Epilepsy and EEG

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Welcome to the Yale Division of Epilepsy and EEG. The Comprehensive Epilepsy Center provides promising options for many adult and pediatric patients with epilepsy. Internationally known for clinical excellence and innovative research, this 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 treatment for medically intractable and new onset epilepsy. This multidisciplinary program includes epileptologists, neurologists, neurosurgeons, neuropsychologists, neuroradiologists, neuropathologists, and psychiatrists. Nurses, technicians, technical staff, and administrative staff complete the team. Outpatient facilities include an adult epilepsy monitoring unit, pediatric epilepsy monitoring unit, and a technologically advanced operating suite.

The program provides educational opportunities and training for physicians, students, patients and their families. Referring physicians can send patients for consultations, specific procedures or clinical trials, and comprehensive evaluations.

Faculty

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Lawrence Hirsch, MD

Division Chief

Professor of Neurology

Chief, Division of Epilepsy and EEG

Co-Director, Yale Comprehensive Epilepsy Center

Co-Director, Critical Care EEG Monitoring Program

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Hamada Hamid Altalib, DO, MPH

Assistant Professor of Neurology and of Psychiatry

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Christopher Benjamin, PhD

Assistant Professor of Neurology

Assistant Professor of Neurosurgery

Assistant Professor of Psychology

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Mary Best, PhD

Assistant Professor of Clinical Child Psychology

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Hal Blumenfeld, MD, PhD

Mark Loughridge and Michele Williams Professor of Neurology and Professor of Neuroscience and of Neurosurgery

Director, Yale Clinical Neuroscience Imaging Center (CNIC)

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Richard Bronen, MD

Professor of Radiology and Biomedical Imaging

Section Chief, Neuroradiology

Director for Faculty Affairs

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Franklin Brown, PhD, ABPP

Assistant Professor of Neurology

Chief, Division of Neuropsychology

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Paul Desan, MD, PhD

Assistant Professor of Psychiatry

Director, Psychiatric Consultation Service

Director, Yale Psychosomatic Medicine Fellowship

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Pue Farooque, DO

Assistant Professor of Neurology

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Jason Gerrard, MD, PhD, FAANS

Assistant Professor of Neurosurgery and of Neuroscience

Chief, Functional Neurosurgery

Chief, Trauma Neurosurgery, YNHH

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Clinical Staff

Candace Cardoza, RN

Pediatric Epilepsy Nursing

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Priscilla Crowder, LPN

Licensed Practical Nurse

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Carrie Erwin, LCSW

Staff Affiliate - YNHH

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Christie Fallon, RN

Staff Affiliate - YNHH

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Maria Fradiani, RN

Staff Affiliate - YNHH

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Stephanie Kane, RN

Epilepsy Program Manager

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Clinical Research Staff

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Jennifer Bonito

Research Associate 2

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Robert Duckrow, MD

Chief, Epilepsy Monitoring Unit

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Administrative Staff

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Carole Amarakoon, BA

Sr. Administrative Assistant

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Mary Jane Lyons

Staff Affiliate - YNHH

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Jessica Newkirk, BA

Senior Administrative Assisant

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Epilepsy faculty

About Us

The Yale Comprehensive Epilepsy Center provides promising options for many adult and pediatric patients. Internationally known for clinical excellence and innovative research, this 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 treatment for medically intractable and new onset epilepsy. This multidisciplinary program includes adult and pediatric epileptologists, neurosurgeons, neuropsychologists, neuroradiologists, neuroradiology and neuropathology within outpatient facilities that includes an eight bed adult epilepsy monitoring unit, two bed pediatric epilepsy monitoring unit, and a technologically advanced operating suite.

Neurologists work in collaboration with neurosurgeons and diagnostic imaging to deliver intensive and innovative therapeutic and diagnostic services to individuals with varying forms and degrees of seizures and epilepsy. Specialists perform intensive audiovisual and EEG monitoring for diagnosis and localization of the affected area. Patients worldwide are evaluated in phases to precisely determine concordance of electrophysiology, cognitive testing, history, physical and neurological examination with advanced imaging, using MRI, SPECT and PET techniques. Many advanced MRI techniques such as functional MRI, and diffusion tensor imaging are clinically performed on patients. Additionally, the National Institutes of Health supports several clinical research studies that build advanced imaging work in ultra-high field imaging, spectroscopic imaging and functional MRI to better understand complex epilepsy.

