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Movement Disorders

Curriculum


The movement disorders fellowship is a 1 year fellowship training stressing the clinical evaluation and management of the full range of movement disorders seen in adults.  Opportunities will be available to create a customized experience that could additionally include pediatric movement disorders, ataxia clinic, limb EMG training but these would not necessarily be part of the core experience. 

Parkinson’s disease

  • Evaluation and Management of Idiopathic PD
  • Early disease – differential diagnosis; motor and non-motor features; neuroprotection; patient education; initiating symptomatic therapy
  • Mid stage disease – management of motor and nonmotor symptoms; use of adjuntive medications
  • Advanced disease – management of complicated motor flucutuations with apomorphine, continuous delivery of levodopa, DBS, experimental therapeutics (clinical trials); management of PD psychosis; management of dementia; swallowing and gait safety; homecare coordination; end of life issues


Other parkinsonian syndromes

  • Diagnostic exam and historical features that are used to clinically diagnose PSP, MSA, CBD and DLB
  • Management of complications of atypical parkinsonism
  • Understanding prognosis and managing patient expectations
  • Awareness of experimental therapy, importance of brain banks

 

Dystonia

  • Clinical phenomenology that define generalized and focal dystonias
  • Application of available treatments for dystonia including oral medications, botulinum toxin and DBS surgery
  • Huntington’s disease and other choreas
  • Differential diagnosis of chorea presenting in adults and children
  • Diagnosis and management of secondary choreas such as hemiballism,
  • Syndenham’s chorea, other immunological choreas
  • Diagnosis and management of Huntinton’s disease
  • Use of genetic testing to diagnose HD and requirements of the predictive HD gene testing program
  • Familiarity with current experimental approaches for treating HD including symptomatic and neuroprotective agent.
  • Management of psychosocial, legal, ethical and other practical management issues in HD
     

Tourette’s syndrome and tics

  • Phenomenology and differential diagnosis of tics in adults and children
  • Management of tics, nonmotor features and comorbid behavioral problems in  Tourette’s syndrome
     

Essential Tremor (other tremors)

  • Clinical features of ET and distinction from other tremor disorders such as PD, dystonic tremor
  • Management of ET with oral medications and DBS
     

Drug-induced movement disorders

  • Recognition and management of drug-induced parkinsonism (learn the drugs that can cause DIP)
  • Recognition and management of tardive dyskinesia and other tardive syndromes
  • Recognition and management of neuroleptic malignant syndrome, serotonin syndrome, acute dystonic reaction
     

Myoclonus

  • Clinical recognition of myoclonus and understanding of anatomical/physiological types (spinal, propriospinal, cortical)
  • Recognition of the causes of myoclonus including metabolic derrangement, epilepsy, degenerative disease, prion disease, essential myoclonus

 

Restless legs syndrome

  • Core clinical features that define RLS
  • Recognition of primary and seconday RLS
  • Role of iron in RLS
  • Management of RLS with oral medications

 

Hemifacial spasm

  • Clinical diagnosis and use of imaging in HFS
  • Use of botulinum toxin to manage symptoms of HFS
    Ataxias
  • Recognition of cerebellar ataxia, sensory ataxia on examination
  • Familarity with the causes of acute, subacute and chronic causes of ataxia including genetic, parainfectious, paraneoplastic and structural pathologies

 

Teaching Tools

Supervised clinics with all attending faculty including;

          • general movement disorders clinics
          • extensive “hands on” training in botulinum toxin injections and DBS programming sessions
          • participation in clinical trial visits to extent allowed by individual protocols
          • optional ataxia clinic (Dr. Koeppen)
          • attend all DBS surgeries (Dr. Ramirez and Pilitsis)
          • training on proper videotape documentation of MDO (will videotape all new patients)
          • competancy in use of EHR, documentation, coding and billing


Minimum Expectations

  • Grand rounds presentation
  • Organize and prepare materials for video conference and journal club
  • Peer review paper submission
  • Presentation of abstract at MDS meeting
  • Perform CAPSIT evaluations on DBS candidates
  • Perform videotape examinations on all new patients
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