Continuum: Lifelong Learning in Neurology—Peripheral Nerve and Motor Neuron Disorders, Volume 23, Issue 5, October 2017
Peripheral Nerve and Motor Neuron Disorders 2017;23(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.
Upon completion of this Continuum: Lifelong Learning in Neurology Peripheral Nerve and Motor Neuron Disorders issue, participants will be able to:
• Develop a strategy for efficient and accurate bedside assessment of peripheral neuropathy
• Discuss the neurophysiologic techniques for the evaluation of large myelinated nerve fiber function and small nerve fiber function and describe the patterns of abnormality these studies can show in patients with polyneuropathy
• Describe practical applications of neuromuscular ultrasound in diagnosing disorders of nerve and muscle
• Discuss the clinical presentation, epidemiology, diagnostic criteria, laboratory testing, variants, and management of Guillain-Barré syndrome
• Discuss the characteristic clinical, diagnostic, and treatment features of the chronic demyelinating polyneuropathies
• Describe the clinical presentation, differential diagnosis, evaluation, symptomatic management, and current understanding of the pathophysiology of amyotrophic lateral sclerosis and other motor neuron disorders
• Recognize various presentations of genetic polyneuropathies and develop a diagnostic and management plan for them
• Discuss the differential diagnosis and management of axonal sensorimotor polyneuropathies
• Identify clinical presentations of immune-mediated axonal polyneuropathy and discuss their diagnostic evaluation and treatment modalities
• Identify, evaluate, and manage patients who present with sensory-predominant polyneuropathies
• Discuss the symptoms, differential diagnosis, EMG characteristics, and management of peripheral nerve excitability syndromes
• Discuss the goals and limitations of right-to-try laws in providing patients access to treatments not yet approved by the US Food and Drug Administration
This Continuum: Lifelong Learning in Neurology Peripheral Nerve and Motor Neuron Disorders issue covers the following core competencies:
• Patient Care
• Medical Knowledge
• Practice-Based Learning and Improvement
• Interpersonal and Communication Skills
• Systems-Based Practice
Kerry H. Levin, MD, FAAN, Guest Editor
Chairman, Department of Neurology; Director, Neuromuscular Center; Professor of Neurology, Cleveland Clinic, Cleveland, Ohio
aDr Levin serves as neurology director of the American Board of Psychiatry and Neurology and on the editorial board of Muscle & Nerve. Dr Levin receives publishing royalties from Elsevier and UpToDate Inc.
bDr Levin reports no disclosure.
Jeffrey A. Allen, MD
Associate Professor of Neurology, University of Minnesota, Minneapolis, Minnesota
aDr Allen serves on the global medical advisory board of the GBC/CIDP Foundation International, on the organizing committee of the Inflammatory Neuropathy Consortium, and as a consultant for CSL Behring and Grifols. Dr Allen receives research/grant support from CSL Behring and has received personal compensation for speaking engagements from Grifols.
bDr Allen discusses the unlabeled/investigational use of alemtuzumab, azathioprine, bevacizumab, chlorambucil, cyclophosphamide, cyclosporine, fludarabine, interferon beta-1a, lenalidomide, melphalan, methotrexate, mycophenolate mofetil, rituximab, tacrolimus, and thalidomide for the treatment of chronic demyelinating polyneuropathies.
Peter D. Donofrio, MD, FAAN
Professor of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
aDr Donofrio has served on the editorial board of Muscle & Nerve and receives publishing royalties from Demos Medical Publishing. Dr Donofrio serves as consultant for and has received personal compensation for speaking engagements for CSL Behring and Grifols.
bDr Donofrio reports no disclosure.
Stephen A. Goutman, MD, MS
Assistant Professor of Neurology, University of Michigan, Ann Arbor, Michigan
aDr Goutman has consulted for Cytokinetics, Inc, and has received research/grant support from the National Institutes of Health/National Institute of Environmental Health Sciences (K23ES027221), the Agency for Toxic Substances and Disease Registry/Centers for Disease Control, the ALS Association, and Neuralstem, Inc.
bDr Goutman discusses the unlabeled/investigational use of amitriptyline, atropine, botulinum toxin, citalopram, and mexiletine used for the symptomatic management of amyotrophic lateral sclerosis.
Raghav Govindarajan, MD, FISQua, FACSc, FCPP, FASA, MAcadMEd, FAAN
Assistant Professor of Clinical Neurology, ALS Association/Muscular Dystrophy Association Clinic Director, Clerkship Director, Associate Medical Director, Director of Patient Safety and Quality Improvement, University of Missouri, Columbia, Missouri
aDr Govindarajan serves as president elect of the Boone County Medical Society, on the neurologist advisory board of Abbvie Inc, and as an associate editor of Frontiers in Neurology. Dr Govindarajan receives research/grant support from the ALS Association and publishing royalties from Springer Nature.
bDr Govindarajan reports no disclosure.
Kelly Graham Gwathmey, MD
Assistant Professor of Neurology, Muscular Dystrophy Association Clinic Director, University of Virginia, Charlottesville, Virginia
a,bDr Gwathmey reports no disclosures.