The combination of advanced clinical and research grade diagnostic techniques available at Yale is not duplicated by any other center in the U.S. Each patient is addressed individually to determine which procedure or combination of procedures—such as the use of multiple different kinds of electrodes—is appropriate in patients being considered for surgery.

The state-of-the-art operating room suite uses advanced methodologies that present multi-modal imaging data, intra-operative MRI, computerized stereotaxy and sophisticated electrophysiology in order to perform optimal, yet safe, resections and to place intracranial electrodes for those patients who need invasive electrophysiological confirmation of an epileptogenic region.

Yale conducts basic and clinical research in all areas; physiology, biochemistry, basic science, and imaging, making this one of the most progressive program in the country. Yale School of Medicine and Yale-New Haven Hospital are participating in a multi-center, FDA-approved feasibility clinical investigation of a responsive brain neurostimulator device for the treatment of epilepsy. The neurostimulator is designed to detect seizures in patients with epilepsy and to deliver mild electrical stimulation to suppress seizures before the patient has any symptoms. Also, Yale is part of a multi-institution consortium testing triggered deep-brain stimulation, a very new approach to treating uncontrolled epilepsy.

The Yale Comprehensive Epilepsy Center has been the leader in a multi-center study on long-term outcome of epilepsy surgery and has been recognized by the National Association of Epilepsy Centers as a Level 4 epilepsy center.

Level 4 epilepsy centers have the professional expertise and facilities to provide the highest level medical and surgical evaluation and treatment for patients with complex epilepsy.

Yale School of Medicine and Yale-New Haven Hospital are participating in multi-center trials that include a clinical trial for childhood absence epilepsy and an outcome of epilepsy surgery.

Several medical treatments are available to patients including antiepileptic drugs, ketogenic diet and other alternative treatments.

Research

The Yale Epilepsy Center is a world center of research into the causes and treatment of epilepsy. Our team of investigators includes over 20 primary faculty members at Yale, in addition to a large number of students, fellows, and other staff. Much progress has been made, but our investigators continue the effort to find a cure for epilepsy.

The faculty members and staff in the epilepsy program are engaged in both clinical and basic research studies. The Yale Epilepsy Program provides a unique environment where basic science studies that advance the scientific knowledge of epilepsy can be translated to clinical studies that benefit patients and their families. Our latest epilepsy research advances are discussed at an annual Research Retreat. To support our ongoing efforts to cure epilepsy, join our team, and make a gift towards epilepsy research.

Patient-oriented epilepsy research at Yale has led to major advances in the diagnosis and treatment of epilepsy. Yale was one of the first centers in the world to perform epilepsy neurosurgery, and remains at the forefront in developing innovative brain imaging methods, deep brain stimulation, other neurosurgical techniques, medication trials, and additional novel approaches. Ongoing projects are listed below.

Clinical Outcome Research PI Summary
Lyrica 12-Week Study of Visual Field Changes Pregabalin or Placebo Hamada Hamid Altalib, DO, MPH

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New Onset Refractory Status Epilepticus (NORSE) Lawrence Hirsch, MD

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Multicenter 1-Year Observational Study of Patients who are Initiating Brivaracetam Hamada Hamid Altalib, DO, MPH Summary
An Open-Label, Safety and Tolerability Study of Chronic Intermittent Use of Diazepam Buccal Soluble Film (DBSF) in Pediatric, Adolescent and Adult Subjects With Epilepsy. Hamada Hamid Altalib, DO, MPH

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Human Epilepsy Project 2 (HEP2): Resistant Focal Seizures Study Hamada Hamid Altalib, DO, MPH

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A Double-Blind, Placebo-Controlled, Inpatient, Dose-Ranging Efficacy Study of Staccato Alprazolam (STAP-001) in Subjects with Epilepsy with a Predictable Seizure Pattern Tappigraphy in Epilepsy Adithya Sivaraju, MD, MHA

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A Double-Blind, Placebo-Controlled, Inpatient, Dose-Ranging Efficacy Study of Staccato Alprazolam (STAP-001) in Subjects with Epilepsy with a Predictable Seizure Pattern Tappigraphy in Epilepsy Adithya Sivaraju, MD, MHA Summary
Long-Term Outcome of Epilepsy Surgery Pue Farooque, DO

This project is a prospective multimodal outcome study funded by NIH and based at Yale which includes 6 other sites, and follows the seizure, quality of life, cognitive and psychiatric outcomes of respective epilepsy surgery with standard interventions and instruments to measure those aspects of patient response. Ongoing analyses will focus on the interplay between these outcomes, predictors of outcomes, differences in procedures involving various cerebral locations, and other questions that can be addressed using this remarkable database. Individual diagnostic methods, for example MRI with standardized interpretation, or SPECT with ictal injection and co-registration and subtraction processing are part of the diagnostic evaluation, and their interpretation, inter-rater reliability, correlation with other localizing studies, and predictive value for pathology and outcome can be examined in this large contemporary surgical population.

