Dale C Hesdorffer

CUNY Graduate Center, New York City, New York, United States

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Publications (115)633.54 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: Historically, epilepsy has been ignored by the public health community, despite the fact that there are more than 2 million people with epilepsy in the United States. Although epilepsy affects 1 in 26 people during their lifetime, the general public lacks basic knowledge and holds misperceptions about epilepsy that contribute to its associated stigma. Consequently, people with epilepsy continue to fare poorly, with lower physical, mental, and social well-being.Recently, the 2012 Institute of Medicine (IOM) report Epilepsy Across the Spectrum: Promoting Health and Understanding inspired a new sense of enthusiasm in the epilepsy community that can serve as a catalyst to change public perceptions about epilepsy. To erase stigma, the IOM committee made recommendations in two areas: (a) informing the media and (b) coordinating public awareness. The committee also identified eight key messages about epilepsy that the public should know. Health promotion and education professionals can play a critical role in disseminating these messages to the general public in their local communities and supporting interventions and policies to change the face of epilepsy.
    Health Promotion Practice 03/2014;
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    ABSTRACT: To investigate the cumulative probability of death and the standardised mortality ratio (SMR) in an adult drug-resistant epilepsy (DRE) population. In two separate centres during 2003-2006, we identified a total of 433 patients with DRE defined as at least one seizure per month and failure of at least two antiepileptic drugs. These patients were subsequently followed for a total follow-up of 6 years. We examined the cumulative probability of death, using Kaplan-Meier methodology, and the SMR based on mortality data from the Social Security Death Index. Clinical predictors of death were evaluated using Cox regression analysis. The cumulative probability of death was 8.7% (95% CI 6.2% to 12.1%) at 6 years. The overall SMR was 2.4 (95% CI 1.7 to 3.3). It was 3.1; 95% CI 2.0 to 4.6 in subjects with remote or progressive aetiology and 1.7; 95% CI 0.8 to 2.8 in subjects with unknown aetiology. The SMR was significantly increased in those with a known remote aetiology (2.5; 95% CI (1.4 to 3.8)). Older age at enrolment and symptomatic generalised epilepsy syndrome were significant predictors of death. Mortality is increased in this drug-resistant population; largely driven by those with a known epilepsy aetiology. The increased mortality remains even after exclusion of those with a progressive aetiology. Previous studies of incident epilepsy cohorts revealed increased mortality that declines to near-normal levels after the first several years, but in our DRE cohort, mortality remains elevated despite a median duration of epilepsy of 25 years at study entry.
    Journal of neurology, neurosurgery, and psychiatry 02/2014; · 4.87 Impact Factor
  • Torbjörn Tomson, Dale C Hesdorffer
    The Lancet 02/2014; 383(9916):510. · 39.06 Impact Factor
  • Epilepsia 01/2014; · 3.96 Impact Factor
  • Epilepsy & Behavior 01/2014; · 1.84 Impact Factor
  • Epilepsy & Behavior 01/2014; · 1.84 Impact Factor
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    ABSTRACT: On April 30th, 2011 the National Institute of Neurological Disorders and Stroke (NINDS) held a workshop to identify key problems in recent epilepsy clinical trials and propose approaches to address the barriers that impede development of new therapeutic options for epilepsy. Preliminary recommendations were made for selection criteria for subjects entered into epilepsy trials that maximize the scientific impact of the trial and increase the ability to recruit appropriate subjects efficiently and safely. These recommendations were further refined by the authors following the workshop, and subsequently shared with all NINDS workshop participants and with the participants of the 2011 AED XI workshop on epilepsy trials (approximately 200 participants) for further comment. The working group agreed to a final set of criteria that include updated considerations of subject age, clinical semiology, EEG and imaging results, use of prior and current therapies, co-occurring conditions, and suicidality, among others.
