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CONTINUUM: Lifelong Learning in Neurology:
doi: 10.1212/01.CON.0000440676.89202.fe
Issue Overview

Issue Overview

Free Access

Continuum: Lifelong Learning in Neurology-Muscle Disease, Volume 19, Issue 6, December 2013

Issue Overview

Muscle Disease, December 2013;19(6)

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 Muscle Disease issue, participants will be able to:

▸ Recognize the signs and symptoms of congenital muscular dystrophies and congenital myopathies in infancy and early childhood

▸ Define the clinical features associated with the muscular dystrophies and use these clinical features to diagnose genetic muscle diseases

▸ Describe the clinical presentation, mechanisms, and treatment of metabolic myopathies

▸ Recognize episodic muscle symptoms and signs associated with inherited muscle channelopathies

▸ Identify the clinical, laboratory, histopathology, and pathogenic bases of dermatomyositis, polymyositis, immune-mediated necrotizing myopathy, and inclusion body myositis, as well as methods to treat these disorders

▸ Recognize and treat myopathy caused by prescription medications and other potential myotoxins

▸ Formulate a multidisciplinary approach to the individual with a myopathy that is centered on strength therapies, symptomatic therapies, supportive care, and psychological support

▸ Generate a differential diagnosis in a patient with a suspected myopathy based on his or her specific distribution of weakness and unique clinical signs and symptoms

▸ Discuss some of the ethical considerations involved for families faced with enrolling a minor child in clinical trials of sophisticated, expensive therapies, including the balance of risks versus benefits, proper consent and assent, and potential conflicts of interests on the part of the investigators

Core Competencies

The Continuum Muscle Disease 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

Carlayne E. Jackson, MD, FAAN, Guest Editor

Professor of Neurology and Otolaryngology, Assistant Dean of Ambulatory Services, University of Texas Health Science Center at San Antonio, San Antonio, Texas

*Dr Jackson has received research support from Biogen Idec; Cytokinetics, Inc; Knopp Neurosciences, Inc; the National ALS Association; Phillips Respironics; and the US Food and Drug Administration Office of Orphan Products Development.

†Dr Jackson reports no disclosure.

Anthony A. Amato, MD, FAAN

Vice Chairman, Department of Neurology, and Chief, Neuromuscular Division, Brigham and Women’s Hospital; Professor of Neurology, Harvard Medical School, Boston, Massachusetts

*Dr Amato has served on the medical advisory board of Biogen Idec, as a consultant for MedImmune, LLC, and provided expert testimony for litigation on a neuropathy case. Dr Amato serves as an associate editor of Neurology.

†Dr Amato discusses therapies for the treatment of myositis, all of which are unlabeled.

Richard J. Barohn, MD, FAAN

Chair, Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas

*Dr Barohn has served on the speaker’s bureaus of Genzyme Corporation and Grifols; on the advisory boards of MedImmune, LLC, and Novartis Corporation; and as a consultant for NuFACTOR. Dr Barohn has received research support from Biogen Idec; BioMarin Pharmaceutical Inc; Cytokinetics, Inc; Genzyme Corporation; Knopp Neurosciences, Inc; Neuraltus Pharmaceuticals, Inc; the National Institute of Neurological Disorders and Stroke; the NIH; PTC Therapeutics; Sangamo BioSciences, Inc; Teva Pharmaceutical Industries Ltd; and the US Food and Drug Administration Office of Orphan Products Development.

†Dr Barohn discusses the unlabeled use of carbonic anhydrase inhibitors for the treatment of hypokalemic periodic paralysis and mexiletine for the treatment of nondystrophic myotonia in the article titled “Muscle Channelopathies: the Nondystrophic Myotonias and Periodic Paralyses.” Dr Barohn reports no disclosure for the article titled “A Pattern Recognition Approach to Myopathy.”

Diana Castro, MD

Assistant Professor of Pediatrics, Neurology and Neurotherapeutics, Children’s Medical Center of Dallas, University of Texas Southwestern Medical Center, Dallas, Texas

*,†Dr Castro reports no disclosures.

Bruce H. Cohen, MD, FAAN

Professor of Pediatrics, Northeast Ohio Medical University, Rootstown, Ohio; Director of Neurology, Akron Children’s Hospital, Akron, Ohio

*Dr Cohen has served as a speaker and an alternate advisor on Current Procedural Terminology for the AAN and is a member of the speakers bureau for the United Mitochondrial Disease Foundation. Dr Cohen has served as a consultant to the US Department of Health and Human Services and the US Department of Justice, Division of Vaccine Injury Compensation. Dr Cohen serves as editor of Motive Medical Intelligence (formerly newMentor) and on the editorial boards of Pediatric Neurology and Mitochondrian. Dr Cohen has received travel expenses and institutional research support from Edison Pharmaceuticals, Inc.

†Dr Cohen reports no disclosure.

John D. England, MD, FAAN

Grace Benson Professor and Head, Department of Neurology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

*Dr England has served on the advisory board of Grifols and as editor-in-chief of Journal of the Neurological Sciences.

†Dr England reports no disclosure.

