art sleep laboratory is run by our pediatric pulmonologist. The program believes in a holistic and customized approach to caring for patients with various neuromuscular disorders. The program is located at Yale New Haven Children’s Hospital’s Pediatric Specialty Center at One Long Wharf Drive, which is a short drive from Yale New Haven Hospital and has ample free parking and easy access for impaired individuals. The program is recognized as an SMA (Spinal Muscular Atrophy) Care Center by CureSMA and offers all three FDA-approved treatments for SMA (Spinraza®, Zolgensma®, and Evrysdi®). A well-established Spinraza program runs in collaboration with Dr. Michele Johnson of Yale Interventional Radiology and is coordinated by Louise Lanouette, RN. We are the only center in Connecticut that provides access to Spinraza to patients of all ages. The program is also recognized as a Certified Duchenne Care Center by Parent Project Muscular Dystrophy (PPMD). We provide access to all FDA-approved treatments for Duchenne Muscular Dystrophy and other neuromuscular disorders, including gene therapy. The program participates in several clinical trials for Duchenne Muscular Dystrophy and Spinal Mus

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

Our Greenwich-based center offers state-of-the-art care for those suffering from voice and swallowing disorders. The Voice Center provides sophisticated and expert care to all of our patients, including professional and performing vocalists, public speakers, executives, teachers, and clergy as well as to those with more routine or recreational vocal aspirations. Individuals experiencing any of the following symptoms may benefit from an evaluation: raspy or hoarse voice, voice strain, voice spasms, reduced pitch range, voice pitch breaks, aging voice changes, difficulty swallowing, frequent throat clearing, or the sensation of a lump in one’s throat (globus sensation). Receiving the right diagnosis is the most important step on the road to vocal recovery. Our voice experts perform comprehensive evaluations utilizing the latest technologies, including laryngeal videostroboscopy, laryngeal electromyography (EMG), and vocal acoustics analysis software to ensure an accurate and precise diagnosis. Our patients receive coordinated care from a team of voice experts with advanced training in the full spectrum of voice and swallowing disorders. Each patient’s care is led by a laryngologist who works closely with a team of speech-language pathologists. Our laryngologists are Yale Medicine ENT (ear, nose, and throat) physicians with additional specialization in treating the larynx, voice, and related problems such as swallowing. Speech-language pathologists are clinically trained, state licensed, and certified (by the American Speech-Language Hearing Association) in voice and speech analysis. A voice rehabilitation regimen incorporates the principles of vocal hygiene, behavioral modification, circumlaryngeal massage, and alternative therapies. Using the latest technologies, including laryngeal videostroboscopy, our patients can visualize the mechanics of their own larynx in high definition and slow motion, allowing them to more fully understand treatment options and outcomes. We offer voice therapy (exercises) and medical management as an alternative to surgery whenever possible and appropriate. However, if a procedure or surgery is indicated, our surgeons use the most advanced and minimally invasive techniques. Our specialists from Yale Medicine offer several advanced treatments performed in the office. In-office procedures include KTP laser ablation, vocal augmentation injection, EMG (electromyography), and botulinum toxin (Botox®) injections. Patients benefit from effective same-day treatments that require local or no anesthesia. Above all, we treat our patients with dignity and compassion. Conditions we treat: Aging voice: age-related changes such as voice roughness, elevated pitch, and reduced projection or volume Laryngitis: inflammation of the larynx and vocal folds, usually causing hoarseness and sore throat Muscle tension dysphonia: hoarseness or discomfort from improper use of muscles around the larynx during speech or singing Spasmodic dyspho

Charcot Marie Tooth disease (CMT) is the name used to describe a group of inherited peripheral nerve disorders caused by a range of changes in the genes responsible for nerve function. Currently, there are more than 80 genes identified as potential causes of CMT. CMT can affect both children and adults and is one of the most common hereditary neurologic hereditary disorders, affecting 1 in 2,500 people. Patients with CMT experience nerve damage leading to sensory loss and changes in sensation, balance, and muscle strength, especially in the legs and hands. Depending on the genetic variant and other factors, the severity of symptoms may range from mild to severe. The Charcot Marie Tooth disease program at Yale was recognized by the CMT Association (CMTA) as one of forty CMTA Centers of Excellence worldwide. Multidisciplinary care of CMT patients is customized to patients’ needs and involves neurologists, orthopaedic surgeons, and physical and occupational therapists. Diagnosing neuromuscular disorders, including CMT, is a complex process involving neurologic examination and diagnostic testing, which often includes laboratory testing and electrodiagnostic evaluation with nerve conduction studies and needle electromyography. Genetic testing is used to identify the gene causing CMT. In recent years, the rapid development of technology allowed a wide expansion of genetic testing for diagnosing hereditary disorders (including CMT), which now helps us to find the cause of CMT in more than 70% of patients. An accurate diagnosis helps us to avoid unnecessary testing and potentially harmful treatments. Advances in research and understanding of hereditary neurologic disorders have also led to new therapies for genetic diseases that may help develop effective treatments for CMT. The CMTA Center of Excellence at Yale is led by neurologist and neuromuscular specialist Sasha Zivkovic, MD, PhD, and orthopaedic surgeon Irvin Oh, MD, who collaborate with physical and occupational therapists. A monthly CMT clinic will be held at the North Haven Yale campus, and care will be coordinated with Yale neuromuscular specialists who evaluate patients in New Haven, Greenwich, Guilford, and New London. The goal is to enhance the care of adult patients with Charcot Marie Tooth disease, improve their quality of life, and promote clinical research in the field. The program helps treat many patients with nonsurgical techniques, including bracing and physical and occupational therapies, and, if indicated, reconstructive foot surgery, which helps many people to stand, walk, and run without pain. During reconstructive surgery, the foot bones and muscles are repaired, so the feet do not turn inward. Correction of high arches and misshapen toes may restore flexibility and balance for natural foot movements without pain. The program will also promote clinical and translational research of hereditary neuropathies to advance the care and quality of life of CMT patients and their f