    Epilepsy research 01/2014; · 2.48 Impact Factor
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    ABSTRACT: Purpose To determine the prevalence of active epilepsy in two southeastern rural Kansas counties. Methods Medical records were abstracted from the emergency rooms, out- and inpatient services and clinics of 9 hospitals, from 10 doctors’ offices, and 1 nursing home in and surrounding the two counties. Letters were mailed from hospitals and doctors’ offices to invite their potentially eligible patients to participate in an interview. Medical record information and the interview, when available, were used for the final determination of active epilepsy, seizure type, etiology, syndrome, age, and gender in consensus conferences. Prevalence of epilepsy was calculated, and capture-recapture methodology, which estimates prevalence based on what is known about the population, was employed to assess active epilepsy in the two counties. Results This study identified 404 individuals with active prevalent epilepsy who visited at least one of the 20 facilities during the observation period. The overall prevalence of active epilepsy was 7.2 per 1,000. The seizure type for 71.3% of prevalent cases was unknown; among the 76 cases with known and classifiable seizure type, 55.3% had focal with secondary generalized seizures. Among the 222 cases with classifiable etiology, 53.1% were idiopathic/cryptogenic. About 75% (n = 301) were captured at only one center, 72% (n = 75) of the remaining 103 patients were captured at two centers, and 28 patients were identified at three or more centers. The capture-recapture assessment yielded an estimation of 982 prevalent patients. The overall estimated prevalence of epilepsy in the two Kansas counties using capture-recapture was 17 per 1,000 population. Conclusions The crude prevalence of epilepsy, using medical record survey methods, was similar to, but on the high end, of other total population prevalence studies in the United States. The capture-recapture assessment suggested that epilepsy prevalence may be considerably higher than the crude prevalence.
    Epilepsy research 01/2014; · 2.48 Impact Factor
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    ABSTRACT: Psychiatric disturbance is common and disabling after traumatic brain injury (TBI). Few studies have investigated the trajectory of psychiatric symptoms in the first 6 months post injury, when monitoring and early treatment might prevent persistent difficulties. The objective of this study was to examine the trajectory of psychiatric symptoms 1-6 months post TBI, the patient/ injury characteristics associated with changes, and characteristics predictive of persisting symptoms. A secondary analysis was performed on data from a clinical trial with 3 data collection points. Across 8 centers, 872 participants with complicated-mild to severe TBI were administered the Brief Symptom Inventory (BSI) at 30, 90, and 180 days post injury. Mixed effects models were used to assess longitudinal changes in the BSI Global Severity Index (GSI). Multivariate logistic regression was used to assess predictors of clinically significant GSI elevations persisting to 6 months post TBI. In general, GSI scores improved over time. Women improved faster than men; race/ ethnicity was also significantly associated with rate of change, with Hispanics showing the most and African Americans the least improvement. Clinically significant psychiatric symptoms (caseness) occurred in 42% of the sample at 6 months, and >1 type of symptom was common. Significant predictors of caseness included African American race, age from 30-60 years, longer post-traumatic amnesia (PTA) duration, pre-TBI unemployment, and pre-TBI risky alcohol use. Findings indicate that psychiatric symptoms are common in the first 6 months post TBI and frequently extend beyond the depression and anxiety symptoms that may be most commonly screened. Patients with longer PTA and pre-injury alcohol misuse may need more intensive monitoring for symptom persistence.
    Journal of neurotrauma 11/2013; · 4.25 Impact Factor
  • James M Noble, Dale C Hesdorffer
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    ABSTRACT: Sport-related concussion (SRC) is a common mild traumatic brain injury among young, active individuals, affecting approximately 300,000 young American adults annually. In this review of the epidemiology of SRC, we describe the challenges in identifying concussion occurrence and review the studies describing concussion incidence in various sports. In high risk contact sports, American football, soccer (European football), hockey, lacrosse, and basketball athletes experience concussion unintentionally during the course of play. Among these, football concussion incidence is reviewed in greatest detail because it has the highest incidence among the contact sports, and some studies have shown long-term neurophysiologic and neurodegenerative outcomes. Mechanisms of injury differ significantly by sport and can be potential targets for concussion risk mitigation. Despite the apparent high incidence of SRC, risk factors determining initial concussion, recovery periods, recurrence, and long-term outcomes remain poorly understood and warrant further study exploring the influence of age, sex, genetics, and athletic factors.
