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CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000436145.63049.ba
Issue Overview

Issue Overview

Free Access

Continuum: Lifelong Learning in NeurologyMovement Disorders, Volume 19, Issue 5, October 2013

Issue Overview

Movement Disorders, October 2013;19(5)

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills.

Learning Objectives

Upon completion of the Continuum: Lifelong Learning in Neurology Movement Disorders issue, participants will be able to:

▸ Recognize the clinical features associated with each of the most common atypical parkinsonian disorders

▸ List the clinical and laboratory features distinguishing essential tremor from dystonic tremor, cerebellar tremor, parkinsonian tremor, and other tremor disorders based on the careful evaluation of resting, postural, and kinetic components of oscillatory behavior

▸ Discuss the clinical, pathophysiologic, and genetic advances in dystonia

▸ Organize the proper workup to identify the etiology in patients with chorea

▸ Identify and classify the expression of myoclonus into cortical, subcortical, and spinal etiologies to assist diagnostic and therapeutic efforts and distinguish from mimickers

▸ List the cognitive, behavioral, and sensory manifestations associated with tics in Tourette syndrome and related disorders

▸ Describe a logical approach to the diagnosis of patients with genetic and secondary cerebellar ataxias

▸ Identify the features associated with a variety of gait disorders ranging from secondary impairments of gait to primary progressive freezing of gait, in order to inform their workup and management

▸ Recognize the criteria for positive rather than exclusionary diagnosis of psychogenic movement disorders, including recently suggested “laboratory-supported” diagnostic category for psychogenic tremor and psychogenic myoclonus

▸ Define therapeutic misconception and describe the ethical principles to consider when a patient asks for an off-label procedure

▸ Identify relevant considerations when recording video of patients with movement disorders

Core Competencies

The Continuum Movement Disorders issue covers the following core competencies:

▸ Patient Care

▸ Medical Knowledge

▸ Practice-Based Learning and Improvement

▸ Interpersonal and Communication Skills

▸ Professionalism

▸ Systems-Based Practice

Disclosures

CONTRIBUTORS

Alberto J. Espay, MD, MSc, FAAN, Guest Editor

Associate Professor, Director of Clinical Research, James J. and Joan A. Gardner Family Center for Parkinson’s Disease and Movement Disorders, University of Cincinnati Academic Health Center, Cincinnati, Ohio

*Dr Espay is supported by the K23 career development award (NIMH, 1K23MH092735) and has received grant support from CleveMed/Great Lakes Neurotechnologies, the Davis Phinney Foundation, and the Michael J Fox Foundation; personal compensation as a consultant/scientific advisory board member for Solvay (now Abbvie), Chelsea Therapeutics, TEVA, Impax, Merz, Solstice Neurosciences, Eli Lilly, and US WorldMeds; royalties from Lippincott Williams & Wilkins and Cambridge; and honoraria from Novartis, UCB, TEVA, the American Academy of Neurology, and the Movement Disorders Society. Dr Espay serves as associate editor of Movement Disorders and Frontiers in Movement Disorders and on the editorial board of The European Neurological Journal.

Dr Espay discusses the use of medications currently recommended for the treatment of myoclonus, none of which have been US Food and Drug Administration–approved.

Bastiaan R. Bloem, MD, PhD

Professor of Neurology, Radbaud University Nijmegen Medical Center, Nijmegen, Netherlands

*Dr Bloem serves as a consultant for Boehringer Ingelheim and GlaxoSmithKline and receives research grants from Abbott Laboratories, GlaxoSmithKline, and Medtronic, Inc.

Dr Bloem discusses the unlabeled use of donepezil and methylphenidate as cognitive enhancers and stimulation of the pedunculopontine nucleus as a surgical indication for the treatment of gait and postural disorders.

Allison Brashear, MD, MBA, FAAN

Professor and Chair, Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina

*Dr Brashear has served as a consultant for Allergen, Ipsen, and Xenoport; receives royalties from _____; and has provided expert witness testimony in ____.

Dr Brashear discusses the unlabeled use of botulinum toxin for spasticity.

Laura Bushong, BA, CPC, CEMC

Reimbursement Analyst and Coding Lead, Department of Neurology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina

*Dr Bushong reports no disclosure.

Dr Bushong discusses the unlabeled use of botulinum toxin for spasticity.

