Neuromuscular Update I Gil I. Wolfe, MD Donald B. Sanders, MD James W. Teener, MD Richard A. Lewis, MD Robert T. Leshner, MD Craig M. McDonald, MD David S. Saperstein, MD Neeraj Kumar, MD James K. Richardson, MD 2008 Neuromuscular Update Course C AANEM 55th Annual Meeting Providence, Rhode Island Copyright © September 2008 American Association of Neuromuscular & Electrodiagnostic Medicine 2621 Superior Drive NW Rochester, MN 55901 Printed by Johnson Printing Company, Inc. ii Neuromuscular Update I Faculty Gil I. Wolfe, MD Donald B. Sanders, MD Professor Director Department of Neurology Division of Neurology University of Texas Southwestern Medical School Duke University Medical Center Dallas, Texas Durham, North Carolina Dr. Wolfe is a professor of neurology at the University of Texas (UT) Dr. Sanders received his degree in medicine from Harvard Medical Southwestern Medical School in Dallas, Texas. In September 2004, he was School and trained in neurology at the University of Virginia. He is named to the Dr. Bob and Jean Smith Foundation Distinguished Chair in Professor of Medicine in the Division of Neurology at Duke University Neuromuscular Disease Research. He serves as Co director of the Muscular Medical Center. He founded the Duke EMG Laboratory, where he is the Dystrophy Association Clinics and Director of the Peripheral Neuropathy Co director, and is Director of the Duke Myasthenia Gravis Clinic. He Clinic at UT Southwestern. He is also the Medical Director and acting Vice is the author of many papers on the diagnosis and treatment of neuro- Chair for the department. Dr. Wolfe completed his undergraduate studies muscular diseases, and in 1999 he received the AANEM’s Distinguished at Princeton University and attended medical school at UT Southwestern. Researcher Award. Dr. Sanders is a past-president of the AANEM and has He completed an internal medicine internship and trained as a neurology served on the AANEM’s Workshop, Regional Workshop, and Program resident and neuromuscular/electromyography fellow at the University of Committees, among numerous others. He has also been a board member Pennsylvania Medical Center in Philadelphia. His main research interests of the American Board of Electrodiagnostic Medicine. include idiopathic and immune-mediated peripheral neuropathies and myasthenia gravis. Dr. Wolfe has received the Trephined Cranium Award for excellence in residency teaching on several occasions. He also serves on the medical advisory boards for the Myasthenia Gravis Foundation of America, Charcot-Marie-Tooth Association, and Neuropathy Association, and has been elected Fellow of the American Academy of Neurology and a member in the American Neurological Association. He is certified by the American Board of Psychiatry and Neurology both in neurology and in clinical neurophysiology. James W. Teener, MD Director Neuromuscular Program Department of Neurology University of Michigan Health System Ann Arbor, Michigan Dr. Teener is Director of the Neuromuscular Program, Co director of the EMG Laboratory, and Associate Professor at the University of Michigan. He completed his residency in neurology and a neuromuscular fellowship at the University of Pennsylvania. His research interests include neuro- muscular disorders associated with critical illness and intensive care treat- ment of severe neuromuscular disease. His clinical interests include the full spectrum of neuromuscular disease. He collaborates widely and provides electrodiagnostic expertise to a wide variety of research projects. Authors had nothing to disclose. Course Chair: Gil I. Wolfe, MD The ideas and opinions expressed in this publication are solely those of the specific authors and do not necessarily represent those of the AANEM. iii Richard A. Lewis, MD Robert T. Leshner, MD Professor and Associate Chair Professor Department of Neurology Department of Neurology Wayne State University School of Medicine George Washington University School of Medicine and Health Sciences Detroit, Michigan Washington, DC Dr. Lewis is Professor and Associate Chair of Neurology and Dr. Leshner attended Cornell University for his undergraduate and Co director of the Neuromuscular Program at Wayne State University medical studies. Postgraduate work in internal medicine and pediatrics School of Medicine. He is also Director of the Clinical Neurophysiology were performed at the University of Vermont. A fellowship in adult and Laboratory. He trained in neurology at the University of Pennsylvania and child neurology was completed at the University of Colorado. Following remained on the faculty there before taking positions at the University of several years of active duty as a Navy neurologist, Dr. Leshner performed Connecticut and Eastern Virginia Medical School. Dr. Lewis