    Neuropsychology Review 11/2013; · 6.42 Impact Factor
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    ABSTRACT: We evaluated several commonly used screening instruments for the detection of mood disorders, anxiety disorders, and attention-deficit hyperactivity disorder (ADHD). These were compared to a criterion-based standardized questionnaire, the Diagnostic Interview Survey (DIS)-IV, designed to make DSM-IV-TR diagnoses in the community-based study of childhood-onset epilepsy. The DIS-IV was administered to young adult cases with epilepsy at a 15-year follow-up assessment and compared to symptom screens administered at the same visit, and at a previous 9-year assessment. Among cases, the specificity of the DIS-IV ranged from 0.77 to 0.99 and the predictive value of a negative psychiatric diagnosis was similarly high. Sensitivity was lower, ranging from 0 to 0.77, with correspondingly low predictive value of a positive diagnosis. Symptom-based instruments assess current symptom burden and are useful for determining associations with ongoing seizures or quality of life. Criterion-based standardized interviews, such as the DIS-IV, provide psychiatric diagnoses over the lifetime, which is most useful in studies of epilepsy genetics and studies of comorbidities and prognosis of epilepsy.
    Epilepsy & Behavior 11/2013; · 1.84 Impact Factor
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    ABSTRACT: Because some recent studies suggest increased risk for suicide-related behavior (SRB; ideation, attempts) among those receiving antiepileptic drugs (AEDs), we examined the temporal relationship between new AED exposure and SRB in a cohort of older veterans. We used national Veterans Health Administration databases to identify veterans aged ≥65 years who received a new AED prescription in 2004-2006. All instances of SRB were identified using ICD-9-CM codes 1 year before and after the AED exposure (index) date. We also identified comorbid conditions and medication associated with SRB in prior research. We used generalized estimating equations with a logit link to examine the association between new AED exposure and SRB during 30-day intervals during the year before and after the index date, controlling for potential confounders. In this cohort of 90,263 older veterans, the likelihood of SRB the month prior to AED exposure was significantly higher than in other time periods even after adjusting for potential confounders. Although there were 87 SRB events (74 individuals) the year before and 106 SRB events (92 individuals) after, approximately 22% (n = 16) of those also had SRB before the index date. Moreover, the rate of SRB after AED start was gradually reduced over time. The temporal pattern of AED exposure and SRB suggests that, in clinical practice, the peak in SRB is prior to exposure. While speculative, the rate of gradual reduction in SRB thereafter suggests that symptoms may prompt AED prescription.
    Neurology 10/2013; · 8.25 Impact Factor
  • Emily B Leaffer, Veronica J Hinton, Dale C Hesdorffer
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    ABSTRACT: To determine whether first febrile seizure (FS) has detrimental effects on development, 159 children (aged 6months to 5years) with FS were compared to 142 controls on measures of cognition, motor ability, and adaptive behavior. Participants were identified through the emergency department in an urban, low-income community. Children were evaluated within one month of the ED visit and one year later, and difference in performance over one year was examined. Performance did not differ between cases and controls on measures of cognition (baseline: p=0.5, one year: p=0.2, change over time: p=0.1) or motor skills (baseline: p=0.9, one year: p=0.7, change over time, p=0.6). The adaptive behavior composite score did not differ by FS case status at baseline (p=0.2) or one year later (p=0.6); however, between-group differences over time approached significance (p=0.05). Findings support the idea that first FS does not pose developmental or behavioral consequences in a low socioeconomic environment.
