Site: NYU Langone Medical Center,
Comprehensive Epilepsy Center
Director: William B. Barr, PhD, ABPP-CN
The NYU Comprehensive Epilepsy Center, housed within the Langone Medical Center, offers an APPCN postdoctoral fellowship in clinical neuropsychology with special emphasis in epilepsy, and also trains pre-doctoral interns via a rotation offered through the NYU-Bellevue internship program in clinical psychology. Fellows have ample opportunities to participate in exciting clinical, research, and didactic opportunities related to the treatment of adults with epilepsy, while also benefiting from opportunities to gain experience with pediatric epilepsy, dementia, TBI, and other areas of brain-behavior dysfunction.
William Barr, PhD, ABPP-CN, serves as Chief of Neuropsychology and directs neuropsychological training at the NYU Comprehensive Epilepsy Center. He holds academic rank of Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. Dr. Barr performs neuropsychological assessments for a wide range of clinical populations, and he also conducts Wada tests and brain mapping procedures in conjunction with the preoperative evaluations for epilepsy treatment. Additionally, he provides neuropsychological consultation services for several local sports teams. Dr. Barr is extensively published, with primary research interests in the areas of neuropsychological functioning in epilepsy and neuropsychological sequelae of sports concussion.
A common misconception is that our program provides experience exclusively with epilepsy patients. That is not true. Our aim is to give the postdoctoral fellows a wide range of clinical experiences. We estimate that epilepsy patients comprise a little less than half of the patients seen by the postdoctoral fellows. In terms of prior experience with epilepsy, it is certainly a plus for candidate applying to our program. However, it is not a “must”. We are interested in candidates with strong training in neuropsychology with the potential to succeed in any one of a number of subspecialties within neuropsychology, with epilepsy, of course, being one of them.
2. Throughout your career you have balanced multiple roles as a clinician, researcher, and leader within many professional organizations. Do you look for a broad range of experiences in your postdoctoral candidates and/or is this something they can anticipate developing during their training with you? Do you have any “secrets to your success” that you would like to share with our ANST members regarding management of multiple roles?
My belief is that a well-balanced neuropsychologist focuses on four major roles: clinical work, research, teaching, and service to the profession & community. While it might be difficult to pay full attention to all four of these roles at once, it is my opinion that one should become active in each of these roles at some point in their career. I certainly don't expect trainees to have substantial experience in all four of these roles while in the midst of their training. It is clear that they must focus mostly on developing their clinical and research skills during those years. However, we do look for candidates that have something unique or interesting to bring to the table, whether it is specialized clinical experience, familiarity with cutting edge research or statistical techniques, or some other professional skill or experience that makes them stand out from other candidates. We do our best to model the behavior in the four domains I mention during the course of our regular work. We also encourage our trainees to become involved in various organizations and to volunteer at annual conferences.
I am not sure of any secrets to so-called success other than spending a lot of time and effort to accomplish various tasks. One will find that activities and deadlines regarding each of the four professional roles come in waves. One might need to spend a week or two completing a grant application and then switch abruptly the next week to prepare for assignments that need to be completed for an upcoming board meeting. Of course, the clinical responsibilities remain constant throughout. One recommendation for keeping up with things is to devote at least part of one's weekly schedule to each of these four roles to ensure that nothing is ignored or delayed to any great degree.
3. Several years ago, you served as guest editor of a special issue of Neuropsychology Review, covering topics related to the care of individuals with epilepsy (2007, Volume 17, Issue 4). In your editorial within the issue (pp. 381-383), you discussed the possibility of future advances in fMRI technology to allow inclusion of selective inactivation procedures, suggesting the use of transcranial magnetic stimulation (TMS) during scanning as a possible method of achieving this less invasive alternative to the intracarotid amobarbital (Wada) test. How have recent technological advances since this publication met with your expectations? What sorts of research and clinical opportunities exist for your post-docs in this area?
I still believe that, one day, we will be at a point where we can combine neurostimulation procedures with fMRI to obtain simultaneous inactivation and measurement of brain responses in an improved form of the Wada test. For this to occur, however, we will need continued technological and scientific advances in both neurostimulation and imaging. I think that we are still at least 10 years away from being able to develop that type of procedure. In the mean time, I believe that there have been advances in our ability to perform functioning functional imaging studies on mesial temporal regions. However, we still have a way to go. The technology is not nearly as advanced as what has been developed for lateralizing language functions. I have been somewhat more impressed with the development of neurostimulation techniques developed for treatment of memory and language disorders. We have recently become involved in this line of work at our center at NYU in collaboration with Anli Liu, M.D., who is one of our junior faculty members in neurology. Dr. Liu has been conducting a clinical trial investigating the use of transcranial direct current stimulation (tDCS) for treatment of memory disorders in patients with epilepsy. Trainees working with us would certainly have an opportunity to become involved in this exciting new line of research.
4. With your knowledge and experience in the area of sports-related head injury, what is your prediction as to where the CTE debate will be in 10 years from now? What opportunities exist for your postdoctoral fellows with interests in this area of research and forensic/clinical practice?
I have always been skeptical about CTE as a new and distinct clinical entity, based on how it has been described in the recent literature and the media. I worry about the degree to which the media hype has outpaced the science. I believe that we will soon learn that, if there is some form of dementia associated with context sports, it is seen in only a small percentage of participants and does not differ that much from the type of dementia seen in other contexts. That said, I believe we have moved into a new positive direction where we now realize that there are long-term neurological consequences of participation in contact sports such as football or hockey. It is my hope that, rather than banning these sports, this will lead us to make positive rule changes to reduce the number and severity of injuries and teach our young athletes to use safe and effective blocking, checking, and tackling techniques.
Trainees coming to our center have increasing opportunities to work with concussion patients through the newly established NYU Concussion Center. Through the opening of this center, our postdoctoral fellows now have the ability to see the full spectrum of MTBI, with more acute cases referred through the concussion center and longer term cases seen through our clinical and forensic practice. There are ample opportunities for fellows to develop research studies through the concussion center and/or through the use of our clinical registries and databases. Fellows have the opportunity to work with me on a full spectrum of civil and criminal forensic cases.
5. What aspects of your training program have not been previously discussed that you would like to highlight?
One thing that many applicants might not know about our center is that our fellows have ample opportunity to supervise and counsel graduate students working with us as clinical externs. This will often involve overseeing the clinical evaluations performed by the externs and performing troubleshooting tasks when necessary. Much of this will involve a review of test administration issues and providing advice on how to work effectively with individual patients. Also, while test selection, interpretation of the data, and preparation of the report are typically handled by faculty members, the fellows will also have some opportunity to directly supervise some externs in the preparation of clinical reports.
For more information about training opportunities at the NYU Langone Medical Center, Comprehensive Epilepsy Center, please visit http://epilepsy.med.nyu.edu/programs-services/neuropsychology-service/neuropsychology-training#sthash.u52JyzP5.dpbs