Bashar Katirji, MD, FACP, FAAN
Director of Neuromuscular Center, Director of EMG Laboratory, University Hospitals Cleveland Medical Center; Professor of Neurology, Case Western Reserve University, Cleveland, Ohio
aDr Katirji receives publishing royalties from the American Association of Neuromuscular & Electrodiagnostic Medicine, Elsevier, and Springer Nature.
bDr Katirji reports no disclosure.
John C. Kincaid, MD, FAAN
Kenneth L. and Selma G. Earnest Professor of Neurology, Indiana School of Medicine, Indianapolis, Indiana
aDr Kincaid has provided expert medical testimony in neurologic legal cases for Social Security administrative law judges and has received research/grant support from Ionis Pharmaceuticals, Inc. Dr Kincaid receives publishing royalties from Wolters Kluwer and Demos Medical Publishing.
bDr Kincaid reports no disclosure.
Yuebing Li, MD, PhD
Staff Physician, Cleveland Clinic, Cleveland, Ohio
aDr Li reports no disclosure.
bDr Li discusses the unlabeled/investigational use of tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, and voltage-gated calcium channel ligands for the treatment of painful polyneuropathy and the unlabeled/investigational use of diflunisal and tafamidis for familial amyloid polyneuropathy.
Sindhu Ramchandren, MD, MS
Assistant Professor of Neurology; Director, Muscular Dystrophy Association Care Center Clinic and Charcot-Marie-Tooth Center of Excellence Clinic, University of Michigan, Ann Arbor, Michigan
aDr Ramchandren has served on advisory boards for Biogen and Sarepta Therapeutics, Inc, and has received research/grant support from the Muscular Dystrophy Association (Foundation Clinic Grant) and the National Institutes of Health (K23 NS072279).
bDr Ramchandren reports no disclosure.
James A. Russell, DO, FAAN
Director, Curt & Shonda Schilling ALS Clinic, Lahey Hospital & Medical Center, Burlington, Massachusetts; Clinical Professor of Neurology, Tufts University School of Medicine, Boston, Massachusetts
aDr Russell has served as a consultant for W2O Group, receives publishing royalties from McGraw-Hill Education, and has received personal compensation for medicolegal record review.
bDr Russell reports no disclosure.
Komal Sawlani, MD
Neurologist, Neuromuscular Center, University Hospitals Cleveland Medical Center; Clinical Instructor, Case Western Reserve University School of Medicine, Cleveland, Ohio
a,bDr Sawlani reports no disclosures.
Zachary Simmons, MD, FAAN
Professor, Departments of Neurology and Humanities, The Pennsylvania State University College of Medicine, Hershey, Pennsylvania
aDr Simmons serves as editor-in-chief of Muscle & Nerve and as a consultant for Cytokinetics, Inc, and Neuralstem, Inc. Dr Simmons receives research/grant support from the ALS Association; Biogen; Cytokinetics, Inc; and GlaxoSmithKline plc.
bDr Simmons discusses the controversies surrounding legislation to permit access to therapies not yet approved by the US Food and Drug Administration.
Jinny O. Tavee, MD
Associate Professor, Neuromuscular Division Medical Director, Northwestern University Feinberg School of Medicine, Chicago, Illinois
aDr Tavee has received personal compensation for speaking engagements from Mallinckrodt Pharmaceuticals and grant/research support for work in clinical trials from Araim Pharmaceuticals, Inc.
bDr Tavee discusses the unlabeled/investigational use of ARA 290 for the treatment of sarcoidosis and IVIg for the treatment of paraneoplastic disease, sarcoidosis neuropathy, neuropathy related to monoclonal gammopathy, celiac-related neuropathy, and other autoimmune neuropathies.
Nimish J. Thakore, MD, DM
Neurologist, Neuromuscular Center, Department of Neurology, Cleveland Clinic; Assistant Professor, Department of Medicine, Case Western Reserve University, Cleveland Ohio
aDr Thakore reports no disclosure.
bDr Thakore discusses the unlabeled/investigational use of subcutaneous immunoglobulin and mycophenolate mofetil for the treatment of multifocal motor neuropathy.
Francis O. Walker, MD, FAAN
Professor of Neurology, Wake Forest University Medical School, Winston-Salem, North Carolina
aDr Walker serves on the editorial boards of the Journal of Clinical Neurophysiology and Muscle & Nerve and has received personal compensation for speaking engagements for Grifols. Dr Walker has received research/grant support from CHDI, Pfizer Inc, Teva Pharmaceutical Industries Ltd, and Vaccinex Inc and receives publishing royalties from Elsevier and UpToDate, Inc. Dr Walker has provided expert legal testimony on botulinum toxin indications.
bDr Walker reports no disclosure.
Douglas J. Gelb, MD, PhD, FAAN
Professor of Neurology, University of Michigan, Ann Arbor, Michigan
aDr Gelb receives royalties from Oxford University Press and UpToDate, Inc.
bDr Gelb reports no disclosure.
Adam Kelly, MD
Associate Professor of Neurology, University of Rochester Medical Center; Chief of Neurology, Highland Hospital, Rochester, New York
aDr Kelly has received research support from the Donald W. Reynolds Foundation.
bDr Kelly reports no disclosure.
a Relationship Disclosure
b Unlabeled Use of Products/Investigational Use Disclosure
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 selfassessment 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.