    Epilepsy & Behavior 05/2013; 28(1):83-87. · 1.84 Impact Factor
  • Dale C Hesdorffer, Charles E Begley
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    ABSTRACT: The Institute of Medicine's report, Epilepsy across the Spectrum: Promoting Health and Understanding contains two recommendations for increased epilepsy surveillance and one recommendation on prevention in epilepsy. Evidence supporting these recommendations and the information that can be gained from them is reviewed. Existing epilepsy surveillance data are inadequate to address factors such as seizure type, syndrome, socioeconomic status, and race/ethnicity in large representative populations. Ongoing surveillance is needed with follow-up of people with epilepsy for adverse epilepsy outcomes so that interventions to prevent these outcomes can be formulated. Substantial barriers to receiving appropriate medical care exist for minorities and the uninsured with epilepsy; more information on these differences and their causes is needed. Lack of standardized study methods and data sources results in differences in medical service costs, care and treatments, and limited information on cost-effectiveness of specific healthcare services for epilepsy. Future epilepsy surveillance should track incidence and prevalence over time, access to epilepsy care, direct and indirect costs, and the cost-effectiveness of treatment. Prevention efforts to decrease the occurrence of epilepsy and improve access and effectiveness of care will ameliorate adverse outcomes in epilepsy.
    Current opinion in neurology 04/2013; 26(2):168-73. · 5.43 Impact Factor
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    ABSTRACT: PURPOSE: Three suicidal ideation and suicidal behavior instruments were used to assess the prevalence of lifetime and recent suicidal ideation and suicidal behavior in patients with frequent treatment-resistant focal seizures who would be eligible for randomized clinical trials. This was done to determine which instrument was optimal for use in epilepsy. METHODS: In a cross-sectional study, we compared lifetime and recent suicidal ideation and suicide attempt on the MINI International Neuropsychiatric Interview (MINI), Columbia Suicide Severity Rating Scale (C-SSRS), and Interactive Voice Response System CSSRS (E-CSSRS). A safety algorithm determined treatment referral. Coordinators and participants evaluated experiences with the C-SSRS. The proportion of participants that baseline assessment would exclude from clinical trial enrollment was determined. KEY FINDINGS: Among 208 participants, 1.6-3.9% had recent high risk suicidal ideation and 1.0-4.7% had a recent suicide attempt across all instruments. Lifetime high-risk suicidal ideation occurred in 12.1-14.1%. Lifetime suicide attempt occurred in 10.2-13.1% of participants. Of those with recent suicide attempt, 31.1% required referral to a health professional, and 3.9% needed urgent referral. Lifetime suicidal behavior (including aborted suicide attempt, interrupted suicide attempt, suicide attempt, preparatory acts or behavior, and nonsuicidal self-injurious behavior) was found in 21.1% on the E-CSSRS and 15.5% on the C-SSRS. Agreement (Kappa) was good to excellent for comparisons of all instruments. Fifty-two percent of subjects preferred either the CSSRS or E-CSSRS, whereas the rest had no preference; of those having a preference, 87.5% favored the CSSRS. Of the 18.9% of participants who might have been excluded from trials based on suicidal ideation and suicide attempt, the CSSRS identified high-risk suicidal ideation or suicide attempt in the preceding 2 years in only 4.4%. SIGNIFICANCE: Suicidality screening is feasible in people with epilepsy. Slightly more suicidal behavior is reported with the E-CSSRS than C-SSRS, suggesting the E-CSSRS may be optimal. The proportion of patients who may be excluded from clinical trials based on worrisome suicidal ideation or suicide attempt is small, suggesting that it is possible to enroll most eligible individuals.