David Charles, MD

Professor and Vice-Chairman of Neurology, Chief Medical Officer, Vanderbilt Neuroscience Institute, Vanderbilt University, Nashville, Tennessee

*Dr Charles’s institution receives income from grants or contracts with Allergan, Inc, Ipsen, Medtronic, Inc, and Merck & Co, Inc, for research or educational programs led by Dr Charles, and he also serves as a consultant for these companies. Dr Charles has served as an expert witness, and has received income from the Davis Phinney Foundation.

Dr Charles discusses the unlabeled use of deep brain stimulation in the early disease course of Parkinson disease.

Robert Chen, MA, MBBChir, MSc, FRCPC

Professor of Medicine (Neurology) and Catherine Manson Chair in Movement Disorders, University of Toronto and Toronto Western Research Institute, Toronto, Ontario, Canada

*Dr Chen has received personal compensation for activities with Allergan, Inc; EMD Serono, Inc; Medtronic, Inc; Merz Pharmaceuticals LLC; the Movement Disorders Society; University of California, Los Angeles; and the University of Pittsburgh. Dr Chen has provided expert testimony and affidavit in welding-related litigations. Dr Chen receives research support from the Canadian Institutes of Health Research, the Dystonia Medical Research Foundation, Medtronic, Inc, and the Michael J. Fox Foundation.

Dr Chen discusses the use of medications currently recommended for the treatment of myoclonus, none of which have been US Food and Drug Administration–approved.

Guenther Deuschl, MD, PhD

Head and Chairman, Department of Neurology, Christian-Albrechts University, Kiel, Germany

*Dr Deuschl serves as a consultant for Medtronic, Inc, Novartis, and Teva Pharmaceutical Industries Ltd and receives royalties from Theime. Dr Deuschl’s employer receives research support from Medtronic, Inc.

Dr Deuschl reports no disclosure.

Andrew P. Duker, MD

Assistant Professor of Neurology, University of Cincinnati, Cincinnati, Ohio

*†Dr Duker reports no disclosure.

Mark J. Edwards, MD, PhD

University College London Institute of Neurology, University College London, London, United Kingdom

*Dr Edwards is supported by grants from the National Institutes of Health Research, Parkinson’s UK, UK Dystonia Society, and the Bachmann Strauss Foundation. Dr Edwards receives royalties from his book Oxford Specialist Handbook of Parkinson Disease and Other Movement Disorders, serves on the editorial board of Movement Disorders Journal, and has received honoraria from the Movement Disorders Society and UCB Pharma.

Dr Edwards reports no disclosure.

Alfonso Fasano, MD, PhD

Associate Professor, University of Toronto, Toronto Western Hospital Movement Disorders Centre, Toronto, Ontario, Canada

*Dr Fasano serves as a speaker for Abbott Laboratories, Chiesi, Medtronic, Inc, and UCB, and receives research support from Afar and Medtronic, Inc.

Dr Fasano discusses the unlabeled use of donepezil and methylphenidate as cognitive enhancers and stimulation of the pedunculopontine nucleus as a surgical indication for the treatment of gait and postural disorders.

James K. Fleming, MD, MSc

Neurology Resident, Vanderbilt University, Nashville, Tennessee

*Dr Fleming reports no disclosure.

Dr Fleming discusses the unlabeled use of deep brain stimulation in the early disease course of Parkinson disease.

Christine Klein, MD

Schilling Professor of Neurogenetics, Head of the Institute of Neurogenetics, University of Lübeck, Lübeck, Germany

*Dr Klein serves as a consultant for Centogene and as a speaker for Boehringer Ingelheim and Orion Corporation. Dr Klein serves on the editorial board of Neurology and as a course faculty member for the American Academy of Neurology. Dr Klein is the recipient of a career development award from the Hermann and Lilly Schilling Foundation; receives support from Deutsche Forschungsgemeinschaft, Possehl Foundation, and Volkswagen Foundation; and has received institutional support from the University of Luebeck for genetics research.

Fred D. Lublin, MD, FAAN, FANA

Dr Klein reports no disclosure.

Irene Litvan, MD, FAAN

Director of the Movement Disorder Center, Tasch Endowed Professor in Parkinson’s Disease Research, Professor of Neurosciences, University of California, San Diego, La Jolla, California

*Dr Litvan has served as a member of the Abbot/Abbvie, Biogen, Bristol-Myers-Squibb, and Pfizer scientific advisory boards and was a consultant for Novartis. Dr Litvan receives grant support from the NIH (R01AG024040) and CurePSP.