Long-term Outcomes of Childhood-Onset Epilepsy Anne Berg, Ph.D.
Susan Levy, M.D.
Francine Testa, M.D.

We are engaged in a longitudinal study of children with newly diagnosed epilepsy, started in 1993. The first phase of the study concerned the prediction of remission, relapse, and intractability early in the course of the disorder. We have addressed several issues concerning the mid-term (5-10 years) seizure outcomes, mortality, status epilepticus, developmental and educational outcomes. We hope to provide information regarding: occurrence of later-appearing intractable epilepsy and the association with hippocampal volumetric measurements. We recently published a paper on the social, educational, behavioral, psychiatric and quality of life outcomes in young adults with childhood onset epilepsy related to seizure outcome. This information will be central to informing evaluation, treatment, management, and counseling approaches for children with epilepsy and their families.



Translational Research PI Summary
Computational Neurophysiology Laboratory Hitten Zaveri, PhD

The research efforts of the Computational Neurophysiology Laboratory (CNL) at Yale University broadly involve functional neurosurgery, cognitive neuroscience, and monitoring in OR and NICU settings. The primary focus of our research is to improve our understanding of epilepsy and the control of seizures. In our work on epilepsy we seek to:

  • Understand how seizure are generated
  • Improve our methodology for sensing, analyzing and controlling aberrant brain activity
  • Employ our knowledge of seizure generation, sophisticated continuous brain sensing methods, and advanced computational methods to:
  • accurately locate the seizure onset area in patients with partial epilepsy
  • detect and predict the onset of seizures and intervene to terminate or abort seizures once they have been detected or predicted
Our work is both highly translational and interdisciplinary. Projects in these various areas are being conducted through collaborations with investigators, in academia and industry, who are trained in, or are being trained in, multiple disciplines including neurology, neurosurgery, neurobiology, neuroscience, lab-medicine, pathology, physiology, biomedical engineering, electrical engineering, material science and mathematics.
For further information, contact Hitten Zaveri, Ph.D.
Laboratory Website: https://medicine.yale.edu/labs/cnl
NeuroPace Responsive Neurostimulator (RNS™) System Lawrence Hirsch, MD

NeuroPace Responsive Neurostimulator (RNS™) System
The Yale Epilepsy Program is participating in a clinical trial of responsive electrical stimulation of the brain as a treatment for intractable partial epilepsy using an implanted medical device. NeuroPace, Inc. is sponsoring this investigational device study of their Responsive Neurostimulator (RNS™) system. The NeuroPace RNS™ is designed to detect abnormal electrical activity in the brain and to deliver small amounts of electrical stimulation to suppress seizures before there are any seizure symptoms. The study is open to patients 18 years of age or older with partial onset seizures that are resistant or hard to treat using two or more antiepileptic medications. Candidates will continue to receive their epilepsy medications while participating in the trial.
Additional links: CenterWatchNational Library of Medicine.

MR Imaging of Epilepsy Ricahrd Bronen, M.D. This project involves the investigation of MR imaging of epilepsy i.e., MR imaging features of epileptogenic anomalies, with emphasis on cortical dysplasia. Using a systematic approach developed for interpretation of MR scans of seizure patients, we are performing prospective studies that will correlate MR imaging features with clinical and surgical characteristics.
Epileptogenic Tissue Localization using EEG-fMRI Todd Constable, Ph.D.
Hal Blumenfeld, M.D., Ph.D.

This proposal is aimed at further developing and understanding combined electroencephalography and functional magnetic resonance imaging (EEG-fMRI). The experiments are designed to improve our understanding of the relationship between MR measures of neuronal activity in the presence of epileptiform activity, and neuronal signatures of activity based on surface or depth recorded EEG.

Functional MRI for Neurosurgical Planning in Epilepsy Todd Constable, PhD Functional MR imaging (fMRI) has the potential to replace, or significantly enhance, the current methods used in Neurosurgical planning. It is noninvasive and has been shown to be able to localize cortical activity.
Bioimaging and Intervention in Neocortical Epilepsy James Duncan, Ph.D.
Todd Constable, Ph.D.
Dennis D. Spencer, M.D.