    Epilepsia 02/2013; · 3.96 Impact Factor
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    ABSTRACT: PURPOSE: This study describes the epidemiology of epilepsy on the Arizona-Mexico border. METHODS: Households in Southern Arizona were identified using two strategies. County-wide random digit dialing telephone surveys were supplemented with door-to-door recruitment in three Arizona border communities. Utilizing a two-step screening process, individuals with a seizure disorder or epilepsy were identified. A consensus diagnosis was arrived at after reviewing results from the detailed interview, medical records and clinical examination. RESULTS: A total of 15,738 household individuals were surveyed. Two hundred and three individuals were identified as having had epilepsy at some point in their life; 25% of them were previously not diagnosed. The sex and age-adjusted prevalence estimate was 14.3 per 1000 (95% CI: 12.5-16.1) for lifetime epilepsy, and 11.8 per 1000 (CI: 10.2-13.5) for active epilepsy (seizures in the past 5 years or currently taking antiseizure medications). Non-Hispanic Whites were two times more likely to have active epilepsy than Hispanics. The majority of individuals with lifetime history of epilepsy had idiopathic or cryptogenic epilepsy; most were localization-related epilepsy although the exact location could not be determined for the majority. Although most individuals with epilepsy report receiving care from a neurology specialist, they were more likely to have visited a non-specialist in the past 3 months. SIGNIFICANCE: The lower prevalence of epilepsy among Hispanics compared to non-Hispanics supports previous survey findings in the Southwest US and may be due to language, acculturation factors, stigma, or a reflection of the "healthy immigrant effect". The surprisingly high proportion of previously un-diagnosed individuals shows a need for further investigation as well as a need to increase community awareness.
    Epilepsy research 01/2013; · 2.48 Impact Factor
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    ABSTRACT: In March 2012 the Institute of Medicine (IOM) released the report, Epilepsy Across The Spectrum: Promoting Health and Understanding. This report examined the public health dimensions of the epilepsies with a focus on the following four areas: public health surveillance and data collection and integration; population and public health research; health policy, health care, and human services; and education for providers, people with epilepsy and their families, and the public. The report provided recommendations and research priorities for future work in the field of epilepsy that relate to increasing the power of data on epilepsy; prevention of epilepsy; improving health care for people with epilepsy; improving health professional education about epilepsy; improving quality of life for people with epilepsy; improving education about epilepsy for people with epilepsy and families; and raising public awareness about epilepsy. For this article, the authors selected one research priority from each of the major chapter themes in the IOM report: expanding and improving the quality of epidemiologic surveillance in epilepsy; developing improved interventions for people with epilepsy and depression; expanding early identification/screening for learning impairments in children with epilepsy; evaluating and promoting effective innovative teaching strategies; accelerating research on the identification of risk factors and interventions that increase employment and improve quality of life for people with epilepsy and their families; assessing the information needs of people with epilepsy and their families associated with epilepsy-related risks, specifically sudden unexpected death in epilepsy; and developing and conducting surveys to capture trends in knowledge, awareness, attitudes, and beliefs about epilepsy over time and in specific population subgroups. For each research priority selected, examples of research are provided that will advance the field of epilepsy and improve the lives of people with epilepsy. The IOM report has many other research priorities for researchers to consider developing to advance the field of epilepsy and better the lives of people with epilepsy.
    Epilepsia 01/2013; · 3.96 Impact Factor
  • Epilepsy Currents 01/2013; 13(5):232-235. · 2.33 Impact Factor
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    ABSTRACT: Epilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care. Purpose The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls. Methods We identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1-2 years, and objective measures of outpatient and inpatient epilepsy management were assessed. Results At baseline, 53% (n = 43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n = 38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p = 0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p = 0.02). Conclusion For most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.
