The Saul R. Korey Department of Neurology

Neuromuscular Medicine/EMG Fellowship

In 2014, the Clinical Neurophysiology Fellowship, EMG track, in continuous existence since 1986, was transitioned into the Neuromuscular Medicine Fellowship at Montefiore Medical Center and the Albert Einstein College of Medicine (AECOM). The fellowship emphasizes excellence in the diagnosis and management of neuromuscular disorders, and the performance and interpretation of electrodiagnostic studies, neuromuscular ultrasound, and neuromuscular pathology.  The Neuromuscular faculty have a broad range of interests in clinical and basic research. The program is accredited by ABPN-AQNM, and fellows can sit for the ABEM and ABPN-AQNM board exams. Trained fellows are prepared for taking on either academic or private practice opportunities.

The fellowship position is a 1-year program focusing on inpatient and outpatient electrodiagnostic testing and clinical neuromuscular evaluation, and management. Fellows evaluate patients and are trained to perform EMG/NCS under direct supervision of the attending staff. Their work is monitored and guided from the initial patient evaluation to the final interpretations and clinical recommendations, with increasing independence as the year progresses.  Fellows spend one afternoon weekly at the Muscular Dystrophy Association clinic, where a large range of adult and pediatric neuromuscular diseases, in particular muscle disorders, present for diagnosis and ongoing management. In addition, we have a weekly Myasthenia Gravis Clinic with a large cohort of patients. Fellows prepare cases for presentation at our weekly Neuromuscular Rounds clinical conference. At weekly EMG conferences we present didactic material and review recent publications of interest. There are ample opportunities for participation in clinical research.

Dr. Steven Herskovitz is Director of the Neuromuscular Division and EMG Laboratory, and head of the Neuromuscular Medicine/EMG fellowship training program. Faculty involved in the training program are listed below.  In addition, the fellows have access to over 60 full-time neurology faculty, a large neurosurgery department, an active neuroscience faculty, a large neuroradiology department, and the broader resources of a major medical school and several academic medical centers.

The prerequisites for fellowship training include successful completion of an accredited residency training program in Neurology and board eligibility.

Primary Faculty

Neurology

Steven Herskovitz, M.D. (EMG/Neuromuscular)
Professor of Neurology
Director, EMG Laboratory
Montefiore Medical Center
Albert Einstein College of Medicine
 

Herbert H. Schaumburg, M.D. (Neurotoxicology/Neuromuscular) 
Professor of Neurology and Neuropathology 
Albert Einstein College of Medicine

Michael L. Swerdlow M.D. (Myasthenia Gravis/General Neurology) 
Professor of Neurology 
Albert Einstein College of Medicine

Phyllis L. Bieri, M.D. (EMG/Neuromuscular) 
Assistant Professor of Neurology 
Albert Einstein College of Medicine

Howard Geyer, M.D., Ph.D. (Movement Disorders/EMG) 
Associate Professor of Neurology 
Albert Einstein College of Medicine

Mark J. Milstein, M.D. (General Neurology/EMG) 
Associate Professor of Neurology 
Albert Einstein College of Medicine

Fabreena Napier MD. (EMG/Neuromuscular/MDA Clinic) 
Assistant Professor of Neurology 
Albert Einstein College of Medicine

Leslie Delfiner MD (Pediatric Neuromuscular/MDA Clinic/EMG) 
Assistant Professor of Neurology 
Albert Einstein College of Medicine

Edward Bahou MD (Neurohospitalist/Neuromuscular)
Assistant Professor of Neurology 
Albert Einstein College of Medicine

Eric Mariuma M.D. (Intraoperative Monitoring/EMG) 
Assistant Professor of Neurology 
Albert Einstein College of Medicine

Other Disciplines

Steven Chin MD (Neuropathology) 
Associate Professor of Pathology

Patrick Lasala, M.D. (Neurosurgery – nerve and muscle biopsy) 
Associate Professor of Clinical Neurological Surgery

 

Curriculum  

Adult and Pediatric Inpatient and Outpatient EMG/NCS/Ultrasound

Adult and pediatric EMG/NCS are provided at the Montefiore EMG Laboratory. Fellows see a large and diverse population of inpatients and outpatients, with a broad spectrum of neurologic disease. These patients are referred from other adult or pediatric neurologists, internists, rheumatologists, orthopedists, plastic surgeons, neurosurgeons, ENT or primary care practitioners. Approximately 2000-3000 patients are seen annually in the lab.

In addition to standard electromyography and nerve conduction studies, fellows have exposure to laryngeal EMG, tremor studies, EMG-guided chemodenervation (Botox),  single fiber EMG, phrenic nerve studies, blink reflex studies, nerve root stimulation, sympathetic skin response and R-R interval variation testing, skin biopsy for small-fiber neuropathy, and neuromuscular ultrasound.

Muscular Dystrophy Association Clinic  

Fellows see patients in the MDA clinic once a week under the supervision of Neuromuscular attendings. The MDA clinic serves a large population of adult and pediatric patients with diagnostically or therapeutically challenging neuromuscular diseases, in whose care the fellows can participate in a longitudinal fashion. Fellows frequently see patients in the MDA clinic, perform EMG/NCS testing on the same patients in the EMG laboratory if clinically indicated, and complete the diagnostic evaluation with genetic testing or neuropathologic examination.