Steven A. Greenberg, MD

Associate Professor of Neurology, Brigham and Women’s Hospital and Harvard Medical School, Children’s Hospital Informatics Program; Affiliated Faculty, Harvard-MIT Health Sciences and Technology Division, Boston, Massachusetts

*Dr Greenberg has served as a consultant for aTyr Pharma, as an expert witness in litigation pertaining to copper deficiency, and is supported by a grant from the Muscular Dystrophy Association.

†Dr Greenberg discusses therapies for the treatment of myositis, all of which are unlabeled.

Amparo Gutierrez, MD, FAAN

Associate Professor of Clinical Neurology, Louisiana State University Health Sciences Center, New Orleans, Louisiana

*Dr Gutierrez has served on the advisory board of Biogen Idec and received compensation for speaking activities from Genzyme Corporation, Novartis Corporation, and Teva Pharmaceutical Industries Ltd.

†Dr Gutierrez reports no disclosure.

Susan T. Iannaccone, MD, FAAN

Professor of Pediatrics, Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, Texas

*Dr Iannaccone has received research support from GlaxoSmithKline; Isis Pharmaceuticals, Inc; the NIH; and Santhera Pharmaceuticals.

†Dr Iannaccone reports no disclosure.

Peter B. Kang, MD

Director, EMG Laboratory, Boston Children’s Hospital, and Associate Professor of Neurology, Harvard Medical School, Boston, Massachusetts; Associate Professor and Chief, Division of Neurology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida

*Dr Kang has served as an officer and trustee of the Massachusetts Medical Society and received grant funding from Isis Pharmaceuticals, Inc; the Muscular Dystrophy Association; and the NIH. Dr. Kang has received honoraria from the AAN, the American College of Medical Genetics, Boston Children’s Hospital, Brooks Publishing, the Fondazione Cariplo, the Massachusetts Medical Society, the US Department of Health and Human Services-Health Resources and Services Administration’s National Vaccine Injury Compensation Program, and the US Department of Veterans Affairs.

†Dr Kang discusses therapies for the treatment of muscle disease, all of which are unlabeled.

Wendy M. King, PT

Associate Professor, Department of Neurology, The Ohio State University Wexner Medical Center, Columbus, Ohio

*Ms King has received partial salary support from an NIH-funded multiclinic trial comparing steroid doses in Duchenne muscular dystrophy.

†Ms King discusses the unlabeled use of corticosteroids in the treatment of Duchenne muscular dystrophy.

John T. Kissel, MD, FAAN

Professor of Neurology and Pediatrics, The Ohio State University Wexner Medical Center and Nationwide Children’s Hospital, Columbus, Ohio

*Dr Kissel has received personal compensation for activities with Alexion Pharmaceuticals and Cytokinetics, Inc.

†Dr Kissel discusses the unlabeled use of corticosteroids in the treatment of Duchenne muscular dystrophy.

Andrew L. Mammen, MD, PhD

Associate Professor of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

*Dr Mammen serves on the medical advisory boards of aTyr Pharma and Biogen Idec and has licensed a patent for an anti–HMG-CoA reductase test to INOVA Diagnostics.

†Dr Mammen discusses the unlabeled use of therapies for toxic myopathies.

Jeffrey Rosenfeld, PhD, MD, FAAN

Professor and Chief of Neurology, University of California, San Francisco at Fresno, Fresno, California

*Dr Rosenfeld has served as a consultant for and received research support from Hill-Rom Holdings, Inc.

†Dr Rosenfeld reports no disclosure.

Jeffrey M. Statland, MD

Senior Instructor, Department of Neurology, University of Rochester Medical Center, Rochester, New York

*Dr Statland has served as a consultant for Cytokinetics, Inc, regarding outcome measures for facioscapulohumeral muscular dystrophy and receives salary support from the Muscular Dystrophy Association Clinical Research Training Grant.

†Dr Statland discusses the unlabeled use of carbonic anhydrase inhibitors for the treatment of hypokalemic periodic paralysis and mexiletine for the treatment of nondystrophic myotonia.

Alejandro Tobon, MD

Assistant Professor of Neurology, University of Texas Health Science Center at San Antonio, San Antonio, Texas

*,†Dr Tobon reports no disclosures.

Matthew P. Wicklund, MD, FAAN

Professor of Neurology and Pediatrics, Penn State College of Medicine; Vice Chairman, Department of Neurology, Milton S. Hershey Medical Center, Hershey, Pennsylvania

*Dr Wicklund has participated as a site investigator for clinical trials sponsored by Eli Lilly and Company and Genzyme Corporation.

†Dr Wicklund discusses the unlabeled use of prednisone, prednisolone, and deflazacort for the treatment of Duchenne muscular dystrophy and of mexiletine for the treatment of myotonia in myotonic dystrophy.

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MULTIPLE-CHOICE QUESTION WRITERS

Douglas J. Gelb, MD, PhD, FAAN

Professor of Neurology, University of Michigan, Ann Arbor, Michigan

*,†Dr Gelb reports no disclosures.

Joseph E. Safdieh, MD

Vice Chairman for Education and Associate Professor, Department of Neurology, Weill Cornell Medical College, New York, New York

*,†Dr Safdieh reports no disclosures.

*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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