has been a fellowship training in neuromuscular diseases and electrodiagnostic member of the AANEM since 1979 and has been on a number of com- medicine at the Medical College of Georgia under the watchful eye of mittees including the Examination and Education Committees. He has Dr. Thomas Swift. For over 30 years, his main clinical interest has been been a participant in practice parameter committees on conduction block, the diagnosis and treatment of neuromuscular disorders. Dr. Leshner is multifocal motor neuropathy, and peripheral neuropathy. He is Deputy currently a staff neurologist at the Children’s National Medical Center Editor of the Journal of the Neurological Society and on multiple other in Washington, DC. He holds the rank of Professor of Neurology and editorial boards including Muscle & Nerve. He is on the national and in- Pediatrics at the George Washington University School of Medicine and ternational Medical Advisory Boards of the Myasthenia Gravis Association Health Sciences. Dr. Leshner is also the 2008 recipient of the AANEM’s and Guillain-Barre Syndrome/Chronic Inflammatory Demyelinating Distinguished Researcher Award. His research interests involve trans- Polyneuropathy Foundation International. Dr. Lewis’ interests include the lational research in genetic pediatric neuromuscular diseases. He is the clinical and electrophysiologic aspects of the demyelinating neuropathies, proud father of five children and spends most of his free time spoiling his both acquired and inherited. He is probably best known for his paper five (and counting) grandchildren. on multifocal demyelinating neuropathy, a disorder that is now known as “Lewis-Sumner Syndrome.” Craig M. McDonald, MD Professor Departments of Physical Medicine and Rehabilitation and Pediatrics University of California Davis School of Medicine Davis, California Dr. McDonald is Professor of Physical Medicine and Rehabilitation and Pediatrics and Director of the Neuromuscular Disease Clinics at the University of California (UC) Davis Medical Center. He is Director of the National Institute on Disability and Rehabilitation Research’s Rehabilitation Research and Training Center in Neuromuscular Diseases at UC Davis. His research interests include clinical endpoints in muscular dystrophy, exercise in neuromuscular disease, energy expenditure, quanti- tative assessment of physical activity, and quality-of-life assessment. iv David S. Saperstein, MD Neeraj Kumar, MD Private Practice Associate Professor Phoenix Neurological Associates Department of Neurology Phoenix, Arizona Mayo Clinic Dr. Saperstein practices in Phoenix, Arizona at Phoenix Neurological Rochester, Minnesota Associates, is Co director of the Neuropathy Clinic at Banner Good Dr. Kumar received his medical degree from Maulana Azad Medical Samaritan Regional Medical Center, and is a clinical associate professor of College at the University of Delhi, India and subsequently did a residency neurology at the University of Arizona College of Medicine. Dr. Saperstein in internal medicine and neurology in India. He later completed a resi- received a bachelor’s degree in Biology from Boston University. He com- dency in internal medicine at East Tennessee University and a residency in pleted his medical training at the Boston University School of Medicine, neurology at the University of Minnesota. Dr. Kumar is board-certified performed a neurology residency at Wilford Hall USAF Medical Center in neurology, internal medicine, and electrodiagnostic medicine. He has in San Antonio, Texas, and completed a neuromuscular disease/clini- received the Distinguished Teaching Award from the Minnesota Medical cal neurophysiology fellowship at the University of Texas Southwestern Foundations in 1997 and in 2005 was named Teacher of the Year by the Medical Center in Dallas. Dr. Saperstein is board certified by the American Mayo Fellows Association. His current research interests include diseases Board of Psychiatry and Neurology (with added qualifications in clinical of the spinal cord, disorders of copper metabolism, and neurological ill- neurophysiology) and the American Board of Electrodiagnostic Medicine. nesses related to heavy metals. Dr. Saperstein has a particular interest in the diagnosis, classification and management of peripheral neuropathies, with a focus on immune-medi- ated polyneuropathies and vitamin B12 deficiency neuropathy. James K. Richardson, MD Associate Professor Department of Physical Medicine and Rehabilitation University of Michigan Ann Arbor, Michigan Dr. Richardson graduated from medical school at the University of Cincinnati. He is currently an Associate Professor within the Department of Physical Medicine and Rehabilitation at the University of Michigan. He is board certified