The University of Louisville Fellowship in Neuromodulation comprehensively covers the major aspects of stereotactic and functional neurosurgery and seeks to train board-certified neurosurgeons with interest to subspecialize in neuromodulation. The positions are awarded on a competitive basis according to academic credentials and the perceived potential for future excellence. The fellowship includes clinical and research components, which can be individually tailored to suit the fellow’s interests. 

Program Requirements

• US graduates can apply for an enfolded fellowship or a postgraduate fellowship
• International medical graduates (IMGs): We welcome applications from IMGs with a strong academic interest and academic track-record. Board certification in neurosurgery in their respective country and fluency of English language is required. 

• Epilepsy: Fellows are expected to learn the basics of patient assessment and EEG interpretation and will spend dedicated time in the neurology epilepsy clinic to master knowledge of medical management and when surgical intervention should be considered. They will play an integral role in epilepsy conference discussions where decisions about phase II monitoring and surgical interventions are made. They will learn an algorithm for surgical diagnosis and intervention in epilepsy and will apply it to presented cases. Finally, they will master a variety of surgical cases including vagal nerve stimulation (VNS) placement and revision, cortical grid implantation and monitoring, SEEG, open resection (temporal lobectomy/selective amygdalohippocampectomy) of lesional and non-lesional epilepsies, laser ablation for epilepsy and cranial neuromodulation including Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS). 
• Pain: Fellows will spend independent time with the anesthesia pain service to learn the basics of pain management and to see the context of the surgical interventions that can be offered. They will attend the monthly complex pain conference to discuss treatment options for specific patients. Finally, they will learn to master a rich variety of surgical techniques for pain management: percutaneous spinal cord stimulation (SCS) placement for trial and permanent implants, epidural SCS placement, open and percutaneous cordotomy techniques, thoracic midline myelotomy for visceral pain, DREZ procedure, thalamic sensory DBS for pain and cingulotomy for chronic cancer pain. They will also learn a variety of techniques for treating trigeminal neuralgia including microvascular decompression, balloon rhizotomy, radiofrequency lesioning, radiosurgery and Nucleus Caudalis DREZ. Emphasis will be placed on achieving a refined knowledge of pain mechanisms and the appropriate application of surgical procedures to different pain locations and causes. 
• DBS and Movement Disorders: Fellows are expected to develop a mastery of the diagnosis, medical management, and surgical indications for Parkinson's disease, essential tremor, and dystonia. They will be expected to be an expert in the surgical selection process including detailed knowledge of potential DBS and lesional targets and the subtleties that recommend one target over another in specific cases. They will spend dedicated time in the movement disorders clinic to gain this expertise. They are expected to have a thorough knowledge of movement disorders surgery including stereotactic planning, the application of different stereotactic framed and frameless techniques, and the use of intraoperative microelectrode recording neurophysiology and stimulation mapping to optimize lesions or DBS placement.

The fellow will participate fully in the evaluation of patients in the outpatient clinic and will learn all aspects of surgical treatments. This experience will be complemented by a weekly series of teaching rounds and by numerous interactions with visiting and partnered leading scientists we collaborate with from around world.

Clinical Duties

• Assist in the pre-operative, intra-operative and post-operative care of patients.
• Assist in the clinic, ward, and didactic teaching responsibilities.
• Take general neurosurgery call in the role of an attending.
• Participate in the teaching of residents, medical students, and nurses.

Research
Fellows are welcome to discuss specfic research interests with us prior to the start of the fellowship. In the first month of the fellowship, fellows will be given opportunities to explore available research projects both within our functional neurosurgery program and broadly throughout the medical center, including our many collaborating labs and other potential researchers. At the end of the first month they will identify, consulting with supervising faculty, 1-2 projects that will serve as the focus of their research for the year. They will create a rough timetable of the literature review, experimental design, data collection and analysis, and manuscript production. Fellows will have ample time during each week to pursue research on off surgery days or during times where faculty is engaged in other surgery types (e.g. trauma call, etc). The expected goal is to have a body of research that can be presented at a national or international meeting and that will be ready for publication by the end of the fellowship year. Fellows will have a more in-depth scientific experience in the 2nd year of fellowship, while the 1st year is dedicated to research.

Fellows will actively participate in monthly or bi-weekly clinical conferences in epilepsy, DBS, and complex pain. They will also regularly attend our weekly Neurocognitive Research Group (NRG) lab meetings, journal club, and departmental grand rounds. 

Research Interests of Faculty:

• Cognition and computational neuroscience
• Robotic and remote neurosurgery
• The science of death: What happens in our brain when we die?

Joseph Neimat, MD, MS, MBA
Professor and Chairman
Department of Neurosurgery
University of Louisville

Ajmal Zemmar, MD, PhD
Assistant Professor
Department of Neurosurgery
University of Louisville
ajmal.zemmar@uoflhealth.org