Myasthenia Gravis Clinic

Fellows see patients in the Myasthenia Gravis Clinic once a week under the supervision of Neuromuscular attendings. The clinic provides an opportunity to learn the evaluation and management of patients with disorders of the neuromuscular junction.

Neuropathology  

Muscle and nerve pathology is supervised by Dr. Steven Chin and incorporated into the neuromuscular conferences presented by the fellows. Skin biopsies for small-fiber neuropathy are performed in the EMG lab.

Conferences  

  • Weekly Neuromuscular Rounds. Fellows present interesting or diagnostically challenging cases involving neuromuscular disease to neurology attendings, residents, other fellows, and medical students. These presentations are detailed and involve review of the current literature. 
  • Weekly EMG fellow conference. This conference begins with essential principles of EMG and nerve conduction studies and continues with topics covered in the AANEM mini-monographs. Waveform recognition, technical issues and uncommon techniques continue throughout the year. Fellows present interesting recent papers in a Journal Club format. Other times unusual diagnostic cases are presented to the fellows for discussion of differential diagnosis and management.   
  • Weekly Neurology Department case conference. Fellows take part in the weekly Neurology Department case conference and often discuss diagnosis or management of these cases.
  • Weekly Neurology Department Grand Rounds. Fellows attend this conference series that occurs at the MMC site.

Research Interests in EMG/Neuromuscular Diseases

The faculty have a broad range of research interests providing many opportunities for involvement.

The peripheral neuropathies

  • Diagnosis and treatment
  • Electrophysiologic identification
  • Aging and neuropathy
  • Animal models of diabetic autonomic neuropathy, small fiber neuropathy

The entrapment neuropathies

  • CTS – electrophysiologic identification 
  • CTS and aging 
  • CTS – conservative treatment 
  • CTS – autonomic dysfunction

Peripheral neurotoxicology

  • Pharmaceutical toxins
  • Environmental/occupational toxins
  • Clinical descriptions
  • Animal models of toxic distal axonopathy
  • Pseudoneurotoxicity

Miscellaneous

  • Neuromuscular Ultrasound
  • Disorders of peripheral nerve hyperexcitability
  • Radiculopathies – electrophysiologic studies
  • Congenital myopathies
  • Muscular dystrophies/myotonic dystrophies

 

Institutional Environment  

Department of Neurology  

The Department of Neurology at AECOM has 60 full-time faculty with diverse clinical and research interests. The adult neurology program includes 27 adult neurology residents, 6 pediatric fellows and 15 clinical and research fellows. The Department is committed to training clinicians skilled in the diagnosis and treatment of neurologic disorders who are able to conduct or interpret clinical and basic research. In addition to EMG/neuromuscular disease, the Department has strong subspecialty clinical and research postgraduate fellowships in the following areas: epilepsy and EEG, sleep medicine, headache, stroke, movement disorders, neuropsychiatry and neuroscience.

The Albert Einstein College of Medicine  

The Albert Einstein College of Medicine (AECOM) and its affiliated hospitals are the major health resource in the Bronx. We serve more than one million residents of the borough and provide tertiary care for the tri-state region comprising the greater New York metropolitan area and beyond. AECOM has strong departments in all disciplines.

The Einstein/Montefiore complex is geographically divided into two major sites - the East campus and the West campus. These sites, in the Northeast Bronx, are fifteen minutes apart and linked by a shuttle bus that runs frequently throughout the day.

The West campus includes the Moses Division of Montefiore Medical Center (MMC), a major voluntary teaching site, and the Wakefield campus, 5 minutes further north. The Moses Division of MMC has 726 beds with a 32-bed neurology floor, including an epilepsy monitoring unit. In addition, a multidisciplinary 4-bed neurology stroke evaluation and intervention unit that focuses on patient centered care is located on this floor. The neurology floor houses a neurorehabilitation facility where patients receive intensive rehabilitation. The EMG Laboratory is located in the Moses Division of MMC, very near the neurology inpatient floor and the neurology conference room where weekly neuromuscular rounds are held.

The East campus includes the College of Medicine, Einstein/Weiler Hospital, and the Jacobi Medical Center. AECOM has a long tradition of excellence in the neurosciences. The Neurology Department’s college-based faculty maintains outstanding research laboratories in molecular biology, stem cell research, muscle disorders, biochemistry of CNS lipids, multiple sclerosis, evoked potentials, neurogeriatrics, neurotransmitters, neurotoxicology, neural development, neurochemistry and neuroimaging.

Many of the Department’s faculty members have secondary appointments in the Neuroscience Department, providing additional educational opportunities for residents and fellows. In addition, the Department has a major clinical research program concerned with aging and dementia with a focus on headache and pain disorders in the elderly.