Magnetic resonance functional and spectroscopic imaging (fMRI, MRS) of the brain provides tremendous opportunities in the study and treatment of epilepsy. We will develop high resolution MRS and fMRI at 4T and advanced analysis and integration methods to better define the epileptogenic tissue and surrounding regions, and enhance our understanding of the biochemical mechanisms underlying the dysfunction in neocortical epilepsy.

Energy and Metabolism in Temporal Lobe Epilepsy

Xenophon Papademetris, PhD
Dennis D. Spencer, M.D.

Energy and Metabolism in Temporal Lobe Epilepsy
A variety of metabolic imaging studies, including FDG PET and MRS, have suggested metabolic and energy deficiencies in epileptogenic regions of certain symptomatic epilepsies.
Multimodal Clinical Image Co-Registration in Epilepsy Hal Blumenfeld, MD, PhD
Xenophon Papademetris, PhD

BioImage Suite is an integrated image analysis software suite developed at Yale. It uses a combination of C++ and Tcl in the same fashion as that pioneered by the Visualization Toolkit (VTK) and it leverages both VTK and the Insight Toolkit. It has extensive capabilities for both neuro/cardiac and abdominal image analysis and state of the art visualization.
Additional Links:Yale Bioimage Suite

Brain Microdialysis and Stimulation in Epilepsy Tore Eid, MD, PhD
Dennis Spencer, M.D.
Ognen Petroff, M.D.

Major goal in our laboratory is to elucidate the neurochemical mechanisms underlying epilepsy using brain microdialysis, intracranial electrode recording and stimulation in conscious neurosurgical epilepsy patients. We are also interested in the neurochemical and electrophysiological changes during cognitive processing, sleep, and in the effects of sex steroids on brain neurochemistry. HPLC is used to analyze the microdialysate samples obtained from the human brain for several neurotransmitters and neurometabolites. Another line of research is to study the effects of direct brain stimulation on neurotransmitter dynamics and brain excitability in order to develop better treatments for brain disorders such as refractory epilepsy and depression. The work involves close collaboration between the departments of neurosurgery, neurology and psychiatry.

Molecular and Neuropathological Studies of Human Seizure Foci Name

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Seizure Awareness Hal Blumenfeld, MD, PhD

This study aims to examine the extent to which epilepsy patients are aware of their seizures as well as describe factors that account for differences in seizure recall and reporting observed across patients. Included among these factors are seizure type, hemisphere and lobe of origin, and impairment of consciousness. Determining the relationship between these factors and seizure reporting will help to determine the accuracy of patient self-reporting, which will in turn assist in treatment of epilepsy.

Absence Epilepsy, Attention and fMRI Hal Blumenfeld, MD, PhD

The mechanisms for impaired attention in absence epilepsy are not known. To determine how human brain networks are affected by absence seizures we perform simultaneous fMRI and EEG recordings in patients during absence seizures. We explore which regions are involved in maintaining human consciousness by examining the areas of the brain that are impaired during seizures. We also make recordings during normal human consciousness, which allows us to investigate how and where the brain moderates’ changes in attention, in both the short and long term. The aim of this work is to gain a better and more complete understanding of the mechanisms of normal and impaired attention in humans.

Virtual Reality to Test Driving Safety in Epilepsy Hal Blumenfeld, MD, PhD

Our research study uses virtual reality driving simulation during video/EEG monitoring to learn more about driving safety in patients with epilepsy. One of the most devastating aspects of epilepsy is its effects on patients’ ability to drive. Some suffer motor vehicle accidents when they have seizures, and many others are prevented from driving for months or years at a time by state laws, doctors’ advice or fear of crashing. Given the risks, patients who show signs of epilepsy in EEG monitoring, but have had no seizures for a while, are not allowed to drive. The goal of our research is to determine how epileptic seizures affect driving performance, and to learn which brain regions lead to impaired driving safety during and following seizures. We are also examining whether we can predict the severity of patient’s seizures from their EEG recordings, allowing us to explore what types of seizures lead to impaired behavior. Our hope is that this research will provide useful information for clinicians when discussing driving risk with their patients. Knowledge of the brain networks affected when driving safety is impaired can also lead to treatments which prevent this problem. This will enhance safety, prevent injuries, and improve the quality of life for patients with epilepsy by providing clarity on risks associated with their condition.