Dr Litvan reports no disclosure.

Mario Manto, MD, PhD

Université Libre de Bruxelles, Brussels, Belgium

*Dr Manto receives honoraria from Cambridge University Press and Springer Science+Business Media, and receives research grants from the Communauté Française, the European Commission, and the Fonds de la Recherche Scientifique Belgium. Dr Manto serves as editor-in-chief of The Cerebellum and as associate editor of the Journal of NeuroEngineering and Rehabilitation.

Dr Manto reports no disclosure.

Davide Martino, MD, PhD

Clinical Lecturer, Queen Mary University of London; Consultant in Neurology, South London NHS Trust, London, United Kingdom

*†Dr Martino reports no disclosure.

Jonathan W. Mink, MD, PhD, FAAN

Professor of Neurology, Chief of Child Neurology, Vice Chair of Neurology, University of Rochester Medical Center, Rochester, New York

*Dr Mink serves on the data and safety monitoring board of Edison Pharmaceuticals, Inc, serves as a consultant to Medtronic, Inc and as an associate editor of Neurology, and performs occasional legal record review.

Dr Mink discusses the unlabeled use of multiple therapies for the treatment of Tourette syndrome. In the United States, only pimozide and haloperidol are labeled for the treatment of Tourette syndrome.

Francesca Morgante, MD, PhD

Assistant Professor of Neurology, University of Messina, Messina, Italy

*Dr Morgante serves on the scientific advisory board of Allergan and serves as a speaker for Chiesi, Lundbeck, Medtronic, Inc, Novartis, and UCB. Dr Morgante serves on the editorial advisory board of Frontiers in Movement Disorders and received research grants from Neureca Foundation Onlus, Milan.

Dr Morgante reports no disclosure.

Massimo Pandolfo, MD

Professor and Chair, Department of Neurology, Université Libre de Bruxelles, Brussels, Belgium

*Dr Pandolfo receives unrestricted support for conferences from Santhera Pharmaceuticals and royalty payments from Athena Diagnostics, Inc, for Methods to Diagnose Friedreich Ataxia. Dr Pandolfo serves on the drug safety monitoring board of and receives research support from Repligen Corporation.

Dr Pandolfo discusses experimental therapeutics for the treatment of inherited ataxias and immunomodulatory treatments for immune-mediated ataxias.

Ruth H. Walker, MB, ChB, PhD, FAAN

Director, Movement Disorders Clinic, Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, New York; Associate Professor, Department of Neurology, Mount Sinai School of Medicine, New York, New York

*Dr Walker reports no disclosure.

Dr Walker discusses the unlabeled use of deep brain stimulation, tetrabenazine, and antipsychotic and anticonvulsant medications for the treatment of chorea.

David Williams, MBBS, PhD, FRACP

Associate Professor, Van Cleef Roet Centre for Neurological Diseases, Monash University, Melbourne, Victoria, Australia

*Dr Williams serves on the scientific advisory board of Ipsen and receives research support from the National Health and Medical Research Council.

Dr Williams reports no disclosure.

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MULTIPLE-CHOICE QUESTION WRITERS

D. Joanne Lynn, MD, FAAN

Associate Dean for Student Life and Clinical Professor, Department of Neurology, The Ohio State University College of Medicine, Columbus, Ohio

*Dr Lynn holds stock or stock options greater than 5% of the company or more than $10,000 in value in Bristol-Myers Squibb Company and Hospira, Inc. Dr Lynn receives research support from Acorda Therapeutics; Allergan, Inc; Novartis AG; EMG Serono, Inc/Pfizer Inc; and Mt Sinai Medical Center.

Dr Lynn reports no disclosure.

Joseph E. Safdieh, MD

Associate Professor of Neurology (Education), Weill Cornell Medical College, New York, New York.

*Dr Safdieh serves as a consultant for Pfizer Inc.

Dr Safdieh reports no disclosure.

*Relationship Disclosure

Unlabeled Use of Products/Investigational Use Disclosure

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Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of review articles, case-based discussions on ethical and practice issues related to the issue topic, coding information, and comprehensive CME and self-assessment offerings, including a self-assessment pretest, multiple-choice questions with preferred responses, and a patient management problem. For detailed instructions regarding Continuum CME and self-assessment activities, visit aan.com/continuum/cme.

The review articles emphasize clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. Video material relating to the issue topic accompanies issues when applicable.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

Copyright © 2013 by the American Academy of Neurology.

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