The Jack D. Weiler Hospital, a Division of Montefiore Medical Center, has 396 beds. The Department includes a 14-bed inpatient unit and stroke program, and provides adult neurology consultation to all hospital inpatient services. There is a new 2000 square foot Neurology Practice Center adjacent to the hospital. This center contains offices for our stroke team, EMG, Headache Unit, pediatric neurology, and adult epilepsy. It also houses our departmental non-invasive vascular laboratory.
Jacobi Medical Center (JMC) is a 550-bed municipal hospital. The Neurology Department maintains an active consultation service with EMG/NCS and neuromuscular disease consultations, The Rose F. Kennedy Center for Research in Mental Retardation and Human Development is part of the College of Medicine and is physically connected to the JMC campus. The Kennedy Center houses most of Neurology’s basic science faculty with research labs focused on neuropeptides, neurophysiology, cognitive function, stem cell research, epilepsy, and developmental disorders.

Directions for Applicants  

Applicants should submit a letter of intent along with their CV and 3 letters of recommendation, either by mail or e-mail, between January and April for the following year, to:
Steven Herskovitz M.D. 
Department of Neurology/EMG Lab 
Montefiore Medical Center 
111 E. 210 Street 
Bronx, N.Y. 10467 
Tel: 718-920-4930 
Fax: 718-231-3718 
E-mail: sherskov@montefiore.org

Faculty Biosketches for Selected Faculty

Steven Herskovitz, M.D.is Professor of Neurology and Director of the Neuromuscular Medicine division/EMG Lab. He earned his medical degree from Cornell University Medical Center in 1980. He completed residencies in both Internal Medicine and Neurology, followed by a Fellowship in Electromyography/Neuromuscular Disorders, all at the Albert Einstein College of Medicine. He is a diplomate of the ABIM, ABPN, ABPN-Neuromuscular Medicine, ABPN-Neuromuscular Ultrasound, and ABEM. His clinical research interests include the peripheral neuropathies, entrapment neuropathies and peripheral neurotoxicology. He has published on various aspects of carpal tunnel syndrome including electrophysiologic diagnosis, treatment and autonomic features, clinical features of a variety of peripheral neuropathies, and the neurotoxicology of pharmaceutical and environmental/occupational agents.

Herbert  H. Schaumburg M.D.is Professor of Neurology and Pathology (Neuropathology) at AECOM. He stepped down as Chairman of Neurology in 2004, after serving for 20 years in that capacity. He pioneered work on the concept of the distal axonopathy, and has made innumerable important contributions in the fields of neuropathies and neurotoxicology, including the texts Disorders of Peripheral Nerve, and Experimental and Clinical Neurotoxicology. 

Michael L. Swerdlow M.D. is Professor of Neurology and Director of the division of General Neurology. His training included a neuromuscular fellowship at the NIH. His practice and particular interest includes a large population of patients with myasthenia gravis as well as other neuromuscular disorders.

Phyllis L. Bieri, M.D. is Assistant Professor of Neurology at Albert Einstein College of Medicine. She completed a neurology residency and a fellowship in EMG/Neuromuscular disease at AECOM as well as additional research in neurophysiology. She is a diplomate of the ABPN, ABPN-Neuromuscular Medicine and ABEM. Her areas of interest are the diagnosis and treatment of neuromuscular diseases, including diseases of nerve, muscle, neuromuscular junction and anterior horn cell.  She has published in electrophysiology of mouse models of hereditary neuropathy, immunologic aspects of Guillain-Barré syndrome and clinical issues related to carpal tunnel syndrome and neuropathy in the elderly.

Howard Geyer, M.D., Ph.D. is Associate Professor of Neurology and division head of Movement Disorders at AECOM. He did an EMG/Neuromuscular fellowship at AECOM, followed by a Movement Disorders fellowship at Beth Israel Medical Center. His interests run the gamut of movement disorders, the use of chemodenervation (Botox), and the intersection of electrodiagnostic testing and movement disorders.

Mark J. Milstein M.D. is Associate Professor of Neurology and director of the Neurology consult service at Montefiore, as well as Program Director for the Neurology Residency Training Program. He is a graduate of AECOM and the EMG/ Neuromuscular fellowship. He is a diplomate of the ABPN, ABPN-Neuromuscular Medicine and ABEM. He participates in the supervision and training of EMG fellows.

Fabreena Napier M.D. is Assistant Professor of Neurology and Co-Director of our MDA Clinic.  She did her residency and neuromuscular fellowship at Montefiore/AECOM. Her interests include management of the spectrum of neuromuscular disorders and electromyography.

Leslie Delfiner M.D. is Assistant Professor of Pediatric Neurology and Co-Director of our MDA Clinic. She did her residency and neuromuscular fellowship at Montefiore/AECOM. Her interests include the genetic myopathies and spinal muscular atrophies, and the delivery of the rapidly evolving genetic therapies to this patient population.

Edward Bahou M.D. is Assistant Professor of Neurology. He did his Neuromuscular Medicine fellowship at Mt. Sinai. His interests include consultative neurology and electromyography.

Eric Mariuma M.D. is Assistant Professor of Neurology and is an intraoperative neurophysiologist and member of the neuromuscular team. He is a graduate of AECOM and the EMG/ Neuromuscular fellowship.

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