Nuclear Medicine Imaging in Epilepsy Hal Blumenfeld, MD, PhD

Our nuclear imaging analysis team has developed novel methods for analyzing single photon emission computed tomography (SPECT) and positron emission tomography (PET) images in epilepsy patients. Improved methods of analyzing blood flow during seizures with SPECT has helped pinpoint seizure onset for surgical planning. The latest method developed by our group is Ictal-interictal SPECT Analyzed by SPM (ISAS). In addition, our group has developed novel methods for detecting the uncoupling of blood flow and metabolism in seizure generating regions of the brain using SPECT/PET ratio imaging.

PET Imaging of SV2 channels Richard Carson, PhD

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Basic Research PI Summary
Neuroimaging and Physiology of Generalized Seizures in Animal Models Hal Blumenfeld, MD, PhD

What changes in the brain’s activity cause a person to have a seizure? Our research using high field fMRI, electrophysiology, and behavioral data from animal models aim to shed light on this critical question. We look at activity in cortical and subcortical networks around and during multiple types of generalized seizure, and identify specific neuronal populations and patterns of activity that cause the behavioral symptoms of epilepsy. Highlighting these cells, and the intracellular components that dictate their activity, is crucial for understanding the mechanisms by which seizures are generated, and for the development of targeted therapies with better efficacy and fewer side effects.
For further information, contact Hal Blumenfeld, M.D., Ph.D.

K channels in epilepsy Imran Quraishi, MD, PhD

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Multicenter 1-Year Observational Study of Patients who are Initiating Brivaracetam Hal Blumenfeld, MD, PhD Summary
Networks for Impaired Consciousness in Focal Seizures Hal Blumenfeld, MD, PhD

Focal seizures with impaired consciousness critically reduces quality of life in patients with temporal lobe epilepsy. Using an animal model, we aim to determine how focal seizures affect the brain networks and neuronal mechanisms causing impaired consciousness. Using various techniques such as electrophysiology recording, optogenetic, imaging or neuroanatomical tracing our research presents functional and anatomical evidence that focal seizures initiated from the hippocampus may lead to subcortical arousal inhibition that contributes to cortical depression. Understanding the neuronal networks for impaired consciousness in focal seizures may lead to more therapeutic options to treat this disorder. For further information, contact Hal Blumenfeld, M.D., Ph.D.

Consciousness in Focal Seizures Hal Blumenfeld, MD, PhD

The sudden and unexpected impairments in conscious awareness during and following seizures has a major negative impact on quality of life for patients with epilepsy. Recent clinically-applicable techniques in neuromodulation, such as deep brain stimulation (DBS) and responsive neurostimulation, provide a unique opportunity to reverse or prevent impairments in consciousness associated with seizures. Disorders of consciousness other than epilepsy have long been known to arise from dysfunction of subcortical-cortical arousal circuits. Recent research has shown that transient impaired consciousness in temporal lobe epilepsy also depends on subcortical-cortical arousal, including intralaminar thalamic nuclei. Translational studies further demonstrate depressed intralaminar thalamic function in limbic seizures and thalamic stimulation has the potential to restore physiological and behavioral arousal in the ictal and postictal periods. We continue to research novel sites for intracranial stimulation to reverse or prevent loss of consciousness associated with the ictal and post-ictal periods with combined techniques in electrophysiology, functional neuro-imaging, and behavioral testing. These translational research projects support on-going efforts to investigate the effects of neurostimulation to prevent loss of consciousness in humans through clinical trials.

Ongoing epilepsy clinical trials at Yale currently open to patient enrollment:

  • NeuroPace Responsive Neurostimulator (RNS™) System
  • Childhood Absence Epilepsy Rx PK-PD-Pharmacogenetics Study
  • Seizure Awareness Study
  • First Seizure Clinic
  • Topiramate in Infants with Partial Epilepsy
  • Anticipating Seizures in Epileptic Networks
  • Pediatric Epilepsy Neuroimaging Research
  • Study of Impaired Attention in Absence Epilepsy through fMRI
  • A Randomized, Controlled Trial of Ganaxolone in Adult Uncontrolled Partial-Onset
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Our History

Learn more about our history.

Learn more about those we hold in memoriam.

Contact Us

Adult and Pediatric Epilepsy Service

For all patient-related issues including appointments, medical records, prescriptions, directions, etc., please contact us at (203) 785-3865.

Epilepsy Administration

For all other matters including academics, administration, etc., please contact Carole Amarakoon at (203) 737-5098.


Email can be sent to epilepsy@yale.edu

Fellowships

For more information on fellowships please visit the neurology fellowships page.
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We are leaders in innovative surgery for medically intractable epilepsy.

Call Us at: 203-785-4085