    Seizure 01/2013; · 2.00 Impact Factor
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    ABSTRACT: Traumatic brain injury (TBI) is a serious public health problem in the United States, yet no treatment is currently available to improve outcome after TBI. Approved for use in TBI in 59 countries, citicoline is an endogenous substance offering potential neuroprotective properties as well as facilitated neurorepair post injury. To determine the ability of citicoline to positively affect functional and cognitive status in persons with complicated mild, moderate, and severe TBI. The Citicoline Brain Injury Treatment Trial (COBRIT), a phase 3, double-blind randomized clinical trial conducted between July 20, 2007, and February 4, 2011, among 1213 patients at 8 US level 1 trauma centers to investigate effects of citicoline vs placebo in patients with TBI classified as complicated mild, moderate, or severe. Ninety-day regimen of daily enteral or oral citicoline (2000 mg) or placebo. Functional and cognitive status, assessed at 90 days using the TBI-Clinical Trials Network Core Battery. A global statistical test was used to analyze the 9 scales of the core battery. Secondary outcomes were functional and cognitive improvement, assessed at 30, 90, and 180 days, and examination of the long-term maintenance of treatment effects. Rates of favorable improvement for the Glasgow Outcome Scale-Extended were 35.4% in the citicoline group and 35.6% in the placebo group. For all other scales the rate of improvement ranged from 37.3% to 86.5% in the citicoline group and from 42.7% to 84.0% in the placebo group. The citicoline and placebo groups did not differ significantly at the 90-day evaluation (global odds ratio [OR], 0.98 [95% CI, 0.83-1.15]); in addition, there was no significant treatment effect in the 2 severity subgroups (global OR, 1.14 [95% CI, 0.88-1.49] and 0.89 [95% CI, 0.72-1.49] for moderate/severe and complicated mild TBI, respectively). At the 180-day evaluation, the citicoline and placebo groups did not differ significantly with respect to the primary outcome (global OR, 0.87 [95% CI, 0.72-1.04]). Among patients with traumatic brain injury, the use of citicoline compared with placebo for 90 days did not result in improvement in functional and cognitive status. clinicaltrials.gov Identifier: NCT00545662.
    JAMA The Journal of the American Medical Association 11/2012; 308(19):1993-2000. · 29.98 Impact Factor

Publication Stats

3k Citations
135 Downloads
633.54 Total Impact Points

Institutions

  • 2014
    • CUNY Graduate Center
      New York City, New York, United States
  • 1996–2014
    • Columbia University
      • • Gertrude H. Sergievsky Center
      • • College of Physicians and Surgeons
      • • Department of Epidemiology
      • • Department of Neurology
      New York City, New York, United States
  • 2012
    • Albert Einstein College of Medicine
      New York City, New York, United States
    • Children's Hospital of the King's Daughters
      Norfolk, Virginia, United States
  • 2011
    • University of Michigan
      Ann Arbor, Michigan, United States
    • University of Houston
      Houston, Texas, United States
    • University of Pavia
      Ticinum, Lombardy, Italy
    • Northern Illinois University
      • Department of Biological Sciences
      DeKalb, Illinois, United States
    • Azienda Ospedaliero Universitaria Maggiore della Carità
      • Department of Neurology
      Novara, Piedmont, Italy
    • The University of Tennessee Health Science Center
      • Department of Neurosurgery
      Memphis, TN, United States
  • 2010
    • Northwestern University
      • Department of Pediatrics
      Evanston, IL, United States
  • 2009
    • Mario Negri Institute for Pharmacological Research
      Milano, Lombardy, Italy
    • New York State Psychiatric Institute
      New York City, New York, United States
  • 2005–2008
    • Harvard University
      • Department of Epidemiology
      Cambridge, MA, United States
    • Weill Cornell Medical College
      New York City, New York, United States
    • National University Hospital of Iceland
      • Department of Neurology
      Reikiavik, Capital Region, Iceland
    • Centre Hospitalier National Universitaire de Fann
      Dakar, Dakar, Senegal
  • 2005–2006
    • New York Presbyterian Hospital
      • Department of Pediatrics
      New York City, NY, United States
  • 2001
    • Mayo Foundation for Medical Education and Research
      • Department of Neurology
      Scottsdale, AZ, United States
  • 1998–1999
    • Mayo Clinic - Rochester
      • • Department of Health Science Research
      • • Department of Neurology
      Rochester, MN, United States
  • 1997
    • University of Texas at Tyler
      Tyler, Texas, United States
  • 1990
    • New York State
      New York City, New York, United States